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CONTENTS Vol 11. No 6, JUNE, 2017

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

Unattended toxic air : A genocide in making

MARKET

Editor Viveka Roychowdhury*

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Chief of Product Harit Mohanty BUREAUS Mumbai Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das, Mansha Gagneja Swati Rana Delhi Prathiba Raju

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Design National Design Editor Bivash Barua

CAN BARIATRIC PROCEDURES BE A NEW AVENUE FOR MEDICAL TOURISM IN INDIA?

GENERICISATION EVOKES FIERCE DEBATE AT THIRD EDITION OF VANTAGE POINT

Asst. Art Director Pravin Temble Senior Designer Rekha Bisht Graphics Designer Gauri Deorukhkar 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

Increasing air pollutants are clogging India's skylines and it is turning out to be a silent killer| P-29

INTERVIEWS

OPINION

IT@HEALTH

P11: SWAMINATHAN JAYARAMAN Chairman, Vascular Concepts

P13: DR AASHISH CHAUDHRY, Orthopedic Surgeon and MD, Aakash Healthcare

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P32: VIVEK KANADE Exceutive Director, Siemens Healthineers

IS INDIA'S HEALTHCARE INDUSTRY READY FOR A DIGITAL TRANSFORMATION?

33

BLOCKCHAIN: OVERHAULING THE ‘CRIPPLED’ RECORD MANAGEMENT SYSTEM IN HEALTHCARE

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P34: TANMAY SHAH Head of Innovations, Imaginarium Life

P35: TEJBIR SINGH CEO and Co-founder, Affordplan

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

Hope vs hype

I

n early May, Egypt's Eman Ahmed was airlifted from Mumbai to Abu Dhabi post her merely two-month long bariatric surgery and treatment at Saifee Hospital. Once the world's heaviest woman, Eman could have been a goodwill ambassador for India's advanced skills in medical technology and compassionate care. Today, the exact opposite seems to be true. And Eman may not be the only or the last patient, from overseas or India, to suffer this fate. When did it start to unravel? When does a daring surgery cross the line of patient privacy? Daring because few doctors dared to take on a case so complicated but Dr Muffazal Lakdawala took it on. Can we condone the need to shout it from the rooftops when this attention also bought in ` 21 lakhs of funding for Eman's treatment as well made the general public more aware of the finer nuances of bariatric surgeries? When does media attention go from information to gossip? When does PR override medical ethics? How much of the medical details of their patients can doctors share on blogs, when they seek crowd funding for such surgeries? Did they go through the informed consent process? Hope turned into hype as the media fanned the flames, and finally the government had to step in to close the issue. Could there have been a more responsible, humane way? Undeterred by the Eman controversy, and in fact thanks to the publicity, Dr Lakdawala plans to get crowd funding for similar treatments for seven obese children from across India, three of them siblings who may have the same genetic mutation responsible as Eman's condition. All children come from poor families so can we grudge them their chance at living normal lives, in exchange for loss of privacy? One of the stories in the June issue Express Healthcare issue, titled, Can bariatric procedures be a new avenue for medical tourism in India? analyses that bariatric surgery cases make a decent share of the medical tourists coming to India. Numbers could pick up post Eman's case, even after all the controversies, simply because being desperately sick and poor at the same time makes patients and relatives close their eyes to almost everything else. But one hopes that the government puts in place a policy and protocols to prevent such mishaps in future. There are signs that this is a lesson well learnt. On May 22, the Ministry of Tourism report-

Hindsight is always 20/20 but these questions need to be asked,and answered, so that we do not fail the next Eman who comes to India seeking compassionate care

edly asked the National Medical & Wellness Tourism Promotion Board to draft the Medical & Wellness Tourism Policy for India. The board is due to submit the draft policy to the government in the next three months, after discussing the framework with various stakeholders and industry associations. Speaking for the media, most of us are not medical experts. We are ruled by deadlines and the hunger to scoop the rival publication/channel. In the era of social media, the 'news' could probably be a tweet that goes viral. News breaks like a doctor choosing Twitter to announce her resignation from treatment of Eman are de rigeur. PR agencies and hospitals flood us with case studies of complicated surgeries to showcase the expertise of the clients, ranging from doctors, hospitals, to the latest medical equipment. Most of it may well be justified but I often wonder if it helps or harms. One sad incident haunts me. A hospital requested us to take off the picture of a patient, a two year old child, which was part of one such ''miracle'' case study, from our archives. When we probed further, as it was featured quite a while back, we were informed that the child was no more. We of course made the alterations and took the page off our archives. But it got me thinking. Did we help or harm patients and their care givers who may have chosen that particular hospital and doctor based on our coverage? And since it was an oncology case, the child could have most probably passed away due to the progression of the condition. But did we unwittingly offer hope, when each cancer patient needs to be treated differently? Could we have tempered the coverage? Medical science and treatment protocols are evolving, as are medical devices and equipment. We need to amplify this evolution, so that they get the right funding and ecosystem to mature. Especially the frugal innovations sprouting from India. But viruses are also mutating, diseases are spreading faster, and climatic changes are adding their garnish to the toxic brew. Hindsight is always 20/20 but these questions need to be asked, and answered, so that we do not fail the next Eman who comes to India seeking compassionate care. Or the seven children who have travelled to Mumbai from different states in the hopes of normal lives. VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

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MARKET ANALYSIS

Can bariatric procedures be a new avenue for medical tourism in India? Bariatric procedures with its varied opportunities is set to drive medical tourism. However, certain SOPs need to be in place, finds out Raelene Kambli

T

he recent furore around the contentious bariatric procedure of the Egyptian national, Eman Ahmed brought to light two important aspects of medical tourism in India-the urgent needs for Standard Operating protocols(SOPs) and an increasing contribution of metabolic and bariatric procedures to medical value travels. As per the Ministry of Tourism, close to 200,000 patients travel to India for medical tourism every year. As per their data, the country is witnessing a 22-25 per cent growth in medical tourism and healthcare providers expect the industry will double to $6 billion by 2018 from its present $3 billion market. The Ministry says that the contribution of metabolic and bariatric surgeries to medical tourism seem minuscule at present , yet the number of medical tourists seeking weight loss treatments is on the rise. The Ministry of Health and Family Welfare as well opines that the discipline has great potential to make India a haven for medical tourism. The industry also seem to be very upbeat about this trend. Metabolic and bariatric surgery experts further inform that on an average around 15000-18,000 surgeries are conducted every year in India and this number is expected to rise. Says Dr Muuffazal Lakdawala, Chairman of institute of Minimal Invasive Surgical Sciences and Research Center, Saifee Hospital, “The bariatric

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200,000 22-25% $6 BILLION patients travel to India for medical tourism

growth in medical tourism

15000 TO

18000 surgery market has been steadily growing since the last decade and so is its contribution to medical tourism. Way back in the year 2004 we did around two- three cases of bariatric surgeries but today do many more metabolic and bariatric procedures. Advances in our medical literature can been a major contributor to this success. Today, bariatric surgeries contribute to around 10-15 per cent to medical tourism which is certainly a small percentage but has significant having patients coming from Iraq, East Africa,

revenue projected by 2018

Metabolic and bariatric surgeries are conducted every year in India and this number is expected to rise

Bulgeria, Russia etc.” Dr Pradeep Chowbey, Chairman- Max Institute of Minimal Access, Metabolic & Bariatric Surgery, ChairmanSurgery & Allied Surgical Specialties, Executive Vice ChairmanMax Healthcare, “Bariatric surgeries in India have roughly increased by twelve-fold in the last decade, with approximately twenty to twenty five thousand surgeries conducted last year itself. However, the number of surgeries conducted on international patients is less”. Let us understand what’s

making India's bariatric procedure market the new avenue for medical tourism.

Drivers for growth Worldover, obesity is on the rise and so are bariatric surgeries. India with its impressive healthcare offerings such as quality care at reasonable costs, high-end infrastructure within hospitals, lesser waiting time for patients, exceptional doctors, customised approach for treatment and procedures and easy availability of medical visa are some of the driving forces for medical tourism

within the country. “In the last decade, Indian hospitals have reached international levels of medical and academic excellence with parallel improvement in quality of services and infrastructure support. Most of the hospitals which are pitching in for international patients have the highest credentials by national and international accreditation centres like JCI,” shares Dr Chowbey. Dr Atul NC Peters, Director, metabolic and Bariatric Surgery, Fortis Hospital chips in saying, “The bariatric surgery market is growing exponentially at 29 per cent annually. The overall contribution of bariatric surgeries to medical tourism has two parts. Bariatric surgery has been in India since 90s, that time it was being performed sporadically on patients coming from developed nations such as US, UK, Australia etc. Around 90 per cent of the medical tourists were from the developed countries. However, there has been a shift since insurance companies in these nations have started covering metabolic and bariatric surgeries as part of their insurance schemes and so number of medical tourist from these countries have decreased over the years. Moreover, countires such as Mexico have been increasing recieving medical tourists from the US and adjourning territories due to healthcare costs equivalent to India. Nevertheless, we have a constant inflow of patients coming from Bangladesh, Pakistan, Africa, South Asian countries, Fiji Islands, Mauri-


MARKET

tius, Iraq, Iran and Nigeria.” Speaking about the drivers for the growth of bariatric surgery market and its contribution to draw foreign patients, Dr Prashanth Rao (Chief Consultant & HOD- Laparoscopic General Surgery & Bariatric Surgery), Global Hospitals, Mumbai says, “Obesity in the world has reached epidemic proportions in the 21st century, with morbid obesity affecting large numbers. Obesity is a major risk factor for diabetes, hypertension, cardiovascular disease, stroke and sudden death. So an increase in the prevalence of obesity and its attendant complications, public awareness, insurance coverage and government efforts to curb obesity are all drivers for the bariatric surgery market. Costs abroad are prohibitive for these surgeries with a lap band costing as much as $10000and as much as $17000 for a lap gastric bypass. The cost can be as high as $50,000 in the US. The same can be done in as less as $5000 – 10000 in India. And India offers the same cutting edge technology and healthcare expertise as developed countries. Patients are also given the option of paying in their own currency, thus generating foreign income for India.” Adding to this, Dr Manish Motwani, Founder and Head at 'B-Lite Clinic'-'Aastha Health Care says, “Medical tourism in India is still in its bud stage. If this avenue of tourism is tapped well, not only will it bring revenue to the country, but also spread the name across the globe of India as a hub for medical tourism. With the type of expertise in the country, the growth of industry will lead to growth of talent and also make India one of the leaders in world map for bariatric surgery and weight loss surgery”.

Opportunities galore With key growth drivers mentioned above it is unlikely that medical tourism for bariatric surgery will diminish. In fact, experts believe that the sector will henceforth grow at a faster pace and will open new avenues for medical tourism.

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The challenges in the future would be related to quality and efficacy of such procedures as well as the SOPs related to such procedures

Says, Dr Rao, “There are newer endoscopic techniques for weight loss being tried, which are still not main stream and as yet freely unavailable in India, but once available, may increase the medical tourism in this field. Indian Hospitals should have more dedicated bariatric centres to attract this

kind of medical tourism. The Government has made visa on arrival for certain countries with a stay of up to 30 days permitted for medical tourism. There could be further facilitation provided for easing the burden of patients travelling for treatment or surgery.” Dr Amit Garg, Bariatric &


MARKET Metabolic Surgeon, Fortis Hospital Mohali points out, “Metabolic surgery for Type 2 Diabetes patients based on Cpeptide levels, revisional bariatric surgeries and new procedures like Adjustable Gastric Banded Plication have immense scope to attract foreign patients.” Additionally, Dr Peters is of the view that bariatric surgery is a high resource and technology-driven industry. Its growth will stimulate demand of plastic and cosmetic surgery, skilled nutritionist, manufacturing among others. In keeping with this growth momentum, is the bariatric surgery sector in India braced to explore future opportunities? Moreover, has the industry anticipating future challenges and figuring ways to overcome them?

EMAN’S STORY IN A GIST Eman Ahmed Abd El Aty is considered to be the heaviest living woman in the world and the second heaviest woman in history (after Carol Yager). Her initial weight was nealry 500kg. In February 2017 Abd El Aty travelled to India where a group of doctors from Mumbai’s Saifee Hospital, headed by Muffazal Lakdawala conducted a sleeve gastrostomy, a surgical weight-loss procedure that reduces the size of the stomach to 15per cent of its original size, on March 7. Doctors also removed a large portion of the 36-year-old’s stomach fat and limited her food consumption ability. The hospital claimed that Eman has lost arounf 242 kgs after the procedure. However, days after the surgery Eman's sister, Shaimaa Selim called Saifee hospital surgeon Dr Muffazal Lakdawala and the hospital ‘liars,’alleging they“put Eman on massive medication to stop her brain activity”.What followed was a a drama of allegations and counter allegations, which attracted media attndtion from across the globe.After days of controversies the matter was later settled and Eman was shifted to Abu Dhabi for further treatment.

Lessons from Eman's case “Bariatric Surgery has grown well and growing fast in the last few years in India. Despite this we should always understand that there are certain rules and protocols to be followed to maintain the standards of the surgery. In our eagerness to operate more, if at all the rules are violated or protocol bent, there can be disastrous results which will bring disrepute to the surgery, disrepute to the organisation, disrepute to the country. This can also legally, medico legally and socially affect the entire field itself. Thus, certain factors have to be kept in mind regarding legality of patients who come to India for surgery and the type of information and knowledge going to the patients before and after surgery to ensure everything is smooth,” replies Dr Motwani. The challenges in the future would be related to quality and efficacy of such procedures as well as the SOPs related to such procedures. Furtheron, there is a need to ameliorate the tainted image of India's medical tourism industry as an aftermath of the contraversial case of Eman Ahmed case (Read Box 1 the Eman's story in a gist). Whom would one blame. Doctors at Saifee Hospitals

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International experts are of the point of view that bariatric procedures as far beyond just surgeries. It is a treatment mechanism that needs to be handled delicately as well as patients need to mentored time and again, even after the surgery has been performed for not providing appropriate treatment and relief to Eman? Or Eman's sister, who was dissatisfied by seeing little im-

provement in her sister's health? Is the health and tourism Ministry is at fault for not having clear SOPs? Was

the Indian media irresponsible in its reporting and publicity and turned an otherwise medical achievement for the country into a PR nightmare? Or was this entire issue a result of a mismatch of expectations from both parties? There are several ramifications related to this case which remain misunderstood. Indian bariatric surgeons call it a mismatch of expectations and a consequence of a PR activity going wrong. Dr Lakdawala providing his clarification on the case, said that henceforth, he would ensure that each and every deliverable is documented and that he would involve the Indian and the foreign embassy to facilitate the proceedings of the

SOPs for such procedures. When asked if there was a mismatch of expectations in this case, he replied, “I cannot say that there was a mismatch as we have delivered what we promise but as I mentioned earlier that the deliverables needed to be documented properly and these copies should have been handed over to both embassies to maintain an appropriate decorum. Moreover, I also believe that there is a need for responsible journalism in India.” When asked about what would be his next step, he informed us of a committee that would be set up by the government where is would also be representing to prepare SOPs for medical tourism, especially for complex procedures.

Going forward Eman's saga is a case in point and a presage for all stakeholders related to medical tourism and especially bariatric surgeries. International experts are of the point of view that bariatric procedures as far beyond just surgeries. It is a treatment mechanism that needs to be handled delicately as well as patients need to mentored time and again, even after the surgery has been performed. Therefore, certain SOPs need to be in place and stakeholders need to take an consorted initiative to rebuilt the trust factor and clear the air surrounding bariatric surgeries and medical tourism in India. Dr Rajeev Yeravdekar, Director SIHS says that there is also a need for education in medical tourism, which will be beneficial for both doctors and hospital administrators. Additionally, experts of the opinion that the government will also need to keep tab of the many online medical tourism platforms mushrooming within the country that promise to facilitate high-end service for foreign patient. Their authenticity and legality under to be kept under the scanner without undermining their efforts and contributions to boost medical value travels for India. raelene.kambli@expressindia.com


MARKET I N T E R V I E W

Universal health (coverage) could be game changer for med devices sector Swaminathan Jayaraman, Chairman, Vascular Concepts, in an interaction with Viveka Roychowdhury, elaborates on the turning points of Vascular Concepts and how it has helped form the foundation for the growth of the medical devices sector in India

Congratulations on Vascular Concepts receiving the 2017 Asia-Pacific Coronary Care-Drug Eluting Stent Growth Excellence Leadership Award this March from Frost & Sullivan. Vascular Concepts will be completing two decades in 2018. What have been the major turning points in these two past decades? Thank you very much for the wishes. The two significant turning points have been the introduction of the Drug Eluting Stent (DES) (ProNOVA) in the Indian market and bringing in regulation in the medical devices sector in the last two decades. Vascular Concepts has played a significant role in the

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MARKET growth of the DES market in India when the market was duopoly with restricted pricing with the MNCs in India. When the DES was launched in India, the Maharashtra FDA passed an order that only US FDA approved products should be sold in the state of Maharashtra. Vascular Concepts challenged the decision in Mumbai High Court and the court ordered the DCG(I) to include medical devices into the Drugs and Cosmetics Act. These have been very significant turning points in the last two decades for Vascular Concepts, which have helped form the foundation for the growth of medical devices sector in the country. What do you see as the possible inflection points in the next five years, both for your company as well as the endovascular devices sector in general? The recent decision by the National Pharmaceutical Pricing Authority (NPPA) to restrict the pricing of stents (both bare metal and drug eluting) is a monumental decision to help Indian companies compete with MNCs in India. This decision is quite similar to the decision taken by the Chinese Government to help the local Chinese manufacturers to garner up market share (today Chinese companies have 98 per cent of the market share of the stents in that market). It is to be seen in the next several years whether Indian manufacturers can really compete maturely to garner the market share in this business. Secondly, there is little or no capital available for growth in this industry. The traditional startup capital shuns this sector due to the challenges in regulation and also the challenges with the marketing practices in the country. Given that India has recently put in place regulations for the medical devices sector, what is Vascular Concepts' strategy to cope with the new market dynamics? Vascular Concepts has a basket of innovations in the endovascular space which it

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there plans to start manufacturing in India, in line with the government's push to Make in India for India as well as the world? Vascular Concepts certainly has plans outlined to move ‘value based manufacturing’ to India. When stents are highly automated and India does not have a manufacturing or a cost edge to manufacture these, there are delivery systems like catheters etc. that can be competitively manufactured in India. Our focus in India has been to develop new technologies and then outsource manufacturing overseas where it makes economic sense. This will indeed change in the future with the emphasis of Make in India combined with a market growth strategy.

While we await the details of the universal healthcare (coverage) unveiled by the government, this could be a real game changer for this industry. I foresee the launch of the Universal Health to do for the medical devices sector what Y2K did for the information technology sector plans to introduce in the next few years. The medical devices industry is a fast changing sector with newer technologies finding new clinical need. While we await the details of the universal healthcare (coverage) unveiled by the government, this could be a real game changer for this industry. I foresee the launch of the Universal Health to do for the medical devices sector what Y2K did for the information technology sector. The focus on attention to personal

health and well-being (which exists with less than five per cent of the population) in the middle class due to the government policy will lead to more screening, more prevention and more curative methodologies. This will contribute to the growth of the medical devices sector enormously. Currently, Vascular Concepts uses Germany as a manufacturing base to ensure quality control. Are

Your company has an extensive patent portfolio exceeding 35 US/EU technology patents. What percentage of revenues is allocated for R&D? We have consistently spent six to eight per cent of our revenues towards development related activities. R&D in this industry is mainly development combined with preclinical and clinical studies to prove safety and efficacy of the devices under development. Could you give us a brief idea of the technologically innovative products already in the market as well as those in research and clinical studies like the aortic valve (transcatheter aortic valve implant) for angioplasty, which is currently undergoing clinical studies? There are two main areas for the launch of innovative products in the future. With angioplasty and stenting extending lives of the patients, the heart needs to be taken care of any structural issues. The valves in the heart need to function normally for the rest of the heart to support the bodily functions. We have launched a slew of structural heart products in the last couple of years and will continue this with the new transcatheter heart valve where the aortic valve can be replaced with a catheter.

There is also considerable initial efforts to look at whether the mitral and the tricuspid valve replacements can also be done percutaneously specifically for heart failure patients. We are also developing a device to prevent strokes in patients that suffer from irregular heartbeats. The second area of focus is the peripheral endovascular technologies, focusing on the treatment of debilitating diseases in the lower abdomen of the body. There are a number of patients (diabetics, etc.) who suffer from reduced mobility due to irregular or improper blood flow in the limbs which lead to claudication and eventually amputation. Newer technologies like drug-eluting balloons, self-expanding stents and stent grafts can potentially tackle these diseases in future which are the focus of vascular concepts. Vascular Concepts is today a `150-crore company having a global presence. What is the percentage of revenue from India and other geographies? Which countries are you seeing maximum growth? India continues to be the major revenue engine for the company in Asia. Our presence in Thailand, Vietnam, Philippines, Myanmar, Cambodia and other Asian markets is through our associate company in Thailand. The sale of the products in Europe is done through a marketing associate company out of the UK. What has been the company's average year-on-year growth (actual figures or percentage) over the past five years? What is the targeted growth for the next two years? In the last two years, while not many companies have seen value growth in the cardiovascular device segment due to the decrease in pricing, Vascular Concepts has seen a single digit volume growth which is in line with the market growth. Moving forward, we expect to see double digit volume growth which will also contribute to the increased revenues for the company. viveka.r@expressindia.com


MARKET I N T E R V I E W

‘We will continue to deliver the excellence and brand trust’ Dr Aashish Chaudhry, Orthopedic Surgeon and MD, Aakash Healthcare, shares his insights on the upcoming Aakash super speciality patient-centric hospital, which will start its operations in July in an interaction with Prathiba Raju Why did Aakash Institute, a leading medical and engineering entrance examination coaching institutes, forayed into healthcare genre with the launch of its super speciality hospital? Aakash Institute has been training students for medical entrance examinations since the last three decades. Over these years, thousands of students transformed themselves into highly capable medical professionals in various specialities. Now, the country’s leading coaching institute is all set to push its boundaries of excellence by making an entry into the healthcare sector with the launch of its state-ofthe-art super speciality hospital ‘Aakash Healthcare.’ Stepping into the healthcare sector was planned since the time I entered into medical profession. And the second genera-

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MARKET tion ownership lies with me. The sector has been growing at a phenomenal pace in the last few years and Indian healthcare sector has become a favourite investing option for corporates, investors and VCs. The upcoming super speciality hospital at Dwarka, New Delhi will be a huge relief for the residents, who have been struggling with dismal state of existing medical services. What facilities will you offer? Which technologies will be implemented and by when it will be operational? Started with a small clinic in 2011 and within five years, the clinic flourished and became the favourite healthcare brand for residents of Dwarka and surrounding areas. The new hospital will be our next big step in the healthcare segment. Aakash Healthcare is a 230-bedded super speciality hospital. The key specialities include orthopaedics and joint replacement, cardiac sciences, minimal access surgery, nephrology, ophthalmology and critical care medicine. The hospital is equipped with advanced radiology (3T MRI, 128 Slice CT Scanner, DR System), laboratory equipment, pneumatic tube system, automatic waste and laundry management system that adds to the efficiency of hospital operations. Robust IT systems connect the entire facility seamlessly. The hospital is likely to be fully operational by July 2017. Being one of the well-known medical coaching centres, how much of it has helped you to become one of the trusted brand in the healthcare space? Aakash Institute being present in the market since the past three decades have established a brand value in the market. The brand value of the parent organisation will help in driving the business and we will continue to deliver the excellence and brand trust. We aspire to become the most desired healthcare brand by providing compassionate, caring and world class services. The hospital will be kindled by same ethics and values that in-

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spire the group. The patients’ satisfaction will be hospital’s avowed aim and will always seek to enhance it. You are well established name in medical coaching centre with 150 classroom centres, 78 corporate branches and 57 franchise centres and have ties with lakhs of medical professionals. How do you plan to utilise this space? The Alumni network of Aakash Institute can indeed prove to be a captive source for not only patients but also to hire qualified medical professionals. We are already working on the strategy to tap this vital database. We have planned few initiatives which will help us reach out to this vast pool of patients, professionals and brand ambassadors. ‘Privilege Card’ is one such marketing tool we have designed. It shall be offered to alumni of Aakash Institute as well as the current employees. The card shall offer attractive discounts and wellness packages. We also plan to provide tele-consultation to the people in this network. This will go a long way in providing needy individuals with correct advice and ethical treatment. The person will have an advantage of seeking right advice from anywhere in the country. Many people trained in our institute have become leading practitioners and surgeons and will be more than willing to renew ties with their alma mater. Delhi is saturated with corporate hospitals. How will your super speciality hospital be different from others. What will be your USP. Has Dwarka as a location benefited you? Corporate hospitals are mushrooming at multiple places but as the saying goes, there's always room at the top. The USP of our hospital will be to provide a patient-friendly environment and cater to the growing needs of the healthcare sector. We are working towards aligning with government’s initiatives; prevention and wellness, digital health, and is also open to PPPs. Dwarka being a fairly

Aakash Healthcare is a 230bedded super speciality hospital, which will provide a patient-friendly environment and cater to the growing needs of the healthcare sector. We are working towards aligning with government’s initiatives; prevention and wellness, digital health and also open to PPPs new suburb, has ever expanding population base, but there is gross inadequacy of quality healthcare services and healthcare provider. Established in Dwarka since the past five years as trusted clinical service provider, we have established ourselves as a brand, which will obviously help us in establishing our super speciality hospital. Do you plan to come up with small and medium-sized hospitals in neighbouring cities? Once the first greenfield project takes off, our focus will be to stabilise the operations. Thereafter, we intend to ex-

pand our network by opening satellite clinics, single speciality hospitals in tier-II and III cities. In the ensuing five years, the brand intends to establish four to five small and medium-sized hospitals in neighbouring cities. Aakash Healthcare will emerge as a brand that is transparent, ethical, honest and focussed towards delivering the highest level healthcare services for the community. How you are trying to scale up the Aakash Institute. Aakash Institute has been ever expanding and the growth has been phenomenal in last 8-10 years. The number of centres

as on today stands at 165. The intent is to reach out to more and more students by providing classroom coaching in comfort of their district or state. Despite so many centres, many students still don’t have an access to classroom coaching. We realised this problem and came up with innovative online products (eg Aakash Tutor) including short-term and long-term courses, teaching videos, online tests etc. Realising the highly competitive environment, we have started foundation classes as well, which focuses on 8-10th standard examinations. Due to the introduction of a unified examination i.e. NEET, a nationwide footprint and vast variety of online products have given an impetus to the business of Aakash Institutes. Catering to the medical education space, what is your say about NEET examination? Do you think NEET is a much-needed reform for improving the standard of medical education? NEET examination was one of the most historic step in education industry. It has brought order, transparency, accountability and above all, saved lot of time for all the students. Public health spending is 1.16 per cent of GDP while the World Health Organisation (WHO) recommends spending five per cent of GDP. National Health Policy 2017 talks about increasing the spending to 2.5 per cent by 2025 but we haven't met the 2010 target of two per cent of GDP. What steps would you like to take to achieve it? Healthcare spending in India is among the lowest as compared to other countries. It is a very important indicator for health of the community. The government must take initiatives to streamline various pending processes and only then we can expect better health for people at large. Universal health coverage and increased public and private partnership will aid in alleviating the dismal state of healthcare services in the country. prathiba.raju@expressindia.com


MARKET POST EVENT

Genericisation evokes fierce debate at third edition of Vantage Point Panelists divided on the impact of the push for generics, many laud the intent but remain sceptical of consequences

Lakshmipriya Nair & Mansha Gagneja Mumbai A FIERY debate on ‘Genericisation: Panacea or Pandora’s Box?’ ensued at the third edition of Vantage Point, Express Pharma’s platform to discuss and deliberate on Indian pharma sector’s most pressing and controversial topics. Partnered by Wellness Forever, the event was held at Sofitel in Mumbai. An eminent panel deliberated on the implications and possibilities of the Centre’s push towards genericisation of pharma brands, in a very interesting and insightful session, moderated by Dr Milind Antani, Head, Pharma and Life Sciences, Nishith Desai Associates. The panel comprised Dr Amar Jesani, Editor, IJME; Dr Jayesh Lele, National Secre-

tary – IMA Board of India; Milind Mangle, Internationally Certified Coach and Consultant, Angle Consultancy & Services; Vaijanath Eknath Jagushte, Treasurer, Chairman of Legal Affairs Committee — AIOCD & MSCDA and Treasurer of MSCDA; Priti Mohile,

Managing Director, MediaMedic Communications; Dr KS Sharma, PG Committee Member, Medical Council of India MCI and Director Academic Tata Hospital; Daara Patel, Secretary General, IDMA and Dr Suleiman Merchant, Dean, Lokmanya Tilak Municipal

General Hospital and Medical College. Dr Antani drew out the panelists to share their views candidly and discuss the ramifications of a mandate to prescribe only generic names of drugs. He steered the debate to touch upon lesser discussed points

and look at the issue in a more detailed manner. He also threw light on many legal aspects of the issue and explained the various grey areas to give more clarity on the same. Dr Antani, in the course of his moderation, quipped that the Indian lifesciences

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MARKET industry is facing a challenge between choosing what is ethical and what is legal. Industry representatives were openly critical of genericisation. They viewed the move with disfavour and highlighted various pitfalls which would arise if genericisation became the law. Do all generic medicines give the same results as their branded counterparts? Are enough generic medicines available in market? While focusing on price, how do we not lose sight of quality? These were some of the questions posed by experts and veterans during the debate. At the same time, there were panelists like Dr Jesani who was totally in favour of prescribing generics. He outlined the various advantages in terms of access and affordability of medicines. He said that if there was political will and collaboration between stakeholders, then genericisation could indeed be a panacea and create significant positive impact for patients. At the same time he admitted that there is a need to have better monitoring mechanisms in place to ensure effective implementation of the government’s push towards generics. Opining that genericisation is a populist move, Dr Lele questioned the preparedness of the government to implement it effectively. He said that quality can be a concern in such a scenario as the industry and medical fraternity is illequipped to deal with genericisation. He lauded the intent of the government but expressed reservations about effective implementation of the move. Mangle pointed out that this is a very multi-faceted issue and would have wide-reaching implications. He explained the rationale of the government behind pushing generics and stated that though the intention was to introduce a panacea to many problems faced by healthcare industry today, inadvertently opened a Pandora’s Box. He said that our public and other stakeholders are still uninformed about various issues and hence not ready for a step like genericisation. He pointed out the various complexities arising from the move and said that lack of accounta-

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Industry representatives were openly critical of genericisation.They viewed the move with disfavour and highlighted various pitfalls which would arise if genericisation became the law. Do all generic medicines give the same results as their branded counterparts? Drew out the panelists to share their views candidly and discuss the ramifications of a mandate to prescribe only generic names of drugs Dr Milind Antani Head, Pharma and Life Sciences, Nishith Desai Associates

bility is one of the major concerns in this situation. Mohile was in favour of genericisation but she too had doubts about the step being successful in achieving its objective. As a communication specialist, she threw light on how marketing and PR would change in times of genericisation and its effect on patients. She also said that information about quality will become paramount in future. Jagusthe expressed concerns about ensuring quality and said that it is a premature move. He pointed out that there is no standardisation in India as far as quality is concerned. He opined that unless quality is assured through proper regulations and infrastructure, enforcing prescription of only generics is not a good decision. He lauded Jan Aushadhi as a good initiative to make medicines available but recommended strengthening it with better economic policies to make it sustainable and extend its reach. Dr Sharma gave instances of how genericisation can fail in

implementation and raised concerns about quality, accountability and efficacy. He said that the government’s intention to nullify the nexus between the medical fraternity and pharma companies might not really succeed as the wrongdoers might find ways to circumvent the move and continue with the malpractices. He also pointed out to various grey areas which may prevent the move from being a beneficial one, for instance, crosspathy practitioners do not have to adhere to these guidelines. Patel was emphatic that ‘generics only’ is a decision which will not serve any objective. He stated that other measures to reduce prices might be more effectual and claimed that the industry would support the government if they come up with better strategies to serve the masses. He recommended slashing taxes of essential medicines as a measure to reduce prices of drugs. Quality was a concern raised by Dr Merchant as well. He said that until the right standards, infrastructure and regulations are put into place to determine the efficiency and efficacy of drugs in India, genericisation will not be successful. He was also of the opinion that it is an idea whose time has not arrived yet. Thus, the panel was divided in its opinion about government’s decision to promote generic medicines. The panel discussion was followed by a Q&A session. Viveka Roychoudhury, Editor, Express Pharma and Healthcare posed the first question. She asked whether seminars held for associations help in maintaining the quality of medicines and in educating patients to take a good decision? To which Patel responded that they have already got an approval to add a

topic on generic medicines to the existing seminars. SR Vaidya, Chairman, SME committee, IDMA, suggested that there must be seminars held on quality of excipients as they constitute 95 per cent of the drug. He insisted on making pharmacovigilance activities mandatory which can increase the quality standards of generics. Deepak Paliwal, External Advisor, GSK, London, connected with the audience and panelists through Skype. He was in favour of the government's move and threw light on a pilot project in the state of Andhra Pradesh where pharmacists are prescribing generics for past three years. He further clarified the government's motive behind mandating writing the generic name in capital letter is to ensure more readability among patients and pharmacists. Akash Rajpal, MD and CEO, Ekohealth Management Consutants, raised a set of legal questions related to the liabilities of doctors while prescribing medicines. He asked, “Is a doctor liable when s/he prescribes a branded medicine of their choice and something goes wrong? Also, if the doctor is not liable in this case, then how can s/he be responsible when s/he prescribes a generic medicine? Are there any drugs available at pharmacies that are not FDA approved?” Mangle replied saying that as of now, doctors can be held accountable for the various brands they prescribe. While prescribing generics, the patient might not know who to hold responsible as the liability might keep shifting among various stakeholders. Further on, the panelists highlighted the importance of bio-equivalence studies and the need for standardisation to

build trust. On the contrary, Dr Jesani raised a point that in case of substandard drugs, the manufacturers are to be held liable and the regulators like CDSCO should be more attentive towards any spurious drugs available in the market. He also suggested that more investments need to be made in order to bring each company under their surveillance. Sripad Desai, Americares, inquired that even if doctors prescribe a generic medicine, will the pharmacists be able to dispense branded ones? The panelists expressed that substitution is against the law and there is a need to take a few learnings from the US where unique codes are allotted to each formulation. Payal Laad, Professor, Community Medicine, Sion Hospital, referred to Bangladesh's drug model and asked what can be the takeaways for India. Patel, informed that the Indian state of Rajasthan has a similar policy but, there are few hurdles faced while extrapolating these schemes across India. Dr Gopal Dabade, President, Drug Action Forum of Karnataka asked whether generic medicines can be available at affordable prices, to which the panelists responded that there is an urgent need to tackle the nexus between manufacturers, doctors, and chemists for patients' benefit. The event came to close with the panelists unanimously agreeing that patients’ well-being should be safeguarded at all costs. Therefore, before the government mandates generication of medicines, they need to put in place the required processes to ensure that quality generic medicines are made accessible for all. lakshmipriya.nair@expressindia.com mansha.gagneja@expressindia.com


MARKET

SYMHEALTH 2017 held in Pune Union Health Minister spoke on his vision of making health as universal and affordable for all at SYMHEALTH 2017

SYMHEALTH 2017, an international conference on healthcare in a globalising world, was recently held in Pune, which was organised by the Faculty of Health & Biomedical Sciences (FoHBS), Symbiosis International University (SIU). The three-day event, was attended by around 1000 healthcare professionals, from India and abroad. The opening address of the pre-conference symposium was given by Dr Rajiv Yeravdekar, Dean, Faculty of Health & Biomedical Sciences. Various career opportunities in healthcare sector were discussed by stalwarts from the corporate industry. The session was chaired by Dr Ravindra Karanjekar, Group CEO, Jupiter Hospital who spoke on opportunities in the field of healthcare and hospital management. The vertical of health insurance was represented by Dr Shreeraj Deshpande, Head-Health Insurance, Future Generali India Insurance Co. The challenges and opportunities arising in the healthcare IT branch was discussed by Narendra Barhate, MD and CEO, Seed Infotech whereas Dr Madhura Nene, Former Director, Quintiles informed on choices available in the field on clinical research. A session on Challenges, Standardisation, Accreditation & Social Perception was chaired by Dr (Gp Capt) Suchitra Mankar, Founder, Doorstep Health Services. Others who took part in the panel were Dr Anuradha Sunil, CMD, Indicare Health Solutions, Dr Mahesh Joshi, CEO, Apollo Home Care, Apollo Hospitals Group, Anshu

L-R: Dr Rajiv Yeravdekar, Dean, Faculty of Health & Biomedical Sciences, Dr SB Mujumdar, Founder and President, Symbiosis & Chancellor, SIU, JP Nadda , Union Health Minister, Dr Vidya Yeravdekar, Principal Director, Symbiosis and D Rajani Gupte, Vice Chancellor, SIU

Verma, Manager Standards, Healthcare Sector Skill Council (HSSC), GoI and Sandeep Oberoi, GM, Philips Home Healthcare. Marjaana Suutarinen, CEO of HY+ Oy, University of Helsinki Centre for Continuing Education, Finland and Leena Liimatainen, Dean, Faculty of Social & Health Care, Lahti University of Applied Sciences (LAMK), Finland gave insights on Finnish Education, Pedagogy and opportunities in home healthcare was discussed by Kumar Krishnaswamy, Group Head - HR, Nightingales Home Health, V Thiyagarajan, MD, India Home Healthcare, Dr Gaurav Thukral, Senior VP and Business Unit Director, Health Care at HOME India and Dr Arun Jamkar, Former ViceChancellor, MUHS, Nashik. On the second day, curtains were raised for SYMHEALTH 2017. The inaugural ceremony was graced by JP Nadda, Union Minister for Health & Family Welfare, GoI, who was the chief guest while the guests of honour were Dr (Prof) Jagdish Prasad, DGHS, MoH&FW, GoI and Dr Soumya Swaminathan, Director General, ICMR. The ceremony was presided over by Dr SB Mujumdar, Founder & President, Symbiosis & Chancellor, SIU. Dr Vidya Yeravdekar, Principal Director, Symbiosis, Dr Rajani Gupte, Vice Chancellor, SIU, Dr Rajiv Yeravdekar, Dean, Faculty of Health & Biomedical

Sciences, SIU & Deans from all faculties of Symbiosis. Dr K Srinath Reddy, President, Public Health Foundation of India, was the chairperson for Track 1, who gave an overview of various sub-themes under Track 1 ranging from sustainable development goals, global and national perspectives on healthcare financing, government policies and interventions to the role of the civil society organisations towards improving healthcare delivery. Alok Kumar, Advisor, National Institution for Transforming India (NITI Aayog), GoI, a speaker in Track 1 on Healthcare Economics and Financing, spoke on the government policies and interventions designed to address the important aspects on healthcare economics. The Track 2 on Healthcare Communications had Dr Pradeep Krishnatray, India- Director, Johns HopkinBloomberg School of Public Health. The Track 3 on Healthcare Laws featured stalwarts such as Dr Mohan Agashe, Former Director, Maharashtra Institute of Mental Health, who talked about mental health. Dr Agashe showed a snippet of his film Astu to the audience. Prof Kris Gledhill, Director of Clinical Legal Education, AUT Law School, Auckland, New Zealand put forth his views on the global advocacy perspectives on mental health. Track 3 also dealt with the medico-legal aspects around

patient safety which was discussed by Prof John Tingle, Reader in Health Law, Nottingham Trent University, UK. The focus of Track 4 on Healthcare: Engineering Design & Geospatial Applications was on recent trends in the designing of ‘Smart Hospitals’, use of technology, innovative applications and adoption of user centric ergonomically designed equipment for effective healthcare delivery. Dr Nitin Tripathi, Professor, Asian Institute of Technology (AIT), Bangkok, enlightened on how Geographic Information System (GIS), a computer system for capturing, storing, checking, and displaying data related to positions on. Day 2 of SYMHEALTH 2017 opened up with two parallel sessions i.e. Track 5 and Track 6. Track 5 on Healthcare IT dealt with the positive impact of technology on the healthcare delivery. Linda Roberson, CEO, Paper Tracer Software System, USA, spoke on IT as an enabler. Track 6 on Healthcare: International Relations threw perspective on the linkages between global healthcare and the various dimensions of International Relations. Dr Roderico H Ofrin, Regional Coordinator, WHO, South East Asian Regional Office (SEARO), New Delhi discussed the role World Health Organization (WHO) plays for ensuring healthcare in humanitarian and environmental crises. Dr Khanindra

Bhuyan, Health Specialist, UNICEF mentioned the role of UNICEF in promoting international relations. Track 7 focussed on Healthcare Innovations & Entrepreneurship and had a very interesting talk on Innovations in India: The Biotechnology Industry Research Assistance Council (BIRAC) model by Dr Shirshendu Mukherjee, Mission Director, Grand Challenges India, BIRAC. The overview for the last track Healthcare: Integrative approach in Indian setup comprised amongst other sub themes a panel discussion on integrative approach to healthcare by Dr Srikanth, Dy Director General, CCAR, GOI, Dr KS Sethi, Deputy Advisor, Homeopathy, GOI , Dr R Nagaratna, Medical Director, Arogyadhama, VYASA. The valedictory ceremony was graced by Adv Ram Jethmalani, Member of Parliament, Rajya Sabha, guests of honour Dr Henk Bekedam, WHO Country Representative, India, Nina Vaskunlahti, Ambassador, Embassy of Finland, New Delhi and presided over by Dr SB Mujumdar, Founder & President, Symbiosis & Chancellor, SIU. Dr Henk Bekedam, WHO Country Representative, India, expressed globalisation is the key and today we are far better connected. However, this poses challenges such as spread of infectious diseases.

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FO C U S : D I G I TA L T EC H N O LO G Y

AGE OFTHE SMARTDOCTOR There is no doubt about the fact that doctors who are proficient in computer science do have an edge over others. These professionals can turn several ideas into reality, solve trivial healthcare concerns and will be ready for future digital disruption BY RAELENE KAMBLI

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t times when managing and integrating vast patient data to lead better healthcare outcomes seems like a herculean task, when understanding the correlation between operational efficiencies and clinical outcomes becomes imperative for hospitals and when effective communication is paramount for a healthy doctor-patient relation; digital technologies act as a panacea for India's healthcare fraternity. But how much do healthcare professionals truly invest in becoming technically proficient in order to effectively utilise these technologies in their clinical practice?

Lets take a look.... In the last couple of years, I have had several conversations with doctors, nurses and hospital administrators on the relevance of digital technologies in healthcare and how it will impact the future of medicine. Typically, every healthcare professional I have spoken to is convinced that digital technologies have changed the dynamics of healthcare communication and management of diseases as well as added more intelligence to medical decisions and clinical research. They also believe that digital technologies have the potential to further remodel India's current healthcare scenario. When asked about the utilisation of these technologies in their clinical practice, healthcare professionals usually respond by citing several examples of how cloud computing, Big data, IOT, artificial intelligences, telemedicine etc., facilitate them to achieve better clinical and healthcare outcomes. Having said that, there are two major concerns that these professionals raise—one is of the possibility of being replaced by technology or by engineers who can assist healthcare technologies to provide healthcare facilities and the other is the issue of cyber security of patient data. To this degree, tech experts may remain irresolute on the concern of medical professionals fearing to be replaced by technology, and to a large extent they are right in their judgement. Man with all his capabilities to expand his intellect has the potential to work around this situation. However, the concern surrounding security of patient data cannot be dismissed. So, what are healthcare professionals doing to mitigate these apprehensions?

The rise of tech doctors In the US, doctors are increasingly attending coding bootcamps to educate themselves on computer sciences and programming. After which, these doctors are leveraging their combined knowledge of computer science and medicine to tackle healthcare problems. For instance, doctors from the Yale University and Stanford Children’s Hospital by learning computer coding have developed mobile apps for clinical studies, the results of which are utilised for clinical practice within the respective hospitals. This has facilitated these doctors in achieving better clinical outcomes as well as helped them in gathering valuable information for further research. Dr Omar Rayward, Opthalmologist-turned-Computer Programmer in his blog writes, “A doctor that is tech-savvy enough to filter the helpful and trustwor-

WHAT IS A CODING BOOTCAMP? A coding bootcamp is a technical training programme that teaches parts of programming with the biggest impact and relevance to current market needs. It enables students with very little coding proficiency to focus on the most important aspects of coding and immediately apply their new coding skills to solve real-world problems. Coding bootcamps teach people with little or no technical coding background how to write code, and build applications on a professional level. Most coding bootcamps in the US last anywhere from 8-12 weeks and are designed for speed and high-impact learning.

thy [apps] could help certain groups of people, such as young people with diabetes.” Dr Nagarjun Mishra, Co-founder, Chief Officer Business & Strategy PurpleHealth speaks about the varied avenues open to doctors who have added skills of coding and this has done wonders for healthcare. Citing the example of the achievement of doctor from the US, he explains, “Yale cardiologist E Kevin Hall, for example, one of the best-known doctor-programmers in the health industry, developed an iPhone-based clinical study using Apple’s ResearchKit to gather information about the quality of life of patients who might have cardiomyopathy. Dr Ed Wallitt set up a medical IT consultancy and software development company (PodMedics). He says that doctors actually make great programmers. They are good at modeling complex systems such as the circulatory system, and compartmentalising complex things. This is exactly what coding is about. Dr Pieter Kubben, a neurosurgeon and award-winning software developer for mobile applications and clinical decision support systems says that we cannot remember everything, and we make mistakes. If we would remember 9 out of 10 issues, we do great in high school. However, we may cause disasters in medicine if the last 10th item is crucial. That is where his coded apps on WHO Surgical Safety Checklist and Improved decision support for subaxial cervical spine injury have helped him and many others in their practice.” Not just in the US, but even doctors from the National Health System, UK, Singapore and many European nations have been upgrading themselves with the knowledge of computer sciences and digital technologies to integrate them into their medical practice. And guess what, they have achieved remarkable results. Moreover in the west, you will find several healthcare digital start-ups set up by doctors which serves as an added advantage for these practitioners to connect to their patients as well as leverage various opportunities that can help them provide healthcare like never before. These medical experts believe that there is a huge gap between medicine and information technology which can be bridged by an integrated knowledge of medicine and computer science. Some of the doctors are of the opinion that there exist a lot of patient algorithms that a doctor can see in the medical books that can easily be converted into computer codes.

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cover ) The Indian story In India, the scenario is slightly different. All healthcare professionals acknowledge that digital technologies add value to their daily functions. They also concede that the lines between medicine and digital technologies are slowly blurring, but there are many at variances to the fact that they would be needing to upgrade their technical know-how in computer science as these lines continue to blur further. Why do I say so? During my research on this subject, I spoke to some general practitioners, diabetologists, and gastroenterologists who see at least 50 patients in a day. I talked about the issues they faced during the time of demonetisation last year. All the doctors shared the challenges they faced due to lack of cash and some also told me how they have overcome this problem by way of not charging a fee to their patients during that period. So, nice of these doctors to have done quiet a bit of social service. When I asked them, whether they opted for an online money transfer option or resorted to mobile wallets for their payments from patients following this crisis, sadly; only five doctors had chosen this option. When asked them the reason behind this, they raised concerns around how do they manage or keep track of all the online transactions on a daily basis. Some even asked me what if the Internet connection fails due to which an misunderstanding crops up between their patients and them. A web developer friend (who does not wish to be named) confirmed that their concerns are genuine, but a serious lack of understanding is where the problem lies. Lack of the understanding of technical know-how of digital technologies prevent these doctors from leveraging its umpteen benefits. This web developer has been working with hospitals and private practitioners to develop websites and mobile apps for them. Sharing this experience he informs, “I have often faced this challenge in explaining technical aspects of electronic health record systems. Also, I have tried to convince few of the doctors for whom I have designed Electronic Health Record systems and websites to learn the basics of computer programming so that they could solve some simple technical issues at their end without having to involve an engineer to do so. This would save them cost of maintenance as well as save time. But, they question the logic behind this concept. At times, this creates a mismatch in understanding what exactly the doctor wants, needs and what we can offer”. Well in future, the situation is not going to be as bad as it may seem currently. I was fortunate to meet and interact with some medical professionals, especially doctors who believe that an amalgamation of medicine and computer science can do wonders and so have set on to the path to acquire knowledge of computer programming.

Cultivating smart doctors for India Dr Mradul Kaushik, Director Operations and Planning, BLK Super Speciality Hospital, New Delhi opines, “Needless to note, for modern doctors it is extremely vital to have good understanding and knowledge of computer science. This becomes especially true for specialists in the field of oncology, radiology, haematology, neurology and cardiology. A good understanding of this stream is hugely useful and this is also apparent in the way in which some specialities have sprung up across institutions. World’s leading John Hopkins University has dedicated centres like Centre for Computational Biology, Centre for Computational Genomics, Institute for Computational Medicine designed to undertake R&D in these areas, and therefore highlighting the criticality of convergence of the two streams. With use of computer algorithms, data mining, text processing and modelling, we can gather clinical research, healthcare databases, patient records and genomics data which is very useful to us.” “Technology is now seeping into every facet of life and healthcare is no exception. With developments in robotic surgery, artificial intelligence and IoT, healthcare is poised to enter its next era. The medical fraternity can benefit immensely by actively participating in this technological change,” states Nivesh Khandelwal, CEO and Founder, LetsMD, an health-tech start-up that connects doctors with patients. As example he speaks of Dr Praneet Kumar, who was earlier the CEO of BLK Hospital, who has developed a health app, called Health Mir. Referring to the present scenario, Khandelwal says, “Currently doctors originate an idea, which are not in sync with the technological possibility of the same. Active engagement by doctors with an understanding of

the underlying technology can help the entire ecosystem innovate more efficiently than currently being done.” Dr Arvind Ranganathan – Clinical Specialist and Product Manager, Philips Innovation Campus, a doctor turned technocrat shares the example of how Philips Healthcare with the help of digitally literate doctors has developed a tele ICU system. He goes on saying, “The digital age is catching up with clinicians in a big way. One needs to be savvy of the technology available and power it brings in when used. Knowledge of technology does not include coding alone. One needs to understand technology, the products available, the power it can bring in, the usability of it and also the robustness of it. Doctors are comfortable using software’s like MS Office, charting solutions, EMR’s, mobile apps. A clinician’s mindset is in tune with that of an inventor and computer knowledge definitely opens up a big avenue for them. Doctors with basic coding skills is definitely a plus for building solutions. Similarly, the bigger value add is the clinical relevance that one brings as a clinician that helps the product. The tele ICU product by Philips is built on this module where clinicians have worked closely with engineers to bring in cutting-edge technology at affordable prices. Here, the synergy between the clinicians and their technology skills along with the minds of the engineers have played a significant part in bringing in quality healthcare to the people.” While multinational companies are aligning with doctors who are technically proficient to develop newer technologies for healthcare, there are a few doctors who have acquired competence in computer coding and are doing great in their careers. Dr Prem Pillay, Co-founder and Non-executive Director, HealthCode and tech-doctor, says, “Although it is not necessary for doctors to have an equivalent knowledge of computer science with medical science, it would be an advantage for doctors to know how to code. Also, a general knowledge of computer science, artificial intelligence and robotics is useful for the doctors of today to develop the medicine of tomorrow. In my own practice, I learnt how to code very early on and I was coding a variety of different systems, particularly in order to analyse complex biochemical and blood flow changes for critical organs in the ICU.” He further cites an example of the same saying, “In the late 1990s, we helped the Institute of System Science, NUS, Singapore, develop an electronic brain atlas. This was a successful and commercialised product that did not require you to refer to a paper atlas to perform navigation and interventions in the brain. I was also involved in using virtual reality and augmented reality glasses for surgery and in using robotic microscopes. A lot of these pioneering activities came because of my deep interest in artificial intelligence and computer science. Currently, I am a medical advisor

IF,DOCTORS TRULYREALISE THE POTENTIALOFDIGITALTECHNOLOGIES AND UPGRADE THEIR EXISTING SKILLS,WE CAN TAKE PRIDE IN SAYING THATINDIAIS SOON GOING TO STEP INTO THE AGE OFTHE SMARTDOCTOR! 20

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( for several companies including Clinify, which has developed an excellent electronic medical record system that is not only paperless but still images, video images of patients, and procedures like MRI can be stored on an iPad and accessed by doctors anywhere. Patient information can also be stored on cloud and, therefore, is retrievable on a smartphone. I also advised the world’s first children’s wearable device called Kiddowear. This device not only enables parents to geolocate their children but also to monitor their general health like nutritional and mood assessment to enable early intervention.” Dr Kaushik lists down various scenarios in which a technology literate doctor can help hospitals in India look and work better and thereby enhance her career prospects. ◗ Each day tonnes of data is generated in a hospital and knowing data mining and developing analytics is critical to make good use of these. A doctor with enhanced computing skills will be far better equipped to deal with this data crunching than one who is not. ◗ Such doctors are also fast to adapt to new software solutions including those that cater to better back end systems for data management, better patient-facing electronic medical record access points, and better software for diagnosing and treating patients who come to the hospital. ◗ Such doctors are also good to help train the hospital staff on a new software tool ◗ Given that many complex cases require multi-disciplinary approach and comprehension, a doctor adept in computer science is better able to read reports and develop analytics in coordination with other specialities Apart from these, learning coding will enhance doctors to climb the leadership ladder. Explains Dr Kaushik, “A leadership role requires comprehensive understanding of the evolving technologies as well as appreciation of these. Doctors who embrace technologies into their profile faster and understand the nuances of computing will most certainly have better career opportunities as future healthcare systems will rely on high-end computing technologies and it will become incomprehensible to have a hospital without such integration. The faster we embrace computer sciences and adapt to it, the better it is”. Another important advantage of learning computer science is identifying cyber attacks. WannaCrypt ransomware, the infamous cyber attacks in the recent times impacted around 150 countries globally. It still continues to affect the National Health System in the UK. Experts say, a clear understanding of computer science among medical professionals can help in averting such attacks. “Knowledge always empowers a person. When doctors learn programming, they will get to understand the technology framework and algorithms better. They can then contribute in troubleshooting problems. It can be their own home PC, phone or tablet, or certain software that they use while consulting patients online,” adds Amit Munjal, Founder, Doctor Insta. Moreover, Dr Mishra looks at the larger picture on how technically-proficient doctors can improve accessibility of healthcare within the country. “I believe that technology would certainly be a key enabler in not only addressing to this demand supply gap, but also in im-

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proving accessibility of specialised care to a larger target audience. Scalability to address to the population of 1.3 billion Indians is only possible through advanced and adaptive technology systems with doctors actively being a part of its creation process”. Dr Jagdish Chaturvedi, Director, Clinical Innovations and Partnerships Innaccel Technologies, is another example to the same. He shares his experience saying, “My first device which I developed in 2010 was a portable ear nose throat endoscopy recorder. It included a digital camera and an adapter that could connect to any standard endoscope enabling portable and low cost endoscopy of the ear, nose and throat. I had licensed this technology to a design firm called Icarus in Bengaluru and it was further licensed out to Medtronic. The final version of the device called Entraview now includes a touch screen digital camera with image processing capabilities that has an ear probe to visualise the ear drum. Over 200,000 patients have been screened using this device by health workers as a part of the Shruti iHear programme in Delhi.” Very well, experts above have propounded on the advantages of learning computing coding such as building apps to monitor patients, tackling clinical

Symbiosis’Faculty of Health & Biological Sciences is in talks with the government for incorporating computer science as an important subject in medical education problems, navigating electronic medical records, recommending health app to their patients, using innovative technologies to clinical practice, etc. Yet, we cannot ignore the fact that the number of embracing this concept are not many. Giving a reasoning to this, Dr Mishra says, “In India, however, I do not see a significant number of doctors turning coders anytime soon. Both because of the already strenuous curriculum and limited opportunities for dual knowledge.” Certainly, Dr Mishra India does not have many doctors who have the added skill of computer coding but as mentioned above by experts, it does make sense to gain this knowledge especially; when mobile apps, electronic health records systems, artificial intelligence and robotics are increasingly being applied to medical practice.

Incorporating computer science in medical education Including computer science into the medical curriculum will undoubtedly facilitate in rearing the nextgen doctors. Dr Pillay advices to teach courses in coding, artificial intelligence and robotics in medical schools.

On similar lines, Dr Aniruddha Malpani, Malpani Infertility Clinic feels that coding should be a part of the medical education curriculum and that healthcare hackathon need to be conducted within medical colleges to cultivate a culture of forward thinking among all medical professional right at the time of their education. “The problem with medical education today is that all the knowledge that is imparted is very authoritybased. They are not encouraged to question the status quo, or think about creating better solutions. In medicine, there's only one right way of doing things, and doctors aren't taught critical thinking skills, or how to improve and innovate. This is a great opportunity, and if we put together a group of different people from varied disciplines (especially medicine!), and with different perspectives, they will be able to come up with ingenious out-of-the-box solutions. The hackathon format works well to encourage this cross-pollination of ideas – short enough to draw people out of their daily routines, and long enough for participants to identify the people they want to work with and arrive at a basic wireframe of the solution they want to explore in more detail,” he expounds. “India has a huge untapped population of intelligent medical students, who haven't yet been exposed to these powerful tools. Once we give them the chance to wield these tools, we will be able to liberate their curiosity and intellectual ability. Given their understanding of the law of the land and their experience working with resource strapped conditions, they’ll be more likely to come up with far clever solutions than some of the ones we have borrowed blindly from the West. India needs home grown solutions, and that's the beauty of these hackathons – they are designed with the intent of catalysing locally relevant innovations. The most important thing is that the hackathon format teaches students how to ask the right questions – “Why are things being done a particular way? What if we did things in this way, which is so much better? And how can we actually implement this in a better way?” These are all inter-related questions, some with easy answers, some far more complicated. Some would be great as thought experiments but would never work in real life,” Dr Malpani maintains. Bringing some good news, Dr Rajiv Yeravdekar, Director, SIHS informs that Symbiosis' Faculty of Health & Biological Sciences is already advocating for the same. They are already in talks with the government for incorporating computer science as an important subject in medical education.

For a brighter tomorrow The digital age has empowered both patients and doctors alike. In times to come, digital transformation will continue to disrupt the field of medicine and medical practice. In order to be braced for future disruptions, the medical fraternity in India will need to upgrade their skills to achieve new levels of understanding, knowledge and abilities in computer science. If, doctors truly realise the potential of digital technologies and upgrade their existing skills, we can take pride in saying that India is soon going to step into the age of the smart doctor! raelene.kambli@expressindia.com

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few decades ago genomics was considered to be a farfetched notion, but defying the belief, it soon emerged as a revolutionary science. The first human genomes were determined in 2001, marking the millennium with innovations and since then it has been exploring new avenues and solving mysteries. The intricate mystery of evolution can be explained with only a few set of theories and genomics plays a significant part in untangling those threads. To unravel our history, to understand the nuances of our functioning, the elements that affect us and to devise a way to personalised ailments, the requirement to innovate genomics arose. Since its advent, genomics has been proving its worth with numerous applications in the healthcare segment. Though the task of completing the entire DNA sequence of the human genome seemed monumental then, exciting advances have already emerged in the field now. Worldover, powerful technologies are being deployed to churn out extensive genetic information, while robust analytical methods help make sense of a massive collection of data.

Digital technologies A World Economic Forum’s report on emerging technologies of 2015 states that digital technologies in genomics such as Digital Genome, Artificial Intelligence and Genetic Engineering Techniques are a gamechanger. Many others including Next Generation Sequencing (NGS), Big Data Analytics, Internet of Things, Cloud Com-

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Genomics is the key to decipher the puzzle of our evolution, a pre-requisite to personalised treatments. Let us examine how innovations in the digital era are aiding genomics BY MANSHA GAGNEJA puting have cropped up to support the building of a grand database which could be significant in reducing the disease burden. Clustered regularly interspaced short palindromic repeats (CRISPR) genome editing technology is yet another innovation which is advancing treatment options for some of the toughest medical conditions faced today, including chronic illnesses and cancers for which there are limited or no treatment options available currently. The applications of

CRISPR are far ranging—from identifying genes associated with cancer to reversing mutations that cause blindness. Aparna Dhar, Medical Geneticist and Genetic Counselor, Core Diagnostics, in regards to upcoming digital technologies opines, “Genomic sequencing technologies are undergoing regular upheavals at unprecedented speeds. The fastest technologies can now sequence an entire genome, three billion bases, in hours and the corresponding costs

have dropped within a year.” Let us now look at how these technologies are helping to transform Indian genomic industry.

Integration in Indian market Though Indian genomic market is a nascent one and so are the technologies adopted by the industry, there have been significant measures taken up by the government along with various initiatives by genomic players to boost the sector.

Government intervention: The Union Budget, 2017-18 allocates `1250.58 crore to Biotechnology Research & Development which includes research for the various technologies that are likely to generate multiple genomics solutions. A Central sectoral scheme, Bengaluru-Boston Biotech Gateway to India has been formed. Through this initiative, a range of institutes in Boston (Harvard/MIT) and Bengaluru will be able to connect to share ideas and mentor the entrepreneurs, especially in the field of Genomics. Another one is the National Laboratories Scheme, which will aid the development of low-cost technologies in big data in health genome biology. These schemes are bound to promote further innovations. The contribution of genomic players: Genomic players are rigorously putting in their time and efforts in devising new technologies as the scope in the genomic industry is enormous. Companies are investing a larger chunk of their resources into research and development of NextGen and Machine Learning platforms to aid the transformation of the healthcare sector. Sam Santosh, Chairman, Medgenome, claims, “We generate almost 1 PB of data every year through diagnostics and research projects. Most of this data is heterogeneous and complex in nature consisting of raw DNA sequencing and other genomics data, clinical and phenotypic data, demographics, medication and family history, variants/mutations associated with an individual, and knowledge curation about a specific disease from literature”.


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FO C U S : D I G I TA L T EC H N O LO G Y

THE UNION BUDGET,2017-18 ALLOCATES `1250.58 CRORE TO BIOTECHNOLOGY RESEARCH & DEVELOPMENTWHICH INCLUDES RESEARCH FOR VARIOUS TECHNOLOGIES THATARE LIKELYTO GENERATE MULTIPLE GENOMICS SOLUTIONS Analysing this data requires sophisticated algorithms as well as the domain knowledge to quickly sift through the mounds of complex data to identify the variations or mutations that explain the disease and can be the potential targets of novel drugs. Various genomic players offer customised tests which use digital technologies to suit the needs of their patients. For instance, Core offers geneCORE Predict which is used as a predictive tool. By sequencing and analysing the genome of an individual they claim to predict the risk, genetic carrier status of 22 types of cancers and the likelihood of passing it on to the next generation, liquiCORE Detect, which enables to obtain information through DNA sequencing, thus assisting the patient to decide the drugs and medical approaches suitable and amnioCORE which is a non-invasive prenatal test (NIPT) detecting the most common foetal genetic disorders during a woman’s pregnancy. Mithua Ghosh, DirectorR&D, Triesta Sciences informs, “Our centre incorporates latest technologies like NGS technology using Illumina sequencers and Digital droplet PCR for Liquid Biopsies in our day-to-day operations. The laboratory is equipped with instruments from companies like Illumina, Agilent, and BioRad which are considered as world standard and trusted in terms of quality. We collaborate with Strand Life sciences for bioinformatics, who are considered as the best in clinical informatics and analysis platform in terms of accuracy,

precision and speed of NGS data analysis.

Benefits Being the second most populous country and with a rising burden of infectious and chronic diseases, India is an upcoming market for integrating innovative and cost-effective models. Genomics focuses on prediction and prevention which could eventually lead to the transformation of the healthcare system in the country. Given that the capabilities of genomic sequencing continue to expand, integrating it fully into clinical settings may reduce overall healthcare expenditures. This will further open path to personalised medicine and tailor treatments to individuals not only based on disease symptoms but also

across disease areas offer another revenue source. The future revenue source is expected to come from our commitment to developing value from rich clinical and genomics data to better understand the diseases, their progression and molecular underpinnings and helping pharma for novel target discovery and conducting effective clinical trials.” Pranav Anam, Founder, The Gene Box adds, “Digital Technologies are helping mainly in terms of automating our structure which helps in fast-tracking the process and reducing the chances of error in operations. Thus, saving time and losses due to human errors.” Though the cost benefits can not be directly interpret-

still in the initial stages. He adds that setting up a highthroughput genomics lab not only requires a significant capital investment but also deep technical know-how and trained professionals to optimise the lab workflows and run it efficiently. There is a need to have the domain knowledge to interpret the results of algorithms in a meaningful context. This requires highly qualified professionals with deep expertise in different disease areas to really translate the raw results into the clinical setting which is useful to patients and physicians. Ghosh elaborates, “Human genetics is evolving so rapidly both in terms of discovery and innovative technologies that costly machines can become obsolete in a very short time.”

AWorld Economic Forum’s report on emerging technologies of 2015 states that digital technologies in genomics such as Digital Genome, Artificial Intelligence and Genetic Engineering Techniques are a game-changer based on the genetic make-up. Santosh elaborates, “These technologies are central to the business because they allow us to generate and analyse the data in a reasonable time and cost, thereby directly benefiting patients by uncovering the underlying cause of the disease faster and accurately. Diagnostic tests based on these advancements offer one of the continuously increasing revenue sources for the company. Services and genomic solutions built using the data

ed, there is cost saving as due to preventive measures along with personalised medicines will decrease the overall expenditure of the patients.”

Challenges Digital technologies are undoubtedly advancing but quite a few hurdles are yet to be overcome. Santosh elaborates that awareness, adoption, affordability and overall reach of these technologies to make the field of medicine and healthcare a truly personalised one is

Anam throws light on the challenges faced due to the issue of quality control. A few challenges would be faced by the healthcare providers if digital technologies are fully incorporated in genomics. With digital technologies being adopted at a fast pace in many parts of the world, there may arise concerns in regards to human intervention. It is likely that machine learning and other digital technologies may displace some, if not all, health-

care providers. Dr Saleem highlights that just like the West would be taken over by automated cars replacing the drivers, the healthcare segment will eventually be transfigured. As the medical sector is lacking precision along with comprehensive analytics which machine learning has a knack for, it may soon be required to provide validation for human intervention.

The way forward On the contrary, Santosh expresses, “Human interventions play a very crucial role to validate the results using independent lines of evidences and translate the results of the algorithms in a context usable by patients and physicians. We strive to build computer systems that can help the domain scientists to pose the right questions, collect evidences from all the necessary databases, literature information – structured or unstructured, validate and visualise the results to eventually generate the report. Despite these advances, given the complex nature of the problem and potential impact on the outcome on patients, these systems are not advanced enough yet to eliminate the human intervention.” If not immediately, increasing government investments to boost research will eventually be advanced enough to take over the genomics sector supplementing human intervention with precision and machine learning. Thus, the healthcare providers along with the genomic players need to constantly upgrade themselves so as to stay in the game. mansha.gagneja@expressindia.com

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OPINION

Is India’s healthcare industry ready for a digital transformation?

ASHU KAJEKAR Founder and CEO, 7EDGE Internet

Ashu Kajekar, Founder and CEO, 7EDGE Internet, elaborates on the need for healthcare companies to integrate latest technologies into existing business models and IT architectures to deliver superior customer experiences

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he Indian healthcare industry has traditionally been a slow adopter of digital technology mainly due to the fragmented and complex nature of the industry. The healthcare environment is becoming more distributed and complex. As digital technology becomes more affordable and more accessible, a change in mindset becomes more and more essential. Digitisation of healthcare products and processes, will dramatically change the game for everyone. Healthcare providers, to thrive in this environment, must be willing to look to the future and embrace change. It is also essential that they fully understand those issues which will have the most transformational impact upon their sector. Healthcare companies need to integrate the latest technologies into existing business models and IT architectures to deliver superior customer experiences. Digital transformation requires you to rethink all your issue processes. It requires an appropriate use of data and digital technology by putting the needs of the customer at the centre of the business. The disruption will motivate insurance companies and healthcare providers to shift from a health system driven model to a customer-oriented model.

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Getting ready for the digital era In the last few years, the healthcare industry is being disrupted by digitisation in the quest to focus on enhanced customer experience—and CEOs and boards are taking notice. The benefits of the cloud, data and mobile technologies has brought about a fundamental mindset change in the healthcare industry as they now shift from a volume-based to a value-

based approach. Traditionally in India, doctors and healthcare providers act as the custodians of patient information and data. With the advent of Internet of Things (IoT), wearable technology, and smart devices, this too is changing. Patients are being given the opportunity to increasingly take charge of their health and decide when action is needed. As the Indian population begins to rely more upon

smartphones and mobile apps to provide individualised health information, they will gain the ability to track their own health metrics. Increased accessibility for patients to their own personal data will create a demand for greater transparency from healthcare providers. The healthcare industry will need better strategies to keep costs low, while also driving engagement and trans-

parency up, through carefully planned record management and the digitisation of paper processes. Digital capability can not only improve profitability by boosting productivity and efficiency, it will also support an overall better standard of care - one that is both compliant and secure, and which meets customer and patient expectations by being personal, responsive, and completely future proof.


OPINION Challenges in the transformation of processes and business models As healthcare companies in India look to transform themselves, they are discovering that digital technologies are to be managed not as utilities but as strategic assets. Some are attempting to bridge the gap between legacy and digital IT by undertaking complex systems transformations. Others are experimenting with ways to maintain its existing IT architecture while using analytics to securely mine the data it collects for useful business insights. A large drugmaker is exploring the use of cloud platforms to reduce data storage and processing costs and to boost the speed of its R&D efforts. Most healthcare companies are lagging behind in digital, as compared to companies in travel, retail, telecommunications, and other sectors. Their digital-transformation efforts can stall for many of the same reasons such efforts are thwarted in other sectors—for instance, a limited understanding of the specific ways that implementation of new technologies across complex product and services lines can create business value, a shortage of native digital talent, and insufficient focus on digital topics from senior leadership.

The framework for a successful industry-wide digital transformation Though this is a potentially exciting time for healthcare providers in India, it is also a challenging one. The ability to adopt new systems and processes is limited by a need to keep costs low and maintain a delicate balance between quality and affordability. There are four basic principles for achieving success with any digital transformation program. ◗ Identifying and prioritising the value propositions As a first step toward digital transformation, healthcare companies must determine the distinctive value propositions they provide to their consumers and stakeholders. A

With digital priorities identified, and service delivery models established, healthcare companies need to make a critical analysis of their current IT infrastructure. Legacy systems and on-premise infrastructure are the primary hurdles for digital transformation simple value proposition could be creating intelligent medical devices such as IoT-based medical devices, inhalers, and auto-injectors, that can monitor and manage specific conditions or assist in medical procedures. Another value proposition could be building a digital platform to collect and analyse historical medical data, conduct synthetic clinical trials, manage market access, and accelerate their research efforts. This will help companies get closer to customers to give them targeted products and services, and engage them in value-based relationships. By establishing a clear value proposition, healthcare companies will be in a better position to understand how the use of digital technologies could enable those activities. Also, they can determine how best to adjust investments in digital technologies and development approaches to meet

the highest priorities during the complicated transformation process. ◗ Establishing service-delivery capabilities Once the value proposition and the priorities have been set for digital transformation, healthcare companies will need to establish the delivery mechanisms and processes by which digital products and services can be delivered to the endconsumers. This will require a re-invention of workflows and processes through automation and personalisation through data-driven insights to complement the user needs. For instance, insights about the supply chain could help healthcare companies reduce general and administrative costs and improve customer service. Agile development, data sciences, and customer-experience design can be useful approaches for these companies to explore. Healthcare organisation can realise tangible

business benefits as a result of combining these approaches. Some device makers have already initiated the process of adding digital capabilities around their products to create better patient outcomes— allowing for predictive diagnostics, early disease detection and remote monitoring of patient care. Meanwhile, some pharma companies are using data analytics and artificial intelligence to discover drugs or identify new uses for established ones. ◗ Modernising infrastructure foundations With digital priorities identified, and service delivery models established, healthcare companies need to make a critical analysis of their current IT infrastructure. Legacy systems and on-premise infrastructure are the primary hurdles for digital transformation. Organisations need to opt for cloud-based infrastructure to support strategic priorities, promote speed and transparency in operations, and build service delivery capabilities at scale. For companies investing in smart medical devices, incorporating connectivity into their IT architectures is of paramount importance - for instance, collation of data from sensors and other monitoring technologies from medical devices in the field. Building a cloud-based information backbone will allow for a holistic management of services and help stakeholders access data sets with ease. Johnson & Johnson, for instance, runs a majority of its computing workload on a cloud-based platform. This has allowed them to manage capacity based on demand, ensure network reliability, and hold costs in check. ◗ Augmenting core capabilities Digital transformation is not just adopting and adapting to digital technologies, but a complete change in a number of core areas. It is not possible to drive a digital transformation strategy without establishing a cultural change. Companies must establish healthy work environments that are open to

new ideas and best practices. They need to invest in talented resources and upskilling of existing resources to take their digital strategy forward. They will also need to develop partnerships with other companies in the healthcare ecosystem and in other relevant industry clusters to reinforce their capabilities. Digital initiatives will requires a dedicated budget and formal governance structures where internal and external stakeholders weigh on investment decisions. Leadership teams need to communicate investment priorities clearly and ensure the alignment of investments to successful business outcomes.

Final word The digital transformation of the Indian healthcare industry is not just starting - it is already underway. However, it will need a considerable amount of strategising and planning to put a method to this madness. They will need to embrace open systems that allow for sophisticated analysis of multiple streams of data and the development of customer-centric services. They must be able to view processes as end-to-end flows rather than discrete handoffs, embrace more risk, move at higher speeds, and engage in innovative partnerships. The winners in Indian healthcare are moving quickly to initiate change and capitalising on the strategy cited earlier. They are investing early in promising technologies and risk-sharing relationships with other companies, inside and outside the industry. They are embracing new development and operating models, and relying more on data-driven insights to make critical business decisions. More importantly, they are re-imagining themselves as digital enterprises—adaptive, collaborative organisations that can keep pace with changes in the healthcare marketplace. This helps them undertake their transformation programmes successfully, creating better patient outcomes and more value for all stakeholders.

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POLICY WATCH

The Medical Devices Rules,2017 – Industry implications and action required Hitender Mehta, Partner and Abhijeet Das, Senior Associate, Vaish Associates Advocates, give an insight key steps that need to be undertaken by the entities engaged in import, manufacture, sale or distribution and clinical investigation of the medical devices

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he medical devices sector has largely enjoyed a free hand from the regulators in India, as the sphere has largely gone unregulated thus far. Presently, there is no medical devicesspecific legislation specifying inter alia standards of safety and quality for most of the medical devices. Only a handful of devices such as cardiac stents, disposable hypodermic needles/ syringes, catheters, etc. make the cut of being classified as a 'drug and thus being regulated under the Drugs and Cosmetics Act, 1940 (Act). Other medical devices presently have no legal provisions governing the aspects of manufacture, product standards, sale or distribution. This unwarranted but longstanding position is extremely short-lived, with the Medical Devices Rules, 2017 (MDR 2017) coming into effect on January 1, 2018. While the wheels of this regulatory framework were set in motion with its notification on January 31, 2017, the Government thought it is best to give the stakeholders ample time to prepare for the paradigm shift in the regime. That being said, the first National Accreditation Board (Board) has already been recognised under the MDR 2017 with effect from January 31, 2017 itself. The Board is going to start entertaining applications for registration as Notified Bodies from July 1, 2017, which, amongst other things, would be empow-

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ered to carry out audit of manufacturing sites of low as well as low moderate risk category medical devices from the next year. Taking the right first steps are often the most important bit of the journey. In view of the impending MDR Rules, below are some key steps that need to be undertaken by the entities engaged in import, manufacture, sale or distribution and clinical investigation of the medical devices: â—— Determining whether the products fall within the MDR 2017 categorisation The first and most important step, is to identify the substances that fall within the ambit of the term medical device

under the MDR 2017. In addition to the aforementioned devices specifically notified to fall under the definition of drugs under the Act, the following would come within the scope of the MDR 2017: (i) substances used for in vitro diagnosis and surgical dressings, surgical bandages, surgical staples, surgical sutures, ligatures, blood and blood component collection bag with or without anticoagulant used (internally or externally) for or in the diagnosis, treatment, mitigation or prevention of any disease or disorder in human beings or animals; and (ii) substances (other than food) intended to affect the structure or any function of the human body or intended to be used for

the destruction of vermin or insects which cause disease in human beings or animals including mechanical contraceptives (condoms, intrauterine devices, tubal rings), disinfectants and insecticides as notified from time to time: With regards the categorisation, the Drugs Controller General (India) (DCG(I)) has been put in charge in terms of the MDR 2017, for categorisation/ classification of medical devices based on its usage (in vitro diagnostic medical devices and otherwise) as well as risk associated with the medical devices. The risk categorisation falls in four classes i.e., Class A (low risk), Class B (low moderate risk), Class C (moderate high risk) and Class D

HITENDER MEHTA Partner Vaish Associates Advocates

ABHIJEET DAS Senior Associate, Vaish Associates Advocates

(high risk). Further, the criteria for assessing risk by DCG(I) has been verbosely specified in the MDR 2017, separately for in vitro medical devices and the other devices. The MDR 2017 does not set a date as to when the categorisation would be finalised/ published, but it may be assumed that the same has to be done well before the MDR 2017 comes into effect on January 1, 2018. In view thereof, it would be advisable for the stakeholders to gauge the possibility of its/ their devices/ substances falling within the MDR 2017, as well as the probable risk classification thereof. The objective of this exercise would be two pronged, firstly, to identify the possible ramifications i.e., compliances applicable on the medical devices post January 1, 2018; and secondly, in case the medical device is mis-categorised by the DCG(I), this exercise will allow the affected individuals/ entities take timely remedial action, may be even before the adverse impact actually commences. Interestingly, the MDR 2017 is silent on the aspect whether representation can be made by the applicants with respect to categorisation of medical devices. However, in the absence of any restriction/ prohibition, it would be worthwhile for the concerned individuals/ entities to make proper representations, in order to assist the DCG(I) make appropriate classification of medical devices.


POLICY WATCH

Further, although the MDR 2017 does not provide for an appeal mechanism to the categorisation of medical devices, given its express power to effect modifications thereto, in case of mis-categorisation of a device to a higher risk level (entailing greater compliances), representations against such decision should be made to the DCG(I) and failing which, judicial intervention may also be sought, to rectify the error. ◗ Identification of applicable product standards While most compliances under the MDR 2017 need to wait for the aforesaid categorisation of the medical devices, the applicable product standards can be assessed and identified now as well. This will allow the concerned persons/ entities to make necessary modifications in the respective medical devices, if required, before the MDR 2017 takes effect. The product standards applicable would be as laid down by the Bureau of Indian Standards or as may be notified by the Ministry of Health and Family Welfare for the relevant

medical device/s. In absence thereof, standards laid down by the International Organisation for Standardisation or the International Electro Technical Commission (IEC), or by any other pharmacopoeial standards would be applicable to the device. Further, in case no such standards are specified even, the device is required to conform to the validated manufacturer’s standards. ◗ Approximation of the applications/compliances required Although, the appropriate authority, application process, etc., would be largely dependent on the class of the medical device, it would be advisable that the process and requirements be identified based on the internal assessment of the class of the medical device for a seamless transition into the new regime under the MDR 2017. For instance, the requirements such as the quality management system, presence of qualified technical staff, would need to be ascertained and met before an application for manufacturing, sale or distribution.

Licenses/ registrations of medical devices under the Act subsisting as on January 1, 2017, would be valid under the MDR 2017 Further, in relation to an import license, existence of a free sale certificate in respect of any medical device by the national regulatory authority or other competent authority of any of the countries, namely – Australia, Canada, Japan, European Union Countries, or the US, would enable the licence to be granted without carrying out any clinical investigation. On the other hand, a license for import of higher risk category medical devices (viz., Class C and D) from other territories would entail a

clinical investigation in India under the MDR 2017. Similarly, criteria for applications for clinical investigation in investigational medical device in human participants as well as in vitro medical devices, should also be evaluated. It is pertinent to mention, that the licenses/ registrations of medical devices under the Act subsisting as on January 1, 2017, would be valid under the MDR 2017 for a duration being the later of (i) July 1, 2018, or (ii) the original period of such licenses/ registrations. Therefore, the medical devices entitled to this benefit should also be identified for such timeline for implementation of the MDR 2017. ◗ Labelling of medical devices and shelf-life The labelling requirements would need to be implemented as soon as the MDR 2017 takes effect from January 1, 2018. In view thereof, adequate preparations, as prescribed/ required, should be in place. Further, the MDR 2017 specifies that a shelf-life exceeding sixty months need prior approval of the DCG(I). Therefore, in case

of products where the shelf-life exceeds sixty months, the evidence in support of the extended shelf-life, e.g., approved shelf-life in other countries, stability data, etc., should be procured beforehand to be submitted along with the application for manufacture and/or import of the corresponding medical devices. Another point to be noted is that import of medical devices after the expiry of a specified percentage of its shelf-life, has also been prohibited under the MDR 2017. The foregoing represent some of the key considerations that are required to be kept in mind by the stakeholders visà-vis the imminent MDR 2017 to avoid any last minute helterskelter and ensure a smooth transition to the new regulatory regime. There are numerous other considerations that would need to be examined after the categorisation/ classification is put in place by the DCG(I). However, the aforesaid represents the basic initiative that the industry as a whole should take, which would act as the proverbial ‘stitch in time’.

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POLICY WATCH

National Health Policy for universal healthcare would be in place soon: JP Nadda The Union Health Minister gave an overview of the government’s measures to improve healthcare in the country at a recent press conference held in New Delhi Prathiba Raju New Delhi JP NADDA, Union Health Minister, Ministry of Health and Family Welfare (MoH&FW), elaborated on the National Health Policy and spoke on the various health initiatives taken under the NDA rule, in a candid and free-wheeling interview with women journalists held at Indian Women’s Press Corps (IWPC) in the national capital. Emphasising on the need for comprehensive healthcare, he also informed that the government intends to start universal free health screening for six diseases, including hypertension and cancer, initially in 100 districts of the country. “A new health policy ensuring universal and comprehensive healthcare would be in place shortly and adequate funds would be provided to the states for its implementation. The government would start universal free health screening for six diseases, including hypertension and cancer. This scheme will be initially launched in 100 districts of the country,” said Nadda. He also termed the Mental Health Policy and the Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) (Prevention and Control) Bill as very ‘progressive’ measures. Giving an update on the various health initiatives undertaken by the government, the Minister indicated that four more vaccines -- IPV, Measles Rubella, Rotavirus and JE Adults -- have also been added to Mission Indradhanush. The mission aims to cover all the children who are either unvaccinated, or are partially vaccinated against seven vaccine preventable diseases which include diphtheria, whooping cough,

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Nadda indicated that four more vaccines -- IPV, Measles Rubella, Rotavirus and JE Adults -- have been added to Mission Indradhanush. The mission aims to cover all the children who are either unvaccinated, or are partially vaccinated against seven vaccine preventable diseases which include diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and Hepatitis B tetanus, polio, tuberculosis, measles and Hepatitis B. Nadda also answered several questions posed by the journalists ranging from promotion of generic medicines and capping of stents to the state's role in healthcare and the decision to Public Health Foundation of India (PHFI) from receiving foreign funding. Speaking on essential medicines, the minister said, “Whatever changes are required to provide affordable and quality

medicines, those would be made.” He also spoke on measures to make healthcare affordable and said, “One of our cost effective programmes is giving away deworming tablets to the children.” Addressing apprehensions towards the recently launched Measles Rubella vaccine in a few sections of the society, he said, “The Ministry is trying to allay all such apprehensions. All our programmes are introduced after they go through a long process of

testing and committee reviews.” Talking about the decision to bar Public Health Foundation of India (PHFI) from receiving foreign funding, he said that the the ministry has sized up the matter and is taking steps accordingly. He said, “At this point of time, I would not be able to tell much about it. Ultimately, whatever is in public interest, will be done.” The Home Ministry has cancelled the FCRA registration of PHFI, thereby barring the NGO from

receiving foreign contribution. Nadda was also asked about the fate of other programmes run by the ministry and funded by foreign donors. In answer to it, he said that all the national programmes run by the government are ‘well-intentioned.’ On being questioned whether there were plans to amend the Medical Council of India (MCI) Act to make it mandatory for doctors to prescribe generic medicines, he said that his ministry was ‘on the job’ and will come out with some concrete measures soon. Elaborating on the issue, he further said the ministry will go ahead with the prime minister’s vision. The minister also informed that National Pharmaceutical Pricing Authority (NPPA) and Department of Pharmaceuticals (DoP) will not merge with the MoH&FW. The health minister also hinted that the government was considering capping prices of other medical devices, after the success with coronary stents, “Stents have been added to the National List of Essential Medicines and we are trying to put more medical devices in this list to ensure that medicines and medical devices remain affordable.” In February, NPPA had capped the price of bare-metal stents at `7,260 and drug-eluting stents at `29,600, after declaring coronary stents as essential medicines. Talking about Affordable Medicines and Reliable Implants for Treatment (AMRIT) outlets, he said that medicines whose cost was worth `179 crores were sold at a cost of `73 crores. He also informed that under the PM’s dialysis scheme, 11 lakh dialysis sessions have already taken place in nine months. prathiba.raju@expressindia.com


STRATEGY

Unattended toxic air : A genocide in making Increasing air pollutants are clogging India's skylines and it is turning out to be a silent killer, writes Prathiba Raju

T

he day is not far away when people will have to buy canned pure air and carry oxygen cylinders when they step out of their home, as inhaling fresh air is turning out to be a luxury in the ensuing years. With alarming levels of air pollutants, cocktail of toxic air emitted out is transpiring to be a rising health hazard for India. As per World Health Organisation (WHO) 1.4 million people in India die pre-maturely due to air pollution, which is one life lost every 23 seconds. GlobalData, a data and insights solution providers, shared WHO's ‘Ambient Air Pollution: A Global Assessment of Exposure and Burden of Disease’ report 2016, revealing that air pollution had caused a total of 0.6 million deaths in India in 2012. Acute lower respiratory infections (ALRI), Chronic obstructive pulmonary disease (COPD), ischaemic heart disease (IHD), lung cancer and stroke were key responsible diseases that caused these deaths. Furthermore, due to air pollution associated diseases, India has also

lost approximately 20 million disability-adjusted life years (DALYs) and approximately 12 million years of life lost (YLLs). WHO's satellite data and ground monitoring data indicates that the Ingo-Gangetic plain in particular is highly exposed to air pollution. A report published in The Lancet on the first annual assessment of Sustainable Development Goals (SDG) health performance, launched at a special event at the UN General Assembly in New York, ranked India at 143rd, which was below Comoros and Ghana. India was placed just ahead of Pakistan and Bangladesh that were ranked 149th and 151st respectively. India’s poor performance on air pollution was one of the factors that placed it lower than countries like Bhutan, Botswana, Syria and Sri Lanka. Several studies have shown that large parts of India fail to meet the safety levels of exposure, indicated Global Data, and it informed that a survey conducted by the US-based institutes Health Effects Institute (HEI), University of Wash-

ington and the University of British Columbia, observed that India’s worsening air pollution caused approximately 1.1 million premature deaths in 2015. The developed nations such as the US, Australia and Spain are considered the least polluted countries of the world. On the other hand, India, China, the Middle East and North African countries are the most polluted nations in the world. Stating that a large number of Indians are breathing unsafe air, Dr T Raja, DM (oncology), Apollo Hospitals, Chennai said, “More than one million Indians are killed every year by indoor pollution inhaled from dung-fuelled fires, stoves and lights. Low standards for vehicle pol-

India’s air pollution caused around 1.1 million premature deaths in 2015

lution and fuels are the reason for this situation. The serious impact of this is reflected in the rising asthma rates in the population, including children. PM2.5 is causing cancer, triggering heart attacks and stroke. Air pollution produces ‘oxidative stress’, which damages the cells caused by excessive oxidation in the body. This, in turn, lead to the development of cancerous lung cells. Research also prove that exposure to polluted air can cause serious damage to the respiratory tract in multiple ways.” A worldwide analysis conducted by the WHO in 1622 cities for PM2.5 reported that 13 of the 20 most polluted cities in the world, are in India, which showcases that a large number of Indians are breathing unsafe air. This is true in cities, but the rural areas are neither spared.

Air pollution – a ticking time bomb India is sitting on a ticking time bomb called air pollution and if we delay, we are bound to reach a point of no-return. Air pollution poses a far more

extensive health hazard, and triggers a rising number of asthma cases, especially in children and the elderly. Longtime exposure to polluted air is now being recognised as a leading cause of lung cancer, in addition to causing heart attacks and strokes. There are short and long-term effects of air pollution. Short-term effects may be temporary and include pneumonia, bronchitis, irritation to the nose, throat, eyes, or skin, headache, dizziness and nausea. If the air quality is not fixed, we will face long-term effects. Long-time exposure to polluted air is recognised as a leading cause of lung cancer, in addition to causing heart attacks, strokes and respiratory diseases such as emphysema. It can also cause damage to people's nerves, brain, kidneys, liver, and other organs. Air pollutants are also suspected to be linked to birth defects. According to the The United Nations Children's Fund (UNICEF), every year, approximately two billion children in the world are breathing polluted air. It is notewor-

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STRATEGY thy that most of these children live in North India and neighbouring countries. Similarly, the total mortality of children (age five years or below) due to air pollution is around 0.6 million across the globe . The same report denotes that approximately 300 million kids are getting exposed to a pollution level which is almost six times higher than the international standards set by the WHO. Out of that, approximately 220 million kids are living in South Asia. As per Breathe Blue survey conducted by Heal Foundation, approximately 21 per cent of school-going children in Delhi have poor lung health (based on the Lung Health Screening Test [LHST]), 14 per cent in Ben-

galuru, 13 per cent in Mumbai and nine per cent in Kolkata. “Children are particularly vulnerable to air pollution exposure as evident in the GBD 2015 assessments, which revealed that there are over 100,000 deaths annually in attributable to air pollution in children under 14 years of age. Much of this is under the age of five, and through acute respiratory illnesses in children exposed to high levels of household air pollution due to cooking and heating using biomass fuels. Initiatives such as the Pradhan Mantri Ujjwala Yojana is aiming to provide Liquefied Petroleum Gas (LPG) in rural areas are a welcome step to reduce particulate pollutants exposure in rural house-

MOH&FW HAS GIVEN CLEAR DIRECTION TO THE STATE GOVERNMENTS TO IDENTIFY DISTRICTS WHICH HAVE HIGH LEVELS OF POLLUTION. PER STATE EACH DISTRICT WOULD BE IDENTIFIED, AND ON A PILOT BASIS FIRST 100 DISTRICTS WILL GET POTABLE SPIROMETER THAT CAN MEASURE LUNG CAPACITY. MOHFW HAS CONSTITUTED AN EXPERT COMMITTEE WHICH PREPARED TECHNICAL GUIDELINES AND TRAINING MODULES FOR MEDICAL OFFICERS IN EACH DISTRICTS.AROU5 LAKHS HAS BEEN ALLOTTED PER DISTRICT

CHINA INSTITUTED A BROAD, REGIONALLYCOORDINATED SYSTEM OF AIR POLLUTION MONITORING. THEY INSTALLED POLLUTIONABATEMENT EQUIPMENT ON A MAJORITY OF ITS POWER PLANTS AS WELL AS DEVISED MEANS TO RESTRICT CAR OWNERSHIP IN MAJOR CITIES. IT HAS DEVELOPED A NETWORK OF 1,500 AIR QUALITYMONITORING STATIONS IN OVER 900 CITIES WHEREAS INDIA HAS ONLY 39 STATIONS COVERING 23 CITIES

DAMODAR BACHANI, Deputy Commissioner (NCD), MoH&FW:

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DR SANDEEP NAYAR, Sr Consultant and HOD, Respiratory medicines, BLK Super Speciality Hospital

holds,” said Prof D Prabhakaran, Vice President Research and Policy, Public Health Foundation of India (PHFI). Appreciating the efforts made by Ministry of Petroleum and Natural Gas (MPNG), under the Pradhan Mantri Ujjwala Yojana scheme, Damodar Bachani, Deputy Commissioner (NCD), MoH&FW said, “The scheme aims to replace the unclean cooking fuels mostly used in the rural India with the clean and more efficient LPG. Adding to it, we in Ministry of Health and Family Welfare suggested that they should have a programme called 'Ujjwala Mamta' scheme. By this, on priority we can give LPG connection for the expectant mothers. Expectant mothers breathing polluted air results in premature birth and is one of the main reason for low birth weight. When a baby is born preterm (less than 37 weeks of gestation), there is an increased risk of death or longterm physical and neurological

MORE THAN ONE MILLION INDIANS ARE KILLED EVERYYEAR BY INDOOR POLLUTION INHALED FROM DUNG-FUELLED FIRES, STOVES AND LIGHTS. LOW STANDARDS FOR VEHICLE POLLUTION AND FUELS ARE THE REASON FOR THIS SITUATION.THE SERIOUS IMPACT OF THIS IS REFLECTED IN THE RISING ASTHMA RATES IN THE POPULATION INCLUDING CHILDREN DR T RAJA, DM (Oncology), Apollo Hospitals, Chennai

disabilities. A study published in the journal Environmental International by a team from the Stockholm Environment Institute at the University of York, in 2010 stated that the largest contribution to global PM2.5associated preterm births was from South Asia and East Asia, which together contributed about 75 per cent of the global total. India alone accounted for about one million of the total 2.7 million global estimate and China for another 500,000. Experts indicated that India’s air quality is affected by several factors, so it is important to take into account control strategies from several places. The roadmap is already there in terms of stronger emissions standards for power plants and industrial emissions, stronger vehicular emissions standards, enforcement of bans on waste burning, enforcement of regulations on construction waste management, etc. It is a question of implementing them effectively and with time-bound deliver-

THE RECOMMENDATIONS OFTHE COMMITTEE ARE BEING TAKEN ON BOARD,AND IT IS LEADING TO REAL POLICY CHANGE.THE MINISTRY IS ALSO KEEN TO ENGAGE OTHER SECTORS IN THE SPIRIT OF INTER-SECTORAL POLICY MAKING TO ENSURE THATTHIS KEY RISK FACTOR FOR ILL HEALTH IS ADDRESSED PROF D PRABHAKARAN, VP, Research and Policy, PHFI

ables which is where we have been lagging.

Tackling pollution challenges The Ministry of Health and Family Welfare (MoH&FW) is taking rapid strides to address the substantial national health burden attributable to ambient air pollution. The first step was the constitution of expert committee followed by a health centered declaration for air pollution and making a cross-ministerial effort to curb air pollution and detecting 100 districts. Informing that the MoH&FW is in the forefront oftackling air pollution, Bachani, said, “Sources of air pollution are different, so we need evidence and detailed analysis. With the help of WHO, we came out with a draft, which was circulated to varied ministries. After looking into it, the Ministry of Environment and Forest (MoEF) had a meeting, in which it was decided that Indian Council of Medical Research (ICMR) will do a continuous surveillance and collection of data on environmental indicators and also its effects on health. ICMR is continuously monitoring air pollution index in major cities on one side and disease occurrence on the other side. By this effort, we have evidence to show that whenever there is an increase in pollution cases of asthma, bronchitis go up.” “We are trying to constitute a standing committee, where MoH&FW and MoEF secretaries will chair, which and will have various other ministries like Ministry of Petroleum & Natural Gas (MPNG), Ministry of New and Renewable Energy (MNRE) and industry representatives. The co-chairs of already existing steering committee, IIT Delhi and Public Health Foundation of India (PHFI) will go through the draft submitted. The standing committee is yet to be functional,” Bachani said. Informing that there is no one prescription for this issue, he informed that it is a combined effort and smart city projects need to instil action points like a city can be identified clean or smart only when


STRATEGY its air quality as per the parameters of the air quality index. Bachani further said, “MoH&FW has given clear direction to the state governments to identify districts which have high levels of pollution. Per state each district would be identified, and on a pilot basis first 100 districts will receive potable spirometer that can measure lung capacity. These can be taken to community health centres (CHCs) where screening for COPD will be done along with other NCDs like diabetes, hypertension, common cancers. MoH&FW constituted an expert committee which prepared technical guidelines and training modules for medical officers in each districts. Around Rs 25 lakhs has been allotted per district.Once hundred districts are identified, medical officers and frontline staff will be trained. It will expand gradually to other districts.” Stating that constituting a steering committee to document the health impacts in India and chart a health-centric framework to reduce exposure is a welcome step, Prof D Prabhakaran, VP, Research and Policy, PHFI, said, “The recommendations of the committee are being taken on board, and it is leading to real policy change. The ministry is also keen to engage other sectors in the spirit of inter-sectoral policy making to ensure that this key risk factor for ill health is addressed.” Lot of cities around the globe have realised the ill-effects of air pollution and have taken measures to reduce it. Particularly China and it's capital city Beijing, which suffered from serious air pollution now no longer features in the WHO’s list of 20 most polluted cities.

Awareness is the key Experts cite that in India debates over air pollution and health impacts increase only when smog covers Delhi and neighbouring cities. But the level of awareness and the impact of air pollution on health is very low, they say. Listing out lessons to be learned from China, Prabhakaran, said, “The strong shift in focus towards renewable en-

ergy is certainly something that can be learned from the Chinese experience. In a decade, they have gone from the backwaters to the largest producers of Solar PV in the world and are installing more wind capacity in a month than most countries do in a year. This is being backed with large investments in grid capacity to take up the electricity produced. We in India have tremendous potential to produce electricity from renewables but are stymied by a lack of investment in grid capacity.” Adding to it, Dr Sandeep Nayar, Sr Consultant and HOD, Respiratory medicines, BLK Super Speciality Hospital, said, “Beijing closed hundreds of industries that lead to high emission of pollutants and switched some of them to alternate mode of energy. These are welcoming steps to curb the pollution levels. China instituted a broad, regionally-coordinated system of air pollution monitoring. They installed pollution-abatement equipment on a majority of its power plants as well as devised means to restrict car ownership in major cities. It has developed

NUMBER OF DALYS AND DEATHS BY DISEASE DUE TO AIR POLLUTION IN 2012 Disease

ALRI

COPD

Lung cancer

IHD

Stroke

Total

Number of deaths 39914

110500

26334

249388

195001

621138

DALYs

3663274

3282841

813674

7455375

5290851

20506014

YLLs

1767111

1492940

606825

5106390

2815829

11789093

Source : WHO – 2016

COMPARING AIR POLLUTION FACTS BETWEEN WORLD'S FOUR MAJOR ECONOMIES Parameters Change in satellite-based PM2.5 levels (2010 to 2015) PM2.5 trend PM2.5 air quality standard, annual (μg/m3) PM2.5 in capital city, annual (μg/m3) Deaths per day from air pollution in 2013 Source : Greenpeace 2017

China

India

U.S.

EU

-17.00 per cent

13.00 per cent

-15.00 per cent

-20.00 per cent

Falling since 2011; (2015 best year)

Increasing steadily for past 10 years

Declining

Declining

35

40

15

25 (from 2020, 20)

81

128

12

18

2700

1800

250

640

a network of 1,500 air qualitymonitoring stations in over 900 cities whereas India has only 39 stations covering 23 cities. To curb industrial pollution, China has installed basic pollution abatement equipment on 95 per cent of thermal plants whereas in India only 10 per cent of thermal plants have these equipment.”

Experts also warn that it is essential for India to work towards addressing the air quality problems nationally. They claim if we are not working towards it, the country will only nurture an unproductive workforce that cannot contribute effectively to its developmental goals. “Tackling air pollution re-

quires an integrative exposure management–driven approach and concerted effort from each individual not just the government. Breathing cleaner air is a birth right, and we cannot leave masks, oxygen cylinders for generations to come,” concludes Bachani. prathiba.raju@expressindia.com

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

‘The primary challenge is to improve the usability of big data by healthcare sector’ Vivek Kanade, Exceutive Director, Siemens Healthineers, explains how his company is leveraging technologies to add value to their exisiting business, in an intercation with Raelene Kambli How has digital technologies helped you provide valuebased healthcare services? The concept of ‘value-based healthcare’ compares successful treatment for an individual patient with spending on such treatment. Through our digital technologies, we are able to contribute to value-based healthcare by enabling fast, simple and seamless interaction between providers of data and knowledge. Which are the digital technologies that you are currently utilising at Siemens Healthineers? ◗ The teamplay cloud-based network enables networking of experts and more efficient use of imaging modalities ◗PEPconnect for individual learning experience with over 7,000 learning activities, in up to seven languages ◗Sense is an ehealth solution that offers a secure way to exchange patient data among physicians, institutions, and patients ◗The LifeNet customer portal can efficiently organise services, resulting in optimum capacity utilisation ◗Digital Ecosystem, which is a recently announced digital platform for healthcare providers as well as for providers of solutions and services How do you leverage cloud computing among your clients? What are its output? With teamplay, Siemens Healthineers offers a cloudbased network for physicians, medical professionals, and decision-makers in healthcare. It allows simple evaluation of capac-

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ity utilisation for imaging equipment, various workflows and individual tests and examinations. With just one click, it is also possible to compare anonymised data with values for similar healthcare providers. It is the ultimate tool of collaboration and helps us to do better quality scanning and to do it more efficiently. The network also allows dose monitoring for medical equipment using the 'Dose' function, because it is vital for patient-oriented treatment to use as much radiation as necessary while also using as little as possible. With the 'Usage' function, users get an immediately available and intuitively understandable overview of usage and performance data, such as patient throughputs. What is the difference between big data and Smart data? Big data — large quantities of data — results from efforts to store more digital data. It includes information on tests and examinations, patient data, system data on imaging modalities, or data on clinical workflows. It has to be converted into smart data made available with much deeper insights than previously possible into the key components that create both clinical and operational value. The primary challenge is to improve the usability of big data by the healthcare sector. It is the goal of Siemens Healthineers to provide comprehensive support to its customers as an enabler in this area. As the product portfolio of Siemens Healthineers continues to develop, Siemens offers individually adaptable solution models such as Teamplay, LifeNet, Dig-

and evaluation of the digital data compiled as part of day-today clinical practice. Teamplay collaboration enables hospitals to optimise their efficiency seeing and learning from what other practices and facilities do. Teamplay gives hospitals the ability to standardise their workflow and protocols through out the entire enterprise.

The goal is to support physicians to define the best possible treatment approach for their patients ital Ecosystem and Sense. The focus is primarily on IT and software solutions aimed at optimising image-supported service provision and medical fleet management. How does Smart data field help your clients in optimum utilisation of capacities? Industrial logic can be applied to the healthcare sector and may be used to standardise workflows or in quality management. One important basis for being able to fully tap one’s own potential as a healthcare provider is communication and cooperation across multiple sectors as a result of secure networking of all service providers

Tell us about Siemens Remote Services. Siemens Remote Service (SRS) is an efficient and comprehensive infrastructure for the complete spectrum of remote support for our medical equipment. Through SRS, many services, updates and even immediate repairs that were previously required onsite visits are now performed remotely. Up to 50 per cent of all deviations can be detected via remote connection before interference with your workflow. With SRS, our customers can take the advantage of earlier failure detection, faster repair times and planned spare parts replacement. How would you envisage the future of digital radiology? We are moving from a volumeoriented healthcare to a more value oriented one. In order to offer more personalised decisions and treatment strategies also, more and more data from different exams per patient will be collected. In addition, the business want to go beyond evidence-based medicine to use big population data to get more precise individualised diagnosis for better personalised therapy decisions. Artificial intelligence for example will be necessary to support that.

SiemensHealthineers will develope artificial intelligence software systems to facilitate diagnosis and therapy decisions with the help of advanced data integration, comprehensive databases, and automatic recognition of patterns and regularities in data (deep machine learning). The goal is to support physicians to define the best possible treatment approach for their patients fast and ensure that they receive the maximum benefit with minimum side effects. Until now image data, findings, lab values, digital patient records, and surgery reports are handled separately. However, there is a current trend aimed at gathering this information in one unified software framework. This data integration enables faster handling of medical information and lays the foundation for more efficient interaction between different specialties. What is Siemens Healthineers vision for digital healthcare? Siemens Healthineers' strategic goal is to help healthcare providers worldwide to meet their current challenges and to excel in their respective environments using products and solutions that increase efficiency and reduce costs. Digitalisation in healthcare is expected to drive the much-needed change towards widespread value-based care and reduced costs. Siemens Healthineers aims to support its customers to meet the challenges of the transformation to value-based healthcare. raelene.kambli@expressindia.com


IT@HEALTH I N S I G H T

Blockchain: Overhauling the ‘crippled’record management system in healthcare Ritesh Gandotra, Director, Global Document Outsourcing, Xerox India, elaborates on how adopting blockchain structure to EHRs will help manage authentication, confidentiality, accountability and data sharing while allowing medical researchers to access insights into medical treatment FOR LONGEST time, the healthcare sector has witnessed constrained development of fundamental design changes for Electronic Health Records (EHRs). Stepping into 2017, we’re faced with the critical need for innovation that not only personalises but also prompts patients to engage in the process of managing their medical data. The current need of the industry is a solution that is not only innovative but also decentralised — a record management system that handles EHRs using blockchain technology. Historically, EHRs were never really designed to manage multi-institutional and lifetime medical records; in fact, patients tend to leave media data scattered across various medical institutes – as he/she moves from specialist to another or when visiting beyond your boundaries of your city. This transition of data often leads to the loss of past data. The problem is further aggravated as record maintenance can prove quite challenging to initiate as patients are rarely encouraged and rarely enabled to review their full records. This leads to patients interacting with records that are fractured manner, reflecting how the records were managed. If health records of patients are managed by a service provider, the interoperability challenges between different providers and hospital systems pose additional barriers to effec-

tive data sharing. This lack of a well-coordinated data management system results in the fragmentation of health records. According to a 2017 Xerox eHealth Survey, 69 per cent of healthcare providers and payers are uncomfortable with the risks of value-based care, and 77 per cent agree that some providers are losing money by adopting the approach. Xerox addresses this concern by analysing a provider’s underperforming value-based contracts and identifying opportunities to improve specific financial and clinical contractual outcomes What is essential in today’s data-driven economy is how patients can benefit from a

records management system that provides a holistic and transparent picture of their medical history. This proves critical in establishing trust, as patients that doubt the confidentiality of their records may abstain from full, honest disclosures or even avoid treatment. In the age of online banking and social media, patients are increasingly willing, able and eager to manage their data on the go. Today, cloud computing among with the Internet of Things (IoT) concept is a new trend for efficient managing and processing of data online. Data management platforms based on cloud computing for management of mobile and wearable

healthcare sensors, are demonstrating ways IoT is enabling healthcare. According to the Protenus Breach Barometer report, there were a total of 450 health data breaches in 2016, affecting over 27 million patients. About 43 per cent of these breaches were insider-caused and 27 per cent due to hacking and ransomware. With the current growth of connected health devices, it will be very challenging for existing health IT infrastructure and architecture to support the evolving IoMT (Internet of Medical Things) ecosystems. By 2020, an estimated 20-30 billion healthcare IoT connected devices will be used globally. Blockchain-enabled solutions have the potential to bridge the gaps of device data interoperability while ensuring security, privacy and reliability around IoMT use cases. In essence, deploying a blockchain structure to EHRs makes lot of total sense. Building on a distributed ledger protocol originally associated with Bitcoin, a blockchain uses public key cryptography to create an append-only, immutable, timestamped chain of content. Copies of the blockchain are distributed on each participating node in the network. The Proof of Work algorithm used to secure the content from tampering depends on a ‘trustless’ model, where individual nodes must compete to solve computationally-intensive ‘puzzles’ (hashing exercises) before the next block of content can be appended to the chain. These worker nodes are known as ‘miners,’ and the work required of miners to append blocks ensures that it is difficult to rewrite history on the blockchain. This clearly indicates why

RITESH GANDOTRA Director, Global Document Outsourcing, Xerox India

healthcare authorities, governments and the provider community globally are intrigued by the new possibilities presented by blockchain implementation. But at the same time it is critical for the industry to foster ecosystem partnerships and create standards or frameworks for future implementation at a macro level. For the healthcare industry, a ‘block’ content represents data ownership and access permissions shared by members of a private or peer-to-peer network. By establishing a secure blockchain, medical records with viewing permissions and data retrieval instructions can be defined for execution on external databases. This can also allow a cryptographic hash of the record to ensure against tampering, thus guaranteeing data integrity. The integrity and security of any and all blockchain transactions can carry cryptographically signed instructions - enforcing data alternation only by legitimate transactions. Such policies can be designed to implement any set of rules which govern a particular medical record, as long as it can be represented computationally. Additionally, a blockchain ledger will help keep an auditable history of medical interactions between patients and service providers/hospitals, likely relevant for regulators and payers (e.g. insurance) in the future. In other words, adopting blockchain structure to EHRs will help manage authentication, confidentiality, accountability and data sharing while allowing medical researchers to access insights into medical treatment - potentially revolutionising how data is gathered and accessed for research purposes.

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START-UP CORNER I N T E R V I E W

‘3D printing technology plays an important role at every stage in healthcare’ The reliability and efficiency of 3D printing technology in clinical practice has been questioned several times by Indian practitioners. Tanmay Shah, Head of Innovations, Imaginarium Life, clears the air and talks about its potential, in an interaction with Raelene Kambli Tell us about the potential impact of 3D printing technology in clinical practice? 3D Printing finds a number of applications in medicine; to produce patient-specific anatomical models, surgical guides, jigs and fixtures, customised implants and device testing prototypes. To provide patient specific anatomical models, we at Imaginarium Life use DICOM data (MRI’s and CT scans) and convert them into exact replicas of a patient’s anatomy. This can then be utilised by doctors for diagnosis and preoperative surgeries. It not only helps a doctor be better prepared, but also helps in avoiding any surprises during the surgery. Another application extends to surgical guides and customised implants. We work with a variety of biocompatible material that can temporarily,

or even permanently, come in contact with internal organs without any hazardous repercussions. A surgical guide is akin to a stencil for a surgery, where it aids the surgeon in making a cut or drilling the bone at very specific angles in a predetermined fashion, so as to make the most precise insertions. A patient-specific implant is exactly what the name suggests — an implant that does not follow the small, medium and large sizes but is customised to fit the shape and size of a patient’s anatomy. As of now, this can only be done for hard tissue i.e. the bones. The coolest application of 3D printing in the medical segment is definitely orthotics and prosthetics. Because 3D printing helps in mass customisation, we can use it for application such as the hand cast, where instead of an

itchy plaster, we can make a airy plaster which also looks fantastic. Where does India stand in this context? India is witnessing a gradual adoption of this technology when it comes to healthcare. Imaginarium Life has engaged with a number of doctors and medical institutions in this respect, and the response is mixed. We’ve carried out a number of successful projects for real time cases in medicine, and it’s the younger generation of doctors who we find to be more open and accepting this technology for its numerous benefits. With respect to the long-drawn myths associated for this technology, some doctors tend to follow the age old view of 'if it ain't broke, don't fix it.' And this leads to only a fraction of them trying their Continued on Page 36

It’s unfortunate that a lot of these regulations restrict 3D printing in exploring and fulfilling it’s enormous potential

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START-UP CORNER I N T E R V I E W

‘We are a healthcare tech platform where you can save medical expenses and get benefits in return’ Tejbir Singh, CEO and Cofounder, Affordplan, a fintech start-up in the healthcare domain, shares the company’s vision of making healthcare accessible and affordable through planned savings for nonemergency medical services, in an interaction with Prathiba Raju Working for a start up like TaxiForSure, how and what made you venture in healthcare fin-tech start-up? TaxiForSure was one of the more controlled entrepreneurial stints which I had. Working in this start up helped me to see and learn the complete business cycle of a start up end to end. Post TaxiForSure, I was looking to venture in a very large market and reach out to the masses. Healthcare is one such sector which spends more than 30 times the size of the cap market. It is one of the sectors which has not embraced technology innovation the way the consumer section had. My partner Hemal Bhatt and I found that a lot of fin-tech interest and start-ups existed but not many in the healthcare

Affordplan empowers hospitals to improve access and affordability to medical services for its patients. Patients who opt for Affordplan don’t have to worry about upfront lump sum payments. They will be able to afford the much needed treatment as the solution is customised for the patient sector or medical lending. Though there are loans for the housing sector, consumer durables , a dedicated medical loan was missing. We found that it's a large market and were

sure that we can definitely make an impact on the financial side of the healthcare vertical. For example, medical loans are growing robustly in the west. The US has $30 billion

category in medical lending. India having a sizeable population of lower and middle income group, have less spend on the medical front. Health insurance penetration is low in

the country as the commercial health insurance covers up to five to six per cent and if you add the government insurance, it goes up to 15 to 16 per cent. These factors made us venture to healthcare and fin- tech company. How does Affordplan work and how different it is from the usual healthcare insurance space? What is your revenue model? When you look at the middle and lower middle income group, with a salary bracket of ` 2.5 lakh to 8.5 lakh of household income, there are about 300 million people in our country, who tussle with the out-ofpocket healthcare expenses. Continued on Page 36

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START-UP CORNER Continued from Page 34

3D printing technology hand at these new techniques. Most laws from the FDA and from the standpoint of the government are made for a highvolume-low-variety approach. Whereas where we come from, it’s a world of medium to low volume and very high variety. In which surgical areas 3D printing technology is currently applied in India? There’s nothing more customised in the world than the human body and 3D Printing allows customisation to a hitherto impossible level of detail. From study, diagnosis and planning to patient specific anatomical models, surgical guides, patient-specific implants and 3D printed customised prosthetics, this technology plays an important role at every stage in healthcare. The benefits are numerous: ◗ Detailed pathology ◗ Analysis of different surgical approaches ◗ Reduction In OR Time ◗ Optimised device design and development by testing and validation ◗ Enhanced clinical education ◗ Effective communication tool What are the future applications that we can

CASE STUDY I

CASE STUDY II

Challenge: Congenital Heart Disease (CHD) is a birth defect that brings with it a further complication of Ventricular Septum Defect, where an abnormal opening in the ventricular septum allows purified and impure blood to mix. 2D DICOM images cannot convey the complexity of these cases where an exact picture of the location and size of the opening is needed to decide on the correct course of action. The doctors asked Imaginarium Life to create a model that could be dissected to show the family the exact nature of the problem and decide for them on how the surgery needed to proceed. Our solution: Imaginarium Life created a digital model along with the virtual patch generation that helped in accurate analysis of the defect. The model outlined the exact shape, size and location of the defect and the 3D geometry made studying the turbulence/linearity of blood flow with ease.This helped visualise the various outcomes of different surgical approaches and helped the family make an informed decision.

Challenge: A patient suffering from advanced renal cancer needed to undergo a complex and delicate surgical procedure.This required the removal of a tumour that was present in the upper cortex of the kidney and even a slight miscalculation could lead to complete renal failure. This could only be done with the help of an exact model of the kidney that segmented crucial veins and arteries.The doctors approached Imaginarium Life to collaborate with them to create the model. Our solution: On receiving the DICOM data, a digital model of the kidney was made. Major veins and arteries were identified and segmented along with the location and size of the tumour. Once the CAD file was locked, it was sent for printing.The printed part was finished and in no time the doctors had a tangible 3D kidney to help plan their surgery.

expect? Apart from a more penetrative adoption of the current solutions that 3D printing has to offer to healthcare, there is also a huge potential in the field of bioprinting. This technology allows us to print in real, living tissue. Infact, experts have reportedly been successful in printing a fully functional organ! If things go as planned, the time is, not far when every hospital starts housing 3D printers, capable of printing everything from implants to prosthetics to real organs for transplant, all of it on-demand. It is said that 3D printing technology has the potential

to save a a lot of cost to healthcare providers and patients. But there isn't much data to proved that. What do you have to say? 3D printing as a process takes digital files and converts it into a physical part. Because of the process that the 3D printers follow, complexity comes without a premium. It enables mass customisation i.e. the ability to mould each and every single product according to the requirements of individual patients. This is easier than it sounds, because with 3D printing, all that needs to be done is tweaking the digital files and making it adhere to every use case. As a result, customised implants

and prosthetics that would otherwise cost a fortune, can easily be 3D printed at a fraction of the cost. There are also questions raised on the quality and durability of 3D technology printed devices. Our medical projects wouldn’t have been such great success if 3D printing was still grappling with something as basic as unreliable material. The technology has been in existence for more than three decades now, and has seen considerable advancements in terms of printing technology and printable materials. The materials used for printing surgical guides are all biocompatible, and can stay in contact with the human body for prolonged durations without causing any complications whatsoever. For implants, we use titanium, the FDA approved standard for such procedures. With the added precaution of sterilising every single piece of equipment before it enters the operation theatre, 3D printed printed devices are just as reliable, if not more than the conventional ones. raelene.kambli@expressindia.com

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‘We are a healthcare tech... For example, if a person earns ` 50,000 a month and has to undergo a cataract surgery, which costs him one month salary, he either postpones the surgery, takes money for high loans or go to a substandard place. Affordplan provides a tailored solution where they can plan, save and pay for their upcoming medical procedures. The savings-led solution caters to the non-emergency procedures which can be planned for in advance such as pregnancy, eye care, dental, plastic surgeries,

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orthopaedic, bariatric and more. Affordplan kiosks, desk or office is set up inside the partnered hospitals with financial counsellors. The patient who walks into a hospital for a elective procedure, meets the financial counsellor and he/she gets to know about the adaptive financial plans that help them to save and pay their treatment expenses in advance through flexible and convenient payment options. We have

consumers to decide on how much to save on a daily, weekly, bi-weekly, or monthly basis according to their chosen plan and then make regular payments at their convenience. We prepare a customised plan for each individual seeing the financial and health situation,and they are given a web app. Payments can be done online, by depositing money at the hospital during their visits, or collected directly from their home. Apart from this, consumers also receive

discounts on medical bills and diagnostic services, which can bring the overall treatment costs down by as much as 15-20 per cent. For example if a person saves money for caesarean procedure and end up going in for normal delivery then the difference of amount is settled. Hence, the whole process is the exact reverse of a medical loan where you get the procedure done and then keep paying the EMI. In this case, you are paying EMIs saving up for the

procedure and then get the procedure done. As far as our RoI is concerned, it is from the hospitals we are tied up with where we get the transaction fee for the technology and the collecting services. Which are the target hospitals and how many hospitals you are partnered with? In the first phase of the business, we targetted small and mid-sized hospitals, which has 15 to 75 beds. We have tied up


START-UP CORNER with over a 120 hospitals in Delhi and the NCR alone. We are trying to expand in tier-I and tier-II cities. Discussions are on with corporate hospitals as well. Few of the big names we are associated with are Batra hospitals, Strand Life sciences, Eye care in Noida and Sharp Sight centre. Apart from hospitals, we also partner with 100 pharmacies who are retailers and standalone entities. We are a healthcare technology platform where you can save for your medical expenses and get benefits in return. Patients can come for diverse needs like maternity, cataract, chemotherapy, bariatric procedure, dental implant and IVF. The elective procedures is where the savings-led products is more applicable and we don't constrain the hospitals with limited verticals. There are a number of products in the pipeline, be it open ended or

pre-payment, high risk insurance and medical lending products. How innovative and different is Affordplan from other health insurance schemes? Most of the health insurance schemes today do not cover many major elective ailments like IVF, dental, wellness, bariatric etc. Maternity, eye care and ortho are covered with a lot of procedures attached to it. Many times, despite having insurance, things need to be planned well in advance to get the expenses. Affordplan itself is an innovative model in the healthcare finance segment. For this, we had to develop an intelligence on various areas like the ailment, patients and hospitals. We have three-pronged approach where we collect the information like - did the patient contribute on time or not, was his/her installment

delayed, did he/she change his/her plan value or cancel it. So, we are developing a database of the middle and the lower income group and will harness this intelligence for other financial products that would be useful in the healthcare vertical. Brief us about the Affordplan app. We have an Affordplan web app, which is an end-to-end solution for the patient. They get login and password with which they can access and see the plan progress, cancel or add value of the plan. They can order medicines, schedule a test or OPD visit, or ask queries asked to the doctors. We do not charge for this. How potential is this health fin-tech market? The intent for us is to extend the financial discipline and planning to any elective proce-

dure that a person could think of. The majority of the business for small and mid sized hospitals comes from the elective ailments and the insurance penetration in these hospitals are not high, many of them who visit this facilities come and pay in cash. It is a published statistic that 87 per cent of all medical spends are out-of-pocket, which means the middle income and lower income group can be put to debt or driven to poverty. So, we want to build a robust system where we can help these income groups to plan for the health, not just elective procedures but even for medicines, which are expensive in certain cases. What worries you the most and what encourages you the most as a start-up? Affordplan fin-tech is at the intersection of healthcare, finance and technology. Health-

care business needs high quality of execution and many of us come from the core operations experience in TaxiforSure, which is very helpful. We have been fortunate enough to partner with two very high quality investors one is the deepest fin-tech portfolio in the country which helps us to connect with banks, financial institutions. The other is the Kaalari Capital which brings in great networks and operational experience. I think the situation for the start-up depends on the eco-system that they are able to create around themselves, be it with investors, partners or employers. We have been fortunate enough with good investment partners and adoption of hospitals is fairly robust as it is 120 in ten months. Healthcare is not e-commerce business we are cognizant about that. prathiba.raju@expressindia.com

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KNOWLEDGE I N T E R V I E W

A chatbot designed to handle follow-up medical care can help hospital deliver better care Shekhar Mhaskar,VP, Isobar India, in an interaction with Mansha Gagneja, reveals more about the applications of a chatbot in a healthcare set up Give us a brief about a Chatbot. Chatbots are simple to complex artificial intelligence(AI) systems that one interacts via text. Those interactions can be either straightforward, like asking a bot to provide weather report, or complex like asking to troubleshoot a problem with Internet services. Even one can seek preliminary to advanced healthcare advice. It ranges right from being functional at one end of the spectrum to fun and entertaining at the other end. Being in the era of messaging, marketing and interfacing, consumers have realised its importance and have slowly shifted to this platform in the form of Chatbots. Even buyer behaviour has witnessed a shift from social networks and apps, to messaging platforms such as SMS, FB Messenger, Apple iMessage, Slack, etc. Hence, technology companies are now building Chatbots on these platforms to offer AIdriven intelligent and more engaging channels to brands for delivering efficient customer service. How does a Chatbot work? A Chatbot is a service, powered by a combination of rules and AI. The functions based on rules are limited in their offerings as it can only respond to specific commands. If you say the wrong thing, it doesn’t know what you mean. This bot is only as smart as it is programmed to be. Chatbot that functions

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using machine learning has an artificial brain a.k.a AI. The chatbot gradually understands the language and one has to be very specific when commanding it. The bot continuously gets smarter as it learns from interactions. Building chatbots is not a complicated task given a plethora of readymade services like Octane AI, wit.ai, api.ai, textit.in, Motion.ai, Chatfuel, IBM’s Watson, Gupshup and many more. Here are a few simple steps to follow:- Figure out what problem needs to be solved; choose the platform for the bot; set up a server to run bot from and finally choose which service to use to build the bot. What are the implications of a chatbot at workplace? How does it redefine wellness at work? How do chatbots redefine employee engagement programme? When it comes to an enterprise environment, there are various disciplines which can take advantage of chatbots to increase business efficiency by deploying them across functions like sales, expense management, automated recruitment, intelligent Q&A, and many other applications. Chatbots at work also help ease the stress of never-ending rigours that come with daily management activities that would otherwise take up a lot of human effort. It could simply be managing to-do lists, to managing the sales team, to even conduct induction sessions for new employees.

Building chatbots is not a complicated task given a plethora of readymade services like Octane AI, wit.ai, api.ai, textit.in, Motion.ai, Chatfuel, IBM’s Watson, Gupshup and many more These AI platforms can also deliver data-driven results in places like call centres, assisting customer service representatives as they solve problems for frustrated customers. Chatbots could even replace human assistants in some situations — instead of asking the front desk to book flights or appointments. Employee fatigue can be brought down to a large extent when machines take over the more menial jobs, thus leading to their improved overall well being. They are able to concentrate on tasks that are

more result oriented. Chat platforms like Slack have revolutionised workplace communications and have nearly replaced traditional tools like e-mails, while creating convenience and saving time for its users. How do chatbots improve healthcare service? There’s nothing better than receiving personalised healthcare and personal attention. Undoubtedly, health assistant bots, if I may call them, are a perfect way to deliver personalised healthcare to any pa-

tient. Health support can range from general medical advice, prescription refills, test results, appointment scheduling, to preliminary diagnosis, ongoing follow up, and so on and so forth. All of this is accessible round-the-clock without having to wait in line. Many industry experts have said that diseases can be predicted by machines more accurately than doctors by analysing data. Chatbots, created by integrating AI and machine learning capabilities, can perform image recognition and sentiment analysis to offer caregivers and patients instant, as well as personalised, responses to critical health-related queries. These bots are not only helpful for patients, but are immensely beneficial for hospitals, doctors, and other medical staff. Hospitals can achieve improved results if the doctors and nurses keep in touch with the patient once they leave the facility. A chatbot designed to handle follow-up medical care can help the hospital deliver better care and even decrease the hospital’s re-admission rate. Doctors could interact with the bot to get the latest information about the patient’s diagnosis results, medication, and recent treatments before the appointment. It ultimately aids the doctor in enhancing productivity and enables them to respond to patients quickly, while helping the hospital to retain patients. mansha.gagneja@expressindia.com


TRADE AND TRENDS

SCHILLER launches DIAGNOSTIC STATION DS20 for easy addition or removal of parameters. Thanks to its intuitive user guidance SCHILLER’s DS20 is self-explanatory and very little training is needed. The large interactive touch screen supports the highest user-friendliness.

DS20 enables physicians to perform tasks in five minutes with one device SCHILLER HAS launched DIAGNOSTIC STATION DS20, the most comprehensive Diagnostic Station with unique features: resting ECG, PWA and Spirometry. It is designed for spot measurements and routine check-ups for of non-critical patients. In addition to physician offices, retirement homes, hospitals and clinics, the DS20 is a useful tool for routine check-ups in occupational medicine. DS20 enables physicians to perform tasks in five minutes with one device, which may otherwise take 20 minutes with multiple devices. It is an ideal tool for patient induction process in a hospital, as the patient’s vital parameters are quickly checked on a single platform and the data can be automatically transferred and stored in the hospital infor-

mation system through HL7 protocols. One of its important features, the advanced Pulse Wave Analysis (PWA) helps in easier understanding of haemodynamic and the process of arterial aging within minutes with graphical indication, which is useful in screening patients for early evidence of vascular disease and monitoring the response to the therapy given.

One touch to the measurement Simply touch the large, high-resolution colour display and you are in business recording, and selecting the highest quality ECGs. ◗ Perform ◗ Review ◗ Store or export wherever you want

DS20 simplifies daily work: ◗ Main vital signs and physical assessment tools united in one device ◗ Ideal for arrhythmia and atrial fibrillation screening: one resting rhythm channel for display, storage and printing with 3 electrodes ◗ Large, interactive touch screen

Connected ◗ Intuitive guidance and ease of use

Fast and easy to use The DS20 immediately detects connected sensors and automatically displays the corresponding value. This fast operation allows

The DIAGNOSTIC STATION DS20 is a networked device. Seamless connectivity to EMR, PACS, HIS or SCHILLER’s SEMA3 Cardiology Information System is possible and bidirectional communication allows for

easy data access, while Wi-Fi with strong security enables direct and fast transmission.

Expandable Easily add new functions and other devices or future technological developments. The DS20 is ready for the most common functions and will satisfy new requirements.

ALL-IN-ONE ◗ DS20 on trolley - easy transport between rooms ◗ DS20 on wall mount - saves space ◗ One-time patient data entry saves time and reduces data errors ◗ Large display (18.5”) - all information at a glance, no submenus ◗ Touchscreen and intuitive icons - one touch to measurement ◗ Interface to scales - automatic weight, height and BMI measurements

Carestream launches software to reduce effects of scatter radiation CARESTREAM HEALTH has introduced SmartGrid software that can reduce the damaging effects of scatter radiation in a radiographic image and help eliminate the need for an antiscatter grid. This optional capability is available for use with Carestream’s portable and room-based DRX imaging systems (see video link) as well as its DRX-1 retrofit system that converts computed radiography systems to digital radiography. The SmartGrid feature has received FDA 510(k) clearance and is scheduled to begin shipping in the third quarter of 2017. Scatter radiation degrades image quality by creating a haze

within the image that reduces both contrast and detail. It is prevalent when imaging thicker anatomy and when collimation is not close enough to the anatomy of interest. An anti-

scatter grid can be placed over a detector but it’s heavy and bulky, which makes positioning and alignment difficult and typically requires an increase in radiation dose.

In addition to enhancing image quality, use of SmartGrid software can boost productivity by reducing the need for technologists to place cumbersome grids over detectors. “Once installed, a technologist can utilise SmartGrid software on Carestream DRX systems whenever it is needed. And because this feature is easy to use, it can help boost image quality throughout an organisation,” said Lori Barski, Research Associate, Carestream's Image Processing and Analysis Group, a division of Research and Innovations. SmartGrid is an enhancement algorithm that estimates

low-frequency scatter distributed throughout an image and removes it. Many physical factors affect the properties of scatter including energy spectrum of the beam, thickness and size of the object, and collimation. Using physics and empirical modeling, SmartGrid software can accommodate these factors through estimation of the algorithm parameters that are tuned to replicate anti-scatter grid visual performance. SmartGrid image processing software is available for roombased and portable AP chest, AP abdomen, AP pelvis, AP hip and AP spine exams for adult patients.

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TRADE AND TRENDS

Dial4242 launched in Mumbai The app-based platform will allow a user book the nearest available ambulance and track its location real-time DIAL4242, an app-based platform providing users the comfort of booking an ambulance within seconds, was recently launched in Mumbai. Dial4242 will allow a user book the nearest available ambulance and track its location real-time. Founded by Nilesh Mahambre, Jeetendra Lalwani and Himanshu Sharma, Dial 4242 aims to eliminate the stress and worries in booking ambulances by setting up a reliable network, reduce the waiting time, and deliver the best in emergency services to people across India. Introducing and launching the ambulance aggregating platform in Mumbai was ace comedian and prominent actor Vrajesh Hirjee. Dial4242 services are available across South Mumbai, Western Suburbs and from Virar to Thane and can be used for outstation travel needs as

(L-R): Nilesh Mahambre, Chairman and Co-founder, Dial4242; Jeetendra Lalwani, Co-Founder and Director, Dial4242 and Himanshu Sharma, Co Founder and Head of Operations, Dial 4242

well. The company is in the process of extending their services to entire Mumbai by June. Over 140 ambulances have already signed up with Dial4242 and the company hopes to increase this number to 500 across Mumbai by year end simultaneously launch across India in phases. The Dial4242 app is currently available to download for free via the Google PlayStore. The iOS version of the app will be available on the App Store shortly. Services provided via Dail4242 are not limited to emergency situations and can also be used by patients for check-ups, medical appointments, after a hospital discharge or for intercity travel needs.

Available under less than 4 MB, the Dial4242 app has a stepby-step interface for bookings. To call for an ambulance, one simply needs to confirm the pick-up point auto-detected via GPS, add the destination and select the type of ambulance needed. Ambulance variants currently available are Basic, ICU or Cardiac and for the transfer of a dead body. The fare estimate and ETA of the ambulance will be displayed for a confirmation further to which the tracking details, and the estimated time to reach the destination with the shortest possible route will be displayed on the app. Once the user reaches his destination, one can pay the fare in cash to the driver or through a host of digital payment op-

tions. The user will receive an invoice via email and within the app. Additionally, ambulances can also be booked via the Dial4242 hotline 022-49414242 in Mumbai and these details would be sent to the caller via SMS. Dial4242 has secured seed capital of approximately `1 crore from an angel for the purpose of R&D, market research, product development and operations. The technologybacked platform has been in development and testing stages for over four months ensuring that it achieves best results in all circumstances and conditions and is now ready for public use. The company is currently in conversation with multiple investors for raising its next round of funds and is being led by its co-founder and chairman Nilesh Mahambre. Dial4242 has currently tied up with Wockhardt Hospital, Mira Road and will be exploring associations with other hospitals and medical services entities as a part of service expansion. Speaking on the launch, Nilesh Mahambre, Chairman and Co-founder, Dial4242 said, “When a taxi can arrive in five minutes, why can’t an ambulance? This was the moot point for the conceptualisation of Dial4242. We are attempting to address this need gap with

Dial4242.” Jeetendra Lalwani, CoFounder and Director, Dial4242, said, “I owe this idea to my dad. My personal experience during his illness is what led me to believe that there is the need to ease up the anxiety levels of people during medical emergencies. Dial 4242 is an idea which has arrived. It is our endeavour to build a mutually beneficial ecosystem where in the ambulance driver gets his due respect and the customer has the power to save lives with timely action” Bhalchandra Padwal, Head Digital Strategy, Aoen Digital, said, “We are partners to the idea, belief and the vision of being able to save human lives with technical assist. Having Aeon Digital on board, we will ensure that there are regular updates and innovation in technology to further simplify our entire offering.” “Dial4242 is an innovative model and we see great value in associating with such a platform which shall ensure a smooth and hassle-free ambulance booking process. We believe that technology and automating systems is a need of the day and Dial4242 is a perfect fit.,” added Ravi Hirwani, Head - Hospital Operations, Wockhardt Hospital, Mira Road on associating with Dial4242.

Transasia Bio-Medicals acquires Calbiotech Group of Companies, USA Transasia-Erba Group is set to strengthen its foray in ELISA and CLIA assays for human and animal research TRANSASIA BIO-MEDICALS recently acquired Calbiotech Group of Companies through its German subsidiary Erba Mannheim. Based in California, USA, the threedecade-old Calbiotech Group is a worldwide leader in immunoassay development and

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manufacturing. With this new addition, the Transasia-Erba Group is all set to strengthen its foray in ELISA and CLIA assays for human and animal research, including specific assays for autoimmune disorders, cancer and infectious diseases.

Speaking on the occasion, Suresh Vazirani, CMD, Erba Group said, “Calbiotech and Dr Noori Barka have developed an excellent range of immunoassay products that will complement our growing range of diagnostic products. Their expertise in Immunoassay will

allow Erba to strengthen our position in this high growth market and integrate their strong R&D programme to further enhance the product development strategy of the Erba Diagnostics Mannheim group.” Dr. Noori Barka, CEO and President, Calbiotech Group added, “We are excited to join the growing Erba Mannheim group and enjoy the synergies of being part of a larger organisation. We found a strong

strategic and cultural fit with Erba Mannheim and are eager to realise the potential of the combined companies. The strength of the Erba brand will support our growing sales activities while enabling Calbiotech to access a wider range of global markets for our products. The acquisition will also bring synergies with Erba’s R&D and work to accelerate the development of our novel and innovative products.”


TRADE AND TRENDS

The unsung heroes of human body Kidneys are the most critical organs of the human body, silently performing their tasks. Kailash Yagnik, Vice President - Strategy, Marketing, Sales Operations, Siemens Healthineers India, gives an insight on how early and accurate diagnosis of abnormalities can prevent possible damage to the kidneys SUSHMA SWARAJ, External Affairs Minister, had undergone a kidney transplant surgery in December last year, and was away from the Parliament for almost four months. She was suffering from diabetes and after kidney failure diagnosis was put on maintenance dialysis. Just like Swaraj, Chronic Kidney Disease (or CKD) affects one in 10 people worldwide. CKD is the eighth major cause of deaths in India and 17th worldwide. Besides, the fact that it is incurable, makes it incumbent on the caretaker to provide the patient lifelong care, facilitate dialysis and eventually a transplant. However, donors are hard to come by. It is therefore imperative to achieve early detection and commence treatment. Early and accurate diagnosis of CKD and other kidney disorders has been a challenge for some time now. However, the technology spotlight on kidney diseases has introduced new ways to help cease a possible damage to the kidneys, via timely diagnosis.

The silent performers Kidneys are complicated but vital organs that perform many essential tasks like maintaining haemostasis to keep a human body healthy. As a result, a medical condition that damages blood vessels or other structures in the kidney can lead to CKD. Hence, high blood sugar levels (diabetes), hypertension and obesity are all major contributors for the increase in instances of CKD. Other factors include kidney infections, blocked renal artery and longterm usage of certain medicines. Some of the common causes are high blood sugar levels and uncontrolled high blood pressure, which damage the vessels in the kidney, gradually

technique for visualising the vessels of the body, for e.g. renal arteries.

Creating awareness on CKD

KAILASH YAGNIK, Vice President - Strategy, Marketing, Sales Operations, Siemens Healthineers India.

leading to the disease. Obesity, being a major contributor to diabetes and hypertension, has direct impact on the development of CKD and End Stage Renal Disease (ESRD). CKD is more likely to develop in obese people including those with diabetes and hypertension. In fact, individuals affected by obesity have an 83 per cent increased risk of kidney disease. According to The Lancet’s latest report, by 2025, it is believed that 18 per cent men and 21 per cent women will be affected by obesity worldwide, of which six per cent men and nine per cent women, will be affected by severe obesity. Recent studies have also shown that obese people have two to seven times more chances of developing CKD.

Novel ways of diagnosis CKD is largely preventable if it is detected and treated in the initial stages. Early screening for the disease is important, since a person can lose up to 90 per cent of their kidney function before experiencing any symptoms. Luckily, over the years, detection and monitoring of CKD has become comprehensive and detailed. Diagnosis of CKD is now possible through classical clinical findings, supported by labo-

ratory and imaging studies. Elevated levels of albumin in urine provide an early warning sign that the kidneys are not functioning properly. Screening for increased urinary albumin excretion can be performed by measuring the albumin-to-creatinine ratio (ACR) in a random spot collection. Ratios utilising creatinine account for the variability of urine concentrations, ensuring the accuracy of untimed specimen collections. The analysis of a spot sample for the ACR is strongly recommended by most authorities. The other two alternatives (24-hour collection and timed specimen) are rarely necessary1. Siemens Healthineers was instrumental in offering ACR testing at the point-of-care by introducing CLINITEK Microalbumin-2 urine strip and is offered on our central lab instrument, the CLNITEK Novus analyser. Our ACR test can detect kidney disease at the earliest stages even for albumin sensitivity as low as 10 mg/L and can provide results in one minute, which further enhances the decision making steps for the treating physician. CT scanning of kidneys has always been a challenge in the industry. It is very critical to perform a CT scan by reducing the contrast dose. Contrast me-

dia dose reduction means preventing contrast-induced renal toxicity, expensive preparations and after care. With conventional CT scanners, the challenge of high doses and vague results hampered early detection in kidneys. Siemens Healthineers was the first to introduce kidney friendly scanning2 in the industry. We introduced the high-end fastest scanner that provides substantially optimized dose efficiency, resulting in more accurate imaging of a growing number of high-risk, asymptomatic individuals. Up to 20 per cent of patients presented to the radiology departments suffer from renal insufficiency. The high-end CT scanners enable radiologists to routinely perform exams at 7090 kV, even in adults, substantially reducing the contrast media needed and thus optimising the entire clinical procedure. These techniques do not require medication or preparation before a CT scan and little after care, resulting in significant improvement in clinical results and huge savings for hospitals. Imaging of kidneys using MRI technology has significantly added value in management of kidney diseases. NATIVE3 (Non-contrast MRA of ArTerIes and VEins) is a contrast-free MR angiography

Education and awareness on the risks of obesity, diabetes, hypertension, and other factors, which lead to CKD, can dramatically help in preventing kidney diseases. In some countries, free public screening of kidney diseases is done to prevent CKD, whereas in others public awareness camps are set to educate people on kidney health. Given the vulnerabilities of obese people and kidney diseases, the growth and development of a nation is often compromised. In some nations, one out of three people is obese, which contributes significantly to overall poor health and rising medical costs. Therefore, this year, the recently concluded World Kidney Day (March 9) was dedicated to promoting awareness about the harmful consequences of obesity, and its association with kidney diseases. Efforts were made to promote healthy lifestyles, the invivo and in-vitro solutions from Siemens Healthineers and share measures that make prevention of CKD possible, so that the unsung heroes can continue to keep human body healthy. References 1Standard of Medical Care in Diabetes, America Diabetes Association Position Statement, Diabetes Care, Volume 27, Supplement 1, January 2004. 2 Siemens Healthineers was the first to introduce kidney friendly scanning in the industry with its SOMATOM Force CT scanner, which is also the world’s fastest CT scanner. 3 NATIVE is an MRI application introduced by Siemens Healthineers

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TRADE AND TRENDS

SCHILLER launches automated CPR device SCHILLER has taken the next step in improving CPR quality further with the launch of smallest and lightest automatic mechanical chest compression device for CPR: the EASY PULSE. SCHILLER’s EASY PULSE is the solution for effective resuscitation. The portable, standalone device delivers chest compressions automatically at consistent rate and depth. It is directly attached to the patient’s upper body and can thus be used in any situation, regardless of ambient conditions. Especially during transport, a high-quality uninterrupted chest compression can be guaranteed. Its size and weight are unparallel. The EASY PULSE weighs less than 3.5kg, opening up entirely new possibilities, such as air rescue serv-

◗ Multidirectional chest compressions (3D) ◗ High-quality chest compressions of consistent rate and depth, which is impossible to achieve with manual compressions as recommended by American Heart Association ◗ Possibility of 30:2 compression-ventilation cycle

ice. Ease of use: thanks to the slider and buckle system, it can be easily attached onto the patient, while resuscitation can be initiated immediately by pressing two buttons only. The EASY PULSE has a unique combination of stamp and band which allows a 3D compression and therefore maximum efficiency. The weight of the device is evenly spread over the baseplate and not on a single point and therefore has no influence on chest compressions or on the recoil.

Simple ◗ Thanks to slider and buckle system, it can be easily attached to the upper body ◗ Easy to position – easy to operate Additional features ◗ Replaceable battery with charge level indicator. Battery can be changed in few seconds. ◗ Autonomous operation for 45 minutes (with one battery) ◗ Connections: external DC input, USB

Technological innovations Lightweight ◗ Unbelievably small and light, electrically driven ◗ CPR device, weighing 3.5 kg ◗ Ideal for limited spaces Comprehensive

Hill-Rom 900 Accella bed enhances patient care The bed system is now available in select markets outside the US HILL-ROM HOLDINGS announced the launch of the new Hill-Rom 900 Accella bed system for higher acuity patients in intensive and acute care settings. Hill-Rom's new bed system is available in select markets outside the US and builds on the successful Hill-Rom 900 platform, with its proven reliability and years of exemplary performance in hospitals around the globe. “Higher acuity settings are some of the most challenging environments in which to provide quality patient care,” said Paul Johnson, President, HillRom Patient Support Systems. “In speciality medical/surgical units and step-down ICUs, patients' needs are increasingly acute, the volume of patients can be overwhelming, and staffing resources are rarely ideal. That's where the new Hill-Rom 900 Accella bed can

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provide significant benefits.” The new Hill-Rom 900 Accella bed offers caregivers a number of features that make caring for patients easier and safer, improving patients' overall care experience. The HillRom 900 Accella bed offers innovations that work towards: Advancing safety: Patient falls result in extended length of stay, higher likelihood of readmission, and increased risk of complications1. With the HillRom Accella bed's three-mode bed exit alarm, intelligent night light, brake-off indicator and low-height indicator, caregivers can more easily prevent the most frequently reported incidents of falls 2. Enhancing outcomes: The Hill-Rom 900 Accella bed allows easy positioning of patients at risk of pulmonary complications. A head-of-bed (HOB) angle alert supports

compliance of local protocols, which can be critical as studies have shown that when the HOB is elevated to 45 degrees, there is a ventilator-associated pneumonia rate of about five per cent compared to when the patients were lying supine, where the rate is 23 per cent 3. With the bed's EasyChair feature, caregivers can easily place patients in a seated position to facilitate better breathing and prepare them for mobilisation. In addition, the bed's OneTouch Side Egress feature allows caregivers to help the patient exit the bed in an optimal sequence by simply pressing one button, therefore facilitating the full focus of the caregiver on the patient. Improving productivity and overall patient experience: The Hill-Rom 900 Accella bed's simple weigh feature allows caregivers to quickly measure a pa-

tient's weight without having to make adjustments to the bed. The bed's intuitive Graphical Caregiver Interface simplifies workflow by offering caregivers a bright and easy-to-use interactive touch screen that controls HOB and bed-exit alerts, simple weigh and bed positioning. With SlideGuard technology, HillRom 900 Accella bed can achieve a 50 per cent reduction in patient migration compared with other similar beds, resulting in less patient repositioning and reduced torso compression 4. “We are proud of the engineering and innovation built in to the Hill-Rom 900 Accella bed,” said Johnson. “This bed system is an excellent solution for high acuity settings given its intuitive bed controls and productivity enhancements that afford increased caregiver time with patients and improved patient satisfaction.”

The Hill-Rom 900 Accella bed is available with a wide range of foam, hybrid and powered surfaces for the prevention of pressure injuries and the promotion of their healing. References 1. Oliver D. Assessing the risk of falls in hospital: time for a rethink? Canadian Journal of Nursing Research . 2006; 38:89-94 2. Demangeat, J.L., Geldreich, M.A., Kessler, B., Kohlbecker, C., Sure, M.C. and Jeanmougin, C. (2009). Putting into place devices for prevention of falls at the hospital center at Haguenau [French]. Recherche en soins infirmiers(99), 26-42. 3. Drakulovic, et al. Supine body position as a risk factor for nonsocomial pneumonia in mechanically ventilated patients: a randomized test. The Lancet. Nov 1999 . 4. Internal Hill-Rom study, 2017


TRADE AND TRENDS

Changing standards in Indian healthcare sector THE INDIAN healthcare industry is at its breakthrough since the last few decades. While, the Make in India initiative is directing the nation rightly, the future success depends on the pace and extent of changes adapted. At present, the healthcare industry globally accounts for approximately $1.3 trillion, of which the medical devices sector contributes about $400 billion, which is almost 31 per cent of the industry. If we look at the report generated by India Brand Equity Foundation (IBEF), the Indian healthcare industry is expected to grow up to $280 billion by 2020. At present, the industry stands at an estimated $130 billion, ensuring a compound annual growth rate (CAGR) of 17 per cent. It will result in enormous growth opportunities for the healthcare industry in India, which is still at its inceptive stage. Though the overall healthcare industry shows a stable growth rate, the Indian healthcare sector is growing rapidly. It is a common belief that uncompromised efforts both from the government to empower the industry and also the medical device companies to tap the right market with right strategies in India, to promote the medical products, will en-

VIVEK TIWARI, CEO and Founder, Medikabazzar

sure growth and success of the medical devices industry in the Indian market. The prevailing scenario suggests that demonetisation and the upcoming GST reform, which is estimated to be one of the biggest indirect tax reforms, — are going to be the two major synergies that could accelerate the growth of overall healthcare industry, but majorly the medical devices sector. Not only this, but it is also expected that this will lead to a major shift of industries moving towards organised sector. This will have a great impact on India's healthcare segment which is crowded with unorganised players.Henceforth it will favour the organised players. However, its probability and time frame depends on the current supply chain process and

GST is expected to focus on facilitating bilateral validation of invoices, online integration of data and big data analytics changes adopted to revise them. GST is expected to focus on facilitating bilateral validation of invoices, online integration of data and big data analytics, which will go a long way in addressing loopholes existing in current healthcare industry. GST is sure to have a positive impact on the Indian healthcare industry. Apart from that, the present concern for the healthcare industry is GST rates. Understanding the current status,

GST rates should be in the lowest tax slab for the healthcare industry, other exemptions remaining the same for lifesaving drugs and medical devices. If GST rates are below the current total tax rate, it will eventually help consumers and businesses by making healthcare more affordable and accessible, which is already a big challenge to overcome for the Indian government. To estimate the potential acceleration in the growth and benefits to the industry, we need

to clearly understand: ◗ The current supply chain process, ◗ The current operational complexities faced by unorganised players, and ◗ New initiatives and the expected changes in the healthcare industry. Understanding the supply chain is again an essential attribute, while mapping the effects of GST on growth of healthcare industry. It will also help to determine the probability of shift from unorganised to the organised market. Conversion from unorganised to organised in the B2B chain will be comparatively easy than in the B2C chain. The currently organised market in healthcare is expected to be furthermore organised and successful under the GST regime.

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TRADE AND TRENDS

AVI Healthcare: Innovations for premature babies AVI Healthcare’s mission is to become a ‘Glocal’ company manufacturing innovative medical equipment to treat, cure and save premature and newborn infants by constant innovation, research and achieving highest quality standards AVI HEALTHCARE was formally Delta Medical Appliances, established in 1983, with the vision of providing quality healthcare in India at affordable costs. Under the leadership of Chirag Gala and Laxmichand Gala, AVI Healthcare is at the forefront in constantly innovating new products for saving the lives of premature babies. AVI Healthcare is an ISO 13485:2003 and ISO 9001:2008 certified company acquiring international quality standards like CE.

Achievements Backed by constant hard work and innovation, AVI Healthcare has won numerous awards and recognition in healthcare industry. Some of the accolades won are – ◗ CRISIL Medicall Healthcare Innovation Awards – 2012 for Transport Incubator TransNANO and BILIPAD LED Phototherapy Unit. ◗ Economic Times’ Power of Ideas Award along with cash price of ` 5 lakh. ◗ Healthcare Innovation and Entrepreneurship Award – 2013 for Emergency Medical Services for Transport Incubator by AIIMS, New Delhi ◗ Times of India Medicall Innovations Award – 2014 for Transport Ventilator ◗ In 2016, recognised among 40 Healthcare innovations in India at Festival of Innovations, 2016 by President of India at Rashtrapati Bhavan.

Latest innovations Some of the latest innovations introduced are Polycarbonate side plates in infant warmers AVI has introduced poly-

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carbonate side support plates in all the models of infant warmers which make them unbreakable, smooth, and easy to drop down. Other manufacturers are known to use Acrylic Side Support plates which break frequently. Polycarbonate material makes the side support plates unbreakable and sturdy.

New LED Phototherapy Unit Bilipod LED Phototherapy Unit is now a sleek, attractive and good looking phototherapy unit which is more effective, light weight and user friendly.

Neonatal Patient Monitor NeoSmart Patient Monitor introduced by AVI Healthcare is smart, Neonatal Monitor having nine parameters. Masimo Technology powers the pulse oximetry and makes the monitor precise and accurate for Neonates. Other Parameters monitored are – ◗ SpO2 by Masimo ◗ 3 led ECG ◗ NiBP ◗ Temperature ◗ Respiration ◗ Apnea ◗ CPAP Pressure ◗ FiO2 ◗ Phototherapy Irradiance Contact details AVI Healthcare 25, Nanddeep Indl. Estate, Kondivita Lane, Andheri East, Mumbai – 400059 Mobile: +91 9322294345 Tel: +91 22 28320452 Email: sales@ avihealthcare.com


TRADE AND TRENDS

MEDICAL GRADE VS CONSUMER MONITORS Ing Juergen Heckel, VP, Medical Business Sales and Marketing, EIZO Corporation, elaborates on understanding the differences in quality and risk of medical imaging diagnostics cancers may be missed and patients may suffer as a consequence. There are many other technical parameters that distinguish medical-grade monitors from non-medicalgrade ones such as brightness, contrast, a non-reflective surface, pixel pitch, uniformity, panel technology, integrated stabilisation and calibration sensors. Such tools are important for keeping image quality consistent, which significantly differs from COTS monitors.

technology solution provider, offers a wide range of medicalgrade monitors in greyscale and colour as well as quality control solutions. (Ing Juergen Heckel is VP, Medical Business Sales and Marketing for EIZO Corporation. He joined EIZO in 1994, and became EMEA business development manager in 2001, working predominantly with medical display solutions. He has given multiple educational seminars around the world to teach the importance of quality control

From a safety, accuracy and legal aspect, only certified medical-grade monitors should be used to avoid risks in misreading patient images. EIZO, as a visual technology solution provider, offers a wide range of medical-grade monitors in greyscale and colour as well as quality control solutions

The medical imaging diagnostic workflow is moving digital throughout India. Nowadays, doctors have to diagnose patients using a Picture Archive Communication System (PACS) viewer which displays medical images on an LCD monitor, either in the hospital or at home through teleradiology. They must rely on the quality of their equipment without accepting any compromises. In radiology, it is incredibly important to accurately detect breast and lung cancer during

the early stages in order to save a patient’s life. Early detection is a big challenge for all radiologists so it’s important that radiologists are provided with medicalgrade monitors that are accurate enough to allow for early detection. On a medicalgrade monitor, radiologists should expect to see images the same as or even better than physical films or CRT monitors showed in the past; providing all the tools required for accurate and early disease detection. To ensure the consistency

of all medical devices, the DICOM standard (described in Part 14) was developed to define the greyscale levels of medical-grade monitors according to the Grey Scale Display Function (GSDF). Medical-grade monitors are able to be calibrated according to this standard in order to display a smooth greyscale. Commerical offthe-shelf (COTS) monitors cannot be calibrated and as such are not able to offer the consistency that medicalgrade monitors offer. Without these features, early-stage

The European CE label for medical monitors (conformity declaration) classifies medical devices into separate classes following the global standards Medical Device Regulation (MDR) and Medical Device Directive (MDD) - USA uses the FDA510K certification according to AAPM TG18 standards and guidelines to show medical device approval. From a safety, accuracy and legal aspect, only certified medical-grade monitors should be used to avoid risks in misreading patient images. EIZO, as a visual

according to international QA guidelines and is an active workgroup member of global standardisations like IEC SC62B and AAPM TG196, TG260 and TG270. He is also an IEC-certified medical device advisor) Contact details Anantha Narayanan EIZO Corporation J 12 SJH SQT Kidwai Nagar West New Delhi – 110023 Mobile: 9999712089 Email: anantha.narayanan@ eizo.com

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TRADE AND TRENDS

Strategic arm of DiaSys India: Point of care Moitry Guha Patnaik, Product Manager-Point of care, DiaSys Diagnostic India, gives an insight about POC tests, which has been hailed as an efficient and innovative way to manage infectious diseases INDIA HAS the highest burden of diseases which depends on a number of factors and are interlinked such as age, changing lifestyle and rapidly evolving socio-economic determinants like access to healthcare or the lack of it. A patient sometimes travel from semi-urban or rural areas to cities in order to seek diagnostic help and treatment on health issues. Many times, patients do not have access to suitable medical treatment due to unavailability of diagnostic tools and dissuading factors like cost of travelling, added expenses of stay in tier I cities where the tests are conducted. This adds to cost of diagnosis due to which many patients show reluctance to the idea of getting proper treatment altogether. It results in increased mortality and morbid-

ity rates in country. In several cases, diagnostic solutions offered to the patients are incorrect, leading to increased mortality rate. Point-of-care (POC) tests have been hailed as an efficient and innovative way to manage infectious diseases, particularly in resource-poor settings, mainly to shorten diagnostic delay and treatment initiation. POC testing includes the critical elements of rapid turnaround-times (TATs) to allow for quick diagnosis, and referral or treatment decisions completed within the same patient encounter (i.e. POC continuum) or at the very minimum, with results delivered on the same day, cost-effectiveness, feasibility. POC is a blooming market in India and is made up of what

MOITRY GUHA PATNAIK, Product Manager-Point of Care, DiaSys Diagnostic India

is termed as ‘Over the Counter’ products such as glucose monitoring and pregnancy testing

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(also called non-professional testing) and the ‘professional market’ which includes all other testing including critical care, infectious disease, cardiac markers, diabetes, lipids, coagulation and haematology. DiaSys Diagnostic India is focussed to put POC segment into framework as programme that envision rather than just a test, across five settings (home, community, peripheral laboratory, clinic, and hospital). POC testing can be included as a spectrum of technologies (simplest to more sophisticated), users (lay persons to highly trained), and settings. DiaSys Diagnostic Systems has three pillars- Reagents, Instruments and Point of Care. DiaSys India is the strategic arm of DiaSys Diagnostic Systems for POC range of prod-

HYDERABAD E Mujahid The Indian Express (P) Ltd. Business Publication Division 6-3-885/7/B, Ground Floor, VV Mansion, Somaji Guda, Hyderabad – 500 082 Board line- 040- 66631457/ 23418673 Mobile: +91 9849039936 Fax: 040 23418675 Email Id: e.mujahid@expressindia.com KOLKATA Ajanta Sengupta The Indian Express (P) Ltd. Business Publication Division JL No. 29&30, NH-6,Mouza- Prasastha

ucts. It has planned to work on strategic and innovative approaches to develop new diagnostic tools of superior quality which can be catered at mid segment laboratory. DiaSys is more focussed in manufacturing and marketing the POC test with laboratory precision with current demand of customer and mitigating the challenge for diagnostic solution in rural areas. DiaSys has developed products and its key features are: innovative, user friendly, requires less training, and has lesser turnaround time, easy to handle, compatible and portable. DiaSys has set the benchmark towards trustworthy diagnostic indication – for reliable assistance to the doctor as well as for the benefit of the well-treated patient.

& Ankurhati,Vill & PO- Ankurhati, P.S.Domjur (Nr. Ankurhati Check Bus Stop) Dist. Howrah- 711 409 Mobile: +91 9831182580 Email id: ajanta.sengupta@expressindia.com AHMEDABAD Nirav Mistry The Indian Express (P) Ltd. 3rd Floor, Sambhav House, Near Judges Bunglows, Bodakdev, Ahmedabad - 380 015 Mobile: +91 9586424033 Email Id: nirav.mistry@expressindia.com

Important: Whilst care is taken prior to acceptance of advertising copy, it is not possible to verify its contents. The Indian Express (P) Ltd., cannot be held responsible for such contents, nor for any loss or damages incurred as a result of transactions with companies, associations or individuals advertising in its newspapers or publications. We therefore recommend that readers make necessary inquiries before sending any monies or entering into any agreements with advertisers or otherwise acting on an advertisement in any manner whatsoever.


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We at M.V.Hospital for Diabetes Royapuram have not only introduced many new tests to detect Diabetes at a very early stage but also to detect Diabetes complications at a very early stage. Advanced diabetes care is possible at the M.V.Hospital for Diabetes Royapuram at an affordable cost. Late Prof. M. Viswanathan, who has been acknowledged as a “Doyen of Diabetology” in India, was a relentless crusader against Diabetes for 50 years. His mission in life was 'every person having diabetes should be helped to live his normal span of life in perfect health' and this is our mission today.

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LIFE

Rebuilding lost trust Dr Srivats Bharadwaj, Founder and CEO, Vatsalya Dental, Bengaluru, opines that healthy doctor-patient relationship is built on mutual trust and respect. It is the foundation of a good healthcare practice

N

ot too long ago, the doctor was your friend, philosopher and guide. Someone who knew your family history, understood your health concerns, and did his best to remedy them. Likewise, the doctor’s biggest incentive was the respect and trust that the patient showered on him. Sadly, somewhere down the line, in our transition from friendly family doctors to fancy corporate hospitals, we seem to have lost the way. Of course, medical equipment today is more sophisticated and scientific research more advanced, but the humane element is missing. We have been witnessing a large-scale disconnect between patient expectations and healthcare delivery – for which doctors are bearing the brunt. Gone are the days when patients blindly trusted their doctor. Today, thanks to Google, everybody is armed with (often half-baked) information on symptoms and treatments. Whatever the doctor suggests has to be seconded by at least one more expert. Rules and etiquettes of the doctor-patient relationship are being rewritten.

What patients want? In a recent study, the Indian Medical Association (IMA) asked 1,000 patients across the country their opinion about doctors, and the results were

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enlightening. Around 90 per cent said they wished doctors actually ‘listened’ to their health complaints during the first consultation, while 80 per cent wanted the doctors to consider their opinion before deciding on the course of treatment. And almost 85 per cent of the patients asked that the doctors disclose all information related to treatments, procedures and risks. The biggest revelation was, perhaps, 50 per cent of the patients stating that doctors seldom say ‘thank you’. Healthcare cannot just be about disease and diagnosis; there has to be more. A healthy doctor-patient relationship built on mutual trust and respect is the foundation of a good healthcare practice. The patient needs to believe that his health is in safe hands. In an interesting study entitled, ‘Feelings of clinician-patient similarity and trust influence pain: Evidence from simulated clinical interactions’, it was found that when patients consult a doctor whom they trust and share something in common with – say, cultural background, for instance – the agony experienced during a painful medical procedure is lesser. According to the researcher Dr Elizabeth Losin, assistant professor of psychology at the University of Miami College of Arts and Sciences, “the doctor is essentially acting as a social placebo, playing

DR SRIVATS BHARADWAJ Founder and CEO, Vatsalya Dental, Bengaluru

the same role that a sugar pill would play if we were doing a study on placebo pain relief.” The study suggests that participants who experience higher levels of anxiety on a day-to-day basis experienced greater reductions in pain from consulting a trusted doctor. Dr Losin plans to use the results of her study to design and test new methods that clinicians can use during the doctor-patient interaction to help build trust.

Learning to be a doctor What does it take to be a doctor? A good academic score? Aptitude for science? Persistence and patience? Well, it does take all of that and a lot more. Medicine is a challenging profession that demands not just sound theoretical knowledge, but also tireless practice. In India, the theory

part of medical education is rather comprehensive, but what about the practice? At no point in their medical education are doctors taught how to communicate effectively; how to empathise with patients and their families; how to build trust. We need to re-look at how medicine is being taught in our country. The time is right to introduce lessons in cultivating the right attitude as well as having meaningful conversations with patients. Aspiring doctors need to be equipped with these vital skills to meet patient expectations. A small, but significant step in this direction is the submission of the findings of the IMA study on patients’ perceptions about doctors to the Medical Council of India. The idea to highlight the urgent need of incorporating soft skills into the medical curriculum in India. Another disturbing study by the IMA shows more than 75 per cent doctors in the country have experienced some form of violence - verbal or physical - while on duty. And according to an article published in The Lancet last month, “These instances (of violence against doctors) point not just to poor safety of health workers in the workplace, but also to deeper malaise of growing mistrust between doctors and patients and inadequate health infrastructure.” In other words, there’s no

denying the need for stronger laws against assault at workplace – The Doctors Protection Act 2010 has failed to have an impact in the 19 Indian states where it’s in force - and better security in hospitals, but that’s not going to resolve this issue. When an orthopedic doctor loses his eyesight, courtesy the ruthless attack by angry relatives of a patient, and doctors feel the need to learn taekwondo for self-defence and wear helmets when attending to patients, you know things have gone too far. I’m yet to come across a doctor who intentionally wants to harm his patients. As doctors, we always want to do our best. Yet, things continue to fall apart. Blame it on the poor healthcare infrastructure in public hospitals and the increasing commercialisation of private hospitals. The fault is in the system. What patients want and what the healthcare system delivers is completely out of sync. What a medical student learns in college and what he deals with on the job seldom have a common ground. The need of the hour is to train young doctors and aspiring medical professionals to meet patient expectations, to listen with empathy, and to embrace a more humane approach. Because the only cure to the current healthcare malaise is rebuilding lost trust. And that’s no mean feat.


Feels right at first sight Save your brainpower for stent deployment.

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Profile for Indian Express

Express Healthcare (Vol. 11, No. 6) June, 2017  

India's Foremost Healthcare Magazine

Express Healthcare (Vol. 11, No. 6) June, 2017  

India's Foremost Healthcare Magazine

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