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Aligning business and healthcare in India

May 2018 Vol 6 • Issue 8 • `50

INFRASTRUCTURE FLOORING TRENDS

SNAPSHOTS

5 SMART HEALTHCARE INDIA SUMMIT TH

BULLISH ON INDIA

DR BR SHETTY, FOUNDER AND CHAIRMAN, BR LIFE, ON ACQUISITION SPREE IN INDIA Published by ITP Media (India)


Contents 16 10

26 COVER STORY

Dr BR Shetty, Founder and Chairman, BRS Ventures, on the group's recent acquisition spree.

BULLETIN 10 This month's important news

COMMENT 32 Universalising access to

updates.

healthcare is one sustainable development goal that India is committed to providing in all rural and urban areas.

EVENT 22 Glimpses of Smart Healthcare India Summit recently held in Bengaluru.

ANALYSIS 26 Insurance patients come to hospital completely unaware about their insurance benefits.

INFRASTRUCTURE 28 We profile flooring choices of a few leading groups.

4

28

INNOVATION 39 Design engineers need tools that help them explore large number of design options.

IT 42 Organisations have the responsibility of protecting the privacy and personal medical information of every patient.

MAY 2018 | HEALTHCARE RADIUS

32


EDITOR'S NOTE

A humanitarian The buoyant Indian healthcare industry has captured the attention of a slew of MNCs, and of them that recently revived its interest in the Indian subcontinent is Dr BR Shetty-led BR Life. After founding the Abu Dhabi-based NMC Healthcare, one of the largest private healthcare providers in the Middle East and creating a chain of 145 facilities across 13 countries, the India-born Dr Shetty has founded BRS Ventures to provide innovative solutions in healthcare, financial services, pharmaceuticals, education, hospitality and infrastructure industries BR Life, the healthcare vertical of BRS Ventures, forayed into India in 2013 but it is only in the last two years it has been on an acquisition spree- spreading wings from Sree Narayana Hospital (SNH) in Raipur, SSNMC Super Specialty Hospital in Bengaluru, Mother & Child Hospital in Udupi and Kalinga Hospital in Bhubaneswar. With ‘quality, ethical healthcare at affordable costs’ being its guiding principle, the group projects a philanthropic outlook towards healthcare, with Dr Shetty emphasising on giving back to society. The group has ambitious plans- aiming to have around 5,000 beds over the next three to four years and have carved out unique business models from Greenfield, brownfield and PPP from hospitals to health centres to achieve its target. With various Government regulations reshaping the private healthcare industry in an endeavour to make healthcare more affordable, it would be interesting to see the value creation by BR Life to catapult Indian healthcare to the next level. .

MAY 2018 • VOL 6 • ISSUE 8

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BULLETIN

Aster announces hospital in Chennai

Dr Harish Pillai

Aster DM Healthcare, a leading healthcare service provider in India and in GC, has entered into an agreement with Subramanya Constructions & Development Company Limited (SCDC), a leading real estate developer, to construct a new hospital in Chennai. This 500 bedded, state of the art, multi-specialty hospital is expected to be commissioned in 2020. The hospital, which would be situated at a prime location in Chennai, will provide advanced

healthcare services to the residents of Tamil Nadu and customers from other states in India as well as overseas. Aster DM Healthcare, which was recently listed at NSE and BSE already operates 11 hospitals in South India with 4,037 installed beds. The new facility is in line with Aster DM’s strategy of strengthening its presence in India. Founder Chairman and Managing Director of Aster DM Healthcare, Dr Azad Moopen, said, “Looking at the demand supply gap, there is a requirement for more hospitals in India in general and in Chennai in particular. With our presence in Kerala, Karnataka, Telangana, Andhra and Maharashtra, we believe that our presence in Tamil Nadu would benefit patients in the country. We hope to provide advanced tertiary and quaternary medical care of the highest quality at affordable cost to the population of Tamil Nadu.” Dr Harish Pillai, CEO – Aster Hospitals & Clinics (India), said, “With our current diversified asset portfolios in Southern and Western India, Tamil Nadu was the only State without our presence. This new flagship hospital, due to be commissioned in 2020, will offer state-of-theart quaternary care services to the people of Tamil Nadu and fulfil the current gap within our network.”

UAE Hospital connects through video series

Narayana Health’s first super specialty hospital in Gurugram

People across the globe are embracing visual communication formats like videos, at a staggering rate. The Middle East and North Africa region ranks second in the world by numbers of daily Youtube video viewers, with over 300 million views, while 79% of UAE residents consume short-form video content of 10 minutes or less, on their smartphone. Amidst this sky-rocketing consumption, Healthpoint, the leading multi-speciality hospital in Abu Dhabi and part of Mubadala’s network of world-class healthcare providers, has announced the launch of an all-new video series covering an engaging behind-the-scenes tour of the hospital through the lens of two young Emirati employees. Serving as an innovative means to communicate with patients, the videos provide an inside look into the hospital’s full-cycle care, medical services and processes which may come in handy for those planning to visit the facility.

Narayana Health has inaugurated Narayana Superspeciality Hospital, Gurugram - their first hospital in Gurugram, reaffirming their resolve to strengthen the presence in Delhi-NCR region. Narayana Superspeciality Hospital, Gurugram, nestled close to Ambience Mall, DLF Cybercity and Delhi Jaipur Highway, is a multi-speciality hospital with world class medical facilities catering to needs of Delhi-NCR, Haryana, Rajasthan, UP and MP, amongst others. The hospital has been built from the ground-up. The hospital has 211 operational beds with world class intensive care units. The hospital comprises six modular operation theatres with advanced critical care and dialysis units and has 24x7 trauma care & pharmacy services and 24x7 radiology services with 128 Slice CT Scan, 3.0 Tesla MRI.

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MAY 2018 | HEALTHCARE RADIUS


BULLETIN

Healthium to be acquired by Quinag Acquisition

Quinag Acquisition (FDI) Limited, a company backed by funds advised by Apax Partners, has announced that it has entered into a definitive agreement to acquire a controlling stake in Healthium MedTech Private Limited (previously known as 'Sutures India'), the leading independent medical devices player in India. The controlling stake was acquired from existing shareholders including TPG Growth, CX Partners, and founding shareholders. Founded in 1992, Healthium manufactures and sells a broad range of medical devices and consumable products including wound closure products, minimally

invasive products including endo surgery and arthroscopy consumables, and urology products. The company’s key brands include Trusynth, Truglyde, Trubond, and Sironix, amongst others. Through its strong pan-India distribution presence under the Sutures India division, Healthium sells its products across large and corporate hospitals, nursing homes, and Government hospitals and institutions, and services over 10,000 hospitals across the country. Backed by the Apax Funds, Healthium plans to further deepen its presence in the Indian market and broaden its portfolio of specialty med-tech products. Shashank Singh, Partner at Apax Partners and Head of Apax’s India office, said, “Healthcare is a key focus area for Apax in India, given secular tailwinds around healthcare spend and government initiatives focused on affordable and universal healthcare. Healthium, with its strong IP and domestic manufacturing base, is well positioned to improve healthcare access and drive excellence in local manufacturing under the Make in India programme.”

Nahar group commissions a hospital in Bhinmal With an aim to provide affordable healthcare facilities to the masses, especially the unprivileged in Bhinmal, Rajasthan, the SB Nahar Charitable Trust, part of Nahar Group, has opened a 82-bed Nahar Hospital Nahar Hospital will be in addition to the existing hospital in Bhinmal, known as Matoshree Charitable Hospital, a 20- bed hospital, which has been operational since the last 30 years. The Nahar Hospital has been aesthetically designed and built by Ajay Nahar to provide patients with a healing experience

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MAY 2018 | HEALTHCARE RADIUS

rich in natural light, soothing colours and cross ventilation. HOSMAC has helped in shaping up the hospital, while AAA consultants have provided commissioning assistance. The hospital infrastructure has robust emergency, critical care and OT facilities, and is also equipped with the latest medical equipment and cutting edge technology. The hospital compound also has residences for doctors to ensure that patients get the best care facilities at all times. The hospital also houses a 24-hour pharmacy.

Snapdeal launches curated health store Snapdeal has launched a curated health store to take care of shoppers’ holistic health needs. The store features a wide range of products covering everything you might possibly like to buy for a healthy life. Besides the regular fitness items like treadmills, gym accessories, and fitness trackers, it also has active wear, sports shoes, sippers, and headbands. There is also a complete range of health management and tracking items including BP monitors, weighing scales, diabetic care, and orthopaedic mattress. The special health and wellness section includes nutritional supplements, health foods, massagers, diffusers, detox patches, eye care patches, essentials oils, stress balls, foam rollers and hygiene products.


BULLETIN

UK and India forge health partnership for cooperation in third countries will be extended, with the aim of improving the health and wealth of both countries. Health research will be expanded in the areas of anti-microbial resistance, low cost health products and high yield crops. The UK government will invest £1 million in an Artificial Intelligence (AI) project that will support India’s national health programmes. UKbased companies with innovative healthcare technologies will be able to participate in this project, which will generate around £50 million of business for the UK’s digital health The UK-India Statement of intent on partnership for cooperation in third countries industry. There are also plans to develop up will be extended. to 5,000 diagnostic centres in India, using NHS expertise, equipment and suppliers. The United Kingdom and India will share research, Eleven new ‘medicities’ are already being developed knowledge and technology in areas of anti-microbial rein India, with related: hospitals, nursing and medisistance, low cost health products and high yield crops. cal colleges and research and innovation centres. The Prime Minister, Theresa May, and Prime Minister, medicities programme is run by the Indo UK Institute of Narendra Modi, at the meeting in UK on 18 April agreed Health (IUIH) in partnership with leading UK hospitals, to step up the health partnership between the UK and the first of which is King’s College Hospital. India. The UK-India Statement of intent on partnership

‘Umeed-Smile’ cures 100th child at FMRI ‘Umeed-Smile’ initiative has recently supported the treatment of a four-month-old baby for her cleft lip surgery, making her the 100th child benefitting from the programme. The treatment was performed by a team of experts led by Dr Gagan Sabharwal, consultant - Dentistry and Maxillo-Facial Surgery, Fortis Memorial Research Institute (FMRI) and Dr Rashmi Taneja, senior consultant – Plastic & Cosmetic Surgery, Fortis Flt. Lt. Rajan Dhall Hospital at FMRI in Gurgaon recently. The patient, Vedika, was first diagnosed with a cleft lip condition when her mother was in her seventh month of pregnancy. After her birth, she was unable to drink her mother’s milk and faced breathing difficulties. The family could not support her treatment with their monthly income of Rs 7,500. After learning about Fortis Foundation’s Umeed-Smile initiative, they reached out for possible support and treatment of Vedika.

Apollo Pharmacy opened its 3000th retail unit Apollo Pharmacy has recently started its 3,000th retail unit at Seevaram, Thuraipakkam, Chennai. Over three decades ago, in 1987, Apollo Pharmacy was started with the single minded goal to ensure protection from spurious drugs and provide consumers with round-the-clock access to genuine life-saving and OTC drugs. Apollo Pharmacy has always upheld Apollo's patient first philosophy and consumers depend on us to always safeguard them when it matters most. Apollo Pharmacy has a presence in 18 states across India.

HEALTHCARE RADIUS | MAY 2018

13


BULLETIN

Group CEO, Parkway Pantai

P

arkway Pantai, one of Asia’s largest private healthcare service providers, has appointed Dr Ajay Bakshi as the Chief Executive Officer for its India Operations Division. He has replaced. Ramesh Krishnan. Dr Ajay Bakshi, a trained neurosurgeon from All India Institute of Medical Sciences (AIIMS), New Delhi, comes with rich experience in the healthcare sector. A former consultant with McKinsey, he has advised large US healthcare and pharmaceutical

corporations on their strategy and operations as well as addressed the effectiveness of healthcare systems in the Middle East and African countries. From 2011 to 2014, Dr Bakshi was with Max Healthcare as their Managing Director & CEO where he led a successful launch of four new hospitals. As the Managing Director & CEO of Manipal Hospitals from 2014 to 2017, he oversaw 16 hospitals covering 7,000 beds in India and Malaysia.

Director General, ICMR

P

rofessor Balram Bhargava has taken charge of Director General of Indian Council of Medical Research (ICMR)-cum-Secretary Department of Health Research (DHR). Professor of Cardiology at the AIIMS; he is a leader in the field of biomedical innovations public health and Medical research. Graduated in medicine (MBBS) he went on to secure MD and DM with specialisation in Cardiology. He is a fellow of the Academy of Medical Sciences (FAMS), fellow of

National Academy of Sciences India (FNASc)/Academy of Sciences (FASc), Fellow of Academy of the American Heart Association (FAHA, Fellow of the American College of Cardiology and Fellow (FACC) and Fellow Royal college of Physicians, UK. The Government of India honoured him with Padma Shri, for his contributions to the field of medicine. Dr. Bhargava founded the Stanford India Bio-design Centre, now School of International Bio- design.

Zonal Director, FMRI

D

r Ritu Garg has taken over as Zonal Director of Fortis Memorial Research Institute. Dr Garg is a clinician turned management professional with over a decade of experience in healthcare across functions. Dr Garg had joined Fortis in 2009, looking after the development of organisational blueprint and medical strategy for each hospital. She had a brief stint with Sakra World Hospital as VP Medical Strategy and Business Development & Amrop India as Principal Consultant for

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MAY 2018 | HEALTHCARE RADIUS

Healthcare practice. Dr Ritu re-joined Fortis as Head-Clinical Talent Management in February, 2016 and played an important role in bringing rigour in clinical hiring and streamlining the clinician engagement forums. Dr Garg also handled Medical Program Management, Clinical Academics, Research and Training (CAT) for the group. In addition to her responsibilities, she has been leading the patient experience function for the organisation since October, 2017.


COVER STORY

Bullish on India Dr BR Shetty, Founder and Chairman, BR Life, speaks on ambitious growth plans BY RITA DUTTA

Dr BR Shetty is founder and non-executive chairman of Abu Dhabi-based NMC Healthcare, one of the largest private healthcare providers in the UAE. Now Dr Shetty has set his eyes on the Indian subcontinent through BR Life, a part of BRS Ventures, to roll out hospitals and health centres. BR Life entered India in 2013. However, it’s only in the last two years that the group has come into prominence with a series of acquisitions. What is the reason for this renewed thrust in India? India’s healthcare industry is growing at a fast pace. There is a growing impetus from the Government of India on the healthcare industry as well. Our recent budget has also given high importance to healthcare. In India, the health insurance penetration is only for 20% of the population. I see this as huge potential for enhancing the healthcare facilities in the country. The Ayushman Bharath Scheme, recently announced by the Government of India, has a lot of promise. There could not be a better time than now to be in India and play an active role in enhancing the healthcare system in the country. Having started NMC in UAE, it has now grown to 145 facilities across 13 countries. My vision is ‘quality, ethical healthcare at affordable costs’. Born and raised in India, the plan was always to do something for the betterment of the people of India. This led to the creation of BR Life. BR Life includes hospitals in India and the sub-continent. SUT

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MAY 2018 | HEALTHCARE RADIUS


COVER STORY

1


COVER STORY

1. Dr BR Shetty, Founder and Chairman, BR Life. 2. SSNMC Super Specialty Hospital, under BR Life, is one of the advanced healthcare providers in Bengaluru.

Hospital, Pattom, Thiruvananthapuram was the first BR Life hospital in India. Sree Narayana Hospital (SNH), Raipur, SSNMC Super Specialty Hospital, Bengaluru, Mother & Child Hospital in Udupi and Kalinga Hospital in Bhubaneswar are the newer hospitals under BR Life. With safety as the cornerstone, BR Life is focused on accurate diagnosis, scientific treatment and precise delivery of healthcare services. Scientific cost accounting, standardisation of procedures, proper training, and alignment with medical and non-medical professionals are just some of the focus areas that BR Life is working on tirelessly to improve patient experience, engagement, and satisfaction. We are a very young company and excited about our foray in India. We look forward to offering our best services to add to the healthcare sector in India. Why the focus has been on India? Healthcare and education are sunrise industries. The Indian economy is growing at a healthy growth rate of 7.2%. These two industries require substantial amounts of

2

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MAY 2018 | HEALTHCARE RADIUS

investment. With quality healthcare at affordable costs, India is also becoming a preferred destination for medical tourism. How do you see the group, a few years down the line? Currently, the group operates and manages over 1,600 beds and intends to concentrate on creating a strong network of hospitals in several tier I, II and III cities across India and the sub-continent. The main aim is to attain a critical mass of around 5,000 beds over the next three to four years and over 20,000 beds thereafter. How has Kalinga Hospital been redeveloped after its acquisition? We have carried out a complete assessment of the facility and identified areas of improvement. The hospital has immense potential to grow, since it is a legendary establishment for the past three decades serving Odisha and the neighbouring areas. Kalinga Hospital has a Centre of Excellence (COE) for kidney transplant at the lowest prices compared to anywhere in the east


COVER STORY

of India. We intend to add more COEs. We are in the process of adding more clinicians, doctors on board; enhance branding and marketing and bring it to the best standards in clinical and managerial facilities in the country. We are also adding new areas like oncology, IVF to cater to the increasing demands of the region. What is the investment on the redevelopment of the project? Substantial investments are being allocated to building additional capacity across all our projects. The bedrock of BR Life is ‘Quality Healthcare at Affordable Cost’. We are constantly working on bettering our clinical excellence and reach out as many diverse patients as possible. Please share details of projects in the pipeline. BR Life will have projects which are a mix of Greenfield, Brownfield and PublicPrivate Partnership (PPP) projects. We have started strong by acquiring several hospitals. We are location/ region agnostic and are constantly on the lookout for new projects and assets all across the country. We have been selected by the Government of Karnataka to set up, upgrade, operate and manage dialysis centres in seven clusters across the state for a period of five years. Each cluster has a combination of already existing dialysis units at taluka hospitals, functional dialysis units requiring upgradation at district/ major hospitals and set up new dialysis units. This is the first of its kind PPP project undertaken by the Government with support from me. The PPP project is one amongst my philanthropic endeavours. I believe it is important for everyone to be grateful and serve the society in whatever manner possible. Why did you choose dialysis centres as a business model? We are fortunate to have had immense experience in serving patients across the

3 globe. The Government trusts us for our clinical and managerial expertise. We excel in all areas and we want to make our portfolio diverse. You have started MCH hospital under the PPP model... Yes, BR Life has taken over the existing Government’s Mother & Child Hospital and constructed a new hospital and this is currently offering free medical care to the underprivileged people in the region. This is a 200-bed hospital that will go a long way in providing high quality healthcare services with advanced diagnostic facilities together with the highest level of care and commitment to the people of Karnataka. This hospital will bring world class healthcare facilities to the women and children of the region and provide services to the weakest sections of the society. BR Life is a pioneer in the PPP model and we wish to replicate it in other states of India. You also have plans to start a Greenfield project in Udupi. Please share details about the project. The new hospital has a 300-bed capacity. It will help sustain the Mother and Child Hospital also in Udupi. The hospital will be

3. The group has started a Mother & Child Hospital in Udupi.

HEALTHCARE RADIUS | MAY 2018

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COVER STORY

4 equipped with state-of-the-art facilities and medical personnel, serving people of Udupi and neighbouring districts and states.

4. The group plans to add new areas like oncology and IVF at Kalinga Hospital.

20

A slew of regulations by the Government, whether it’s the attempt to fix the cost of procedures and devices, are dissuading many private players to invest in hospitals. Is not BR Life deterred by such stringent regulations to invest in the Indian healthcare eco-system? Regulatory norms are putting pressures on the healthcare industry in the country. Shrinking margins neither help the service providers or the equipment manufactures. The Government must enable us to serve people better. The recently introduced schemes such as Ayushman Bharat Yojana are welcome steps in this direction. The Government must help reduce import prices, provide land at affordable rates, reduce procedural times for approvals for new hospitals and provide an impetus to drug manufactures in India. All these will help reduce cost to service providers medical which they can in turn pass on to the consumers and thus remain financially viable. What are the unique challenges to foray into the Indian healthcare firmament? The healthcare industry is vibrant in India.

MAY 2018 | HEALTHCARE RADIUS

But due to long timelines involved in the implementation of the regulations, investors could become sceptical. Greenfield projects take lengthy periods of time. International investors prefer brownfield or combination of brownfield and greenfield projects. PPP is critical to enhance overall healthcare system across all tiers and sections of the society. We have recently begun making inroads into this space in India. Which are the other countries that the group is looking at foraying? We are looking to grow in the SAARC countries, Africa and the Middle East. How similar and different are NMC and BR Life as organisations? NMC enjoys a leadership position in UAE. My vision is ‘quality, ethical healthcare at affordable costs’. This will be the cornerstone for BR Life as well. What is the business model for expansionGreenfield or acquisition? We currently have multi super specialty hospitals. However, we are open to single specialty units like IVF, oncology as well. We are open to relevant opportunities that will help us feed to prevailing demands in the market.


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Healthcare simplified Glimpses of 'The 5th Smart Healthcare India Summit 2018’, organised by ITP Media India in Bengaluru 5th

2018

BUILDING TOWARDS NEW-AGE HEALTHCARE

Meghna Dekhtawala Conference Producer, ITP Media India, anchored the event.

IN ASSOCIATION WITH

POWERED BY

MEDICAL COLD CHAIN PARTNER

INFECTION PREVENTION PARTNER

Dr BS Ajai Kumar, Chairman and CEO, HCG, delivered the keynote address on ‘ Building Patient-Centric Healthcare Delivery Model For A Billion Plus People’.

APPLIANCES

MAGAZINE PARTNER

Bibhor Srivastava, Group Publishing Director, ITP Media India, gave the welcome note.

AN EVENT BY

Sunil Khatwani, VP & Business Head (System ac Division), LG, spoke on ‘HVAC Systems in healthcare’. Rita Dutta, Editor, Healthcare Radius, and Sanjay Bhan, Director, ITP Media India, felicitating Dr Shubnum Singh.

Prof Rajendra Pratap Gupta, Advisor to Union Minister of Health, Family & Welfare, was the chief guest of the summit.

Dr Shubnum Singh, Governing Board Member, Health Sector Skills Council, spoke on ‘Meeting current challenges in HR in healthcare’.

Bibhor Srivastava and Sunil Khatwani felicitating Prof Rajendra Pratap Gupta.

HEALTHCARE RADIUS | MAY 2018

23


EVENT

From left to right: Members of the panel discussion on ‘Meet the Decision Makers’: Deepak Venugopalan, Regional COO, Manipal Health; Dr Selwyn Colaco, COO, Cytecare Hospitals; Dr Nandakumar Jairam, CEO & Chairman,Columbia Asia Hospital; Dr Madan S Gaekwad, President, PANHA; Rajit Mehta, MD & CEO, Max Healthcare; Madhur Varma, Group CEO, Sahyadri Hospital; Akash Malik, Group CEO, Cloudnine Healthcare, Rupak Baruah, Group CEO, AMRI, Hospitals; Lalit Mistry, Director-Healthcare, KPMG.

From left to right: Members of the panel discussion on ‘Smart, Smarter, Smartest’- Chaitanya Shravanth, CDO, Cloudnine Hospital; Dr Mudit Saxena, CEO and MD, Ovum Hospitals; Dr Deepak Sagaram, Associate Vice President- IT, Gleneagles Global Hospitals; Niranjan Ramakrishnan, Group Head IT, Kauvery Hospital; Arun Goyal, Group CIO, HCG Group; Rajendra Kshirsagar CIO, Meitra Hospital.

A delegate asks a question to a member of the panel.

From left to right: Members of the panel discussion on ‘Designing a Healing Environment’: Sunil Khatwani, VP & Business Head (System ac Division), LG; Siddharth Puri, Co-Founder and Director of Architecture at W-ARD FOUR Design; Dr Amit Hajela, Architecture & Urban Design; Ajay Gupta, Executive Director, KGD Architecture; Shekar N, Head–Projects & Maintenance, Aster CMI Hospital; Arun Mathur, Head Projects, Narayana Health.

Bibhor Srivastava and Pratik Agarwal, New Business Development Manager, Godrej Appliances, along with Dr Mudit Saxena.

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MAY 2018 | HEALTHCARE RADIUS

Panelists exchanging notes on various issues impacting healthcare.


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ANALYSIS

Does insurance helpdesk help?

1

Insurance patients come to hospital completely unaware about their insurance benefits and restrictions BY ANUJ JINDAL

H

ospitals want insurance patients. That is why they invest years of effort to gain empanelment with insurers or third party administrators (TPA). They complain when an insurer doesn't empanel them. Hospitals are also willing to block their working capital and receive payments for cashless after a month or so. Such is the hunger for insurance or TPA business. So what happens when finally such a prized business comes to the hospital?

1. The IRDAI data suggests one in 15 cashless claims is rejected.

26

Current cashless process At the time of admission, patient or their representative is asked to make a choice for the treatment package and room category. Once the selection is made, they sign on a pre-authorisation form to be sent to insurance company for approval. The patient is

MAY 2018 | HEALTHCARE RADIUS

assigned a bed, and depending on complexity of case, it may take 2-24 hours to get pre-auth approval. Patient takes the treatment and on the day of discharge, all medical records are sent to insurance company for final approval. Mostly the claim gets approved for a certain amount, but in a few cases, the cashless claim gets rejected. The IRDAI (Insurance Regulatory and Development Authority of India) data suggests one in 15 cashless claims is rejected. Even in case of approved claims, patients may end up paying substantial amounts outof-pocket because of several reasons, some of which are – ⊲ Copayment clause ⊲ Chosen room category is more expensive than the one allowed as per insurance policy ⊲ Treatment-specific capping ⊲ Sum insured limit exhausted


ANALYSIS

Patient experience Insurance patients are mostly clueless why they’re being made to pay in a cashless claim. Especially when the claim gets rejected, insurance desks get anxious because now they have a few hours to convince the patient to pay the full amount of the bill. Insurance products are complex and let us accept that most patients are oblivious to policy terms and conditions and do not exactly understand how their decisions impact their financial liability in a claim. Insurance desks have an important role of counseling the patients to help them make informed choices regarding their insurance use. Let me offer a step-by-step guide for success in dealing with insurance patients. 1) Admission-time experience: Insurance helpdesks should create awareness among patients regarding three aspects – room rent limit, waiting period and co-payment clauses. If patients pick a higher room category, they end up paying significant amount due to proportionate deduction. Assist patients regarding their expected prorated deduction when higher category is selected. If they take treatment for disease/surgery while policy is in the waiting period, then insurer will not pay the claim. Ask patients to check for waiting period at admission time. If there is copayment of 10-50%, patients must be prepared with their share by the time of discharge. Insurance helpdesks should keep customer care numbers of all insurers and TPAs and share these with patients to check eligibility information. And Proactive counseling of patients regarding their liability in claim helps them to prepare better financially. 2) Claim rejection: Around 60% of cashless rejections are due to non-disclosure of pre-existing diseases and waiting period. Remaining 40% rejections are frivolous and patients have a good chance in reimbursement claim. Insurance helpdesks should encourage patients to file reimbursement claims. Help is available online if

people make the effort to search. I suggest patients speak to their insurer or online experts to get clarity on their options after the claim denial. 3) Patients with multiple policies: IRDAI allows a patient to split their bill over multiple policies. Helpdesks must educate patients to claim remaining expenses from second or third policy. 4) When you don’t have tie-up with patient’s insurer: Most insurance helpdesks do not bother with patients whose insurers are not tied-up with hospital. This lack of sensitivity leads to loss of business as patient will switch to some other hospital. But you can retain the patient if the helpdesk offers support in reimbursement claim or encourages patients to seek help from experts. 5) Pre and Post Hospitalisation (PPH) expenses: Patients’ perception of their outof-pocket expenses at hospital can substantially be improved by educating them about PPH reimbursement claims. Almost every policy issued in India provides OPD cover of 30 days before admission and 60 days after discharge, for which patient needs to file reimbursement claim. Patients are happily surprised every time insurance helpdesks inform them about these benefits. Helpdesks have a great opportunity to deliver superlative patient experience. Most insurance patients come to hospital completely unaware about their insurance benefits and restrictions. By educating them about some standard benefits and restrictions in policies, and how they impact them, can make a great difference to financial outcome in their claims. By encouraging patients to seek explanation or help from their insurers or other experts, helpdesks will build a good rapport with patients and boost their confidence and trust in hospital.

Anuj Jindal is Co-founder of SureClaim.

HEALTHCARE RADIUS | MAY 2018

27


INFRASTRUCTURE

Safe & durable Three leading groups share their flooring choices BY TEAM HR

1

Columbia Asia Hospital, Sarjapur Road

1. The reception area has primarily used marble simulating larger slabs of vitrified tiles.

28

The floor finishes of Columbia Asia Hospital, Sarjapur Road, Bengaluru, were carefully selected for aesthetic value, functionality and durability. The selections are a neutral palette with splashes of colour in pockets.  Lobby and reception: The reception area primarily uses marble simulating larger slabs of vitrified tiles. Vitrified tiles have the ease of maintenance in public spaces

MAY 2018 | HEALTHCARE RADIUS

and also allow flexibility in replacement later. Waiting area pockets are created using carpet tiles to bring in some vibrancy and softness to the space. It carries a language of blues and whites in textures  Patient waiting area: Flooring for the patient waiting area varies floor wise. Says Amrita Phookun, Senior Architect, Kgd-architecture, “In outpatient areas, a concept similar to the reception is followed wherein a combination of vitrified


INFRASTRUCTURE

2

tiles and carpet is used. In the clinical and diagnostic area waiting, homogeneous vinyl flooring is used in two shades forming linear patterns.”  Diagnostic area: The flooring for the diagnostic area iclutter free and uses two shades of homogeneous vinyl in linear patterns.  Doctor consultation room: The consultation rooms are designed to very utilitarian for this facility. Vitrified tiles have been

used in the flooring for ease of maintenance and durability in the same palette as the rest of the facility.  Patient rooms: Homogeneous vinyl flooring has been used in all patient rooms. “Neutral shade of base vinyl with controlled use of vibrant accents makes the space appealing, fresh and energetic,” says Phookun.  ICU: Antistatic vinyl flooring is two shades are used in all ICUs keeping its functional aspects in mind. Anti-static floors help by taking the static electricity that builds up naturally in ICU environment because of the use of chemicals and flammable particles. By grounding the charge, anti-static flooring prevents the ESD from building up and discharging into the environment.  OTs: Conductive vinyl flooring in two shades forming a pattern has been used in the six OTs in the facility. “Due to the extensive use of electrical and mechanical equipment inside the OTs, conductive flooring is an absolute must,” adds Phookun.  Canteen: The facility has a deli counter on the ground floor which uses the same vitrified tile flooring as the reception carrying forward the design language. The canteen with its outdoor spillover seating also uses larger slabs of vitrified tiles because of its ease of maintenance in public spaces and also allows flexibility in replacement later. Vendors used for flooring: Kajaria, Somany, Nitco, Gerflor, Forbo and Tarkett.

Amrita Phookun, Senior Architect, Kgd-architecture

2. Homogeneous vinyl flooring has been used in all patient rooms.

HEALTHCARE RADIUS | MAY 2018

29


INFRASTRUCTURE

3

Narayana Health

Arun Mathur, GM- Projects, Narayana Health

3. The group has opted for a mix of granite, vinyl, marble flooring for various areas

30

Narayana Health, a leading healthcare services provider, has a network of 24 hospitals and seven heart centres across India and single hospital overseas at Cayman Islands with nearly 6,000 operational beds across all its centres. The group has opted for a mix of granite, vinyl, marble flooring for various areas:  Lobby and reception: The preferred choice of material for the lobby and reception area is usually granite stone slabs. Says Arun Mathur, GM- Projects, Narayana Health, “As compared to vitrified tiles, marble or vinyl flooring, granite has the maximum strength and does not get worn off, as compared to the other materials.” Secondly, granite can be very well polished to provide a high gloss and rich feel to the ambiance.  Patient waiting area: The first preference would have been polished granite stone, but if costs are a constraint, than the next alternative is for vitrified tiles. Vitrified tiles are available in large varieties, so the selection criteria is by comparing the flexural strength / breaking strength and abrasion resistance.  Diagnostic area, doctor consultation room, patient room: For all the three areas, the choice of material is usually either vitrified tiles or vinyl flooring.  ICU and OT: For ICUs and OTs, the pre-

MAY 2018 | HEALTHCARE RADIUS

ferred choice for flooring is vinyl. The basic reason is vinyl flooring provides a seamless finished floor. There are no joints which would allow dust accumulation or chances of fungal / bacterial pores growth. Vinyl floorings are available in 2mm, 3mm, 4mm thickness for normal applications. "For commercial use, heavy traffic areas, we prefer 3mm or 4mm thickness vinyl. For heavy traffic areas, the vinyl quality preferred is one with PUR (Polyurethane Reinforced ), for handling better wear and tear. It is preferred to use homogenous vinyl, which has a uniform structure, as compared to heterogenous vinyl, which is composed of different layers," says Mathur. For OTs, , it is recommended to go for anti-static and conductive vinyl, which take care of dissipation of any static charge build up from the medical equipment. “For physio-therapy dept, we usually prefer ‘sports vinyl’ which is 4.5 – 5mm thickness or more, and has an underlayer for shock-absorption. It is meant to ensure safety of patients from falls and injuries,” says Mathur.  Canteen: The flooring can be either vitrified tiles or vinyl. In some cases, even polished Kota stone is used. Vendors NH uses for flooring: Gerflor Vinyl, Armstrong and Tarkett.


INFRASTRUCTURE

4

American Oncology Institute American Oncology Institute (AOI), the flagship international centre of US-based Cancer Treatment Services International (CTSI), operates a chain of cancer hospitals in multiple cities of India. The group uses different types of flooring like the vinyls, ceramic tiles, marbles, Kotah stone, etc. These are used keeping in view both the patient safety and aesthetics of the place. A lot of thought has been given while designing and specifying the flooring material especially keeping the patient safety in mind.  Lobby and reception: Due to the high footfall, this area generally needs a hard flooring. So to make the place aesthetic, marble or granite is used. Says Rajesh Sivan, Head of projects, AOI, “We just have to ensure that the flooring selection and polish is such that it does not become slippery.”  Patient waiting area: There are different types of waiting areas like the OPD waiting, day care waiting, etc. The flooring will have to be in line with the adjacencies. Both vitrified and vinyls are used depending upon what is used in the department.  Diagnostic area: These areas typically are vinyl, as in most cases one needs to maintain a level of sterility.

 Doctor consultation room: “Mostly, we have seen the use of vitrified tiles in these areas. But nowadays since there is great thrust in the area of dry wall construction, fixing vitrified after partitions is a bit challenging and sometimes there is more wastage in the tile quantity. So vinyls have proven to be better options over a self-levelled screed,” says Sivan.  Patient room: Both vitrified and vinyls are used and again with the patient rooms and toilets now going the dry wall route, AOI uses vinyls is most projects.  ICU: “Sterility is the key here and we need to have flooring which is seamless, almost zero joints and has no short corners between the wall and the floor to have total infection control on surfaces. Due to this, we have been using vinyl very effectively. One should ensure that homogenous vinyl is important here, so that the flooring material surface does not get worn off easily,” says Sivan.  OT: Conductive vinyls have to be used here to ensure any static electricity produced from the mobile medical equipment is earthed.  Canteen: This being an area susceptible to spillages and moisture, vitrified tiles or granites are the most preferred option. Vendors AOI uses for flooring: Gerflor and Tarkett.

Rajesh Sivan, Head of projects, AOI

4. AOI uses marble or granite in the lobby and reception areas of its hospital.

HEALTHCARE RADIUS | MAY 2018

31


COMMENT

Achieving universal health coverage Universalising access to healthcare is one sustainable development goal that India is committed to providing in all rural and urban areas BY DR SOUMITRO CHAKRABORTY

T

1. The recent union budget has shown us serious commitments on decreasing the maternal mortality rate.

32

1

he World Health Organisation was founded on the principle that every individual should be able to realise their right to the highest level of health. Therefore providing the facility of health to every individual became its guiding mantra for more than seven decades now. Keeping this trend alive, this year, the WHO is calling countries in moving towards the Universal Health coverage. Universalising access to healthcare is one sustainable development goal that India is committed to providing in all rural and urban areas. Highlighting the importance of health mechanism in India, the union budget has shown serious commitments on decreasing the maternal mortality rate and the measures to tackle them. India has made exten-

MAY 2018 | HEALTHCARE RADIUS

sive efforts to reduce the maternal mortality rate and to increase access to reproductive health. In some regions, it has achieved much progress. Implementation of schemes like Janani Shishu Suraksha Karyakram is targeted to provide benefit to more than 12 million pregnant women who access Government health facilities for their delivery. Moreover, it also motivated those who still choose to deliver at their homes to opt for institutional deliveries. However, the quality of antenatal care services that have been provided to the pregnant women has been deplorable. According to a study conducted by BMJ journal in Chattisgarh, one of the poorest state in India,


COMMENT

the coverage of antenatal care services under the JSSK scheme, was quite high with 84% of the women having attended at least three antenatal care visits. However, the quality of antenatal care services was better in the non-tribal district compared to the two tribal districts. Availability of free transport to the facility was found to be high for people who called for it while return transport was provided to 60% of women who delivered at a public facility. Free food was provided to 55% of women. Emergency referral transport for maternal complication to a higher public facility was not ensured in all cases. Though most of the facilities surveyed are undertaking deliveries, huge gaps were identified in preparedness for dealing with both basic deliveries and emergencies. These gaps include non-availability of essential medicines and/or blood bank/ storage facility in most of the community health centres. Most of the community health centres had no gynaecologist or adequate facilities available for C-section delivery. Out-of-pocket expenditure was incurred by 98% of women who went to a private facility and by 56% of women going to a public facility. In private facilities, median out-ofpocket expenditure was 10 times higher than in public facilities. Even though half of the women had insurance cards under Rashtriya Swasthya Bima Yojana or Mukhyamantri Swasthya Bima Yojana, only 16 women made

2. Quality of care in maternal health services has also been shown to differ according to economic and residence status.

2 HEALTHCARE RADIUS | MAY 2018

33


COMMENT

3

3. Training and providing information to both men and women about maternal and post childcare is important.

34

use of these schemes. Out of these 16 women, 12 still incurred out-of-pocket expenditure. In spite of implementing such strong policies, majority of women still lack access to maternal and reproductive healthcare. But what has been the cause of such failure of these policies? In India, poverty levels differ widely. Government health spending is around 1% of GDP, while the total spending on health in India is around 5% of the GDP. India has one of the highest levels of outof-pocket payments for healthcare in the world-imposing a large financial burden on individuals and households. Utilisation of antenatal care (ANC) and skilled attendance at birth has also increased in India in the last 15 years. However, progress among women from economically disadvantaged segments of the populations has been slow. Quality of care in maternal health services has also been shown to differ according to economic and residence status. The healthcare providers are also unable to meet the national standards on minimal care during pregnancy and delivery in the poorer areas of the country, whereas this did not seem to be a problem in the higher-income areas of the city. Although monitoring at various levels could be a reason behind it in many other settings, social structures also prevent women from having access to maternal and reproductive healthcare. According to data published by NFHS 4, only 16.7% women in rural India receive full antenatal care- at least four ANC visits, at least one tetanus toxoid injection, and iron and folic

MAY 2018 | HEALTHCARE RADIUS

acid tablets or syrup taken for 100 or more days- which is about half as many as in Urban areas (31.1%). What is the cause of such a number where one woman out of seven does not get access to antenatal care during pregnancy? The gendered nature of decisionmaking in Indian households affects women’s healthcare-seeking behaviour. The family did not think it is necessary to seek any medical assistance for women to give birth to a child. One in four men whose wives did not receive ANC said they did not think it was necessary. One in five men said their family members did not think it was necessary while one in 10 said the women themselves thought ANC to be unnecessary. Nearly one in four men said it was ‘too costly’. What could be the effective solution to bridge this gap and decline the maternal mortality rate? While strict monitoring of the Govt initiated plan across various level is important, improving infrastructure and human resources in healthcare are equally important. Policy attention to promoting women’s agency through education and paid employment as well as sensitising men about women’s right to healthcare is also required to improve the stature of women in the society. Private organisations and corporate bodies should also come forward voluntarily to support the backward communities in improving the health condition. Improved levels of educational attainment, participating in income-generating employment and belonging to households in the higher wealth quintiles will raise women’s participation in decision-making about their own health. Lastly, training and providing information to about maternal and post childcare will help us achieve the related sustainable development goal targets and ensure the ‘Health for all’ target.

Dr Soumitro Chakraborty is CEO at Fiinovation.


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TECHNOLOGY

1

Disruptive growth Patients are becoming more empowered to monitor and improve their well-being through personal and wearable devices BY BRIAN WYATT

P 1. Medical product evolution and disruptive innovations are focused on providing basic health to people in remote rural areas.

36

ersonal and portable devices are leading significant transformation in the medical technology industry with their ability to integrate with personal diagnostics and information technology (IT) systems. We have witnessed tremendous recent growth in the integration of Internet of Things, wearables and Pointof-Car e(PoC) diagnostics along with IT, connectivity, access and personalised medicine. Also, the industry is learning from other sectors about the use of innovative technology platforms to streamline processes. In both established and growing econo-

MAY 2018 | HEALTHCARE RADIUS

mies, such as India, medical product evolution and disruptive innovations are focused on providing basic health to people in remote rural areas, reducing infant and maternal mortality and diagnosing diseases as early as possible. These macro trends have increased demand for more affordable solutions. Accessible PoC healthcare technology, big data and better integration of services are delivering preventative care and building population health efficiencies. Collaboration among healthcare stakeholders and a cross-pollination of ideas across industries plays a pivotal role in


TECHNOLOGY

addressing the current challenges in the industry. Initiatives like the India 2022 Coalition – a business-led collaboration committed to creating new growth models by the 75th year of India’s independence – will help facilitate and nurture these efforts by overcoming development barriers. While there is a clear case for timely diagnostics for better disease management and preventative care, this segment remains grossly under-invested in India. Early disease detection programmes account for only 0.1% of total healthcare spending. Beyond this, a mere 1 % of total healthcare spending is allocated for the dissemination of information, education, and counseling programmes. Limited access to affordable and high-quality medical services further complicates disease management. In numerous cases – despite having access – the adoption of low-cost medical technology has not scaled due to inherent biases among providers and patients. Diagnostic tests provide the basis for medical decision-making and therefore have a substantial impact on the continuum of care. Early and accurate diagnosis helps reduce the burden of disease on the overall health ecosystem: the patient gets treatment earlier in the disease stage, healthcare infrastructure is utilised more efficiently, and the overall cost to both patient and system is reduced. India's healthcare market may see a threefold jump in value to $ 372 billion by 2022, driven by growing incidence of lifestyle diseases and rising demand for affordable healthcare delivery systems, says a report. The medical devices market in India, which was valued at $ 4 billion as of 2016, is likely to cross the $11 billion mark by 2022 on the back of improving general healthcare access, an uptick in medical tourism and a gradual decline in the cost of medical services, the survey noted. Report cites key trends that are driving the healthcare market India including increasing incidents of lifestyle diseases, rising demand for affordable healthcare delivery systems, rising healthcare costs, the

2 emergence of tele-medicine, rapid health insurance penetration, start-ups that are helping reach untapped markets, and large-scale government initiatives. Easier access to healthcare solutions Patients are becoming more empowered to monitor and improve their well-being through personal and wearable devices. They also want patient-centric and cost-effective healthcare solutions, so the use of tablets and smart phones for health monitoring purposes will continue to increase. In a market with a shortage of physicians, simple to use and artificial intelligence-powered PoC devices would enable untrained primary care field workers to effectively leverage the technology, improve access to affordable care and improve patient outcomes. Remote and virtual monitoring devices owned by healthcare organisations that patients take home for a period of time are another transformative way physicians can provide efficient patient care. Start-ups and OEMs also have started leasing programmes to make more expensive technology accessible to hospitals and clinics. Data collected from these devices by the healthcare industry and researchers could be used to predict disease incidences and epidemiological outbreaks. An expanding segment of monitoring devices is available for collecting and tracking data related to general vital signs (heart rate,

2. Patients are becoming more empowered to monitor and improve their well-being through personal and wearable devices.

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TECHNOLOGY

3 blood pressure,and temperature) or other metrics, such as electrocardiograms for those with heart issues or blood sugar for people with diabetes. The latest innovative products provide not only diagnostic monitoring but also provide physical therapy or adjust ongoing therapy of implantable devices. Using Bluetooth and similar technology, caregivers can track movements of elderly and vulnerable patients. The data is transmitted to health professionals to monitor these patients remotely and act on the information received as part of the treatment plan. Soon there could be less of a need for someone to visit the physician’s office. Telemedicine that extends connected solutions to patients who live in remote or rural areas or have transportation issues and would otherwise be challenged to return to the point of care, the physician’s office or hospital would be a true game-changer for the industry.

3. Telemedicine extends connected solutions to patients who live in remote or rural areas.

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Blending innovation across industries There is potential for medical device and imaging markets to leverage new technology platforms to reduce development time, save investment costs and lower barriers to market entry. Medical technology design must rely on distinguishing features and market adaptability to ensure it is in-line with global trends. Many innovations will carry forth a technology convergence that’s increasing health access for the Indian population. Globally this trend is creating an openness

MAY 2018 | HEALTHCARE RADIUS

to innovation in a highly regulated industry, allowing new technologies and products to be developed by companies outside of the healthcare industry. The likes of Google and IBM, for instance, are investing in technologies and building partnerships to be a part of this growth. The LV Prasad Eye Institute in Hyderabad is working with Microsoft to scale eye care services. We are in an age where knowledge bounds across different disciplines and affects innovation between sectors more frequently. The so-called developed economies represent a smaller percentage of the world’s population, and logically existing and start-up companies would more rapidly grow in populous and developing countries like India. These medtech manufacturers can produce localised medical devices that are affordable and better address the needs of the specific populations. The way people are adopting an interconnected way of living gives clues about how they want to approach healthcare such as being more involved and aware. Industry and government regulators have recognised this connection with end users and are clearly working to evolve development investment for how healthcare is delivered.

Brian Wyatt is Sr Vice President, Medical and Healthcare with Cyient, an engineering services and design company.


INNOVATION

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Safer healthcare through simulation Design engineers need tools that help them explore large number of design options BY RAFIQ SOMANI

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ccess to affordable and advanced healthcare is a key to driving innovation for healthcare companies focusing on India. This is going to be especially crucial for the 1.25 billion population in India. With increasing insurance coverage and also the surge in Government spending, there is a

large population in India who are looking at accessing high quality healthcare facilities. The need of the hour is better healthcare facilities. Along with this, there will also be a higher demand for medical devices and equipment. In the current scenario, there is a huge gap between demand and supply, especially local supply. Approximately 75%

1. Design analysis and review in the virtual environment will enable engineers to study cost-effective approaches.

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INNOVATION

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2. Simulation innovations are also instrumental in making healthcare safer.

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of medical devices and equipment in India are imported today. This makes the devices expensive and the treatment more expensive. In future, medical treatment will evolve to towards P4 Medicine. This includes Preventive, Predictive, Participatory, and Personalised. To achieve this goal, we need to continuously measure the virtual parameters that can define patient health. It is only through digital technologies such as artificial intelligence, VR/AR, 3D-printing, robotics or nanotechnology, that this can become a reality. To make it accessible to all, it is pertinent to ensure that this is affordable. Demand for affordable healthcare is never so high as today. The demand is huge when it comes to both cutting edge precision technologies as well as affordable low-cost technology. It is a fact that India requires both in order to provide quality healthcare access to its large population. Reducing cost without compromising on key functionalities of any medical device requires one to look for non-traditional design and development approaches. Yesterday's design practices will not help in achieving this aim.

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Design engineers need tools that help them explore large number of design options. This is nearly impossible to do using traditional build-and-test approaches. Design analysis and review in the virtual environment will enable engineers to study cost-effective approaches and in turn bring affordable devices and treatment to patients. Simulation technology will forever change the way healthcare is today and make it accessible to all. Engineering simulation help in achieving both these goals simultaneously – that of cutting-edge technology and affordability. Devices with complex designs can be tested in a virtual environment before making prototypes. This results


INNOVATION

in reducing risks and saving costs. Also, analysis in a virtual environment helps in reviewing several cost-cutting options. This helps companies in coming up with low-cost alternatives for the Indian market. Quality and affordable healthcare can become a reality. Companies have also been laying emphasis in creating product lines specifically for the local market. Deploying engineering simulation upfront in the design cycle will not only reduce the design and development time, but also ensure that the product is meeting the local needs of India. Competing goals of reliability, robust connectivity and low-cost can be achieved to create India specific IoT enabled medical devices using extensive usage of engineering simulation in the device design. Using simulation tools, one can start building virtual prototypes of new product ideas and concept. These virtual prototypes can be modified and tested with simulation hundreds of times in the same time it would take to build and test one physical prototype –saving time and money in perfecting the product design. Companies are also using simulation to speed up new process designs and regulatory certification in drug-manufacturing. Simulation innovations are also instrumental in making healthcare safer. Medical devices are getting technologically very complex with IoT, large number of embedded software and

4 controls, feature rich user interface and so on. Physically testing each ‘what-if’ scenario may not cover all the blind-spots. Simulation helps scientifically testing the limits of safe operations of medical devices and equipment, thereby reducing chances of failure scenarios. The medical devices sector in India is at a nascent stage with most of the indigenous manufacturing restricted to medical consumables. Considering the strong demand and the government’s ‘Make in India’ initiative, global and Indian companies are investing heavily in India. The Government of India's initiative is also incentivising design and manufacturing for the local market. What we have today is a very vibrant ecosystem of MNCs, SMEs, Start-ups, Government funding projects and academic participation in India who are working to bridge the gap between affordability and the cost of quality healthcare. So, there is no better time than now to adopt simulation technology to aid this revolution.

Rafiq Somani is Country Manager South Asia Pacific & Middle East at ANSYS, Inc.

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3. Deploying engineering simulation upfront in the design cycle will reduce the design and development time and ensure that the product is meeting the local needs of India. 4. Devices with complex designs can be tested in a virtual environment before making prototypes.

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IT

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Patients as priority Organisations have the responsibility of protecting the privacy and personal medical information of every patient BY RAJESH MAURYA

T 1. Following the WannaCry ransomware attack that hit India, protecting against ransomware has been a top priority for healthcare providers.

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he healthcare space is undergoing drastic changes in terms of operations and patient communication as a result of digital transformation initiatives and the patient-centric care movement. Healthcare providers are implementing new technology to improve patient care and outcomes. Such innovation has simplified physician-patient communication through applications and wearable devices, as well as physician collaboration through electronic health records and cloud analytics. Now, patients are able to talk to doctors and get medical care without physically going to medical facilities, and doctors are able to perform research leveraging newly available computing power. These advancements in healthcare have opened up immense opportunities for medical communities. However, they have also opened up opportunities for cybercriminals. Greater technology use means increased at-

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tack vectors for cybercriminals to target as a means to steal confidential data, with 90% of healthcare providers having been victims of at least one data breach in the last two years. Healthcare organisation also have the added responsibility of protecting the privacy and personal medical information of every patient. When it comes to protecting patient information and proprietary medical research, the healthcare industry faces significant cybersecurity challenges every day. The adoption of new medical technology—including electronic health records (EHRs), online patient portals, connected devices and wearables—offers improved patient care and convenience. However, it also creates greater opportunity for attack. Of all the industries affected by advances in cybercrime techniques, healthcare providers continue to be at high risk. That’s because providers not only store personal and financial data that’s extremely valuable to criminals, but their network systems are


IT

also very sensitive to interruptions. And with lives potentially on the line, they may be more motivated than other sectors to pay ransoms to decrypt or release hijacked network resources. However, this sector also historically lags in terms of technology adoption – including cybersecurity. Here are some of the top healthcare IT challenges: Speed -Time can be a matter of life and death Today, consumers, administrators, and physicians alike demand speed. People have become accustomed to having information rapidly available at their fingertips. Despite being necessary, security can often be seen as an inhibitor to speed, and particularly cumbersome security measures might have employees circumventing protocols altogether to get to information faster. In healthcare, where time can be a matter of life and death, it is crucial that security not slow operations down. Ransomware - Can have a catastrophic effect on medical facilities Following the WannaCry ransomware attack that hit India, protecting against ransomware has been a top priority for healthcare providers. Ransomware is a type of malware that encrypts a user’s or network’s data, and does not return it until a certain amount of money has been paid. Hijacked and encrypted electronic healthcare records can have a catastrophic effect on medical facilities as they attempt to treat patients without a full medical history on hand. Moreover, once data is returned, it can be difficult to validate that none of the records have been tampered with. As ransomware continues to target healthcare providers, healthcare security teams are adopting security controls to prevent and prepare for ransomware attacks, including redundant systems, offsite data backup, network segmentation, and effective security systems combined with real-time threat intelligence.

Geographical Distribution - Restrict access based on location Healthcare does not happen in a single space. Rather, it happens in labs and clinics and medical practices, sometimes located all over the world. As healthcare providers aim to secure the expanding borders of healthcare, they must implement access management systems that can restrict access to sensitive information based on location, user privileges, and roles. Fewer people with access to data means fewer data breaches. As such, only necessary employees should be able to access confidential information. Agile segmentation - Critical to mitigating risks from cloud adoption As healthcare organisations embrace more technology, they often look to cloud adoption as a way to enhance resource sharing, maximise efficiency, and reduce spending. As network traffic shifts from traveling north-south to east-west across the distributed network, internal segmentation is critical to mitigating risks brought on by things like cloud adoption, virtualisation, and mobility. As a result, agile segmentation is quickly gaining traction as a critical option in the healthcare space to drive security deep into the network infrastructure to provide

2. The key to cybersecurity is visibility; you cannot protect what you cannot see.

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IT

way to stay ahead of cybercriminals is to act immediately whenever and however they strike. Use big data analytics to examine and analyse these files in combination with AI and adaptive learning to mitigate the threat in order to detect and predict threats and threat behavior.

3 protections across business units, applications, and east-west traffic. Each of these healthcare technology trends improves the ability of healthcare professionals to provide high-quality care for patients, yet they also affect how IT professionals must approach cybersecurity. Thus, as medicine evolves to include greater digitization, security strategies and protocol must evolve alongside it to ensure strong functionality combined with defense in-depth.

3. Ninety per cent of healthcare providers having been victims of at least one data breach in the last two years.

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The role of AI in security The key to cybersecurity is visibility; you cannot protect what you cannot see. If you know what is happening in your network, at the granular level, you can quickly identify any anomalous behaviour and act to isolate it from spreading throughout your network. So then, the challenge is to take advantage of AI to address two critical issues: greater visibility and improved collaboration. Capturing and correlating all relevant threat intelligence from your entire network of sensors adds transparency to network operations. The next step is to combine this intelligence with metrics observed across individual networks to provide a benchmark for comparison. And, to expand visibility even further, healthcare organisations can create partnerships with vendors and other industry members to integrate local and global metrics to build an industry-specific knowledge base as a launching pad for AI-based analytics. There is an old saying in network security: “Attackers only need to be right once. You need to be right every single time.” The only

MAY 2018 | HEALTHCARE RADIUS

AI & automation: A winning combination Increasingly, adversaries are adding automation and machine learning to their attack toolkits at a rapid pace to better scale across the newly expanded attack surface. As a result, targeted systems need to become more intelligent and integrated. Driving towards intent-based security will enable organisations to leverage the power of automation and integration as critical tools to combat the constantly evolving ransomware and malware attacks on the horizon. Security needs to be able to operate at digital speeds, which means automating security responses and comprehensively applying intelligence combined with selflearning technologies, so that networks can make effective and autonomous decisions. To survive the sophisticated and increasingly intelligent and autonomous attacks currently being developed, healthcare organisations will need to replace organically developed, ‘accidental’ network architectures with intentional design that folds automation and AI into an expert system that creates actionable intelligence. In this way, healthcare providers will be able to detect and withstand serious and sustained attacks. High-quality patient care cannot be sacrificed for cybersecurity. Or vice versa. However, making security a secondary consideration can lead to major consequences for organisations and individuals in the event of a data breach or other security compromise.

Rajesh Maurya is Regional Vice President, India & SAARC, Fortinet.


MARKET

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Medical air market trends The global market for medical air is estimated at $1.12 billion BY ANVAR JAY VARADARAJ

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edical air is the reliable supply of clean, dry, filtered, medical grade compressed air that is compressed to about 345-380 kilo Pascal pressure (about thrice atmospheric pressure) for use in life support systems, and other medical procedures such as surgery. Compressed medical air is used to transport medicine and anaesthetics for inhalation, and for critical care ventilation. In the pharmaceuticals industry, oil and contamination free compressed air is required at every stage of the drug manufacturing chain. The global market for medical air is estimated at $1.12 billion annually,

growing at 8% every year including in India. Several international standards such as NFPA 99 in the US, CSA in Canada, NF EN ISO 7396-1, HTM 02-01 and European pharmacopeia specifications all make stringent requirements for the production and use of medical air. Oil-free screw compressors Atmospheric air drawn from the atmosphere, which is a mix of 78% nitrogen, 21% oxygen and traces of other harmless gases is filtered to remove all toxic impurities and compressed. Oil-free compressors are used to produce medical air in-house in an intensive and controlled process, and is rarely

1. Compressed medical air is used to transport medicine and anaesthetics for inhalation, and for critical care ventilation.

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MARKET

2 transported. The compressed air should not only be of high quality and consistency, but also be oil-free (compared to traditional air compressors which are oil-lubricated). The oil-free, compressed, cool, dry and filtered air is then either stored in high pressure cylinders or is distributed through installed medical gas pipeline system. Design for quality and innovation is one of the three universal processes of ‘Quality by Design’ pioneered by Joseph M Juran. The concept is that quality should be inherent, and should be built into the product itself with complete knowledge of the risks involved. Applying this principle, oil free reciprocating compressors should determine design measures to prevent contamination in the delivered air. Modern oil-freescrew compressors have rotors with multi-layer non-metallic, food-grade protective, non-corrosive coating that also serve the dual purpose of being dry lubricant. The timing gears and bearings that supports rotor rotation however need oil lubrication, and therefore, perfection in design should stop any oil from entering the compression chamber by sealing them. The case for oil-free air It is important to know that oil-flooded compressors have in the past decade, let out 10 million litres of oil impurities into the air, polluting the already stressed atmosphere. Oil-free air compression techniques,

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therefore, is not only favoured by the medical industry, but are also being increasingly adopted in a wide variety of other industries and applications. The roadblocks for high adoption of oilfree air compressors are the high investment costs, and the reduced efficiency, struggling to compete with oil-flooded machines. Manufacturers of air compressors are now shifting their strategy, and are not seeing oil-free and oil-flooded compressors are distinct industry segments. Companies are investing in finding ways to simplify current oil-free technology, reduce costs and improve efficiency. Technologies such as water injection are ways to lower costs and up the efficiency. Bigger organisations that need a large volume of medical air supply upwards of 4,000 CFM (cubic feet per minute) can also move to invest in centrifugal machines. Research is also on to find ways to reduce the size of centrifugal machines to cater to lower-volume requirements. The connected future Air compressor manufacturers are not restricting themselves to being mere suppliers in the value chain, and are seeking to take an active part in continuous monitoring of the functioning of installed air compressors by the use of data connectivity. Data transmitters fitted in compressors send back data on variations detected in volume, pressure, temperature, moisture, etc, for the quality team to proactively address failures by nipping issues in the bud. Oil-free compressors are thus expected to be adopted in a higher rate in future, and data will serve as a key enabler, forging valuable partnerships between manufacturers and operators.

Anvar Jay Varadaraj is Head - Marketing and Corporate Communication and ELGi Equipments.


Hr 01 05 2018  

Dr BR Shetty is founder and non-executive chairman of Abu Dhabi-based NMC Healthcare, one of the largest private healthcare providers in the...

Hr 01 05 2018  

Dr BR Shetty is founder and non-executive chairman of Abu Dhabi-based NMC Healthcare, one of the largest private healthcare providers in the...

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