Medgate Today ,Nov-Dec2012

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Volume III || Issue IV || Nov - Dec 2012

The Gateway to Health & Medical World

WORLD DIABETES DAY

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HEALTHCARE Architecture

News Update | Expert Views | Dental Hygiene | Health & Fitness | Product Line

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July–Aug 2012

3

Editor speak Volume-III Issue-III Nov-Dec 2012

World Diabetes Day 14 November 2012

Chief Editorial Adviser Dr. Pradeep Bhardwaj National Head Afzal Kamal Sr. Manager I.A Khurshid Cheif Correspondent SA Rizvi l Dr HN Sharma

W

orld Diabetes Day raises global awareness of diabetes-its escalating rates around the world and how to prevent the illness in most cases. Started by the International Diabetes Federation (IDF) and WHO, the Day is celebrated on 14 November to mark the birthday of Frederick Banting who, along with Charles Best, was instrumental in the discovery of insulin in 1922, a life-saving treatment for diabetes patients.

WHO estimates that more than 346 million people worldwide have diabetes. This number is likely to more than double by 2030 without intervention. Almost 80% of diabetes deaths occur in low- and middle-income countries.

IT Solutions & Consulting Healthcare extends beyond one person, in one department, in one building. It is an active process that requires communication, collaboration, and decision-making-across care providers and care settings. Siemens solutions help you eliminate silos, so patient information flows to the authorized care team-enabling better collaboration, and more informed and efficient decision-making.

We offer solutions that break down barriers to help you solve business problems, improve patient safety, strengthen the revenue cycle, and enable technology to improve patient care.

Learn how Siemens helps you achieve better patient outcomes with innovative information technology (IT) solutions today.

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E-mail: editor@medgatetoday.com

4

Editor Dr. m.a. Kamal

Design and Layout Mohd. Javed Ahmad Sales and Marketing Amjad Kamal Rahul Ranjan Neetu Sinha S.Y Ahmed Khan Subscribtion & Cirrculation Pallavi Gupta All right Reserved by all everts are made to insure that the information published is correct, Medgate today holds no responsibility any unlikely errors that might occur.

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July–Aug 2012

CONTENT Volume-III Issue-IV Nov-Dec 2012

16

Expert Views

Ms. Ameera Shah

Changing trends in Diagnostics Industry

18

Doctor Speak

Dr. Rajiva Kumar

Diabetes Toddlers in INFANTS & PRESCHOOLERS

DENGUE FEVER.................... 6 MEDTRONIC RESOLUTE INTEGRITY........

8

India Healthcare Industry 1H12.......

10

Dr. Reddy’s Announces........

12

GE Healthcare IT Showcases ...... 14 Muskotia Retreat Nainital.......... 32

22

Doctor Speak

Dr. M. Wali

DIABETES A SILENT KILLER

HEALTHCARE CONSULTANCY........

34

NABHAccreditation an.............

38

m-Health The Road Ahead......

40

SCIENTECH 14B, MULTI-PARA.........

44

EXCLUSIVE INTERVIEW WITH........

46

HOSPITAL FURNITURE TENDERS....... 48 The 3rd International........

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Cover Story

Dr. M. Wali

ARCHITECTURAL Challenges for DESIGNING HOSPITALS OF TOMORROW

52

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NEWS UPDATE

Dengue Fever D

engue fever , also known as breakbone fever, is an infectious tropical disease caused by the dengue virus.

Symptoms include fever, headache, muscle and joint pains, and a characteristic skin rash that is similar to measles. In a small proportion of cases the disease develops into the life-threatening dengue hemorrhagic fever, resulting in bleeding, low levels of blood platelets and blood plasma leakage, or into dengue shock syndrome, where dangerously low blood pressure occurs.

Signs and symptoms Dengue is transmitted by several species of mosquito within the genus Aedes, principally A. aegypti. The virus has four different types; infection with one type usually gives lifelong immunity to that type, but only short-term

8

immunity to the others. Subsequent infection with a different type increases the risk of severe complications.

As there is no vaccine, prevention is sought by reducing the habitat and the number of mosquitoes and limiting exposure to bites. Platelets in blood will be less than 1,00000 Mode of Transmission Dengue viruses are transmitted to humans through the bites of infective female Aedes mosquitoes. The disease is not directly transmitted from person to person.

Prevention and Control z z Vector control is implemented using environmental management and chemical methods. Proper solid waste disposal, elimination

of stagnant water in domestic environment and improved water storage practices. z z Aerosol and liquid spray has to be applied directly to the adult mosquito for effective killing, e.g. household pesticides. z z Mosquito coil and electric mosquito mat/ liquid has to be placed near possible entrance, such as window, for mosquito. z z Wear long-sleeved clothes and long trousers when going outdoors.

Bodies could be protected from mosquito bite by applying insect repellent (containing DEET) on the clothes and exposed part of the body especially when you travel to Dengue Fever endemic areas. z z Mosquito bednet could be used when the room is not air-conditioned.

Nov – Dec 2012

NEWS UPDATE

Medtronic Resolute Integrity™ Drug-Eluting Stent now available in India

S

peaking to the Media, India Medtronic’s Managing Director & Vice President-South Asia - Milind Shah said “The device combines deliverability, efficacy and safety, not to mention that it is the first DES approved for patients with diabetes. With India having the second highest Diabetic population in the world, the Resolute Integrity coronary stent is set to gain wide acceptance in the country. Medtronic looks forward to providing the benefits to the patients here.”

diabetes now have access in India for the first time to a medical device that has been approved by the FDA as a treatment option specifically studied and clinically validated for their particularly complex and potentially life-threatening health conditions. Historically patients with diabetes who undergo PCI have been a difficult-to-treat patient population. They tend to The Resolute Integrity DES have smaller and often tortuous builds on the success of the mar- arteries, longer lesions, diffuse disket-leading Integrity bare metal ease and a higher rate of treatment stent. The Integrity platform’s failures including relatively high rapid adoption is the result of a rates of repeat procedures and Its approval by the FDA is based proprietary engineering advance stent thrombosis. on the impressive performance of called continuous sinusoid techthe Resolute DES in a wide variety nology (CST).CST encompasses Medtronic offers a broad range of patients. The global RESOLUTE one continuous, single strand of of innovative medical technology clinical program consisted of a wire that is molded into a sinu- for the interventional and surgilarge randomized controlled trial soidal wave and then wrapped in cal treatment of cardiovascular and a series of confirmatory sin- a helical pattern and laser-fused at disease and cardiac arrhythmias. gle-arm studies involving nearly certain points, making each stent The company strives to offer prodcomparable to a flexible spring. ucts and services that deliver 250 sites in 32 countries. clinical and economic value to With the Resolute Integrity healthcare consumers and proIn total, the program enrolled more than 5,100 patients who DES, patients with both CAD and viders worldwide.

10

received a Resolute DES; about a third (1,535) of these patients had diabetes. With the device’s compelling combination of deliverability, efficacy and safety, not to mention that it is the first DES approved for patients with diabetes, the Resolute Integrity DES promises to gain rapid acceptance nationwide.

Nov – Dec 2012

NEWS UPDATE

India Healthcare Industry 1H12

H

ealthcare covers the sector overview, sector size, competitive landscape and enviromental scanning for India. It also covers the market trends and outlook, health status indicators, infrastructure, human resources, medical equipments, medical tourism & health insurance, foreign investments and industry forecast, plus the profile, comparative matrix and SWOT analysis of the industry leading players:

of 15% and is expected to cross USD 75 bn by the end of calendar year 2012.

The country was ranked amongst the lowest in terms of government spend on infrastruc-

in terms of average number of hospitals, hospital beds, doctors, nurses and other paramedical staff.

The huge population accompanied with large prevalence of communicable and non-communicable diseases demands large scale

z z Apollo Hospitals Enterprise Limited z z Fortis Healthcare Limited z z Opto Circuits India Limited z z Executive Summary Indian economy saw a period of slowdown in fiscal year 2012. The country recorded a GDP growth of 5.3% in the fourth quarter which was its worst performance in last nine years.

However, Indian healthcare industry continued to show resilience in the face of slowdown with leading healthcare players recording a double digit growth, both in revenues and net profits.

The industry is growing at a CAGR 12

ture which was around 1.2% of GDP in 2010. Fiscal year 2012 saw a 13% increase in government budget allocation to the flagship programme named National Rural Health Mission (NRHM). The programme has been quite successful in raising the standards of people’s health, healthcare infrastructure and healthcare delivery across the country within a short span of seven years. However, the country is likely to miss the healthcare targets for 2015 under Millennium Development Goals.

Huge demand supply gap exists in the healthcare sector of India.

The country was lagging behind

development and growth in this sector. Private sector is playing a big role in this regard accounting for more than 70% of country’s health expenditure.

The outlook for Indian healthcare is positive owing to double digit growth rate in almost all of its segments, whether its primary healthcare, secondary and tertiary healthcare, medical equipments, disgonotics, health insurance or medical tourism. The ever growing population, increasing government expenditure on health and growing per capita income will increase the size of this industry in the years to come.

Nov – Dec 2012

NEWS UPDATE

Dr. Reddy’s Announces the Launch of Montelukast Sodium Oral Granules

D

r. Reddy’s Laboratories (NYSE: RDY) announced today that it has launched Montelukast Sodium Oral Granules, a bioequivalent generic version of Singulair® (montelukast sodium) oral granules in the US market on September, 26, 2012, following the approval by the United States Food & Drug Administration (USFDA) of Dr.Reddy’s ANDA for Montelukast Sodium Oral Granules.

The Singulair® Oral Granules brand had U.S. sales of approximately $61 million for the most recent twelve months ending July 2012 according to IMS Health*.

Dr. Reddy’s Montelukast Sodium Oral Granules in 4 mg are available in unit dosage package of 30.

Assessment of the Indian Probiotics Market

T

he Indian probiotic industry is developing at a steady rate with the environment set for huge growth in near future. Although the market in India is still in a comparatively nascent stage, it is expected that it will grow at a CAGR of 11 per cent by 2016. The key driver will be the awareness campaigns endorsing its benefits. In a country like India, it is of paramount importance that the advantages of consuming probiotic-fortified foods are explicitly communicated to consumers.

India at present accounts for little more than 1 per cent of the total global market revenue in the probiotic sector and it is an enormous shortfall taking into consideration the fact that India has the maximum cattle population and is the world’s largest milk producer.

14

Philips and Elekta announced that they were working on an MRI-guided radiation therapy unit they say could help make cancer treatments more accurate.

A

prototype has already been built at the University Medical Center Utrecht in the Netherlands that combines a 1.5-Tesla MRI scanner with a linear accelerator.

Now that the prototype has been developed, the two companies will create a limited number of pilot systems that can be used by a consortium of radiation oncologists and doctors that will help develop the technology. The consortium so far includes University Medical Center Utrecht, Philips said.

Elekta, best known for its Gamma Knife radiosurgery equipment, and the Dutch conglomerate recently signed a multi-year joint development agreement, a spokesman for Philips said in an e-mail.

Elekta president and CEO Tomas Puusepp said the technology has the potential to “revolutionize cancer care” by using MRI’s soft-tissue imaging to make treatments more precise.

“The need to maximize therapeutic radiation on the target, while minimizing the exposure of healthy tissue is entirely driven by the best interests of the patient — they deserve the best chance for a cure and an improved quality of life,” he said in a statement.

However, when this system comes to market, it won’t be the first MRI-guided radiation therapy unit to be released. In May, Cleveland-based View Ray Inc. received Food and Drug Administration clearance for its MRI-guided Cobalt system.

Also, this isn’t Philips’ only MRI-guided cancer treatment endeavor. The company is also working on the MR-guided High Intensity Focused Ultrasound system, which uses MRI to guide focused blasts of ultrasound to heat up and destroy tumors.

Nov – Dec 2012

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NEWS UPDATE

GE Healthcare IT Showcases its Latest Innovations at HIMSS, Singapore

G

E Healthcare IT, a division of General Electric Company, will be exhibiting regional firsts among its latest range of IT solutions at this year’s HIMSS AsiaPac12 Conference and Exhibition, from 17-19 September at the Marina Bay Sands, Singapore, on stand #527. Additionally, a full slate of Company experts will be featured as part of the AsiaPac12 conference speaker series.

At the expo, GE Healthcare IT will demonstrate how its broad portfolio is helping to fulfill the needs of its customers, in particular supporting the aim of providing patients with access to high quality healthcare in a cost effective and efficient way.

“The face of healthcare is changing and we are entering a time of ‘collaborative care’ which is a patient-driven, outcomes-driven method of delivering healthcare,” said Mitchell Silong, General Manager, GE Healthcare IT, Asia Pacific. “IT helps make this possible by linking together information from across the healthcare delivery system (inpatient, ambulatory, and home-based) to generate new insights that contribute to improved patient outcomes.”

A key theme running through GE Healthcare IT’s latest innovations is accessibility. Clinicians want to access all types of patient data at the touch of a button from anywhere at any time. In particu16

lar, they want to improve work flow and be able to share information and collaborate with other specialists to make clinical decisions more quickly.

“Our IT solutions connect data from across departments, the hospital enterprise and the region to provide a comprehensive view of the patient, and have been developed to give clinicians access to the right, quality information precisely when they need it,” continued Mr. Silong.

“This is particularly significant in ASEAN where we are addressing the need for care in remote areas through teleradiology. We believe moving data, rather than moving the patent is the most efficient way to allow access to the best care available, specifically for rural areas.”

Highlights of the company’s broad portfolio of technologies on display on the GE Healthcare IT stand include: Radiology z z The GE Centricity* Radiology Information System (RIS), offering the latest generation of community-wide radiology workflow sharing capabilities z z A Web based PACS viewer for global reading across enterprises which is deeply integrated with RIS through a single user interface

z z A four-level Vendor Neutral Archive which allows patient records from across different hospitals, to be consolidated and stored using industry standards2 z z A Clinical Patient Information Viewer which provides access and viewing of patient histories to multi-disciplinary teams throughout the patient’s health community z z Centricity Radiology Mobile Access (CRMA) allows clinicians and radiologists to quickly find images and reports through the AccessNow app, on their mobile device - iPhone, iPod,Touch, android Touch.

High Acuity Care z z The Centricity Perioperative software is highly adaptable management software to streamline workflow and help enhance patient care before, during and after surgery Cardiology z z Launching for the first time in Asia, Centricity Cardiology Enterprise is a tightly interfacedcardiovascular IT solution that includes both CVIS (Cardiovascular Information System) andCVPACS (Cardiovascular Picture Archiving and Communications System) functionality,providing clinicians full access to a single comprehensive, web-based patient record.

Nov – Dec 2012

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EXPERT VIEWS

There are numerous opportunities for the Pathology sector, as India has emerged as a preferred healthcare destination.

Ms. Ameera Shah Managing Director and CEO, Metropolis Healthcare Ltd.

Changing trends

H

ealthcare is one of the key parameters in which a country’s development and key stature is measured. Being one of the largest sectors in terms of revenue & employment generation, the healthcare industry is growing rapidly with expectations to become a US$280 billion industry by 2020. Healthcare industry comprises of pharmaceuticals, hospitals & diagnostics. However, diagnostics in India forms an integral part of the healthcare industry which comprises of hospitals and allied sectors such as; pathology, medical equipments & supplies, medical tourism and private medical insurance.

The industry is comprised of more than 100,000 labs across the country and only 10% of the

18

in Diagnostics Industry

market is consolidated by few major players. The current market exhibits strong demand and huge investments and therefore the organized sector is expected to command close to 50 % market share by end of this decade.

Key dimensions that shape the market growth are – z z Resource information available to the patients z z Compliance programmes / rewards z z Clinical diagnosis & Direct Drug marketing z z Disease management programme

z z Wellness Movement z z Competitive environment by the healthcare providers Major segments which need services of diagnostic players are Doctors who prescribe tests to patients, corporate clients for wellness programmes and clinical trial lab support as well as routine laboratories and hospitals who need a referral center for specialized tests. With the rising awareness for healthcare, demand for good quality diagnostics has grown as well, and customers prefer to partner with laboratories demonstrating high levels of accuracy and services. The other major change has come through advances in technology and auNOV – DEC 2012

EXPERT VIEWS

tomation of equipment, resulting in reducing the turnaround time for reports and providing quicker diagnosis. Molecular diagnostics and Diagnostic Medical Imaging are the rapidly growing fields in the Indian diagnostic market.

The core focus is to provide convenience to customers, be it through all varieties of tests processed in India, home health services, using technology for result communication or providing a network of collection centres for easier access. All these changes have contributed to the consolidation of the lab industry.

range and utility of tests

convergence with the radiology services will enable culmination z z Lack of proper coverage under into service of Prognosis Monihealthcare insurance toring based on Radiology / Lab Results. z z Accreditation of healthcare facilities Way Forward z z Dearth of skilled personnel

z z Penetration of health insurance

z z Resistance from Government policy makers

z z Further consolidation amongst organized players and entry into smaller towns

India is soon becoming a hub for alternative medicine. Even at a very basic level, there are emerging pressures in demanding insurance and health plans for national healthcare. Suddenly we are witnessing a robust penetration of Insurance in the Healthcare Industry and reformation of health insurance schemes has taken precedence.

Although the entire scenario remains highly fragmented, the market is witnessing rapid expansion with organized diagnostic centers adopting innovative business models. Moreover, the mounting number of diagnostic centers and tests are proving lucrative for both Exploring the Opportunities: foreign and domestic players.

There are numerous opportuIndustry growth however comes nities for the Pathology sector, as along with some challenges India has emerged as a preferred healthcare destination. Consoliz z Vast geography poses logistical dation of organized players and issues the health insurance industry is opening for privatization. Diagz z Affordability of new tests and nostic centers are now harboring accessibility of new centres advanced laboratory techniques like Molecular diagnostics, Nanz z Uniqueness of each market in otechnology and Multiplex assays terms of culture, language and using Micro arrays to provide betcustom differences ter diagnosis. There is complete automation covering various laboz z Competition from regional ratory segments from pre-analytics players to final reporting.

z z New advances in Home ( non-invasive glucose monitoring) and Point of Care Testing z z Pathology and Radiology getting recognized as specialized areas of medicine rather than “support areas” z z Convergence of pathology and radiology services to reach a final diagnosis- Prognosis Monitoring based on Radiology / Lab Results) z z Support a paradigm shift towards integrated, preventive health care z z Promote financing systems and policies that support prevention in health care z z Equip patients with needed information, motivation, and skills in prevention and self-management z z Make prevention an element of every health care interaction

z z The healthcare system requires z z Lack of awareness among Pathology industry has central- to be upgraded and in some cases healthcare professionals for the ized its focus on “brands” and its completely re-imagined NOV Nov –– Dec DEC2012 2012

19

DOCTOR SPEAK

World Diabetes Day 14 November

Diabetes Toddlers in Infants & Preschoolers The target range for these young children is to achieve pre-meal sugars of 6 to 12 mmol/L (110 to 220 mg/dL). This range allows good blood glucose control while reducing the risk of severe hypoglycemia.

Dr. Rajiva Kumar

Child Specialist, Muzaffarpur

T

ype 1 diabetes is less common in preschoolers than in older children and adolescents. Less than 1% of diabetes is diagnosed in the first year of life. Less than 10% is diagnosed before the age of 5. The diagnosis is often missed in younger children for 2 reasons. The first is because diabetes is less common in younger children. The second is that the symptoms are often confused with other minor illnesses.

A baby might be in severe diabetic ketoacidosis before a diagnosis is made. Once the disease has been diagnosed, however, the situation can be corrected quickly and longterm management can begin.

When it comes to managing diabetes in young children, It’s helpful to first consider how nor-

20

Nov – Dec 2012

DOCTOR SPEAK

mal infants and toddlers behave.

Diabetes care in young children: Diabetes care in children under 5 involves a balance between what might be considered ideal–close to normal blood sugar readings– and what is safe and practical.

The target range for these young children is to achieve pre-meal sugars of 6 to 12 mmol/L (110 to 220 mg/dL). This range allows good blood glucose control while reducing the risk of severe hypoglycemia. Too tight control in infants and toddlers is especially risky as they cannot yet recognize the symptoms of low blood sugar. Repeated episodes of severe hypoglycemia in these children may lead to mild intellectual or learning impairment later in life.

Very young children often have changing appetites. They don’t always eat the same amount of food from day to day. It’s important that the diabetes care routine reflects that. If blood sugar levels before meals are allowed to go slightly higher than for older children, the infant or toddler is more likely to remain safe even during periods of food refusal or picky eating.

Parents will be less worried and frustrated, and mealtime will be more pleasant. For safety’s sake, young children should eat at regular meal and snack times, having at least 3 meals and 3 snacks a day. But beyond that, imposing a rigid meal plan on an infant or toddler may only increase the stress in the family.

22

World Diabetes Day 14 November

As children grow they become more predictable in their eating.

They can also start to recognize and describe their low blood sugar reactions. At that time blood sugar targets also change. More structure in meal planning becomes both possible and necessary.

Signs of a healthy infant or toddler with diabetes: How do parents and others who care for your children know that everything is going well? Look for:

z z blood sugar readings that are not often less than 6 mmol/L (110 mg/dL) z z blood sugar readings that are not over 12 mmol/L (220 mg/dL) for long periods of time z z a happy and secure attitude in the child Impact of diabetes on an infant & toddler:

Young children with type 1 diabetes go through the same stages of development as their friends z z normal growth and weight gain without diabetes. However, the z z developmental milestones, such routines and tasks needed for good as rolling over, sitting up, crawling, diabetes care may influence and standing, walking, and talking at sometimes interfere with this development. All parents of young about the expected age children with diabetes worry about z z no signs of high blood sugar the effects of diabetes on their levels, no overly wet diapers, no growth as individuals, and how unusual thirst they will cope with the condition as they grow older. z z good energy z z few mild low blood sugar reactions, and no severe reactions

Parents are often concerned about:

z z no ketones in the urine

z z the fact that their young child

Nov – Dec 2012

World Diabetes Day 14 November

cannot talk about symptoms of hypoglycemia (for example, is the toddler having a hypoglycemic spell or a temper tantrum?) z z dealing with their own and their child’s anxiety about the pricks and injections z z developing a treatment plan that does not interfere with the child’s normal daily activities, including naps

or family member help with the diabetes routines on a regular basis. This prevents the toddler from playing one caregiver off against the other. The parent, the toddler, and the support person can remain confident that the child will be safe in the parent’s absence. z z Acknowledge your child’s feel-

z z giving meals and snacks on time and in the same amounts (toddlers with picky appetites can really cause stress at mealtimes) Try to balance your child’s need for support against the risk of overprotection and being excluded from activities they would normally do at that age.

Coping strategies Some helpful hints in coping with diabetes in a young child include: • Try to adopt a matter-offact approach to insulin injections, finger pricks, and mealtimes.

Young children quickly pick up on parents’ anxieties and use them to control their environment. Try to be quick, calm, and reassuring when carrying out routines. Reduce your child’s fears by preparing the insulin or blood testing equipment in another room before involving your child. When it’s over, give her a big hug and kiss. z z Share responsibility for the routines wherever possible. In single-parent families, have a friend Nov – Dec 2012

DOCTOR SPEAK

avoid insulin injections and finger pricks. Sometimes it’s because the needle hurts. More often they are angry about being held still or having their play interrupted.

Remember how hard it is just to wipe a toddler’s nose! They may also be reacting to the fear and anxiety they sense in you. Here are some helpful hints for making injection time go more smoothly: z z Try to take a matter-of-fact approach to the insulin injections and finger pricks. z z Be quick, calm, and reassuring when you carry out these routines.

ings and provide reassurance, but don’t delay needles or finger pricks until he is “ready.” Consider using distractions such as toys, songs, or television. z z Try to allow your child to have some control over the routine if she wishes. For example, she can choose the finger for the next prick. z z For the really picky eater, set limits on time allowed for meals and snacks. Don’t sit for hours fighting over each piece of food.

The child always wins.

Making injection time go smoothly It’s not unusual for children of all ages to go through periods when they cry, squirm, and try to

z z Reduce your child’s anxious time by getting the dose and/or equipment ready before you involve your child. z z If possible, go where your child is playing to cause less disruption. z z Crying, protests, and other delaying tactics are normal. Remember that each time you give insulin or do a finger prick you are helping your child stay healthy. z z Gently hold or restrain your child if she struggles. z z Get the needle or finger prick over with quickly. Delaying it only prolongs the agony for everyone. z z Give your child a big hug and kiss after you give the needle, even if she didn’t cooperate. z z Praise your child for any sign of cooperation.

23

DOCTOR SPEAK

World Diabetes Day 14 November

diabetes a silent killer

Diabetes Mellitus is going to be one of the greatest killer in next twenty years and India is going to be capital of Diabetes by 2050

Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use can prevent or delay the onset of type 2 diabetes.

Dr. M. Wali

Physician to the President of India

D

iabetes disorder:

a Lifestyle

Diabetics have to maintain a healthy lifestyle that includes lifestyle modification and healthy eating. z z 347 million people worldwide have diabetes z z In 2004, an estimated 3.4 million people died from consequences of high blood sugar. z z More than 80% of diabetes deaths occur in low- and middle-income countries. z z WHO projects that diabetes deaths will increase by two thirds between 2008 and 2030.

Most of the people do not know when they have become diabet-

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ic, so it is very important to get checks for diabetes. Once at the age of 6months in the infancy then at 2 years and then 5 years and later on at college going age and thereafter at the age of 35, 50 and 70 years respectively.

Women an become diabetic during pregnancy who are otherwise normal as per the sugar parameters. It becomes very important to look for diabetesduring ante- natal care so the Gynecologist and obstetricians have a very responsible job in the future years not to miss any diabetic patients.

Diabetes involves the body from head to toe. It causes complication in Heart, Eyes, kidney, Brain, Blood vessels and almost all of the organs of the body. Diabetes can be treated once a person knows that he is diabetic. So it

is very important to detect diabetes and to diagnose it early because if the diabetes is caught early, the outcome of treatment is much better especially in the target organs mentioned above are protected and the complication are minimized. Sudden death ,stroke, Kidney failure, blindness and fetal deaths are common complication which can be avoided with proper medication and lifestyle changes.

Monitoring of diabetes is also very important and school going children should be encouraged to come forward for early detection of diabetes. The cutoff sugar level as per W.H.O definition is 126 mg/ dl in fasting state and glycosylated hemoglobin values of more than 6 are suggestive. One should be very careful if one has three cardinal symptoms of diabetes such Nov – Dec 2012

DOCTOR SPEAK

World Diabetes Day 14 November

as Poly-urea (Frequent passing of Urine) Polyphagia (Increased Appetite) and Polydypsia (Disproportionate excessive thirst) .Should the above symptoms persists one should immediately consult the doctors.

How can the burden of diabetes be reduced?

Prevention: Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of type 2 diabetes. To help prevent type 2 diabetes and its complications, people should: z z Achieve and maintain healthy body weight; z z Be physically active – at least 30 minutes of regular, moderate-intensity activity on most days. More activity is required for weight control;

three and five servings of fruit and vegetables a day and reduce sugar and saturated fats intake; z z Avoid tobacco use – smoking increases the risk of cardiovascular diseases.

347 million people worldwide have diabetes

WHO projects that diabetes deaths will increase by two thirds between 2008 and 2030

In 2004, an estimated 3.4 million people died from consequences of high blood sugar.

More than 80% of diabetes deaths occur in low- and middle-income countries.

z z Eat a healthy diet of between Nov – Dec 2012

25

COVER STORY

Architectural Challenges for Dr. R. CHANDRASHEKHAR B. Arch. HFP Phd. FIIA FIHE MAHA Chief Architect (Govt. of India)

26

Designing Hospitals of Tomorrow Nov – Dec 2012

COVER STORY

H

ospitals are the most complex of building types that we often come across in our lives. Each hospital comprises of a wide range of services and diverse types functional units. A functional design can promote skill, economy, conveniences, and comforts that we often seek in a hospital.

complexities of Hospital Designing, we must understand that there are two types of hospital projects that we often accomplish to serve the varied types of healthcare needs of the mankind. We can broadly categorize them into two types: The Green Field Project and the Brownfield Project.

project whereas a Brownfield Project focuses on the modernization, remodeling and expansion of an existing hospital.

Brownfield Hospitals

A Brownfield Project is often considered as a popular model where the existing structures are A Green Field Project is the utilized to build something which However, keeping in mind the commencement of a new hospital has more functional advantages.

Nov – Dec 2012

27

COVER STORY

ity, the review of the existing technology to meet the current standards.

The increased efficiency becomes a key element.

For optimization of the Brownfield projects, some of the key issues are: tity”.

Since the loss of functionality poses a major economic burden, such projects are gaining more acceptance today where the objective broadly revolves around the reduction of the direct economic losses of non-functional hospital units by bringing in modern and advanced facilities fulfilling the varied heathcare needs “A business model which utilizes existing infrastructure, local resources, trains local manpower, corrects deficiencies and overrides constraints by constantly innovating ,Referred as “Light Asset Model” of expansion which can be replicated fast and has low gestation.

“A retrofit model of expansion which optimizes on all available resources in the vicinity & yet manages to create its own brand iden28

Even in the Metros, when local body clearances from different departments involving various formalities delay the project, the utilization of the existing envelope of the building saves you from taking any municipal sanctions.

Hence, remodeling of an existing hospital can be a viable option.

The purpose of Brownfield hospital is to achieve optimization of an existing infrastructure which leads to functional excellence required for the healthcare needs of the public and staff. The project may aim at the improvement in elevations and interiors to suit the modern-day needs and also achieve green architecture/ healing environment. The various facilities mixed to suit the latest needs and these can be augmented by the engineering services such as medical gases, DG sets, HVAC with required air changes and electrical needs suiting the latest technologies and equipment. And in total-

z z Budget: Financial analysis, work of the Financial Team. z z Execution: for infrastructure developments, the Project Management Team. z z Technology: Engineering and Bio-Medical Team to understand and use resources. z z Resources: HR Team z z Operations & Commissioning: A dedicated team to fine tune and monitor the execution and commissioning of the Project as per schedule.

These Teams can be In-House Teams or Outsourced from professional healthcare consultancy firms or institutions.

The success of a Brownfield project lies in Accurate Analysis of Existing Infrastructure, utilisation of Existing Technology and Manpower, meticulous planning ,viability analysis and due diligence practices, precise project planning and a budget planning , up gradation needs and commissioning process, & HR activities.

Nov – Dec 2012

COVER STORY

Implementation of the project with proper monitoring system can result in timely completion of a project with optimization of Resources, which may attributes to Financial gains in terms of reduced cost of project, increased return on investment, fast replicability.

With these upgrade, the existing infrastructure can be successfully utilized to augment the level of care. The expansion possibility and the architectural facelift can turn the built up area to look more pleasing and functional. However, it also has to address important elements like cordoning the site, providing timely logistic services, material handling, operating essential departments and ensuring adequate supply of electricity, water supply etc., utilizing and upgrading the technology of available existing equipment and introducing new technology. Additionally from a manpower point of view, it should look at re-appropriating the skills of the operating staff, absorption of staff in requisite manner and training of the available manpower.

One may also have to follow a robust organizational process for speedy commissioning and quality management system, IT technology, and finally accreditation rules to be followed for motivation.

In green field projects, which are generally done on a virgin or a new site, the process begins with the selection of the site. While selecting the site, one has to be careful of the location with respect to the geological phenomenon of that area, i.e assessing whether the area is prone to earthquakes, volcanic eruptions, landslides, Tsunami, hurricane or flooding, because these factors do have bearing in the working out of the right kind of structure, plinth level of the building etc. Then follows Master planning strategies in which you always work out a complete master plan, and every design should have a planned zone for the future growth and these can appear as dotted lines on the site plan. Or, these may be developed as constructed unoccupied shell space or as structural capacity to allow for future vertical addition to a building.

Hence, any master plan layout will have an Institutional zone consists of Hospital zone, an Academic zone, Services zone, these will deal with bulk services like electric room, generators, Air conditioning plant, overhead tanks, underground tanks etc and the hostel facility will be housed in a Residential zone and a green buffer is planned to segregate residential and institutional zones.

From the Macro-zoning, the planning is carried on to Micro-zoning in which various configurations in terms of blocking are done based on the facilities to be accommodated in a particular floor plate e.g. floor consists of cardiology, cardiac

Green field hospitals Nov – Dec 2012

29

COVER STORY

surgery with their respective OPD, IPD etc. And if it’s a teaching institution, a faculty area should be located in the same level and various such groupings on the basis of their specialization are stacked one upon another on different floors with a common floor where extensively service oriented facilities like OT, ICU, Endoscopy, dialysis etc. can be accommodated.

Importance is also given to the functional circulation by segregating different types of traffic that include the movements of the patients, doctors and support services. Each department is planned after identifying activities and activity sequences to achieve smoother functional relationship.

Every design should have a strategy to deal with the issues surrounding flexibility, convertibility robust utility and expandability.

These are achieved in modern days by working out with a pre-engineered structure, nicknamed as ‘Plug & Play’ infrastructures. These light weight structures can be used independently as a loose-fit design.

The concept of loose fit design is more appropriate f o r

30

larger spaces that can be used for more than the minimum functions originally proposed. And to arrange in departments or regrouping that allow for future expansion.

While incorporating the flexibility in design, spaces can be designed to adapt to multiple designs . An example is a patient room that can be adapted for the purpose of simple procedures such as a line insertion. The different function can be accommodated by simply adapting the space because it has been planned to serve a range of possibilities

simplifies and dramatically reduces the cost of the future project.

We also need to understand that in the healthcare infrastructure, we need to address convertible flexibility which is a type of flexibility with relatively low effort, time, and/or cost, a space can be converted to another use. Example : a patient room with plumbing, gasses, and electrical systems in the wall for future conversion to critical care.

Indoor Air Quality (IAQ)

In order to offer flexibility in design, the utility and communication infrastructure of a healthcare facility should be capable of expansion and upgrade. The availability of utility and network c ap a c it y

Both project types have their own set of complexities and have desired goals to achieve that we need to keep in mind while working on any hospital projects. There are, however, key elements that can be commonly applied while working on any of the above hospital projects. Some of these elements have been discussed here for your benefits:

The importance of indoor air quality (IAQ) is very critical in hospitals and healthcare facilities. Hospital air conditioning plays a more important role in help maintaining the total hygiene and prevention of Hospital Acquired Infection (HAI) within the hospital environment than merely being a source of comfort. In many cases, proper air conditioning and improved indoor air quality can be an important aspect in patient therapy while in several cases it could be a part of the treatment itself. Thus properly designed air conditioning systems are imperative in a hospital with specific requirements for ventilation, filtration and cross-con-

Nov – Dec 2012

COVER STORY

tamination.

Use of Environmental controls to prevent the spread and reduce the concentration of infectious droplet nuclei in ambient air.

Primary environmental controls consist of controlling the source of infection by using local exhaust ventilation (e.g., hoods, tents, or booths) and diluting and removing contaminated air by using general ventilation Secondary environmental controls consist of controlling the airflow to prevent contamination of air in areas adjacent to the source (AII rooms) and cleaning the air by using high efficiency particulate air (HEPA), filtration, or UVGI (Ultra Voilet Germicidal Irradiation).

Improperly maintained HVAC systems may cause symptoms associated with Sick Building Syndrome (SBS). SBS symptoms that may be attributed to moisture with the HVAC systems .”Humidification systems with poor condition/ maintenance are associated with significantly increased upper respiratory symptoms, eye symptoms, fatigue/difficulty concentrating, and skin symptoms. Less frequent cleaning of cooling coils and drain pans are associated with significantly increased eye symptoms and headache. Symptoms may be due to microbial exposures from poorly maintained ventilation sysNov – Dec 2012

tems and to greater levels of vehicular pollutants at air intakes nearer the ground level.

The Indoor air quality is generally maintained by use of filters in HVAC which generally prevents particulates gasses and microbial . However the trapped pathogens are in the filter bank and never killed. Thus forming colony of pathogens. Hence judicious utilization of ‘UVGI’ (Ultra Violet Germicidal Irradiation) is recommended in HVAC. Or using the Photo-Hydro-Ionisation,(PHI) in the AC system where-in Hydrogen based oxidizers are created by exposing activated oxygen molecules to a hydrated catalyst containing four unique metals and 300 nm UV light (Photon Energy).

These Friendly Oxidizers are…

Hydro-peroxides, Hydroxides, Super Oxide Ions, Ozonide Ions.

Friendly Oxidizers are blown into the conditioned space, Microbes and gases are destroyed on contact.

Oxidizers break down into oxygen and water vapor. this system kills airborne and surface pollutants.

Hospital acquired infections

Most infections that become clinically evident after 48 hours of hospitalization are considered hospital-acquired. It was also established that 80% of HAI are thru Touch surface.

“The Direct Cost of Healthcare Associated infections in the UK alone is 1 billion GBP each year” Antimicrobial Copper is the most effective touch surface material, killing greater than 99% of bacteria within two hours of exposure. No other material, such as silver-containing coatings, comes close !

Copper and copper alloys have intrinsic antimicrobial properties with well documented efficacy against a wide range of pathogens. The Copper Development Association (CDA) has conducted a series of laboratory tests under Environmental Protection Agency (EPA) Good Laboratory Practices (GLP) protocols that have provided evidence that copper surfaces kill microbes in a matter of hours.

Antimicrobial Copper isn’t just pure copper, It’s shorthand for a host of copper alloys that can be formed into

31

COVER STORY

DURABLE WEAR RESISTANT CAN STAND UP TO HARSH ENVIRONMENTS CAN RETAIN DETAILS AND FINISH OVER TIME -Affordable touch surfaces can be available in a variety of colours and finish options.

Green Architecture Many of the amenities that newer hospitals are becoming known for consume lots of energy. Thus, it’s has become important for the design architects to blend green architecture elements with health care design so that consumption of energy can be minimized to a certain extent. One of the benefits of incorporating green architecture 32

elements is to make the hospital en- efficiency of the staff. Such evivironment more patient-friendly. dence will also allow facility design and construction to be flexible, The Healing architecture or adaptable and future ready. the Evidence based health care architecture creates safe and ther- Building Information apeutic environment for patient Management care and encourages family involvement. It promotes efficient It expands benefits to hospistaff performance and is restorative tal design and operations and infor workers under stress. It allows cludes a better design coordinafacilities professionals to use sci- tion between different disciplines. entific research to Plan, Design, It also systematically assembles Construct and Operate health care structured information about the facilities that are geared towards health facility for project manager promoting not only treatment but from planning, commissioning more conducive healing and work- and maintenance point of view. It ing environment. saves time and helps avoid errors in project implementation. ConEvidence-based Design is sidering the green building patransforming the healthcare en- rameters, the design should come vironment by providing proven with a compact plan, increased architecture methodology to im- efficiency with a better control of prove patient outcomes, safety, the useable area and ease of future and satisfaction, as well as service expansion. Efforts should be made Nov – Dec 2012

COVER STORY

to reduce the travel distances of people and services.

Hospital Design safety measures

patients, doctors and other staff.

Emergency Exit

Hospitals should also make sure that clinical parameters with regards to the patient safety must be adhered to, in order to make a hospital safe in terms of structural and non-structural members.

Hence every hospital should strictly follow codes of structural safety and safety from non-structural members such as False ceiling, A/C ducts etc...

The evacuation plan with blending of open spaces and built spaces with a proper fire escape, staircases and routes, proper refuge areas for easier evacuation are important for a multistoried structure. The appropriate signage (way finding) and display of evacuation routes in different parts of building need to be included. These important safety measures will build confidence among patients and give them a sense of security in the hospital.

Hospital represents an enormous investment, the value of non-structural elements can be higher than the structure itself, and the required safety measures need to be incorporated to maintain the structure as a safe place for

Successful completion of a project is the mission that we always strive to make with meticulous attention to all aspects of construction quality and time and cost. The objective is always to complete the project in time with affordable

Nov – Dec 2012

cost, whether it’s a Green Field Project or a Brownfield Project.

By integrating healthcare support services, systems and equipment commissioning along with functional construction, we can make the hospital commissioning perfect and user-friendly. Project management is, however, the key to timeliness and cost control of any project that we need to always keep in mind while working out a hospital designing project.

33

HEALTH

PROPERTY

Muskotia Retreat

Nainital-an exclusive residential community for the discerning few!!

Muskotia Retreat at Nainital is a dream of long years of creating Vacation homes for the discerning few. Plan is to provide Rent-A-Villa proposition to the people who own homes at Muskotia Retreat.

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V

acation homes is an upcoming concept in India. Owning of Vacation homes is being adopted by people with higher disposable income and it is generally considered for investment post the basic housing and real estate investment needs are met. In India Goa has been one of the most preferred destination for owning Vacation homes amongst high net worth individuals, professionals and Rich and famous. Holidaying in Vacation homes are a great break for the family for rejuvenation and healthy living. Mostly in US, Europe, Canada and also Goa vacation home owner prefer to give their property on rental to ensure best upkeep of the property and get revenue income. Vacation rentals usually occur in privately owned vacation properties (holiday homes), so the variety of accommodation is broad and inconsistent. The property is a fully furnished property, such as

Nov – Dec 2012

HEALTH

PROPERTY

a holiday villa, apartment, cottage, condominium, townhome or single-family-style home.Vacation rentals can range from budget studio apartments to lavish, expensive private villas in the world’s most desirable locations.

manner, thereby creating a unique asset for their family and friends. The community will have their own homes within Muskotia Retreat. Sustainability is the core to the concept at Muskotia Retreat.

The team working on the design is attempting Muskotia Retreat at Nainital is a dream of long number of initiatives like use of Solar power in years of creating Vacation homes for the discerning passive heating of homes, rain water harvesting few. Plan is to provide Rent-A-Villa proposition to and purification, recycling of water, LED lightning, the people who own homes at Muskotia Retreat.These local area plants and flora that has strong survival homes are coming up in surroundings of Kilbury instincts and consumes less water and some more. forest adjoining Nainital which is an international Endeavour is to get right balance between environbirding destination and within the touching vi- ment and those who live, learn, and play here to cinity of Corbett National Park. Muskotia Retreat make sure it lasts long in future. homeswould be constructed using unique composite material with standard RCC structure,fully At Muskotia retreat there will be great emphasis furnished, heated homes,set in a wildscape , whilst for good health. There are planned paved and unusing various sustainable methods of living. paved trails that will encourage residents to get out and enjoy nature in its most beautiful untouched The attempt at Muskotia retreat is to create a small forest setting. Visit www.muskotiaretreat.com to community of likeminded people who would help experience the concept. build this unique living complex in an integrated

Nov – Dec 2012

35

EXPERT VIEWS

healthcare Consultancy goes online KRISHNENDU GHOSH

H

osconnn.com–online healthcare Consultancy Portal aims to use Internet Tech-know-logy

enced healthcare industry professionals having rich experience, strong commitment, high focus on customization, with an empathy to client’s needs that makes it z zTo simplify the Inherent com- completely focused and involved plications in any project that it undertakes. z zTo provide value based decision We provide consultancy sermaking, and vices on specific issues through z zTo provide expert advice avail- Case Study based approach (conable and accessible…..to the sultants of the projects would be medical fraternity throughout cross examined to enhance the the nation Quality of Recommendations/ Solutions).

Hosconnn.com has experi-

Industry Expert www.hosconnn.com

Through online route we offer advisory consultancy and solutions to the clients, and provide guidance to the team Implementing and executing the project on behalf of the client. On implementation issue, we wish Clients to have more Comfort Levels, Ease & Leverages vis a vis their Resource Mix. Our key responsibility would be to advise client to manage/optimize project cost.

Perceptual Balancing: Over the years knee-jerk /adhoc responses (to the issues, challenges and even opportunities) have been quite common across various strata of healthcare.

Through Expert & Experienced knowledge pool of Hosconnn.com, we would strive to “Analyze & Grade” the Operational & Opportunity issues and “Calibrate” the responses.

Speed is the need: Our Online Status would enable 36

Nov – Dec 2012

H

O C nNn

“Simplifying the Complications of Healthcare� www.hosconnn.com

: info@hosconnn.com

J Business Strategy Consultancy......

J Marketing/Branding/Promotions

J Purchase / Materials & Inventory Consultancy

J Administrative Consultancy

J Project Consultancy

J Architectural Consultancy (sans PMC)

www.hosconnn.com

On-line Case Study Driven Healthcare Consultancy

EXPERT VIEWS

us to have more time & sharper focus resulting into Quality Deliverables in 2-4 weeks irrespective of issues/locations Also On-line “Case Studies Driven” Healthcare Consultancy is “relevant” in changed Perspectives (Competitiveness, Quality, Commercials, Cost, and Technology etc). because z z It would bring in fresh perspectives to the issues to be undertaken and prevent Intellectual and Creative Inertia. z z It would also keep CCP (Cut, Copy & Paste) Syndrome in check z z Lack of Experienced Consultancy professionals across nation z z On-line consultancy is beyond Infrastructural Limitations z z On-line Case Studies allow thinking out of box and healthy debate & cross Examination among the experienced Professionals

z z Market is Eternal so no Short cuts z z Market is primarily driven by Professional Values & Character

InnovatioN: Preparatory Consultancy We wish to introduce this InnovatioN “Preparatory Consultancy” with the Following

Key & Urgent objectives: z z To ensure Smooth & Early Transition from “Project Mindset” to “Functional/Operational Mindset” z z To remove/minimize all sorts of Teething Troubles/Excuses/ Complacency (early Negligence/ Nuisance Management is an urgent need). This would decide the Break-even Time & subsequent Revenue Projections/Generation.

“Simplifying Health Care”

Consultancy Service Portfolio We provide comprehensive consultancy services for: z z Hospital Design/Architectural Services z z Hospital Construction/Project Consultancy (Sans PMC) z z Hospital Administration z z Hospital Operations z z Hospital Environmental ,Regulatory & Statutory compliances z z Hospital Quality Benchmarks like ISO, NABH etc, z z Hospital IT Infrastructure z z Hospital HR solutions z z Value System 38

Nov – Dec 2012

Total Hospital Solutions from ACME Consulting www.acmeconsulting.in

New / upgrading Hospital Projects

Quality & Performance Improvement

Head Office F 159, 5th Street, Anna Nagar (East) Chennai – 600 102 Tel Nos: 91-44-26267 6703, 04, 05 Suresh Shenoy , General Manager Mobile: 97104 01761

• • • • • •

Market Research Techno-Commercial Feasibility Studies Project Reports Design, Planning & Architecture Facilities & Equipment Planning HR & Staffing Services

• • • • • •

NABH Accreditation NABL Accreditation ISO Certification Hospital Quality Improvement Third Party Patient Satisfaction Surveys IT Solutions- HMIS – NABH Compliant

Regional Offices Kerala: Karnataka & Andhra Pradesh Western Region Haridas Menon, Marketing Manger B.H. Balaji, Regional Head Devasri Chatterjee, Regional Head Mob: +91 96332 76757, Mob: +91 94488 84514 Mob: +91 98202 64749

Highest Technically Rated Consultancy in India by NHRC 2010 2011

EXPERT VIEWS

NABHAccreditation

an essential requirement for Global recognition of our Quality.

I

ndia is today acknowledged as a rapidly growing global healthcare major. The fame of our Doctors and Nurses is legendary and they can claim to be the first skilled manpower export from our country, much before the software professionals started going abroad.

Today Indian Doctors and Nurses are at work in almost all countries of the world, both in the highly developed countries like the US, UK, Australia and Europe and in the interiors of Africa and across the Middle East countries.

India’s claim to global healthcare major status has also been reinforced by our Hospitals here, being touted as the new low cost healthcare destination of the world. This has led to the coining of the term, ‘Medical Tourism’, Medical Treatment and Tourism in the cost of one. We have today a number of the leading Healthcare Groups setting up Hospitals exclusively to cater to patients

40

from abroad.

We also have the fairly recent phenomenon of leading Indian Healthcare Groups setting up Hospitals abroad, currently, mainly in the Middle East and SAARC countries and some coming up in African countries like Nigeria, Uganda and Kenya. All these developments point clearly in the direction of India becoming recognised as a global healthcare provider, definitely a good foundation for us to now build on and become a healthcare super power.

But what do we lack for reaching that highest level or are we doomed to remain just a low cost destination, popular only because our charges are much much lower than those in developed countries? when will we see international chartered flights coming in droves to our country, when will we see Western Insurers supporting treatment in our Hospitals.

We will see that day happen when our Hospitals become cen-

B.G. MENON

Managing Director, ACME Consulting Taken from his talk given at NEXUS HOSPICA’ 12 National Conference held on 5th October 2012

ters of excellence, comparable with the best in the world, when we gain that ‘touch of class’ in our services. z z When all patients to the Hospital – not just the foreign ones, get greeted at the front desk with smiling and courteous staff, who have the answers to all their queries, who ensure that appointments are given and adhered to, who inform you in advance if the doctor is getting delayed. z z When the signage at the Hospital is sufficient, multilingual and unambiguous and really helps you get to where you want to go, without asking anyone. z z When the Doctors keep to their timings and clearly explain the diagnosis and line of treatment. z z When Nurses smile, show they care, speak the language of their patients and follow standard practices, when the Nurse is trained at handling difficult patients, stressed Nov – Dec 2012

EXPERT VIEWS

out and impatient ones. z z When the Waiting Areas are comfortable, with enough seats, temperature and air quality well maintained, enough toilets and all kept always spotlessly clean z z When tests are carried out in well equipped labs and radiology centers, with equipment duly calibrated and operated by qualified persons. When the results can be absolutely relied upon by the Doctor.

a day what the Americans would charge for an hour of work. Later, we woke up to this situation and began acquiring skills and a reputation for good quality work.

The Infosys and TCS and Wipros’ went in for higher value added work. Most important they went in for the most stringent quality management standards like the CMM and the ISMS 27001 which brought them on par with the US and Europe’s best IT Companies.

z z When the food from the Canteen is safe, hygienic and delivered by clean servers promptly, on time.

The challenge for our Hospitals is huge, if we have to become globally recognised as a healthcare super power. All these and more are aspects that we all from the healthcare sector know that we lack. Then what is it that prevents us from taking that determined step forward and lift ourselves to the next level.

Today these Indian majors have been joined by another 10-15 Companies from India to compete on par with the US IT Majors like the IBMs and Accentures for huge global IT contracts. We are now This was the dilemma faced by no more known as low cost IT Indian IT Companies about 7-10 Service providers, but as a high years back. All of them were at that value provider who delivers best time pure ‘body shops’, arbitraging quality and at very competitive on the difference in salaries paid in prices. the US and here. We used to ship, in those days, hundreds of IIT and For this transformation to take REC engineers, the best brains in place in the Indian Healthcare our country to work at the prem- Sector, we need to strive for that ises of the American Companies perfection and passion for excelon an hourly or daily rate, doing lence. Our Hospitals should be basic coding and data entry which accepted as the best in the world. till then was being done by 12th Our Orthopeadic Hospitals should Standard American kids and even be re-known for doing the best school dropouts. We charged for hip replacements, our NephrolNov – Dec 2012

ogy Centers for the safest kidney transplants and our Cardiac Units for most successful rate of by-pass surgeries conducted in the world.

To achieve this global level of excellence, the NABH is today the only way forward.

The NABH, National Accreditation Board for Hospitals and Healthcare providers is acknowledged to be on par with the world’s best healthcare accreditations like the JCAHO or JCI of the US, the ACHS of Australia. It is a truly independent body coming under the Quality Council of India.

As NABH approved Consultants for over 5 years, incidentally the only accredited consultants by NABH in the whole of South India, we can vouch for the absolutely credible and unbiased nature of their assessments, seen by the fact that from 2007, from the time the Accreditation was introduced till now, less than 150 hospitals have got the NABH, out of the over 5,000 medium to large Hospitals we have in this country.

The assessment by NABH covers every single area and aspect of the Hospital and in a most detailed manner. For the final audit at a large hospital 4-5 senior Assessors come and spend nearly 4 days at the Hospital, thereby ensuring that no practice, process, system or practice is left un-examined. Such a stringent accreditation requires the most rigorous development and implementation of the system and it is this that lays the right path for the Hospital to later go on striving and maintaining global standards.

41

EXPERT VIEWS

m-Health The Road Ahead

Dr. Sanjeev Sood

Hospital Administrator Air Force Station, Chandigarh

O

ver the past few years, several agencies in developing and developed countries have undertaken m-Health projects with mixed outcomes and formulated strategies to actively pursue the deployment of these projects at a larger scale for universal delivery of quality healthcare.

Many of these projects have been successful in enhancing efficiency and reaching the last mile; while there have been few projects that also warranted amendments in the processes and raised few questions.

With over eight billion mobile subscribers worldwide 850 million in India, mobile networks and devices are ubiquitous. Leveraging their power can accelerate achieving the MDGs, especially for health.

The emerging technologies: The governments and private telecom companies of developing and developed countries now have rich experiences and business models which can be shared 42

Nov – Dec 2012

EXPERT VIEWS

regionally and globally to further enhance the success of m-Health projects. At the same time, the advent of new technologies, sensor networks, mobile applications, and home-based services for healthcare, and the sheer level of penetration of mobile devices at the rural level, raised the expectations of the masses and created a certain hype around m-Health. This requires a shift in the way government and private agencies have been strategizing their m-Health projects to live up to these expectations.

m Health –Managing the hype Hardly a week passes when there is not a seminar or a conference on “m-Health” in some part of the world. These brochures project high-gloss images of mobile phones and heart signals, celebratory claims about how all of this will “revolutionize” healthcare, and liberal use of the words “innovation” and “transformation” in almost every keynote title.

However, this well-intentioned but premature celebration of all things “m-Health” may come back to bite us, if we’re not extremely careful. Here are some of the concerns that need to be addressed:

Defining m-Health

to drive prevention. Others define it as mobile applications, usually on smart phones, that leverage some of the government’s public health data so consumers can know things from their pollution exposure to flu migrations.

Managing expectations

As m-Health reaches a fevered There is a lack of consensus pitch, there is a fear that no techamong the experts when talking nology solution could ever achieve about say “m-Health.”There is a the enormous claims and utopian difference of opinion how they de- breakthroughs so many are promfine the term--what’s in and what’s ising. Experts are doing a terrible out of the definition. Then, some job with expectations management experts feel that it is all about “well- because consumers and clinicians ness” applications for the masses are all likely to believe that these Nov – Dec 2012

solutions and services are widely proven, affordable, and available.

This is just not the case yet. The potential is there, but not yet the products and price points.

So, too, there is much risk in trumpeting the power of m-Health prematurely. It’s easy and quick to put up a slick demo. It’s hard and time-consuming to do a clinical trial, or a complete redesign of a care model that integrates m-Health data into meaningful medical practice, or a longitudinal ROI or behavior change study. At the same time, not every m-Health application or service requires a randomized, clinical trial to prove 43

EXPERT VIEWS

has to offer.

sure we are designing solutions and systems that fit well into the Moving Beyond lifestyles and cohorts who most m-Health Bias- need them.

es:

its worth, but some kind of evidence is warranted.

For that matter, there are still regulatory issues abounding around software, mobile devices and applications, decision support tools, and online forums that provide medical protocols, care plans, or advice. There is no end to of private players making incredibly un-validated medical claims on keynote stages, and the jury is still out on how, when, and to what degree the regulatory bodies are going to weigh in on these new capabilities. Similarly, there are privacy policies to be negotiated and navigated with this convergence of consumer electronics and medical technologies.

There are some biases about m-Health movement that are matter of concern : it’s supposed to be about cell phones, with cool gadgets, for young people.

There may be many out there who don’t share these biases, however one need to tackle these biases related to m-Health.

First, do we really understand who the users of these technologies will be and what the specific scenarios and contexts of usage are? In particular, there is concern about some anti-aging bias in this movement.

Part of the problem may be one of definition, part of it trying to understand the market, its needs, the technology currently available to meet those needs and how does that technology become a part of the workflow of traditional care processes, or augment if not disrupt that workflow. Many questions that remain unanswered or poorly answered.

Challenges and Opportunities Ahead: Quite awhile back, when researchers first started looking into the m-Health market, they felt that indeed, there truly is something here and that provided the tools were simple enough, the value big enough that m-Health. It was at that time when the term was coined: Health is Mobile. Health does not happen when one is infront of laptop or desktop computer, it happens when one is on the move, going to an appointment, picking up a sick child from school, etc. Researchers agree with Deloitte that an mPHR like application has incredible potential, however, the lack of personal health information (PHI) in a common, computable digital format, (eg CCD or CCR) is a significant hurdle.

While there is great promise for m-Health applications to drive a more prevention-oriented paradigm for younger populations worldwide, the ground reality is that we also have some senior citizens--many of whom aren’t comfortable with or just can’t see smart phone screens--to reckon with So again, it is hoped that the for the next 20 years or so. The m-Health proponents and prog- population with multiple chronnosticators can better manage ex- ic conditions is the largest cost In the West, there is a signifpectations, ease out these thorny challenge one faces in healthcare, icant change occurring and the issues, and under-promise while and account for almost 3/4th of rapid acceleration in adoption of over-delivering what m-Health hospital visits. One needs to make smartphones is staggering. This 44

Nov – Dec 2012

EXPERT VIEWS

may truly be key, for as the PWC report points out, most consumers would prefer to get their m-Health solution from their physician.

Thus, if physicians get on-board in using something like the iPad, this could become a virtuous circle. First, the doctor will be able to easily create and update a patient’s record, digitally creating the content (PHI) that a consumer/ patient could then use to populate their own mPHR. The physician’s familiarity and use of such technology will also drive a higher comfort level with using such in the process of care coordination and engagement with the consumer, including reviewing data in the consumer’s mPHR that may not have originated from their practice.

Conclusion: Challenges and Next Steps: There are several key challenges to consider in developing mobile healthcare solutions and delivering the promised m-Health benefits.

Whilst mobile healthcare can provide incremental revenue for network operators and vendors, the consumers of healthcare services (namely healthcare professionals, insurers, and patients) are more concerned with its impact on the system itself. Thus, a successful solution will need to overcome the following challenges which can be effectively managed through careful planning and design: a) m-Health devices and services must be easy to use and provide clear benefits Nov – Dec 2012

b) m-Health solutions need to be tightly integrated into existing healthcare professionals workflow

lish open interoperable systems.

It is understandably easier for a hospital, insurer, or heath care professional to launch a modular component of a healthcare sysc) The cost-benefits of the tem rather than replace the entire m-Health solutions need to system itself. Yet, even modular be clear and must have a sus- components require clearly defined policies and work flows to tainable business model facilitate integration and uptake. d) m-Health solutions must comply with all necessary privacy A third challenge to mobile healthcare adoption is cost-effecobligations tiveness. Mobile healthcare soluUltimately, mobile healthcare tions must demonstrate an unamservices and devices are only effec- biguous return on investment with tive if adopted by healthcare pro- visible improvements to efficienfessionals and patients. Healthcare cy and patient care. Vendors and solution providers must therefore network operators need to work focus on developing products and with healthcare professionals and services that are easy to use, with- insurers to develop and prove the out additional layers of complexity. business case for their solutions.

However, a further challenge lies Healthcare professionals must in developing business models that see clear and immediate benefits work for all players in the overall from any new device before add- healthcare value chain. This can ing it to an already bulging doc- often be a significant obstacle due tor’s bag. Devices (such as smart to the complexity and differences phones that allow mobile access in healthcare ecosystems. Lastly, to patient records and contain device manufacturers and netimaging software) can improve work operators must ensure that healthcare worker efficiency and devices and connections are both also make doctors jobs easier, reliable and resilient for rural Inthereby mitigating chronic man- dian conditions. power shortages and increasing employee retention.

Serving the healthcare vertical requires additional measures At the same time, highly usable to ensure limited interruption to devices still face a major challenge data transmission and accuracy. from established vertically integrated technologies used in existFor example, network operators ing systems. Ease of integration could keep secure backups of data with existing systems is a criti- whilst maintaining redundant syscal selling point for hospitals and tems that would function in case healthcare professionals, which of a primary network or device emphasises the need to estab- failure.

45

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INTERVIEW

EXCLUSIVE INTERVIEW WITH DIKSHU C. KUKREJA ARCHITECT

Rise in demand of Hospital , Healthcare Architects &consultants

India presently has a bed deficit of approximately 30 lakh beds as per the WHO recommendation of four beds per 1000 population.

Considering even a 250 bedded hospital on an average, the country would need 12000 hospitals in the near future.

Q.: Brief About yourself ?Tell us about your projects done and upcoming projects?

Our firm CP Kukreja Associates is a leading architecture and engineering firm based in New Delhi.

The firm has over 200 professionals across various disciplines ranging from architecture, structure and other services disciplines. The firm has designed prestigious hospital and healthcare projects both in India and abroad.

Q.: How normal architects are different from Healthcare architects.

A healthcare architect needs to have a scientific temperament and strong engineering and coordination skills since a hospital project involves coordination between various architecture and engineering disciplines. Hospitals are driven by complex functional requirements and processes. Accordingly, an architect dealing with healthcare projects should be able to address these issues.

Q.: Are you concerned about envi-

ronmental and social sustainability in your buildings? If so, what role 48

Nov – Dec 2012

INTERVIEW

does green building play into your work?

Our firm is recognized for environment friendly and sustainable design. Accordingly the entire architectural design approach is to amalgamate architectural and engineering disciplines keeping in mind Green Building principles.

Q.: Many of your fans would say

that you design your buildings with a strong focus on both user experience and natural light, is this correct? Can you tell us more about this?

Yes, our architecture lays strong emphasis on the experience of the user and natural elements such as natural light, ventilation, views, etc. We strongly believe that buildings need to be rooted in the context of where they are designed for. This context could be geographical , cultural, climatic or social.

Q.: Who inspires you?

spiration not only for me but for our entire firm.

Q.: What is your ultimate goal

when it comes to your work? What do you want to be remembered for?

My ultimate goal is to create buildings which can shape the way people live in them and their behavioural patterns. The building should not just look beautiful from outside but have a lasting impression and experience both from outside and within.

Q.: How would you describe your

signature style? As we all know, we’re in the era of the ‘iconic building’ and the ‘starchitect’. However facile this might be, the designs of public institutions are often offered to the biggest names, and the most ‘iconic’ architects. How do you feel about this trend, and how do you work in a system like this and continue to create thoughtful, meaningful architecture, when so many developers

are looking for ‘the next Bilbao’?

We do not believe in a single architectural style, since styles are only a passing phase while buildings are supposed to last for much longer. Having said that, for us our signature approach is to make each building contextual, purposeful and symbolic.

While I do not believe in the notion of ‘starchitect’, I do feel that as a professional one builds ones reputation based on what you deliver in your practice. Accordingly, a well deserving architect is sought out by institutional clients to design their buildings as iconic.

Therefore it is first my endeavour to create good architecture and further projects can follow later based on one’s performance and beliefs.

The design philosophies of Mr. CP Kukreja are an in-

Nov – Dec 2012

49

TENDER

HOSPITAL FURNITURE TENDERS Ref Number: 6627669 Tender Number: 2012_RMSCL_2954_1 Tender Prod. No: 2012_RMSCL_2954_1 Buyer/Seller: Rajasthan Medical Services Corporation Limited Requirement:

Supply of furniture & hospitals other supplies section-j

(hospital furniture and hospitals other supplies)

for the rate contract period 2012-2014.

Location: Jaipur - Rajasthan - India Document Fees: INR2,000 EMD: INR100,000 Estimated Cost: INR200,000,000 Closing Date:

9/11/2012 at 13:00 Hrs. Contact Details: MD, RMSC RMSC, D Block, Swasthya Bhawan

Tilak Marg, C-Scheme, Jaipur, Rajasthan, India Document Sale To: 8-11-2012 at 18:00 Hrs

Ref Number: 6627654 Tender Number: 2012_RMSCL_2952_1 Tender Prod. No: 2012_RMSCL_2952_1 Buyer/Seller: Rajasthan Medical Services Corporation Limited Requirement: Providing of Hospital Furniture & Hospitals Other

Supplies for The Rate Contract Period 2012-2014 Location: Jaipur - Rajasthan - India Document Fees: INR2,000 EMD: INR100,000 Estimated Cost: INR80,000,000 Closing Date: 9/11/2012 at 13:00 Hrs. Contact Details: Md, Rmsc Rmsc, D Block, Swasthya Bhawan,

Tilak Marg, C-Scheme Jaipur, Rajasthan, India Document Sale To: 8-11-2012 at 18:00 Hrs Ref Number: 6627635 Tender Number: 2012_RMSCL_2951_1 Tender Prod. No: 2012_RMSCL_2951_1 Buyer/Seller: Rajasthan Medical Services Corporation Limited Requirement: Supply of furniture & hospitals other supplies section-J

(hospital furniture & hospitals other supplies) for the rate contract period 2012-2014.

Location: Jaipur - Rajasthan - India Document Fees: INR2,000 EMD: INR100,000 Estimated Cost: INR70,000,000 Closing Date: 9/11/2012 at 13:00 Hrs. Contact Details: MD, RMSC, RMSC, D Block, Swasthya Bhawan

Tilak Marg, C-Scheme, Jaipur, Rajasthan - India Document Sale To: 8-11-2012 at 18:00 Hrs 50

Nov – Dec 2012

TENDER

Ref Number: 6617199 Tender Number: 2012_RMSCL_2931_1 Tender Prod. No: 2012_RMSCL_2931_1 Buyer/Seller: Rajasthan Medical Services Corporation Limited Requirement: Supply of hospital furniture & hospitals other supplies

for the rate contract period 2012-14 - Section J Location: Jaipur - Rajasthan - India Document Fees: INR2,000 EMD: INR100,000 Estimated Cost: INR50,000,000 Closing Date: 9/11/2012 at 13:00 Hrs. Contact Details: MD, RMSC RMSC, D-Block, Swasthya Bhawan

C-Scheme, Jaipur – 302005 Rajasthan - India Document Sale To: 8-11-2012 at 18:00 Hrs Ref Number: 6630422 Buyer/Seller: Metal Handicrafts Service Centre Requirement: Supply, Delivery, Erection, Testing & Commissioning

Of ICP-MS. Supply, Delivery, Erection, Testing &

Commissioning Of FTIR. Supply, Delivery, Erection,

Testing & Commissioning Of Fume Hood Location: Moradabad - Uttar Pradesh - India Document Fees: Rs.2,500 EMD: Rs.300,000 Estimated Cost: Rs.11,000,000 Closing Date: 31/10/2012 at 15:00 Hrs. Contact Details: Metal Handicrafts Service Centre Peetal Nagri,

Rampur Road Moradabad, Gujarat - India

Tel # +91-0591-2460131 Fax # +91-0591-2460131 Document Sale To: 29-10-2012 Ref Number: 6559430 Tender Number: PUB-002/12-13 Buyer/Seller: Tata Institute Of Fundamental Research Requirement: Supply, installation & commissioning of laboratory furniture.

2.Supply, installation, erection & commissioning of office

furniture. 3.Design (architectural & structural), supply,

installation & construction of aluminum partition

along with doors. 4.Supply, installation & commissioning of

laboratory equipment like fume hood, exhaust blowers & chemical cabinets Location: Mumbai - Maharashtra - India Document Fees: Rs.500 EMD: Rs.120,000 Estimated Cost: Rs.6,000,000 Closing Date: 5/11/2012 at 00:00 Hrs. Contact Details: Tata Institute Of Fundamental Research

Homi Bhabha Road, Mumbai, Maharashtra - India 400005

Tel # 91-22-2278 2890/2588/2510 Fax # 91-22-2280 4566 Nov – Dec 2012

51

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PRE EVENT

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The 3rd International Hospital Build & Infrastructure India joins hands with leading healthcare companies as their Sponsors…

H

ospital Build Infrastructure India 2012, the only dedicated B2B trade show for the Hospital Infrastructure & Healthcare sector is receiving an overwhelming response from the industry for their 3rd edition, which is scheduled for 14th- 16th December 2012 at the Bombay Exhibition Centre.

upgrade knowledge, source, sell, share ideas and technology and partner, all under one roof. The event promises to showcase the best range of latest trends and technologies in the Healthcare sector.

Participants speak on their offerings at HBII 2012

Partners at HBII 2012. “Allarch offers solution from Architecture Designs to Medical Grade Mobile Computing under one roof with understanding of Evidence Based Healthcare. Allarch Healthcare Technologies is committed to deliver innovative and enabling technologies to healthcare provider for translating vision of Safer, Optimized and Healing Environment into Practice. Allarch believes that Hospital Build & Infrastructure India 2012 is the right platform to share vision of complementing solutions and introduce more “care” in healthcare” - Allarch Healthcare Technologies, Silver Partners at HBII 2012.

“Looking into the huge demand for Quality HealthCare Services in the coming years in India and so the need to have World Class Healthcare Infrastructure to support the industry, Godrej Interio has launched new series of Healthcare Furniture in recent times.

Our Healthcare Furniture range is indigenously designed to match Global Safety Standards and offer “Tata Motors recognizes the distinct competitive advantages fact that the healthcare industry in to patients, healthcare providers India is slated for a paradigm shift and all other stake holders alike. in years to come. With increased Going by the response and supawareness and better access to port the platform is receiving, it Our presence at 3rd Interna- healthcare coupled with increasis indeed evident that HBII 2012 tional Hospital Build & Infrastruc- ing congestion in the cities, the will again captivate the industry’s ture India 2012 will provide an demand for advance life support attention and offer everyone in ideal platform to show case our ambulances has to increase. In the hospital supply chain an un- offerings in the most appropriate order to meet the future needs, matched opportunity to network, ambience” - Godrej Interio, Gold Tata Motors has developed a wide

Godrej Interiors, Allarch Healthcare, Tata Motors, Portalp International, Draeger India, Tahpi, Alvo, Modular Concepts, Responsive Inds, Hospaccx India systems, Medica Synergie, Zebra Technologies, Bioni Paints India, Sio Vasundhara, CR Medisystems, RR-Eubiq are few of the leading participants who will stamp their presence at this 03 day awe-inspiring platform.

54

Nov – Dec 2012

PRE EVENT

SHOW

range of ambulances. We are excited for this opportunity at 3rd International Hospital Build & Infrastructure India 2012 to showcase how Tata Motors is providing a complete transport solution to the Healthcare industry” – Tata Motors, Supporting Partner at HBII 2012. Knauf is one of the world’s leading productions and construction material company with over 220 facilities and 22,000 employees present in over 60 countries. Knauf recognizes that each part of a new hospital holds unique challenges, such as mixtures of acoustic, fire ratings and impact performances. It has solutions for special requirements, such as X- Ray protection (new technologies), interior and exterior design, and Access Panels options for operation Theaters.

and we look at Hospital Build & Infrastructure India as the best platform to meet our clients from the Health Sector” – Sio Portalp, Bag Sponsor at HBII 2012.

“Looking at the growth in the healthcare sector and their requirements Knauf is excited to be a part of Hospital Build India 2012” - Mr. Amer Bin Ahmed, Managing Director Knauf Middle East, Registration Partner at HBII 2012

We are enthusiastic and excited for this wonderful opportunity at 3rd International Hospital Build & Infrastructure India 2012 to showcase how Eubiq India is providing all the power, data & gas management solutions” - Eubiq India Pvt. Ltd, Lanyard Sponsor at HBII 2012.

“Sio Vassundhara International along with Portalp International will launch a range of automatic doors, security devices & builder’s hardware for the Health Industry , with their state of art set up, bringing together world class products with the latest technologies for security and safety, thus ensuring true value on investment.

“Eubiq India recognizes the fact that healthcare industry in India is going to touch the sky in recent coming years. With increased awareness and better facilities Eubiq India is going to stand in the next line of advancement of Indian healthcare industry.

Eubiq Singapore is the inventor and manufacturer of GSS System - The World’s Most Flexible Power Outlet System. GSS System is the infrastructure platform of the future - all your Power, Data and Communication (Audio, Video and Telephone) needs can be neatly integrated onto a single track.

Archetype Group, a leading multi-disciplinary construction consultancy in Asia, and AIA Associes, a French-based firm specialized in the development of high quality and technical healthcare facilities, will showcase our combined skills and competencies at Hospital Build & Infrastructure India 2012. Founded in 1971, and We cater to the Hospital In- with nearly 600 employees working frastructure sector in a big way out of several agencies in France Nov – Dec 2012

and China, AIA Associés is one of Europe’s foremost healthcare design firms, offering a full range of combined expertise and outstanding services in architecture, engineering, urban planning and sustainable development.

As the ideal partner to AIA’s activities, Archetype Group brings extensive experience in fast-growing markets in the Asian region, with a particular focus on Project Management expertise gained over several years in India. Together, we aim to bring our recognized leadership in design and project management to the rapidly developing healthcare sector in India.

We look forward to learning more about India’s great potential and specific needs and to meet with key leaders in this industry at Hospital Build & Infrastructure India 2012. – American Institute of Architects & Archetype Group, Exhibitor at HBII 2012. “Bioni India will introduce a modern coat of paint that can do a lot more than simply look good.Bioni India, in collaboration with Bioni Germany & Fraunhofer Institute will launch paints & Coatings based on Silver Nanotechnology that creates new & eco-friendly painting solutions for building interiors and exteriors.

HBII has undertaken a magnificent job by acquainting hospital facilitators and hospital expeditors under one roof and thus creating a smaller world and helping the hospital industry grow in a healthier, efficient & resourceful way” – Bioni Paints, GermanyExhibitor at HBII 2012.

55

BUSINESS SECTION

56

Nov – Dec 2012

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