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Healthcare Delivery Healthcare Technology

How Technology can reduce the cost of critical care in India

One of the biggest costs when it comes to healthcare in India is critical care. This is the care delivered to patients in the ICU (Intensive Care Unit). Often after a critical episode like a heart attack the patients need to be monitored for some time and thus are based in an ICU.

The daily cost for a patient to use the ICU can be anywhere between Rs 5,000- Rs 10,000 in a tier one city in India. As most tier 2 and tier 3 towns don’t have ICUs patients from these areas have to be shifted to the tier 1 cities for treatment for critical ailments and hence the high cost. Also the lack of qualified health personnel in smaller towns hinders the care delivery process there.

Add to this others costs like manpower, medicines, Infrastructure and taxes, a stay at the ICU for a patient ends up eating into the savings of an entire family and is one of the biggest reasons for rural indebtedness, The image below gives an indication of the costs for treatment in most urban hospitals.

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On a recent visit to the Philips Innovation Center I came across an interesting system can help reduce the cost for the critical care of patients. The application aptly named ‘Consultative Critical Care’ is a application which can be used to monitor patients admitted in ICUs from Tier 2 and Tier 3 cities. The biggest requirement for an ICU is an Intensivist or a physician that specializes in monitoring patients in the ICU. India today has roughly 500 physicians who are qualified intensivits and most of them are based at urban hospitals. But using this application an Intensivist in Bangalore can monitor a patient in Hubli.

Now how does the system work? Firstly it consists of a set of monitors and cameras that relay the patients vital signs and physical condition from the ICU to a monitoring station in the city. So at any given point of time the Intensivist sitting in say Bangalore can see the patient in Hubli and can also monitor his key signs. At any point the intensivist can send instructions to the on duty physicians in the ICU to give the medication or to intervene as the patients conditions require.

On the technical side the application has to be hosted on a data center and the connectivity to the monitoring station is possible through ASDL or 3 G. The records can be shared between both hospitals through the System as long as the hospital systems are HL 7 compliant.

This will require some integration services and is a mouth water prospect for many Indian IT service providers especially given the scope for data center hosting, network monitoring and application support.

The ‘Consultative Critical Care ‘ System has been a process of reverse innovation from Philips Healthcare who have brought in this system from the US centers and reverse engineered it to suit the Indian conditions. Philips Healthcare did not comment on the pricing, but said this is being offered as both Capex and Opex Model.

According to MR Srinivas Prasad the Head of Philips Healthcare in India, this application could reduce the cost of ICU monitoring by as much as 40 %. Philips Healthcare did share some images of the system and a typical monitoring station could look like the one below.

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But I want to know your opinion on this system. Do you think such an application would work in India? Will the current infrastructure in the country allow such a system to be effective?

Please do write in and leave your comments.

Categories
Healthcare Delivery Public Health

Why we need to focus on serious problems like Tuberculosis before tackling more complex problems in India? A few thoughts on World TB day 24th March

 

TB-res-580x300(Image source: http://en.rylkov-fond.org/blog/tbr/effective-tb-treatment/)

In India it is cool to start tackling conditions like Alzheimer’s and Parkinson’s disease. Actually most celebrities lend their support to even cooler issues like AIDS. But the biggest killer in India today is Tuberculosis(TB). Almost 1/5th of the global cases according to the WHO occur in India. Of the 2 million Indians that develop tuberculosis almost 8,70,000 have the type that turns infectious and out of those people, almost 330,000 die every year. Compare that to 134,000 people that died in India due to road accidents in 2010, an issue that gets more coverage than the epidemic of Tuberculosis.

So why has TB become such an issue and why has it fallen off the radar of the empowered Indian. Well first and foremost TB affects a strata of society that is usually ignored by all the main stream channels. Secondly the social stigma attached with TB prevents the patient from going public and in some cases he refrains from help as well. Thirdly half the patients are treated by the private healthcare set up where the standards of care are not on lines with the government – WHO prescribed model, hence the private players themselves don’t report these cases.

As of last year TB has become a notified disease, hence any private hospital or nursing home treating TB is mandated by law to inform local health authorities. Now though the Government’s intentions in this move are noble again the social issues would force patients out of the healthcare system and actually not seek any help. The fight against TB is based on the early detection and right treatment of the condition.

The treatment of choice recommended by WHO and followed by Govt of India is DOTS (Directly Observed Therapy- Short Course) which includes

DOTS (directly observed treatment, short-course), is the name given to the World Health Organization-recommended tuberculosis control strategy that combines five components:

  • Government commitment (including both political will at all levels, and establishing a centralized and prioritized system of TB monitoring, recording and training)
  • Case detection by sputum smear microscopy
  • Standardized treatment regimen directly observed by a healthcare worker or community health worker for at least the first two months
  • A regular drug supply
  • A standardized recording and reporting system that allows assessment of treatment results

For more on DOTS please visit this page.

How can we as individuals help with TB?

Well I have a personal story here, one of my colleagues, once came to me with a peculiar problem, his maid had just fainted and collapsed in the middle of the household chores. I had suggested that he take her to a local hospital where they discovered that she had the beginning of onset of tuberculosis. As usual her family had refused to come to her aid and actually shunned her asking her not to come back home. In such a situation I reached out to a govt hospital, whose chief medical officer was known to me. Not only did the govt hospital admit this lady but also they treated her for free and organized a counselling session for her family members.

The lesson from this episode is that TB is curable, it needs to be diagnosed and treated at an early stage. If you do come across a patient who is suffering due to lack of help and treatment, just direct that person to the nearest govt hospital, which is mandated to treat these cases for free. Please note seeking help from a Govt hospital is better than going private in TB cases and this is important point to note.

So on the 24th of March which is World TB day, let us at least make a start in getting this issue out in the open and taking the step in eradicating this disease from the face of the earth. For more on the WHO trategy for TB in India, please read this

In conclusion, the fight against TB has to be fought on two fronts- Medical front and on the Societal front. On the medical front our doctors and health workers are in action, but it is upto us to Galvanise the society and do what is needed.

 

 

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Healthcare Delivery Healthcare Start ups Healthcare Technology

Indian Startups: Shifting the paradigm in medical technology Part 2

 

In continuation to the previous post that talked about how India based organizations are making their mark in the medical technology field, here are few of the medical technology Indian companies that are funded by venture capitalists and whose products are gaining widespread application in emerging countries such as India and also knocking on the doors of developed markets such as US and Europe.

Medical Devices:

The robot products developed by Perfint Technologies are used for ablation, drug delivery and biopsy. These affordable and unique devices are sold under the brand name ‘Robio’ in SE Asian countries, Europe and Latin America. This four year old start-up is now working to develop a new robot product, Maxio, which will make complex life-saving procedures much easier to perform with high success rate and with the introduction of which Perfint plans to enter markets like the US, Japan and Korea. The price of these devices ranges from $150,000 to $300,000. With $17 million from various venture capitalist and current revenue hovering around Rs. 50 crore, Perfint aims to ten-fold the revenue to around Rs. 550 crore in the next four years.

Nano Drugs:

Invictus Oncology, a Delhi-based start-up is developing a drug smaller than one-thousandth the diameter of a human hair, which immerses into the tumor, shrinks it by cutting off blood supply and continues to sit on the tumor till it dies. The brain behind this technology built it in his lab in Harvard Medical School and has been further developed by a group of scientists who relocated to India.

Diagnostics:

Core Diagnostics, a Gurgaon-based start-up, offers specialized tests in cardiology, endocrinology and oncology which are unavailable in India. Patients used to send the test samples overseas and the results came back in around three weeks costing about Rs. 20,000 to Rs. 1 lakh. Core diagnostics, backed by Artiman Ventures, aims to make these tests available in India for as low as Rs. 4000 to Rs. 50,000 with results in just 48 hours. This startup has tied with 50 specialists and physicians working in US to train their Indian counterparts.

Computational Imaging:

Tonbo Imaging, a startup in Bangalore, has developed an imaging technology that has also made inroads into the defense technology such as drones of the armed forces around the globe. Artiman Ventures have infused Rs. 34 crore in this startup that will be utilized for R&D enhancement and team expansion in India, the U.S and Israel.

Personalized Cancer Therapy:

Mitra Biotech, a Bangalore-based bio-technology organization, has developed the ‘OncoprintR’ technology that allows doctors to differentiate with great deal of accuracy the drugs which will work on a cancer patient from the drugs which will have no clinical effect. This technology saves the patient from undergoing a series of drug regimes that often results in side-effects and associated complications. Mitra has struck a deal with several leading hospitals in India and abroad for delivering personalizes treatment options. Imagine what changes this technology can bring in a country like India where nearly 6 lakhs Indians die of cancer every year where 70% of them belong to the age group 30-70yrs.

Stem Cells:

Stempeutics Research, a startup focused on stem cells in alliance with Vignani technologies, a niche engineering services company is developing ‘Stempeuron’ an automated, point-of-care medical device for isolation of stem cells from humans. The device helps to extract good stem cells out of the tissue quickly whereas the current procedure of bringing fat tissues to the lab and processing it for isolating stem cells is time consuming, cumbrous and has a poor viability rate. The alliance is working to reduce the cost of their device to below Rs. 20 lakh that is much below the cost of such devices in US which is around Rs. 1 crore.

India ranks 4th in global general cosmetic surgery market, which is valued at $40. Billion in 2013, with 850,000 cosmetic surgeries a year compared to US, ranked 1st with 3,100,000 such procedures. Indian firms such as Stempeutics and Vignani which are still in the research and development phase are leaving no stone unturned to make a mark in such markets and increase their presence across the globe. This new crop of go-getters and innovative startups are here to make a difference and bring India on the medical technology globe in the years to come. Watch out for the rise of similar Indian organizations and make their mark.

 

By Dr Sumeet Kad

Sumeet KadMarketing and Business strategy professional with considerable experience in marketing and consulting for MNCs and Fortune 500 clients in the Healthcare and Life Sciences industry  Dr. Sumeet is an avid reader, social media evangelist and has authored various blogs on marketing, branding, healthcare and life-sciences and social media.

He also manages his blog The New Age Marketing Blog. Find him at hisLinkedin Page and follow him at @sumeetkad.

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Healthcare Delivery

How India missed the oppurtunity to take Ayurveda Global

China today dominates the herbal medicine market. One of the reasons for that is branding.

In many ways the natural leader in that market should have been India. Unfortunately we as a nation have missed that bus in the 50-70’s. Ayurveda our core herbal offering to the world lay mired in home enterprises which never concentrated on branding. Most remedies were dispensed as powders, given in unmarked sachets, with little or no standardization on packaging or consumer literature that one sees with other allopathic offerings.

In that gap China catapulted itself in the global space. Today Chinese traditional medicine popularised by the Kung- Fu movies has travelled far more than the Indian science of Ayurveda. According to a report by Global Industry Analysts the market is estimated to be $ 100 Billion by 2015. The rate of growth of the market is around 9 %. The largest market for these therapies remains Europe while Asia Pac as market is fastest growing.

Herbal therapies have received a shot in the arm from the adoption of the cGMP (Good Manufacturing Practices) by most of these firms as prescribed by the FDA. Also there is a growing feeling within the patient community to adopt herbal medicines from a prevention and diet supplement point of view.

The other trend in this space is a shift by many manufacturers from single ingredient formulation to a multi ingredient formulation with a focus the outcomes. This shift from source to outcome is also leading to a spurt in the growth of herbal medicines.

With China slated to dominate this market what can Indian manufacturers do?

 

For one they can take a cue from Dabur and Himalaya and focus on branding their products. Dabur for example is one of the leading Indian Ayurveda brands and continues to lead the charge on getting India the rightful place in the Global Herbal market.abur

Secondly many firms might have to adopt the cGMP practices as laid down by the FDA. This will lead to opening up of many markets especially in Europe and America.

Thirdly firms need to spend time on patient education, Letting both Indian and global consumers know the benefits of using Ayurveda. I do feel that many young Indians associate Ayurveda with the older vision of India and do not want to adopt it. During a recent trip to a Natu Marandu (Traditional Ayurveda )Shop in Chennai I saw that most customers were in the age group of 50 plus. As a matter of fact many in my peer group found it funny that I was buying traditional medicine despite being trained in Allopathy.

In conclusion I feel the future of Ayurveda is in our hands. Firms need to get smart about branding, manufacturing and patient education for us to get our due in the global market place.

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Health Insurance Healthcare Delivery Public Health

Why Indian Healthcare firms should focus on Healthcare education.

 

One of the first projects I got involved in, after joining CSC in Chennai was a education portal for a major US based Health Insurance company. The portal was essentially targeting the African American Community and addressed the common health issues for that ethnic group.

So why was a Health Insurer spending so much time and money on educating its members? Well the intentions though altruistic were not without financial benefits. The insurer wanted this particular set of members to be aware of the common ailments affecting their community so that they could take corrective action. This would reduce the incidents of them visiting hospitals and making a claim that the insurer would have to pay.

Interestingly if we look at the amount of education material out there in the west put out by insurers, hospitals and pharmaceutical companies its mind numbing. One starts to wonder what the Indian healthcare firms are doing?

To seek answers to this question and to get a better perspective I came across an interesting site called Patient information and education trust (PIET) The site is the brain child of Dr Aniruddha  Malpani. Dr Malpani had practiced abroad and on his return to India was appalled at the level of patient education available in India. He is an In Vitro Fertilization (IVF) specialist and was used to patients looking online for medical content. but when it came to India there was hardly any content available.

“The situation is worse when it comes to vernacular languages” says Dr Malpani, “for example the only medical education in Gujrati language is from the NHS and not from any of the Indian firms”

As I looked back at the data available I came to the Johnson & Johnson website called “Baby center”. This site is very informative but is a J & J site that has been rolled out globally.

So why don’t Indian healthcare firms invest in patient education?

According to Dr Malpani all nursing homes, chemists and clinics should have a small self service kiosk with patient information. And I agree with him. surely it does not cost much to do this and India has the technology to implement such a scheme.

In my opinion most healthcare players in India have a short term vision of who a patient is. They probably don’t think it is worth their time to educate the patient parties on the perils of ignoring the initial warning signs of a condition.

Investing in patient education is a long term strategy and firms need to look beyond the short term gains. For example PIET has a tie up with the Global leader in Health education called “Healthwise” and all PIET does is customize the content for Indian market.

In conclusion I feel preventive care as a concept depends on the right and timely health information and education. So it is up to the Industry to implement this and reduce the burden on the existing health infrastructure in India.