The critical care environment has undergone significant alterations in the past several years. This has happened because our lifestyles in the fast-paced lives of modern India are ensuring that most people, in the age group of 30-50 years are falling prey to life-threatening cardiac diseases and strokes, in addition to diabetes, hypertension, cancers, liver, kidney and lung diseases – these diseases being called Non-Communicable Diseases or NCDs. They are now responsible for killing more than 65% of our population says Dr Arvind Lal, known for his diagnostic labs across the country.

Flagging concerns on such trends, these patients need high-cost intensive care, be it for complications of heart attacks, strokes, diabetes, hypertension, cancer or lung diseases. This is where the importance of Point-of-care testing (POCT) comes in. It helps in almost diagnosing the patient instantly and improves the physician’s ability to take immediate corrective action and decreases hospital stay. One such test is Troponin – that has revolutionized cardiac care by diagnosing heart attacks or myocardial infarction.

This article is based on the keynote address on the occasion of 2nd Annual International InnoHEALTH Conference 2017 – ‘Transforming Healthcare Through Innovation’ in New Delhi, said there are numerous promising diagnostic technologies. The key message is that in a country where 70% of the population lives in rural surroundings, ‘it is our duty to rapidly adopt disruptive innovative affordable technologies including telemedicine. Thus, our underserved population would be able to avail of the best treatment possible and bring in massive visible change’. He said the importance of bringing quality healthcare needs no reminder and the time has come for India to change the direction of healthcare for the masses.

Healthcare is a right – and access to good healthcare should not depend on where one lives and how much he or she earns. But sadly, that is exactly what plagues India’s healthcare today, he lamented. India faces a severe shortage of both hard infrastructure and talent. With about one doctor and one functional bed per 1000 population, healthcare is truly underserved in India. Add to this the regional imbalances and variations in healthcare delivery. The healthcare infrastructure is skewed towards urban over rural India.

Although rural India accounts for about 70% of the population, it has less than one-third of the nation’s hospitals, doctors and beds, resulting in large disparities in health outcomes across urban and rural India. British Medical Journal (BMJ) has observed that there is a remarkable saving of lives in India if good healthcare facilities consisting of operation theatres, surgeons, anaesthetists, blood banks are available within 50 kilometres of the patient providing quality medical services within the ‘golden hour’.

Though there has been a sea change in the last five decades, India now needs to reinvent the field of diagnostics as laboratory tests are responsible for 70% of all clinical or medical decisions.

In today’s life where internet rules the roost, the patients have become very knowledgeable, thanks to the globalisation of healthcare, and are demanding very high-quality healthcare for themselves. They are insisting on a very wholesome and satisfying experience rather than being told that the ‘treatment is over’.

Soon, a time will come when the tests shall be ordered by the patients based on clinical history and clinical findings that shall be answered by an Artificial Intelligence (AI) application. Artificial intelligence has already found several areas in healthcare from the design of treatment plans to assist in repetitive jobs to medication management and drug designing. The most obvious application of artificial intelligence in healthcare is data management. Collecting it, storing it, normalizing it, tracing its lineage – it may well be the first step in revolutionizing the existing healthcare systems.

Recently, the AI research branch of the search giant, Google, launched its Google Deepmind Health project, which is used to mine the data of medical records in order to provide better and faster health services. The project is in its initial phase, and at present, they are working with Moorfields Eye Hospital of NHS Foundation Trust, UK to improve eye treatment.

Just a few years ago the patient after giving the sample used to come back in the evening to the lab to collect a physical copy of the test report. This was replaced by making the report available on the internet that could be downloaded by the patient in the comfort of his home. These days this has been further replaced by making available an App on his mobile phone wherein he can book an appointment for the sample to be collected at home and the report being later available on the same mobile App.

‘IBM Watson, whose headquarters I had the privilege of visiting a few months back in the Silicon Valley, is an AI-based engine that has launched its special program for oncologists to provide clinicians evidence-based treatment options. The program has an advanced ability to analyze the meaning and context of structured and unstructured data in clinical notes and reports in its encyclopedic memory that may be critical to selecting a treatment pathway’. IBM launched another algorithm called Medical Sieve. It is an ambitious long-term exploratory project to build a next-generation ‘cognitive health assistant’ that is able to analyze radiology images to spot and detect abnormalities faster and more reliably. This shall help radiologists in the future to look at the most complicated cases where human supervision is essential.

The lab-on-a-chip (LOC) is another device that integrates one or several laboratory functions on a single integrated circuit (commonly called a “chip”) of only a few square centimetres to achieve automation and high throughput screening. Imagine that a patient comes to one of our 2,100 collection centres in the remote tier three or tier four towns in India with the high fever. We take a drop of blood from his finger and inform the clinician almost immediately that the patient is suffering from Chikungunya and not from Malaria or Typhoid, or Dengue fever or Japanese Encephalitis – all in a matter of minutes! The driving notion behind POCT is to bring the test conveniently and immediately to the patient. Needless to add, the patient’s data by POCT shall be made available to update the patient’s electronic health records (EHR).

Talking about POCT Instruments: Currently, two broad type of POCT instruments are available: Small benchtop analyzers (for example, blood gas and electrolyte systems) and handheld, single-use devices (such as urine albumin, blood glucose, and coagulation tests). Now let us talk about if POCT is Boon or Bane? The strong point of POCT is speed and the rapidity with which it shall save lives in emergencies. As India marches towards quality healthcare delivery, in course of time regulatory compliances shall have to be adhered to in the interest of the patient’s health.

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This is the age of Disruption, Sebastian Thrun, computer scientist says, and hits bull’s eye.

On 7th April 2018, a gush of fresh air of innovative ideas buffeted gently a modest wood-paneled auditorium in central Delhi as two enterprising innovators unveiled their ongoing disruptive technologies – based projects to depollute air and save thousands of litres of water as well as million units of electricity.d save thousands of litres of water as well as million units of electricity.
As audience clung to these innovators’ narratives in rapt attention, another eminent speaker Denny John dwelt at length on an absorbing theme of how to assess a healthcare technology for the larger interest of society. “Mine is a disruptive technology”, a lanky but hefty new age entrepreneur stole the limelight at the meet as he, in his baritone voice, said as an industry always have the tremendous appetite for future technologies and thereby revolutionize deliverable. He was Monish Bhandari of OptiMaser™ which works for disinfection of hospital wastes including many other things.
An engineer, who appeared firmly grounded and did not betray any sign of tremendous potential his “Shudh Vayu” and “Swasthgram” campaign holds for the society by cleaning tons of carbon in air by a simple filter on roofs of cars threw light on his disruptive innovation for combating menace of spiking pollution plaguing many cities.
The engineer Amit Bhatnagar said 920,000 children die under 5 years due to air pollution worldwide. In Delhi, it is 3000 in 365 days, almost 8 deaths per day, according to UNICEF report. Air Pollution inhaled during pregnancy can cross the placenta and affect the developing brain of a fetus.
Swasthgram and Shudh Vayu were founded by Mr. Amit Bhatnagar and his common friends. Mr. Amit Bhatnagar is an IITian turned into the social entrepreneur. He did his M.S. in Bio-Engineering from Penn State (US) in 2007 and B.Tech in Mechanical, Hollywood (USA). After relocating to India, he started envisioning his life’s goal and along with common friends established Swasthgram in 2012. He uses disruptive technology, innovated & specially designed to cater to all healthcare needs.
Also Read: Cyber-Biosecurity: Are we ready?

The Saturday morning’s meet was a gathering of young innovators and industry experts in a conference hall in the national capital’s prestigious India International Centre to learn how to assess a healthcare technology for a beneficial outcome for the society.
Marking a step forward towards its promise of providing an encouraging platform to young innovators and innovative startup of the health sector, InnovatioCuris organized its fourth IC Innovators Club meeting that day. A date well was chosen, celebrating World Health Day, InnovatioCuris called on industry leaders to stand up to the pledges and join hands to take concrete steps to advance #HealthcareForAll.
We live in a culture where everyone’s opinion, views, and assessment of situations are twisted on social media if feared and hated by environmentalists (industry name say) and the public alike. Yet many a time, the scientific assessment of technology is remarkably different and tells altogether a different story. And we all know we become what we behold, we shape our tools and then our tools shape us. So, the assessment of any new tool or technology is very important. With this agenda, Denny John addressed the listeners which within no time compelled them to shed away their morning blues. Mr. John holds an external Ph.D. in HTA from Maastricht University, the Netherlands on the cost-effectiveness of vaccines related to infectious diseases in India. He is also an adjunct Scientist with ICMR-NIMS.
Being an Associate Editor for IJTAHC and Cost Effectiveness and Resource Allocation journals, he has also conducted various workshops on SR, EE and HTA training for over 300 members in Nepal, Ghana, and India. Under his literature, he has 10 peer-review publications on SR, EE and HTA, 2 book-chapters on Pharmacoeconomics, and 1 book on Systematic Reviews. Co-guiding 1 Masters and 2 Ph.D. students in HTA. He is a task force member on National Registry of Injuries in India. He is also a co-researcher on cost-effectiveness analysis of glaucoma screening in cataract camps.
The interventions used to promote health, to prevent, diagnose or treat acute or chronic diseases, or for rehabilitation which includes pharmaceuticals, devices, procedures and organizational systems used in healthcare, defines healthcare technology says, Mr. John. After he made listeners to understand what healthcare technology is, he guided them to understand what exactly HTA (Healthcare Technology Assessment) is.

A systematic evaluation of the properties of a health technology, addressing its direct and intended effects, as well as its indirect and unintended consequences, to inform decision-making is HTA. He explains, not only the assessment of the technology but also the evaluation and calculation of any input that goes into the delivery of the technology will be covered under HTA.
Narrating the story about BEMPU, a hypothermia monitoring device, he made a strong point that one should practice evidence-based approach, that stating evidence is very important not only while assessment of a technology but also in day-to-day healthy lifestyle habits. This gives context-specific inputs into the decision-making process at policy and organizational levels.
Evidence-based practice, Health economic evaluation, Policy and market analysis are the formation bricks of the architecture of HTA where Social aspects is also another brick in the wall catering its stakeholders, patients, health professionals, industry, third-party players and the government with trust and a good decision-making capability. A feedback from any stakeholder is always a good approach to perform analysis of your technology says, Mr. John. Especially when it comes to the customers, patients as (here) the case is, patient engagement is a huge buzz topic and knowing your customer is a great idea to improve. Taking feedback whether they are willing and are comfortable in using the technology and how they feel about the integration of it in their life could give you the taste of your own drug.
So, what is evidence-based practice? An evidence-based approach is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of an individual. Mr. John emphasizing on the usage and reporting of the evidence says, “wherein day-to-day life reporting of evidence is weak, the evidence should be taken based on the studies from multiple trials and research studies and not from a single study or trial”.
After stressing on the importance for stating the evidence he also explained the impact and need of economic evaluation analysis which addresses the additional health benefit gained from investment in a technology, such as the cost per additional Quality Adjusted Life Year (QALY) gained, by comparison of that technology to a different intervention or to no intervention.
Another important component of this valuable session was Budget Impact Analysis (BIA). Mr. John told that BIA addresses the affordability of the technology, such as the net annual financial cost of adopting the technology for a finite number of years.
Also Read: Early Detection of Dengue

All this directly or indirectly contributes to the assessment of healthcare technology that one plans to adopt and present. In addition to this, he also explained briefly the ways a person can perform the economic evaluation of the technology under observation like cost-effective analysis, cost-benefit analysis or be it cost-utility analysis.
Mr. John also walked listeners through the schematic structure of Health Technology Assessment in India (HTAIn). Also, telling about how patients and consumers can be engaged in HTA, what all parameters are there on which they can evaluate the technology and how it would be beneficial for the same.
Mr. Monish Bhandari said post signing of the CITAR incubation MoU on 2nd May 2017, the entire aura of the association has fast-tracked with translating the lab research to commercial success, augmenting the brand value, potential & technical excellence of OptiMaserTM & it’s futuristic new Avatars.
OptiMaser™ potential in excess is exemplified by the fact that it can achieve systematic volumetric heating for disinfection with its mobility in any diverse industry environment. CITAR’s clinical ability to instantly establish protocols, validate clinical results has given OptiMaserTM the required thrust to develop dedicated cycles for medical waste disinfection; OT instrument disinfection; blood bag disinfection; dialyzer disinfection; linen disinfection; Bactec (BD) bottle disinfection and animal bedding (rice husk & corn cob) disinfection. He said that the technology being pursued by them, saves hundreds of liters of water and electricity consumption while disinfecting hospital wastes – many prestigious institutions are adopting the mode. The IC meeting came to an end after a very provocative question and answer session.

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