The Inaugural ceremony was graced by Mr. Prabal Chakraborty, Vice President & Managing Director, Boston Scientific India. The ceremony was also graced by Dr. Vidya Yeravdekar, Pro-Chancellor, SIU and Dr. Rajani Gupte, Vice Chancellor, SIU. Mr. Prabal Chakraborty mentioned that the complexity of healthcare is arising due to multiple stakeholders, multiple information flows, unstable geopolitical environment, and multiple decision-making processes. Dr. Rajiv Yeravdekar, Dean, Faculty of Health & Biological Sciences, SIU justified the concept of SYMHEALTH by a small story of a young boy who tried to search for god and succeeded. Dr. Rajani Gupte talked about the inter-departmental connections and platform where students get to inculcate skills like teamwork and hard work. Dr. Vidya Yeravdekar explained the need to have communication skills along with other pre-requisite skills in health sciences. Dr. S. B. Mujumdar, Founder and President, Symbiosis; Chancellor, Symbiosis International (Deemed University) emphasized on the need of the hour to have a healthy mind and a healthy body.

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The first session was on Public Health Agenda for India by Dr. Sanjay Zodpey, Vice President, Public Health Foundation of India.

He started his session by stating the 21st-century challenges in healthcare in India and the need to have a healthy population. He did a comparative study of healthcare status in 1947 India and the status at present. He emphasized the poverty status, gender inequality, the situation of sanitation and education in India as compared to the data available globally. He also discussed health landscape indices regarding immunization coverage, sustainable health goals index, related to health and wellbeing, life expectancy, infant mortality rate, etc. He stressed upon the need for government to increase the amount of GDP expenditure in the healthcare sector to have a positive impact on indices like life expectancy and national per capita income. He also talked about the challenges associated with the low expenditure on healthcare, the shortage of clinical and non-clinical staff. He also touched upon the topic of Universal Health Coverage and the point to be focused upon: affordability of healthcare, quality health service and financial protection to the public. He ended the session with the note “Creating ‘Swasth Bharat’ along with ‘Swachh Bharat”.

Mr. Bhaskar Nerurkar, Head, Health Bajaj Allianz ltd started the session with a little humor and introduced his co-panelists. Ms. Gayatri Iyer, Regional Manager, NIC then proceeded with her speech introducing the concept behind RSBY (Rashtriya Swasthya Bima Yojna), Ayushman Bharat and NHPS (National Health Protection Scheme). She also talked about the initial Planning commission and its transformation into NITI Aayog. She concluded her speech by perks and eligibility of the scheme. The session was then proceeded by Mr. Bhaskar where he started by appreciating Symbiosis International University for their educational services by saying that ‘Pune is the home of education and Symbiosis is the kitchen’. He talked about the aspects and the need to have Ayushman Bharat and Pradhan Mantri Jan Aarogya Yojana (PMJAY) from the insurance sector’s perspective.

The session then moved forward to Mr. Arunesh Punetha, Regional Director, Narayana Health who discussed about the anticipated challenges for public and private healthcare providers like the low rate of packages being made available to the clinical staff and the shortage of health workforce. He gave his insights on the Michael Porter’s model of ‘Agenda for Value Transformation’ with patient centricity at the core. He ended the session with a talk about PMJAY and its influence on public health.

Dr. Sanjay Gupte, Medico-Legal Expert began the session by talking about the types of law in healthcare statutory and case laws. He projected the issues by focusing on the interpretation of law changes as per circumstances, unlicensed practitioners, quacks and midwifery. He gave an overview on consent for sterilization, MTP, PCPNDT Act, surrogacy laws passed by loksabha, altruistic surrogacy with the help of many case studies. He spoke about the punishments for the failure to report or to record a case. He gave his inputs on medical negligence and its implications. He majorly focused on euthanasia in India i.e., withdrawal of life supports to patients. He concluded the session by talking about the latest changes in medical acts.

Mr. Rohit Sathe, President, Health Systems, Philips headed the panel discussion and began the session by introducing Philips and their mission and vision. His session was mainly focused on 4 components- accessibility, speed & accuracy, value solutions and innovations.

The session then moved forward to Mr. Vidhi Prasad K V, Head, Wipro GE South Asia. He talked about medical technology. He also touched upon the E-commerce portal for service parts & accessories like Medtronics, Siemens, Philips, etc.

Mr. Surendra Deodhar, VP, Reliance Life Sciences Pvt Ltd took over the session and proceeded to talk about equitable distribution of medicines in India, especially in rural areas, where access to these privileges is a challenge.

The session was concluded by a small Q-A session between the speakers and the audience.

Dr. Simmardeep Singh Gill, COO CK Birla Group Kolkata, began his session by touching upon the very concept of strategic leadership. He talked about the increment in competition and other factors with the help of forecasted charts based on reported data. He also described the challenges associated with the business models. These include: low public spending and high out of pocket spending, talent shortage and high attrition, fragmented industry and lack of standardization. He spoke about the widening trust deficit between the patient and the provider. He stressed about the high asset business model which has put a lot of strain in the financial metrics like sinking valuation, margin pressure an payout of insurance players. Micro insurance was given key importance. He concluded by sharing with us the growth story of CMRI which majorly focused on procurement optimization, patient experience, clinician engagement and manpower optimization.

The post tea break proceedings of day one of SYMHEALTH 2019 began with two parallel sessions. The first session was chaired by Dr. Satpathy, Director, School of Public Health, KIIT Deemed University. He talked in detail about the conceptual meaning of Universal Health Coverage (UHC). He emphasized on the need to have quality medicine, quality treatment, skilled workforce and the public should not face any difficulties while accessing them. He also stated the importance of having Primary Health Centres (PHCs), their efficiency and effectiveness in providing health to all. He stated that 80% of the Health needs can be taken care at PHCs. Further, he addressed the myths regarding Universal Health Coverage. He then proceeded to describe some key facts about UHC and its association with the World Health Organization (WHO). He concluded the session by talking about NRHM and Health Service Providers.

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The second parallel session on Pharmacovigilance & Clinical Data Management was conducted by Dr. Raman Gangakhedkar, Head, Epidemiology & Communicable Diseases, ICMR. He started his session with elaborating on why is pharmacovigilance required. He stated that the aim of pharmacovigilance is to detect unknown AEs at earliest and ensure patient safety. He did a comparative analysis of clinical trials and use after approval.

This analysis was done on the basis of the number of participants, the total duration of observation, vulnerable population, pharmacogenetics, concomitant medicines, and dose and duration. He spoke in detail about the increasing scope of pharmacovigilance. He spoke about the key stakeholders in pharmacovigilance. He spoke in detail about Nevirapine and post-exposure prophylaxis. He further emphasized the importance of the Periodic Safety Update Report (PSUR). Inputs regarding the mandatory data fields in reporting were provided. Role of Indian pharmacopeia commission topic was touched upon by sir. Sir primarily spoke about the importance of the Bradford Hill criteria. He further gave an overview of the national AEH surveillance and emphasized on the ICSR processor. Lastly, sir spoke about IC025 and disproportionate reporting. Sir concluded by saying that pharmacovigilance is an important activity for safety and that good data quality and its completeness is critical in signal detection.

Mr. Lalit Mistry, Director of Healthcare, KPMG began his session by talking about the emerging health trends in India and speaking about the future of consulting in healthcare. He talked about the potential impact on the healthcare industry by the emerging medical technology innovations, treatment innovations, proactive wellness, and digital health. He discussed the drivers of healthcare; the drivers being technology improvements, market forces, costs, regulatory reform, and consumerism. Mr. Mistry then proceeded to talk about the major broad buckets of consultancy sector including project management, management consulting, HR consulting, etc. He stated the fact that healthcare consulting market in India is fragmented and underdeveloped mainly in operations, clinical and strategy consulting. He then concluded the session by giving a brief overview about the career path prospect in healthcare consulting and the skills required like number crunching, report writing, communication skills and the ability to travel in short periods of time and domain knowledge. The session was proceeded by a Q-A session between the speaker and the audience.

The day concluded with sessions on Emerging roles & Opportunities for Healthcare management professionals by Dr. Dinesh Pashankar, Associate Professor, Yale University, USA. He spoke about the equitable distribution of medical equipment’s devices & pharma products. The Department of Pharmaceuticals of India is working towards the initiative to source at least 50% of these domestically so as to reduce procurement and heavy import charges and also make these easily available.

The day concluded with session by Dr. Col. Ajay Gangoli, Group Medical Director, Apollo Health & Lifestyle Ltd. He talked about the Multiple Dimensions of Communication in Health Care Industry. He stated that the purpose of disseminating health information is to influence personal health choices by improving health literacy.

Day 2: Saturday, April 20, 2019

Day 2 of SYMHEALTH 2019 opened up with paper presentations by delegates. There were 4 candidates who presented on various topics.

The second session of the day was an engaging talk on Corporate Social Responsibility in Healthcare by Dr. Sitarama Budaraju, Consultant, Healthcare Projects, Tata Trust. He introduced top 10 healthcare CSR projects in India in 2018. He spoke about the current health status. He touched upon the supply side constraints namely Human resource for health infrastructure, Health financing, Pharmaceutical, and supply chain and Technology. He emphasized the training of peripheral health workers in soft skills. He ended his session by focusing on the importance of documentation support.

Dr. Anirudha Malpani, Director & Founder, Malpani Ventures discussed the common beliefs among the people that doctors are dinosaurs i.e. they work in older ways than embracing any new technology. He said these days’ people practice eminence-based medicine, not evidence-based medicines. He stated that self-diagnosis and self-prescription are very common among the people and wrongful. He further spoke about different innovations such as Heart buds – using the smartphone as the stethoscope, smartphone-based ECG monitor, peek – smartphone-based eye testing kit, etc. He said that the doctors see the patients daily, doctors know the patients then why should they wait for the engineers to do the innovation. He concluded the session by saying that patients should receive information therapy from doctors. He also appreciated word of mouth marketing approach. His whole session was focused on “Patient as Partner approach” and how communication is the key. The session was full of jocular remarks that made the session very interesting.

The session was anchored by Col. Ajay Gangoli, Group Medical Director, Apollo Health & Lifestyle. He introduced the other speakers. Col. Gangoli gave introductory of the topic than Ms. Nishi Saini took over.

Ms. Nishi Saini, Head- North, Clove Dental Clinics started the session with Clove dental clinics’ inception. She spoke about clove dental history and its vision and mission. She showed a various graph showing clinics and dentist. She explained how to manage the services at such a big scale smoothly. She spoke about talent management under which she focused on intelligent recruitment. She concluded by showing various aspects where Clove serves the need of the society. She concluded by showing various aspects where Clove serves the need of the society.

Mr. George Chemban, Business Head, Suburban Diagnostics started his session with an introduction about his company Suburban Diagnostic which was started by Dr. and Ms. Sanjay Arora. He stated that doctor-patient relationships are transactional in nature. He focused on the essentials for creating a chain of business units by specifying the business strategy and alignment of goals, standardization for customer experience, standardization of people and processes and standardization of technology.

Mr. Anand Mote, COO, Aster Hospital started his lecture by speaking about why healthcare chains are required. He replicated the lecture by third man’s view of setting a healthcare system. He spoke about the changing landscapes in healthcare chains where he spoke about the global players who are entering the Indian market, availability of capital and importance of well-informed customers. He gave a brief about types of healthcare facilities. He also gave a basic template for setting up and managing a chain of healthcare facilities. He ended the session by explaining how the brand is created and perceived in the healthcare system.

The valedictory ceremony on May 20, 2019, was graced by Surg. Vice Admiral Ravi Kalra, NM,VSM, Director and Commandant, Armed Forces Medical College, Pune; Dr. Sanjeev Kumar, IAS Divisional Commissioner, Nagpur, Dr. Rajani Gupte, Vice Chancellor, SIU & Dr. Rajiv Yeravdekar, Dean, Faculty of Health & Biological Sciences (FoHBS).

Around 1000 to 1200 healthcare professionals, from across the country comprising of professionals from diverse verticals of the healthcare sector including domains of Hospital & Healthcare Management, Medico-Legal Systems, Medical Insurance, Clinical Research, Healthcare IT professionals, General practitioners, Specialists & Doctors from Allied Health Sciences, Policymakers & Administrators, Representatives of the Pharma sector, Representatives of Civil Society Organizations and Representatives of private and public Healthcare sector organizations participated in this event.

SYMHEALTH 2019 | 19 – 20 April 2019

Ransomware epidemic is spreading in healthcare like wildfire due to its increasing digitalization which is and will attract more attention of hackers.

The healthcare industry has been a victim of various cyber attacks in the last few years. According to recent studies, healthcare has outnumbered financial services and become the most cyber attacked industry. The latest in cyber-attack is ransomware wherein the hacker encrypts the data and threatens to publish it until the ransom is paid in form of bitcoins. In US alone, healthcare industry was the victim of 88 per cent of all ransomware attacks across industries last year.

The recent case of WannaCry ransomware crippled the IT systems of NHS, UK. And after hitting NHS, it spread globally targeting more than 99 nations. The hackers demanded payment of £300 – £600 to unlock systems and have earned about £55,000 in ransom.

Ransomware has indeed become a lucrative revenue source for hackers due to which the number of attacks is predicted to quadruple by 2020. Medical records have 10-20 times more value than the credit card data in the internet black market. Ransomware epidemic is spreading in healthcare like wildfire due to its increasing digitalization which is and will attract more attention of hackers. Also, the vulnerability of the health data tends the organizations to pay the ransom to get the data back to maintain privacy and confidentiality of patient data.

Even after so many cases of cyber attacks compromising millions of electronic health records each year, the healthcare industry is inadequately prepared to prevent and resolve these attacks. Whether it is India or US, cyber security is always discussed in forums and budget is allocated for the same but is not put to proper use. Cyber attacks happen due to outdated security infrastructure or employee negligence.

Hospitals and insurance companies have been the main targets of hackers. But, a new vulnerability is catching everyone’s attention i.e. medical devices. The next nightmare in ransomware attacks could be hacking of medical devices such as insulin pumps, pacemakers, defibrillators, implants etc.

Disfunctioning of medical devices can be catastrophic. Just imagine, hackers take control of one’s pacemaker and ask for ransom or else they would manipulate the device which could be fatal. This kind of attack has been showcased in the very famous TV show Homeland wherein the Vice President dies due to hackers remotely disable his pacemaker.

Just like the serial, the former US Vice President Dick Cheney’s doctors disabled his pacemaker’s wireless functionality due to fear of possible assassination attempts as revealed by him during an interview in 2013. This clearly showcases that medical devices can be the next target for hackers.

Regulators such as FDA are increasingly getting concerned about medical device security and have issued warning. In 2015, for the first time FDA issued safety notice to hospitals which strongly discouraged hospitals to use an infusion pump which was found to be vulnerable to cyber attacks. But it has been observed that FDA did not force the company to fix the devices being used in the hospitals and didn’t investigate other insulin pump models. This shows that FDA needs to be more stringent towards medical device security. The vulnerability of infusion pump was pointed out by a white hat hacker Billy Rios during his hospital stay.

Few of the medical device companies/providers have been proactive in strengthening their device security such as Johnson & Johnson in Oct 2016 warned 114,000 diabetic patients about a security lax that a hacker could exploit in one of its insulin pumps (J&J Animas OneTouch Ping). The hackers can disable or alter the dosage which could be fatal. J&J suggested ways to the patients for mitigating risk.

There have been no documented cases of medical device hacking till date but demonstrations have been conducted in research environment. One such example is of Barnaby Jack who succeeded in hacking an insulin pump and demonstrated giving off lethal dose of insulin without the pump alerting the user. Another example is that of St Jude Medical’s implantable devices such as pacemakers, defibrillators, and resynchronization devices. The radio frequency (RF) enabled St. Jude medical implantable cardiac device and corresponding Merlin@home Transmitter enables transmitting and receiving patient data stored on the device to the physician to monitor his health. But FDA reviewed the device and confirmed about cybersecurity vulnerabilities, if exploited, could be fatal.

Also, researchers at TrapX Security analysed three hospitals for medical device hacking. The deception technology was installed which utilized emulated medical devices in the hospitals. These emulated devices attract and trap hackers so that TrapX could trace the hackers activity. These fake medical devices such as Radiation Oncology system, LINAC , Fluoroscopy, PACS and Xray system appeared real to the hackers and TrapX could monitor hacker’s activity.

According to TrapX, these hospitals utilized older version of Windows that made it vulnerable and most medical devices did not have additional endpoint security software which made the attack undetectable. It was also noticed that the main goal of hackers was to steal medical records not to manipulate the device.

Another research at University of South Alabama showcased how they hacked pacemaker and killed a medical simulator called iStan. The $100,000 medical dummy comes equipped with robotics that mimic the human cardiovascular, respiratory, and neurological systems. The researchers could speed the heart rate up or could slow it down. Not only pacemaker, researchers could manipulate an insulin pump or a number of things that would cause life-threatening injuries or death. This clearly illustrates why medical device security is important.

With the advent of IoT, where devices are connected via internet should focus on cyber security. Industrial experts are realizing that cyber security is prime priority for all the devices connected to the internet.

Devices such as wearables, smart bed, smart emergency system, etc. are all lagging behind in cyber security. Apart from medical devices, surgical robots are not being scrutinized for cyber security. Just imagine, surgical robots been hacked which could lead to life threatening situation of the patient. One such demonstration has been showcased by researchers at University of Washington in 2015. They hacked a tele-operated surgical robot, Raven II. The experiment demonstrated three types of attacks that made telesurgery vulnerable with this robot. The researchers demonstrated how they took complete control over the robot and disrupted the operation.

All of this sounds scary but it can be prevented if we are well prepared. It is important to understand that not only regulators like FDA need not address the challenge of cyber security but also the medical device vendors and providers should take shared responsibility. It has been observed that providers point the device manufacturers to be accountable for cyber security for responding to vulnerabilities and providing fixes for the same.

On the other hand, the device vendors hold providers responsible for their negligence and having outdated network  protection. To be safe from such attacks, organisations should review their cyber defence strategies and budget. Also, employee training and awareness needs to be tackled to avoid falling for opening phishing mails and change passwords regularly.

It has also been observed that providers such as middle scale hospitals, clinics or laboratories have often overlooked cyber security as priority as they believe not much data is present with them and only the big organisations are in trouble. Which is not true, as hackers are aware of the precious financial and patient data these clinics hold and are aiming at clinics or small hospitals also to get the data. So, they should also focus on medical device security.

The next big thing in helping fight against cybersecurity is artificial intelligence (AI). According to some analysts, the advantage of using AI is it can help predict cyber attack before it happens with the use of behaviour analysis. It alerts security team on any behaviour deviation or authentication failures while accessing records. AI not only helps in detecting threats quickly but it is also cost efficient compared to the money paid by companies in ransom. It does not replace security tools but acts as an additional layer of security. AI can also help in analysing employee behaviour for avoiding any internal security breach. AI can help in bridging the shortage of skilled cyber security professionals also. According to Centre for Cyber Safety and Education, there is a shortfall of 1.8 million cyber security professionals by 2022 worldwide. Companies such as IBM are already investing in AI system Watson for cyber security.

Also start-ups such as Cognetyx are providing cognitive cyber surveillance solution to healthcare organizations. Use of AI for cyber security in other areas has been showcased, for example, the Las Vegas city officials and UK government to monitor their Public Services Network and protect their records from security threats. Whereas, the successful implementation of AI in healthcare cyber security is yet to happen.

The next wave of medical device cyber attacks can be prevented by collaborative approach and commitment from all the stakeholders. Not only the healthcare organizations should make sure their security practices and strategies are updated but the government should also help in skill development of cyber security professionals and encourage more research on medical device security by providing medical device at low cost. Since medical devices are expensive and require license, it makes it difficult for researchers to explore this area. At the end, we should not forget that we have to stay a step ahead of hackers to be a hard target for them.

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Read all the issues of InnoHEALTH magazine:
InnoHEALTH Volume 1 Issue 1 (July to September 2016) – https://goo.gl/iWAwN2 
InnoHEALTH Volume 1 Issue 2 (October to December 2016) – https://goo.gl/4GGMJz 
InnoHEALTH Volume 2 Issue 1 (January to March 2017) – https://goo.gl/DEyKnw 
InnoHEALTH Volume 2 Issue 2 (April to June 2017) – https://goo.gl/Nv3eev
InnoHEALTH Volume 2 Issue 3 (July to September 2017) – https://goo.gl/MCVjd6

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Authors share, Intentional or unintentional – frequent use of medical and healthcare services have led the way towards the design of an integrated approach in healthcare management

Health systems worldwide are challenged by the increasing demand for services while operating within limited fiscal resources to meet growing patient demand. There is an increasing recognition that small segments of the population are accessing health services very frequently due to multi-co morbidities and very complex health needs.  In one Canadian province, it has been documented that just 5% of the 13 million citizens consume and account for 67% of health system service resources (Wodchis, 2013). This population is an important priority patient group in the region, known as the ’frequent user’.  The majority of these individuals have multiple co-morbidities and are confronted with navigating numerous, complex health services across a number of different programs, medical specialties and locations which are often isolated and disconnected from each other and focused on a single disease management approach. The frequent user population has expressed many challenges and significant dissatisfaction with accessing current health services that are neither integrated nor connected in a meaningful way.

This lack of integration and coordination leads to gaps in care, frequent use of emergency department services, and hospitalizations when their health deteriorates. 1% of the province’s ‘frequent user’ population consumes 34%, and the top 5% consume 67% of health system expenditures in the provincial health system. There is an impressive opportunity to implement an innovation strategy to re-design health services to more adequately meet the needs of these complex patients, and in doing so, reduce health system costs through a more coordinated and integrated model of care, focused on health and wellness that enhances quality of life.

A collaboration team for research is currently underway to design and implement an integrated health services strategy for patients identified as ‘frequent users’ across one provincial region.  The research team is examining the impact of this integrated model of care that leverages innovative technology to identify the frequent users in real time as they access health services.  A case management solution designed by the clinical team is implemented to engage patients and their families as partners in managing their own care, and focus on meeting the health goals identified by the patient and family rather than disease management goals determined by clinicians.  Results of the pilot phase of the research demonstrated that patients’ utilization of services decreased dramatically over a six-month period after the integrated model of health services was implemented.  Outcomes measured included the patient’s self-report of perceived wellness, satisfaction with the new model, ease of accessing primary care services and health services utilization (emergency visits, hospitalizations, length of stay).

Preliminary Findings Over a 6-month Period:

Frequent Users require integrated care led by primary care teams that engage specialists only when required, self-identified health goals focused on quality of life and maintaining their independence in the community, reported high levels of perceived wellness and readily engaged in self-management, with the support of their primary care team and a case manager as well. Clinicians reported working collaboratively to achieve integrated services focused on patient health and wellness across primary and specialist care. Health service utilization data for this population demonstrated 40% reduction in hospital days, reduced emergency department visits, and reduced length of hospital stay.

Both – the collaborative approach to integrated care and building an innovative eco-system strategy into the region to influence system change – are key conditions affiliated with the success of the integrated model of care in this pilot phase of the study. Phase II of the study continues with approximately 300 ‘frequent users’ being followed for 12 months to determine the impact of this integrated approach to care over time.

 
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