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Artificial Intelligence Coming Big Way in Healthcare Sector

InnoHEALTH Magazine — Mon, 19 Nov 2018 10:13:51 +0000

Brig Arvind Lal, CMD of Dr Lal Path Labs, is a pioneer in bringing laboratory services in India at par with the western world. In 1977, he took charge of the medical diagnostics laboratory founded in 1949 by his late father. Under his expert guidance and leadership, the initiative has become one of the most reputed laboratories in Asia, having to its credit quality accreditations from various national and international bodies.

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.

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‘Wearable Tech is another area which I am personally very excited about. It has the potential to change the world as it helps people understand their own bodies by using mass data collected on a daily basis. From fitness bands to smartwatches to eye based wearables, they are being adopted widely. Take the case of Zephyr’s Anywhere Bio Patch which is an FDA-approved, small device that is attached to a patient’s chest and monitors their vitals minute-by-minute and collects medical-grade data for doctors’ use. These devices will connect our organs digitally, enabling disease detection at very early stages. It has the potential to bring down cardiac and other deaths drastically. This offers immense potential to do remote testing, monitoring and thus assisting the doctor in timely treatment’.

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Point of Care Testing: Technological advancements in laboratory automation, including POCT, and initiatives to increase patient satisfaction are transforming the clinical laboratory market. POCT has come a long way from a handful of simple tests to a multibillion-dollar global market that holds great promise for the future. Not so long ago, laboratory data would often arrive at the bedside too late to be of significant use in the active, continuing care of critically ill patients. Now, most clinicians acknowledge that POCT is a prerequisite for early recognition of life-threatening conditions as they require that laboratory results are made available in real-time and, if possible, at the critically ill patient’s point of care. The College of American Pathologists defines POCT as tests designed to be used at or near the site where the patient is located, that do not require permanent dedicated space, and that are performed outside the physical facilities of the clinical laboratories.

Examples include kits and instruments that are hand-carried or transported to the vicinity of the patient for immediate testing at that site (e.g. capillary blood glucose) or analytical instruments that are temporarily brought to a patient care location (like operating room, intensive care unit). In many cases, the simplicity was not achievable until technologies developed that was simple and affordable. For example, various kinds of urine test strips have been available for decades, but portable ultrasonography did not reach the stage of being advanced, affordable and widespread until recently. Similarly, pulse oximetry can test arterial oxygen saturation in a quick, simple, non-invasive, affordable way today, but in earlier eras, this required an intra-arterial needle puncture and a laboratory test. Thus, over decades, testing continues to move toward the point of care.

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.

The post Artificial Intelligence Coming Big Way in Healthcare Sector appeared first on InnoHEALTH magazine.

IC InnovatorClub Sixth Meeting

InnoHEALTH Magazine — Mon, 22 Oct 2018 09:19:41 +0000

IC InnovatorClub Sixth Meeting: Ignite imaginations encased within: A recent National meet’s takeaway

For many decades, inspiring and juicy narratives, pertaining to iconic first generation entrepreneurs like Apple’s Steve Jobs, Microsoft’s Bill Gates, Truecaller’s Swedish developers, Flipkart’s launchers are being succinctly dished out at publicly to fire imagination of those fancying own start-ups in the contemporary era of out of the box ideas linked innovative business enterprises, and this is what was exactly scripted at a one-day workshop at the famed Shriram Institute for Industrial Research recently.

An inspiring story of a young entrepreneur was narrated as he had designed a multipurpose scissor for operation theatres after quietly peeping through a glass window that a team of surgeons was battling with a bunch of varied sized scissors while operating his close kin at a hospital. Likewise, another speaker delved out an emotional story of currently internationally popular “smart cane” to the benefit of millions of blinds across the globe.

Those present at the workshop were awe struck on such absorbing and motivating narrations that kindled hopes and vindicated the time proven fact that nothing was inaccessible by a fertile and intelligent mind of any diligent individual. The import of a day-long meet was that everyone should ignite imaginations encased within their minds rather than sitting tightly over those.

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A One-Day Workshop on “Technological Innovations for Healthcare Start-ups & 3rd Anniversary celebration of InnovatioCuris (IC)” was jointly organized by SRI-Technology Business Incubator (TBI) & InnovatioCuris on 4th August 2018 at SRI Auditorium, New Delhi. Participants included key members from healthcare start-ups, medical professionals, industrialists, entrepreneurs, medical device manufacturers, plastic industry, officials from govt. institutions and students from various universities.

The event was inaugurated by addressing the distinguished delegates and budding entrepreneurs about the advancement and new innovations in the healthcare sectors. It was a delightful moment to see the positive response from industry stalwarts of the region and Science and Technology start-ups’ keen interest in venturing into new business entities.

Also Read: 5th IC Club Meeting: Fairytales of Nanoparticles from Iceland to Jamia Millia Islamia

Dr. K. M. Chacko, Director, Shriram Institute in his address briefed about the Technology Business Incubation concept. He highlighted the excellent support provided by the Department of Science & Technology (DST) at the Indian Ministry of Science & Technology because of which the Shriram Institute – Technology Business Incubator (SRI-TBI) has been running for past so many years. The center provides services in the fields of healthcare, plastics, rubbers, specialty chemicals, and waste management. Continuing the inaugural session, the address of the Surgeon Rear Admiral & MD, InnovatioCuris Prof. (Dr.) V.K. Singh helped in setting the tone for the workshop. He briefed the national & international status of healthcare sector during his delightful thought.

Chief Guest of the event, Mr. Vijay Kumar, briefed about the support available to the start-ups at the Ministry. He appreciated the efforts made by SRI-TBI team and opined that the multidisciplinary activities of SRI would be useful for promotion of incubator programme. He briefed about the various funding schemes offered by the Ministry to micro, small & medium enterprises which both the existing and the future entrepreneurs can take advantage of. The floor was taken by Dr. Shirshendu Mukherjee who added his appreciation for the joint efforts made by team InnovatioCuris & SRI-TBI. He briefed about the industry-academia interface and implementation of its benefits through a wide range of impact initiatives, be it providing access to risk capital through targeted funding, technology transfer, IP management and handholding schemes that help bring innovation excellence to the biotech firms and make them globally competitive. He added that the supporters of change for building the Indian bio-economy would be biotech start-ups & SMEs & hence our focus is on raising their capabilities.

The inaugural session followed with the launch of a start-up innovative product Nylon Sleeve Anchor Fastener. The product was developed by Mr. Rajendra Gupta, Director, Axel India with the support of SRI-TBI & are in scaling up the process for the healthcare sector. The Inaugural session ended with the vote of thanks by Dr. Ajay Tyagi who mentioned that the efficiency, benefits, barriers, and challenges for healthcare industry are very process-centric and technology use can be mainly attributed to the success of entrepreneurs. This was followed by two technical panel discussions.

The first technical session was on Innovations for Reducing the Burden of NCDs. The panelists stated that the Non-Communicable Diseases (NCDs) are reaching epidemic proportions worldwide and present an unprecedented challenge to economic and social development globally. The latest projections from the World Health Organization (WHO) suggest, 57 million deaths occurred globally of which 36 million (63%) were the result of NCDs. Despite the immense burden of disease, NCDs, defined here as cardiovascular diseases, cancers, chronic respiratory conditions, and diabetes. It is estimated that 80% of NCDs are preventable with appropriate diet and lifestyle choices and good control of NCDs can have a substantial effect on the incidence of downstream complications. Hence there exists a need for innovations to reduce the burden of NCDs. The panelists also suggested the steps for reducing the burden of NCDs in the present scenario.

The second technical session was on What will take Indian Healthcare sector forward. The panelists discussed various aspects about the current scenario of healthcare sector and suggested several notable points including obtaining proposals from private insurance companies and the government on ways to provide medical insurance coverage to the population at large and execute the strategy; it is healthy to have competition in health care and provide health insurance to the millions who cannot afford it; revise the curriculum in medical, nursing, pharmacy and other schools that train healthcare professionals, so that they too are trained in the new paradigm; the government should appoint a commission which makes recommendations for the healthcare system and monitors its performance; encourage business schools to develop executive training programmes in healthcare, this will effectively reduce the talent gap for leadership in this area; rapidly develop and implement national accreditation of hospitals – those that do not comply would not get paid by insurance companies. However, a performance incentive plan that targets specific treatment parameters would be a useful adjunct.

The programme concluded with a visit to SRI-TBI Prototype Development Facility. The participants were highly excited to see the actual processing of plastics injection molding and blow molding processes and expressed their earnest desire to be incubated in the facility.

The post IC InnovatorClub Sixth Meeting appeared first on InnoHEALTH magazine.

An Interaction with J.P. Nadda on Health Plan

InnoHEALTH Magazine — Mon, 14 May 2018 10:23:03 +0000

World’s Largest Health Scheme Unspooled in India

Apparently bracing up to showcase India’s achievements in Health Sector management during general elections due within a year and a half, Union Health and Family Welfare Minister Jagat Prakash Nadda, who recently hogged limelight during mega health plan announced in the Union Budget 2018-19, and also played prominent role in the ruling party activities at the national and states’ level, says the NDA government is committed to advancing Universal Health Coverage (UHC) agenda. World Health Organisation Director-General Dr Tedros Adhanom Ghebreyesus has recently said that India should have UHC.

In an interaction with InnoHEALTH magazine, the Minister asserts that the government would herald a new era of healthcare and the plan announced in the Union Budget would be implemented with full sincerity. It will take a few months to roll out all nitty-gritty’s of implementation. He dismisses apprehensions of those sceptical of the plan in wake of massive funds required for the implementation of the world’s largest healthcare plan. There would be no laxity in the successful implementation of the scheme and it had nothing to do with elections but it is a well-thought-out plan to ensure holistic healthcare to common people. Massive machinery has started churning out plans to bring the scheme to the ground reality. Informatively, a plan to provide health coverage to 50 crore people has been proposed in the current budget 2018-19 and is being viewed as a precursor to the UHC.

WHO’s definition of UHC — one of the goals of sustainable development — includes financial risk protection (against medical expenses), access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

The National Health Policy 2017 approved last year envisages the attainment of the highest possible level of health without anyone having to face financial hardship as a consequence. The Ministry of Health & Family Welfare (MoHFW) has taken concrete steps to reduce the Out of Pocket Expenditure (OOPE).

Mission Indradhanush launched in 2014 which was one of the largest global public health initiatives. In its four phases till date, Mass Immunisation (MI) has successfully reached over 25 million children in over 528 Districts. The focus is also on increasing the basket of vaccines. Since 2014, Rotavirus vaccine, Pneumococcal Conjugate Vaccine (PCV), and the Measles-Rubella (MR) vaccine, and also the JE vaccine for adults have been launched.

Under Pradhan Mantri Dialysis Program (PMDP) 1.43 lakh patients have availed free services from 1,069 Dialysis Units and also under Free Drugs and Diagnostics Program; Affordable Medicine and Reliable Implants for Treatment (AMRIT) outlets nearly 47 lakh patients have benefitted and through the purchase of subsidized medicines from AMRIT Pharmacies.

To provide comprehensive primary care, the Government has announced of transforming 1.5 lakh sub-health centres to Health and Wellness centres i.e. MoHFW is now moving towards the provision of comprehensive primary care through the Health and Wellness Centres.

The MoHFW has initiated universal screening of common Non-Communicable Diseases (NCDs) such as diabetes, hypertension and common cancers at the sub-centre and Primary Health Centre (PHC), which will enable the strengthening of preventive and promotive health, improve patient referral and access to secondary care.

Excerpts

Q. Please share some major highlights of 2017 in promoting health initiatives?

I am proud to say that there have been several achievements. Few on top of my mind are—Release of the new National Health Policy 2017 after a gap of 15 years, the Passing of HIV & AIDS (Prevention & Control) Act, 2017, the Cabinet approves the Mental Healthcare Act 2017, and the most recent National Medical Commission Bill, 2017.

Besides these policy and legislature decisions, the MoHFW launched some major health initiatives. Starting with the most recent National Nutrition Mission 2017 with Ministry of Women and Child Development (WCD), the intensified Mission Indradhanush. After the success of MI, the annual rate of increase of full immunisation coverage has increased from 1% to 6.7 % during the two rounds. We increased the basket of Universal Immunization Programme (UIP) with the introduction of new vaccines i.e. Rotavirus vaccine, MR vaccine and the PCV.

The PMSMA (Pradhan Mantri Surakshit Matritva Abhiyan) has helped detect more than 5 lakh high-risk pregnancies. Similarly, MoHFWs Rashtriya Bal Swasthya Karyakram (RBSK) has screened 11.7 crore children, 43.4 lakh children were referred to secondary tertiary facilities, 27.8 lakh children availed services in secondary tertiary facilities. The MoHFW also launched the Mission Parivar Vikas (MPV) in 146 Districts of 7 states for substantially increasing the access to contraceptives and family planning services in Districts with Total Fertility Rate (TFR) of 3 and above.

The MoHFW announced transformation of sub-health centres to Health and Wellness Centres (HWCs) to expand the basket of services of primary care to make it comprehensive. The HWCs are expected to provide preventive, promotive, rehabilitative and curative care for a package of services related to reproductive, maternal, newborn, child, and adolescent health (RMNCH+A), communicable diseases, non- communicable diseases, ophthalmology, ENT, dental, mental, geriatric care, treatment for acute simple medical conditions and emergency and trauma services. In addition, the recently launched population-based Screening of Diabetes, Hypertension and Common Cancers (Oral, Breast & Cervical) represents a massive step in identifying and addressing the risk factors at the community level itself. More than 150 Districts are taking up in 2017-18.

There are global achievements in terms of India being declared Infective Trachoma free. The MoHFW has also signed MoUs with Italy, Morocco and Cuba.

Q. What challenges did you aim to achieve next year?

Provisioning UHC and to restrict the growing burden of Non – Communicable Diseases. We have initiatives in place to manage both.

Q. How to address the fund crunch issue?

There is no fund crunch. In 2017-18 Union Budget, the health allocation was increased by 27.7%. The MoHFW is committed to 2.5% of GDP to healthcare in a phased manner under the National Health Policy 2017. So I don’t foresee any fund crunch.

Q. Your comments on private sector role in healthcare? Is their contribution satisfies you?

Private sector engagement is a part of new National Health Policy 2017 for a reason. They have a very significant and important contribution to the country’s health services landscape. In terms of real-time support, we are satisfied with their contribution to the Pradhan Mantri Swasthya Matritva Abhiyan (PMSMA) and provisioning dialysis services through PPP under the Pradhan Mantri Dialysis Program.

Q. Please throw light on Universal Health Coverage initiatives?
There are several, however, I can list a few:-

• In 2017-18, the MoHFW announced transformation of subhealth Centres to Health and Wellness Centres (HWCs) to expand the basket of services of primary care to make it comprehensive. The HWCs are expected to provide Preventive, Promotive, Rehabilitative and Curative Care for a package of services related to RMNCH+A, Communicable diseases, Non-Communicable Diseases, Ophthalmology, ENT, Dental, Mental, Geriatric Care, treatment for acute simple medical conditions and emergency and trauma services. The indicative package of services envisaged is

a. Care in pregnancy and childbirth
b. Neonatal and infant health care services
c. Childhood and adolescent health care services
d. Family planning, contraceptive services and other Reproductive Healthcare services
e. Management of Communicable diseases: National Health Programmes
f. Management of Common Communicable Diseases and General Out-Patient care for acute simple illnesses and minor ailments
g. Screening and management of Non-Communicable diseases
h. Screening and basic management of mental health ailments
i. Care for common Ophthalmic and ENT problems
j. Provision of basic dental health care
k. Geriatric and palliative health care services
l. Trauma Care and Emergency Medical Services

The Health and Wellness Centre (H&WC) will deliver comprehensive primary healthcare using a team-based approach and would be led by a mid-level service provider with a primary healthcare team including ANMs, ASHAs, and AWWs, of the sub-centre area. Altogether, 4000 sub-centres are targeted to be transformed to HWCs by March 2018 and 1.25 lakh HWCs by March 2022. So far approval has given for 3871 HWCs.

• National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS)— -In order to prevent and control major NCDs, the MoHFW is implementing the NPCDCS in all states across the country with the focus on strengthening infrastructure, human resource development, health promotion, early diagnosis, management and referral. As on date, the programme is under implementation in total 436 Districts, with setting up of NCD clinics in 435 District Hospitals, and 2145 Community Health Centres. Cardiac Care Units have been set up in total 138 Districts and Day Care Centres for Cancer Chemotherapy have been set up in 84 Districts. Provision has been made under the programme to provide free diagnostic facilities and free drugs for NCD patients attending the clinics at the District and CHC levels.

• Population-based screening for Diabetes, Hypertension and Common Cancer (Oral, Breast & Cervical)—The recently launched Population-based Screening of Diabetes, Hypertension and Common Cancers represents a massive step in identifying and addressing the risk factors at the community level itself.

More than 150 Districts are being taken up during 2017-18. As of September 2017, approvals given for about 170 Districts in 16309 sub-centres and screening has been initiated in about 60 Districts, 12 states, 2 UTs and 20,15,474 people have been screened.

Q. How the Ministry ensures safe pregnancy in rural/remote and tribal areas where access to hospitals is not that easy?
The issue focuses on our entire Reproductive Child Health (RCH) programme and National Health Mission To list a few viz.-
a. Janani Suraksha Yojana (JSY)
b. Janani Shishu Suraksha Karyakram (JSSK)
c. HBNC/HBIC (Home-Based Neonatal Care/Infant Care)
d. National Ambulance Service (108/104)
e. Tribal Birthing/Waiting Homes
f. Pradhan Mantri Swasthya Matritva Abhiyan (PMSMA)

Q. What message do you want to share with the community in their fight against dengue and chikungunya?

I want to focus solely on prevention viz. preventing water logging around the house. And other measures which we keep reiterating through our regular Information, Education, and Communication (IEC) campaigns. This requires community partnership and ownership.

Q.8. What has been the status of constructing of new AIIMS across the country?

The Government has been at the forefront to strengthen the tertiary care. As such six new AIIMS are functioning and six will come up in due course.

Q. Pl throw light on MoU signed with Morocco. What will be the major gains?
The main areas of cooperation include the following:
a. Non-communicable diseases, including child cardiovascular diseases and cancer
b. Drug Regulation and Pharmaceutical quality control
c. Communicable Diseases
d. Maternal, child and neonatal health
e. Hospital twinning for the exchange of good practices
f. Training in administration and management of health services and Hospitals
Q. Generic medicines: How to address availability issue?

The MoHFW recently issued a draft gazette notification making it mandatory for Pharma companies to carry the generic name of drugs on packs that are at least two fonts larger than the brand name. This clause will be a legal provision as a rule under the existing Drugs and Cosmetics Act. And any violation will be punishable under the provisions of the law. The Ministry has sought public comments on the draft, after which it is likely to become part of the drug law.

Also, issued orders to the Medical Council of India (MCI), state governments and all central government hospitals asking them to ensure that doctors write prescriptions with generic names of medicines in legible handwriting.

In last three years, the government has capped prices of around 700 essential medicines. It has also capped prices of stents and is working to make drugs for critical diseases like cancer and heart disorders available through various schemes. It has also launched several programmes to make free drugs and diagnostics available under the National Health Mission.

Also, our AMRIT stores provision generic drugs. 19 states have set 105 pharmacies for providing medicines for Diabetes, CVD, Cancer and other diseases at discounted prices to the patients. A total of more than 5000 drugs and other consumables are selling at up to 50% discounts.

As of 15th November 2017, 44.54 lakh patients benefitted from AMRIT pharmacies. The value of drug dispensed at MRP is Rs 417.73 crore and savings of Rs. 231.34 crore from AMRIT stores thereby reducing theirs out of pocket expenditure.

Q. Doctors’ shortage: What measures should be put in place to address the concern?

• The MoHFW has granted permission for the establishment of 83 new medical colleges in the last 3 years including 31 in the government sector. The country has today 479 medical colleges with more than 67,000 MBBS seats.

• The Ministry has taken various measures to facilitate the setting up of new colleges viz.

a. norms for medical colleges rationalized
b. urban areas have dispensed with the minimum area of land within notified
c. Companies have to allowed to set up medical colleges.

• The MoHFW is implementing a Centrally Sponsored Scheme namely “Establishment of new medical colleges attached with existing district/referral hospitals”

• Under this Scheme, 58 Districts in 20 States/UT has identified to establish new Medical Colleges attached with existing district/referral hospitals. Out of these, 56 have been approved to date.

• Out of 56 approved medical colleges, 8 are functional and 29 have applied for MCI’s permission to start new medical colleges from the academic year 2018-19.

• The increase of PG seats:

• In January 2017 the teacher-student ratio was revised in government medical colleges in clinical subjects and consequently around 3,000 PG seats added as a one-time measure.

• In the normal course of permission under IMC Act added 700 seats. Combined with the increase of DNB seats, the ministry could achieve an increase of nearly 5800 PG seats in 2017.

• The country has today around 38,000 PG seats including Diplomate of National Board (DNB).

Q. Please throw light on Mental Healthcare Act, 2016. What steps the did government plan to create awareness on this?

• The Act adopts a rights-based statutory framework for mental health in India and strengthens equality and equity in the provision of mental healthcare services in order to protect the rights of people with the mental health problem to ensure that they are able to receive optimum care and are able to live a life of dignity and respect.

• Mental Healthcare Act strengthens the institutional mechanisms for improving access quality and appropriate mental health care services.

• The Act increases accountability of both government and private sectors in the delivery of mental health care with the representation of persons with the mental health problem and their caregivers in statutory authorities such as Central and State Mental Health Authority.

• The most progressive features of the Act are the provision of advance directive, nominated a representative, special clause for women and children related to admission, treatment, sanitation and personal hygiene; restriction on the use of Electro-Convulsive Therapy and Psychosurgery.

• Decriminalization of suicide is another significant facet of the Act, which will ensure proper management of severe stress as a precursor for suicide attempts.

Finance Minister Arun Jaitley recently has announced two major initiatives in the health sector, as part of Ayushman Bharat programme. This is aimed at making path-breaking interventions to address health holistically in primary, secondary and tertiary care systems, covering both prevention and health promotion.

THE INITIATIVES ARE AS FOLLOWS:-

(i) Health and Wellness Centre:- The National Health Policy, 2017 has envisioned Health and Wellness Centres as the foundation of India’s health system. Under this 1.5 lakh centres will bring healthcare system closer to the homes of people. These centres will provide comprehensive healthcare, including for non-communicable diseases and maternal and child health services.

These centres will also provide free essential drugs and diagnostic services. The Budget has allocated Rs. 1200 crore for this flagship programme. In adopting these centres is also envisages the contribution of the private sector through CSR and philanthropic institutions.

(ii) National Health Protection Scheme:- The second flagship programme under Ayushman Bharat is National Health Protection Scheme, which will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage up to 5 lakh rupees per family per year for secondary and tertiary care hospitalization. This will be the world’s largest government-funded healthcare programme. Adequate funds will be provided for smooth implementation of this programme.

In order to further enhance the accessibility of quality medical education and healthcare, 24 new Government Medical Colleges and Hospitals will be set up, . This would ensure that there is at least 1 Medical College for every 3 Parliamentary Constituencies and at least 1 Government Medical College in each state of the country.

Want to write for InnoHEALTH? send us your article at magazine@innovatiocuris.com

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Tele-Medicine System to Strengthen Healthcare Services in India

InnoHEALTH Magazine — Thu, 10 May 2018 09:43:02 +0000

Till date, the Indian Government has taken various steps to strengthen the telemedicine network. Healthcare services take in the country, especially in rural India. Some of the efforts in this direction which need a mention are:

National Medical College Network (NMCN): With the purpose of e-Education and e-Healthcare delivery, 50 Government Medical Colleges has selected to interconnect, riding over NKN (National Knowledge Network). For this, one National Resource Centre (NRC) requires to centralise infrastructure and 7 Regional Resource Centres (RRCs) has established.

State Telemedicine Network (STN): The States/UTs have been supported under National Health Mission (NHM) under Program Implementation Plan (PIP) for strengthening State Telemedicine initiatives under STN & to create reliable, ubiquitous and high-speed network backbone, all available and future networks. So far,10 states have financially supported.

Ministry of Health & Family Welfare (MoHFW) in collaboration with Department of Space has setup Telemedicine nodes at some pilgrim places for health awareness, screening of non-communicable disease (NCD) and for providing specialty consultation to the devotees visiting holy places like Maa Vindhyavasini Mandir, Vindhyachal Dham, Mirzapur (UP), Sheshnag, Amarnath Pilgrimage (J&K), Pampa Hospital, Ayyappa Temple at Sabrimala (Kerala) and Kashi Vishwanath Temple, Varanasi, Uttar Pradesh.

Tele-Evidence: The tele-evidence facility streamlines the process of doctors appearing in courts in response to the summons. And saving their time not only for patient care but also for medical education and research. The project is operational in Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh since March 2014.

Also Read: An Interaction with J.P. Nadda on Health Plan

Want to write for InnoHEALTH? send us your article at magazine@innovatiocuris.com

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Testing Times for India

InnoHEALTH Magazine — Thu, 23 Nov 2017 07:34:34 +0000

Brig (Hony) Arvind Lal is a pioneer in bringing laboratory services in India at par with the international world. He has modernized Indian medical diagnostics and initiated the first Public Private Partnership (PPP) in the field of laboratory testing in India. Under his guidance, Dr Lal PathLabs (LPL) has become one of the most reputed laboratories in Asia having to its credit quality accreditations from various national and international bodies. Currently they operate over 172 labs, including Asia’s biggest lab at Rohini, New Delhi with 1,500 collection centers and pick-up samples from another 7,000 medical establishments all over India. The lab tests over 50,000 patients every day or nearly 10 million patients in a year.

He holds the honorary rank of a Brigadier in the Indian Army and the Government of India conferred him Padma Shri (Indian national award) in 2009, for his contributions to Medicine.

In an interview with KANIKA CHAUHAN InnoHEALTH , he sheds light on the evergrowing demands of quality testing and test labs in the country and shares his vision of a healthier future for India and every Indian.

Q1. When the Lal Path Labs started 68 years back, what was the scenario of Indian healthcare industry? How do you see the market now? And how has been the journey?

My late father Dr. Major S.K Lal started this lab in April 1949. He was a displaced person from the partition and came to India from Rawalpindi in 1947. After coming to Delhi he worked in a government lab for one-and-a-half years and then started the first pathology lab in North India. At that point of time there were hardly any pathology tests as we know neither there were any routine tests like, HP, TLC, ESR, Urine Test, Blood sugar Test, Cholesterol test. So there was not any competition then.

Q2. What is your future business plans both at National and International level?

We are running 1700 laboratories in India and about 1600 collection centers. In addition we take another 5000 collections of blood samples from our pick up points. For example Medanta, Fortis, Moolchand and Apollo are some of the pick-up points we have.

Last year we tested about 1.35crore patients, so the average of the samples we can test is about 55000 in a day. We are the biggest Histopathology Biopsy Centre in the world.

Histopathology Biopsy is a test basically to detect cancer. Suppose if a lady has a lump in her breast, so she feels something has to be done about the lump, a part of the lump is surgically taken out which is known as the biopsy, it is the biopsy we test and find out the results. There is a possibility of two things either the tumor is benign (Non-Cancerous) or malignant (Cancerous). If the lady has malignancy she under goes with further tests, chemotherapy and radioactive therapies as per clinical requirement. We are the largest Histopathology in the world. We test about 1000 biopsies in one day and we are the second largest kidney biopsy center in the world. We are the only laboratories in India which have their own electro-microscope for very high end testing. We have our centers in all the major cities of India.

Our next step would be to set up another comprehensive laboratory in Lucknow. We have such research center in Kolkata and next year we will make one in Lucknow. With this we will provide high end services for the people in the region for whom the services are not available.

Q3. With so many market players why people should opt for Dr. Lal? What additional value you bring to the table?

We have many reasons, first of all people know that we are not fly by night operators and also they have faith in us since last 70 years plus people come to us for their pathological tests because 70% of all the medical decisions are nbased upon the pathology test of a patient, hence if the pathological tests result aren’t in place 70% of the medical decision can’t be taken. Gone were the days when people used to visit the “vaids” and doctors and they felt the nerves and pulse gave medicines, now it is evidence based medication. If someone has fever the doctor would suggest the person to get a blood test because it could be malaria, chikungunya, dengue or it could be anything. And if the person is diagnosed with anything she or he will get the treatment for the same. Now the medicines are completely evidence based, there is no hit and trial. These are the reasons why people come to us.

Q4. With Dr. Lal Path labs entering into the international market with operations in countries like Middle East, Malaysia, Bangladesh, Nepal and many more, where do you see the potential for growth of your organization?

The first reason is, India is not having the kind of quality labs that it should have. There is a demand and supply problem. That is because there are no large laboratories. There are lots of facilities that claim to do testing, but they are not testing laboratories but testing shops. This is what is to be changed and people give the example of our establishment and say that “they should be like Dr. Lal’s laboratory.” All these countries you have mentioned, we are getting their samples for testing but only one lab is set up in Nepal and next would be in Bangladesh and then we will go to other countries. The reason we are slow on this is because our own country is huge. I usually say to people that if we will take out Uttar Pradesh and put it in the Indian Ocean, India would be the 5th largest country in the world. So this is the reason that we want to look at our country first and then look at the outside market.

Q5. What kind of environment does your organisation provide to patients?

Our organisation provides a very sterile kind of an environment, it doesn’t smell, and blood is not spilled around, there are no flies buzzing around the surroundings. This is a kind of a place where anyone would like to go to.

Q6. Now days there so many machines available in the market for test like sugar, BP etc, which we can be used by the patients themselves. How good is that? What are your views?

These are known as point of care testing and people can test a few things but in India people can only test blood sugar. For which we suggest the patient to check his or her blood sugar on a regular basis of 15 or 20 days, so these are called Point of Care Testing (POCT).

The POCT in India is not established because firstly, it is very expensive and secondly the Indian people aren’t savvy. There are seven types of care testing which is emanated by a lady. A lady can go to the bathroom and test her pregnancy by a UPT (urinal pregnancy test) in which she gets to know whether she is pregnant or not then in this case there is no need of a pathological test. When I was young we never had cats and dogs as pets but we had rabbits , so I never couldn’t understand why my father killed those rabbits and I got my answer when I was studying medicine. The reason why rabbits were killed during that time i.e, in early 1950s people used to check the pregnancy through it. A pregnant woman’s urine was injected into a female rabbit and after killing them they use to dissect the abdomen area to find ovulating ovaries. This is how pregnancy test were conducted.

Q7. Now a days Dr. Lal Path labs is focusing on inorganic growth; how beneficial it is to patients?

The growth in any sphere or in any business is either organic or inorganic, organic means when a person is creating his own set up, say if a person is doing well in Delhi so he decides to open a set up in Uttar Pradesh and then in Uttarakhand, and inorganic growth is when other person is ready to give up her or his lab to somebody else irrespective of any reason the former will give some certain amount of money to the latter in position of the lab this is called inorganic growth. We have done 10 inorganic growths till now and yes we will buy some more from south of India and west of India.

Q8. What innovations you think can bring down cost, keep quality and improve efficiency on which researchers and start-ups concentrate?

There is no start-up in my line, if one is a qualified pathologist either he can work in a pathology lab or can start his own lab. The start-up in Delhi is difficult because Delhi has become a saturated city. there are many people who are running many pathology labs and they shouldn’t run these pathology labs and the reason they are running the labs is because it is very lucrative, which is very unethical and should not be done.

So the government of India has also started the voice to our ways and they said that we are going to have a clinical establishment act which has been passed by the parliament in 2010. Since the healthcare is state subject so all the 29 states have not adopted it or implemented it. There are a chain of pathology labs which are not run by the pathologists they are run by the non-pathologists they are not even doctors they are quacks. So this brings out the quality and efficiency of the whole industry.

They are many diseases which affect the mankind these days and these diseases are called the non-communicable diseases. The non-communicable diseases can’t communicate with others, whereas malaria, chikungunya and dengue are communicable diseases because it happens through a mosquito bite. TB is a communicable disease too and if a person’s lungs are infected by TB people around them will get infected. In India we lose two patients of TB in every three minutes, India has a burden of communicable diseases which includes Hepatitis A.

But a bigger set of diseases have come out which are called NCDs (Non Communicable Diseases) and the NCDs are killing 65% of our people and if we will not control the NCDs it will also affect the two per cent of our GDP. The NCDs are headed by the high blood pressure, obesity, smoking, cardiac diseases, lung diseases, cancer, kidney diseases and stroke. Why it is becoming so important to us because it is also called the life style diseases, it changes the lifestyle of the person which has suddenly come up. India has large number of cancer patients and also large number of blood pressure patients. There is an element of genetic transfer of physical appearance of a person but some diseases are also transferred which only run in families.

The problem with Indian people is they only come in illness, but they should know that they should get their self-check on a regular basis to keep a check on their health, my main point is to make people aware of the annual healthcare which is very important for one’s health which is in between the doctor and a patient and also make them aware of the testing in wellness not in illness.

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