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February 2014 Medical Solutions The Magazine for Healthcare Leadership India’s Shining Example Dr. Devi Shetty’s Mission to Make World-Class Healthcare Accessible in India
Editorial “India is home to many healthcare leaders who are tackling India’s challenges with courage and ingenuity.” Hermann Requardt Member of the Managing Board of Siemens AG and CEO of the Healthcare Sector 2 Medical Solutions | February 2014 | www.siemens.com/medical-solutions
Editorial Hermann Requardt, Member of the Managing Board of Siemens AG and CEO of the Healthcare Sector Dear Reader, India is facing numerous challenges in healthcare and Some Indian hospitals are setting new global standards in there is no doubt that the healthcare situation is far from enabling affordable, high-quality healthcare: Players from perfect. Despite solid economic growth over the past two emerging markets can gain insight into ways to improve decades, around one third of the Indian population con- access to affordable healthcare services. Players from tinues to live below the poverty line with only limited access developed countries, constantly under cost pressure, may to medical care, especially in rural parts of the country. find some inspiration for raising productivity and keeping Medical practitioners are struggling to meet the increasing healthcare costs down without compromising on quality. needs in healthcare – with a constantly expanding middle Our focus on healthcare in India also demonstrates how class and a rising prevalence of cardiovascular disease, low-income countries are putting pressure on established diabetes, and others. markets. In the era of telemedicine and medical tourism, However, necessity is the mother of invention – and of healthcare is now a global business where prices for ser- innovation. India is home to many healthcare leaders who vices are compared across countries. Indian healthcare pro- are tackling India’s challenges with courage and ingenuity. viders count on these market mechanisms. Not only are They are finding new ways to deliver quality healthcare at they establishing state-of-the-art clinics in international affordable rates – and on large scales. comparison in India, they are also extending locations to be even closer to customers in the West. The renowned Healthcare in rural areas can by all means translate into heart surgeon and entrepreneur Dr. Devi Shetty even con- profitable business, as our customers from Surat in the west siders India to be on the way to becoming a healthcare (p. 40) and Imphal in the easternmost region of India have provider to the world (p. 8). shown. These customers have business models that lever- age economies of scale – be it in imaging or laboratory Siemens is a partner to each of these Indian healthcare diagnostics. Their productivity makes their business both providers – whether they have entry-level or high-end affordable for patients and profitable for the institution. needs – in developing and producing tailored products The same is true of Thyrocare, which is, according to its and solutions. founder and CEO, the largest and fastest lab of its kind in I hope you enjoy reading this issue. the world – thanks to Siemens laboratory automation. Read how Thyrocare is changing the rules of lab testing in India on page 28. The customer stories in this issue are initiated to a large extent by individuals, entrepreneurs, and philanthropists who lack the support of a comprehensive public infra- structure. But these centers provide a foundation on which Hermann Requardt to build a general healthcare system – which would barely Member of the Managing Board of Siemens AG be possible without these frontrunners. and CEO of the Healthcare Sector Medical Solutions | February 2014 | www.siemens.com/medical-solutions 3
Contributors Arush Mayank Renowned photographer Arush Mayank landed in Bangalore for the cover shoot of Dr. Devi Shetty with plenty of ideas. “When we met Dr. Shetty, it was evident that he had very little of what we wanted from him – his time. All my plans for the shoot went down the drain,” says Mayank. He then decided to work around the doctor’s schedule. He stayed one day longer to follow him wherever he went. “I adopted his business model – going for quantity. I went on a clicking spree,” he says. After two days of shooting, with long hours of waiting for Dr. Shetty, Mayank got countless photographs. But more importantly, he left with a “gratifying feeling of meeting a man who has inspired our country and especially our generation,” says Mayank. See page 8 Moritz Gathmann Russia correspondent Moritz Gathmann (left) gets excited every time he visits St. Petersburg. “I always remember the feeling of arriving there the first time during a school exchange at the age of 14. Of course, since 1994 the city has changed a lot – for the better,” he says. And he sees Dr. Arkady Stolpner (right) as a good example “of people who make change happen in this huge country: He established medical centers that revolutionized diagnosis and therapy in the field of oncology in St. Petersburg – and then all over the country.” See page 60 Andre Vieria Internationally acclaimed photographer Andre Vieria says that during his assignment at DASA in Rio de Janeiro he was most amazed by “how sophisticated all the technology is.” He adds: “For me, luckily someone not very familiar with hospitals, it’s incredible to see the human body at work in real time on the computer screens. Sometimes I’d get so fascinated by what I was seeing on the screen that I’d forget to take photos. I guess everyone of us will eventually be inside one of those machines at least once in our lives. It’s nice to be able to see them from the control room side, see what they’re capable of doing.” See page 72
Sroop Sunar London-based illustrator Sunar Sroop says she always enjoys opportunities to illustrate topics to do with her native country. “This article on Indian healthcare allowed me to explore a current issue surrounding the country today. Being based in the UK, it is ever more important to me that I sustain my ties with India through illustration. India is my inspiration. It drives my focus and dedication, perhaps like many of the young talents featured here,” she says. See page 52 and the geographical icons at the beginning of each India story. Roman Elsener Getting to know the Inspira Health Network in Southern New Jersey in just one day and over five different locations was a challenge for U.S. correspondent Roman Elsener (right, together with Lynette Newkirk, Inspira’s Adminis- trative Director) – but ultimately a rewarding experience. “Together with photographer Skye Parrot, we really got to see how Chet Kaletkowski and his team bring it all together and connect doctors, hospitals, and patients via the sophisticated software that Siemens installed,” Roman recalls. “At the same time, we were reminded of the long way to go until healthcare reform in the USA is fully implemented.” See page 78 Swati Prasad Senior business journalist Swati Prasad loved every minute of the four trips she took to Salem, Madurai-Coimbatore, Bangalore and Surat to meet clinicians, entrepreneurs, and philanthropists who are changing India’s healthcare arena. “It was interesting to see how the sector is deploying technology to address the country’s healthcare chal- lenges. A lot is changing across the length and breadth of India,” she says. But the most delightful was Swati’s meeting with Dr. Devi Shetty. “He’s someone who has taken a holistic view and is determined to change the healthcare scenario through his innova- tive business practices, medical techniques, and insurance programs.” The interview was strewn with quotes from Mother Teresa, as he had served as Mother’s personal physician. “I took back a lot more than just the interview with Dr. Shetty,” says Swati. See page page 8, 24, 36, 42 and 46 Wiebke Kathmann When medical writer Wiebke Kathmann visited the Ambulatory Healthcare Center Prof. Dr. Uhlenbrock and Partners in Dortmund, Germany, she was excited. “Learning more about the latest advances in low-dose mammography meant a lot to me,” she says. Being a woman and knowing that this screen- ing method means quite a bit of radiation exposure over the years, “I was happy to hear that nowadays a comparable image quality can be achieved with up to 30 percent less radiation.” See page 68 Medical Solutions | February 2014 | www.siemens.com/medical-solutions 5
Contents Contents 08 28 Medical Solutions met with One Mumbai-based lab Dr. Devi Shetty, chairman of Narayana alone serves one billion Health in Bangalore, India. people – at affordable rates. Healthcare in India: Trends and Insights 08 India’s Healthcare Visionary 36 On the Quality Highway Interview with renowned heart surgeon and After investing in digital radiography, a hospital in entrepreneur Dr. Devi Shetty on how healthcare in Coimbatore turned to be the probably most updated India can be made affordable for all. hospital in its region. 16 The Road Less Travelled 40 Giving Shelter to the Needy In India’s turbulent and rather inaccessible By charging less than half the market rate, an northeastern region, a laboratory has invested in Indian imaging center is making high-end magnetic automation to provide quality healthcare at resonance imaging scans affordable for the masses. affordable rates. 46 Pioneering CT in Salem 24 A Trailblazer in Orthopedics Both physicians and patients at SKS Hospital in An Indian expert uses simple radiological tools for Salem, India, benefit from advanced CT technology. research to transform international methodologies in orthopedics. 52 Smart, Ambitious, Dedicated – India’s Young Doctors 28 Mastering the Volumes Portraits of some of India’s next generation A Mumbai-based laboratory processes 100,000 of medical professionals: Their work, their goals, diagnostic tests per night – more than in any other their dreams. comparable lab worldwide. 6 Medical Solutions | February 2014 | www.siemens.com/medical-solutions
Contents 46 60 SKS Hospital in South India saves time and costs despite a higher The success story of a investment in a high-end CT scanner. Russian revolutionary in diagnostic imaging. Features 02 Editorial 60 The Russian Revolutionary in Diagnostic Imaging How Dr. Arkady Stolpner improved access to magnetic resonance imaging throughout Russia. 04 Contributors 64 Timing is Everything 84 Digital Highlights Workflow management technology helped a California medical center synchronize quality improvement efforts. 92 Further Publications 68 A Winning Team for Low Dose Digital 93 Imprint Mammography An expert teamed up with Siemens to find ways of reducing radiation dose in breast cancer screening. 72 Forging a Unified Healthcare Culture Interview with the chairman of Latin America’s largest diagnostic company on investments in innovation and on being a pioneer. 78 Bye Bye, Paper Files! A health network relies on IT solutions to implement the healthcare reform in its corner of the USA. Medical Solutions | February 2014 | www.siemens.com/medical-solutions 7
Healthcare in India India’s Bangalore Population 8,425,970 Healthcare Visionary Dr. Devi Shetty, Chairman of Narayana Health, headquartered in Bangalore, India, is on a mission to expand the reach of world-class healthcare facilities to the poorest in India. And he’s convinced his model can be replicated the world over. Text: Swati Prasad Photos: Arush Mayank Illustration: Kelli Anderson 8 Medical Solutions | February 2014 | www.siemens.com/medical-solutions
Healthcare in India Dr. Devi Shetty examining an infant with a congenital heart defect. Several patients wait for hours outside his office at Narayana Health, Bangalore, for his opinion. Dr. Devi Shetty does everything differ- “India will become the first country to ently. When most private healthcare dissociate healthcare from affluence,” chains in India are adding fancier says Shetty, in his spacious corner room restaurants, multiplexes, and super- at Narayana Health City in Bomma luxury wards to their new hospitals, sandra, on the outskirts of Bangalore. Shetty – Founder and Chairman of “India will prove that a country need Narayana Healthcare (NH) – is doing not be rich to offer quality healthcare away with air-conditioning and marble to its citizens,” he adds. With ‘Om’ chants flooring in order to make healthcare playing in the background, there is more affordable. He can talk about peacefulness in his demeanor and con- expanding operations, improving prof- viction in his voice as he spells out his its, and reducing cost in the same vision for India and the world. breath. Although his business model And there is no doubting his convic- goes beyond economics: Shetty’s hos- tion. Back in 2001, Shetty founded pital chain never turns away a patient Narayana Health (earlier known as due to a lack of funds. Despite this Narayana Hrudayalaya) because he policy, Shetty claims to be more prof- could not find an employer who under- itable than leading American hospital stood his vision for making world-class chains. 10 Medical Solutions | February 2014 | www.siemens.com/medical-solutions
Cover Story healthcare affordable to all. From a 300-bed hospital in 2001, NH has grown to a 6,000-bed healthcare conglo Dr. Devi Shetty: merate, with 17 hospitals present in 13 locations across India. Over the next An Unparalleled Clinician six years, Shetty plans to grow five- fold – into a 30,000-bed healthcare conglomerate. He plans to achieve that Shetty was awarded Padma Bhushan in 2012 – the third- by building low-cost, 300-bed, multi- highest civilian award conferred by the Indian government. specialty hospitals that take just six months to construct. He is the first surgeon in India to perform heart surgeries Shetty has proved that ‘affordable world- on newborn babies, using a micro-chip camera to close holes class healthcare’ is not an oxymoron. in the heart. “We are a low-cost hospital but our hos- pital is accredited by the Joint Com mission International of the USA,” says Shetty and his team have performed over 70,000 major Shetty. “People always say ours must heart surgeries out of which 15,000 were on children, be an Indian way of doing things (with many of them newborn babies. reference to low costs). There is no Indian way of doing things. There is only one way of doing it and that’s the Along with the Indian Space Research Organization, best way of doing it,” says Shetty. NH manages the world’s largest telemedicine program. Mastering the Volumes NH has built a 150-bed hospital in Mysore for 300 million Shetty, who is also known as the Henry INR (US$ 4.6 million) – which is a fifth of the industry’s cost. Ford of heart surgery, pioneered the low-cost healthcare model by employ- ing an assembly-line approach to sur- gery where junior doctors complete all the preliminary steps, leaving only the crucial step to be p erformed by their seniors. This way, the senior surgeons are able to perform more surgeries in a day than their peers in the West. It also has a centralized supply-chain any finite component. It is dependent “Surgeons are like technicians. The management system geared to getting on human skill. And human skill is more surgeries they perform, the better the best deals in exchange for high replenishable. We can technically they get at it,” says Shetty. Interns from volumes from a select set of suppliers. reduce the price of any service to any developed countries come to NH to In fact, 85 percent of its drugs and level we want,” explains Shetty. With get a first-hand experience of Shetty’s consumables are purchased by its this approach, Shetty aims to reduce assembly-line approach to surgery. central buying unit. the cost of healthcare by as much as Today, a fair number of surgeons come 50 percent over the next decade. to NH from countries such as China, Moreover, NH does not go for fancy England, and the USA for training. interiors. This way, its 150-bed Working on the hospital in Mysore has managed to Apart from cardiology, NH offers facili- reduce the cost of heart surgery to Challenges ties across various specializations, such US$ 800, compared to US$ 1,000 in Shetty’s vision for India is fraught as gastroenterology, vascular services, Bangalore. with challenges. For one, India does nephrology, urology, neurosurgery, According to Shetty, while there is a not have many specialists, due to the pediatrics, obstetrics, and gynecology, market for luxury hospitals, the bulk lower number of post-graduate medi- as well as endocrinology, cosmetic of the business will come from the cal places. “We have 45,600 under- surgery and rehabilitation, organ trans- poor who can’t afford treatment due graduate places in our medical col- plants, and oncology. to a lack of medical insurance and leges, but only 12,000 post-graduate NH deploys technology to bring down prohibitive cost of healthcare. places. In comparison, the USA has costs. It uses IT expertise to improve 19,000 undergraduate and 32,000 management systems. For example, He feels it is easier to bring down post-graduate places,” he says (more NH’s extensive database is on a cloud, costs in healthcare, as opposed to on the challenges medical students saving infrastructure and people costs. manufacturing. “Unlike manufactur- in India are facing on page 52). ing, healthcare is not dependent on u Medical Solutions | February 2014 | www.siemens.com/medical-solutions 11
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Cover Story The Pediatric Intensive Care Unit at Narayana Health is well-equipped to manage difficult childhood emergencies. It’s critical to have specialists to improve a problem, he feels. Therefore, NH nurse practitioner, a nurse anesthe- the healthcare standards. “Among has launched a scholarship program – tist, a nurse intensivist... or even the top ten causes of death are heart Udayer Pathey (which means ‘rising become a doctor,” he says. But not so disease, cancer, accidents, strokes, path’ in Bengali). Its objective is to in India. Alzheimer’s, and psychiatric problems. help 2,000 students from villages of Shetty has played a key role in the All these diseases require specialists,” West Bengal become doctors every ‘Save the Doctor’ campaign, started Shetty explains. year. “We give them scholarships and by the Indian Medical Association mentor them,” adds Shetty. Two, the medical profession is losing (IMA) and the Association of Health- its charm, since it doesn’t pay as well The other challenge for India, accord- care Providers India (AHPI). Through as many other industries. “When I was ing to Shetty, is that it needs more this campaign, Shetty hopes to in school, when someone asked us nurses, technicians, and administra- address several issues plaguing the who wants to become a doctor, virtu- tors. “Behind every skilled doctor you industry. “We want to create an infra- ally the entire class would raise their need to have at least two highly-skilled structure to address the issues con- hands. Today, very few hands go up,” nurses, at least four to five techni- fronting doctors first, and then we he says. cians, and good administrators.” will take up the causes of nurses, technicians, and the like,” he says. Shetty is working on this. “Across the But, due to the government’s myopic world, outstanding doctors generally policies, “the nursing profession may “If every country has adequate num- come from deprived backgrounds – soon be extinct in India,” says Shetty. ber of surgeons, radiologists, anes- they have fire in their bellies and can “Admission to nursing colleges has thetists, and cardiac surgeons, believe work round the clock to change the come down nearly 50 percent,” he me, costs will come down by more rules of the game,” he says. If these adds. The reason? There is no career than 50 percent. It is a question of youngsters find medical education progression for nurses and technicians. demand and supply,” he says. Shetty expensive and non-rewarding, there is “In the USA, a nurse can become a is optimistic that the scenario will u Medical Solutions | February 2014 | www.siemens.com/medical-solutions 13
Creating Equitable Growth How can India address the issue of volumes in east India. Nearly 150 districts in the east of India order to create more supply of doctors, nurses, are affected by Naxalism (a term used to refer to specialists, and so on? various militant Communist groups operating in India). The Naxalite problem is not a law-and-order Shetty: The industry has to start lobbying. That’s problem. It is an economic problem. You start a the only way we can change the scenario. Medical medical college in this region and within three to diagnostic equipment manufacturers, pharmaceuti- four years, there will be about 5,000 to 8,000 students cal companies, and clinicians have to influence the living in that district. They will change the economy policymakers. Companies like Siemens are not able of the entire district. to sell many radiology systems in India because there aren’t that many radiologists. Today, people have Globally are there any healthcare models that the money to buy a magnetic resonance imaging India can emulate? (MRI) scanner, but there is a dearth of radiologists Shetty: We have a lot to learn from the USA and who can interpret the reports. The same applies to Europe. In the USA, a large number of procedures pharmaceutical companies. They manufacture so are done by physician assistants. They significantly many specialty drugs, but there aren’t enough post- reduce the volume of work to be done by the graduate doctors in India who can prescribe them. surgeons. You mentioned that healthcare creates The process of healthcare is a lot more streamlined equitable growth. Can you explain this? in these countries. For instance, in oncology there Shetty: Healthcare is a unique industry that creates is an oncology nurse, who knows all about the drugs millions of jobs for millions of households. It is a and can talk to the patient very confidently. We have main driver of the nation’s economy and creates not reached that yet. highly skilled jobs for a few people. But a large num- When you talk of bringing down costs, what’s ber of jobs require semi-skilled and unskilled people. the first step hospitals need to take? If India wants equitable growth, the government Shetty: In global forums, everyone talks about must open more medical colleges in regions such as reducing the cost of healthcare. But no one knows how much they are spending today. We have invested in technology. Every day at noon, I get an SMS on my cell phone with yesterday’s reve- nue, expenses and EBIDTA (earnings before interest, depreciate, taxation, and amortization) margin. For us, looking at a profit and loss account at the end of the month is like reading a post-mortem report. You cannot do anything about it. Whereas if you monitor it on a daily basis, it works as a diagnostic tool. You can take remedial measures. While charity is not scalable, good business princi- ples can be scaled up, and can be taken to any level. “Healthcare is a unique industry that creates millions of jobs.”
Cover Story Globally, healthcare is a US$ 4.5 trillion industry. It is the second largest industry after food and agro- processing. “Despite its size, it only addresses about 30 percent of the world population. Nearly 70 percent of the world population is nowhere near receiving decent healthcare services. We need a revolution in order to service the entire market,” he adds. According to Shetty, India can address most of the challenges with- out spending a single cent. “All we have to do is relax the norms for higher medical education,” he says. “India has all it takes to emerge as a major healthcare provider to the world. Indians are born healers. We produce the largest number of doctors, nurses, and medical technicians. We have a very mature pharmaceutical industry,” he says. People from different religions come to the multi-faith temple at Narayana Health to pray for the speedy recovery of patients. According to Shetty, the policymakers need to realize that it is not just about healthcare. “It is about creating equitable growth across the society,” change soon. “We have received a very Now, Shetty is convincing policy- he adds. positive response from the government,” makers to float a scheme through As a first step towards going global, he says. which every mobile phone subscriber NH is partnering with the Ascension in India pays 20 INR (US$ 0.32) over Group in the USA to set up a hospital Increasing Medical Cover and above the regular bill, in order to in the Cayman Islands – close to create a robust health insurance pro- patients in the USA and Central Shetty’s approach to increasing acces- gram. “In India, we have 850,000 America. It will be inaugurated on sibility of healthcare facilities is two- mobile phone subscribers who spend February 2014. “Initially, we expect it pronged. On the one hand, he is work- at least 150 INR (US$ 2.3) per month to be 30 to 40 percent cheaper than ing on supply – of both hospitals and just to speak on the phone. If there is other hospitals in the region. But over healthcare professionals. On the other a policy that provides them with health a period of time, we plan to make it hand, he is working on increasing the insurance for an additional 20 INR even more affordable,” says Shetty. penetration of health insurance. (US$ 0.31), I do not think anyone will By expanding overseas, NH is sound- “Ten years ago, we realized that tax- mind paying that additional money,” ing the bell for a healthcare competi- payers’ money cannot pay for health- he says. tion on a global scale – and paving care,” says Shetty. He conceptualized the way for world-class healthcare at The state governments are very open the Karnataka Yeshasvini Health Care affordable prices in the future. p to this suggestion, he adds. “The Scheme, which became operational Indian government will soon become in June 2003. Through this scheme, a health insurance provider. Not only farmers contributed 5 INR (US$ 0.08) a healthcare provider,” says Shetty. per month towards medical insurance. The government agreed to be the rein- Healthcare Provider to Swati Prasad is a freelance business surer. Today, the premium has risen to 18 INR (US$ 0.27) per month. “Over the World journalist based in Delhi. She reports from India for several publications overseas and the last decade, over 450,000 farmers The economy of the 20th century was has worked as a correspondent and editor had a variety of surgeries, including driven by machines. “The healthcare for The Economic Times, Business Standard, major heart operations,” informs Shetty. and wellness industry is going to The Indian Express, and Business Today. drive the world economy of the 21st century,” says Shetty. Medical Solutions | February 2014 | www.siemens.com/medical-solutions 15
Healthcare in India Imphal The Road Population 264,986 Less Travelled In the rather inaccessible and turbulent northeast of India, Babina Diagnostics opted for the high-end Siemens StreamLAB Analytical Workcell. With more than one million laboratory tests performed each year, this investment is helping to increase workflow and patient satisfaction. Text: Archis Mohan Photos: Atul Looke 16 Medical Solutions | February 2014 | www.siemens.com/medical-solutions
Laboratory Diagnostics Imphal is the capital of the eastern-most state of India and destination for many who want to get their blood tested at a state-of-the-art laboratory. K. Lungrei Ekhrol, 60, a farmer, sits gleaming Siemens StreamLAB™ the StreamLAB solution just over two watching television in the spacious hall Analytical Workcell, the only one in years ago. It is an investment that of Babina Diagnostics in Imphal, the India. Singh says he has never regretted. capital of Manipur, a state in north- “StreamLAB is the pride of this labo- StreamLAB is an intuitive automation eastern India the size of Slovakia. It’s ratory,” says Dr. Th. Dhabali Singh, the solution that consolidates all tasks in nine in the morning but the hall is founder and Managing Director of a single workstation that helps stream- already full. Like Ekhrol, all patients Babina Diagnostics. Babina acquired line workflow. It is fully-automated, u are awaiting their turn to have their blood drawn for various clinical diag- nostic tests. Most of the patients started from their homes in the rural countryside at the crack of dawn. They walked several kilometers to reach the nearest paved road before they boarded a bus to get to this sleek four-storey building that houses Babina Diagnostics. Ekhrol says he would need to return home before sundown. The good news is that everyone in the hall can expect their blood reports by lunchtime. It will leave him, says Ekhrol, ample time to visit his doctor and share the report, do some shopping, and still manage to return home before dusk. The reason for Ekhrol’s calm confi- dence, although he is quite unaware of it, sits some meters above his head. At the center of a similarly-sized hall 60-year-old Ushokholun with his son Mangpu from Myanmer travelling by moped to give his blood on the third floor of the building sits a sample at the Babina collection center in the Indian border village of Moreh. Medical Solutions | February 2014 | www.siemens.com/medical-solutions 17
Healthcare in India 70 percent of diagnostic tests at Babina Diagnostics are of walk-in patients. loads and unloads the test tubes from ment school, walking several kilometers one single location, accommodates carrying his own gunny bag, used for different tube types, has an efficient sitting on the ground as the classes took tube sharing system and accelerated place out in the open during winter turnaround times, offers extensive season. He says it was his father who, immunoassay menu options, and is despite being a small trader, motivated compact in size. Its small footprint, all his children to study. “He realized and productivity equalling systems the importance of education and loved twice its size, convinced Singh to the medical profession. He kept push- include the StreamLAB solution in his ing me to study medicine,” says Singh. armory of diagnostic instruments. To the surprise of most of his friends and relatives, the future entrepreneur Betting Big on returned home to Imphal after his Automation medical studies in faraway Chandigarh. A stint at a hospital in Imphal made Singh says he always had a burning him realize that Manipur didn’t have ambition to do something for his the facilities to do even the most basic homeland. He studied at a govern- 18 Medical Solutions | February 2014 | www.siemens.com/medical-solutions
Laboratory Diagnostics of diagnostic tests. Financial assistance Babina Diagnostics from its 100 col- from his father-in-law and help from lection centers across Manipur and friends, including a microscope rented from major cities across the northeast at INR 175 (US$ 3), helped him start – such as Agartala in Tripura, Silchar the laboratory in November of 1983. and Guwahati in Assam, and Dimapur It did well and by 1994 he quit his job and Kohima in Nagaland. Of late, a as an associate professor in the local couple of dozen samples come daily government-run medical college. Singh from the border towns of Myanmar, is proud of the fact that he came back which is 117 kilometers from Imphal. to his homeland when his contempo- raries were busy making a beeline for Minimizing Errors With the UK and the USA. Automation With time, Singh realized the need Singh named Babina Diagnostics for an automated solution that could after his daughter, Babina. His daugh- reduce turnaround times significantly ter, who is also a doctor, helps him and be error-free. He had set his heart run the laboratory. She says mistakes on acquiring the StreamLAB solution occur primarily due to human error for Babina Diagnostics from the time it and automation is the only solution was launched. “We had been looking for minimizing them. u for a complete automation solution The destination of many medical travellers: Babina Diagnostic’s laboratory. for Babina Diagnostics for some time, especially clinical chemistry and immu- noassay, of which our sample volumes are considerably high,” he says. Good after-sales service from Siemens con- vinced him further. He says at times his children and rela- tives berate him for investing so much money in expensive diagnostic equip- ment in a place like Manipur, where purchasing power is low. “The invest- ment in StreamLAB was significant, but I was confident it was viable,” says Singh. And indeed: The StreamLAB solution has helped Babina Diagnostics carry out an impressive one million tests a year, most of which are processed between morning and early afternoon so that customers can reach their homes in distant places before the sun sets on the valley. Singh says the laboratory’s turnaround times have reduced by 30-35 percent with the introduction of the StreamLAB solution, and errors have been significantly reduced. Currently, Babina Diagnostics com- mands a 70 percent share of the diag- nostic market in Manipur, processing nearly 1,000 patient samples per day. Singh says approximately 70 percent The lab performs tests on the most common medical conditions in northeastern India, of diagnostic tests are from walk-in such as endocrine and autoimmune disorders, diabetes, and infectious diseases. patients. The rest of the samples reach Medical Solutions | February 2014 | www.siemens.com/medical-solutions 19
Healthcare in India Setting an Example India’s northeastern region is both relatively inaccessible and underdeveloped. Good healthcare services are mostly unavailable. Babina Diagnostics is an exception. For the last 30 years, it has made quality healthcare services accessible to the people of Manipur. It turned to automation to handle its huge volume of samples. The StreamLAB Automation Solution has helped reduce turnaround times, increase employee efficiency, and improve physician and patient satisfaction. With the advent of the StreamLAB barcoded. Bundles of these barcoded solution, Babina Diagnostics’ opera- tubes are then put into plastic bottles tions have significantly reduced that are pushed into an automated errors. pneumatic sample delivery system that reaches the third floor. There, the tube The entire process from collecting bundles are brought out of the bottles blood samples to issuing test reports and put onto the StreamLAB track. requires minimal human intervention at Babina Diagnostics. The tubes Singh says the StreamLAB solution can with blood samples collected from accommodate different kinds of tubes the patients on the first floor are that may come from the collection At the StreamLAB track: Only minimal staff is required to process the 1,000 tests per day. 20 Medical Solutions | February 2014 | www.siemens.com/medical-solutions
Laboratory Diagnostics “Babina Diagnostics changed the market scenario in the region, benefitting both doctors and patients.” Dr. Th. Dhabali Singh, founder and owner of Babina Diagnostics, Imphal, India centers, does centrifugation to sepa- than three to four hours. Patients for its technicians. The doctor says rate plasma or serum from other com- that walked into the laboratory at maintenance is the key to ensuring ponents of blood like leucocytes for 9 a.m. can collect their test report by reliability and efficiency of the lab better test results, reads the barcodes 1 p.m. There are also times when the automation systems. “We have our to conduct the prescribed tests, and laboratory does emergency tests for own quality policy in place that takes updates the test results in the master samples from collection centers and care of the maintenance,” he says. server. results are communicated immedi- Some of the most common medical ately, either via fax, the Internet, or The results are then sent by email or problems in northeastern India are by phone. the printout is given to the patient endocrine disorders, autoimmune dis- waiting in the ground floor hall. The Babina Diagnostics conducts routine orders, diabetes, infectious diseases, entire procedure doesn’t take more skill development training sessions conditions like HIV and hepatitis, and u Medical Solutions | February 2014 | www.siemens.com/medical-solutions 21
Healthcare in India cancer. These are also the most com- monly performed tests at Babina Diag- nostics to detect and diagnose these diseases. Braving the Odds The diagnostics market in Manipur is relatively small compared with metro politan cities in other parts of India. Manipur with a geographical area of 22,347 square kilometers is one of the smaller states in India and, with 2.7 million inhabitants, also one of its least populous. “But most physicians and people in the region trust Babina Diag- nostics. The sample load has been increasing by the day,” says Singh. Babina Diagnostics ushered in qualita- tive changes in healthcare in Manipur, which lacked a diagnostic culture. “In time, physicians and patients began to realize the importance of correct diag- nosis and accurate test reports,” says Singh. Earlier, people from Manipur sent patient samples to laboratories in Kolkata and Delhi, which are 1,500 and over 2,000 kilometers from Imphal, respectively. “We know the importance of timely diagnosis in the treatment of a disease. Babina Diagnostics changed the market scenario, benefitting both doctors and patients,” says Singh. Singh says his wide network of collec- tion centers and joint venture units have made health services more accessible. Babina Diagnostics is the preeminent diagnostic centre in the region. It was also the first pathological laboratory run by a pathologist in Manipur. “Being a pathologist myself, I was aware of the needs of the treating physicians and the people. It has always been my dream to run a diagnostic laboratory The barcoded vials are put into plastic bottles on the ground floor and then pushed of my own. Fortunately, all my instincts into an automated pneumatic sample delivery system that reaches the lab automation on the third floor. and gambles proved right. There were financial risks involved, but I was con- fident they would pay off,” says Singh. “The law-and-order situation, the fre- quent blockades on the highways, the geographical terrain, and the natural calamities such as landslides, as well as the erratic power supply, are prob- lems that we have to encounter as entrepreneurs,” he says. Poor power 22 Medical Solutions | February 2014 | www.siemens.com/medical-solutions
Laboratory Diagnostics Patients accept long journeys to have their blood tested, but thanks to the lab’s fast turnaround times, they arrive back home on the same day. supply has meant the laboratory has two of its collection centers situated at affordable rates,” says Singh. Despite to rely on diesel generators for power, in the bordertown of Moreh. In col- the challenges, Singh is unwavering which is expensive. Blockades of high- laboration with pharmaceutical com- in his commitment to “give the best ways lead to total stoppage of samples panies, Babina Diagnostics conducts to the people of Manipur and the coming from outside Manipur. free health camps on a regular basis northeast region.” p in Moreh and inside Myanmar. Despite these problems, Singh is opti- mistic about the future. Manipur’s con- The investments in instruments and nectivity with the rest of the country automation have not caused Singh to and the larger southeastern region of increase the cost of the tests. Babina Asia is set to become better with Imphal Diagnostics has rates that are less expected to have a rail link with the expensive than in cities. Singh plans rest of India by 2016. There are also to promote a multispecialty or cancer Archis Mohan is a New Delhi-based free- plans for an international airport. hospital in Imphal in the future and lance journalist. He writes on a range of even a medical college to improve the issues for both Indian and foreign print and The doctor says Imphal could become television media outlets, including Hindustan doctor-patient ratio, which is currently the center of medical tourism not only Times, The Telegraph, NDTV and Times Now. at one doctor for 1,660 patients. for people from other northeastern states, but also from neighboring “The potential is huge. I would like to Myanmar. Babina Diagnostics already see many more hospitals and diagnos- ww.siemens.com/ w has customers from Myanmar, with tic centers offering premium services laboratory-automation Medical Solutions | February 2014 | www.siemens.com/medical-solutions 23
Healthcare in India Coimbatore Population 1.1 million A Trailblazer in Orthopedics Dr. S. Rajasekaran of Ganga Hospital, Coimbatore, has used simple diagnostic tools for research to transform international methodologies in orthopedics. His approach of putting the patient first is now driving him to evolve new healthcare models for India. Text: Swati Prasad Photos: Arush Mayank Coimbatore is amongst the fastest it impacts on the international com- into a specialty hospital for orthope- growing tier-II cities in India, bustling munity. Moreover, it is also a hospital dics and plastic surgery. Back then, with textile mills, factories, informa- that never turns away patients, even Ganga was a polyclinic for obstetrics tion technology companies, and if they do not have the money for and gynecology, pediatrics, and hospitals. Unlike most small cities in treatment. “We look for donors and neurology. south India, it doesn’t boast many ask our surgeons to operate for free,” “Many of our friends and colleagues tourist spots. Its fame comes from says Rajasekaran. thought we didn’t stand a chance. But entrepreneurs and from institutions His research interests relate to spinal we believed there was a niche segment like Ganga Hospital, which has put tuberculosis, open fractures, genetic we could address,” says Rajasekaran. Coimbatore on the world map of studies, back pain and disc degenera- The belief came from the fact that orthopedics. tion, disc diffusion studies, computer- Coimbatore, as well as India, were grow- One of the largest orthopedic hospi- assisted orthopedic surgery, and dif- ing at a fast pace. “There is one death tals in South Asia, Ganga Hospital fusion imaging of the spinal cord. on Indian roads every four minutes,” is a rare institution that has seen the Rajasekaran‘s research has won him informs Rajasekaran. With rising road right blend of clinical and academic numerous awards including the pres- traffic and concomitant accidents, both activities. Research has played a key tigious EuroSpine Open Paper Award orthopedics and plastic surgery to his role in the success of Ganga Hospital. for 2008. He is also one of the very mind held a lot of potential. The rapid Dr. S. Rajasekaran, Chairman of the few surgeons in the world who has growth of Ganga only confirmed this. Department of Orthopedic and Spine won the prestigious ISSLS Spine In 2012, it recorded 154,790 outpa- Surgery, stands firmly at the helm of Research Awards three times: in 2004, tients, 23,518 in-patients, and 13,446 a success story that was started back 2010, and 2012. surgeries, up from 111,986 outpa- in 1978 by Rajasekaran’s father, Dr. J. tients, 19,317 inpatients and 11,766 G. Shanmuganathan, an anesthetist. From Diagnosing to Under- surgeries in 2010. standing a Disease Today, Rajasekaran and Ganga are With his return to India, Rajasekaran known the world over for medical In 1991, Rajasekaran and his brother, realized the huge difference in the research and new methodologies in Dr. S. Rajasabapathy, a plastic surgeon, approaches adopted by orthopedists orthopedic treatment. When returned to India from the UK. Both in India and their peers in the West. Rajasekaran adopts a methodology, brothers wanted to convert Ganga While those in the West believed sur- 24 Medical Solutions | February 2014 | www.siemens.com/medical-solutions
gery was the answer to every injury, infection, stenosis, or back pain, ortho- “Previously only meant pedics in India were busy attending to trauma and accident cases. Surgeries for diagnosis, today were not too common in India. And in the West, the results of surgery were unsatisfactory. radiology is also being Even today, very little is understood used to understand about back pain. “A magnetic resonance exam may show some changes in the spine, but the pain maybe coming from diseases.” somewhere else – the joint, the disc, Dr. S. Rajasekaran, Chairman of the Department of Orthopedic nerves, muscles – or the problem and Spine Surgery, Ganga Medical Centre and Hospital, Coimbatore, India maybe in the brain. You can also expe- rience pain due to depression, stress u Medical Solutions | February 2014 | www.siemens.com/medical-solutions 25
40 percent of the hospital beds are allotted to the poor, 30 percent to the middle-class, and 30 percent to the upper-class. or anxiety.” And so Rajasekaran nificant role in the research under- the research fund. That enabled us to decided to get into research. It all taken at Ganga. One important system do the research,” he says. started with kyphosis (over-curvature is the MAGNETOM® Symphony 1.5 Today, the foundation has grown and of the thoracic vertebrae) in children Tesla MRI eco system. “In spine, since has to its credit various activities such even after complete cure of spinal there is no moving part, excellent as supporting the academic training tuberculosis. clarity is obtained with 1.5 Tesla of the hospital staff, holding scientific systems,” Rajasekaran says. Rajasekaran uses computed tomogra- meetings and conferences, funding phy (CT), magnetic resonance imag- The Importance of Research on-going research activities of the ing (MRI), and X-ray systems for his orthopedic department, providing funds research. “Previously only meant for Research also has a special place at for Project Helpline (a project to sup- diagnosis, today radiology is also being Ganga Hospital. Therefore, in 2002, port the surgical correction of physical deformities in poor children), and primary education of under-privileged children. The funds continue to come The department of orthopedics performs from Rajasekaran’s family, members of the board of directors, and philan- more than 3000 thropists. The second step was to utilize hospital resources for research. The MRI eco major surgeries per year. system, for instance, was relatively free after 8.30 pm. “We convinced our con- sultants to charge less for research,” he says. “When you are a high-volume used to understand diseases,” he says. the hospital founded the Ganga surgeon, professional fatigue sets in “It is used to identify, grade, and stage Orthopedics Research and Education after some time,” says Rajasekaran. the disease, to tell whether surgery is Foundation. “The initial corpus for Research not only prevents the onset required or not, to prognosticate, to the foundation was by a donation of this, it also gives medical practitio- plan the treatment … In fact, at every from the family. Subsequently, I kept ners a fresh perspective. “You start stage radiology has a role to play.“ the fund growing by regularly allot- analyzing. And then, every patient looks Siemens systems have played a sig- ting a major part of my revenues to interesting.” 26 Medical Solutions | February 2014 | www.siemens.com/medical-solutions
Orthopedic Research Putting the Patient First In the mid-nineties, while planning Ganga Hospital’s expansion from a 42- In the last 15 years, Ganga Hospital has trained 463 doctors to a 135-bed hospital, Rajasekaran and Rajasabapathy met their architect. The siblings allotted 40 percent beds to the poor, 30 percent to the middle-class, and 30 percent to those who prefer a from 42 countries. luxury ward. The architect advised them to reduce beds for the poor. In his view, this would make the project more viable in the eyes of the bankers and increase the possibility of getting a bank loan. But the siblings were adamant about stick- ing to their ratio. They gave an impres- sive presentation to the bankers to prove their model could work. “It needed a But then Rajasekaran’s methodologies to share this liability and strategize lot of convincing, but we finally got the have spread in many different ways – our policies around this stratum,” he loan sanctioned,” he adds. through his research papers, through adds. According to Rajasekaran, the conferences, and, most importantly, private sector must focus on the poor. For Ganga Hospital, the patient comes through training. Ganga Hospital pro- “Once you achieve a critical mass, you first. The hospital ensures the treatment vides fellowships to senior residents can do a lot of good.” is affordable for the middle-class and from all across India. It has a team of doesn’t turn away patients if they can’t As far as Ganga Hospital is concerned, international students coming every afford the treatment. The information Rajasekaran says it has seen steady year to learn new techniques in spine about Ganga has spread by word of progress since 1991. The last expan- surgery. Hence, the best practices mouth. Ganga Hospital does not have a sion at Ganga Hospital happened in adopted here percolate through to the marketing department. “We have never 2007. “The scope for expansion is national and international community advertised,” says Rajasekaran. But still, huge,” he adds. In his view, expan- of orthopedics. “In the last 15 years, 30 percent of Ganga Hospital’s turnover sion must be dovetailed to the needs we have trained 463 doctors from 42 comes from patients who do not reside of the various strata of society. “We countries,” he says. Rajasekaran also in the region. However, medical tourism need to be aware of the different receives students from the prestigious to Ganga Hospital is yet to pick up. affordability levels and needs. We Japanese Spine Society. “That’s due to poor accessibility,” explains need a healthcare delivery strategy Rajasekaran. Although Coimbatore has Towards a Different that does not compromise on deliv- an international airport, there are only Healthcare Model ery of quality healthcare,” he says. two international flights to the city. Rajasekaran is now looking at the According to Rajasekaran, India is a very different market and the various next big step to get into sub-special- health delivery models that the gov- ties. In order to take that leap, he is ernment and the private sector are examining whether there is a scope working on should be aware of this for a 300-bed spine hospital, a 300- fact. “Our models have to be different bed joint replacement hospital, and from the West,” says Rajasekaran. a 500-bed accident hospital in Coim- Talking about the demographic profile batore. “It may not happen today, but of the country, he says the top two it will happen in the next three to percent of Indian society comprises four years,” says Rajasekaran. p people who are richer than the rich in the West. For them, the healthcare models are irrelevant. Then, there are the next 500 million who form the middle-class. “Our middle class popu- lation is far bigger than the population Read more about Dr. Rajasekaran’s of the USA. In this segment, affordabil- research at Medical Solutions Online: ity has been on the rise,” he adds.Then, there are the next 400 million which ww.siemens.com/ w are below the poverty line. “We need orthopedics-india Ganga Hospital is one of the largest orthopedic institutes in South Asia, with academic research playing a key role. Medical Solutions | February 2014 | www.siemens.com/medical-solutions 27
Healthcare in India Mumbai Population 13.8 million Mastering The Volumes 28 Medical Solutions | February 2014 | www.siemens.com/medical-solutions
Laboratory Diagnostics From its centralized laboratory in suburban Mumbai, India, Thyrocare Technologies processes 100,000 diagnostic tests each night – more than in any other comparable lab worldwide. Made possible by one man’s vision coupled with state-of-the-art automation solutions. Text: Archis Mohan Photos: Atul Loke Medical Solutions | February 2014 | www.siemens.com/medical-solutions 29
Healthcare in India At midnight, a laboratory the size of founder. Thyrocare was also the first in hospitals, nursing homes, and labo- a football field situated in the base- in India to use barcodes and bidirec- ratories across the country. Each patient ment of a nondescript three-storied tional interfacing in diagnostics to sample is collected in Thyrocare pre- building in a suburb of Mumbai sees eliminate errors. barcoded empty vials. The barcode frenetic activity. Men and women in identifies each patient specifically dur- white lab coats place bundles of bar- King of Volumes ing collection, ruling out the majority coded vials on two serpentine tracks of pre-analytical errors. After entering In 1995, Thyrocare started as a thyroid linked to a series of diagnostic the data related to the barcodes in the function testing laboratory. Today it is machines. webserver, the Thyrocare franchisee the youngest of the four key players aggregates all the vials, and packs them During the day, nearly 25,000 vials in the Indian diagnostic industry. Yet, in a temperature-controlled transpor- with blood and urine samples are it commands 60 percent market share. tation system for air-cargo delivery to flown in from every corner of India. Thyroid function testing continues to Mumbai. So while the patient data Each sample undergoes an average generate 70 percent of Thyrocare’s typically reaches Thyrocare in couple of four tests on a lab automation solu- business. The thyroid is a vital butter- of minutes, the consignment of vials tion by Siemens that consists of two fly-shaped gland below the Adam’s takes a couple of hours by airplane. tracks of 17 meters and 12 meters apple that releases a hormone that in length, with 14 immunoassay ana- Most consignments reach the city by helps the body use energy, stay warm, lyzers linked to each track. ten in the evening and are collected by and keep all organs working normally. Thyrocare employees, who deliver them By the time dawn breaks over the It is estimated that 42 million Indians to the centralized laboratory within a Mumbai coastline, the automation have thyroid disorders.1 couple of hours. All samples are in the solutions at Thyrocare Technologies There are four pillars to Velumani’s laboratory by two in the morning. These have processed nearly 100,000 tests business model – large volumes, low samples are subsequently loaded onto and posted the reports online, almost costs, speed, and accuracy. “We are a the two lab tracks with the immuno all without any human intervention. single laboratory for a billion people. assay instruments that read the bar- The man behind Thyrocare is Dr. A We are faster than any local labora- codes, conduct the tests, and post the Velumani. His entrepreneurial vision, tory that serves its local population. reports online by six in the morning. supported by state-of-the-art auto- We are the fastest on earth,” boasts Laboratory workers across the length mation solutions, has made Thyrocare Velumani. and breadth of India punch in a pass- the leader in the Indian diagnostic He has modeled his business on the word on the laboratory’s website to industry. “Thyrocare is the world’s newspaper industry. Every morning, download and dispatch the reports to largest single-floor, centralized, fully- Thyrocare’s franchisees collect blood customers. Thyrocare boasts a turn- automated, IT enabled laboratory,” samples from 20,000 collection points around time of less than 20 hours from says the 54-year-old CEO and the time the sample was collected. The immunoassay analyzers offer more than 275 assays for screening, diagno- sis, prognosis, and monitoring of most diseases. “Siemens rules my floor and I am proud of it,” says Velumani of the decade long association. Siemens has accom- panied Velumani at every step and turn of Thyrocare’s meteoric rise. From Rags to Riches Velumani hails from a very poor family from Appanaickenpatti Pudur, a small village 28 kilometers from Coimbatore in Tamil Nadu. At the age of 16, Velu- mani enrolled at a college in Coimbatore to study chemistry. He even worked as a domestic servant in a rich man’s house to ensure that his graduation dream would come true. At 23, Velumani arrived in Mumbai and was lucky enough to find a government Thyrocare’s headquarter houses a laboratory the size of a football field in the basement. job as a lab researcher at the Bhabha u 30 Medical Solutions | February 2014 | www.siemens.com/medical-solutions
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