WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE JULY-AUGU S T 2023 19 PREETHA REDDY Executive Vice Chairperson Apollo Hospitals on Empowering Nurses and Ensuring Patient Safety DR. H. SUDARSHAN BALLAL Chairman Manipal Hospitals on medical education INSIDE fiffffl ffiflffl ffi ffiffffl fiffffl JULY-AUGUST 2023 | Rs 300 | RNI HEALTHCARE WORLD 40 UNDER 40 Hari Subramaniam Co-Founder LifeSigns Revolutionising Patient Care LifeSigns iMS is focused on transforming the healthcare industry through wireless digital monitoring
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4 BW H E A LT H CA R E J U LY - AU G U ST 2023 WWW.BWHEALTHCAREWORLD.COM TECH TAKING THE LEAD EDITOR-IN-CHIEF’S NOTE Dear reader, Tech has been changing the landscape in the healthcare sector for quite some time now. By leveraging technology, we are seeing rapid and significant progress across the industry. Take for example, the key aspect we are highlighting in the current issue – remote patient monitoring. Remote patient monitoring is revolutionizing the medical industry,it can be efficiently used in a hospital setting as well as for out of hospital care. It is estimated that the global multiparameter patient monitoring market is expected to reach a value of USD 15.2 billion in size by 2028, growing at a CAGR of 8 per cent with the industry presently valued at USD 9.55 billion. In this issue, we spotlight Hari Subramaniam, Co-Founder LifeSigns who talks about the remote monitoring product, LifeSigns iMS, its journey and opportunities it presents to the medical fraternity and the healthcare system in India. Initially the device was tailored to aiding medical professionals providing cardiac care by providing real-time ECG etc. since India has a significant number of cardiac fatalities. From there,they developed algorithms and software that enables the device to be used by other specialties as well. Read all about the device in the pages ahead. In addition, we go in-depth into various aspects of AI and its uses in the medical industry. Voices of industry leaders help capture the advantages and the areas that require a larger focus. Another key focus of the current issue is clinical trials. India has seen an increase in clinical trials, we look at the reasons for this and take note of factors that need to be addressed. Even here, technology plays a crucial role in patient recruitment, retention, data collection and analytics, and also remote monitoring of recruits. India’s potential in clinical trials is immense, with the opportunity to contribute to medical advancements and improve patient outcomes. Addressing concerns regarding transparency, safety, and effectiveness is essential to build trust and credibility. Moving away from technology, we have industry experts writing on various aspects of the healthcare industry. We also have our regular columns and features. Happy reading. “The reasonable man adapts himself to the world: the unreasonable one persists in trying to adapt the world to himself. Therefore, all progress depends on the unreasonable man.” George Bernard Shaw [email protected] ANNURAG BATRA
WWW.BWHEALTHCAREWORLD.COM BW H E A LT H CA R E J U LY - AU G U ST 2023 5 Towards Tech Progress FROM THE CEO’s D E S K Dear reader, The one thing that has been driving the healthcare industry towards efficiency and better outcomes is technology. This has emerged as the underlying force when it comes to better medical outcomes, reliable remote monitoring and building business efficiencies. The healthcare ecosystem is striving on this expedited growth that technology has brought about. Another aspect that has emerged as an important area of concern is patent safety and care. The challenges related to negligence have brought out the need for better monitoring of the patient, and that too real time. This issue of BW Healthcare World focuses on this. The one perceived threat as a result of the advancement of technology has been the loss of jobs. It is similar to the perceived threat when computers emerged as technology that could replace humans, but the reality is that jobs have rather increased ever since. So getting the perspective of doctors and paramedical staff is of prime importance, and that is exactly what we have tried to get. We have tried to capture their perspective. In this issue we also capture the thought process of the various thought leaders from the healthcare industry, both from healthcare infrastructure space, healthcare technology domains as well as pharmaceutical industry. Hope you will enjoy reading this issue of BW Healthcare World, which is all about the business of healthcare. Happy reading. Harbinder Narula CEO, BW Healthcare World & BW Wellbeing World [email protected]
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8 BW HE ALTHCARE JULY - AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM JULY-AUGUST 2023 26 10 CONT ENTS COVER STORY Columns COLUMNS In-depth HEALTH BULLETIN REVOLUTIONISING PATIENT CARE Hari Subramaniam speaks about Life Signs iMS and its journey. The opportunities it presents to the medical fraternity and the healthcare system in India PREETHA REDDY Executive Vice Chairman Apollo Hospitals on Empowering Nurses and Ensuring Patient Safety DR. H. SUDARSHAN BALLAL Manipal Hospitals Chairman on medical education INSIDE fiffffl ffiflffl ffi ffiffffl fiffffl JULY-AUGUST 2023 | Rs 300 | RNI HEALTHCARE WORLD 40 UNDER 40 Hari Subramaniam Co-Founder LifeSigns Revolutionising Patient Care LifeSigns iMS is focused on transforming the healthcare industry through wireless digital monitoring 12 46 52 60 64 36 42 44 136 140 144 Manoj Saxena MD Bayer Zydus Pharma Preetha Reddy Executive Vice-Chairperson Apollo Hospitals Dr. Vikram Vora, Medical Director International SOS Himalayan Siddhaa Akshar Founder Akshar Yoga Institutions Adith Chinnaswami Co-founder MediSim VR Vijay Agarwal President Consortium of Accredited Healthcare Organisations (CAHO) Ganesh Subramaniam Vice President R&D Murata Vios Are Sugar free products safe? Growth prospects in Indian Pharma Clinical trials in India New medical device policy
WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE JULY - AUGU S T 2023 9 Spotlight CAHOCON World Transplant Games The pages in BW Businessworld that are labelled BWi or Promotions contain sponsored content. They are entirely generated by an advertiser or the marketing department of BW Businessworld. Also, the inserts being distributed along with some copies of the magazine are advertorials /advertisements.These pages should not be confused with BW Businessworld’s editorial content. Cover design by SHIVAJI SENGUPTA 70 76 146 TOTAL NO. OF PAGES INCLUDING COVER 148 CONT ENTS In Conversation: 16 Dr. Ashutosh Raghuvanshi CEO, Fortis Healthcare 20 Dr. Ashok Seth Chairman, Fortis Escorts Heart Institute 22 Chaitanya Sarawate MD, Wipro GE Healthcare 38 Siddharth Mittal MD & CEO, Biocon 56 Dr. H. Sudarshan Ballal Chairman, Manipal Hospitals 132 Nikhil Chopra CEO, JB Chemicals & Pharmaceuticals The BW Healthcare World 40 Under 40 recognises and celebrates healthcare professionals under the age of 40 who have redefined and excelled in their domains 83 LAST WORD Gauranga Das Prabhu
10 BW HE ALTHCARE JULY - AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM AMR Needs Unified Mission Quadria Capital Gets $35 Mn Boost The Union Health Ministry recently held discussions on the status of National Action Plan for Anti -Microbial Resistance (NAP-AMR), and decided that soon the Ministry will launch second phase of the plan NAP-AMR 2.0 based on the implementation learnings of the first phase unveiled in 2017. The Union Health Secretary, Rajesh Bhushan who chaired the discussion stated that “AMR cannot be tackled in a linear and singular manner. As the issues and action points are multi-agency across the government and non-government sectors, the action plan to address it requires the joint efforts of all stakeholders through a unified mission By Shivam Tyagi By Team BW Healthcare HEALTH BULLETIN mode approach”. The meeting discussed the ongoing initiative including the need for developing a digital platform to collect and collate national and state level data on antimicrobial consumption and duly converging human, animal, environment and food sector. While also focusing on creation of state specific action plans on AMR, and involvement of research agencies to develop an integrated research agenda. Bhushan further urged the partner ministries and departments to work in a convergent mode with the whole of government approach to bring together the expertise and domain knowledge for a comprehensive action plan with key perforProparco, a subsidiary of Agence Francaise de Developpement Group, has invested equity worth of 35 million US dollars in the healthcare focused private equity firm Quadria Capital. Proparco had also invested in the firm previously and stated that its previous investments helped Quadria in improving access to health by creation of more beds and facilities in several undeserved locations. Sunil Thakur, Partner, Quadria Capital stated that there is a tremendous need of investments in India alone with estimates suggesting that the country requires over 200 billion USD to scale up the adequate healthcare infrastructure. He added mance indicators that can be periodically monitored. Globally 7,00,000 people lose the battle against AMR per year, with research suggesting another 10 million people succumbing to it by 2050. In India, injudicious use of antimicrobials and inadequate treatment of waste are few of the main drivers of AMR. Quadria Capital is happy to partner with Proparco to provide high impact investments that drive sustainable and equitable social outcomes. Singapore based Quadria Capital was founded in 2012 and invests in transformational businesses across the healthcare sector including pharma, medical devices and health services that contribute affordability and accessibility. The company’s investments are focussed on mid-cap healthcare firms across South and Southeast Asia and claims to have over USD 3.4 billion under asset management.
Sahyadri Hospitals Plans Expansion By Kavi Bhandari WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE JULY - AUGU S T 2023 11 Alarming Rise In Lifestyle Diseases In India According to the findings of a nationwide survey published in The Lancet Diabetes and Endocrinology journal, the prevalence of diabetes in India has reached 11.4 per cent, while 35.5 per cent and 15.3 per cent of people are By Kavi Bhandari Sahyadri Hospitals has planned to expand healthcare infrastructure and its network to Navi Mumbai, Thane, Pimpri Chinchwad, Nagpur, Solapur Kolhapur and other cities apart from reinforcing its presence in Pune and Nashik. As part of the expansion plans, Sahyadri has doubled its capacity at the Hadapsar facility, which will primamrily focus on mother and child care. According to media reports - Sahyadri Hospitals, the Pune-based regional hospital chain controlled by Ontario Teachers’ Pension Plan Board, has lined up a 750-crore expansion plan for the next 3 to 4 years to double the capacity through both organic and acquisitions. According to a statement by Abrarali Dalal, Director and CEO, of Sahyadri Hospitals, there is a demand-supply mismatch in terms of high quality healthcare infrastructure in the interiors of Maharashtra, which they want to fill. The hospital chain aims to enhance its services and meet the growing demands of the community as per its expansion strategy. To further strengthen their medical offerings, Sahyadri has recruited a team of over 20 highly skilled clinicians specializing in mother and child care, as well as more than 100 dedicated clinicians across various specialties. It also found that the prevalence of generalised obesity and abdominal obesity in India stood at 28.6 and 39.5 per cent, respectively. According to the authors of the study the prevalence of diabetes and other metabolic NCDs in India is considerably higher than previously estimated. At present 101 million people in India are living with diabetes whilst 136 million are suffering from pre-diabetes and another 315 million people have high blood pressure. Additionally, 213 million people have hypercholesterolaemia. The findings stated that the national average prevalence of diabetes in India is at 11.4 per cent with Goa leading the charts at 26.4 per cent of its population suffering from diabetes and with the lowest being Uttar Pradesh with 4.8 per cent of its population affected with diabetes. suffering from hypertension and pre-diabetes respectively. This study was conducted by the Madras Diabetes Research Foundation (MDRF) in collaboration with the Indian Council of Medical Research (ICMR) and funded by the Ministry of Health and Family Welfare.
12 BW HE ALTHCARE JULY - AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM COLUMN As India’s pharmaceutical sector is recognised globally for producing quality medicines at affordable costs, the time has come for the country to step up its efforts and truly establish itself as the pharmacy of the world. Recognising this potential, the Government of India has envisaged Vision Pharma 2047 to create an enabling policy framework for the country’s pharma sector. Expressing the need for creating an ecosystem Vision Pharma: Augmenting Local Prowess to Achieve Global Leadership While innovations in India in respect of medicines, devices and diagnostics have been mostly incremental, the need of the hour is to leapfrog into deep innovation and for this, a buoyant IP regime with robust enforcement needs to be put in place By Manoj Saxena for innovation that will make India a leader in drug discovery and innovative medical devices, Prime Minister Narendra Modi has assured policy interventions based on consultation with all stakeholders. One of the key challenges is to strengthen India’s Intellectual Property (IP) framework, especially in the domain of patents, to encourage innovation, scientific discovery, and technology transfer. A strong patent system not only provides an economic incentive to inventors but also encourages investors to risk capital in high-risk-high-returns inventive activity. While innovations in India in respect of medicines, devices and diagnostics have been mostly incremental, the need of the hour is to leapfrog into deep innovation and for this, a buoyant IP regime with robust enforcement needs to be put in place. TIMELY DECISIONS Concerted efforts by the Government to address outstanding IP issues such as pre-grant oppositions, disclosure requirements under` Section 8, annual working requirements in Form 27, etc. will go a long way in fortifying the framework. An effective IP regime can serve as a solid commercial tool for researchers from an early stage, not only protecting the originality and exclusivity of an invention but also helping researchers to hone their focus on the most commercially viable aspects of their work. In the current IP framework offering protection to patented pharmaceutical products for 20 years, certainty and reliability of the IP eco-system are critical factors for enabling ease of doing business in India. The Parliamentary Standing Committee (PSC), in its report on ‘Review of the Intellectual Property Rights Regime in India’, has recommended the need to establish a robust and effective IPR regime that
WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE JULY - AUGU S T 2023 13 encourages and incentivizes innovation, while streamlining the patent practice and procedure in India. THE IP ADVANTAGE With India’s pharma sector receiving FDI to the tune of USD 20 billion up to September 2022, strengthening the IPR framework will significantly boost new investments. By modifying the current IP regime through a comprehensive Patents Act amendment, addressing the challenges faced by the pharma companies and taking measures to streamline the patent procedure, India can emerge as the top FDI destination not only for technologydriven enterprises but any company investing significantly in R&D. Strong IP regimes are critical to engendering a robust and vibrant innovative pharmaceutical industry. Increased patent protection will spur local innovation, significantly augmenting the country’s scientific and technological capabilities. An effective IP regime can serve as a solid commercial tool for researchers from an early stage, not only protecting the originality and exclusivity of an invention but also helping researchers to hone their focus on the most commercially viable aspects of their work India’s position as a key emerging market with sustained economic growth makes it a logical hub for foreign biopharmaceutical R&D investments. This will lend momentum to the Government of India’s Make in India initiative, ushering in a new paradigm and making India a leader in exports of pharmaceuticals not only in terms of volume but also value. WAY FORWARD The recent announcement made in Budget 2023- 24 on a new programme to promote research and innovation in pharmaceuticals through Centres of Excellence is a welcome initiative in this direction. As industry leaders, we look forward to the finalization of the Department of Pharmaceutical’s ‘Draft Policy to Catalyze Research & Development and Innovation in the Pharma- MedTech Sector in India’. For continued innovation for finding new cures, the protection of ideas and innovations through IP rights is vital in the interests of patients and society at large. Harnessing digital technologies, a notification system can be developed where non-commercial information in respect of all regulatory applications filed and pending before the Central and State FDAs and of the approvals granted is made available publicly. This would go a long way in bringing much-needed transparency to the sector. While the creation of IPR Divisions in High Courts is a welcome initiative, considering the existing and consequential burden of voluminous pending cases, infrastructural challenges on the courts, the re-establishment of the Intellectual Property Appellate Board (IPAB) and revisiting the National IPR Policy 2016 will address key IP issues faced by the pharma sector. The protection of scientific and technological innovations will not only encourage researchers and pharma companies but also help in reducing mortality and improving the quality of life of patients. Even as the industry faces patent challenges ranging from the cyclic filing of pregrant oppositions and denials to a lack of full transparency and burdensome disclosure requirements, it remains hopeful that recent deliberations between the Government and industry stakeholders will yield positive results. MANOJ SAXENA President Elect OPPI Managing Director Bayer Zydus Pharma
14 BW HE ALTHCARE JULY-AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM COLUMN Cybersecurity leads the discussions on the digitisation of our healthcare industry. To keep our systems safe and secure and prevent breaches from cybercriminals, cybersecurity systems must be on par with global standards and consistently improving. With the growing prevalence of digital processes in our healthcare sector, we have come to see an increase in cyberattacks and infiltration attempts on our security infrastructure. In 2022 alone, the country faced almost 14 lakh cybersecurity incidents, according to the Ministry of Electronics and Information Technology data. In the future, for our country to fulfil the goals and hopes of digitisation and transition to a paperless economy, cybersecurity practices and systems in our country must be brought up to a level that makes the citizens of India feel secure about their information. As per a Check Point Research (CPR) report, India in 2022 also emerged as the most frequent target of cybercriminals, with cyberattacks almost doubling compared to 2021. This was attributed to lax cybersecurity practices, with sub-standard firewalls deployed to protect crucial user/client data. Owing to this, it becomes imperative for Indian institutes and organisations to keep their eyes on the future and ensure they abide by the best practices with the evolving trend in the healthcare cybersecurity industry. DIGITISATION VS CYBERSECURITY One of the major focuses of the cybersecurity industry in 2023 should be to protect HEALTHCARE CYBERSECURITY SYSTEMS Must Be On Par With Global Standards The dramatic rise in the incidence of cyberattacks and hacking witnessed in the health sector is a direct result of the growing digitalisation in the sector Shankar Lingam Sunnathi SHANKAR LINGAM SUNNATHI, SVP - IT & Compliance, Omega Healthcare
WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE JULY-AUGU S T 2023 15 and secure patients’ data, as it is one of the most frequently targeted pieces of information by cybercriminals. A common tool used by cybercriminals to infiltrate a system is ransomware. Ransomware attacks have dramatically increased since the pandemic, displaying 105 per cent growth in 2021. However, the industry needs to be prepared for other tools, systems, and forms of attack being adopted by cybercriminals. These forms of attacks can include BEC, phishing, and DDoS, where the attacker has the ability to shut down the victim’s server. Hence, it is essential that organisations keep their workforce aware and prepared against any potential threats. UPSKILLING As per a recent market study, the current cybersecurity industry is facing an acute shortage of talent. With the demand for cybersecurity services at an all-time high, the industry needs young talent to join the workforce. In order to fill this talent gap, steps need to be taken to improve the educational systems and ensure regular upskilling opportunities are provided to professionals. A special focus needs to be given to certain key areas such as network security control, monitoring of the systems, virtual machine operations, and other relevant skills within the industry currently. Upskilling opportunities would allow the industry to expand its talent pool and cater to a wider audience. OUTSOURCING One of the biggest challenges in cybersecurity for small-scale institutions is a lack of resources. Modern cybersecurity programmes require constant updates and maintenance, which requires a number of skilled professionals working round the clock to keep the systems functioning at their best capacity. Investing that amount of capital in one department isn’t feasible for a lot of organisations. This is where certain administrative interventions are needed in order to aid these organisations in sourcing high-quality cybersecurity services. Outsourcing cybersecurity is beneficial because it is relatively more economical and allows multiple organisations to pool capital and receive the services. In the recent Budget, the government allocated more than Rs 600 crore to improve the cybersecurity infrastructure in the country, which is a step in the right direction because the industry requires aid to strengthen its operations and expand its horizons. Meanwhile, government schemes such as Ayushman Bharat Yojana have significantly promoted digital practices in the healthcare sector. In a short period of time, it can be said that the cybersecurity industry has made significant progress. However, a considerable amount of work still needs to be done to achieve the ultimate goal of digitising the healthcare industry, and cybersecurity is a critical component of this effort. It is essential for building consumer trust and establishing credibility. A robust and secure cybersecurity network is evidence of a highly skilled workforce and assures consumers that their information is being protected at all times. A common tool used by cybercriminals to infiltrate a system is ransomware. Ransomware attacks have dramatically increased since the pandemic, displaying 105 per cent growth in 2021
16 BW HE ALTHCARE JULY - AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM INTERVIEW The healthcare providers in India are looking at steady waters to swim through in times to come. According to a report by the credit rating agency ICRA, the aggregate occupancy in the hospital industry will remain at 62 to 64 per cent in FY 2023-24.With a double digit growth rate of 15 to 17 per cent in FY23, the agency expects this rate to moderate to around 4 to 6 per cent in FY24 given the high base of FY23. Industry insiders opine that the demand in the hospital industry is backed by elective surgeries, resurgence of medical tourism and continued market share gains for organised players. Dr Ashutosh Raghuvanshi, the MD and CEO of Fortis Healthcare who runs more than 20 hospitals in the country maintains this confidence in the Industry. In an exclusive interaction with BW Healthcare World, he said that, “As far as healthcare is concerned in India, it is public knowledge that there is a deficiency in the number of hospital beds, there is shortage of physicians and also a shortage of nurses.” Due to these aspects Dr Raghuvanshi says that there is a huge demand in the industry and that demand has to be served, therefore the growth is imminent. Dr Raghuvanshi informs that in the last couple of years there has been decent growth in the healthcare industry, however because of the pandemic some of the developments went on a slow burner and many expansion projects could not take off. The Whole System Has To Change For Outcome Based Payments: Dr Ashutosh Raghuvanshi In an exclusive interaction with BW Businessworld, Dr Ashutosh Raghuvanshi, MD & CEO, Fortis Healthcare delineates on the growth of the hospital industry, outcome based payment model, slashing costs, PPP models and the hospital chain’s plans for expansion & acquisitions By Shivam Tyagi DR ASHUTOSH RAGHUVANSHI MD & CEO Fortis Healthcare
Post pandemic the demand is huge, bed occupancies are as high as they were pre pandemic and international patients are back in similar numbers and all that is leading to upswing in the business environment and private health care WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE JULY - AUGU S T 2023 17 “Post pandemic the demand is huge, bed occupancies are as high as they were pre pandemic and international patients are back in similar numbers and all that is leading to upswing in the business environment and private health care,” he adds. VALUE BASED PAYMENTS FOR HEALTH Many healthcare leaders and industry bodies in India are now rallying for a value based or an outcome based payment model to replace the currently at place fee for service model in the industry. A fee for service model is simply paying the healthcare providers based on the number of services or procedures that they provide whereas an outcome based model means paying the providers for better results or outcomes. Dr Raghuvanshi says “Presently, I do not believe that this can be implemented in the current form that the private sector operates in, as our systems are not geared up for this. But the systems will evolve over a period of time. And the DRG goals, a disease group coding, currently functional in the United States can serve as a path to an outcome based or a value based payment system.” He further explains that the system should also have some capitation or a fixed cost for the hospitals as getting paid only for outcomes is unviable for private healthcare to sustain and survive. “The whole system has to change and it has to be a collaborative approach, the private sector can participate in it but the initiative has to be created by the public sector,” Dr Raghuvanshi delineates. The CEO, enumerates that there also has to be some patients that are attached to a particular hospital. And only then the replication of how full care is managed and provided in the US by firms like ‘Kaiser Permanente’ will be possible in India. He further says that India can manage the full care for its citizens but only with a powerful digital healthcare ecosystem. “I believe that our policies have gone towards creating digital capacities. So, virtually the healthcare system can be provided, from pri-
When one has to create a hospital which is solely dependent on Ayushman Bharat rates, then it is difficult to make it viable, especially in Tier-2 and Tier-3 cities 18 BW HE ALTHCARE JULY-AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM can work but until that digital system is not in place, outcome-based payment model is not going to be easy,” Dr Raghuvanshi says. PRICE, A CONSTRAINT IN INDIA With material and manpower costs surging in the healthcare industry, cost cutting has become a crucial activity for the hospital sector. The Fortis CEO says in India price is always going to be a constraint. He says that the majority can’t afford the high price of the private sector but is compelled to access it due to an incapable public sector which does not provide the care it should deliver, and the price will always be under scrutiny for that reason. “Various cost efficiency measures are being taken by various hospital groups and individual hospitals as well, and this will be an ongoing thing. There has to be an effort to reduce the cost year on year. That’s how any business operates. And in a country like India, where many people don’t get proper healthcare it is imperative for the private as well as the public sector to reduce the cost of healthcare delivery,” Dr Raghuvanshi emphasises. OPEX VS CAPEX IN PPP To augment healthcare infrastructure across the country, the government brought public private partnership with viability gap funding scheme, but the PPPs have seen only limited takers until now. Experts say that the PPP models lack fundamental design and policy constructs which do not suit the healthcare industry. Dr Raghuvanshi says that the PPP models have not seen desired outcomes due to the way they have been structured, adding that the imperatives are different for the public sector and the private sector. “For the private sector the imperative is different, which is to make a years is actually double the amount of capex which is required to start a hospital. Due to this reason, he believes the focus should shift from a capex fund to an opex fund. HEALTHCARE FINANCING IN TIERS Speaking about the reimbursement rates in the Ayushman Bharat Scheme, Dr Raghuvanshi says the rates are very low and for a private setup to become sustainable is not possible at those rates. “When one has to create a hospital which is solely dependent on Ayushman Bharat rates, then it is difficult to make it viable, especially in Tier-2 and Tier-3 cities,” he explains. Another challenge that the Fortis CEO believes exists is of getting specialised manpower specifically for tertiary and quaternary care. “It’s challenging to attract specialist doctors to these places and if they come they come at a higher cost. And if your pricing is going to be lower and your cost is going to be higher then it becomes unviable,” he says. ACQUISITIONS & EXPANSION EXPECTED Dwelling on the expansion plans for Fortis Healthcare, Dr Raghuvanshi says that the hospital chain’s balance sheets are looking pretty strong with an EBITDA to debt ratio of 0.6 and with this momentum, the hospital chain has an appetite to grow inorganically as well as organically. “We have an organic growth plan where we are going to add about 1,400 beds in our existing hospitals and all these hospitals are operating presently at 75 per cent plus occupancy, so there is a demand also that needs catering,” he says, adding that the hospital chain will also look for acquisition opportunities within the clusters where the group can operationalise the business model. INTERVIEW viable business whereas for the public sector, it is important to provide the largest number of beneficiaries and the highest possible benefit and that is what causes divergence completely and hence there should be a practical approach while forming the policies,” he says. Speaking on the design of the PPP models, he says many PPP projects have a capex-led approach where viability gap funding comes in capex but the opex in starting 10 to 15
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20 BW HE ALTHCARE JULY-AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM INTERVIEW As per a 2016 World Health Organisation (WHO) report, India accounts for onefifth of the total cardiovascular-related deaths in the world, and heart attacks account for 28 per cent of all deaths in the country. The report said that 45 per cent of these deaths happen in the age group of 40 to 69 years. Whereas, in recent times and especially in the postpandemic world, the occurrence of heart attacks and cardiac arrests have considerably grown with doctors reporting a sudden jump in these episodes. In an exclusive conversation with BW Healthcare World, Dr Ashok Seth, Chairman, Fortis Escorts Heart Institute states that in India, coronary artery disease (CAD) is on the rise, and while the West has managed to curb deaths from coronary disease, their numbers are are going up in our country. According to him, the second-biggest concern that India is facing is the rise of heart diseases in the young population, with cardiac problems occurring 10-15 years earlier in India compared with the West. He believes that in the coming years the cardiovascular challenge is going to be immensely big. “The disease burden that we’re going to see exactly 15 to 20 years from now is going to overtake anything that we have actually ever seen before,” he explains. Talking about disease processes, he says the main challenges in cardiology today are an increase of CAD, hypertension, and diabetes. To curb this, the diagnosis and treatment of diabetes and hypertension has to go downstream and technology can play a huge role in enabling this. “Heart disease and heart blockages can occur silently and don’t need to get to 90 per cent for one to feel discomfort and then have a heart attack. Blockage as much as 40 per cent, 50 per cent and Silent Blockage of Even 40 percent Can Cause Heart Attacks: Dr Ashok Seth In an exclusive conversation with BW Healthcare World, Dr Ashok Seth, Chairman, Fortis Escorts Heart Institute says that the West has managed to curb deaths from coronary artery disease whereas in India deaths from coronary disease have been steadily increasing By Shivam Tyagi DR ASHOK SETH Chairman Fortis Escorts Heart Institute
Heart disease and heart blockages can occur silently and don’t need to get to 90 per cent for one to feel discomfort and then have a heart attack, blockages as much as 40, 50 and 60 per cent, which otherwise would not create any symptoms can also cause heart attacks in situations of severe exercise and severe stress WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE JULY-AUGU S T 2023 21 60 per cent, which otherwise would not create any symptoms, can also cause heart attacks in situations of severe exercise and severe stress,” Dr Seth says. The age group of 30 to 50 years is seeing these kinds of episodes more, due to either undiagnosed heart conditions or conditions which are causing symptoms like minor blockages, but also have situations of extreme stress that cause clotting of blood. Whereas very early deaths of people less than 20 years are usually due to congenital heart problems which can cause sudden cardiac death, says the doctor. “The blockages can occur from a family history, diabetes, hypertension, and especially due to heavy smoking. People may not have anything else but if they’re heavy smokers, they will suddenly form a clot in their arteries of the heart on extreme exercise. And that’s one of the clear worries about a heavy smoker who actually can have a heart attack even on a 10 per cent blockage during severe exercise,” Dr Seth reveals. He says that people doing extreme exercises including suddenly getting into gyming, heavy weight lifting etc. should have at least some checkups to know and understand their risk factors. COVID MADE MATTERS WORSE The Indian Council of Medical Research (ICMR) is presently investigating the correlation of heart attacks and Covid for the Indian population, as announced by Union Health Minister Mansukh Mandaviya in late March, who said that ICMR will conclude the study in two months. A 2022 study published in the Medical Journal of Virology looked at the mortality data of US citizens pre- and post-pandemic, and the results of the study revealed that post-pandemic the incidence of heart attacks rose by 14 per cent. The study said the rise in acute myocardial infarction persisted throughout the pandemic, even during the mild Omicron variant wave. “Covid has definitely contributed to an increased tendency for clotting of arteries of the blood to create heart attacks, heart muscle weakening, and irregular heartbeats to create arrhythmias all of which can cause or contribute to a sudden cardiac arrest,” Dr Seth said. He added that it’s been seen in vast population studies that there’s been a two and a half to three times increase in heart diseases in every person who’s had Covid. “Further 30 per cent deaths in severe Covid occurred due to cardiac-related problems. But even for those who had mild Covid, the tendency for increased clotting and heart attack has remained there for a period of up to a year,” Dr Seth explained. Dr Seth says that taking precautions in this scenario is incumbent on the people because now there is an added effect of the Covid-19 virus. Apart from Covid, pollution is also contributing to heart diseases, and that the heart attacks and sudden collapses could be multifactorial. “It’s multifactorial and that’s why if we add on to our own risk factors Covid and pollution, we now have an increased milieu for having heart attacks,” the doctor cautions. KNOW YOUR RISK FACTORS Dr Seth’s advice is that everyone should be aware of their risk factors for heart diseases as much of it is in our hands and does not require vast clinical investigations. Family history of heart disease, smoking, hypertension and diabetes are some of the risk factors that everyone should keep in check for keeping their heart healthy. “Just walking briskly for 45 minutes a day. 150 minutes in a whole week can decrease your chances of having heart disease or heart attack by 25 per cent because it lowers lipid and obesity. It actually gets you fitter. It controls your diabetes, it will close your hypertension, and yet we are fond of bodybuilding, but not of cardiac friendly exercises,” Dr Seth concludes.
22 BW HE ALTHCARE JULY-AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM Q&A The last few years have been quite unique for the healthcare industry because of Covid and as a result, certain portions of the market grew quite a bit such as testing, ventilators, and equipment which were related to Covid, says Chaitanya Sarawate, President and CEO, GE HealthCare South Asia and Managing Director, Wipro GE Healthcare. He further delineates that presently the market is normalising and going through the regular trend of pre-pandemic growth adding that overall, the Indian market is very strong, with many new hospitals and diagnostic centres coming up on the private side, and the government is also making a pretty significant push to build facilities or upgrade the existing facilities. “And whenever you upgrade facilities, you are required to invest in medical technology which ensures that the market for us is in great shape,” he adds. WHAT ARE THE KEY PRODUCTS THAT HAVE SEEN AN UPTICK IN THE INDIAN MARKET FOR YOU? From a healthcare lens, one has to look at the diseases which are significant contributors to morbidity and mortality, naturally, the investments are Manufacturing Components For Medical Devices Big Challenge In India: Chaitanya Sarawate In an exclusive interaction with BW Healthcare World, Chaitanya Sarawate, President and CEO, GE HealthCare South Asia and Managing Director, Wipro GE Healthcare, speaks on key products in the Indian market, Chat GPT, reducing import dependence of Indian MedTech, and future plans of his company By Shivam Tyagi CHAITANYA SARAWATE President & CEO GE HealthCare South Asia Managing Director, Wipro GE Healthcare
Heart disease and heart blockages can occur silently and don’t need to get to 90 per cent for one to feel discomfort and then have a heart attack, blockage as much as 40, 50 and 60 per cent, which otherwise would not create any symptoms can also cause heart attacks in situations of severe exercise and severe stress WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE JULY-AUGU S T 202 3 23 happening there. There is high mortality in cardiac care and as a result, a lot of investments are happening in screening, diagnosing, and managing cardiac patients. There are also interventions which go along with them such as ECG machines or Cath labs which are also witnessing an uptick. Oncology is another area, as cancer is a significant illness and its incidence is also growing in India, so the equipment which can screen early - whether they are mammograms for breast cancer or ultrasounds for diagnosing cancer or X-ray for lung cancer, all are seeing growth. Again, going along with them, the devices for managing diseases are also growing such as PET-CT for oncology, and RT-CT for planning radiotherapy and a lot of growth is also being witnessed in MRIs which are applicable to neurology and orthopaedics. WHAT ACCORDING TO YOU WILL BE THE USE CASE OF CHAT GPT IN THE HEALTHCARE INDUSTRY? In healthcare, the primary motivation is to do no harm. Hence, any healthcare application before it comes. We allow the regulator to evaluate the risk and the benefit associated with its uses and that’s the reason the Chat GPT application will not come immediately to healthcare. Although, it will have many other use cases in other fields. But in the long run, it can absolutely be leveraged in healthcare. As there are many mundane tasks that our limited resources of healthcare professionals do, some of those might get transferred to Chat GPT. Secondly, it can allow individual patients to ask questions from someone and get an answer, now whether that answer is viable or verified is what the regulators have to evaluate and allow its widespread use. Till that time, people will ask questions from Chat GPT. You can’t stop it from happening but whether the information you get is verified or not is still a question. HOW DO YOU THINK INDIA CAN REDUCE ITS 85 PER CENT IMPORT DEWe allow the regulator to evaluate the risk and the benefit associated with its uses and that’s the reason the Chat GPT application will not come immediately to healthcare. Although, it will have many other use cases in other fields. But in the long run, it can absolutely be leveraged in healthcare
24 BW HE ALTHCARE JULY-AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM PENDENCY IN MEDICAL DEVICES? We have been manufacturing in India for the last 30 years and have 4 manufacturing plants including one that is under the Production Linked Incentive (PLI) scheme which ensures that we are able to get an incentive for manufacturing and export. So from a local manufacturing standpoint, we are well positioned now to help the industry while the government is doing quite a bit by incentivising or by duty reductions etc. The part which can be helpful is, if there is more focus on quality, especially in medical devices, whereby we just don’t ensure the quality of the device at the beginning but also throughout the lifecycle of the equipment. And if regulation can be brought in to ensure that quality is the focus of all healthcare infrastructure, then it will naturally build an ethical quality conscious healthcare industry. This will not just benefit the manufacturers here but there will be more acceptance of their equipment in other countries as well. So, we have to be willing to make those kinds of investments and regulations which will ensure that a regulated medical device industry develops in India. Another aspect is that as a medical device manufacturer we need a supply of components and the components industry has to come to India as well, today chips are still manufactured outside India and we have to import from there. So, unless those chipsets and other components get manufactured here, more deepening of local manufacturing will not happen. HOW DO YOU THINK ER&D CAN BE LEVERAGED IN INDIA TO AID THE MEDTECH INDUSTRY? The requirements for chip design and chip manufacturing are two different elements. In chip design, we have had a decent amount of investment which has taken place in India because there are a lot of chip companies who have a very strong R&D presence in Bangalore. And as a result, we already have the chip design capability to a certain extent in India. What we need is chip manufacturing or fabrication capabilities and that requires a significant amount of investments and scale which needs to take place. This will require huge incentives and other benefits so that the companies can find it attractive to manufacture in India. Presently manufacturing components is a big challenge for India. What is required is to be able to build and scale chip manufacturing capabilities and I think that is something which requires more attention rather than just innovation. WHAT ARE YOUR PLANS FOR THE COMPANY IN THE COMING YEARS? Going forward, we are going to further deepen our manufacturing in India. Secondly, we continue to sell and service high-quality equipment in the Indian market and we want to focus our attention on cardiology and oncology given that India has a huge burden of non-communicable diseases. Secondly, we have a big innovation lab centre in Bangalore which is involved in end-to-end product development that is used in India and other countries. We want to deepen that so that we can design and manufacture more products for the Indian market and other markets around the globe. Under the PLI scheme, we have started manufacturing Ultrasounds and CTs here which are getting launched outside of India and more such projects will continue in the future as well. We allow the regulator to evaluate the risk and the benefit associated with its uses and that’s the reason the Chat GPT application will not come immediately to healthcare. Although, it will have many other use cases in other fields. But in the long run, it can absolutely be leveraged in healthcare Q&A
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26 BW HE ALTHCARE JULY-AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM Remote patient monitoring (RPM) is the new revolution that is taking over the healthcare technological universe, and firms innovating in this space are travelling at great spped thanks to the heightened demand after the Covid 19 pandemic and the rising disease burden, globally. Today, there are numerous companies, startups and tech giants developing new technologies to monitor patients. The global multiparameter patient monitoring market is exploding and expected to grow to $15.2 billion in size by 2028, growing at a CAGR of 8 per cent with the industry presently valued at $9.55 billion, as per a 2023 report by Markets and Research. A 2023 ICMR report has revealed that in India close to 101 million people are living with diabetes which is a 44 per cent increase over 2019 when India had 77 million people with diabetes. It also shows that about 136 million people in India are living with prediabetes, 315 million with high blood presREVOLUTIONISING PATIENT CARE COVER STORY By Team BW Healthcare The global multiparameter patient monitoring market is expected to reach a value of $15.2 billion in size by 2028, growing at a CAGR of 8 per cent with the industry presently valued at $9.55 billion critical care setups, as continuous monitoring is a crucial component of intensive care units. These help first in noticing critical changes in a patient’s vital signs and second to guide appropriate clinical action depending on the health status. Research suggests that trends in vital signs of patients help clinicians to identify the best location for the patient on their transfer from critical care units. Due to technological advancements these patient monitors are services. As these patient monitors can be efficiently used in not hospital care but also ambulatory and mobility services. Rise Of RPM Devices Today, real time patient monitors are growing in demand and are proving a boon in continuous patient monitoring in hospital’s sure, 254 million have generalised obesity and 351 million abdominal obesity, while 213 million people suffer from hyper cholesterolaemia. Clinical experts say that chronic diseases such as diabetes, hypertension, obesity and hyper cholesterolaemia are big risk factors for cardiovascular diseases (CVD) such as heart disease and stroke. In fact, experts believe that a person with diabetes and high blood pressure is four times more likely to develop a heart disease. Several researches on the Indian population have revealed that the CVD epidemic in India is occurring at an earlier age with higher case fatalities and higher premature deaths. This coupled with non-communicable diseases poses a huge public health challenge for India. In such a scenario technologies tracing the health parameters or vital signs of individuals become an utmost priority to avert or to alert them about these health challenges. Portable multiparameter patient monitor is one such technology which has come to the rescue and is widely being accepted in healthcare
WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE JULY-AUGU S T 2023 27 being used even in outpatient care and post-surgical care maintaining the care continuum. The portability factor of these devices enables patient mobility. According to the Markets and Research report globally, the portable and compact monitoring devices held 57 per cent of the market share against fixed monitoring devices in 2022. Geriatric diseases accounted for a major part of the market share contributing 48 per cent of the devices being used, with hospitals being the major end users at 65 per cent. The multiparameter portable patient monitors are set to dominate the market in coming years owing to the growing home healthcare sector, ease of monitoring post-surgical patients, its use in ambulances and increasing awareness of remote patient monitoring. One such multiparameter monitoring solution has the potential to transform healthcare delivery in India. LifeSigns iMS, a product of the LifeSigns is a near real-time continuous patient monitoring solution using LifeSignls biosensor which has 21 patents to its name and is accredited by many regulatory authorities globally such as the United States Foods and Drugs Administration (USFDA) and Europe’s CE marking, Australia TGA, Singapore HSA and many more. It has been approved by India’s own Central Drugs Standard Control Organization (CDSCO), besides others.
28 BW HE ALTHCARE JULY-AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM COVER STORY
WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE JULY-AUGU S T 2023 29 In an exclusive conversation with BW Healthcare World, Hari Subramaniam, Co-founder, LifeSigns talks about LifeSigns iMS, its journey and opportunities it presents to the medical frate rn it y a n d t h e healthcare system in India. What was the inspiration behind the product? Patient monitoring usually takes place manually, and in some top hospitals collected manually maintained digitally. Even when data is collected digitally, it is analysed manually. This is where errors creep in, and the cost of these human errors is significant. I noticed this during my chemotherapy sessions. Of course, there is no one to blame because medical personnel are always doing their best and, in most instances, stressed out managing a heavy caseload. They have to give nursing care, monitor vitals, support doctors in treatment, added to it do system entry and load of paper work. Another thing I noticed was that we spend a lot of money on healthcare infrastructure and a large chunk of this is used on equipment, machines, devices that come into play once the condition of the patient deteriorates. If we are able to alert the medical staff before the condition of the patient worsens, we will be able to save a lot of this money, which can then be channeled into other areas of our healthcare system. When I was admitted for my chemotherapy sessions, I noticed that there they put me through tests before and after the sessions. The results were studied by the doctor when he would come for his patient rounds, by which time the data would be hours old. If we had a device collecting data and monitoring the patient in real time, which can be shared or viewed by doctors from anywhere which can help doctors to give timely advice and care, would be more effective. All of these aspects made me think about having a device that would monitor patients in real time, alert, and aid medical professionals in providing optimal care and treatment for the patients. I went on to partner with LifeSignals Inc USA a renowned healthcare chip design makers who have created a single device that would monitor patients in real-time, alerts the system if the vitals breach threshold. We developed and did trials in various hospitals and doctors, field trials and evaluation done in hospitals across India, understood the pain points and gaps, tweaked the product addressing those. All these learning inculcated has made our solution matured and acceptable to healthcare providers. We started commercial tests and trials in 2021, and commercial marketing in 2022. We are in 76 hospitals across India at the moment, including the Apollo Hospitals group. Is the device used primarily for cardiac care or can it be used across the board? Barring pediatric care, it can be used for patient monitoring across specialties, we have recently launched LifeSafe continuous monitoring of patients in Ambulance, Lifehome a home monitoring solution. What are the challenges you have seen during this journey? Most medical professionals after sometime in the profession shut the door of learning. As a result, they are not aware about the new innovations and technologies coming in. In our case, some of them were not even listening to us while we were making the presentation - they were not interested. In the near future IoT based devices and AI will play a significant role in medicine and since we are the first entrant with our product, the burden of teaching
30 BW HE ALTHCARE JULY-AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM and training is on us at the moment. When they realiaze the convenience and efficiency of the solution and understand it’s a tool which can enhance clinical outcomes they are happy to accept. The second challenge is getting enough funding to develop and sustain the infrastructure. We have scaled up, and will be managing 40,000 beds by the end of March 2024. Going forward, what is your vision for the product? Initially the device was tailored to aiding medical professionals providing cardiac care by providing real-time ECG etc. We started with cardiac care because in India cardiac fatalities are quite high. From there we have developed algorithms and software that enables the device to be used by other specialties as well. The device is widely spread, we are influencing LifeSignals to bring manufacturing of the hardware to India which can bring down the cost. For a start LifeSignals will plan to start assembling it in India if the adoption is good. It is a disposable device with an MRP of Rs 6,999. We want to be the monitoring solution across hospitals such that doctors and nurses will have patient vital data anywhere and anytime ,could monitor their patients using our dashboard. Let’s talk about the reservations the nurses have about this device. When computers first came, the banking staff went on strike till they understood the value of computers in aiding their work and realized its not replacing them. We are in that moment in healthcare technology is to help, aid and it’s a tool not to replace. LifeSigns solution has a robust real-time alert system, which is helpful to both doctors and nurses. It is aimed at aiding their work and making them more efficient. At times, nurses think it is aimed at replacing them. However, they come around once they understand how helpful the device is. What are the differentiators for your product? One is the form factor; it is small and a light-weight wearable patch. Second, there are very few wearable continuous monitoring devices in the world. Our alert engine and early warning system is very robust which helps health care professional to intervene and avoid deterioration of patient condition ending in better positive clinical Blood Pressure Our Warning Systems Reduced Mortality: Dr Girish Chandra COVER STORY outcomes. Through such a soultion, we would save a life everyday given the data monitoring and the alert system. Third, it lets the patient be mobile, put their feet on the ground and move around in the bed giving them better feeling but still they are monitored 24/7, they can be relaxed without wires all sides, helps them cone out of sickness early. Your views on the success of your journey? Success to me would be a billion peopletreated with great skill of our healthcare professionals using technology like ours, get back to good health avoiding deterioration all this spending less money. Build a healthy nation with lean infrastructure, and with smart healthcare professionals and high technology. Vitals Tracked By LifeSigns iMS 2 Channel ECG Skin Temperature Heart Rate Respiration Rate Posture Spo2
WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE JULY-AUGU S T 2023 31 Dr Girish Chandra practiced medicine for more than 25 years working in different countries around the world before coming to India 10 years ago. He says that when a friend showed him the LifeSigns iMS product and explained its scope, he felt the product had immense potential to improve how clinicians provide patient care. “As a clinician and administrator, I regularly come across various technologies and new developments. Sometimes, you get excited, but most of the time, you do not see the point of the new technology. However, LifeSigns wireless monitoring system was one such technology that intrigued me from the word go,” he says. He further says that the device gives real-time data for the patient, which can be used by the concerned clinician to support the patient all the time while the patient is hooked to the device. Besides, it has the ability to give warnings and alerts which are helpful in planning care and preventing emergencies. “The system is so adaptable that other new technologies can be seamlessly integrated,” Dr Chandra believes. Looking at progress As per clinical experts, the battery life of LifeSigns iMS is around five to six days. On whether the company plans to increase the battery life in future, Dr Chandra says that the battery life of the product as of now is good for the kind of product it is, adding that improvements in battery technology are an ongoing plan for the company. “Our ongoing research has helped us design the best user interface and make it easy for patients and healthcare professionals. Our warning systems have helped us save many lives by reducing mortality,” he explained. Dr Chandra further states, “As healthcare providers, the demands of patients continue to push us into new directions, we all have to keep adapting. Real-time patient data, which can make an immediate difference to patient care, is something that can’t be ignored. We at LifeSigns will be working really hard to make sure we continue to strive to make life better.” Our Warning Systems Reduced Mortality: Dr Girish Chandra As healthcare providers, the demands of patients continue to push us in new directions, we all have to keep adapting. Real-time patient data, which can make an immediate difference to patient care, is something that can’t be ignored. We at LifeSigns will be working really hard to make sure we continue to strive to make life better. Dr Girish Chandra, Founder and Director, LifeSigns speaks about the potential of LifeSigns iMS in improving patient care and his outlook on patient monitoring devices.
32 BW HE ALTHCARE JULY-AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM How many monitoring devices have sold so far, and which hospitals are they being used at? What has been the growth for the product in the last year and in the March quarter? Up until this point, we have installed 38,800 biosensors in a variety of hospitals across India. Our goal is to cover 40,000 beds by March 2024. How do you plan on onboarding more hospitals? Already, we have agreed to take on the responsibility of managing and monitoring all beds located within six different corporate chain hospitals. We intend to increase the amount of engagement we have with medical professionals by holding round table discussions, conferences, and seminars that highlight the clinical efficiency, features, and benefits of our solution. How AI is changing medical diagnosis, therapy, and prognosis? These advancements in medical technology are allowing doctors to more quickly and accurately diagnose their patients and devise more efficient treatment plans. Artificial intelligence and machine learning are used to tailor medical plans to each individual patient’s needs. The ability to predict a patient’s response to a treatment is made possible by the analysis of large dataCOVER STORY Our goal is to cover 40,000 beds by March 2024: Gaurav Sharma Gaurav Sharma, Chief Strategy Officer, LifeSigns speaks to BW Healthcare World on the company’s future plans, role of AI and steps to improve public health Advancements in medical technology are allowing doctors to more quickly and accurately diagnose their patients and devise more efficient treatment plans sets by machines. After gathering this data, an individualised treatment strategy can be developed, enhancing patient care. What other steps do you think we should take to improve public health? To better prepare for future pandemics such as COVID-19, India should increase public health spending and strengthen national capacity. There are 766 districts in India, but only one or two have capacity to identify viruses. In addition to new students, I believe that education of healthcare professionals and policymakers should be a top priority. LifeSigns is currently forming a foundation to assist rural hospitals and connect them with urban hospitals and physicians. The stated goal of the Foundation is to facilitate or coordinate the CSR efforts of numerous organisations, NGOs, and charities working in underserved communities.
WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE JULY-AUGU S T 2023 33 Our goal is to cover 30,000 beds by March 2024: Gaurav Sharma The LifeSigns iMS is being used extensively across many hospitals, one such hospital where the medical device is presently helping patients is the Chennai’s Kauvery Hospital. Dr Sridhar, Consultant Intensivist, Critical Care, Kauvery Hospital says that the main advantage for patients is that they can recuperate in the privacy and comfort of their room while being monitored 24 hours a day, irrespective of whether they are in bed, sitting in a chair, or even outside the room in the corridor. Dr N Sridhar speaks of the mobility feature of the device, which lets the patient move and enables tracking of vital signs. “The FDA and CE-approved LifeSigns biopatch meets my criteria for a high-quality wearable monitoring solution that can be easily deployed throughout the hospital, providing accurate vital sign data without compromising patient comfort. We predominantly use it for patients stepping down to the wards from our ICU, so that we can continue to monitor them remotely,” Dr Sridhar believes. The device tracks conditions like arrhythmias, critical drops in oxygen levels, rapid or slow breathing, and these changes are markers of serious illnesses like infections, inflammation, and heart attacks. The device can Cardiac Arrests In Wards Dropped To Zero: Dr N Sridhar In a small study done in our hospital where we used LifeSigns patches over three months for all patients stepping down from ICU, the number of unexpected cardiac arrests in the wards dropped to zero Dr Sridhar says that the main advantage of LifeSigns iMS for patients is that they can recuperate in the privacy of their room while being monitored 24 hours a day. be used in homes to alert care providers remotely, who can then direct care via the home nurse or advise hospital transfer. “In ambulances, it can be used to transfer critical information to the ER, allowing the ER doctor to keep appropriate teams on standby, minimising delays when the patient reaches the hospital,” Dr Sridhar adds. Speaking on the device’s ability to avert code blues and code oranges in a hospital setting, Dr Sirdhar reveals that in a small study done in Kauvery Hospital, the LifeSigns patches were used over the course of three months for all patients stepping down from ICU. During the three months, he says that the number of unexpected cardiac arrests on the wards dropped to zero. “Although this was a relatively small before-and-after type of study, it showed a clear signal for patient benefit. In the future, when we combine the continuous vital signs data from the LifeSigns patch with blood results from the EMR and throw in analytics, we will soon be able to predict patient deterioration before it happens,” Dr Sridhar believes.
34 BW HE ALTHCARE JULY-AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM COVER STORY I am pretty happy with how the device is working. It’s very easy to use, quite easy to deploy and can be done relatively quickly with minimal training. The device provides us the heart rhythm, heart rate, temperature and also gives an indicator of position of the patient among other vital signs. What is the need for real time monitoring devices in hospital setups and in out of hospital setups? In general, the more information you have about a patient, the better. The old way of doing it was to measure everything separately such as the ECG, the blood pressure, the temperature as well as the pulse rate, which we still do. But typically, in the ward setting many patients don’t have this type of monitoring, where they are being monitored frequently. Now as the patients are getting sicker, older and are having multiple medical issues, not everybody needs to be in intensive care. Most of them can be in a normal ward if you are monitoring closely. But the issue there is that one doesn’t have cardiac monitoring in the ward setting. Usually, patients need that and get it in ICU settings only. We know patients can get sick anywhere. This can happen at home, in an ambulance, at a workplace or at the hospital. Now, the whole concept of wearables and these monitoring devices can actually measure the vital signs without having a lot of other devices attached. What are your views on the LifeSigns iMS device that you have deployed in Apollo Hospitals? I am pretty happy with how the device is working. It’s very easy to use, quite easy to deploy and can be done relatively quickly with minimal training. The device provides us the heart rhythm, heart rate, temperature and also gives an indicator of position of the patient among In an exclusive conversation with BW Healthcare World, Dr Sai Praveen Haranath, Senior Consultant, Pulmonary and Critical Care Medicine and Medical Director, Apollo e-ACCESS Tele-ICU speaks on the need of realtime monitoring devices in homes and hospitals It has transformed the entire patient care journey: Dr Sai Praveen Haranath other vital signs. We have tested it out fairly rigorously in a very large number of patients at the hospital and even at home. We also have a clinical dashboard in Apollo where all this information gets collected and we are able to see the vital signs. If any of these vital signs go out of the range that we set, we get alerts and those alerts are measured and monitored by our team in the command centers which then alert the concerned doctor who is treating the patient. So, overall, the whole way we take care of patients is revolutionising. Do you think with the price point and the shelf life that LifeSigns iMS presently come with is reasonable? Yes, it is mainly because we use it typically for three to five days on average, which is kind of about the time that the patch lasts at the same time you can always change the patch and put in a fresh one. And we give it to only those who really need it and use it to monitor them as it works like a seatbelt where if something happens it is detected, alerted and prevented.
WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE JULY-AUGU S T 2023 35 For Doctor Accurate, Clinical Grade multi parameter data including 2 channels of ECG gathered continuously in near real time Both live data & historical data that can be viewed from anywhere in the world on your browser for collaborative treatment plans & 2nd opinions as needed. Post discharge monitoring of patients who continue to need monitoring for a duration for possible adverse developments Trend view at a glance, continuous trend plots of a patient’s progression Alerts: The power to spot abnormalities as they occur, helps to save lives. Auto alerts via SMS, WhatsApp, & E-Mail 1 View Patient Data from anywhere in the world LifeSigns opens up a world of freedom from location. Whether the doctor is in the hospital or at home or in another city, patient vitals — both real time & historical are available at your fingertips. 2 Ambulance Monitoring The first few minutes of data before the patient is brought to the hospital are crucial in making correct decisions for the clinicians. LifeSigns wireless biosensors start transmitting the data to the hospital within seconds from the application of the biosensor & transition the data to the to hospital EHR once the patient is admitted. What Differentiates LifeSigns iMS ? 3 Avoidance of Code Blues The comprehensive set of monitoring parameters, combined with a robust alert engine, results in avoiding code blues, MET events & ICU readmissions. 4 Post Discharge Monitoring LifeSigns seamlessly transitions a patient from hospital to home, without any disruption to automated, multi-vital parameter monitoring. Now the hospital can keep an eye on their patients even after a patient is discharged using the same biosensors that were used for in-hospital For Hospital Quickly convert regular wards into smart, digital & wirelessly monitored wards within hours Zero Capex & No maintenance solution with managed infrastructure. Seamless integration with Hospital’s EHR/ EMR. Significant Nursing productivity enhancements, Significantly increased nursing productivity and ability to monitor more patients efficiently. No other monitoring solution offers insurance Reimbursement. For Nurses No more manual data collection of Patient vitals. All vitals collected automatically. Ability to set individual threshold levels for individual patients-recognizing that each patient is unique. Automated intelligent alerts right to your palm — you will not miss any adverse condition of any patient even if you are performing other clinical tasks elsewhere. Reduced anxiety and stress levels on the ward since all atients are constantly monitored Monitoring Designed with purpose
36 BW HE ALTHCARE JULY-AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM VR is taking over the medical industry, pushing it forward with more realistic treatments and education, not only for medical students but patients and their relatives as well. Patients are better informed, and the doctor-patient relationship is enhanced with more empathy and understanding from both sides. As the medical fraternity becomes more aware of treatments of particular diseases, VR images are being used to show patients exactly how the treatment will affect or heal their body. This allows them and their families to make informed decisions while curbing their fears of the unknown. Artificial Intelligence and Simulation technology aims to create environments that help transport patients into a space of virtual reality. VR is also becoming more conducive to patient care, enabling the medical industry to gain control over bigger global issues, epidemics, pandemics, and their treatments. Educating the patient A VR image using hyper-realistic CGI transports the patient inside his own body and gives him a 360-degree view of his own condition, helping patients feel prepared and educated on their condition. It shows the patient exactly what the disease looks like and how it is progressing inside their body. Clinical practitioners can also show the procedure and treatment of the disease in real time. It is reassuring to the patient to get a clear picture of the procedures involved, allowing the patient to see exactly how the body reacts to the suggested treatment and its side-effects. Various treatment options can also be presented, to enable informed decision-making on the mode of treatment. Pain Management VR is especially successful in the pain-management category. It is harmless and works on the mind,mental vision and strength of the patient. Once a patient is immersed in the metaverse, they can be virtually transported to a different environment.. This shift in focus induced by the experience relaxes and distracts the patient, reducing their feelings of pain and anxiety. Research shows, VR can reduce pain by 24 per cent. This is particularly helpful in cases of physiotherapy and long-term treatments like chemotherapy or burns, and can be used as an adjunctive therapy. VIRTUAL REALITY Taking Over THE MEDICAL INDUSTRY OPINION By Adith Chinnaswami The Virtual Reality sector is rapidly growing at an astounding rate. From transforming healthcare to bridging the gap in remote exploration, this cutting-edge technology is pushing the boundaries of what’s possible in India and globally
WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE JULY-AUGU S T 2023 37 The OPIOID Crisis One of the worst disasters of public health across the world, especially in Canada and USA, is the Opioid crisis. Ironically it started with pain-killing medication prescribed by doctors themselves. As of recent studies, over 600,000 people have died of an overdose from these prescribed drugs. Pain-relief drugs were either prescribed for long periods of time or in high doses for shorter intervals. This short-term relief catapulted into life-threatening issues, turning the situation into an epidemic that the medical industry is still struggling to remedy. With the help of AI, the medical industry is working on realistic CGI to create immersive experiences that distract a patient from on-going pain. It attracts the brain’s attention, leaving lesser brain receptors to process any pain signals. This follows the Gate theory of attention which states that “VR reduces the perception of pain by absorbing and diverting attention away from pain.” Simulations aim at transporting the patient to soothing surroundings and distracting the mind with audio and visual stimuli. This exercise intends to temporarily make the patient forget their pain and therefore reduce the frequency or need of the pain-killer. These simulations can also be interactive, moving the patient away from their painful experience, reducing the dependency on drugs. The non pharmacological therapy trains the mind to tackle pain without the need for opioids. Rehabilitation VR works as an assistive technology for physical rehabilitation in patients. Programs are created to recover sensory and motor skills that a patient may have lost due to an accident or ailment. It creates an interactive domain similar to real life situations, generating sensory information artificially. It also provides therapy effectiveness, functional recovery and compliance through audio-visual feedback. VR rehabilitation is a cost-effective solution which provides personalized therapies to patients at home with minimal therapist supervision. It motivates patients through recording personal benchmarks and victories and gaming concepts with a variety of dynamic and stimulating elements. VR glasses, auditory presentations and three-dimensional motion analysis makes the technology fun for patients. Rehabilitation is no longer a painful, boring and strenuous process. The Virtual Reality sector is rapidly growing at an astounding rate. From transforming healthcare to bridging the gap in remote exploration, this cutting-edge technology is pushing the boundaries of what’s possible in India and globally. With the AR/VR market expected to reach USD 300 billion by 2024 as per mondaq.com in March 2023, the race is on to secure the gamechanging ideas shaping this exciting field and thus is slated to soon penetrate various industries beyond the medical world. Immersive Technology in forms of AR, VR, and Augmented Surgery are having definite positive impacts on patients and the medical industry as a whole. A myriad of possibilities is being created by those crafting Immersive Technology, where patients are becoming a part of this immersion process. Clarity, conversation, empathy, knowledge and education are allowing patients to be fearless about the unknown. These harmless, risk-free methods of VR treatments display an optimistic path for science, technology and medicine in the months to come. With the AR/ VR market expected to reach USD 300 billion by 2024 as per mondaq.com in March 2023, the race is on to secure the game-changing ideas shaping this exciting field and thus is slated to soon penetrate various industries beyond the medical world ADITH CHINNASWAMI Co-Founder MediSim VR (Virtual reality medical simulation company)
38 BW HE ALTHCARE JULY - AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM The Indian pharmaceutical major, Biocon is seeing a huge potential in peptide drugs and plans to heavily invest in the said therapeutic area in the times to come. Peptide therapeutics are short polymers of amino acids which are used for the treatment of conditions like type 2 diabetes, Biocon Investing Heavily In Peptides, Potent Oncology APIs: Siddharth Mittal Biocon’s MD and CEO, Siddharth Mittal in an exclusive interaction with BW Healthcare World stated, “We see a huge potential in peptides. It is a growing segment where the big shift is being seen with companies like Novo Nordisk and Eli Lilly moving their focus from insulins to Glucagon-like Peptide-1 (GLP-1) drugs, and what used to be USD 20-30 bn insulin market is now projected to be over USD 100 bn GLP-1 market” By Shivam Tyagi SIDDHARTH MITTAL MD & CEO Biocon Q&A weight loss, multiple sclerosis and hypertension. Biocon’s MD and CEO, Siddharth Mittal in a post-annual results interaction with BW Healthcare World stated that, “As we move forward, we see a huge potential in peptides. It is a growing segment where the big shift is being seen with companies like Novo Nordisk and Eli Lilly moving their focus from insulins to Glucagon-like Peptide-1 (GLP-1) drugs, and what used to be USD 20-30 billion insulin market is now actually projected to be over USD 100 billion GLP-1 market, so we see that as a significant growth driver for us for the next five to 10 years. And we are investing heavily there in terms of both pipeline capacity and capability building.”
WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE JULY - AUGU S T 2023 39 Biocon delivered handsome financials for FY23 with its revenues closing 59 per cent higher at Rs 3,929 crore compared to last year. The company’s growth was led by its subsidiary Biocon Biologics which contributed Rs 2,100 crore. The EBITDA margins this year fell by 1 per cent. Do you see them increasing in the upcoming financial year? The Core EBITDA margins actually grew from 33 per cent to 35 per cent this quarter and from 32 per cent to 34 per cent on a full-year basis, so the margins have been growing. Of course, our investment in R&D is also going up. And we hope that on a full-year basis, we will continue to maintain these levels of margins despite all the pricing pressures that we see in the US and other key markets that we have. Tell us about the gener- ics business growth this year, with your major revenues coming from the biosimilar business, will we see the generics business going on the back burner or will it return to the centre stage as well going forward? Our entry into biopharmaceuticals happened through our API business 25 years back and it has been a core part of our overall business. Our focus, of course, was on biosimilars for many years. But we started focusing again on the generics business or the API business a couple of years back and one of the reasons why we spun off biosimilars into a separate subsidiary was to bring back focus on the generics business. We have started investing again in creating capacities, in creating pipelines and strengthening our quality systems for the generics business. We are investing almost half a billion dollars over a period of five years in creating capacities and an R&D pipeline for the generics business, our focus would of course continue to be on fermentation, which has been our strongest area. How are you planning to grow your product portfolios going forward? We have expanded our R&D infrastructure and more than doubled the investment and the number of people who are working on our products. And now we are looking at filing anywhere between five to seven new APIs and between eight to 10 ANDAs in the US. And these would, of course, be focused on mainly fermentation and peptides. But we are also looking at a very important segment, which is the potent oncology API segment as We are investing almost half a billion dollars over a period of five years i n c r e a t i n g capacities and an R&D pipeline for the generics business, our focus would of course continue to be on fermentation, which has been our strongest area
40 BW HE ALTHCARE JULY - AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM we are aware that cancer as a disease or oncology as a therapeutic area has been the biggest in the whole healthcare sector where affordability and accessibility is a big concern. Hence, we are working on a wide portfolio of oncology APIs and formulations which we plan to bring to various parts of the world over the next five to seven years. What is the assessment, for how long are we going to see these pricing pressures in the US? The pricing pressures will not go away, they have always been there and it was just that during a certain number of years, it went deeper from a 5-7 per cent average reduction in prices to a double-digit reduction. And we do not see the pricing pressures ever go away because the prices of generic drugs or biosimilars never go up, they always go down. Especially in the US when the customers do contracts whether it’s for three months, six months, nine months or one year, and when they invite bids again, after the expiration of the contract. There’s an automatic tendency to reduce prices to retain that business and hence you see that annual price reduction. Right now we are not seeing the price reduction going back to its original levels of 5-7 per cent. It’s somewhere between 7-10 per cent. But again, it’s drug-specific, for some drugs we continue to see much deeper price erosion whereas in the case of other drugs there is a rationalisation that’s happened and there is lower price reduction. Your company is already diversifying into other markets. Tell us about that. And future partnerships when you think about moving away from the US or focussing your attention on other markets? We have been supplying insulin to 70 countries and filing for approvals for our drugs in various parts of the world, not necessarily going by the size of the market. And that would continue to be our endeavour in Q&A future whether directly or through partnerships, or by an indirect government tender participation. The volumes of the revenue growth will of course come from larger markets. So beyond the US, and Europe, traditionally Latin America, comprising Mexico and Brazil, have been strong markets for us. The Middle East has also been quite strong. We also definitely see a huge opportunity from China although it takes a longer time to get one’s foothold in China, it is the secondlargest pharmaceutical market in the world today. And we do see a shift where the Chinese companies are looking at sourcing drugs from Indian companies, especially the more speciality complex drugs which are of high quality. Because the Chinese regulators are looking to source drugs for local patients more in line with international drug standards. So, that opens up opportunities for companies like ours. What are your growth projections for FY24? As I mentioned, in the generics business, we expect mid-teens kind of growth, and in research services high teens to low 20s. And in biosimilars, we are starting with a very solid base of USD 1 billion and there are a couple of important launches coming up such as Adalimumab in July. So, we would be looking to expand our market share as well as geographical presence for our existing commercialised molecules. In addition to that, we are also hoping that we are able to get the approval for our biosimilar Aspart and biosimilar Bevacizumab by the end of this fiscal and we are able to launch these drugs. A large part of the impact of these launches would come only twelve months post the launch. So we will see very little impact maybe this year, but at least it will help us grow in FY25. We have been supplying insulin to 70 countries and filing for approvals for our drugs in various parts of the world, not necessarily going by the size of the market. And that would continue to be our endeavour in future
Block your pages... Indepth into an Indian corporate Law School Rankings 2023 - Who Made the Cut Industry/Corporate Law School Ranking AUGUST 12, 2023 Regular features and columns Opinion articles from industry leaders fifffflffiflfflffifflffffl flflff Ensure Your Brand’s Presence in this Special Issue!!! Aparna Sengupta, [email protected], +91 9958000128 Anjeet Trivedi, [email protected], +91 9818122217 Ravi Khatri, [email protected], +91 9891315715 CS Rajaraman, [email protected], +91 9342262859 Somyajit Sengupta, [email protected], +91 9818247444 Kiran Dedhia, [email protected], +91 9833399009 Sajjad Mohmmad, [email protected], +91 9911855935 Saurabh Jain, [email protected], +91 9911334633 Shruti Arora, [email protected], +91 7982628913 For Editorial: Noor Fathima Warsia, [email protected] Issue Highlights +
42 BW HE ALTHCARE JULY - AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM Empowering Nurses & Ensuring Patient Safety: PATH TO SAFER HEALTHCARE I t is often said that saving one life makes you a hero, but saving a hundred lives makes you a nurse. This statement holds true as nurses are the backbone of healthcare, bringing hope to billions of people worldwide. The 12th day of May was the International Nurses Day and the perfect occasion to celebrate them, honour their tireless efforts and also deliberate on what more must be done for our wonderful nurses. Nurses constitute two-thirds of the health workforce in India and 50 per cent of the global healthcare workforce. They play a crucial role in deliverNurses constitute two-thirds of the health workforce in India and 50 per cent of the global healthcare workforce. They play a crucial role in delivering high-quality patient outcomes ing high-quality patient outcomes. When patients enter into hospitals or medical establishments, they do so with the innate hope of receiving safe and high-quality care. Nurses, who spend the most time by the patient’s bedside, are a key resource in meeting this expectation. It is critical to note that nurses deal with potentially more dangerous and latent errors in the healthcare environment and their role in detecting and preventing errors, near misses should never be underestimated. This reality emphasises the need for greater emphasis on qualitative nursing practices, which are essential for reducing adverse events and negative outcomes, as patient safety is an imperative dimension of delivering high-quality healthcare. Put simply, incompetent, inadequate or poor nursing care is a serious risk factor for negative outcomes in patients, hospiCOLUMN Dr Preetha Reddy
WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE JULY - AUGU S T 2023 43 talised especially in a tertiary care setting. Bearing this in mind, to achieve patient safety and quality in a healthcare setting, nursing empowerment must be a central component. An empowered nursing team influences staff morale, productivity, staff retention, associated costs, patient care quality, and patient safety. Therefore, to deliver universally safe and recognised highquality care, we need to plan and reaffirm the current and future role of nurses. Nationwide, meaningful efforts should be made to improve the quality and safety of care, as well as continue the work already initiated to achieve positive clinical outcomes. Several factors contribute to nurse empowerment, including decision-making, autonomy, manageable workload, fairness, reward, and recognition amongst many more. Likewise, we must invest in the development of nurses and enable them to take up meaningful roles as part of the global healthcare workforce. The path towards it includes targeted clinical skills training in areas such as theatres, ICCUs, ward management, and specialty nursing, as well as soft skills and language training. Such investments will create a robust career path for nurses and result in better compensation for their invaluable work. Today, our nation has gained global recognition as a leading provider of high-quality and affordable medical services. This was also underlined when Honourable Prime Minister, Shri Narendra Modiji called upon the world to “Heal in India and Heal by India,” demonstrating his confidence in India’s healthcare sector. Hence, at this juncture, India must prioritise patient safety which will cement its reputation as a preferred global medical destination. Prioritising patient safety will help build a culture of trust and accountability, raising the bar for clinical outcomes and enhancing patient satisfaction. In summary, as patient safety is fundamental to delivering quality care, it is essential for India to deploy ground-breaking strategies to equip its nurses with the necessary skills and foster innovative solutions to develop and strengthen this critical talent pool. Building a robust nursing workforce should be a central focus of the national health services charter. We must collectively deliberate on further actions needed to future-proof the nursing workforce. Also, more than ever before, the nursing profession was under the spotlight as the world combatted the impact of the Covid-19 pandemic. Yet, despite the huge paucity of nursing professionals in India, our nurses delivered care tirelessly and they were pivotal to India’s able management of the crisis. The pandemic was certainly the most significant crisis of this era, but it may not be the last health challenge that humanity faces. The rising burden of non-communicable diseases, increasing ageing populations, and persistent health disparities require us to prepare and introduce innovations to make our healthcare systems lot more resilient. With the burgeoning prevalence of chronic illnesses, digital and remote care innovations are crucial for crisis management and will require multidisciplinary teams, as superlative nursing care and positive clinical outcomes are inseparable! As a responsible nation, India must pave unprecedented paths to empower every individual involved in patient care, ensuring safety and serving as a model for the world to follow. DR PREETHA REDDY Executive Vice Chairperson, Apollo Hospitals & Former President, NATHEALTH
44 BW HE ALTHCARE JULY - AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM The World Health Organisation (WHO) estimates that medical errors affect millions of patients worldwide each year and are a leading cause of death and injury in healthcare settings.A study published in the Journal of Patient Safety in 2019 estimated that medical errors may be responsible for up to 5.2 million deaths annually in India, making it one of the leading causes of death in the country and also accounts for the growing mistrust between the community and healthcare providers. It is surprising that inspite of increasing numbers of litigations and violence against medical professionals, there is no holistic approach to tackle this problem. It is not possible to eliminate errors all together but efforts should be put in place to reduce them substantially. Medical errors have become an increasingly recognised problem in healthcare over the past few decades. Some of the key reasons why they have increased include: Accreditation alone not enough to PREVENT MEDICAL ERRORS Medical errors may be responsible for up to 5.2 million deaths annually in India.World over accreditation alone has failed to make significant impact on reducing errors but has made an impact in sensitising the medical fraternity OPINION By Dr Vijay Agarwal Increased complexity of healthcare: Advances in medical technology, the increasing prevalence of chronic diseases, and the ageing population have all contributed to the growing complexity of healthcare. This complexity can make it more difficult for healthcare providers to deliver safe and effective care, and can increase the risk of errors. Fragmentation of care: Patients often receive care from multiple providers in different settings, which can lead to communication breakdowns, inadequate handoffs, and other issues that increase the risk of errors. Pressure to reduce costs and increase efficiency: Healthcare organisations are under increasing pressure to reduce costs and improve efficiency, which can lead to a focus on productivity over patient safety. This can result in shortcuts, inadequate staffing, and other practices that increase the risk of errors. Lack of standardisation and coordination: Healthcare providers often have different training, practices, and workflows, which can lead to inconsistencies in care and increase the risk of errors. In addition, the lack of standardisation and coordination can make it more difficult to identify and address systemic issues that contribute to errors. Human factors: Medical errors are often caused by human factors, such as fatigue, stress, and distractions. These factors can impair decision-making and increase the risk of errors. Efforts to reduce medical errors have been ongoing for several decades and involve various stakeholders in healthcare,
WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE JULY - AUGU S T 2023 45 including government agencies, healthcare organisations, healthcare providers, and patients. One of the most popular system is to subject oneself to an accreditation system. Accreditation is a process through which healthcare organisations are evaluated to ensure that they meet certain standards of quality and safety. World over accreditation alone has failed to make significant impact on reducing errors but has made an impact in sensitising the medical fraternity. Accreditation in healthcare organisations is designed to ensure that healthcare providers comply with established standards and regulations, and that they deliver safe and high-quality care to their patients. However, accreditation alone may not be enough to prevent medical errors from occurring. One reason for this is that an accreditation is often seen as a “checklist” approach to quality improvement. Accrediting bodies typically focus on whether a healthcare organisation has the required policies and procedures in place, rather than assessing whether these policies and procedures are actually effective in preventing medical errors. Another reason is that medical errors can be caused by a complex interplay of factors, including human error, communication breakdowns, system failures, and organisational culture. Addressing these underlying factors requires a more comprehensive and systems-oriented approach to quality improvement, which may go beyond the scope of accreditation. Moreover, healthcare organisations may view accreditation as a one-time achievement, rather than an ongoing process of quality improvement. This can lead to a complacent attitude towards patient safety and a failure to continuously monitor and address potential risks. While accreditation is an important tool for ensuring basic standards of quality and safety in healthcare organisations, it may not be sufficient to prevent medical errors. To address this issue, healthcare organisations must work to develop a culture of safety. Developing a culture of safety in healthcare organisations requires a multifaceted approach that involves leadership commitment, staff engagement, continuous learning and improvement, and a focus on patientcentred care. Here are some key steps that healthcare organisations can take to promote a culture of safety: 1. Establish a clear and visible commitment to safety at all levels of the organisation, from senior l e a d e r s to frontline staff. This can DR VIJAY AGARWAL, President, CAHO (Consortium of Accredited Healthcare Organisations) involve developing a safety mission statement, providing safety training for all staff, and integrating safety goals into performance evaluations. 2. Encourage staff participation and engagement in safety initiatives. This can involve creating safety committees, soliciting staff input on safety issues, and recognising and rewarding staff who contribute to a culture of safety. 3. Promote transparency and open communication about safety issues. This can involve establishing reporting systems for adverse events, near misses, and unsafe conditions, and ensuring that staff feel comfortable reporting safety concerns without fear of retaliation. 4. Provide ongoing education and training on safety-related topics, such as medication safety, infection control, and communication skills. This can involve offering regular safety workshops, providing access to online learning resources, and encouraging staff to participate in continuing education programmes. 5. Use data and performance metrics to monitor and improve safety outcomes. This can involve conducting regular safety audits, tracking safety-related events and near misses, and using data to identify areas for improvement. 6. Foster a patient-centred approach to care that prioritises patient safety and encourages staff to involve patients in their own care. This can involve promoting shared decision-making, providing patient education and support, and involving patients and families in safety initiatives. By taking these steps, healthcare organisations can create a culture of safety that promotes continuous learning and improvement, empowers staff to identify and address safety concerns, and ultimately improves patient outcome.
46 BW HE ALTHCARE JULY - AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM THE CHANGING FATE OF SUGARFREE PRODUCTS: Experts Weigh in On Regulation & Reducing Dependence IN-DEPTH By Shivam Tyagi The fate of non-sugar sweeteners (NSS) or popularly known as sugarfree substitutes might just be changing as the scientific evidence gathering against them suggests that the artificial sweeteners might not provide the health benefits that they were previously lauded for
WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE JULY - AUGU S T 2023 47 The fate of non-sugar sweeteners (NSS) or popularly known as sugar-free substitutes might just be changing as the scientific evidence gathering against them suggests that the artificial sweeteners may not be efficacious for many health benefits that they were previously lauded for or which led to their fame. Earlier on May 15, 2023, the World Health Organisation (WHO) warned people about the use of artificial sweeteners and advised against using them for controlling body weight or reducing the risk of non-communicable diseases (NCDs). The WHO stated that there may be potential undesirable effects from long-term use of NSS, such as an increased risk of type 2 diabetes, cardiovascular diseases, and mortality in adults. However, the WHO said that these guidelines do not apply to people with pre-existing diabetes. The WHO’s recommendation includes all synthetic and naturally occurring or modified non-nutritive sweeteners that are not classified as sugars found in manufactured foods and beverages, or sold on their own to be added to foods and beverages by consumers. “Common NSS include acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives,” the WHO stated. The clinical experts in India have lauded and welcomed the WHO guidelines but among the many questions that arise, one is could these guidelines have come earlier, “The guidelines by the WHO are quite pertinent and well-directed. Although they should have come in earlier as patients have been misled into believing that this is a healthier option,” stated Dr Shuchin Bajaj, Founder Director, Ujala Cygnus Group of Hospitals. Dr Subhash Kumar Wangnoo, Senior Consultant Endocrinologist and Diabetologist, Apollo Hospitals, said that by highlighting the lack of long-term benefits and potential risks associated with NSS, the WHO has promoted healthier alternatives and encouraged people to adopt balanced diets that limit the consumption of artificial sweeteners. “WHO conducted a comprehensive analysis of 283 studies, which included both randomised trials and observational studies. Despite this comprehensive review, the findings indicate only a minimal amount of weight loss, if any. Therefore, it is reasonable to conclude that the impact of non-sugar sweeteners on weight loss is not significant,” said Dr AmbrishMithal, Chairman and Head - Endocrinology and Diabetes, Max Super Speciality Hospital. Evidence Is Piling Up A 2022 study published in the US journal National Centre For Biotechnology Information stated that multiple scientific studies in humans suggest that artificial sweeteners have “no effect on body weight or glycemic control” while the early intake of NSS was also shown to suppress the taste response to sugar. “Notably, the effects of artificial sweeteners depend on individual differences, including the gut bacteThe guidelines by the WHO are quite pertinent and well-directed. Although they should have come in earlier as patients have been misled into believing that non-sugar sweeteners is a healthier option DR SHUCHIN BAJAJ, Founder Director, Ujala Cygnus Group of Hospitals
48 BW HE ALTHCARE JULY - AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM ria, and may increase blood glucose levels, promote atherosclerosis, and increase cardiovascular risk and total mortality,” the author of the study stated. The study further pointed out that the use of NSS in treatment of diabetes and obesity should be reconsidered, “The replacement of sugar with artificial sweeteners in patients will require long-term tracking of not only intake but also changes in blood glucose and weight as well as future guidance based on gut bacteria data.” Another study published in 2020 in the same journal stated that there is mechanistic evidence that artificial sweeteners may induce gut microbiota dysbiosis, by altering the gut microbiota composition and function. The gut microbiome or microbiota are microorganisms that exist in the human digestive system helping in energy harvesting, digestion and immune defense. Dr Edwina Raj, Head of Clinical Nutrition and Dietetics, Aster CMI Hospital delineated that according to recent evidence replacing free sugars with NSS does not benefit weight control in the long-term and its regular consumption disturbs your gut health which increases the risk of obesity, diabetes, heart disease, stroke, hypertension, and pre-term delivery among pregnant women. “The disruption of microbiota function by NSS is a topic of ongoing research, and the specific effects on individuals with diabetes and obesity are still being investigated. However, it is believed that the gut microbiota plays a significant role in metabolic health, including glucose regulation and weight management. Disruptions to the microbiota can potentially impact these processes,” said Dr Wangnoo. Dr Mithal further added that there are also suggestions that the intense sweetness of artificial sweeteners can condition the brain to prefer excessively sweet tastes, making naturally sweet foods like fruits seem less appealing. People With Diabetes, Obesity The WHO’s new guidelines exclude people with pre-existing diabetes, this clinical experts say could be due to the help rendered by artificial sweeteners to people who have diabetes, “It is acknowledged that artificial sweeteners can help reduce the spike in blood sugar levels when substituted for sugar. This aspect is well-established and there is no doubt about its efficacy. Considering this perspective, artificial sweeteners can be viewed as a suitable option for occasional use when one has a craving for sugar but wants to avoid the associated spike in blood sugar levels,” Dr Mithal WHO conducted a comprehensive analysis of 283 studies, which included both randomised trials and observational studies. Despite this comprehensive review, the findings indicate only a minimal amount of weight loss, if any. Therefore, it is reasonable to conclude that the impact of non-sugar sweeteners on weight loss is not significant DR AMBRISH MITHAL, Chairman and Head, Endocrinology and Diabetes, Max Super Speciality Hospital IN-DEPTH
WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCARE JULY - AUGU S T 2023 49 explained. Dr Bajaj stated that the WHO guidelines may not apply directly to people with pre-existing diabetes, as they often have specific dietary considerations and need personalised guidance from healthcare professionals or registered dietitians. “It is important for people with pre-existing diabetes to work closely with healthcare professionals or registered dietitians to understand how non-sugar sweeteners fit into their overall dietary plan and provide recommendations tailored to their unique circumstances,” he enumerated. Nonetheless, Dr Mithal warns that the artificial sweeteners should not be used as a constant substitute and should be used sparingly, “It is important to note that artificial sweeteners should not be considered a comprehensive solution for managing diabetes.” Dr Wangnoo pointed out that for individuals with diabetes, alterations in the gut microbiota could potentially affect glycemic control, adding that a healthy and diverse gut microbiota composition is generally associated with improved glucose metabolism. “Therefore, any changes caused by NSS consumption that negatively impact the microbiota could potentially have implications for blood sugar regulation in people with diabetes,” he added. For obesity, Dr Wangnoo said that studies have suggested a potential link between alterations in the gut microbiota and weight gain or difficulty in losing weight and disruptions caused by NSS could potentially influence energy metabolism and fat storage, which might impact obesity management. However, medical experts added that more research is needed to fully understand the extent of these effects and how they may differ among individuals. Regulating The Artificial Sweetener Industry Today, the artificial sweeteners industry is booming with its offerings present in sugar-free sachets, beverages, snacks, bakery products and other processed foods available in the market which are hailed and For individuals with diabetes, alterations in the gut microbiota could potentially affect glycemic control. A healthy and diverse gut microbiota composition is generally associated with improved glucose metabolism. Therefore, any changes caused by NSS consumption that negatively impact the microbiota could potentially have implications for blood sugar regulation in people with diabetes DR SUBHASH KUMAR WANGNOO, Senior Consultant Endocrinologist and Diabetologist, Apollo Hospitals branded as “healthy” and “safe”. According to a 2022 report by Market Data Forecast, the global artificial sweeteners industry is valued at USD 7.2 billion and is presently growing at a CAGR of 5.05 per cent, expected to reach USD 9.7 billion by 2028. While in India another report by Mordor Intelligence suggests that the industry is expected to grow at a CAGR of 3.2 per cent going forward. Major players like Zydus Wellness, Sunwin Stevia International, and PureCircle among many oth-
50 BW HE ALTHCARE JULY - AUGU S T 2023 WWW.BWHEALTHCAREWORLD.COM ers have dug deep into the industry offering a wide range of sugar-free products under their brand names while also collaborating with other major players selling food and beverages products. The question is will the new guidelines or emerging scientific evidence change the fate of the industry? And if yes, how should the food regulators look at this transition? Experts are in favour of a comprehensive approach that the Indian food regulators should adopt to evaluate and regulate sugar-free products to protect the health of the consumers. “The Indian food regulators should ensure that sugar-free products are clearly labelled with accurate and transparent information about the type and amount of non-sugar sweeteners used. This will help consumers make informed choices based on their individual needs and preferences,” stated IN-DEPTH Dr Wangnoo. Agreeing to this Dr Mithal said that the issue of non-labelled foods containing artificial sweeteners, where individuals may unknowingly consume them without checking the label or due to unclear labelling, should be addressed. Highlighting the presence of artificial sweeteners on food labels would serve as a useful warning for consumers, he said. Dr Raj said that people should educate themselves and refrain from promotional advertisements and brand endorsements that carry NSS in their food products. Dr Mithal explained that another concern regarding artificial sweeteners is that people often consume them in larger quantities due to the belief that they contain few to no calories. This increased portion size, he said, offsets the advantage of lower calorie content. “A prime example is diet cola, where people may exercise caution with regular cola but become more liberal in their consumption of diet cola, thereby exposing themselves to various chemicals that may not be beneficial for their health,” Dr Mithal added. He further said that like with most things in life, moderation is key, and occasional use is unlikely to have detrimental effects. “However, relying on them excessively and consuming them with every cup of tea or coffee may not be advisable,” he stated. Medical experts concluded that while it is possible that some individuals may choose to completely avoid artificial sweeteners and opt for sugar instead, it would be unwise and potentially disastrous to encourage a widespread shift back to sugar consumption. Instead, it is advisable to gradually reduce reliance on sweeteners and work towards developing a preference for less intense sweetness.