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February 2014 Medical Solutions The Magazine for Healthcare Leadership India’s Shining Example Dr. Devi Shetty’s Mission to Make World-Class Healthcare Accessible in India
Editorial “India is home to many healthcare leaders who are tackling India’s challenges with courage and ingenuity.” Hermann Requardt Member of the Managing Board of Siemens AG and CEO of the Healthcare Sector 2 Medical Solutions | February 2014 | www.siemens.com/medical-solutions
Editorial
Hermann Requardt,
Member of the
Managing Board of
Siemens AG and CEO of
the Healthcare Sector
Dear Reader,
India is facing numerous challenges in healthcare and Some Indian hospitals are setting new global standards in
there is no doubt that the healthcare situation is far from enabling affordable, high-quality healthcare: Players from
perfect. Despite solid economic growth over the past two emerging markets can gain insight into ways to improve
decades, around one third of the Indian population con- access to affordable healthcare services. Players from
tinues to live below the poverty line with only limited access developed countries, constantly under cost pressure, may
to medical care, especially in rural parts of the country. find some inspiration for raising productivity and keeping
Medical practitioners are struggling to meet the increasing healthcare costs down without compromising on quality.
needs in healthcare – with a constantly expanding middle
Our focus on healthcare in India also demonstrates how
class and a rising prevalence of cardiovascular disease,
low-income countries are putting pressure on established
diabetes, and others.
markets. In the era of telemedicine and medical tourism,
However, necessity is the mother of invention – and of healthcare is now a global business where prices for ser-
innovation. India is home to many healthcare leaders who vices are compared across countries. Indian healthcare pro-
are tackling India’s challenges with courage and ingenuity. viders count on these market mechanisms. Not only are
They are finding new ways to deliver quality healthcare at they establishing state-of-the-art clinics in international
affordable rates – and on large scales. comparison in India, they are also extending locations to
be even closer to customers in the West. The renowned
Healthcare in rural areas can by all means translate into
heart surgeon and entrepreneur Dr. Devi Shetty even con-
profitable business, as our customers from Surat in the west
siders India to be on the way to becoming a healthcare
(p. 40) and Imphal in the easternmost region of India have
provider to the world (p. 8).
shown. These customers have business models that lever-
age economies of scale – be it in imaging or laboratory Siemens is a partner to each of these Indian healthcare
diagnostics. Their productivity makes their business both providers – whether they have entry-level or high-end
affordable for patients and profitable for the institution. needs – in developing and producing tailored products
The same is true of Thyrocare, which is, according to its and solutions.
founder and CEO, the largest and fastest lab of its kind in
I hope you enjoy reading this issue.
the world – thanks to Siemens laboratory automation.
Read how Thyrocare is changing the rules of lab testing in
India on page 28.
The customer stories in this issue are initiated to a large
extent by individuals, entrepreneurs, and philanthropists
who lack the support of a comprehensive public infra-
structure. But these centers provide a foundation on which Hermann Requardt
to build a general healthcare system – which would barely Member of the Managing Board of Siemens AG
be possible without these frontrunners. and CEO of the Healthcare Sector
Medical Solutions | February 2014 | www.siemens.com/medical-solutions 3
Contributors
Arush Mayank
Renowned photographer Arush Mayank landed in Bangalore
for the cover shoot of Dr. Devi Shetty with plenty of ideas.
“When we met Dr. Shetty, it was evident that he had very
little of what we wanted from him – his time. All my plans
for the shoot went down the drain,” says Mayank. He then
decided to work around the doctor’s schedule. He stayed
one day longer to follow him wherever he went. “I adopted
his business model – going for quantity. I went on a clicking
spree,” he says. After two days of shooting, with long hours
of waiting for Dr. Shetty, Mayank got countless photographs.
But more importantly, he left with a “gratifying feeling of
meeting a man who has inspired our country and especially
our generation,” says Mayank.
See page 8
Moritz Gathmann
Russia correspondent Moritz Gathmann (left)
gets excited every time he visits St. Petersburg.
“I always remember the feeling of arriving
there the first time during a school exchange
at the age of 14. Of course, since 1994 the
city has changed a lot – for the better,” he says.
And he sees Dr. Arkady Stolpner (right) as a
good example “of people who make change
happen in this huge country: He established
medical centers that revolutionized diagnosis
and therapy in the field of oncology in St.
Petersburg – and then all over the country.”
See page 60
Andre Vieria
Internationally acclaimed photographer Andre Vieria says that during his
assignment at DASA in Rio de Janeiro he was most amazed by “how sophisticated
all the technology is.” He adds: “For me, luckily someone not very familiar
with hospitals, it’s incredible to see the human body at work in real time on the
computer screens. Sometimes I’d get so fascinated by what I was seeing on
the screen that I’d forget to take photos. I guess everyone of us will eventually
be inside one of those machines at least once in our lives. It’s nice to be able to
see them from the control room side, see what they’re capable of doing.”
See page 72
Sroop Sunar
London-based illustrator Sunar Sroop says she always enjoys opportunities to
illustrate topics to do with her native country. “This article on Indian healthcare
allowed me to explore a current issue surrounding the country today. Being
based in the UK, it is ever more important to me that I sustain my ties with India
through illustration. India is my inspiration. It drives my focus and dedication,
perhaps like many of the young talents featured here,” she says.
See page 52 and the geographical icons at the beginning of each India story.
Roman Elsener
Getting to know the Inspira Health Network in Southern
New Jersey in just one day and over five different locations
was a challenge for U.S. correspondent Roman Elsener
(right, together with Lynette Newkirk, Inspira’s Adminis-
trative Director) – but ultimately a rewarding experience.
“Together with photographer Skye Parrot, we really got
to see how Chet Kaletkowski and his team bring it all
together and connect doctors, hospitals, and patients via
the sophisticated software that Siemens installed,” Roman
recalls. “At the same time, we were reminded of the long
way to go until healthcare reform in the USA is fully
implemented.”
See page 78
Swati Prasad
Senior business journalist Swati Prasad loved every minute of the four trips she took
to Salem, Madurai-Coimbatore, Bangalore and Surat to meet clinicians, entrepreneurs,
and philanthropists who are changing India’s healthcare arena. “It was interesting to
see how the sector is deploying technology to address the country’s healthcare chal-
lenges. A lot is changing across the length and breadth of India,” she says. But the most
delightful was Swati’s meeting with Dr. Devi Shetty. “He’s someone who has taken a
holistic view and is determined to change the healthcare scenario through his innova-
tive business practices, medical techniques, and insurance programs.” The interview
was strewn with quotes from Mother Teresa, as he had served as Mother’s personal
physician. “I took back a lot more than just the interview with Dr. Shetty,” says Swati.
See page page 8, 24, 36, 42 and 46
Wiebke Kathmann
When medical writer Wiebke Kathmann visited the Ambulatory Healthcare
Center Prof. Dr. Uhlenbrock and Partners in Dortmund, Germany, she was
excited. “Learning more about the latest advances in low-dose mammography
meant a lot to me,” she says. Being a woman and knowing that this screen-
ing method means quite a bit of radiation exposure over the years, “I was
happy to hear that nowadays a comparable image quality can be achieved
with up to 30 percent less radiation.”
See page 68
Medical Solutions | February 2014 | www.siemens.com/medical-solutions 5
Contents
Contents 08 28
Medical Solutions met with One Mumbai-based lab
Dr. Devi Shetty, chairman of Narayana alone serves one billion
Health in Bangalore, India. people – at affordable rates.
Healthcare in India: Trends and Insights
08 India’s Healthcare Visionary 36 On the Quality Highway
Interview with renowned heart surgeon and After investing in digital radiography, a hospital in
entrepreneur Dr. Devi Shetty on how healthcare in Coimbatore turned to be the probably most updated
India can be made affordable for all. hospital in its region.
16 The Road Less Travelled 40 Giving Shelter to the Needy
In India’s turbulent and rather inaccessible By charging less than half the market rate, an
northeastern region, a laboratory has invested in Indian imaging center is making high-end magnetic
automation to provide quality healthcare at resonance imaging scans affordable for the masses.
affordable rates.
46 Pioneering CT in Salem
24 A Trailblazer in Orthopedics Both physicians and patients at SKS Hospital in
An Indian expert uses simple radiological tools for Salem, India, benefit from advanced CT technology.
research to transform international methodologies
in orthopedics. 52 Smart, Ambitious, Dedicated – India’s Young
Doctors
28 Mastering the Volumes Portraits of some of India’s next generation
A Mumbai-based laboratory processes 100,000 of medical professionals: Their work, their goals,
diagnostic tests per night – more than in any other their dreams.
comparable lab worldwide.
6 Medical Solutions | February 2014 | www.siemens.com/medical-solutions
Contents
46 60
SKS Hospital in South India saves time and costs despite a higher The success story of a
investment in a high-end CT scanner. Russian revolutionary in diagnostic
imaging.
Features
02 Editorial 60 The Russian Revolutionary in Diagnostic Imaging
How Dr. Arkady Stolpner improved access to
magnetic resonance imaging throughout Russia.
04 Contributors
64 Timing is Everything
84 Digital Highlights Workflow management technology helped
a California medical center synchronize quality
improvement efforts.
92 Further Publications
68 A Winning Team for Low Dose Digital
93 Imprint Mammography
An expert teamed up with Siemens to find ways of
reducing radiation dose in breast cancer screening.
72 Forging a Unified Healthcare Culture
Interview with the chairman of Latin America’s
largest diagnostic company on investments in
innovation and on being a pioneer.
78 Bye Bye, Paper Files!
A health network relies on IT solutions to implement
the healthcare reform in its corner of the USA.
Medical Solutions | February 2014 | www.siemens.com/medical-solutions 7
Healthcare in India
India’s
Bangalore
Population
8,425,970
Healthcare
Visionary
Dr. Devi Shetty, Chairman of Narayana Health,
headquartered in Bangalore, India, is on a mission
to expand the reach of world-class healthcare
facilities to the poorest in India. And he’s convinced
his model can be replicated the world over.
Text: Swati Prasad Photos: Arush Mayank Illustration: Kelli Anderson
8 Medical Solutions | February 2014 | www.siemens.com/medical-solutions
u
Healthcare in India
Dr. Devi Shetty examining an infant with a congenital heart defect. Several patients wait for hours outside his office at Narayana Health,
Bangalore, for his opinion.
Dr. Devi Shetty does everything differ- “India will become the first country to
ently. When most private healthcare dissociate healthcare from affluence,”
chains in India are adding fancier says Shetty, in his spacious corner room
restaurants, multiplexes, and super- at Narayana Health City in Bomma
luxury wards to their new hospitals, sandra, on the outskirts of Bangalore.
Shetty – Founder and Chairman of “India will prove that a country need
Narayana Healthcare (NH) – is doing not be rich to offer quality healthcare
away with air-conditioning and marble to its citizens,” he adds. With ‘Om’ chants
flooring in order to make healthcare playing in the background, there is
more affordable. He can talk about peacefulness in his demeanor and con-
expanding operations, improving prof- viction in his voice as he spells out his
its, and reducing cost in the same vision for India and the world.
breath. Although his business model
And there is no doubting his convic-
goes beyond economics: Shetty’s hos-
tion. Back in 2001, Shetty founded
pital chain never turns away a patient
Narayana Health (earlier known as
due to a lack of funds. Despite this
Narayana Hrudayalaya) because he
policy, Shetty claims to be more prof-
could not find an employer who under-
itable than leading American hospital
stood his vision for making world-class
chains.
10 Medical Solutions | February 2014 | www.siemens.com/medical-solutionsCover Story
healthcare affordable to all. From a
300-bed hospital in 2001, NH has grown
to a 6,000-bed healthcare conglo Dr. Devi Shetty:
merate, with 17 hospitals present in
13 locations across India. Over the next An Unparalleled Clinician
six years, Shetty plans to grow five-
fold – into a 30,000-bed healthcare
conglomerate. He plans to achieve that Shetty was awarded Padma Bhushan in 2012 – the third-
by building low-cost, 300-bed, multi- highest civilian award conferred by the Indian government.
specialty hospitals that take just six
months to construct.
He is the first surgeon in India to perform heart surgeries
Shetty has proved that ‘affordable world- on newborn babies, using a micro-chip camera to close holes
class healthcare’ is not an oxymoron. in the heart.
“We are a low-cost hospital but our hos-
pital is accredited by the Joint Com
mission International of the USA,” says Shetty and his team have performed over 70,000 major
Shetty. “People always say ours must heart surgeries out of which 15,000 were on children,
be an Indian way of doing things (with many of them newborn babies.
reference to low costs). There is no
Indian way of doing things. There is
only one way of doing it and that’s the Along with the Indian Space Research Organization,
best way of doing it,” says Shetty. NH manages the world’s largest telemedicine program.
Mastering the Volumes
NH has built a 150-bed hospital in Mysore for 300 million
Shetty, who is also known as the Henry INR (US$ 4.6 million) – which is a fifth of the industry’s cost.
Ford of heart surgery, pioneered the
low-cost healthcare model by employ-
ing an assembly-line approach to sur-
gery where junior doctors complete all
the preliminary steps, leaving only the
crucial step to be p
erformed by their
seniors. This way, the senior surgeons
are able to perform more surgeries in
a day than their peers in the West.
It also has a centralized supply-chain any finite component. It is dependent
“Surgeons are like technicians. The management system geared to getting on human skill. And human skill is
more surgeries they perform, the better the best deals in exchange for high replenishable. We can technically
they get at it,” says Shetty. Interns from volumes from a select set of suppliers. reduce the price of any service to any
developed countries come to NH to In fact, 85 percent of its drugs and level we want,” explains Shetty. With
get a first-hand experience of Shetty’s consumables are purchased by its this approach, Shetty aims to reduce
assembly-line approach to surgery. central buying unit. the cost of healthcare by as much as
Today, a fair number of surgeons come 50 percent over the next decade.
to NH from countries such as China, Moreover, NH does not go for fancy
England, and the USA for training. interiors. This way, its 150-bed Working on the
hospital in Mysore has managed to
Apart from cardiology, NH offers facili- reduce the cost of heart surgery to Challenges
ties across various specializations, such US$ 800, compared to US$ 1,000 in Shetty’s vision for India is fraught
as gastroenterology, vascular services, Bangalore. with challenges. For one, India does
nephrology, urology, neurosurgery,
According to Shetty, while there is a not have many specialists, due to the
pediatrics, obstetrics, and gynecology,
market for luxury hospitals, the bulk lower number of post-graduate medi-
as well as endocrinology, cosmetic
of the business will come from the cal places. “We have 45,600 under-
surgery and rehabilitation, organ trans-
poor who can’t afford treatment due graduate places in our medical col-
plants, and oncology.
to a lack of medical insurance and leges, but only 12,000 post-graduate
NH deploys technology to bring down prohibitive cost of healthcare. places. In comparison, the USA has
costs. It uses IT expertise to improve 19,000 undergraduate and 32,000
management systems. For example, He feels it is easier to bring down post-graduate places,” he says (more
NH’s extensive database is on a cloud, costs in healthcare, as opposed to on the challenges medical students
saving infrastructure and people costs. manufacturing. “Unlike manufactur- in India are facing on page 52).
ing, healthcare is not dependent on u
Medical Solutions | February 2014 | www.siemens.com/medical-solutions 1112 Medical Solutions | February 2014 | www.siemens.com/medical-solutions
Cover Story
The Pediatric Intensive Care Unit at Narayana Health is well-equipped to manage difficult childhood emergencies.
It’s critical to have specialists to improve a problem, he feels. Therefore, NH nurse practitioner, a nurse anesthe-
the healthcare standards. “Among has launched a scholarship program – tist, a nurse intensivist... or even
the top ten causes of death are heart Udayer Pathey (which means ‘rising become a doctor,” he says. But not so
disease, cancer, accidents, strokes, path’ in Bengali). Its objective is to in India.
Alzheimer’s, and psychiatric problems. help 2,000 students from villages of
Shetty has played a key role in the
All these diseases require specialists,” West Bengal become doctors every
‘Save the Doctor’ campaign, started
Shetty explains. year. “We give them scholarships and
by the Indian Medical Association
mentor them,” adds Shetty.
Two, the medical profession is losing (IMA) and the Association of Health-
its charm, since it doesn’t pay as well The other challenge for India, accord- care Providers India (AHPI). Through
as many other industries. “When I was ing to Shetty, is that it needs more this campaign, Shetty hopes to
in school, when someone asked us nurses, technicians, and administra- address several issues plaguing the
who wants to become a doctor, virtu- tors. “Behind every skilled doctor you industry. “We want to create an infra-
ally the entire class would raise their need to have at least two highly-skilled structure to address the issues con-
hands. Today, very few hands go up,” nurses, at least four to five techni- fronting doctors first, and then we
he says. cians, and good administrators.” will take up the causes of nurses,
technicians, and the like,” he says.
Shetty is working on this. “Across the But, due to the government’s myopic
world, outstanding doctors generally policies, “the nursing profession may “If every country has adequate num-
come from deprived backgrounds – soon be extinct in India,” says Shetty. ber of surgeons, radiologists, anes-
they have fire in their bellies and can “Admission to nursing colleges has thetists, and cardiac surgeons, believe
work round the clock to change the come down nearly 50 percent,” he me, costs will come down by more
rules of the game,” he says. If these adds. The reason? There is no career than 50 percent. It is a question of
youngsters find medical education progression for nurses and technicians. demand and supply,” he says. Shetty
expensive and non-rewarding, there is “In the USA, a nurse can become a is optimistic that the scenario will u
Medical Solutions | February 2014 | www.siemens.com/medical-solutions 13Creating Equitable Growth
How can India address the issue of volumes in east India. Nearly 150 districts in the east of India
order to create more supply of doctors, nurses, are affected by Naxalism (a term used to refer to
specialists, and so on? various militant Communist groups operating in
India). The Naxalite problem is not a law-and-order
Shetty: The industry has to start lobbying. That’s
problem. It is an economic problem. You start a
the only way we can change the scenario. Medical
medical college in this region and within three to
diagnostic equipment manufacturers, pharmaceuti-
four years, there will be about 5,000 to 8,000 students
cal companies, and clinicians have to influence the
living in that district. They will change the economy
policymakers. Companies like Siemens are not able
of the entire district.
to sell many radiology systems in India because there
aren’t that many radiologists. Today, people have Globally are there any healthcare models that
the money to buy a magnetic resonance imaging India can emulate?
(MRI) scanner, but there is a dearth of radiologists
Shetty: We have a lot to learn from the USA and
who can interpret the reports. The same applies to
Europe. In the USA, a large number of procedures
pharmaceutical companies. They manufacture so
are done by physician assistants. They significantly
many specialty drugs, but there aren’t enough post-
reduce the volume of work to be done by the
graduate doctors in India who can prescribe them.
surgeons.
You mentioned that healthcare creates
The process of healthcare is a lot more streamlined
equitable growth. Can you explain this?
in these countries. For instance, in oncology there
Shetty: Healthcare is a unique industry that creates is an oncology nurse, who knows all about the drugs
millions of jobs for millions of households. It is a and can talk to the patient very confidently. We have
main driver of the nation’s economy and creates not reached that yet.
highly skilled jobs for a few people. But a large num-
When you talk of bringing down costs, what’s
ber of jobs require semi-skilled and unskilled people.
the first step hospitals need to take?
If India wants equitable growth, the government
Shetty: In global forums, everyone talks about
must open more medical colleges in regions such as
reducing the cost of healthcare. But no one knows
how much they are spending today.
We have invested in technology. Every day at noon,
I get an SMS on my cell phone with yesterday’s reve-
nue, expenses and EBIDTA (earnings before interest,
depreciate, taxation, and amortization) margin. For
us, looking at a profit and loss account at the end of
the month is like reading a post-mortem report. You
cannot do anything about it. Whereas if you monitor
it on a daily basis, it works as a diagnostic tool. You
can take remedial measures.
While charity is not scalable, good business princi-
ples can be scaled up, and can be taken to any level.
“Healthcare is a unique
industry that creates
millions of jobs.”Cover Story
Globally, healthcare is a US$ 4.5
trillion industry. It is the second
largest industry after food and agro-
processing. “Despite its size, it only
addresses about 30 percent of the
world population. Nearly 70 percent
of the world population is nowhere
near receiving decent healthcare
services. We need a revolution in
order to service the entire market,”
he adds.
According to Shetty, India can
address most of the challenges with-
out spending a single cent. “All we
have to do is relax the norms for
higher medical education,” he says.
“India has all it takes to emerge as a
major healthcare provider to the world.
Indians are born healers. We produce
the largest number of doctors, nurses,
and medical technicians. We have a
very mature pharmaceutical industry,”
he says.
People from different religions come to the multi-faith temple at Narayana Health
to pray for the speedy recovery of patients.
According to Shetty, the policymakers
need to realize that it is not just
about healthcare. “It is about creating
equitable growth across the society,”
change soon. “We have received a very Now, Shetty is convincing policy- he adds.
positive response from the government,” makers to float a scheme through As a first step towards going global,
he says. which every mobile phone subscriber NH is partnering with the Ascension
in India pays 20 INR (US$ 0.32) over Group in the USA to set up a hospital
Increasing Medical Cover and above the regular bill, in order to in the Cayman Islands – close to
create a robust health insurance pro- patients in the USA and Central
Shetty’s approach to increasing acces-
gram. “In India, we have 850,000 America. It will be inaugurated on
sibility of healthcare facilities is two-
mobile phone subscribers who spend February 2014. “Initially, we expect it
pronged. On the one hand, he is work-
at least 150 INR (US$ 2.3) per month to be 30 to 40 percent cheaper than
ing on supply – of both hospitals and
just to speak on the phone. If there is other hospitals in the region. But over
healthcare professionals. On the other
a policy that provides them with health a period of time, we plan to make it
hand, he is working on increasing the
insurance for an additional 20 INR even more affordable,” says Shetty.
penetration of health insurance.
(US$ 0.31), I do not think anyone will By expanding overseas, NH is sound-
“Ten years ago, we realized that tax- mind paying that additional money,” ing the bell for a healthcare competi-
payers’ money cannot pay for health- he says. tion on a global scale – and paving
care,” says Shetty. He conceptualized the way for world-class healthcare at
The state governments are very open
the Karnataka Yeshasvini Health Care affordable prices in the future. p
to this suggestion, he adds. “The
Scheme, which became operational
Indian government will soon become
in June 2003. Through this scheme,
a health insurance provider. Not only
farmers contributed 5 INR (US$ 0.08)
a healthcare provider,” says Shetty.
per month towards medical insurance.
The government agreed to be the rein- Healthcare Provider to Swati Prasad is a freelance business
surer. Today, the premium has risen to
18 INR (US$ 0.27) per month. “Over the World journalist based in Delhi. She reports from
India for several publications overseas and
the last decade, over 450,000 farmers The economy of the 20th century was has worked as a correspondent and editor
had a variety of surgeries, including driven by machines. “The healthcare for The Economic Times, Business Standard,
major heart operations,” informs Shetty. and wellness industry is going to
The Indian Express, and Business Today.
drive the world economy of the 21st
century,” says Shetty.
Medical Solutions | February 2014 | www.siemens.com/medical-solutions 15Healthcare in India
Imphal
The Road
Population
264,986
Less Travelled
In the rather inaccessible and turbulent northeast of India,
Babina Diagnostics opted for the high-end Siemens StreamLAB Analytical
Workcell. With more than one million laboratory tests performed
each year, this investment is helping to increase workflow and patient
satisfaction.
Text: Archis Mohan Photos: Atul Looke
16 Medical Solutions | February 2014 | www.siemens.com/medical-solutionsLaboratory Diagnostics
Imphal is the capital of the eastern-most state of India and destination for many who want to get their blood tested at a state-of-the-art laboratory.
K. Lungrei Ekhrol, 60, a farmer, sits gleaming Siemens StreamLAB™ the StreamLAB solution just over two
watching television in the spacious hall Analytical Workcell, the only one in years ago. It is an investment that
of Babina Diagnostics in Imphal, the India. Singh says he has never regretted.
capital of Manipur, a state in north-
“StreamLAB is the pride of this labo- StreamLAB is an intuitive automation
eastern India the size of Slovakia. It’s
ratory,” says Dr. Th. Dhabali Singh, the solution that consolidates all tasks in
nine in the morning but the hall is
founder and Managing Director of a single workstation that helps stream-
already full. Like Ekhrol, all patients
Babina Diagnostics. Babina acquired line workflow. It is fully-automated, u
are awaiting their turn to have their
blood drawn for various clinical diag-
nostic tests.
Most of the patients started from their
homes in the rural countryside at the
crack of dawn. They walked several
kilometers to reach the nearest paved
road before they boarded a bus to get
to this sleek four-storey building that
houses Babina Diagnostics.
Ekhrol says he would need to return
home before sundown. The good news
is that everyone in the hall can expect
their blood reports by lunchtime. It
will leave him, says Ekhrol, ample time
to visit his doctor and share the report,
do some shopping, and still manage to
return home before dusk.
The reason for Ekhrol’s calm confi-
dence, although he is quite unaware
of it, sits some meters above his head.
At the center of a similarly-sized hall 60-year-old Ushokholun with his son Mangpu from Myanmer travelling by moped to give his blood
on the third floor of the building sits a sample at the Babina collection center in the Indian border village of Moreh.
Medical Solutions | February 2014 | www.siemens.com/medical-solutions 17Healthcare in India
70 percent of diagnostic tests at Babina Diagnostics are of walk-in patients.
loads and unloads the test tubes from ment school, walking several kilometers
one single location, accommodates carrying his own gunny bag, used for
different tube types, has an efficient sitting on the ground as the classes took
tube sharing system and accelerated place out in the open during winter
turnaround times, offers extensive season. He says it was his father who,
immunoassay menu options, and is despite being a small trader, motivated
compact in size. Its small footprint, all his children to study. “He realized
and productivity equalling systems the importance of education and loved
twice its size, convinced Singh to the medical profession. He kept push-
include the StreamLAB solution in his ing me to study medicine,” says Singh.
armory of diagnostic instruments. To the surprise of most of his friends
and relatives, the future entrepreneur
Betting Big on returned home to Imphal after his
Automation medical studies in faraway Chandigarh.
A stint at a hospital in Imphal made
Singh says he always had a burning
him realize that Manipur didn’t have
ambition to do something for his
the facilities to do even the most basic
homeland. He studied at a govern-
18 Medical Solutions | February 2014 | www.siemens.com/medical-solutionsLaboratory Diagnostics
of diagnostic tests. Financial assistance Babina Diagnostics from its 100 col-
from his father-in-law and help from lection centers across Manipur and
friends, including a microscope rented from major cities across the northeast
at INR 175 (US$ 3), helped him start – such as Agartala in Tripura, Silchar
the laboratory in November of 1983. and Guwahati in Assam, and Dimapur
It did well and by 1994 he quit his job and Kohima in Nagaland. Of late, a
as an associate professor in the local couple of dozen samples come daily
government-run medical college. Singh from the border towns of Myanmar,
is proud of the fact that he came back which is 117 kilometers from Imphal.
to his homeland when his contempo-
raries were busy making a beeline for Minimizing Errors With
the UK and the USA. Automation
With time, Singh realized the need Singh named Babina Diagnostics
for an automated solution that could after his daughter, Babina. His daugh-
reduce turnaround times significantly ter, who is also a doctor, helps him
and be error-free. He had set his heart run the laboratory. She says mistakes
on acquiring the StreamLAB solution occur primarily due to human error
for Babina Diagnostics from the time it and automation is the only solution
was launched. “We had been looking for minimizing them. u
for a complete automation solution The destination of many medical travellers:
Babina Diagnostic’s laboratory.
for Babina Diagnostics for some time,
especially clinical chemistry and immu-
noassay, of which our sample volumes
are considerably high,” he says. Good
after-sales service from Siemens con-
vinced him further.
He says at times his children and rela-
tives berate him for investing so much
money in expensive diagnostic equip-
ment in a place like Manipur, where
purchasing power is low. “The invest-
ment in StreamLAB was significant, but
I was confident it was viable,” says
Singh.
And indeed: The StreamLAB solution
has helped Babina Diagnostics carry out
an impressive one million tests a year,
most of which are processed between
morning and early afternoon so that
customers can reach their homes in
distant places before the sun sets on
the valley. Singh says the laboratory’s
turnaround times have reduced by
30-35 percent with the introduction of
the StreamLAB solution, and errors
have been significantly reduced.
Currently, Babina Diagnostics com-
mands a 70 percent share of the diag-
nostic market in Manipur, processing
nearly 1,000 patient samples per day.
Singh says approximately 70 percent
The lab performs tests on the most common medical conditions in northeastern India,
of diagnostic tests are from walk-in such as endocrine and autoimmune disorders, diabetes, and infectious diseases.
patients. The rest of the samples reach
Medical Solutions | February 2014 | www.siemens.com/medical-solutions 19Healthcare in India
Setting an Example
India’s northeastern region is both relatively inaccessible
and underdeveloped. Good healthcare services are mostly
unavailable. Babina Diagnostics is an exception. For the last
30 years, it has made quality healthcare services accessible
to the people of Manipur. It turned to automation to handle
its huge volume of samples. The StreamLAB Automation
Solution has helped reduce turnaround times, increase
employee efficiency, and improve physician and patient
satisfaction.
With the advent of the StreamLAB barcoded. Bundles of these barcoded
solution, Babina Diagnostics’ opera- tubes are then put into plastic bottles
tions have significantly reduced that are pushed into an automated
errors. pneumatic sample delivery system that
reaches the third floor. There, the tube
The entire process from collecting
bundles are brought out of the bottles
blood samples to issuing test reports
and put onto the StreamLAB track.
requires minimal human intervention
at Babina Diagnostics. The tubes Singh says the StreamLAB solution can
with blood samples collected from accommodate different kinds of tubes
the patients on the first floor are that may come from the collection
At the StreamLAB track: Only minimal staff is required to process the 1,000 tests per day.
20 Medical Solutions | February 2014 | www.siemens.com/medical-solutionsLaboratory Diagnostics
“Babina Diagnostics changed the
market scenario in the region,
benefitting both doctors and patients.”
Dr. Th. Dhabali Singh, founder and owner of Babina Diagnostics, Imphal, India
centers, does centrifugation to sepa- than three to four hours. Patients for its technicians. The doctor says
rate plasma or serum from other com- that walked into the laboratory at maintenance is the key to ensuring
ponents of blood like leucocytes for 9 a.m. can collect their test report by reliability and efficiency of the lab
better test results, reads the barcodes 1 p.m. There are also times when the automation systems. “We have our
to conduct the prescribed tests, and laboratory does emergency tests for own quality policy in place that takes
updates the test results in the master samples from collection centers and care of the maintenance,” he says.
server. results are communicated immedi-
Some of the most common medical
ately, either via fax, the Internet, or
The results are then sent by email or problems in northeastern India are
by phone.
the printout is given to the patient endocrine disorders, autoimmune dis-
waiting in the ground floor hall. The Babina Diagnostics conducts routine orders, diabetes, infectious diseases,
entire procedure doesn’t take more skill development training sessions conditions like HIV and hepatitis, and u
Medical Solutions | February 2014 | www.siemens.com/medical-solutions 21Healthcare in India
cancer. These are also the most com-
monly performed tests at Babina Diag-
nostics to detect and diagnose these
diseases.
Braving the Odds
The diagnostics market in Manipur is
relatively small compared with metro
politan cities in other parts of India.
Manipur with a geographical area of
22,347 square kilometers is one of the
smaller states in India and, with 2.7
million inhabitants, also one of its least
populous. “But most physicians and
people in the region trust Babina Diag-
nostics. The sample load has been
increasing by the day,” says Singh.
Babina Diagnostics ushered in qualita-
tive changes in healthcare in Manipur,
which lacked a diagnostic culture. “In
time, physicians and patients began to
realize the importance of correct diag-
nosis and accurate test reports,” says
Singh. Earlier, people from Manipur
sent patient samples to laboratories in
Kolkata and Delhi, which are 1,500 and
over 2,000 kilometers from Imphal,
respectively. “We know the importance
of timely diagnosis in the treatment of
a disease. Babina Diagnostics changed
the market scenario, benefitting both
doctors and patients,” says Singh.
Singh says his wide network of collec-
tion centers and joint venture units have
made health services more accessible.
Babina Diagnostics is the preeminent
diagnostic centre in the region. It was
also the first pathological laboratory
run by a pathologist in Manipur. “Being
a pathologist myself, I was aware of
the needs of the treating physicians
and the people. It has always been my
dream to run a diagnostic laboratory
The barcoded vials are put into plastic bottles on the ground floor and then pushed
of my own. Fortunately, all my instincts
into an automated pneumatic sample delivery system that reaches the lab automation
on the third floor. and gambles proved right. There were
financial risks involved, but I was con-
fident they would pay off,” says Singh.
“The law-and-order situation, the fre-
quent blockades on the highways, the
geographical terrain, and the natural
calamities such as landslides, as well
as the erratic power supply, are prob-
lems that we have to encounter as
entrepreneurs,” he says. Poor power
22 Medical Solutions | February 2014 | www.siemens.com/medical-solutionsLaboratory Diagnostics
Patients accept long journeys to have their blood tested, but thanks to the lab’s fast turnaround times, they arrive back home on the same day.
supply has meant the laboratory has two of its collection centers situated at affordable rates,” says Singh. Despite
to rely on diesel generators for power, in the bordertown of Moreh. In col- the challenges, Singh is unwavering
which is expensive. Blockades of high- laboration with pharmaceutical com- in his commitment to “give the best
ways lead to total stoppage of samples panies, Babina Diagnostics conducts to the people of Manipur and the
coming from outside Manipur. free health camps on a regular basis northeast region.” p
in Moreh and inside Myanmar.
Despite these problems, Singh is opti-
mistic about the future. Manipur’s con- The investments in instruments and
nectivity with the rest of the country automation have not caused Singh to
and the larger southeastern region of increase the cost of the tests. Babina
Asia is set to become better with Imphal Diagnostics has rates that are less
expected to have a rail link with the expensive than in cities. Singh plans
rest of India by 2016. There are also to promote a multispecialty or cancer Archis Mohan is a New Delhi-based free-
plans for an international airport. hospital in Imphal in the future and lance journalist. He writes on a range of
even a medical college to improve the issues for both Indian and foreign print and
The doctor says Imphal could become television media outlets, including Hindustan
doctor-patient ratio, which is currently
the center of medical tourism not only Times, The Telegraph, NDTV and Times Now.
at one doctor for 1,660 patients.
for people from other northeastern
states, but also from neighboring “The potential is huge. I would like to
Myanmar. Babina Diagnostics already see many more hospitals and diagnos- ww.siemens.com/
w
has customers from Myanmar, with tic centers offering premium services laboratory-automation
Medical Solutions | February 2014 | www.siemens.com/medical-solutions 23Healthcare in India
Coimbatore
Population
1.1 million
A Trailblazer
in Orthopedics
Dr. S. Rajasekaran of Ganga Hospital, Coimbatore, has used simple
diagnostic tools for research to transform international methodologies
in orthopedics. His approach of putting the patient first is now driving
him to evolve new healthcare models for India.
Text: Swati Prasad Photos: Arush Mayank
Coimbatore is amongst the fastest it impacts on the international com- into a specialty hospital for orthope-
growing tier-II cities in India, bustling munity. Moreover, it is also a hospital dics and plastic surgery. Back then,
with textile mills, factories, informa- that never turns away patients, even Ganga was a polyclinic for obstetrics
tion technology companies, and if they do not have the money for and gynecology, pediatrics, and
hospitals. Unlike most small cities in treatment. “We look for donors and neurology.
south India, it doesn’t boast many ask our surgeons to operate for free,”
“Many of our friends and colleagues
tourist spots. Its fame comes from says Rajasekaran.
thought we didn’t stand a chance. But
entrepreneurs and from institutions
His research interests relate to spinal we believed there was a niche segment
like Ganga Hospital, which has put
tuberculosis, open fractures, genetic we could address,” says Rajasekaran.
Coimbatore on the world map of
studies, back pain and disc degenera- The belief came from the fact that
orthopedics.
tion, disc diffusion studies, computer- Coimbatore, as well as India, were grow-
One of the largest orthopedic hospi- assisted orthopedic surgery, and dif- ing at a fast pace. “There is one death
tals in South Asia, Ganga Hospital fusion imaging of the spinal cord. on Indian roads every four minutes,”
is a rare institution that has seen the Rajasekaran‘s research has won him informs Rajasekaran. With rising road
right blend of clinical and academic numerous awards including the pres- traffic and concomitant accidents, both
activities. Research has played a key tigious EuroSpine Open Paper Award orthopedics and plastic surgery to his
role in the success of Ganga Hospital. for 2008. He is also one of the very mind held a lot of potential. The rapid
Dr. S. Rajasekaran, Chairman of the few surgeons in the world who has growth of Ganga only confirmed this.
Department of Orthopedic and Spine won the prestigious ISSLS Spine In 2012, it recorded 154,790 outpa-
Surgery, stands firmly at the helm of Research Awards three times: in 2004, tients, 23,518 in-patients, and 13,446
a success story that was started back 2010, and 2012. surgeries, up from 111,986 outpa-
in 1978 by Rajasekaran’s father, Dr. J. tients, 19,317 inpatients and 11,766
G. Shanmuganathan, an anesthetist. From Diagnosing to Under- surgeries in 2010.
standing a Disease
Today, Rajasekaran and Ganga are With his return to India, Rajasekaran
known the world over for medical In 1991, Rajasekaran and his brother, realized the huge difference in the
research and new methodologies in Dr. S. Rajasabapathy, a plastic surgeon, approaches adopted by orthopedists
orthopedic treatment. When returned to India from the UK. Both in India and their peers in the West.
Rajasekaran adopts a methodology, brothers wanted to convert Ganga While those in the West believed sur-
24 Medical Solutions | February 2014 | www.siemens.com/medical-solutionsgery was the answer to every injury,
infection, stenosis, or back pain, ortho- “Previously only meant
pedics in India were busy attending to
trauma and accident cases. Surgeries for diagnosis, today
were not too common in India. And in
the West, the results of surgery were
unsatisfactory.
radiology is also being
Even today, very little is understood used to understand
about back pain. “A magnetic resonance
exam may show some changes in the
spine, but the pain maybe coming from
diseases.”
somewhere else – the joint, the disc,
Dr. S. Rajasekaran, Chairman of the Department of Orthopedic
nerves, muscles – or the problem and Spine Surgery, Ganga Medical Centre and Hospital, Coimbatore, India
maybe in the brain. You can also expe-
rience pain due to depression, stress u
Medical Solutions | February 2014 | www.siemens.com/medical-solutions 2540 percent of the hospital beds are allotted to the poor, 30 percent to the middle-class, and 30 percent to the upper-class.
or anxiety.” And so Rajasekaran nificant role in the research under- the research fund. That enabled us to
decided to get into research. It all taken at Ganga. One important system do the research,” he says.
started with kyphosis (over-curvature is the MAGNETOM® Symphony 1.5
Today, the foundation has grown and
of the thoracic vertebrae) in children Tesla MRI eco system. “In spine, since
has to its credit various activities such
even after complete cure of spinal there is no moving part, excellent
as supporting the academic training
tuberculosis. clarity is obtained with 1.5 Tesla
of the hospital staff, holding scientific
systems,” Rajasekaran says.
Rajasekaran uses computed tomogra- meetings and conferences, funding
phy (CT), magnetic resonance imag- The Importance of Research on-going research activities of the
ing (MRI), and X-ray systems for his orthopedic department, providing funds
research. “Previously only meant for Research also has a special place at for Project Helpline (a project to sup-
diagnosis, today radiology is also being Ganga Hospital. Therefore, in 2002, port the surgical correction of physical
deformities in poor children), and
primary education of under-privileged
children. The funds continue to come
The department of orthopedics performs from Rajasekaran’s family, members
of the board of directors, and philan-
more than 3000
thropists.
The second step was to utilize hospital
resources for research. The MRI eco
major surgeries per year. system, for instance, was relatively free
after 8.30 pm. “We convinced our con-
sultants to charge less for research,”
he says. “When you are a high-volume
used to understand diseases,” he says. the hospital founded the Ganga surgeon, professional fatigue sets in
“It is used to identify, grade, and stage Orthopedics Research and Education after some time,” says Rajasekaran.
the disease, to tell whether surgery is Foundation. “The initial corpus for Research not only prevents the onset
required or not, to prognosticate, to the foundation was by a donation of this, it also gives medical practitio-
plan the treatment … In fact, at every from the family. Subsequently, I kept ners a fresh perspective. “You start
stage radiology has a role to play.“ the fund growing by regularly allot- analyzing. And then, every patient looks
Siemens systems have played a sig- ting a major part of my revenues to interesting.”
26 Medical Solutions | February 2014 | www.siemens.com/medical-solutionsOrthopedic Research
Putting the Patient First
In the mid-nineties, while planning
Ganga Hospital’s expansion from a 42- In the last 15 years, Ganga Hospital has trained
463 doctors
to a 135-bed hospital, Rajasekaran and
Rajasabapathy met their architect. The
siblings allotted 40 percent beds to the
poor, 30 percent to the middle-class,
and 30 percent to those who prefer a from 42 countries.
luxury ward. The architect advised them
to reduce beds for the poor. In his view,
this would make the project more viable
in the eyes of the bankers and increase
the possibility of getting a bank loan. But
the siblings were adamant about stick-
ing to their ratio. They gave an impres-
sive presentation to the bankers to prove
their model could work. “It needed a But then Rajasekaran’s methodologies to share this liability and strategize
lot of convincing, but we finally got the have spread in many different ways – our policies around this stratum,” he
loan sanctioned,” he adds. through his research papers, through adds. According to Rajasekaran, the
conferences, and, most importantly, private sector must focus on the poor.
For Ganga Hospital, the patient comes through training. Ganga Hospital pro- “Once you achieve a critical mass, you
first. The hospital ensures the treatment vides fellowships to senior residents can do a lot of good.”
is affordable for the middle-class and from all across India. It has a team of
doesn’t turn away patients if they can’t As far as Ganga Hospital is concerned,
international students coming every
afford the treatment. The information Rajasekaran says it has seen steady
year to learn new techniques in spine
about Ganga has spread by word of progress since 1991. The last expan-
surgery. Hence, the best practices
mouth. Ganga Hospital does not have a sion at Ganga Hospital happened in
adopted here percolate through to the
marketing department. “We have never 2007. “The scope for expansion is
national and international community
advertised,” says Rajasekaran. But still, huge,” he adds. In his view, expan-
of orthopedics. “In the last 15 years,
30 percent of Ganga Hospital’s turnover sion must be dovetailed to the needs
we have trained 463 doctors from 42
comes from patients who do not reside of the various strata of society. “We
countries,” he says. Rajasekaran also
in the region. However, medical tourism need to be aware of the different
receives students from the prestigious
to Ganga Hospital is yet to pick up. affordability levels and needs. We
Japanese Spine Society.
“That’s due to poor accessibility,” explains need a healthcare delivery strategy
Rajasekaran. Although Coimbatore has Towards a Different that does not compromise on deliv-
an international airport, there are only Healthcare Model ery of quality healthcare,” he says.
two international flights to the city. Rajasekaran is now looking at the
According to Rajasekaran, India is a
very different market and the various next big step to get into sub-special-
health delivery models that the gov- ties. In order to take that leap, he is
ernment and the private sector are examining whether there is a scope
working on should be aware of this for a 300-bed spine hospital, a 300-
fact. “Our models have to be different bed joint replacement hospital, and
from the West,” says Rajasekaran. a 500-bed accident hospital in Coim-
Talking about the demographic profile batore. “It may not happen today, but
of the country, he says the top two it will happen in the next three to
percent of Indian society comprises four years,” says Rajasekaran. p
people who are richer than the rich
in the West. For them, the healthcare
models are irrelevant. Then, there are
the next 500 million who form the
middle-class. “Our middle class popu-
lation is far bigger than the population
Read more about Dr. Rajasekaran’s
of the USA. In this segment, affordabil-
research at Medical Solutions Online:
ity has been on the rise,” he adds.Then,
there are the next 400 million which ww.siemens.com/
w
are below the poverty line. “We need orthopedics-india
Ganga Hospital is one of the largest orthopedic
institutes in South Asia, with academic research
playing a key role.
Medical Solutions | February 2014 | www.siemens.com/medical-solutions 27Healthcare in India
Mumbai
Population
13.8 million
Mastering
The Volumes
28 Medical Solutions | February 2014 | www.siemens.com/medical-solutionsLaboratory Diagnostics
From its centralized laboratory in suburban Mumbai, India,
Thyrocare Technologies processes 100,000 diagnostic tests each
night – more than in any other comparable lab worldwide.
Made possible by one man’s vision coupled with state-of-the-art
automation solutions.
Text: Archis Mohan Photos: Atul Loke
Medical Solutions | February 2014 | www.siemens.com/medical-solutions 29Healthcare in India
At midnight, a laboratory the size of founder. Thyrocare was also the first in hospitals, nursing homes, and labo-
a football field situated in the base- in India to use barcodes and bidirec- ratories across the country. Each patient
ment of a nondescript three-storied tional interfacing in diagnostics to sample is collected in Thyrocare pre-
building in a suburb of Mumbai sees eliminate errors. barcoded empty vials. The barcode
frenetic activity. Men and women in identifies each patient specifically dur-
white lab coats place bundles of bar- King of Volumes ing collection, ruling out the majority
coded vials on two serpentine tracks of pre-analytical errors. After entering
In 1995, Thyrocare started as a thyroid
linked to a series of diagnostic the data related to the barcodes in the
function testing laboratory. Today it is
machines. webserver, the Thyrocare franchisee
the youngest of the four key players
aggregates all the vials, and packs them
During the day, nearly 25,000 vials in the Indian diagnostic industry. Yet,
in a temperature-controlled transpor-
with blood and urine samples are it commands 60 percent market share.
tation system for air-cargo delivery to
flown in from every corner of India.
Thyroid function testing continues to Mumbai. So while the patient data
Each sample undergoes an average
generate 70 percent of Thyrocare’s typically reaches Thyrocare in couple
of four tests on a lab automation solu-
business. The thyroid is a vital butter- of minutes, the consignment of vials
tion by Siemens that consists of two
fly-shaped gland below the Adam’s takes a couple of hours by airplane.
tracks of 17 meters and 12 meters
apple that releases a hormone that
in length, with 14 immunoassay ana- Most consignments reach the city by
helps the body use energy, stay warm,
lyzers linked to each track. ten in the evening and are collected by
and keep all organs working normally.
Thyrocare employees, who deliver them
By the time dawn breaks over the It is estimated that 42 million Indians
to the centralized laboratory within a
Mumbai coastline, the automation have thyroid disorders.1
couple of hours. All samples are in the
solutions at Thyrocare Technologies
There are four pillars to Velumani’s laboratory by two in the morning. These
have processed nearly 100,000 tests
business model – large volumes, low samples are subsequently loaded onto
and posted the reports online, almost
costs, speed, and accuracy. “We are a the two lab tracks with the immuno
all without any human intervention.
single laboratory for a billion people. assay instruments that read the bar-
The man behind Thyrocare is Dr. A We are faster than any local labora- codes, conduct the tests, and post the
Velumani. His entrepreneurial vision, tory that serves its local population. reports online by six in the morning.
supported by state-of-the-art auto- We are the fastest on earth,” boasts
Laboratory workers across the length
mation solutions, has made Thyrocare Velumani.
and breadth of India punch in a pass-
the leader in the Indian diagnostic
He has modeled his business on the word on the laboratory’s website to
industry. “Thyrocare is the world’s
newspaper industry. Every morning, download and dispatch the reports to
largest single-floor, centralized, fully-
Thyrocare’s franchisees collect blood customers. Thyrocare boasts a turn-
automated, IT enabled laboratory,”
samples from 20,000 collection points around time of less than 20 hours from
says the 54-year-old CEO and
the time the sample was collected.
The immunoassay analyzers offer more
than 275 assays for screening, diagno-
sis, prognosis, and monitoring of most
diseases.
“Siemens rules my floor and I am proud
of it,” says Velumani of the decade
long association. Siemens has accom-
panied Velumani at every step and turn
of Thyrocare’s meteoric rise.
From Rags to Riches
Velumani hails from a very poor family
from Appanaickenpatti Pudur, a small
village 28 kilometers from Coimbatore
in Tamil Nadu. At the age of 16, Velu-
mani enrolled at a college in Coimbatore
to study chemistry. He even worked as
a domestic servant in a rich man’s house
to ensure that his graduation dream
would come true.
At 23, Velumani arrived in Mumbai and
was lucky enough to find a government
Thyrocare’s headquarter houses a laboratory the size of a football field in the basement. job as a lab researcher at the Bhabha u
30 Medical Solutions | February 2014 | www.siemens.com/medical-solutionsYou can also read
