From Jan 1, pharma companies can no longer gift freebies to doctors

( Courtesy eMedicalnews, Dr. KK Aggarwal ; http://ijcp.ft.mailguard.co.in/ijcp/vm.php?m=6137&u=8c454705ff0f132de329bbb8f3923002)

Excerpts from a report by Rupali Mukherjee in TOI news dated Dec 23.

1. Doling out freebies, cruise tickets, paid vacations and sponsorships to educational conferences and seminars for doctors by pharmaceutical companies has been banned from January.
2. The government has woken up belatedly to curb unethical marketing practices of pharma companies by spelling out a uniform code of conduct for the industry. The code will be voluntary to start with, and kicks in from January 1. It will be reviewed after six months; if not implemented "effectively", the government will "consider” making it mandatory, sources told TOI.
3. At present, the pharma industry follows a "self-regulatory'' code that curbs unethical sales promotion and marketing expenses, bans personal gifts, and all-expenses paid junkets for doctors and their families, but there have been several instances where companies have violated the code, industry experts say. They say the code exists only on paper as companies try to influence prescriptions through several ways.
4. This is the first time in years that the code has been finalized by the government, as earlier attempts to do so got mired in bureaucratic red tape.
5. Industry experts say that the government's Uniform Code of Pharmaceutical Marketing Practices has been modeled on the Medical Council of India (MCI) guidelines for doctors and healthcare professionals, which were further tightened in 2012.
6. The code clarifies the relationship with healthcare professionals. Regarding gifts, it says "no gifts, pecuniary advantages, or benefits in kind may be supplied, offered or promised to persons qualified to prescribe or supply drugs, by a pharma company, or any of it agents including retailers, distributors or wholesalers".
7. It says "in any seminar, conference or meeting organized by a pharma company for promoting a drug or disseminating information, if a medical practitioner participates as a delegate, it will be on his/her own cost."
8. It further says that gifts for the personal benefit of healthcare professionals and family members (both immediate and extended) such as tickets to entertainment events are also not to be offered or provided by pharma companies, nor cash or monetary grants for individual purposes. Hospitality should also not be extended to any doctor or their family members.
9. The industry associations have to upload the Uniform Code on their websites and will be responsible for informing its members, and the government in case of violations.
10. The code also adds that "where there is any item missing, the code of MCI as per the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulation, 2002 as amended from time to time, will prevail''.

eMedinewS Comments

• There is an MCI code of ethics s for doctors. Any violation of the same can only be challenged in High Court.
• Pharma companies until now were affected for any violation in the Act Now pharma companies will also be governed by a similar (like MCI) code of conduct.
• Unless both pharma and doctors group are covered in their respective codes of conduct, the problem will not end. Until now, the MCI code did not cover pharma companies violating MCI regulations.
• It is same like, if doctors violate any MCI code they are punished under violation of MCI ethics regulations but the same violations, if done by medical establishments are not punished. The need of the hour is to have a uniform code of conduct for medical establishments also.
• Another answer is to bring medical establishments as well as pharma companies under the preview of MCI ethics regulations.

The home healthcare market in India

A few facts on the burgeoning Home Healthcare market:

1.       Current market size is $ 2 billion in India; largely unorganized ( 80 % in unorganized sector). Growing at 15 % annually.

2.       Focus area:  Elderly population. According to a UN report, by the year 2025, India is expected to have 177 million elderly.

3.       A large number of patients who are chronically ill and need constant hospitalisation, prefer the home-healthcare mode in order to save hospital costs. Many patients prefer spending time at home either as post-operative care or in case of chronic illnesses.

4.       Clinical benefits :

a)      45% reduction in mortality rates

b)      20% reduction in emergency admissions

c)       15% reduction in A&E visits

d)      14% reduction in elective admissions

e)      14% reduction in bed days

f)       8% reduction in tariff costs

5.       Some of the other benefits: Possibility of regular monitoring, greater prevention, higher convenience, cost-effectiveness, lesser chances of getting hospital-acquired infections

6.       Challenges:

a)      Affordability of services

b)      Apprehension in the minds of consumers regarding the safety and efficacy of services

c)      Lack of awareness amongst consumers

d)     Limited distribution of services

7.       Services  spectrum:

a)      Home Attendant, Nursing, Physiotherapy, Doctor visit

b)      Injection, Wound care, Nebulisation

c)        Postoperative care

d)      Sample collection and report dispatch

e)      Home care devices

f)       Home-based monitoring

8.       Hospitals such as Max Healthcare, Columbia Asia, BM Birla, Apollo have launched services

9.   Leading players in India are:

a)      Medwell

b)      Health Care at Home

c)       Portea ( Delhi)

d)      India Home Healthcare ( Chennai)

e)      Homital

10.   In Kolkata:

a)      Care Continuum

b)      Tender Care

c)       DPP ( Deep Probin Porisheba) India

Newer models of healthcare

A few models of healthcare that are likely to emerge in our country in the near future, are:

 1. Public Private Partnership (PPP) 

Various models of PPP between public and  private sectors have come up. These include- joint ventures,  management contract, co-ownership etc . One of the first PPP ventures was the Indraprastha Apollo Hospitals in New Delhi.

2. Low cost healthcare 

With the advent of lowcost healthcare chains such as Vaatsalya Hospitals, Lifespring Hospitals, Glocal Healthcare etc, the era of lowcost healthcare has arrived.  These are asset-light models with minimal operating expenditure.

3. Single Speciality Chains (SSH)

Single speciality hospitals such as Cardiac, Eye (Ophthalmology) , Mother and Child  ( Obs- Gynae and Paediatrics) 

4. Day Care Hospitals

Day care hospitals, which provide services such as Eye surgery, routine ambulatory surgery etc, are being set up.

5. Telemedicine

 Telemedicine is being used to reach out to distant areas, using the hub and spoke model, where the tertiary care hospital is the hub and the smaller centres are the spokes. This has been employed successfully by several hospitals such as Narayana Hrudayalaya, Apollo Hospitals, Care Hospitals etc.

6. Wellness Centres

Health is defined by WHO as a state of “complete physical , mental and psychological wellness and not merely the absence of disease.” Wellness Centres focus on preventive health, health checkups etc. These centres are also being set up across several cities, and provide health checkups as well as diagnostic services.

Hospital CEO Turnover Rate hits 20% in USA

 
The CEO Turnover Rates in hospitals in the USA hit 20% last year, While this is attributable to a number of reasons, such as Private capital/ venture capitalist involvement, Changing role of IT, New health plan partners etc, it is an alarming trend which needs to be arrested.

An article on this phenomenon, and its impact on the healthcare industry :

http://www.healthcaredive.com/news/hospital-ceo-turnover-a-symptom-of-a-greater-sickness/263642/

( Courtesy: Healthcare DIVE)

APIC guidelines for Infection Control

Infection Control is an important part of hospital quality management and hospital management. Presenting  the APIC ( Association for Professionals in Infection Control and Epidemiology)  guidelines for Infection Control :

http://apic.org/Professional-Practice/Implementation-guides

Risk management in hospitals

Hospitals carry a natural amount of risk in their operations: both clinical, and non-clinical risk. While there exist the apparent clinical risks such as infections, wrong medication, wrong surgery etc, there also exist non- clinical risks such as fire, chemical spillage, electrical hazards etc.

Risk management is an important part of Quality Management and Patient Safety activities in hospitals. The US National Library of Medicine’s controlled vocabulary thesaurus,  MeSH, defines Risk Management as “ the process of minimizing risk to an organization by developing systems to identify and analyze potential hazards to prevent accidents, injuries, and other adverse occurrences, and by attempting to handle events and incidents which do occur in such a manner that their effect and cost are minimized. Effective risk management has its greatest benefits in application to insurance in order to avert or minimize financial liability.”

The management of risks require a proactive approach consisting of  Risk identification, Risk assessment, Risk mitigation, Problem Prioritization, Risk reporting , Risk management, Investigation of adverse events and  Establishment of a safe organizational culture.

An incident reporting policy is required. An important part of risk management is the reporting system for incidents such as adverse events , sentinel events and near misses. Sentinel events, which are events not related to the primary illness, resulting in patient death/ permanent loss of function, may include serious injury such as  loss of limb or function. The number of sentinel events are to be  monitored on a monthly basis and reported to the Quality Steering Committee. Patients are assessed at admission for risk of adverse episodes such as falls, and proactive measures are taken accordingly. It is recommended that the incidents are analysed and  analysis is done , including Root Cause Analysis for Sentinel events. This analysis is used to redesign /modify processes or carry out corrective/ preventive steps.

“Safety First” programme is implemented in many hospitals for vulnerable patients

(patients<16 yrs/ >60 yrs, women in labour, critical care patients, patients unable to perform ADL). In addition, the following patients/ processes are high risk and departmental level precautions are to be taken: Patients undergoing surgery, sedation, blood transfusion, chemotherapy, dialysis.

For long-staying patients, medical board is to be held and communication is to be carried out with the patient’s relatives.

Failure Mode and Effects Analysis (FMEA) is a technique used for proactive risk reduction. It consists of the computation of a RPN ( Risk Probability Number) , which is arrived at by multiplying Severity (S), Occurrence (O) and Detection ( D), i.e. S X O X D. It can be used for a variety of problems such as Medication Errors (MEs), Needle Stick Injuries ( NSIs) etc.

According to Hippocrates, the father of modern medicine, the basic principle of medicine should be “ Primum non nociere” , i.e. “ First do no harm.” Keeping this in mind, Risk management is an activity that should be proactively carried out by hospitals.

Data Data Every Where, But Not A Bit Makes Sense

Details of Author:
Name:  Dr. Gunjan Sharma; Age: 29 years; Qualification:  B.D.S (RGUHS) , PGDHM (ASCI)

Experience: 3 years; Presently working at: Fernandez Hospital, Hyderabad; Department: Quality

Designation: Quality Coordinator; Areas of Interest:    Quality aspects in Indian healthcare industry,       Training needs of Indian healthcare workforce,  Auditing,  Data Management 

In today's healthcare industry everyone is talking about high end information systems and technology solutions like HIS, EMR etc. but the ground reality is far more different than these jargons.

Budding generation of Managers and mandatory rules or standards laid down by various governmental and non governmental bodies in India have sparked the process of data collection in hospitals. Lot of data is available in raw and manual form but most of it is of no use as it cannot be processed for obtaining any inferences.
Major concerns in this area are:

Manual Data

In this computer driven era still lot of data is entered manually. Huge piles of manual data are difficult to handle as it first needs to be digitized. Moreover problems like overwriting, corrections and incomplete data sets are spoiling the quality of collected data.

Lack of Staff

I fail to understand the repulsive attitude of Indian hospitals towards the data entry personnel. It might be due to their cost cutting strategies that they find them to be of no use. Hospitals are more keen in utilizing their existing staff in entering data for their concerned department. I think it’s time for them to realize that data entry is an art and the entire life cycle of data depends on its inception. Bad quality data is the horror of any data research scientist.

Transcription Errors

Even if some of the hospitals recruit data entry operators many transcription errors occur while digitizing the data. One of the major reasons for this can be; untrained data entry operators. Majority of data entry operators are recruited from other industries as there is a lack of staff which is specialized in hospital data and understands healthcare terminologies.

Poor HIS

Most of the hospitals are either buying or developing their own HIS. But there is lack of planning in customizing or developing HIS products as the end users are ignorant about their present and future needs. Lack of training and sensitization of hospital staff towards the statistics driven processes has led to this condition. Hence hospitals end up with HIS which is incomplete and is not able to satisfy the requirements of the departments.

Lack of Analysts

Huge sets of data needs the magic touch of an analyst to transform into sense making graphs and trends. Hospital management courses need to focus more stringently in the area of data analysis by introducing subjects like Business Intelligence. But it’s not just the educational institutes, hospitals also need to motivate and provide opportunity to young managers into the less explored Indian woods of healthcare data.

I hope that this miniscule effort of mine will encourage all upcoming managers and administrators in the area of healthcare data management and analysis.