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Month: February 2017

In healthaffairs
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Disposables like catheters, guide wires and balloons used in every angioplasty are reused and billed repeatedly in many private hospitals.

Adding to the risk of infection, you could be paying for something that has already been paid for. And the hospital may be making a profit of Rs 20,000 to Rs 30,000 on every procedure with simple reuse and rebilling, say industry sources.

The practice is so rampant that the health ministry has issued an office memorandum warning against reuse of disposable surgical items, particularly in cardiology, when they are meant for one-time use.

Medical Equipment HIGHLIGHTS

  •  Private hospitals may make a profit of Rs 20,000 to Rs 30,000 by reusing disposables
  •  Risk remains higher as these things can not be  resterilised properly, say doctors
  •  Government hospitals do not indulge such  practices as there is no pressure to make profit

“The items after one procedure are sterilised and reused and (patients) are charged full amount of these items,” stated the memo dated December 21, 2016. The matter had been “viewed by this ministry seriously”, it said, and clarified that “reuse of disposable items, particularly in cardiology and other specialties, is not permitted in healthcare organisations empanelled under CGHS (Central Government Health Scheme)”.

It goes on to warn of “suitable action including withdrawal of CGHS empanelment” against defaulters. It is silent on action against big corporate hospitals that are not empanelled under CGHS.

“Most private hospitals, especially hospitals chains, insist that cardiologists reuse these items. While reusing these items a couple of times might be justified in some cases where you want to help bring down costs for a patient, in most of these hospitals, not only do they reuse four or five times, patients are also billed afresh for each of these items, helping the hospitals make a profit of Rs 20,000 to Rs 30,000 on each procedure or patient,” explained a cardiologist who has worked in several leading private hospitals.

All disposable items have clear instructions on the packaging saying they should be used only once and cannot be resterilised. Some cardiologists in private hospitals admitted that reuse was common but said it was not a problem if the items were properly resterilised. Companies, they said, insisted on single use to sell more of their products.

hospitals reuse disposables
Image Source : timesofindia.indiatimes.com

Cath lab technicians and dealers who sell disposables and stents to hospitals also confirmed that such reuse was common. Hospitals like AIIMS and PGI hardly ever reuse these items as there is no pressure to cut corners to make profit.

“In the US, solid catheters or catheters without holes can be resterilised and reused but only once or twice. But reuse of catheter with holes like a guide catheter used in angioplasty is not allowed as it is difficult to clean the insides where blood residue might remain. This is to prevent any chance of HIV and Hepatitis B infection. Also, resterilising affects the quality of the item as it hardens the plastic, making it less flexible,” explained a senior AIIMS cardiologist.

Chain hospitals are the worst offenders, according to a cardiologist who has worked in one such institution. “If doctors in one hospital in the chain reuse an item five or six times, that is lauded as a great example of cost saving. It is pushed as standard operating procedure across the entire chain, putting enormous pressure on doctors who try to resist such unethical overuse of a disposable item,” explained the cardiologist.

“Reuse is bad and doing so without the patient’s consent is criminal,” said another cardiologist. “And charging for resued items is fraud of the highest order being done in most elite hospitals to push up profits. It is easy to investigate and expose this. The government can get the number of angioplasties done in a hospital and ask for proof of purchase of the disposables for the last two years. There is a formula for how many disposables are needed for each angioplasty. They will find that far fewer disposables have been purchased than the required number, which will show clear reuse. Such hospitals should be prosecuted,” he said.

However, reusing of items with patients‘ consent to reduce costs for the poor should not be treated as criminal acts, he added.

Source : Timesofindia
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In healthaffairs
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A common man may highly underestimate the costs involved in getting treated for a disease.  For example, a simple visit to clinic to get rid of a viral fever may cost nothing short of Rs.1000/-.  Half of this amount may go to the physician as his fee while the rest may go to the medical shop for buying medicine.  For a manual laborer working on daily wages, Rs.1000/- is a big unaffordable amount.  In the above example we are only talking about a viral fever.  Imagine if it is a life threatening disease. If it is a life threatening disease, we may have to replace the word unaffordable with ‘impossible’.  This situation is not an exaggerated situation but an everyday common scenario among the 21.2% of the estimated BPL (Below Poverty Line) population.

The government and corporate hospitals should take practical steps to bring medicine within the affordable range of this 21% population.  After all, as everyone would agree, medicine is not a luxury, it is a need.  This need unlike other basic needs such as food, clothing cannot wait for 2-3 days during emergency situations.  It requires attention that has to be immediate.  The life and death of a person depends on this need.  There is more than one way that a government can lend a helping hand to this population.  Like in every other industry, in the field of medicine, the players involved try to get benefit out of their work.  The doctors, corporate hospitals, medical equipment manufacturers and everyone else wants to earn money at the end of the day.  The overhead cost of medical equipment increases because of the different taxes involved in purchase of the raw material from the very beginning.  All these costs run into the overall cost of the final product which is levied by the manufacturer on the purchasing party.  The purchasing party could be a corporate hospital or a diagnostic lab.  Either way, once the lab or hospital purchases the equipment for a defined amount, the hospital or lab try to recover the cost of purchase from the patient.  Ultimately, the entire cost has to be borne by the patients.

medical equipment manufacturers

Government can get actively involved and can probably provide a discount on the purchase of raw materials used in the manufacture of medical equipment such that the overhead cost that goes into manufacturing is reduced and ultimately this reduction may get applied on the patient’s bill as well. On the other hand, players in the field of medicine such as diagnostic centers and corporate hospitals can also do their own bit in helping the BPL population.  They can identify ways that can reduce the overall cost of treatment and medicine.  They can actively start using refurbished medical equipment which will be a cost saving factor for them as well.

Now one may have doubts over the use of refurbished products in place of brand new products.  So, to clear all the questions in mind, let’s try to understand what refurbished products are and if they are safe to use.  According to a new market research report, the refurbished medical equipment market will be worth 11.91 billion USD by 2021.  Refurbished medical equipment is that medical equipment which received cosmetic changes to increase its appeal.  In some cases, some of the refurbished medical equipment could have received a replacement of functional part to restore its full functionality.  However, refurbished medical equipment are fully functional equipment like the original.  They are actually beneficial to the buyers in a way as they reduce the overall cost of the product.  Some of the companies may be hesitant to buy them considering the fact that cosmetic changes were made before their sale.

The refurbished GE Voluson P8 ultrasound color Doppler available online at Medventura with a minimum bid of Rs.16,00,000/- at the time of writing this article is a best example for this.  The original price of the GE Voluson P8 Ultrasound Color Doppler may run into double the minimum bid mentioned above.  However, we are getting a fully functional equipment for half of the original price.  Adopting strategies such as buying of refurbished medical equipment will reduce the overhead costs of medical labs and corporate hospitals as well.  Whatever saving the medical lab or corporate hospital is able to make, they can pass it on to BPL patients by providing them discount in the medical treatment or medicines.

REFURBISED ULTRASOUND
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In healthaffairs
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When it comes to diagnosing a disease, a doctor relies on multiple factors apart from close physical examination of the patient which is unarguably an important and essential element.  Depending on the nature of disease, the physician may advise the patient to give sample of his blood, urine or body issue.  Lab analysis and report from these samples carry great deal of information about the nature of disease the patient is suffering from.  Sometimes the doctor may require additional information in the form of images of patient’s anatomy or physiology.  An MRI scanner comes to the rescue in this situation by providing clear images of patient’s anatomy.  The only alternative for doctor is to cut open and examine the internal structure of the patient to diagnose the disease if MRI scanners were to be unavailable. So, let’s take a deep dive into MRI Scanner, their functioning and some of the companies that manufacture them.

MRI scanner or Magnetic resonance imaging use strong magnetic fields with the help of which they generate body internal images.  MRI scan images are far superior of quality when compared to X-ray images.  However, there are certain risks associated with MRI scanners. They make noise and they take more time to yield the image.  Also, they require the patient to go into a cylindrical vessel  for extracting the image.  People who are claustrophobic may feel more than a certain degree of discomfort with MRI scanners.  MRI cannot be performed on people who have metal implants in their body as they create strong magnetic fields to capture and generate body image.  In clinical MRI, hydrogen atoms are often used to generate a detectable radio-frequency signal.  Based on the relaxation properties of hydrogen atoms, different contrasts are generated and an image is made out of it.

Magnetic Resonance Imaging (MRI) or MRI scanner

MRI Scanner is a boon when it comes to research in the medical field.  Multiple specialties including Neurology, Ortho, cardiology and gastroenterology widely use MRI scans to determine and diagnose the disease.  It is the modality of choice in any neurological diagnosis, including cancer.  The images provided by MRI scan in diseases such as dementia, central nervous system related medical conditions are conclusive.  In cardiology, iron overload and congenital heart disease are some of the many medical conditions where doctors rely on MRI images while diagnosing the disease. Back pain condition is also best diagnosed by an MRI Scan.

The uses of MRI scanner are so critical and innumerable, there is altogether a specialization in medical field that is dedicated to MRI scanning and imaging.  MRI Medical Director/Research Director (MRMD) is a supervising physician who has overall responsibility in a clinic for the safe use of MRI equipment.  As detailed in the beginning, various techniques of scan are used to address the different needs of multiple organ specialties.

Diffusion MRI:

Clinically diffusion MRI is used in neurological diseases such as stroke.  It measures the diffusion of water molecules in tissues.

Magnetic Resonance Angiography

It helps generate pictures of arteries to evaluate them for wall dilations.  This technique is often used to evaluate the arteries of neck and brain.

Magnetic Resonance Spectroscopy :

This technique is used to measure the levels of various metabolites in body tissue.  Tremendously useful in diagnosing metabolic disorders especially the ones that affect the brain.

Functional MRI :

This technique measures signal change in the brain that occurs due to alterations in neural activity.

Now that we have reviewed enough information about the various types of MRI scanning techniques and their practical uses.  Let us quickly take a look at the major players in MRI scanner manufacture and what they have to offer.

The top MRI manufacturers are GE, Philips, Siemens,( called GPS)  Hitachi and Basda , to name a few.

  • GPS brands cover more than 80% of the world market . An upcoming brand is Basda, which is low cost and offers excellent value for money . This is exclusively available thru Medventura.
  • Each manufacturer has some USP and some drawbacks. The medical Equipment buyer has to strike a balance between the same .
  • MRI Service in now easily available in India , as well as MRI parts are available with many vendors .

Conclusion:  All in all, MRI scanner is a great tool that a doctor is totally dependent on in determining and diagnosing the medical conditions.

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In healthaffairs
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Internet has made tremendous changes in our lives.  What sounded like ‘impossible’ and ‘unimaginable’ a few decades back seem to be practical and common in our everyday lives.  A person without the need to step out of his home can perform all of his daily activities and lead a happy life.  He can earn livelihood without stepping out of his house through internet.  He can purchase groceries online from the nearest departmental store and have them delivered to his house address or he also has the choice of ordering readymade food.  He can watch movies sitting at home.  He can have a video chat with his friends located in a different part of the world altogether.  All the above at the comfort of home.  As if to prove that such a lifestyle is possible and practical, we can find large section of people every now and then who are leading such lifestyle.
Now most of us are already aware of the traditional selling where we go to a departmental store, browse through the products, pick the ones that suit our needs, reach the counter and pay money to own the products.  However, with the advent of internet, large section of the world population is bidding goodbye to traditional shopping and they are stepping towards online shopping. Also, called as e-commerce a shorter name for electronic commerce, online shopping is nothing but purchase of goods with the help of internet.  An individual is not required to visit a departmental or for that matter any physical store to make a purchase.  He/she can access the website of the vendor, review or browse through the virtual product catalogue, select the items that he intends to buy, add them to the cart, pay the bill and checkout.  The items would get delivered to his address of preference within 2-3 days.  This way of online shopping not only saves money but also great deal of time and energy
Sell Medical Supplies on Medventura

A picture speaks a thousand words

The first and foremost thing that one needs to keep in mind while selling anything online is the visual factor. Customer is deprived of the look and feel of the actual product when it comes to online sale. Buyers need to fill this gap. So, how do buyers fill this gap? It is a simple task. They need to take pictures of the medical equipment with the help of a high resolution camera that can capture even the minutest detail of the equipment. Hiring a professional photographer or buying high resolution product images online is a good alternate. The images of 2000 Siemens .2T MAGNETOM Concerto placed on Medventura, a unique platform to buy, bid and sell medical equipment is an excellent example for this. The image of the product is not only clearly visible but also gives enough details of the product.
Product Details:
Another important factor is being proactive in providing all the product related information.  Products, especially in the medical field can have various details.  For example, take the case of Ultrasound transducer.  There could be many different types of ultrasound transducers such as linear, sector and convex.  They could also differ in their construction based on piezoelectric crystal arrangement, aperture and operating frequency.  Hence, the image of the product needs to be backed up with more than sufficient details.  Consumer or buyer should not be kept in a situation where he needs to come back to us asking for information.  Making him come back will not only decrease his interest in buying the product but there is a high probability of him not buying the product at all.
Communicate:
Finally, once the product is listed with image and description, leave your contact details and make yourself available to receive any enquiries from prospective buyers. Talk to the buyers patiently and answer all their queries.  Keeping an open communication channel will not only help the buyers clear all their queries but may lead to an actual sale within no time.
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In healthaffairs
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Medical equipment also known as armamentarium. its is designed to aid in the diagnosis, monitoring or treatment of medical conditions. The development of new advance featured medical equipment helps a patient to easily recover from their disease.
Some of the most commonly used pieces of diagnostic equipment include MRI, ultrasound machines, PET scanners (which use cameras and tracer fluid to produce images of a patient’s internal organs in order to detect signs of cancer or other diseases), CT scanners (which use x-ray sand dye to do the same job as PET scanner)

There are Several Basic Types of Hospital Medical Equipment are :

There are more than 10,000 types of medical devices available. Life support medical equipment is used to maintain a patient’s bodily function. This includes medical ventilators, incubators, anaesthetic machines, heart-lung machines, ECMO, and dialysis machines.

Medical monitors allow medical staff to measure a patient’s medical state. Monitors may measure patient vital signs and other parameters including ECG, EEG, and blood pressure.

Laboratory Medical equipment automates or helps analyze blood, urine, genes, and dissolved gases in the blood.

Diagnostic Medical Equipment  may also be used in the home for certain purposes, e.g. for the control of diabetes mellitus

Therapeutic: physical therapy machines like continuous passive range of motion (CPM) machines

A bio medical equipment technician (BMET) is a vital component of the healthcare delivery system. Employed primarily by hospitals, BMETs are the people responsible for maintaining a facility’s medical equipment. BMET mainly act as an interface between doctor and equipment.

Medical Diagnosis & Medical Equipment

Medical diagnosisMedical diagnosis is the process of determining which disease or condition explains a person’s symptoms and signs. It is most often referred to as diagnosis with the medical context being implicit. The information required for diagnosis is typically collected from a history and physical examination of the person seeking medical care. Often, one or more diagnostic procedures, such as diagnostic tests, are also done during the process. Sometimes Posthumous diagnosis is considered a kind of medical diagnosis. Medical equipment is designed to aid in the diagnosis, monitoring or treatment of medical conditions. The development of new advance featured medical equipment helps a patient to easily recover from their disease.

1. Medical imaging : Medical imaging is the technique and process of creating visual representations of the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to reveal internal structures hidden by the skin and bones, as well as to diagnose and treat disease. Medical imaging also establishes a database of normal anatomy and physiology to make it possible to identify abnormalities. Although imaging of removed organs and tissues can be performed for medical reasons, such procedures are usually considered part of pathology instead of medical imaging.

2. Medical ultrasound : (also known as diagnostic sonography or ultrasonography) is a diagnostic imaging technique based on the application of ultrasound. It is used to see internal body structures such as tendons, muscles, joints, vessels and internal organs. Its aim is often to find a source of a disease or to exclude any pathology. The practice of examining pregnant women using ultrasound is called obstetric ultrasound, and is widely used.

Ultrasound is sound waves with frequencies which are higher than those audible to humans (>20,000 Hz). Ultrasonic images also known as sonograms are made by sending pulses of ultrasound into tissue using a probe. The sound echoes off the tissue; with different tissues reflecting varying degrees of sound. These echoes are recorded and displayed as an image to the operator.

Many different types of images can be formed using sonographic instruments. The most well-known type is a B-mode image, which displays the acoustic impedance of a two-dimensional cross-section of tissue. Other types of image can display blood flow, motion of tissue over time, the location of blood, the presence of specific molecules, the stiffness of tissue, or the anatomy of a three-dimensional region.

Compared to other prominent methods of medical imaging, ultrasound has several advantages. It provides images in real-time, it is portable and can be brought to the bedside, it is substantially lower in cost, and it does not use harmful ionising radiation. Drawbacks of ultrasonography include various limits on its field of view including patient cooperation and physique, difficulty imaging structures behind bone and air, and its dependence on a skilled operator.

3. Magnetic resonance imaging (MRI) :- Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body in both health and disease. MRI scanners use strong magnetic fields, radio waves, and field gradients to generate images of the inside of the body.

MRI does not involve x-rays, which distinguishes it from computed tomography (CT or CAT). While the hazards of x-rays are now well-controlled in most medical contexts, MRI can still be seen as superior to CT in this regard. MRI can often yield different diagnostic information compared with CT. There can be risks and discomfort associated with MRI scans. Compared with CT, MRI scans typically: take more time, are louder, and usually require that the subject go into a narrow tube. In addition, people with some medical implants or other non-removable metal inside the body may be unable to safely undergo an MRI examination.

MRI is based upon the science of nuclear magnetic resonance (NMR). Certain atomic nuclei can absorb and emit radio frequency energy when placed in an external magnetic field. In clinical and research MRI, hydrogen atoms are most-often used to generate a detectable radio-frequency signal that is received by antennas in close proximity to the anatomy being examined. Hydrogen atoms exist naturally in people and other biological organisms in abundance, particularly in water and fat. For this reason, most MRI scans essentially map the location of water and fat in the body. Pulses of radio waves excite the nuclear spin energy transition, and magnetic field gradients localise the signal in space. By varying the parameters of the pulse sequence, different contrasts can be generated between tissues based on the relaxation properties of the hydrogen atoms therein. Since its early development in the 1970s and 1980s, MRI has proven to be a highly versatile imaging technique. While MRI is most prominently used in diagnostic medicine and biomedical research, it can also be used to form images of non-living objects. MRI scans are capable of producing a variety of chemical and physical data, in addition to detailed spatial images.

Positron emission tomography (PET) : is a nuclear medicine, functional imaging technique that is used to observe metabolic processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide (tracer), which is introduced into the body on a biologically active molecule. Three-dimensional images of tracer concentration within the body are then constructed by computer analysis. In modern PET-CT scanners, three dimensional imaging is often accomplished with the aid of a CT X-ray scan performed on the patient during the same session, in the same machine.

If the biologically active molecule chosen for PET is fludeoxy glucose (FDG), an analogue of glucose, the concentrations of tracer imaged will indicate tissue metabolic activity as it corresponds to the regional glucose uptake. Use of this tracer to explore the possibility of cancer metastasis (i.e., spreading to other sites) is the most common type of PET scan in standard medical care (90% of current scans). However, although on a minority basis, many other radioactive tracers are used in PET to image the tissue concentration of other types of molecules of interest. One of the disadvantages of PET scanners is their operating cost.

4. CT scan : A CT scan (often referred to as a CAT scan) makes use of computer-processed combinations of many X-ray images taken from different angles to produce cross-sectional (tomographic) images of specific areas of a scanned object, allowing the user to see inside the object without cutting.

Medical Equipment : Digital geometry processing is used to generate a three-dimensional image of the inside of the object from a large series of two-dimensional radio-graphic images taken around a single axis of rotation. Medical imaging is the most common application of X-ray CT. Its cross-sectional images are used for diagnostic and therapeutic purposes in various medical disciplines. The rest of this article discusses medical-imaging X-ray CT; industrial applications of X-ray CT are discussed at industrial computed tomography scanning.

The term “computed tomography” (CT) is often used to refer to X-ray CT, because it is the most commonly known form. But, many other types of CT exist, such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT). Older and less preferred terms that also refer to X-ray CT are computed axial tomography (CAT scan) and computer aided tomography. X-ray tomography is one form of radiography, along with many other forms of tomographic and non-tomographic radiography.

CT produces a volume of data that can be manipulated in order to demonstrate various bodily structures based on their ability to block the X-ray beam. Although, historically, the images generated were in the axial or transverse plane, perpendicular to the long axis of the body, modern scanners allow this volume of data to be reformatted in various planes or even as volumetric (3D) representations of structures. Although most common in medicine, Medical equipment like CT scanner is also used in other fields, such as nondestructive materials testing. Another example is archaeological uses such as imaging the contents of sarcophagi. Individuals responsible for performing CT exams are called radiographers or radiologic technologists

5. X-ray generator : An X-ray generator is a device that produces X-rays. It is commonly used in a variety of applications including medicine, fluorescence, electronic assembly inspection, and measurement of material thickness in manufacturing operations. In medical applications, X-ray generators are used by radiographers to acquire x-ray images of the internal structures (e.g., bones) of living organisms, and also in sterilization.

Treatment medical equipment : includes infusion pumps, medical lasers and LASIK surgical machines.

1.Infusion pump : An infusion pump infuses fluids, medication or nutrients into a patient’s circulatory system. It is generally used intravenously, although subcutaneous, arterial and epidural infusions are occasionally used.

Infusion pumps can administer fluids in ways that would be impractically expensive or unreliable if performed manually by nursing staff. For example, they can administer as little as 0.1 ml per hour injections (too small for a drip), injections every minute, injections with repeated boluses requested by the patient, up to maximum number per hour (e.g. in patient-controlled analgesia), or fluids whose volumes vary by the time of day.

Because they can also produce quite high but controlled pressures, they can inject controlled amounts of fluids subcutaneously (beneath the skin), or epidurally (just within the surface of the central nervous system – a very popular local spinal anaesthesia for childbirth).

2. Laser : A laser is a device that emits light through a process of optical amplification based on the stimulated emission of electromagnetic radiation. The term “laser” originated as an acronym for “light amplification by stimulated emission of radiation”. The first laser was built in 1960 by Theodore H. Maiman at Hughes Research Laboratories, based on theoretical work by Charles Hard Townes and Arthur Leonard Schawlow. A laser differs from other sources of light in that it emits light coherently. Spatial coherence allows a laser to be focused to a tight spot, enabling applications such as laser cutting and lithography. Spatial coherence also allows a laser beam to stay narrow over great distances (collimation), enabling applications such as laser pointers. Lasers can also have high temporal coherence, which allows them to emit light with a very narrow spectrum, i.e., they can emit a single colour of light. Temporal coherence can be used to produce pulses of light as short as a fem to second.

Among their many applications, lasers are used in optical disk drives, laser printers, and bar code scanners; DNA sequencing instruments, fiber-optic and free-space optical communication; laser surgery and skin treatments; cutting and welding materials; military and law enforcement devices for marking targets and measuring range and speed; and laser lighting displays in entertainment.

3. LASIK : LASIK or Lasik (laser-assisted in situ keratomileusis), commonly referred to as laser eye surgery or laser vision correction, is a type of refractive surgery for the correction of myopia, hyperopia, and astigmatism. The LASIK surgery is performed by an ophthalmologist who uses a laser or microkeratome to reshape the eye’s cornea in order to improve visual acuity. For most patients, LASIK provides a permanent alternative to eyeglasses or contact lenses.

LASIK is most similar to another surgical corrective procedure, photorefractive keratectomy (PRK), and both represent advances over radial keratotomy in the surgical treatment of refractive errors of vision. For patients with moderate to high myopia or thin corneas which cannot be treated with LASIK and PRK, the phakic intraocular lens is an alternative. As of 2011, over 11 million LASIK procedures had been performed in the United States and as of 2009 over 28 million have been performed worldwide.

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