Mindray 18 Feb 2021
The battle against COVID 19 wasn’t a cakewalk. We have had to lose too many lives and had to completely change our lifestyle having to sacrifice the most integral part of human behavior-social life. But in this turmoil, we also are close to achieving scientific triumph regarding vaccine development and medical technology innovation. In our experience, we gathered a significant understanding of the opportunities that can help India progress as a nation, for the health and well-being of its citizens. Despite difficulties, we as a community have looked beyond the crisis to build a buoyant society. The focus now shifts to rebuilding our economy and fix areas that need utmost attention such as expanding healthcare infrastructure and capability, improving access and healthcare financing, and fostering a culture of innovation and collaboration. We also look at policy interventions and preventive strategies for diseases such as infectious diseases, diabetes, CVDs, cancer, and accordingly strengthen healthcare infrastructure within critical care and emergency medical centers. In this article, Dr. A B Gopalamurugan, revered for his cutting-edge interventional cardiology and transcatheter valve replacement therapy expounds on the need to build robust cardiac care and critical care system for India and how medtech players like Mindray can contribute to this mission.
We are all aware that besides the infectious COVID 19 pandemic, India is facing an NCD [Non-Communicable Disease] epidemic. CVDs are one of the top killers in our country. Around 17 lakh people have died of cardiovascular diseases this year in India. Cardiologists across the world are reporting a marked increase in sudden cardiac deaths even as the current focus has shifted to the challenges from COVID and other communicable diseases. “People don’t know that heart diseases are 17 times more of a killer than COVID. The number of people dying of heart disease is quite high as compared to COVID. People need to understand that the symptoms of heart diseases should not be ignored. One can easily come out of a COVID infection but heart disease will lead to more complications and hence more risk of mortality. Therefore, all our policy interventions should also be focused on improving this awareness of this fact. We need to encourage people to seek cardiac care”, informs Dr. A B Gopalmurugan. While Dr. Gopalamurugan pointed out the criticality of the situation, he also brought the most important aspect to the fore such as infection control and building patient confidence.
He highlighted that the current COVID situation has generated fear among people and so there is a need for healthcare providers to reassure patients that they are safe to return to hospitals. “There should be stringent infection control protocols followed at all touchpoints. There shouldn’t be any room for a mistake. Take technological support to ensure patient safety and become robust in our communication ways. Incorporate digital technologies such as video consultations for known patients. It is time we move on to utilizing cutting edge technologies that help us to deliver care in the safest and quickest way so that patients get a good quality of life, have minimum exposure to infections
and has lesser hospital stays, ”, he says. However, he also points out that the adoption of technology in our country is very heterogeneous as there are no standardized protocols that elaborate on one uniform care system. Hence, the adoption of technology has been widely disproportionate in terms of geographical distribution and we as a nation need to change that. Similarly, he speaks about the need to effectively upgrade critical care units and emergency services.
Now clinicians can activate the voice recognition component of iVocal on TE7 Ultrasound System by selecting the iVocal feature on the system and then tapping the Play button. With these simple clicks, the TE7 is all set to perform its tasks assigned by the operator via voice command. This also means lesser human contact and higher patient and provider safety.
Advances in ultrasound are making the technology appear more attractive for certain clinical applications, from breast health to cardiology, thanks to their non-invasiveness, cost-effectiveness and lack of radiation. Some of the emerging innovations in ultrasound, such as advanced applications in 3D imaging, newer applications of ultrasound contrast, shear wave elastography, development of wireless transducers, app-based ultrasound technology, fusion with CT/MR, laparoscopic ultrasound, are set to transform health diagnosis and interventions shortly.
“In the field of cardiology, the use of ultrasound in angioplasties has helped in achieving long-term outcomes for treatment. Intravascular ultrasound (IVUS) guidance during the percutaneous coronary intervention (PCI) offers tomographic images of the coronary vessels, allowing optimization of stent implantation at the time of PCI. Therefore, ultrasound has become a vital element for conducting PCIs. Not only this, ultrasound today has been extensively used to guide surgeons during complex cardiac surgeries. So, I would say that without ultrasound, cardiac interventions are incomplete”, opines Dr. Gopalamurugan. In the current pandemic situation, it is advised to keep our equipment’s clean and sanitized. It is inconvenient for clinicians to physically reach the console and the body part they need to scan
Advancements such as cardiac monitoring, catheter monitoring, and some fancy ways to raise alarm bells when a patient is likely to go down have actually improved efficiencies with ICU
during surgery, especially when performing an ultrasound-guided exam. Mindray introduced iVocal, the voice-enabled command feature, on its TE7 Touch Screen Ultrasound Device to resolve these pain points. This role of voice recognition helps clinicians to monitor the device through voice command alone, thus reducing the risk of the infection spreading.
One extremely critical flaw that the pandemic slammed on our face was the lack of appropriate ICU infrastructure in the country. In developed countries, caring for critically ill patients involves a coordinated system of triage, emergency management, and critical care. This is complicated and unaffordable in
many parts of our country. In contrast, critical care remains at a nascent stage in some tier II-III cities within our country. However, these can be upgraded and improved with better technologies such as early warning scoring, critical stats for patient monitoring, and data mining capabilities in order to provide care anywhere at any time and in the most efficient manner. Today, technology is becoming more pervasive. Especially within ICUs, we see a lot of connected devices that help in the overall physician, nursing, and patient experience. Advancements in the field of patient monitoring are one such example. “Advancements such as cardiac monitoring, central monitoring, catheter monitoring, and some fancy ways to raise alarm bells when a patient is likely to go down have actually improved efficiencies with ICUs. The critical numbers that we get from these monitoring systems help us to save many lives. Moreover, technologies such as AED and ICD also play a significant role in saving lives”, he further states.
Apart from this, Dr. Gopalamurugan pointed out that in India many people die of sepsis.
If this condition is timely recognized, evaluated, and treated, healthcare providers, can save many lives. Mindray provides a full sepsis solution that incorporates all SOFA and qSOFA guidelines, including PCT examination, blood culture, and patient monitoring solution, which offers important clinical significance at any level of medical management. Benefiting from cutting-edge clinical metrics such as rSO2, ICG, PiCCO, AG, RM, BIS, NMT, and state-of-the-art support resources for clinical decision-making such as HemoSightTM, ST GraphicTM, DSA, BeneVision N22/N19 improves clinical confidence to the full and helps make clinical decisions easier and quicker.
Further, the connectivity capabilities of BeneVision N22/N19 fit seamlessly into any clinical workflow for a paperless future. Revolutionary iView clinical informatics workstation brings all intelligence (PACS, LIS, EMR, etc) on screen at the point of care for one-stop diagnosis. Industry-leading BeneLink integrates all bedside devices to the monitor in real-time and facilitates centralized data management.
Interestingly, BeneVision can be utilized in the out-of-hospital setting too. In compliance with out-of-hospital patient transport standards such as EN1789, EN13718-1, IEC60601-1-12, and U.S. military standards, N1 is a highly competent solution for various out-of-hospital transport settings both on land and in air. The N1's exceptional reliability and strong performance enhance your confidence to provide seamless patient care during transport no matter intra or out of the hospital.
Weighing less than 1 kg, this palm-sized portable patient monitor is designed for uninterrupted monitoring during intra and out-of-hospital patient transport with maximum reliability. It provides a steadfast and versatile solution that connects the vision for caregivers throughout the entire care process. Moreover, when connected to a bedside patient monitor, advanced parameters collected from the host monitor such as AG and BIS, etc., will also be stored in N1 with trend data and alarm events reviewable even when it is disconnected.
Moving on, Dr. Gopalamurugan also spoke about the improvements needed in the concept of Home-to-hospital. He emphasized the need for educating patients on the golden hour, the risk of heart diseases, and the kind of emergency medical services available to them. “While patient education is paramount, ambulance vehicles and EMS should also be upgraded with the needed technologies.” Ambulatory technologies should include equipment that provides real-time patient information such as ECG, SpO2 , EtCO2, Temp, NIBP, to the hospital, allowing doctors to track the entire rescue process all the way from the field to the hospital.
He further mentioned that Mindray’s PHEIS features patient information and data sharing between the ambulance and the hospital very effectively. It allows the hospital to be involved in the rescue right from the beginning, thereby saving valuable time and lives. This system enables doctors to support paramedics via the internet during the patient's C-B-A procedure by advising drug therapy, CPR, or intubation. For patients in critical condition every second count. PHEIS helps to save valuable time by supporting remote diagnosis and allowing the hospital to prepare treatments well in advance. Its powerful data transmission capability, including vital sign waveforms as well as alarm and defibrillation events, provides hospitals with all relevant information.
Especially the 12-lead ECG report helps doctors to quickly decide on the reperfusion method (intervention or fibrinolytic therapy) for a suspected STEMI (ST-elevation myocardial infarction) patient
There are various capacities in which AI is emerging as a game-changer for healthcare delivery. Recent studies show that the care of critically ill patients generates a median of 1348 individual data points per day and that this number has increased 26 percent over five years. A smart clinical decision support solution with easy-to-use interfaces and real-time data mining capabilities is essential for an ICU in order to lessen the cognitive load, improve workflow and reduce medical error. To navigate this complex array of data, Mindray developed a comprehensive ICU solution consisting of patient monitors, ventilators, infusion pumps, and point-of-care ultrasound systems, all of which are
integrated with various smart decision support tools. Through a range of Clinical Assistive Applications (CAAs), these devices can integrate, analyze and interpret large volumes of patient data in real-time, helping clinicians quickly identify adverse events and make accurate, informed, and timely decisions that assure patient safety.
On the same line, Dr. Gopalamurugan speaks about how AI-backed devices can help in bringing in the required efficiencies inpatient care.
“AI improves efficiency, accuracy and workflow management. In many ways, AI has been helpful to healthcare providers, especially in diagnostics, but it has to be guided by human intellect. For example, if we do an AI-backed abdomen ultrasound, then the results should be vetted by a doctor. So there is a strong need for AI and correlation analysis by clinical experts”, he informs.
For example, in today's fast-paced and crowded hospital settings, clinicians are challenged to deliver accurate patient assessments rapidly and to perform routine interventions quickly and effectively. Ultrasonography, especially Point-ofCare (POC) ultrasonography is a proven method to provide more efficient and cost-effective healthcare. However, there existed a number of situations where a clinician or sonographer may have difficulty completing the exam using only the console to manipulate an ultrasound system, and hence affecting work efficiency.
While incorporating technology to improve patient outcomes is one aspect, the other thing is quality control. “Most importantly, our country needs quality control measures from the government. So, if we have to be seen as a cutting-edge healthcare delivery center then we have to develop homogenous means to deliver the same kind go care across the country. And to do that we need similarly trained people and unified treatment protocols arcs the country. Patients should get the best no matter where they are. It should be geographically decided. There should be high-quality care delivered nationwide in a very homogenous manner”, he emphasized. So as healthcare providers need to focus on quality healthcare delivery, technology partners need to adhere to quality compliance and standardized QA/ QC. And here comes the role of technology partners such as Mindray.
“There is a lot that technology providers can do to complement the efforts put by healthcare providers to uplift cardiovascular services in India. For instance, our country needs 88,000 cardiac specialists but currently, we have less than 5000 specialists.
Therefore, we are short of cardiac care providers and ultrasound specialists for CVDs. I feel technology partners like Mindray have a big role to play in building a future-ready cardiac care system. They have a huge market to capture. They can come up with quality-based cost-effective technologies that can be beneficial to patients”, Dr. Gopalamurugan believes. Moreover, he stresses the fact that partners like Mindray can be instrumental in building emergency care and bring in advanced technologies in ambulatory care. He further urged Mindray to focus its innovation on AI-based technologies to improve healthcare in remote India.
So as Dr. Gopalamurugan highlights various aspects in which India can strengthen its cardiac care system, he also threw light on some of the significant technological innovations that can be incorporated. Going forward, as he mentioned technology partners such as Mindray has a key role in making India truly a healthier nation.