Welcome to weekend seminar
Designing PMS for Primary Health Centers
“ Innovation - any new idea - by definition will not
be accepted at first.
It takes repeated attempts, endless
demonstrations, monotonous rehearsals before
Innovation can be accepted and internalised by an
organization.
This requires "courageous patience."
- Warren Bennis
Presentation By :Ronald Lewis
14 July 2010
Copyright 2010
LARSEN & TOUBRO LIMITED
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Public Health Care in India
Globally, governments are searching for ways to improve equity, efficiency,
effectiveness and responsiveness of their health systems.
Primary healthcare is essential healthcare based on practical, scientifically
sound and socially acceptable methods and technology made universally
accessible to individuals.
The art of public Health Care in India can be traced back to nearly 3500
years.
During his rein, Emperor Ashoka Maurya (273-232 B.C.) was
the first leader in world history to attempt to give
healthcare to all of his citizens.
14 July 2010
Bill Gates at the 2005 World Health Assembly in Geneva->
importance of a fully-functioning healthcare delivery system;
how millions of people could get the benefits of new discoveries
if healthcare delivery was a priority and if delivery shaped
design.
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Indian healthcare market
The Indian healthcare market was estimated at US$35 billion in 2007 and is expected to
reach over US$70 billion by 2012 and US$145 billion by 2017.
According to the Investment Commission of India the healthcare sector has experienced
phenomenal growth of 12 percent per annum in the last 4 years
In India, Primary Health Centres (PHCs) are the cornerstone of rural healthcare;
a first port of call for the sick and an effective referral system; in addition to being the
main focus of social and economic development of the community.
It forms the first level of contact and a link between individuals and the national
health system; bringing healthcare delivery as close as possible to where people live and
work.
Healthcare in India is the responsibility of constituent states and
territories of India. The Constitution charges every state with "raising of
the level of nutrition and the standard of living of its people and the
improvement of public health as among its primary duties".
NATIONAL HEALTH POLICY ==> was endorsed by the Parliament of India in 1983
and updated in 2002.
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http://mohfw.nic.in/np2002.htm
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The primary health center deals with
·
Mother and child health care including new born care.
·
Prevention and control of local diseases.
· Collecting statistical information.
· Training - Tribal women as ANM’s.
health guides, health workers, dayees.
schools , anganwadis & self – help groups.
Providing promotive, preventive, curative and rehabilitative care.
This implies offering a wide range of services.
Including => Stocking and distribution of low – cost , quality
essential drugs to NGO’s , hospitals & other organizations .
BIN card system for drug stocking in all PHC’s.
Gender – sensitive primary Health care.
Integration of community mental health care in PHC’s.
Basic laboratory investigations.
Health monitoring & information system (HMIS) with
gender disaggregated data Management system for PHC’s.
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ELEVENTH FIVE YEAR PLAN 2007 – 2012
National Rural Health Mission ( 2005-2012 )
Mission Steering Group
Integrated Disease Surveillance Programme.
The focus of the five-year programme “is to increase access to health care for the rural
poor and the underprivileged, and to strengthen primary health care with community
participation”.
Central government efforts at influencing public health have focused on the five-year
plans, on coordinated planning with the states, and on sponsoring major health
programs.
The Government has approved the launch of the National Rural Health Mission
(2005-12) for providing integrated comprehensive Primary Healthcare Services,
especially to the poor and vulnerable sections of the Society.
http://www.mohfw.nic.in/NRHM.htm
http://www.nhsrcindia.org/
http://stg2.kar.nic.in/healthnew/
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Primary Health Centers (P.H.C) :
Primary health center and its sub-centers are intended to meet the health care
needs of rural population,
Each PHC is targeted to cover a population of approximately 25,000.
The PHCs are hubs for 5-6 sub-centres that cover 3-4 villages.
These facilities are a part of the three tier healthcare system; the PHCs act as
referral centers for the Community Health Centres (CHCs), 30-bed hospitals
and higher order public hospitals at the taluka and district levels.
The primary health center is looked after by a Medical Officer, Block
Extension Educator, one female Health Assistant, a compounder, a driver and
laboratory technician. It is equipped with a jeep and necessary facilities to
carry out small surgeries. Each sub center is managed by a Junior Health
Assistant.
Department of Health and Family Welfare, has established separate
Departments as stated below,
1.
Directorate of Health and Family Welfare Services.
2.
Directorate of Medical Education.
3.
Directorate of Indian System of Medicine and Homeopathy
(AYUSH).
4.
Drugs Control Department.
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Case study , Scorpion sting and cardiovascular complications
Scorpion Sting is a major health problem in many tropical countries.
Indian red scorpion is one of the most toxic envenomation in
animal kingdom
It is seen all over western Maharashtra, Bellary of Karnataka,
all over Andhra Pradesh, Kutch of Saurashtra. Pondicherry,
Chennai, Uttar Pradesh.
( The Indian Anaesthetists’ Forum – www.theiaforum.org )
Haemodynamic changes following scorpion envenomation,
Typical symptoms of scorpion bite include vomiting, profuse sweating all over the body,
salivations, cold extremities, confusion , puffy face, and raised blood pressure with
cardiac arrhythmias. Also absence of local pain at the site of sting is a diagnostic
premonitory signs and symptoms.
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Treatment of scorpion stings- Acute massive pulmonary edema
( Fluid accumulation )
HR : 120, NIBP 90/70 mmHg, SaO2 45%, ABG : pH:7.25, PCO2:41.8, PO2:32.6,
HCO3:18.2, BE:8.5, Na+:145, K+:4.9, Ca++:1.29.
HR, NIBP, ECG, SpO2, EtCO2 & CVP were monitored continuously. Blood sugar Once in 2
Hour.
The patient was intubated & put on Engstrom Ventilator SIMV mode with: Vt:350 ml,
FiO2:80%, RR: 10/min, PEEP: 8 cm of water, PS:14 cm of water.
The patient was treated with Inj. Amoxycillin+clavulanic acid 1.2gm IV tds, Inj.
Metronidazole 100ml IV tds, Inj. Prazosin 0.5 mg IV stat followed by 0.5mg IV bd ,
Inj. NTG infusion @0.5 mic/kg/min. Inj.
Dobutamine @ 10 mic/kg/min. Inj. Tetanus
toxoid stat and Inj. Rabeprazole 20mg IV od.
Dobutamine infusion was continued. Inj.
Midazolam infusion @ 1mg/hr started to keep
the patient sedated & for better tube
tolerance.
Jump start
menu buttons
After 36 hour the patient was shifted to
CPAP mode with settings: FiO2: 40%,
PEEP: 5, PS: 10. Chest became clear..-..--..14 July 2010
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Treatment of scorpion stings ……..After 48 hour patient was given T piece trial and
after successful trial was extubated and maintained on ventimask with FGF: 5 lit/min.
Incentive Spirometry was started. Dobutamine infusion was stopped, as patient was
maintaining normal BP. HR was 80/min, NIBP: 110/72 mmhg, SpO2: 97%, CVP: 9 cm of
water and the chest was clear. Patient was monitored for 24 hours after extubation and
discharged.
Scorpion venom delays the inactivation of neuronal sodium channels resulting in an
autonomic storm. Prazosin hydrochloride ( poor man antivenin ) is a post-synaptic alpha-1
blocker. It reduces preload and left ventricular impedance without rise in heart rate. It
enhances insulin secretion which is suppressed in scorpion sting victim due to catecholamine
hormone excess.
Your patent title wil be ( Designing PMS with dieseases specific menu)
A Knowledge based PM expert systems for differential diagnosis, classification
& treatment List for human illness using C++ / CLIPS programming.
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Case study Typhoid_fever ( Designing PMS with dieseases specific menu)
http://en.wikipedia.org/wiki/Typhoid_fever
Classically, the course of untreated typhoid fever is divided into four individual stages,
each lasting approximately one week.
First week, slowly rising temperature with relative bradycardia, headache and cough. A
bloody nose and abdominal pain is also possible. The decrease in the number of circulating
white blood cells, lymphocytosis, …..a positive diazo reaction and blood cultures are
positive. The classic Widal test is negative in the first week.
In the second week high fever of around 40 °C (104 °F) and bradycardia with a
dicrotic pulse wave. Delirium is frequent, frequently calm, but sometimes agitated.
Rose spots appear on the lower chest and abdomen of patients. There are rhonchi in
lung bases. The abdomen is distended and painful …… Diarrhea can occur in this stage.
The spleen and liver are enlarged and tender,
and there is elevation of liver transaminases.
The Widal reaction is strongly positive with antiO and
antiH antibodies.
Blood cultures are sometimes still positive at this stage.
(The major symptom of this fever is the fever
usually rises in the afternoon up to the first and
second week.)
Temperature reading with Real Time Clock?.
Circadian rhythmicity.(www.circadian.org)
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In the third week of typhoid fever, a number of complications can occur:
Intestinal hemorrhage due to bleeding in congested Peyer's patches; Intestinal
perforation in the distal ileum: this is a very serious complication and is frequently fatal.
It may occur without alarming symptoms until septicaemia or diffuse peritonitis sets in.
The fever is still very high and oscillates very little over 24 hours. Dehydration ensues
and the patient is delirious (typhoid state). By the end of third week the fever has
started reducing.
This carries on into the fourth and final week.
Diagnosis
Diagnosis is made by any blood, bone marrow or stool cultures and with the Widal test.
The diseases given with State Priorities
1. Filariasis
2. Kyasanur Forest Disease
3. Handigodu Syndrome
4. Leptospirosis
5. Fluorosis
6. Vaccine preventable diseases like Tuberculosis,
Diphtheria, Kala-azar
7. Iodine Deficiency Disorders
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Tune your Brain as an
“IDEA CAMPUS”
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PMS with Automatic Patient Sorting /Electronic TRIAGE
System/Evacuee Tracking software
Designing PMS systems with Past History ,current physical
examination ,Vital signs, drug presciptions ,record of end results Addmition to discharge.
Physical examination or clinical examination is the process by which
a doctor investigates the body of a patient for signs of disease.
It generally follows the taking of the medical history — an account
of the symptoms as experienced by the patient. Together with the
medical history, the physical examination aids in determining the
correct diagnosis and devising the treatment plan. This data then
becomes part of the medical record.
Systematic examination generally starts at the head and finishes at the extremities.
http://www.med-media.com
14 July 2010
After the main organ systems have been investigated
specific tests may follow when a particular disease is
suspected.
With the clues obtained during the history and physical
examination the healthcare provider can now formulate a
differential diagnosis, a list of potential causes of the
symptoms.
Specific diagnostic tests (or occasionally empirical
therapy) generally confirm the cause, or shed light on other,
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previously overlooked, causes.
PMS with logistical drugs and warehouse management software
http://stg2.kar.nic.in/healthnew/Admin_Dire
ction.aspx
In all the PHC’S / CHCs, Taluk Hospitals and
District Hospitals Govt. has plans for “Drugs
Distribution Centres”. Budget Rs. 1,00,000
for each PHC.
Rs. 2,00,000 for each Community Health
Centre.
1)
Consumables like ECG electrodes,IBP kits,GEL,Thermal paper……
2)
To implement the logistical drugs and warehouse management through IT to ensure
the drugs are made available at all levels and used rationally with due monitoring.
3)
Cold-Chain for Oral Polio Vaccine in Rural India. Vaccine transportation mechanism.
Portable Blood Storage Management.
4)
Total computerization for e-governance and management.
5)
To monitor various drug and therapy-related information and to take necessary
follow up action.
6)
To maintain the accounts for all expenditure under the project and ensure total
transparency and accountability.
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Alternative uses of PMS for the following when not used for primary function.
Using ‘Right of Information’ for the ‘Right to Health Care ‘ Campaign.
Information dissemination regarding health and primary health care activities of the
Government to NGOs and communities. - in Local language.
Details of health programmes of the government (including health insurance schemes).
 Documentation of cases of denial of health care.

Structure of health system, staffing pattern and staff responsibilities. Training of
medical officers of PHCs .

Medicines and availability, equipment, monitoring and inspection,
All districts are reporting
weekly Surveillance data and
Outbreak Reports in time.
www.idsp.nic.in
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PMS workstation – various possibilities –
'Widest Product Range - That's Leadership!'
1)
2)
Patient Height,weight ,Girth measuring system.
( Telescopic electronic height rod.)
LED overhead lightings –During minor surgeries.
3)
Patient warming/incubation.
4)
PMS with integrated Pathology modules.
5)
Cataract Operation/School Eye Screening
6)
IV poles- Glucose,medicine
7) Portable Oxygen generators/ concentrators
www.sequal.com/, www.helixindia.com/atlas.htm
www.portableoxygenconcentrators.com
8)
Village health census modules /Software.
9)
Mass education software ,
10) Evidence based ESI reference to other hospital – printout.
11)
Dual OS => RTOS for vital sign monitoring
& desktop OS for all other application.
12) Float & Boost charger with -48 Volt DC Telecom supply.
Dual battery bank UPS ( Copy 0/Copy1 )
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http://www.cdot.co.in/home.htm
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Prior Art Search : PMS Work Station
US Patent D486915 , D477082 Combination electro-surgical generator and cart.
US Patent 20010034530 , Mobile cart for electro-surgical instruments and accessories.
BiliSoft LED Phototherapy System => LED and fiber-optic
based technology for treatment of indirect hyperbilirubinemia
in newborns => blue narrow-band LED light
430-490 nm ( peak 440-460 nm ) Treatment of indirect
hyperbilirubinemia in newborns.
Matching the peak absorption wavelength at which bilirubin is
broken Down (458 nm)
www.gehealthcare.com AAP Guidelines
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Sam the Switching Man, Telecom czar
The Centre for Development of Telematics (C-DOT) is the Telecom
Technology development centre of the Government of India.
Established in August 1984 , triggered a telecom revolution in the
rural India that was responsible for all-round socio-economic
development. “ Bypass Surgery for Telecom”
More than 30,000 C-DOT Exchanges totaling
approximately 25 million telephone lines & 600,000 bright
yellow STD PCO operational in field.
C-Sam's "OneWallet"
Over 50 patents, for
digital switching,
synchronization, tone
generation, tone
receiving, conferencing,
and m-commerce.
http://www.sampitroda.com/trib.htm
Example:United States
Patent 4627047
Integrated voice and data
telecommunication
switching system
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PMS with integrated Pathology data & image aquisition
Clinical Pathology is a medical specialty that is concerned with the diagnosis of disease
based on the laboratory analysis of bodily fluids, such as blood, urine, and tissues using
the tools of chemistry, microbiology, hematology and molecular pathology.
Photomicrography
http://www.photoxels.com/article-oem.html
Voice recording systems have been usual to store description of
organs, microscopy descriptions, comments and diagnoses that
later on are typed by secretaries.
Blood film or peripheral blood smear - to investigate
hematological problems (disorders of the blood) and for
detecting parasites within the blood such as malaria and filaria.
http://karhfw.gov.in/Aboutus.html
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http://www.paxcam.com/clinical_anatomical_pathology.asp
Daydreaming is counter productive; but sometime it fosters creativity
( Deccan Herald July 5, 2010 )
There are totally 1,45,272 ( SC ) subcenters, 22,370 PHC , 4045 CHCs.
Total = 1,71,687 ( As on Year 2007 )
171687 total centers x 50,000 INR per stellar =
858,43,50,000 INR ( lower end )
171687 total centers x 4,00,000 INR per PMS work station =
6,867,48,00,000 INR
( higher end )
Under the Rs.765-crore World Bank-assisted `Health, Nutrition and Population (HNP)
Project’ the government hopes to improve and extend the primary health care system.
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O is the Last letter of ZERO or first letter of OPPORTUNITY ?
News : Welch Allyn Partners with BPL Healthcare to Support Emerging Indian Market
www.bpl.in
www.welchallyn.com
The e-Clinic A concept developed jointly by Welch Allyn and BPL, is designed as a stateof-art primary healthcare center , using world class diagnostic instruments.
The e-Clinic will have facilities for general health check up and will be equipped with all
Welch-Allyn made front-line diagnostic products and BPL made imaging products.
“The strategic alliance between Welch Allyn and BPL provides us with a tremendous
opportunity to tap into a ready and reliable network to support sales, service and logistics
for our products. It will allow us to further broaden our reach in a country that has one of
the largest and fastest growing healthcare sectors in the region.”
Con Hickey, senior vice president, Asia Pacific at Welch Allyn.
Air Ambulance
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Discoveries are often made by not following instructions, by going off
the main road, by trying the untried.
- Frank Tyger
Reference:
http://www.manage.gov.in/RRSites/Ghatkesar/primary_health_centers.htm
http://www.expresshealthcaremgmt.com/20050831/ruralhealthcare01.shtml
http://en.wikipedia.org/wiki/Healthcare_in_India
http://www.cehat.org/publications/aa02a10.htm
Presentation By :Ronald Lewis
Larsen & Toubro Limited
D & D- Medical Equipment & Systems
Gate No. 5, Mysore Campus
KIADB Industrial Area, Hebbal
Mysore- PIN 570018
----------------------
Intellectual Property Management
Innovation & New Product Development
Phone :- 91-821-2407308
E-MAIL: ronaldlewisv@myw.Ltindia.com
www.LNTMEDICAL.com
DISCLAIMER :-
14 July 2010
The opinions, views, fururistic statements presented in this SSD seminar belongs to
author only. They are not the opinions of the management or D&D department. The information
regarding manufacturers websites , sourcing leads are only for knowledge distribution purpose.
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Thanks to,
1)
Mr. N. Ravindran –Head, L&T Medical D&D.(RavindranN@myw.ltindia.com)
2)
Mr. Rajdeep Ghosh – Medical D&D (GhoshR@myw.ltindia.com)
3)
Arunkumar Sathiyamoorthy (SathiyamoorthyA@myw.ltindia.com )
4)
The PMS-48 Team
Last Thoughts………………..
Mr. A.M. Naik, spoke about his role model his father.
“ He was very concerned about the poor people in our village who had to walk miles to
see a doctor”.
My father told me that I should do something for the poor peoples medical and
health needs as well as educational needs. I remember the days when I donated a
substantial amount from my own savings for the village hospital and I saw tears in his
eyes ‘ I am very proud of you my son’ he said. That was the most precious certificate
I have received so far’.
Extracted from the “ L&T ite –2004 march “.
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Copyright 2010
LARSEN & TOUBRO LIMITED