In quest for the right diagnosis

Written by BV Mahalakshmi | Updated: Aug 4 2014, 07:48am hrs
Bullish on the Indian market, the $7.3 billion New Jersey-based Quest Diagnostics is looking to strengthen its presence in the growing domestic healthcare business through specialised testing services. As part of its India-specific strategy, the diagnostic information services firm is developing innovative diagnostic tests and advanced healthcare information technology solutions and has tied up with HCL, which has diversified into the healthcare sector through its subsidiary, Avitas. The focus of Avitas is to set up Indias largest healthcare network with a robust technology backbone and electronic medical records (EMRs); provide long-term patient care through evidence-based medicine; and associate with Johns Hopkins Medicine International to bring clinical expertise and global best practices to India.

Mukul Bagga, managing director, Quest Diagnostics India, said, We are looking to strengthen our presence in the growing domestic healthcare business through specialised testing services. The lack of awareness related to importance of quality in pathology testing has resulted in a huge volume of the pathology services outside hospitals being present in the unorganised sector. Moreover, specialised testing in India is still at a nascent stage due to lack of awareness about these tests, wherein a certain time lag exists between a test being introduced in the West and then finding its way to India.

While the pathology testing market, according to the Quest Diagnostics India MD, is growing at double digits, there is clearly a under penetration/utilisation of pathology testing in India due to lack of quality and accuracy in testing services across the country. While almost 70% of decisions around medical treatment are based on lab results, however, only 2% of healthcare market is the lab testing industry in India. This gap can be attributed to poor access to healthcareIndia being a self-pay market, lack of awareness and lack of confidence on the quality of testing. The low entry barrier with little or no regulation for setting up of diagnostics labs and NABL accreditation being voluntary and not mandatory has led to less than 1% of the over 1,00,000 labs in the Indian market to get accredited to NABL.

According to Bagga, the availability of skilled manpower, especially for histopathology, molecular testing and genetic testing, is limited in the country too. The Clinical Establishment Act 2010 passed by the central government is a step in the right direction but its implementation in various states is still under process.

On Quest Diagnostics becoming a technology and lab diagnostics partner of HCL Avitas, Bagga said, It is a relationship where all the testing requirements of HCL Avitas clinics are served by Quest. All tests being offered by Quest in India are available to HCL Avitas to offer to its patients. We are providing the electronic medical record (EMR) system. Its function is to provide the interface of the doctors with the patients in terms of history taking, record keeping, etc. This entire system is based on a proprietary system of Quest named Care 360 EMR which we have licensed to HCL Avitas.

EMR is an important part of ultimate diagnostics. It ensures that there is proper protocol in history taking and then that is captured once and for all in the system. The unique thing is how you are able to create those scientific protocols that have to be very thoroughly scrutinised, aligned with medical practice. Interestingly, every hospital claims to have EMR but not many doctors use it because they find it too cumbersome. At HCL Avitas, they have trained their doctors on the use of the system.

Overall, the Indian healthcare industry is estimated to grow at a rate of 23% per annum, from the current size of $35 billion to reach $80 billion by 2015. The diagnostics sector is projected to contribute $3.5 billion by 2015. One of the challenges is that the Indian diagnostics sector is currently dominated by the unorganised players who have a limited test menu. Presently there are only four to five labs who are national players with a systematic and professional approach to quality lab testing.

Accuracy levels vary across the sector and pin-pointing an acceptable accurate level for a given test is


Going forward, we will continue to focus on therapy areas with high unmet need such as cancer and prenatal genetic by leveraging our technology expertise both within India and the US in a seamless technology access model, the Quest Diagnostics MD pointed out. With the successful completion of the human genome project, scientists now have a set of molecular tools that can be readily used by them in order to understand the complexity of diseases and their variability in different human beings. These tools assist scientists in refining risk prediction and also in evaluating the response to therapies with greater precision.

Another benefit of such tools is that this could also help to reduce the cost of therapy as the physician could select the precise therapy that the patient could respond to, thus reducing the usual trial and error approach. An example is the use of Trastuzumab for patients of breast cancer who have the Her2 Neu gene mutation.

The field of bioinformatics has evolved to provide tools to extract and analyse information from these databases, on the basis of which clinicians could take decisions for the benefit of the patients. Global labs chains, which have access to proprietary databases, are able to test individuals for various genomic markers and provide meaningful information on the basis of which the treating physicians can take appropriate decisions on the management of patients.