Critinext is Asia's largest electronic intensive care unit (EICU) network that provides remote patient monitoring and support to ICU beds across India. The document discusses gaps in critical care in India, such as shortages of ICU beds and specialists. It introduces Critinext's model of using technology to allow intensivists to remotely monitor multiple ICU patients from a command center. The benefits of Critinext include reducing mortality, infections, and costs while improving quality of care. Critinext has expanded to over 350 ICU beds across India and one site in Bangladesh, and its outcomes have been recognized in 10 scientific publications globally.

1. STRICTLY CONFIDENTIAL
CRITINEXT
Asia’s Largest EICU Network
May’2016

2. HealthQuad
“The Brilliance Isn't The Technology, But The Fact Is That We Can Use Technology To
Help Physicians Practice Evidence Based Medicine”
Critical Care
What ,Why & How
Critinext
The Futuristic Critical Care
The NEXT Stumbling Block
In Healthcare In India
OBJECTIVES

3. 2 3
TABLE OF
CONTENTS
Gaps In Indian Healthcare
The ICU: Gaps In Critical Care
Medicine
About Critinext
Impact & Benefits
Scientific Publications &
Awards
Academics & Training By
Critinext
5
8
11
17
21
25

4. INTRODUCTION
Gaps In Indian Healthcare

5. Indian Healthcare Healthcare Trends
India spends 5.2% of GDP on healthcare (US ≈ 15%) and it has only
0.9/1000 registered physicians as compare to 2.9/1000 (average) in
developed world.
Changing demographics that yield a higher proportion of geriatric
individuals in the overall population will further increase the burden on
supply side infrastructure
With a growing economy, aging population, urbanization, improved
living standards & better education & awareness patient’s expectations
are rising
Indian healthcare market is expected to grow at a CAGR of 15% during
2011-17 to reach USD 158 Billion
35% 32% 29% 27% 25% 23%
27% 28% 29% 28% 26% 24%
20% 20% 20% 21% 23% 24%
11% 12% 14% 15% 16% 16%
7% 8% 8% 9% 11% 12%
2001 2007 2012 2017 2021 2026
0-14 15-29 30-44 45-59 60+
Large, Rapidly Growing And Ageing Population
Gaps In Indian Healthcare
Aging Population, Increasing Disease Burden Without Adequate Health Infrastructure InIndia
5% 4% 4% 3%
1%
7% 5% 6%
2% 2%
Asthma Heart Disease Other CVS CNS Cancer
2001 2014
Increasing Incidence Of Chronic Diseases
41% 23%
48%
39%
10% 35%
2010 2020Deprived Aspirers Middle Class Upper Class
Increasing Affordability Due To Rising Incomes

6. Growth in Indian Healthcare Market Strong Growth In Sector
Indian Healthcare : The Future
Aging Population, Increasing Disease Burden Without Adequate Health Infrastructure InIndiaStrongDemand
• Market expected to reach US$ 280 Bn by 2020 (CAGR
of 17% over 9 years)
• Rising incomes, greater health awareness, lifestyle
diseases, insurance penetration to contribute to
growth
Attractive
Opportunities
• 3x of current healthcare infrastructure required
• 1.8 Mn beds to be added
• 1.5 Mn doctors & 2.4Mn nurses needed to support
the load
PolicySupport
• Government supported measures aim to develop
India as a global healthcare hub
• Strong focus on PPP initiatives to improve access and
quality of service
Quality&
Affordability
• Availability of large pool of well-trained medical
professionals
• Competitive advantage of high quality medical
services at low cost
45 52 60 68 73 77 81 100
160
280
2008
2009
2010
2011
2012
2013
2014
2015
E
2017
F
2020
F
India’s Healthcare Sector Growth (US$Bn)
Global Healthcare Market Size : US$ 9.6 Tn
Global Healthcare Market Growth : 4%
CAGR:
17%
71%
13%
9% 4% 3% Hospitals
Pharmaceutical
Medical Equipments & Supplies
Medical Insurance
Diagnostics
43 44
54 61 58
71
83 91
2008 2009 2010 2011 2012 2013 2014 2015E
Per Capita Healthcare Expenditure (US$)
Global Per Capita Healthcare Expenditure: US$ 1,200
CAGR:
11%
Segment-wise Market Share

7. THEICU
Gaps In Critical Care Medicine

8. Critical Care Medicine Growing Per Capita Income in Tier2,3 Cities
Gaps In ICU Care : The Critical Care Medicine
Patient Mindset Is Changing
Critical Care is Continuous 24*7 management includes monitoring,
diagnostics to support failing life functions.
Dependent upon Cutting Edge Technology and performed by an
Integrated team of Intensivist, Nurses, Paramedics &Technicians it
takes on a radically different approach in medicine by basing patient
selection on acuity instead of age, techniques, organ or disease
5 million patients require ICU care & only 70,000 ICU beds are available
& less than 15% ICU does receive dedicated intensivist care & there is
huge shortage of ICU specialists
Less than 15% ICU does receive dedicated intensivist care & there is
huge shortage of ICU specialists
25-30% of hospital beds are earmarked for ICU’s where ICU care
accounts for 20%-30% of a hospital budget
Apart from huge capital expenditure, out of total hospital deaths 10%
happens of preventable ICU mistakes and delayed interventions
Apart from capital expenditure, out of total hospital deaths 10%
happens of preventable ICU mistakes and delayed interventions
Urbanisation & opening up of service sector leading to a rapid increase
in affordability
Better education & awareness has changed patient mind set for ICU
care & overall outcomes
18 22
31
42
64
90
118
0
40
80
120
160
1990 1995 2000 2005 2010 2015E 2020E
INR('000)
10%
12%
14%
16%
19%
7%
9% 10%
12%
16%
3% 4% 4% 5%
7%
0%
5%
10%
15%
20%
2008 2010 2012 2015E 2020E
Metros Tier II/III Rural
Per Capita Healthcare Spend in Tier II/III cities

9. Needs & Expectations Across Various Stakeholders
The Evolving Healthcare Sector Increasing Expectations of Across All Stakeholders
Patients
Physicians
• 24X7 Care Of Patients by Trained Intensivist
• Early Recognition of Warning Signs
• SOP & Quality Bundles Implementation &
Compliance
• Access To Patients Anytime Anywhere
• Multidisciplinary Team A Call Away
• Regular Upgradation Of Skills
• Quality & Affordable ICU Care
• Availability of Intensivist
• Speed of ICU service (Golden
Hour)
• Convenience of service
• Value for money spent
• Patient flow and satisfaction
• Decrease ALOS
• Quality and speed of outcome
• Cost management
• Enhanced Branding
• Smooth Running Of ICU’s with
Limited Manpower &
Resources
• Sales volume
• Quality of offer
• Value for Money
Hospitals
Hospital Administrators

10. CRITINEXT
Concept & Process Flow

11. Critinext Concept Critinext Command Centre
 Critinext is a 24x7 remote ICU patient monitoring systems aided by
real time two way audio-visuals and smart alerts
 Its an ideal blend of medical technology, sophisticated telemedicine to
improve critical care delivery Provides a solution to scarce critical care
resources and growing physician , nurses shortage
 It’s a clinically proven programme to improve quality outcomes & to
reduce ICU mortality rates
 While provides same standards & quality of care as in major cities also
this also generates revenue streams for spoke hospitals
 EICU Enhances the quality & patient safety with standardizations of ICU
care
 1000 ICU beds can be manned by only 20 Intensivists. This Develops of
Regional Delivery Systems through
Critinext : Concept & Process Flow
Brilliance Is Not The Technology But Its True That Technology Can Be Used To Help Physicians Practice Evidence Based Medicine
Focus on Clinical
Outcomes
Critical Care Resources
Utilization
Establishment of
Evidence Based
Critical Care Protocols
& Processes
SOP Implementation
for Error Prevention
Smart Alerts Rapid
Response Mechanism
in Place

12. Dashboard View Of ICU At Critinext Alarm Notifications & Trends
Critinext processes & EMR provides collaborative &
comprehensive dashboard view of key patient information to the
Critinext intensivists as per their requirements to monitor &
manage critically ill patients:
 Detailed physiologic & lab data including ABG
 Diagnosis, treatments, lines & tubes History
 Trends & ICU scoring
 Real time vital parameters
 Summary of current therapies & Critical Incidents
Critinext : ICU In Pockets
Critinext Technology Help Physicians To Access Their Patients From Anytime Anywhere

13. Critinext Spokes & Beds
Critinext Presence In India (below. Today we serve over 350 ICU beds in 11 different cities ) With One
International Site in Khulna Bangladesh

14. Critinext Focus Areas Average Hospitalization Cost India
Accessibility of Critical Care:
 Concept of Golden Hour
 Demand Supply Mismatch of ICU skilled manpower
 Standardization of Acute Care
Affordability of ICU Care:
 Delivered at price point of INR 600/day
 Prevents transfers of patients which are then treated at spoke site
 Enables access regardless of economic class
Quality of Critical Care Medicine:
 SOP implementation as there is lack of standardization of care in
tier2,3 cities
 Readily defined quantifiable parameters such as ICU Mortality,
Average Length of Stay & ICU Infection Rates
Critinext Focus
Accessibility, Affordability & Quality Of Critical Care Are Major Concerns In India Especially In Tier II/III Cities
0
5000
10000
15000
20000
25000
2004 2014
5695
8851
14935
24436
Average Hospitalization Cost (India) Rural
Average Hospitalization Cost (India) Urban
Early Recognition and goal directed therapy
Timely institution of non-invasive ventilation & Intubations
Adherence to clinical practice guidelines (SOP)
Constant Training of ICU Staff (doctors, nurses, Support staff)
Critical Care Quality Bundles & ICU Scoring Systems
Quality indicator analysis
Factors That Help Improving ICU Outcomes

15. Business Models & Support Tools 3 Business Models
 Comprehensive model provides 24x7x365 ICU monitoring
& support
 Monitoring model helps in establishing electronic medical
record system in the hospital & optimizes paper use in ICU
by making it digital.
 Only audio visual model helps in establishing an extra layer
of monitoring & support by Intensivist from command
center in spokes where acuity is low.
Other tools to meet requirement of each spoke are:
 Tailor made use of Technology by Developing Economical
Solution as per every site need without the need to
transferring the patient to bigger city hospitals
 Creation of Smart Alert System/Clinical Notification Tools
– for immediate & 24x7 engagement with bedside
caregivers
 Development of Collaboration Cockpit converging
detailed patient information, alerts, audio-visual on a
single screen and enabling one doctor to manage more
number of patient at a given time.
 Remote Care Tools – To improve Collaboration at Point of
Care
 Decision Support Tools for more Proactive & Quality care
Critinext : Business Models
Comprehensive
• 24x7 Intensivist
Cover
• Full Loaded EMR
• Training for
Doctors & Nurses
for local site
• Quality &
Optimization
Improvement
• SOP
implementation
• Implemented in all
tier 2 Spokes
Monitoring
• EMR
Implementation
• Training
• Optimization &
Reduction of Paper
in the ICU
• Remote availability
of data to all
consultants
• Implemented at
tertiary care ICU’s
Running ICU’s
• Placing Critinext
Intensivist on site
• 24x7 management
of ICU’s
• EMR
Implementation
• Responsibility of
Training
• SOP
implementations
• Enhancing
Revenue through
Critical Care
• Implemented at
larger ICU's.
Critinext Has Various Business Models Depending Upon The Acuity And Requirement Of The Hospital

16. CRITINEXT
Impact & Benefits

17. Major Impact Areas With Critinext
Critinext (eICU) Impact
Major Impact Noticed At Cardiac Arrest, Mortality & Antibiotic Usage
Reduction in
ICU Mortality & Cardiac Arrest
Incidents
Reduction in use of
High End
Antibiotics
Nosocomial
Infection Control
Prevention of
ICU mistakes by
Timely Response
Implementation
of Standardized Care
Decrease Trend Of Cardiac Arrest & Mortality Numbers
6
510
8.34
404
79
332
826
505
8.76
306
60 112 36
Pre EICU Post EICU
5
475
59 59 49
10.3 4.25
484
40 24 29
5.6 3.6
Hospital XYZ
Reduction in High End Antibiotic Usage
Post EICU
Implementatio
n Antibiotic
Usage
decreased
from 79.22%
to 60.59% and
Carbapenam
from 82.18%
to 36.60%
• Discrete Intervention by Critinext > 850 as a result potential life saving
• >1000 Nurses & 80 doctors Trained in EMR
• ICU SOP’s Established in 10 Hospitals (most of the sites are non-accredited)
• ACLS , BLS Courses Workshops Organized
• Optimizing Resource Utilization
• Crucial Night support
• Antibiotic policy/Antibiogram Established at all the spokes
• Critical Care Fellowship Programs Initiated
• Virtual Training of Critical Care Nurses
• Key Performance Indicators in Place
• Structured Infection Control practices in place
• Monthly audits & reviews
Other Value Add By Critinext Are

18. Major Impact Areas With Critinext
Critinext Impact
Decrease in Infection Incidence Rate/1000 Days – Hospital XYZ
Decrease Trend Of Cardiac Arrest & Mortality Numbers
Reduction in High End Antibiotic Usage
51
40.7
45.7
39.7
13.9
3.6 3.43.4 5.35.3 3.73.73.7 5.35.35.3
0000 2.62.62.635.55.5
02.1
Mar-…
Apr-15
May-…
Jun-15
Jul-15
Aug-15
Sep-15
Oct-15
Nov-…
Dec-15
Jan-16
Feb-16
Mar-…
Apr-16
VAP 21.2
6.3 4.9 3.7 1.8 0 00 1.4 22 1.61.6 1.81.81.8 000 00
3.1
1.4
Mar-15
Apr-15
May-15
Jun-15
Jul-15
Aug-15
Sep-15
Oct-15
Nov-15
Dec-15
Jan-16
Feb-16
Mar-16
Apr-16
CLABSI
ALOS (%) HAI (%)
100 10094.2
7.69
PRE eICU POST eICU
463
1362
2.92
434
59 37 31 0 0 2
631
1050
345
APRIL 2016
Major Impact Areas With Critinext

19. Critinext Benefits
Critinext Outcomes Are Proven, Predictable & Sustainable
 Better Survival Rates
 Able to stay & get treated locally.
 Avoid expensive/dangerous transfers & Save
Money
 Overcoming Geography/Weather Challenges
 Timely Quality Critical Care when seconds
saves lives
For Patients
 24x7 availability of Intensivist
 Lower mortality
 Fewer complications
 Better bed utilization
 Patient Volume & Brand Building
 Better patient care : real time
 Reduction in the number of patients
requiring transfer.
 Paper less culture in ICU
For Hospitals
 Generating new revenue streams &
increasing market penetration.
 Electronic Medical Records brings more
transparency in Health Care.
 Leverage existing infrastructure, procedure &
practices.
 Expand geographic footprints.
 Help unaffiliated healthcare entities improve
performance & save more lives.
For Healthcare Industry
 Expanded Market competiveness
 Extended Horizons : Intensive Care Beyond
Boundaries
 Increased case mix acuity & revenue
 Improved physician/nurses recruitment &
retention
Other Strategic Impact

20. CRITINEXT
Scientific Publications &
Awards

21. 10 Scientific Publications Globally
Critinext Proven Outcomes Has Been Recognized & Published By Many Scientific Societies

22. Critinext Publications
Year 2015
SCCM:
Brussels ISICEM:
ISCCM:
Year 2014
SCCM
Global Heart Elsevier:
Year 2013
ESICM Annual Lives;
PARIS
ISCCM INDIA
SCCM: Role of EICU to modify antibiotic misuse in the developing world / Shamit Gupta, Kaushal, Sandeep Dewan, Shelly Mittal, Amit Varma
Dep. of Critical care Medicine, Fortis Escorts Heart Institute, Okhla Road, New Delhi.
SCCM : “Can 10$ a day Save Lives? EICU implementation reduces mortality in the Developing World./Kaushal1, Shamit Gupta1, Sandeep Dewan2,
Amit Varma1
Brussels ISICEM: Can EICU support timely RRT in resource limited areas of the developing world / Shamit Gupta1, Kaushal1, Sandeep Dewan2, Amit
Varma1
ISCCM: LOW COST INNOVATIONS TO SUPPORT REMOTE HEALTHCARE FACILITIES / Shamit Gupta1, Kaushal1, Sandeep Dewan2, Monu S. Dewan3,
Amit Varma1
Global Heart Elsevier: EICU Reduces Mortality in STEMI Patients in Resource-Limited Areas / Shamit Gupta*, Sandeep Dewan, Kaushal, Ashok Seth,
Jagat Narula, Amit Varma
SCCM:EICU can save lives in myocardial infarction in remote areas in the developing world / Shamit Gupta, Amit Varma, Sandeep Dewan, Kaushal
Changing Paradigm of Health Care Delivery System in Developing World: India’s First E-ICU “Critinext” / Kaushal, Shamit Gupta, Sandeep Dewan,
Amit Varma
ESICM: EXTENDING TELE-ICU/E-ICU TO RATIONALIZE ANTIBIOTIC USAGE IN CORONARY CARE UNIT IN INDIAN SCENARIO / Shamit Gupta, Sandeep
Dewan, Kaushal, Pradyut Bag, Amit Varma
Technology & Innovation: The Future of Medicine in Developing World - India’s First Tele ICU “Critinext” / Kaushal, Shamit Gupta, Sandeep
Dewan, Amit Varma
“Impact of Tele ICU/E-ICU on Antibiotic Stewardship” (Oral Presentation) / Shamit Gupta, Sandeep Dewan, Kaushal, Pradyut Bag, Amit Varma
Year 2016
SCCM:
Brussels ISICEM:
SCCM 2016 : Overcoming nosocomial infection burden in a developing country through eICU / Shamit Gupta; Anjali Kaushal; Sandeep Dewan;
Naveen Chandra; Amit Varma
SCCM 2016 : EICU (ELECTRONIC INTENSIVE CARE UNIT) BEYOND INTENSIVE CARE / Gupta, Shamit; Kaushal, Anjali; Dewan, Sandeep; Varma, Amit
ISICEM 2016 : eICU (electronic intensive care unit): Impact on ALOS (average length of stay) in a developing country like India / Shamit Gupta1;
Sandeep Dewan2; Anjli Kaushal1; Amit Varma1
Year 2013 – 2016

23. HealthQuad
Awards & Recognition
Asia Healthcare Excellence Award for “Innovation In Quality of
Service Delivery” August2015, Singapore
The Golden Globe Timer Summit Award for “Innovation In Quality
of Service Delivery” Year 2015, Kuala Lumpur
Critinext was recognized as a “Showcase” at Asia Healthcare
Summit in Singapore in June, 2015 & during “Indo Africa Summit”
in Nov, 2015 in New Delhi, India.
Times of India Award for “Innovation in Improving Care &
Efficiency with Technology” Year 2014, India
Frost & Sullivan Award for “Technology Innovation Leadership
Award for E-Intensive Care Service Delivery” Year 2014, India
Times of India Award for “Innovation in Improving Care &
Efficiency with Technology” Year 2014, India
Fortis Health Care Award for “Medical Excellence” Year 2013, New
Delhi
Business World Healthcare Award for “ Innovation in Service
Delivery with Medical Technology” June,2016, Delhi

24. CRITINEXT
Academics & Training

25. Training By Critinext
Academics/ ICU Training By Critinext
Critinext Strategically Plans Academic Sessions As Per The Specific Requirement Of The Each Spoke Hospital
Training Done Hospital A
Critical Care Topic Covered – Hospital B
 Critinext offers ongoing academic programs/virtual teachings to
support the diverse needs of continuous up gradation of knowledge
in medical community.
 It provides continuous learning opportunity on all current Issues,
currant guidelines in healthcare, EMR software, ACLS protocols,
Infection Control & quality policies & many more.
Few of Critinext Initiative Are
Platform for Case based learnings with
Critinext Medical Rounds
Share knowledge & Sustain Excellence
Critinext Quartly Conclave
Critinext Research Institute
A Unique Opportunity for Research
Collaborative Virtual Teachings Programs
and Hands on ACLS/BLS workshops
2 1 2 2 3 2 3 4 2 1 43
5 4 4 5 5 5 2
6
5 3 5
7
82
4
2
4
5
4
2 4
5
2
OPD WARD HCC RECOVERY
OT/RECOVERY Floors Emergency ICU HCC NICU

26. ThankYou