FINAL REPORT

Impact of ICT on Business

and Its Effective
Management

INDUS HOSPITAL

GROUP MEMBERS
KASHIF AZAM
KHUSHBAKHT SUHAIL
LARAIB MOHIB
(BBA III-III)

DECEMBER 23, 2010

Table of Contents
Preface
Executive Summary
Introdustion……………………………………………………………………………………………
…………………………………………….
Information Management Lifecycle
Primary Research Indus Hospital
• Introduction
• Services
1. General facilities
2. Clinical services
• The Indus hospital management information system
1. Introduction
2. Team members
3. Information life-cycle
a. Identification of information needs
b. Three steps in one (acquisition, organization,
dissemination)
c. Authorization
b. Deletion
4. System implementation strategy
5. Implementation threats
• How does the software look like?
• Indus Hospital Research Centre (IHRC)
1. Centre for community development
2. Centre for injection safety
3. Centre for clinical trials
• Community outreach program
1. Household Registration and Follow-up
2. Disease Prevention and Control
3. Integrated Microfinance and Health Insurance
• The DOTS program
• The DOTS-plus program
• Mapping
• Food assistance program
• The last word

Conclusion

2
PREFACE
The topic ‘impact of ICT on business & its effective management” is basically a very broad area

which can include a multitude of information on various developments in the subject of

management. Keeping this in mind, we have restricted the scope of our topic to ILM at Indus

hospital. Technology has greatly facilitated the process of ILM. Without technology this process

wouldn’t have been nearly as effective as it is now. Indus hospital has achieved remarkable

results by implementing ILM due to the appropriate technology available.

3
 EXECUTIVE SUMMARY

This report basically highlights the various impacts of technology on a business. Rapid

advancement in technology has influenced every aspect of a business, but it is in management,

that its effects are so clearly visible. One particular aspect is the process of ILM (Information

Lifecycle Management) which is the systematic archiving of data so that it is used effectively

throughout its life.

Indus hospital was revived from Islamic Mission Hospital two years back. Since then it

has become a pioneer in actually implanting the MIS concept rather than debate it on paper.

Indus hospital is the first paperless hospital in Pakistan, a feat accomplished by no other. It

achieve this through the process of ILM, which is aided through computers and other related

equipment. Since the data is basically stored as a soft copy, the need for paper is diminished to a

point where it is only used as a bare necessity.

The impact of ICT on businesses is considerable and it is only in the utilization of that,

that businesses have seen remarkable change in the way they carry out their routine activities &

lowered their administrative expenses.

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INTRODUCTION:
The dawn of 21st changed many things & management was one of those things. One of the most

significant advancement was held in the field of Information & Communications Technology

(ICT). ICT has completely revolutionized the concept of management by opening it external

influences that can determine its effectiveness. In fact ICT has given birth to new areas of

management & improved the viability of others. Examples include information technology

management, knowledge management, customer relationship management etc.

Information Technology Management is “concerned with exploring and understanding

Information Technology as a corporate resource that determines both the strategic and

operational capabilities of the firm in designing and developing products and services for

maximum customer satisfaction, corporate productivity, profitability and competitiveness”

1
(Wikipedia). In other words IT today can make or break a business. Where Globalization may

have opened up new venues for a business & increased its profitability, it has changed the way

an organization functions. The whole concept behind information technology management is

that IT as to be used in such a way that it creates value for a business.

A “management information system (MIS) is a system or process that provides information

needed to manage organizations effectively” 2.Previously managers used to rely on printed

reports which were not available when required the most or were inaccurate or very time-

consuming. Using MIS, managers are able to access all the desired information with one click.

This has greatly improved the effectiveness of management.

1 http://en.wikipedia.org/wiki/Information_technology_management

2 http://en.wikipedia.org/wiki/Management_Information_Systems

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 ADVANCEMENTS IN COMMUNICATION

Recent advancements in communication are making the businesses faster, adaptive and global.

Moreover, by using new communication techniques, businesses are reaching out to consumers

more and are staying close to them.

MOBILE TECHNOLOGY:

Advancements in mobile technology include laptops, tablet computers, wikis, IM and PDA’s.

They allow companies to communicate instantly, cheaply with their employees as well as

customers. Updates can be sent quickly, interaction with customers is very easy hence increasing

the accessibility for the company. In case of emergencies also, instant communication is very

effective. Other than that, many companies are advertising now through IM’s and Wikis like they

are sending promotion offers to customers through SMS’s.

INTERNET TECHONOLGY:

To begin with, e-mails have always been used are still used for all sorts of business

correspondence. Many companies are using social networking websites to stay connected to

customers and get information about them. In B2B markets, E-procurement has become very

common. Businesses purchase supplies and components online and interact with the suppliers.

Nearly all companies nowadays use internet portals, websites to purchase/sell online all over

the world. Many organizations like Dell and Amazon communicate only via internet. The biggest

advantage of internet to firms is “becoming global”. They are not restricted to a particular

location. Furthermore, it is very convenient now to have teams of employees spread all over the

world. This means they have a large diversity of employees. Video conferencing technology

allows companies to talk to their overseas managers, employees in no time. Not only this,

6
businesses can research more through the internet. For instance, focus groups can be conducted

involving people from all over the world. Moreover, brain writing is another technique. This

brings together an interactive group of people from the world on the computer. Then people

contribute by giving ideas and expressing their thoughts on various issues.

However, investment has to be made in acquiring the latest technology. It doesn’t come free of

cost. Secondly, technology changes very rapidly and it is difficult to remain up to date always.

Moreover a business needs to maintain the right amount of balance between technology and

personal touch. Too much technology and computerization can reduce the personal touch which

can put off employees and customers.

Moreover, how much technology a company employs also depends on the type of industry the

firm operates in? For example, Motorola keeps a strong control on the engineers and use less

technology with them. However for their sales and marketing they have employees and people

all over the world.

Now we will show an example of how an organization in Pakistan has employed IT effectively

to manage its business and work in the most competitive environment successfully. We will

discuss Indus Hospital’s Information Lifecycle Management to clarify its system of IT.

INFORMATION MANAGEMENT LIFE CYCLE

7
Information management lifecycle is a data archiving process which moves the data to the most

appropriate and cost effective storage media available, so that it remains intact and useful

throughout its estimated life. It consists of many tools, policies and steps that help companies to

manage information properly.

There are several steps in ILM and they are discussed briefly below.

1. IDENTIFICATION OF INFORMATION NEEDS:

This is the most important step because companies need to be fully aware about what type of

information they really require. It is a recurring process and companies need to monitor the

changing information needs all the time. The needs can be on 3 levels:

i. Inter-organizational

ii. Intra-organizational

iii. Compulsory reporting requirements

2. AUTHORIZATION:

This step in ILM establishes the responsibility and ownership in an organization. It identifies

who has access to what type of information according to their position in the company.

3. ACQUISITION AND VERIFICATION:

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The next step in the process is to collect the information either by creating it or collecting form

secondary sources. However this isn’t enough. The company also needs to see whether the

information is relevant, current, impartial and accurate.

4. ORGANIZATION, MAINTENANCE AND STORAGE

Acquisition is followed by storing the information in the company for use. Often technological

tools are employed to store information for long periods of time. The companies organize the

data into databases, indexes and then linking them together. For maintenance purposes the

existing information is reused, updated and refreshed by employees. The employees are

responsible for protecting the information for future reference too.

5. INFORMATION DISSEMINATION

In this step the information is made available to all users in the company both in and out the

organization

6. INFORMATION DELETION:

It is costly for firms to have databases and tons of information saved with them. Moreover, data

ages quickly. To avoid rising costs and privacy issues, information deletion is also very

important. 3

INDUS
3 ‘Management’ by Danny Samson & Richard L. Draft

9
HOSPITAL
THE FIRST PAPERLESS
HOSPITAL OF
PAKISTAN
TOTALLY FREE-OF-
COST

10
Introduction:

Dr. Abdul Bari, who is a renowned cardiothoracic surgeon, had a vision for a hospital

that is free of cost and provides quality healthcare to the needy. He built up a team of doctors and

IT professionals to accomplish his vision. His team consisted of philanthropists with a previous

background of providing improved healthcare services to the poorest sections of the community.

On going projects of the hospital includes Patient Welfare Association, founded by three

students of DMC in 1979. It has been providing screened blood, medicines and medical services

to patients of Civil Hospital Karachi since then. This association also provided the Civil Hospital

with completely renovated obstetrics and gynecology emergency services, a new emergency

operation theater and free of cost surgeries at department of cardiology.

The Indus hospital is a joint project of Islamic Mission hospital and Rufaydah

Foundation. This foundation was also founded by Dr. Abdul Bari Khan & some other doctors.

The Islamic Mission hospital provided 20 Acres of hospital land at Korangi, Karachi. The

Islamic Mission Hospital was revived into the now known Indus Hospital of Karachi within 2

years.

11
 The hospital plan has so far completed its first phase of development and has at least 4

more stages planned ahead. Indus hospital has a capacity of 150 beds right now, but they aim to

increase this figure to 750 with all supporting facilities. The hospital is now providing its

facilities in Karachi only but they are looking forward to spread it to other cities as well. The

Indus hospital is totally free and runs on philanthropic donations. Many doctors from all over the

world provide time to patients at Indus for free.

These are the numbers of patients that have been treated for free from

2007 to Oct 2009.

4 Reference: http://indushospital.org.pk/images/stat_report09.pdf

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SERVICES:

1. GENERAL FACILITIES

• Community Health Centre: Walk-in general out-patient clinic

• Consulting clinics

• 6-bed Emergency Room

• 130 inpatient beds

• 10 haemodialysis beds

• 6-bed ICU

• 6-bed CCU

1. CLINICAL SERVICES

• Cardiology, Invasive Cardiology • Adult & Paediatric -

& Cardiac Surgery Orthopaedics & trauma

• Adult & Paediatric - Nephrology • Adult & Paediatric – ENT

& Urology (including dialysis, • Internal Medicine

lithotripsy, minimally invasive • Infectious Diseases (HIV, MDR-

and laparoscopic surgery) TB, Rabies)

• Adult & Paediatric - General • Gastroenterology

Surgery • Pulmonology

• Diabetes Care Clinics

13
 • Nutrition Clinics • Blood bank

• Anesthesia, critical care and pain • Biochemistry lab

management • Hematology lab

• Plastic surgery • Microbiology lab

• Cath Lab

• X-ray lab

The list is constantly increasing as dedicated specialists continue to join our team, some of them

donating their time completely free to the Hospital.

THE INDUS HOSPITAL MANAGEMENT INFORMATION

SYSTEM (HMIS):

Introduction:

The Indus hospital is the first truly paperless hospital of Pakistan. Shakeel Akhtar, the CIO of

Indus Hospital said,

“All the data from the time the patient comes into the Filter Clinic to get his details

entered into the system, to the time he gets a medical test done. X-rays, results of blood

tests, angiograms – everything that we can do in the hospital, a digital record is

maintained in the database entry of each patient. We have successfully computerized our

Cath Lab, and brought automation to ICU and CCU, which is a great achievement.”

Shakeel Akhtar was awarded the “best CIO – Private Sector” by P@SHA ICT Awards 2009. He

was the first cover CIO of the local edition of the magazine, CIO Pakistan.

14
Team Members:

CIO Shakeel Akhtar

System Administrator Khalid Mehmood
Senior Programmer / Analyst Asif Shaikh
Programmer Abdul Karim
Oracle Programmer Junaid Noor Siddiqui
Assistant Programmer Athar
Network Administrator Khalid Asghar
Hardware Support Engineer Kashif Mehmood
Hardware Support Engineer Fahim

Identification of Information Needs:

The records or documents that are needed to be stored or worked on are5

Patient Medical Record

• Patient History

• Examination Notes

5 Reference: http://www.pkeducation.com/iba/spring-2009/e-commerce/wp-content/uploads/pakistans-
first-paperless-hospital-management-system.pdf

15
• Consultation Notes

• Consultant / Physician Orders

• TPR & BP Charts

• Fluid Balance Chart (Intake / Output)

• Ward Management

• Clinical Summary

• Medication Order

• In-Patient Progress

• Anesthesia Checklist

• Complication during hospital stay (incident reporting)

• Pre / Post Surgical Check List

• Pre / Intra OP / Post OP Anesthesia Record

• Operation Notes

• Nursing Notes

• Dialysis Session Record

• Lithotripsy Session Record

• ICU monitoring Charts

• Blood Sugar / Blood Gases Record

• Blood Transfusion Record

• Discharge Summary

Medical Services / Investigation Record

• Laboratory Investigations (Various kind of International standard reporting)

• Radiological opinion (X-Ray, Ultrasound, MRI, & CT Scan), (Films and Reports)

16
• Non-Invasive Cardiology (ECG, ETT and Echocardiography) results

• Invasive Cardiology (Angiography) reporting

• Departmental statistical analysis reporting

Administrative Information / Module

• In Patient / Out Patient Billing / Costing systems

• Employee Record (Time System, Payroll and HR)

• Financial Information (GL, Fix Assets, Budget)

• Procurement Information (Purchase and Payable Information Reports)

• Inventory Reports and Ledgers

• And many more.

THREE STEPS IN ONE:

(Acquisition, Organization, maintenance and storage, Information dissemination)

The IT team of Indus Hospital along with the doctors has developed customized software which

collects, creates, stores, organizes, maintains and disseminates information. Let’s take an

example of a patient medical record. When a patient enters the hospital he is first taken to

Community Health Centre aka Filter Clinic. The person attending the patient there takes data

about the illness of the patient, past history and personal information such as age etc. The

attendant then enters the information directly on to the computerized medical record chart, which

is stored on a computerized database. Then the patient is referred to specialist clinic regarding his

problem. If the patient is admitted, notes are taken about dosage of drugs, treatment progress and

all the fields mentioned previously under the heading of ‘Identification of needs’, are stored,

managed and organized in a database using the software.

17
Similarly, administrative information is also recorded and stored through

the software and kept in the database. Other than providing an efficient

means of monitoring day to day patient progress, this System has the

huge benefit of facilitating audits and clinical research6.

At Indus paper is used for just the following three documents:

1. Patient card (issued to the patient)

2. Concern form

3. Discharge summary

6 Reference: http://www.pkeducation.com/iba/spring-2009/e-commerce/wp-content/uploads/pakistans-
first-paperless-hospital-management-system.pdf

18
Authorization:

There are approximately 300 workstations in the hospital and the person sitting at every terminal has access to

information according to his/her information needs. Every employee has been given an ID and password by the

HMIS department without which they cannot access their terminal.

7 Reference: http://www.pkeducation.com/iba/spring-2009/e-commerce/wp-content/uploads/pakistans-first-paperless-
hospital-management-system.pdf

19
There are a total of six servers namely:

 Authentication Server

 Main Database Server

 Backup Domain Server

 Images Server

 File and Mail Server

 FTP Server (outside)

The users ID and passwords are passed through the authentication server before the users can then access the

information they want, and are authorized for, from the other servers. Indus uses Oracle to limit access to users.

Each of the users is to give attendance to the system via thumb prints, to access their terminals. The users

cannot access their workstations without giving attendance. This proved to be an effective way to encourage

older employees to give their attendance and break the ritual of skipping attendance

Information Deletion:

All the hospitals around the globe are required to keep the patient’s information till ten years after the death of

him/her. Thus deletion is rare at Indus. Other information regarding employees is also kept in their database

even until after the employee has left.

System Implementation Threats:

These are few of the problems that needed to be encountered

 Management Commitment

 Non Computer literate user

 User acceptance

 Cost of Hardware (Computers and other Peripherals)

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Implementation Strategy:

These are the ways through which they encountered the problems

 Modular Implementation of HMIS

 Defined user accessing privileges

 As per user rights, two session Training Plans for End User(morning session)

• HMIS Training (morning session)

• Computer Literacy and Keyboard awareness (post lunch session)

 Continues education and updates to end users

 Motivations

Through this strategy they have successfully managed to make their employees accustomed to HMIS, whether

they are less of age or more of age, which is a very big achievement.

How does the software look like?

21
 This picture shows the fields of information that are gathered and stored for an OPD patient.

This picture shows how records of medicines that has to be taken by the patient are stored and viewed through

the software.

22
We have here a sample X-ray report. As we can see it is easier to analyze the report as we can do things like

zoom in, increase brightness etc to see detail which simply is not possible to see in a physical x-ray.

This is how reports are viewed on the system.

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24
 INDUS HOSPITAL RESEARCH CENTER (IHRC)

Indus Hospital has entered into a strategic partnership with IRD (interactive research development), a non-profit

research and service organization committed to saving lives through improvements in global health. IRD seeks

to create opportunities for scientists and social entrepreneurs that maximize the impact of health interventions in

low-income communities. Indus Hospital and IRD have established the joint Indus Hospital Research Center,

IHRC for short, focused on the following areas.

• Center for Community Development (CCD):

It implements programs to help improve health and increase economic opportunities for low-income

households. CCD is collaborating with Partners in Health to design and implement the “Community Outreach

Program” (explained ahead) at the Indus Hospital.

• Center for Injection Safety:

It works to prevent the reuse of needles and syringes in health care settings, the driving force behind the

Hepatitis C and B epidemics in Pakistan. CIS has trained over 700 paramedical staff and administrators at 25

major hospitals and has conducted advocacy workshops for general medical practitioners in over 10 cities. CIS

partners include Becton Dickinson and the Infectious Diseases Society of Pakistan for advocacy and training,

and the Safe Injection Global Network (SIGN) at the World Health Organization for research.

• Center for Clinical Trials:

It helps cessation of smoking in patients with myocardial infarction which is a type of heart attack8.

COMMUNITY OUTREACH PROGRAM

8 Reference: http://indushospital.org.pk/index.php

25
The Community Outreach Program is being developed in collaboration with Partners in Health to provide

volunteer-based health and social services to a population of 2.4 million. The program is being implemented by

an Indus Hospital team led by IRD and will expand outwards from the localities immediately surrounding Indus

Hospital. The program aims to provide sustainable, volunteer-based health and social services at the door step

through.

• Household Registration and Follow-up:

All households in the service population will be registered through a baseline census, and will be assigned a

unique identification number. A “household” is defined as a family group that shares a cooking stove.

• Disease Prevention and Control:

This service is designed to prevent the most common causes of childhood and adult deaths in low-income

communities, primarily through vaccination and other low-cost strategies. High priority diseases include

pneumonia, diarrhea, tuberculosis and malaria.

• Integrated Microfinance and Health Insurance:

This service integrates micro finance products with volunteerism and health interventions. This initiative aims

to provide health safety nets to increase utilization of microcredit loans and improve the productivity of the

individuals and families9

9 Reference: http://indushospital.org.pk/index.php

26
  The DOTS Program

The Indus Hospital, in collaboration with the National Tuberculosis Program (NTP), has established a DOTS

(Directly Observed Therapy Short-course) Program for the management of TB patients according to WHO

guidelines. Free TB medications are provided to Indus Hospital by the NTP for all patients in the DOTS

program. The DOTS team comprises of clinicians, microbiologists and coordinators who make sure that

patients come for regular follow-up appointments, and ensures daily uninterrupted supply of medications with

the help of treatment supporters.

 The DOTS-Plus Program

Faced with the high burden of MDR-TB patients in the regular TB population, a free comprehensive

community based

MDR-TB control program was developed by the Indus Hospital in collaboration with IRD, Sindh Government

Hospital New Karachi, and the Marie Adelaide Leprosy Center. Key components of this program include free

monthly consultation,

investigations, and counseling; free medications; household mapping and screening of close contacts; daily

observation of treatment; and social support program to encourage adherence to treatment. The program follows

guidelines developed by Partners In Health (PIH) which has successfully implemented MDR-TB management

programs in Peru, Haiti, Lesotho and Siberia proof that community-based control of MDR-TB has been highly

successful in resource-poor settings such as Karachi10.

Mapping:

10 http://indushospital.org.pk/downloads/newsletter/ih_newsletter_julsep2008.pdf

27
The IHRC have acquired GPS coordinates of all major landmarks around hospital for example GP clinics, EPI

clinics, maternity centers etc. Moreover the provided each residential structure with a unique identification

28
number and associating each unique identifier with a gas meter number(s)

29
The picture below shows the individual level GIS (geographical information system) mapping and tracking they

are doing in their DOTS program (TB control program by WHO). They currently have 101 persons that have

either completed treatment or have defaulted, transferred out, or died. The slide shows some of these persons

being tracked at home. They can access full record of a patient by clicking on the circles or squares of him/her.

30
The MDR-TB (multi-drug resistant tuberculosis) patients who are to be administered at home are given Nokia

sets, which are kiindly donated by Nokia, are programmed such a way that when a pateint takes a dose, the time

and other details of the dose are entered in the mobile set and recorded in their datbase directly from the field. A

person from the hospital called treatment supporter goes personally to give the dosage to the pateint. Below it is

shown how the information is entered into a mobile phone.

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FOOD ASSISTANCE PROGRAM

MDR-TB patients have to take several medicines for a period of 24 months, and often have side effects. A large

number of our patients are the sole breadwinners of their family and are unable to work and provide for their

families. The DOTS-Plus Program at the Indus Hospital delivers free monthly food rations for a family of 6 to

the home of each patient for 24 months. These monthly food rations have a major impact on improving cure

rates by providing better nourishment for the patient and serving as an incentive to comply with drug treatment.

Each food basket contains

20 Kg Flour

5 Kg Rice

4 Kg Lentils

4 Kg Sugar

5 Ltr. Cooking oil

1 Kg Powdered milk

http://indushospital.org.pk/downloads/newsletter/ih_newsletter_julsep2008.pdf

32
 Shamaon Sadiq is a 36 year old factory

worker who has been hypertensive for the

past 10 years. He is married with 2 children

and the sole bread earner for his family. He

was diagnosed to have chronic renal failure

1 year ago. He was started on dialysis at a

private hospital but was unable to continue

due to financial constraints. He has been on regular dialysis at the Indus Hospital since March 2008.

Providing dialysis to one patient costs the Indus Hospital an average of Rs. 36,000 per month. In the last one

month alone, the Indus Hospital has spent Rs. 1,558,644 on dialysis – with no fee charged to the patients.

Have we ever given a thought that how easily we spend a crisp note of thousand rupees for an average meal at

tha Pizza Hut or McDonalds? If 100,00 people join hands and commit the same note of thousand rupees to

33
Indus hospital, then all expenses of Indus hospital can be easily covered. That same note of thousand rupees can

help save a lot of lives.11

So join them in their vision to help humanity and achieve their ultimate goal that is Raza-e-Ilahi!

11 http://www.indushospital.org.pk/downloads/newsletter/ih_newsletter_julsep2008.pdf

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35
 CONCLUSION

In our report we have highlighted the increasing impact of ICT on the way firms are managed and operated in

today’s technological world. Following advantages can be attributed to the use of IT in managing businesses.

ADVANTAGES

1. Technology has made companies more accessible and available both to consumers, suppliers and

employees.

2. The speed of business operations, research and decision making has increased immensely.

3. The costs for companies fall including marketing, transaction, production and communication costs.

4. Firms do not have to relocate or shift employees from one country to another, saving more costs.

5. The companies are becoming become wireless and more virtual. They are able to attract more customers

and thus increase the profits.

In modern times the mangers are over loaded with information. This has increased the burden on them and

better techniques are needed to manage the information and use it appropriately. This is why the concept of

ILM is extremely relevant and important nowadays.

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The example of INDUS HOSPITAL shows that how businesses can improve their performance greatly by using

information management lifecycle. They can better manage information, extract the relevant knowledge and

apply it to make sound strategic decisions. Moreover ILM helps firms to reduce their costs significantly and

hence improve profits.

The example also shows how an organization can reap the fruits of IT and gain countless and endless benefits

from it.

So it is imperative that more and more Pakistani firms should learn from this example and make efforts to

implement Information management technology in their companies.

REFERENCE LINKS

1. Reference: http://en.wikipedia.org/wiki/Information_technology_management

2. Reference: http://en.wikipedia.org/wiki/Management_Information_Systems

3. Reference: Book ‘Management’ by Danny Samson & Richard L. Draft

4. Reference: http://indushospital.org.pk/images/stat_report09.pdf

5. Reference: http://www.pkeducation.com/iba/spring-2009/e-commerce/wp-

content/uploads/pakistans-first-paperless-hospital-management-system.pdf

6. Reference: http://www.pkeducation.com/iba/spring-2009/e-commerce/wp-

content/uploads/pakistans-first-paperless-hospital-management-system.pdf

7. Reference: http://www.pkeducation.com/iba/spring-2009/e-commerce/wp-

content/uploads/pakistans-first-paperless-hospital-management-system.pdf

8. Reference: http://indushospital.org.pk/index.php

9. Reference: http://indushospital.org.pk/index.php

10. Reference:

http://indushospital.org.pk/downloads/newsletter/ih_newsletter_julsep2008.pdf

37
11. Reference:

http://www.indushospital.org.pk/downloads/newsletter/ih_newsletter_julsep2008.pd

38