Health­care’s Big Leap

The Economic Times - - Power Of Ideas -

Dr Vani Raviku­mar has been a pathol­o­gist for al­most three decades. Her daily rou­tine in­volves go­ing through sam­ples, one af­ter an­other, one af­ter an­other, day in and day out. Re­cently, Ben­galuru-based AIn­dra, an ar­ti­fi­cial in­tel­li­gence-based cer­vi­cal cancer screen­ing startup, reached out to her. Its propo­si­tion was sim­ple—ap­ply AI to screen and iden­tify sam­ples. Only those sam­ples in­di­cat­ing a risk of cancer would be sent to the ex­perts for fur­ther ex­am­i­na­tion.

“My first thought was, ‘you are go­ing to re­place me, your al­go­rithm will say if cancer is present or not.’ If the com­puter does this job of mine, what will hap­pen to me? You are try­ing to pull me out of my seat,” said Raviku­mar, co­founder of Kar­nataka-based di­ag­nos­tic chain RV Me­trop­o­lis.

Af­ter a few more in­ter­ac­tions, Raviku­mar’s ap­pre­hen­sions be­gan to wear out. Screen­ing by AI, she sensed, could help her ex­am­ine more sam­ples in less time as the al­go­rithm would al­low her to con­cen­trate on the ones that re­quire her ex­per­tise. “In the hands of clin­i­cians, it will be­come a force mul­ti­plier, it will make them su­per­men,” said Adarsh Natara­jan, co­founder of AIn­dra.

AIn­dra is one of a hand­ful of star­tups that are push­ing the en­ve­lope ap­ply­ing emerg­ing tech­nolo­gies such as ar­ti­fi­cial in­tel­li­gence, vir­tual re­al­ity and 3D print­ing to health­care.

TECH ON THE TA­BLE

This new wave of emerg­ing health­care tech­nolo­gies prom­ises some­thing unique—real-time and per­son­alised care. “Doc­tors do not know what is hap­pen­ing in re­al­time. Imag­ine that a pa­tient has suf­fered a series of car­diac at­tacks. (Now) I am see­ing a pat­tern and I can say he is go­ing to go down in three hours. You can now do what you need to do, (say) with­draw or add a cer­tain drug,” said Sud­hir Bor­gonha, co­founder of ten3T.

The com­pany makes ‘Cicer’, a 9 cmwide wear­able patch with mul­ti­ple em­bed­ded sen­sors. Cicer, which can fit into an adult’s palm, tracks ECG and res­pi­ra­tion and rhythm anom­alies in real-time. Sig­nals are gath­ered from the patch, in­te­grated and then trans­ferred re­motely to doc­tors. ten3T is also work­ing on in­te­grat­ing tem­per­a­ture, oxy­gen sen­sors and a way to track blood pres­sure in real-time.

Both glob­ally and in In­dia, the health­care startup ecosys­tem is ad­vanc­ing from one break­through to an­other. Us­ing ad­vanced tech­nol­ogy that were more in the realm of aca­demics, say, even a decade ago, star­tups are de­sign­ing ar­ti­fi­cial limbs specif­i­cally suited to one’s body type and struc­ture; en­abling stu­dents wear­ing VR head­sets to ob­serve surg­eries as if they were stand­ing next to the sur­geon; and de­vel­op­ing var­i­ous pre­dic­tive and di­ag­nos­tic ap­pli­ca­tions.

Sin­ga­pore- and Ben­galuru-based Su­per­craft 3D, funded by Flip­kart co­founder Binny Bansal, among oth­ers, de­vel­ops pa­tient-spe­cific vi­su­al­i­sa­tion tools that pro­vide hospi­tals, doc­tors and aca­demics deeper per­spec­tive about the hu­man anatomy.The­com­pa­nyal­so­makes ad­di­tive man­u­fac­tured cus­tomised body im­plants us­ing bio-com­pat­i­ble ti­ta­nium al­loy. “The unique­ness of 3D print­ing is it is de­signed for in­di­vid­ual ap­pli­ca­tion. One rea­son why we started was that the rest of the world was get­ting into this tech. A coun­try like In­dia has unique di­ver­sity and body struc­ture. We felt there was a unique op­por­tu­nity. 3D print­ing al­lows cus­tomi­sa­tion of ser­vices and at an af­ford­able cost hith­erto not pos­si­ble in In­dia,” said Mal­tesh So­masekharap­pa, co­founder of Su­per­craft 3D.

If Su­per­craft 3D is into cus­tomis­ing body im­plants, Pan­do­rum Tech­nolo­gies is into 3D print­ing of tis­sues. While the im­me­di­ate busi­ness use case is for pharma com­pany re­search, the next step is hu­man im­plan­ta­tion. “We were fo­cussing on the liver tis­sue ini­tially. It was closer to our rev­enue stream. We are mov­ing to other tis­sues. We are work­ing on cornea im­plants, now. We are into tis­sues be­cause for pharma com­pa­nies, who need to test a lot of drugs, they need it for re­search. Us­ing the same tech­nol­ogy plat­form, the same tis­sue can be used for hu­man im­plan­ta­tion, but that is a slightly long term plan,” said Arun Chan­dru, chief ex­ec­u­tive of Pan­do­rum Tech­nolo­gies.

Ac­cord­ing to Geetha Man­ju­nath, chief ex­ec­u­tive of Ni­ra­mai, a breast cancer screen­ing startup, AI can also help bridge the skill gap in the coun­try. “In emerg­ing mar­kets, (a lack of) skill sets is an is­sue. Hav­ing tools that are AI-en­abled will en­sure that even lowly skilled peo­ple can take hard de­ci­sions. The AI tool will tell the per­son if the con­fi­dence in a de­ci­sion is low, in which case the tech­ni­cian can call in the highly skilled doc­tors. It also helps to im­prove the ef­fi­ciency of the ex­pert as his time is used only in im­por­tant cases,” she said.

Ni­ra­mai is build­ing a non­in­va­sive, non-touch, non-ra­di­a­tion ap­proach to de­tect breast cancer. The startup’s hard­ware-soft­ware tech­nol­ogy so­lu­tion, called Ther­m­a­lytix, uses ar­ti­fi­cial in­tel­li­gence over ther­mal im­ages for early de­tec­tion of breast cancer and re­moves tech­no­log­i­cal, lo­gis­ti­cal, and cul­tural bar­ri­ers that hin­der breast cancer screen­ing.

REACH­ING FAR AND WIDE

In­dia’s health­care sys­tems are con- cen­trated in the cities, and large hospi­tal chains and other med­i­cal cen­tres are vy­ing for the same pie. Star­tups work­ing with new, emerg­ing tech­nolo­gies could open up a larger and mostly un­ad­dressed de­mo­graphic that des­per­ately needs per­son­alised and low-cost health­care. “Large ex­pen­sive sys­tems are not suited for emerg­ing mar­kets be­cause ac­ces­si­bil­ity is very low. Far­ther down from ur­ban cen­tres, peo­ple do not have ac­cess to high­qual­ity health­care. Legacy sys­tems are cen­tralised. Tech­nol­ogy that en­ables health­care sys­tems to be de­cen­tralised are the ones that will drive the ac­ces­si­bil­ity part of the equa­tion. Since all peo­ple can­not come to ur­ban cen­tres, qual­ity health­care needs to be taken to the peo­ple,” said Natara­jan of AIn­dra. “All health­care play­ers are fight­ing for an over­sat­u­rated mar­ket. But there are mar­kets that do not have ac­cess to th­ese fa­cil­i­ties.”

This can be made pos­si­ble without hospi­tals or doc­tors hav­ing to pay a bomb to add or up­grade in­fra­struc­ture. Ex­pand­ing or reach­ing re­mote cen­tres can be as easy as up­dat­ing an app on your per­sonal smart­phone. “(The so­lu­tion) will be digi­tised, a cloud-based plat­form. It will ex­tract ob­jects of in­ter­est and the AI model will gen­er­ate a holis­tic re­port and not just num­bers. If you have to add new fea­tures, (you) up­grade the model on the cloud,” said Ro­hit Ku­mar Pandey, CEO of SigTu­ple.

The core prod­uct of SigTu­ple is Man­thana, which us­ing vis­ual med­i­cal data such as blood sam­ple im­ages can clas­sify var­i­ous ob­jects of in­ter­est, de­tect dis­eases if any, and com­pute the met­rics for re­port­ing. The met­rics pro­vided by the plat­form are sup­ported by vis­ual ev­i­dence, which elim­i­nates the need for a med­i­cal ex­pert to be phys­i­cally present next to a pa­tient, med­i­cal de­vice or bi­o­log­i­cal Dr An­shu Ma­ha­jan, an as­so­ciate con­sul­tant fel­low in the depart­ment of neu­roin­t­er­ven­tion surgery at Medanta, a med­i­cal col­lege and hospi­tal, uses Buz­z4health’s VR tech­nol­ogy to learn com­plex pro­ce­dures. “I am a trainee in this field. I wanted to have a feel of the equip­ment and the pro­ce­dure. With VR, I can re­move the risk of mis­takes, it helps build con­fi­dence. Be­fore go­ing into ac­tual prac­tice, we can do it in a safe way. It is a teach­ing aid. It is help­ful for trainees and res­i­dents to see and feel the depth of per­cep­tion in this com­plex pro­ce­dure,” he said.

Buz­z4health is work­ing on more tools. “We want to do a mix of VR and AI. We can cus­tomise user­ex­pe­ri­ence. For VR, we are work­ing with doc­tors and try­ing dif­fer­ent con­cepts. With VR and AI, we can look at prob­lems across the jour­ney of a pa­tient’s life,” said Gan­joo.

Gan­joo and his team have tied up with hospi­tals to cre­ate in-house VR labs. The idea is to pro­vide im­mer­sive and ex­pe­ri­en­tial train­ing and ed­u­ca­tion for doc­tors and paramedics so they can learn (Mum­bai, 2015, Ke­mark Ven­tures Zishaan Hay­ath Amit Ran­jan

(Ban­ga­lore, 2014,

Vill­gro In­no­va­tions Foun­da­tion

(Chen­nai, 2011, Undis­closed)

Depart­ment of Biotech­nol­ogy co­founder, AIn­dra CEO, Ni­ra­mai through sim­u­la­tions. The startup is also in early-stage talks with a ma­jor med­i­cal tech­nolo­gies firm to sim­u­late con­di­tions in emer­gency or in­ten­sive care units. If the deal goes through, the firm’s de­vel­op­ment teams will be able to use Buz­z4health’s tech­nol­ogy to un­der­stand ICU en­vi­ron­ments and de­sign prod­ucts.

For Man­ish Sing­hal, found­ing part­ner of AI and IoT-fo­cussed fund pi Ven­tures, the emer­gence of such tech­nolo­gies is a “leapfrog mo­ment in health­care.”

“If (the star­tups) get it right, and mar­ket adop­tion hap­pens, th­ese com­pa­nies will be­come valu­able. (This is) def­i­nitely early, but we are see­ing some re­ally good work. As com­pared to the Val­ley, it is def­i­nitely early, but the growth rate is rapid,” he said.

The rapid growth rate could po­ten­tially mean that In­dia could give unique ideas for deal­ing with com­plex med­i­cal prob­lems. “Mon­i­tor­ing will rapidly be­come main­stream. Di­ag­nos­tics, say pre­dic­tive ones like ‘I will have a heart at­tack’… that will re­quire a test­ing, say, two-three years un­til doc­tors trust it. Tech in In­dia is be­com­ing more com­mon, a lot of heavy data is com­ing into play. In­dia is not a fol­lower of the West. It is, in fact, a leader be­cause of the vol­ume. In­dia will be­gin to play a big­ger lead,” said Bor­gonha of ten3T.

But there are road­blocks in terms of ‘trust is­sues,’ such as ac­cep­tance from pa­tients who might want doc­tors to be phys­i­cally present, and the el­derly, who are likely to have an aver­sion to­wards tech­nol­ogy. “Cul­tur­ally, the feel of a doc­tor is im­por­tant and the el­derly, who need care more, will be less adap­tive to re­mote care. In­cen­tive model of provider and emo­tional con­tent­ment of pa­tient is also a part of this,” said Mu­ralid­ha­ran Nair, part­ner, Life Sciences, EY In­dia.

Nair be­lieves In­dia is dif­fer­ent from ad­vanced economies in terms of med­i­cal tech­nol­ogy as the coun­try is seek­ing to solve core is­sues such as ac­ces­si­bil­ity and af­ford­abil­ity. “Our key driver is af­ford­abil­ity,” he said.

The rapid growth rate could mean that In­dia could give unique ideas for com­plex med­i­cal prob­lems In emerg­ing mar­kets, (a lack of) skill sets is an is­sue. Hav­ing tools that are AI-en­abled will en­sure that even lowly skilled peo­ple can take hard de­ci­sions

COM­PANY IN­VESTOR IL­LUS­TRA­TION: ANIRBAN BORA

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