IoT-based Cardiotrack redefines dynamics of telemedicine

By Anusha Ashwin

For many years now, the incorporation of information technology and telecommunication in the field of medicine has broken grounds and is doing wonders. But! Deploying those technologies do have limitations in a country like India where the medical infrastructure and facilities are categorized into many types. Currently, med-tech entrepreneurs are interested in developing cost-effective devices for Primary Health Centers, where majority of the Indian population seek medical assistance. As primary health care centers are largely ill-equipped in taking life-saving decisions, especially cardiovascular related diagnosis, startup entrepreneurs have found a large untapped market to develop IoT-based devices that can help doctors diagnose better.

Ashim Roy and Avin Agarwal are among those startup entrepreneurs who saw tremendous opportunity in combining their information technology knowledge with medical technology to create an IoT device suited for primary health care centers.

Both Roy and Agarwal combined their expertise to form a healthcare diagnostics company called uber Diagnostics with Cardiotrack as their flagship product. The entrepreneurs incorporated the company in 2014 with a mission to reduce the cost of diagnosis through innovation in product design and enhancements in healthcare workflow. As the key challenges faced by healthcare providers include high cost of diagnostic equipment and lack of trained professionals, especially in semi-urban areas, uber Diagnostics is addressing both these issues through an evolved technology in medical electronics, data analytics, cloud storage and diagnostics workflow management. Co-Founder Ashim Roy, shares the technology; working of the product, its reach; and future plans in an interaction with Voice&Data.

How it all began?

After spending 30 years in Australia, Canada and USA, Roy returned to India in early 2007. During his first year on comeback, he travelled extensively in rural parts of Karnataka for the deployment of e-Government services. While traveling, he learnt first-hand, the need for better primary care facilities, access and affordability for better healthcare services. “In India, healthcare technologies have remained largely disconnected from information technologies. This is one of the reasons healthcare technologies have not followed Moore’s Law that states that cost of technology comes down and performance improves by a factor of 2 every 18 months. For healthcare technologies and services to achieve this trend, IT has to be an integral part of any healthcare solution. Combination of healthcare and IT can do wonders to healthcare services and make healthcare affordable and accessible for all,” Roy begins expressing about the thinking behind uber Diagnostics.

Introducing uber Diagnostics further, Roy says, “In 2012, my co-Founder Avin Agarwal and I were helping a group of NGOs. That chance meeting led to multiple discussions about healthcare, and finally led to the incorporation of Cardiotrack, on Valentine’s Day in 2014. Cardiotrack idea was the result of discussions between Avin Agarwal and researchers at St. Johns Research Institute in Bangalore. The problem Cardiotrack is trying to address is lack of diagnostics capabilities at primary healthcare centers (PHC) – equipment and expertise. Cardiotrack solves those problems by developing robust and clinical grade diagnostics platform that is easily portable and affordable and it allows diagnostics data to be shared instantaneously with a specialist hundreds of miles away.” 

IoT Informatics Platform

Cardiotrack is an IoT-based healthcare informatics platform. In fact, IoT is integral part of the name – Cardiotrack. The device uses AI to analyse the Echocardiogram (ECG) waveform for instance interpretation. The platform is designed to fulfil all the basic requirements of a primary care clinic. Using Cardiotrack, doctors can detect heart health problems, consult specialists, refer and track patients, maintain medical history and start the intervention process. The platform includes multi-parameter, light weight healthcare IoT devices and mobile health software that helps to screen illnesses such as cardiovascular diseases and hypertension and helps doctors to perform diagnosis and then safely store the patient records.

Cardiotrack solution has four major components:

Cardiotrack Sensors: Cardiotrack provides complete 12-channel diagnostic grade ECG integrated with sensors to monitor blood oxygen saturation and blood pressure.

Cardiotrack Mobile App: App displays, analyzes and stores the patient’s diagnostic reports.

Cardiotrack Cloud Service: This provides a secure storage of patient records on a private cloud.

Cardiotrack Intervention: A tele-intervention platform that allows the physician to connect with specialists and hospitals to initiate intervention.

The patient’s health information is captured at the Primary Healthcare Center (PHC) by primary care physician using the sensors. This information is displayed on a phone or a tablet. The information may be shared with a cardiologist or a specialist for next level of intervention. The patient record is securely saved in a cloud server for future use.

There are two key features in the device that assist in diagnosis:

Cardiotrack-AI: Based on the AI, the device can provide interpretation of captured ECG signal instantaneously. This avoids the need for detailed ECG knowledge at the primary care level. This will speed up the intervention process and can use the cardiologist’s time efficiently.

Cardiotrack-DA: All patient data is automatically saved at the cloud server. The Data Analytics (DA) engine at the cloud server analyses the aggregate information from all primary care physicians and provides a health demographics that identifies prevalence of heart health problems in specific geographies, by gender, by age and other information that could be used by healthcare planners to improve services based on direct healthcare information not just surveys or guesswork.

Roy, commenting on the combination says, “AI and DA will be a game changer in healthcare services in India and many other countries around the world. I am confident that Cardiotrack will gain traction in the market owing to its affordability, ease of use and mobility that the product renders to its users. Most of the expensive health diagnostics products can only be operated in hospital environments, which are air-conditioned. However, the working environment at primary care facilities in the developing economies is different. The diagnostic sensors used in Cardiotrack, function at extreme temperatures and dust ridden and humid environments. The Cardiotrack tele-intervention platform is built to overcome limited availability of specialists, lack of transportation infrastructure and power breakdowns that are common constraints in emerging economies and provide effortless remote patient management and disease care.”

In September 2015, Cardiotrack launched its diagnostics solution, a 12-lead ECG monitor. Since its launch, the company has deployed more than 100 devices, mainly in NCR, Bengaluru and Gujarat. Most of the company’s deployments are in tier-1/2 cities with less than 5% in tier-3/4 cities. 

Investor-backed; international presence; clear revenue model chalked

uber Diagnostics has three parts to its funding. Roy and Agarwal initially funded operations of the company for a period of 2 years from late 2012 through early 2015. In mid-2014, the company took a line of credit as the working capital to help with manufacturing. In mid-2015, equity funds were raised from HNI angel investors, which was used for R&D and initial sales and marketing. In 2016, additional equity funds were raised. Roy says 50% of the investments are from Singapore and the remaining from North America and India. The total equity investment in the company so far is $650,000.

Quoting the numbers, Roy says, “Cardiotrack was launched in Sept 2015 and sales in FY 2015-16 was $74,000. I am expecting it to clock $250,000 for FY 2016-17. Our product has been sold in many countries, however active engagements are in India, Myanmar, Indonesia, Mexico and USA. The company received initial exposure in ASEAN market through our investors. Subsequently, we have managed to connect with potential customers in USA and Mexico. The key to our international presence has been high level of support that we have provided in early days of engagement. This has helped in building rapport with our customers. We believe this model can be replicated in other regions, globally. However, we do not want to spread too thin and hold back on some of the interest we find in regions other than ASEAN and North America.”

Cardiotrack, in a short time, has gained international recognition and has won accolades. Sharing an interesting testimonial, Roy, shares, “Open Source Maker Labs (OSML), USA wanted to do a product demo for a ship in Cartagena, Colombia. We had shipped the Cardiotrack units to them ahead of time. The day before the ship sailed from the port, we had one-hour video call with the paramedics on the ship to provide training. After the ship sailed we provided the paramedics support via WhatsApp. OSML team was really impressed with the level of support and how well the equipment worked to capture patient records on-board the ship and transmit the information via Satellite-Internet to OSML HQ in Fairbanks, Alaska. Tim Baker, Founder of OSML personally called me to say, ‘Cardiotrack is a great solution for 12-lead ECG’.” 

International tie-ups; product pipeline and expansion

Cardiotrack has chosen global technology partners rather quickly. Roy says, “Our clinical advisor is Dr Jonas de Jong, a cardiologist based in Amsterdam. We are working with Cardiologs, a French AI company to provide robust AI assisted interpretation. We are working with a team of scientists in Israel for the next generation healthcare IoT solution in diabetes. And, we have collaboration with UK-based clinical trial company – Onorach, to ensure that our products are put through a rigorous clinical trial. In India, we are working with some of the regional engineering colleges to identify talent to expand our team. We have an innovative internship program that allows students to work with us as interns during third-year of their engineering curriculum.”

Roy says that the Cardiotrack team is continuously enhancing the platform to provide better solutions to its beneficiaries – healthcare providers and patients. There are number of initiatives in the pipeline:

With Cardiotrack-AI, the team is combining with a group of French AI experts to bring AI technology to India at a cost that is affordable. The outcome of this collaboration is expected to further reduce the intervention time by providing the primary care physician with instantaneous report on cardiovascular problems based on the ECG report generated by Cardiotrack.

On the other hand, with the aid of Cardiotrack-Data analytics (DA) the plan is to generate advanced health demographics map that can be used for better healthcare planning.

Around June-July 2017, Cardiotrack will have a Patient App to help patients in all their healthcare management. Roy indicates that the App will provide full access to the patient records and ability to share the information with healthcare specialists or family members. Also, there will be significant discounts for patients when they visit a doctor who is part of the Cardiotrack network of primary care physician and specialists.

Parallelly, Roy is also exploring Real-time Communications; a solution in soft-launch stage right now is being tried out by some of his key customers. When launched, the feature will allow primary care physicians to share the patient record in real-time with a specialist and initiate audio/ video call to help speed up the intervention process. Cardiotrack is also working with Cook Medical to co-develop a new product for the hospital market.

As all of these plans unfold, Roy has not overlooked the rural market for increasing sales. He believes, “Telemedicine is the way to go for delivering healthcare services to remotest areas. However, there must be telecommunications infrastructure without which the ‘tele’ part of the telemedicine is missing. Once the infrastructure is available, Cardiotrack with its AI and Data Analytics platform is ready for any deployment. While we are waiting for such infrastructure to improve, we are deploying our solutions in tier-2/3 cities.”