Dissecting India’s Healthtech
India's healthtech startups were growing rapidly even before the pandemic, but Covid-19 has ushered in a new age. This series dives into the trends, startups business models emerging in the wake of Covid-19.
[playht_player width=”100%” height=”175″ voice=”Jessica”]Cartoonists find a way and a sense of humour even in times of crisis, or perhaps particularly so. Editorial cartoonist Satish Acharya recently sketched the state of India’s fight against Covid-19 and preparation in the form of lockdown. Well, as he rightly pointed out, the lockdown may have delayed the climb of cases, but India is still not clear of Covid-19, as many countries have become over the past month. With the third-highest number of Covid-19 cases in the world, Indian healthcare has been stretched to its limits by the pandemic.
Given the gravity of the situation, the Indian government has taken a host of healthcare policy initiatives which had been locked up in various drawers in the ministry of health and family welfare and ministry of electronics and information technology. This includes financial standing committee approval to National Digital Health Blueprint 2019, telemedicine guidelines approval and IRDAI’s order to insurers to extend insurance on tele-consultancy as well.
Efforts have also been made to seek greater support from private healthcare providers, especially healthtech startups. Startup India under the DPIIT started conducting webinars to offer strategic mentorship to healthtech startups, helping incubators go virtual. It also organised open challenges and offered funding to startups who wanted to offer innovative solutions against Covid-19 pandemic.
While a huge number of solutions have come up to help fight the hygiene battle, bring genetic testing data up to par with global standards and more, there are several startups that have flown under the radar as well. Inc42 has handpicked six such startups that have come to be unsung heroes in India’s fight against Covid-19.
Dozee: India’s Only Contactless Health Monitoring System
One of the biggest issues with Covid-19 treatment is that doctors and nurses that come into close proximity to patients are also at the danger of spreading the disease. Diagnostics and treatment of patients have become even more complicated with medical practitioners being discriminated against by landlords as well as other business owners. Bengaluru-based Dozee is looking to help doctors minimise all tough contact with patients with its contactless health monitoring system.
Speaking to Inc42, COO and CBO Pritish Gupta explained that the contactless health monitoring system is a cost-effective solution to monitor a patient’s heartbeat, respiration, risk of heart failure, and other parameters related to sleep and stress level. It reduces the direct contact with patients by manifold. All the caregiver has to do is to place the device below the bedsheet when the patient is not in the ward. The parameters to monitor patients are fetched through sensors and remotely conveyed to doctors in real-time.
Having published a slew of research papers, Dozee has so far applied for three India patents for its innovation and has already received CDSCO’s certification of approval pertaining to the device. Gupta said that besides CDSCO, Dozee has also received the CE mark which is valid in 150 countries and in the EU. The company is now in process to apply for an FDA approval as it gears up to foray into the US market. Currently, Dozee’s accuracy level is said to be 98.4% in heart rate monitoring.
Given the fact that many companies such as Bione could not make it through the regulatory process, what was Dozee’s experience?
“The certification process took 2-3 months. It was relatively easier for us as being a contactless device, it came under the non-regulated category,” Dozee’s Gupta revealed.
The company so far has raised INR 4 Cr from Fund of Funds, Bill and Melinda Gates Foundation and is in the process to close a Pre-Series A funding within a month.
Helping doctors and nurses to maintain social distancing, the device is equally applicable to home healthcare too. “We have started working on around eight hospitals such as AIIMS and Kaveri hospitals that are treating Covid-19 patients. Around 10-15 hospitals are in the pipeline to adopt our solutions,” Gupta told Inc42.
WONDRx: Making Prescriptions Smarter
While Dozee limits how often doctors and medical professionals visit patients, there are other ailments besides Covid-19 to tackle. Writing prescription and handing them over to patients or their caregivers also increase the susceptibility to Covid-19 for those seeking regular medical help.
Having worked in stealth mode for the last three years, Pankaj Sindhu and Pankaj Agrawal have come up with a host of solutions for WONDRx. The Mumbai-based startup helps doctors, as well as patients, practice social distancing even during consultations.
WONDRx’s Smart Rx electronic prescription device digitises a doctor’s handwritten prescription along with voice notes for posterity as well as easy perusal. The startup also claims to have launched India’s first healthtech app which integrates the entire healthcare ecosystem for patients and hospitals.
Talking about the WonDRx Smart Rx platform and the Smart Pen, cofounder and CEO Sindhu explained, “More than 90% of doctors are still handwriting the prescription or typing them. In a country where the doctor to patient ratio and overall health spend is so skewed, we should focus on improving doctor’s productivity, typing or writing reduces this. Plus, the attention of the doctor is more on the laptop screen than the patient. Now, this creates a lot of disharmony between the patient and doctor.”
Sindhu said that WONDRx retains the handwritten prescription as is for the patient and for the purpose of medicine dispensing etc. The format and the information in the prescription is captured for machine readability and is digitised with more than 98% accuracy. Information such as their age and gender, date of consultation, diagnostic tests, videos and more is displayed through the app thanks to the AI engine and machine learning.
“We are looking to focus on the verbal instructions given in local language by the doctor to the patient which are very crucial for treatment success and today no application other than WONDRx, whether handwritten or typed, stores and relays these voice instructions to the patient for medication and instructions compliance at the patient end. With this, we will be able to reduce the treatment errors significantly and save more lives,” Sindhu added,
Cofounder Pankaj Agrawal elaborated that getting a legitimate prescription for re-ordering basic ongoing medicine can be tedious today. The pandemic neither allows patients to step out to collect this from doctors nor can doctors send them digitally, without friction. The bigger pitfall is data retrievability and keeping track of what was given to whom.
“Patients will have access to doctor consultation through our app with an integrated payment gateway, digital prescriptions and the ability to share it with service providers. Every healthcare provider is getting the power of digital at low cost, while every patient is getting easy healthcare access. Each of our products is focussing on ensuring that patients and providers don’t have to meet in person unless mandated by the clinical condition,” said Agrawal.
Qure.ai: ML-Based Covid-19 Monitoring
With AI-based diagnosis making healthcare far simpler in complicated diseases such as Covid-19, startups that empower doctors with machine learning and algorithm-based tools are seeing a big boom. Qure offers an ML-based solution called qXR which quickly segregates patients into groups to make it easier for caregivers to prioritise patients. In the case of Covid-19, it sorts patients into those that need immediate attention and those can live under home quarantine. This helps optimise the available resources in the most adequate manner.
The company has launched qXR, its Covid-19 progression monitoring tool and qScout, a pandemic response care platform in light of the dire need of the hour. Speaking to Inc42, founder and CEO Prashant Warier said, “Our product qXR has been around for four years now, but with regards to Covid-19, we have put another algorithm on the top of it to filter Covid-19-related anomalies.”
Simply put, qXR monitors the progression of infected patients via daily bedside chest x-rays and with an automated readout in seconds without burdening the radiology team. The solution estimates the percentage area of the lung and tracks change with each chest x-ray.
While a confirmed diagnosis of Covid-19 is not possible through a chest x-ray, because it looks like so many other kinds of pneumonia, this still has a use case in triaging and progression monitoring.
Warier elaborated, “In late Feb, we started looking at publications coming out of China about how Covid-19 presents itself on a chest x-ray. It up as opacities and shows up as a bilateral distribution i.e. on both sides of the lungs; it presents as a peripheral distribution more prevalent on the outside of the lungs. Identifying the presence, location and size of opacities was a capability that our qXR solution already had. We packaged all of this information into a Covid-19 score that can classify x-rays into high, medium or low-risk categories and also separate out completely normal chest x-rays.”
In many scenarios, with RT-PCR tests in short supply, the COVID-19 risk score on a chest x-ray, in conjunction with symptoms and other clinical indications, can be used to decide who should be prioritised for testing. Also, by precisely marking out and quantifying the percentage of lung infected, qXR can help measure progression and treatment efficacy.
According to the company, the qXR algorithms have been trained and tested using a growing database (over 2.5 Mn) of x-rays from diverse sources and can detect and localise multiple findings in a chest x-ray including abnormal classification, different types of lung parenchymal opacities, pneumothorax, pleural effusion, cardiac enlargement, and anatomical variations seen in the chest.
“We have also developed qScout chatbot which is based on Q&As with people monitors and maps Covid-19 hotspots. If identified Covid-19 positive the chatbot could automatically send the information to healthcare officials,” said Warier.
With lockdowns in effect across the world and most people isolated at home, it became imperative that governments and health systems track health remotely. Qure’s qScout uses a natural language chat capability to enable WhatsApp chats (also works with other messaging platforms) with self-isolated or quarantined people. It also tracks the progression of their symptoms. “This longitudinal user data is used to triage whether they need to be hospitalized or need to visit a testing center to be tested for Covid-19. The government of Oman saw qScout as a perfect fit to their national Covid-19 response app (Tarassud Plus). We’re helping them manage patients remotely and triage high risk cases using the qScout platform.”
HelpNow: Building An OYO For Ambulances
Amid Covid-19, one of the biggest issues that people have been facing is the lack of ambulances. With the requirements skyrocketing, conventional ambulance operators are not operating in full capacity or in many cases refuse to carry Covid-19 patients. As a result, thousands of Covid-19 patients have died even before they could reach the hospitals.
HelpNow, a startup founded by IIT-Bombay alumni, has come up with an OYO-like model to aggregate ambulances. Catering to all kinds of requirements i.e. basic, ICU, air, hearse ambulance, HelpNow claims to have reached a waiting time of nine minutes within the massive Mumbai city, which has the most number of cases in India. Amid the pandemic, the startup also claims to offer subsidized pricing.
With the thinking that ambulance is not something that one would always require, HelpNow launched a call number instead of an app. Once a user calls the number and specifies the need, the ambulances are matched accordingly and sent to the mentioned address from their nearest available location.
Cofounder Venkatesh Amrutwar told Inc42, “Since we fully launched our platform in August 2019, there has been an exponential hike in terms of demands, especially post March 2020. There were days when we got over 2000 calls a day.”
With the ongoing coronavirus scare, the company has also been working on optimising its services to meet the surge in demand. HelpNow has been converting Uber cabs into emergency first responder vehicles. These cabs are equipped with a patent-pending “Mini-ambulance” kit, which includes most of the services installed in the Basic Life Support ambulance. The company is working on launching its platform in other cities — Pune, Bengaluru and Delhi in the next few weeks.
The company is in talks with few VCs and is hopeful to close a funding round within the next few weeks.
Nocca Robotics: More Ventilators Are What Matters Now
Started in a mission mode in March 2020, Nocca Robotics, originally a solar panel producer, had initially aimed to innovate pressure-controlled invasive ventilators in order to fulfil the rising demands across the country at the lowest cost of around INR 50K. However, with more and more inputs from doctors, the team which was working with IIT Kanpur soon realised that the budget ventilators may not fulfil the complete requirements of Covid-19 patients.
And that’s been the story of the global fight against Covid-19 — where technology intervenes, but the needs keep changing. Startups have to keep evolving with this need if they are really looking to solve problems.
Speaking to Inc42, cofounder and CEO Nikhil Kurele said, “Our design and development has been led by senior doctors from India as well as from the US. This is why we made several changes since our first prototype Noccarc V110. The latest Noccarc V310 is industry-ready and has incorporated all the requirements that doctors had raised earlier. The ICU ventilator is currently being used by multiple hospitals in Mumbai, Gurugram, Pune and other cities.”
Nocca Robotics recently won the Marico Innovation Award for its ICU ventilators. The turbine-based Noccarc V310 ventilator is smaller than the conventional ICU ventilators but offers the full range of capabilities. Noccarc V310 costs around INR 4 Lakh and has successfully completed its clinical validation and is recommended to be used in ICU by intensivists after being tested on patients suffering from a critical lung infection. The ventilator has been tested for safety and essential performance of medical electrical equipment by a NABL-accredited laboratory as per standard IEC 60601-1. It has also undergone endurance testing for more than 24 days at a hospital in Pune and has been successfully certified by the HLL Committee.
The company, which has its own manufacturing plant in Pune, has also partnered with other companies in Mumbai. “While we will be manufacturing around 200 units this month, our full capability to produce ventilators has gone up to 2000 a month,” Kurele added.
The Auric: Building Better Immunity
“Before Covid-19, beauty was perceived as gold, wellness as silver. However, after Covid-19, things have changed and wellness too is now equally perceived as gold. There is an increased awareness towards building a better immune system,” said The Auric founder and CEO Deepak Agarwal.
The Auric offers beauty and wellness drinks powered by coconut water. Among the five categories that it offers are drinks for mind, body, skin, hair, and weight balance.
“Since Covid-19, our best selling product has become body defence drinks, as it improves the immune system. These are mostly served in coconut water and are 100% natural. All these products have no preservatives, no added sugar and low calories,” the CEO added.
Unlike other drink companies who usually sell their beverages via marketplaces such as Amazon, Flipkart, BigBasket or offline stores, The Auric has been mainly offering subscription-based products through its website. Almost 90% of its products are sold through its own website. “The major reason behind going B2C instead of B2B2C is that we want to understand consumer behaviour, the results of how these products have been beneficial for them. If they stop the subscription, we want to know why. This gives us immense data research which further helps in future market strategy and product development,” said Agarwal.