A stethoscope and a computer. The best startups in digital medicine
Businessmen in white coats
How to launch a startup in the field of Digital HealthNewport Beach Hospital is ahead of fashion: while the world is discussing such Digital medicine trends as diagnostic applications for iPad and da Vinci surgical robots, California doctors have been introducing them into their practice for a long time.
Not to mention the electronic registry – here it is considered an achievement of the last century.
Olga Grinevich, Business weekly "Company" No.19(752)-2013
According to a report by the Rock Health organization, American investors are interested in biotechnologies, developments in diagnostics and digital fitness. In 2012, venture funds invested $1.4 billion in digital medicine, Digital Health, which is 46% more than in 2011. But the young and risky market of "digital" medicine has also become the cause of a negative phenomenon – Frankenstein syndrome. This is when technologies, such as the Marrow Miner – a device that quickly collects bone marrow, almost without causing pain to the donor – seem so fanatical that they frighten investors: the risks are too great. In Russia, the situation with Digital Health is different – we have a completely new, and for most it is also a terrible trend. Domestic venture capital is cautiously studying the market, so now projects in our "digital" medicine can be counted on the fingers. Ko chose interesting digital startups and talked to their creators.
Make an appointment for me to see a doctorThe idea to create an electronic service for finding doctors Med-Room.com she was born at the Novosibirsk surgeon Mikhail Cherkasov after another friend called to consult on three points – ay, it hurts, what to do and who to run to.
Aesculapius shared his thoughts about a startup at the junction of IT and medicine with several friends who, as a selection, turned out to be successful entrepreneurs. They liked the idea. So Mikhail Cherkasov attracted seed investments, added his own money and went into online business with 3 million rubles.
Cherkasov realized at the university that, in addition to the surgeon's talent, he has an entrepreneurial streak. To begin with, he opened a beauty salon with a home visit. Two years later, the project, however, was closed, not surviving the crisis. After receiving his diploma, Mikhail launched two more businesses: a medical clothing store and an agency offering warehouse services. But the desire to practice medicine did not let go. For a while, he worked on two fronts – in a public hospital and his office, but eventually realized that developing a business strategy was more interesting than routinely managing managers, suppliers and movers. Cherkasov did not want to sell projects, but focused on a new role for himself – a strategist. The medical clothing store and warehouse logistics have not suffered at all from this decision – they are still successful.
As the basis of a startup Med-Room.com Mikhail Cherkasov took the business model of the American service in comparison of medical services and electronic registry Zocdoc.com . "But the differences between the American and Russian healthcare models are enormous," Mikhail explains the nuances of copying. – Accordingly, the approach of patients is different. I had to adapt to the domestic market. And first of all, to focus on the values of our clients: to show that finding a doctor and making an appointment with him is easy and convenient, and the absence of queues in clinics is not a utopia."
Now the company works only in the field of commercial medicine: Med-Room.com cooperates with 972 clinics in 16 cities of the Siberian region. 40% of them, by the way, are multidisciplinary. The rest are dental hospitals and clinics of aesthetic medicine and cosmetology. Mikhail Cherkasov is going to monetize the project through a commission for attracted patients, without a subscription fee. According to him, of all such services that exist on the market, Med-Room.com it offers a more profitable option – the clinic pays 100 rubles for each patient who comes. "The project has not yet reached operational self–sufficiency," he adds. – Nevertheless, the growth of the main key indicators over the last quarter inspires confidence. We will reach it within four months."
After the main competitors Med-Room.com – DocDoc.ru and Timetovisit.ru we found good money for development, the team Med-Room.com concentrated on... simplicity. Now the patient makes an appointment himself without unnecessary calls to the call center.
Another trump card in the competition for investors was the so-called patient exchange. "This is when a client leaves an application for medical services, and clinics fight for it and offer favorable conditions in real time," Mikhail explains. In such a scenario, according to the entrepreneur, everyone wins: the patient goes to a first-class doctor with a discount that is pleasant for the wallet, and the clinic receives a guaranteed influx of new customers. But Cherkasov is most pleased with everyone – with such a pace, the online service will really reach operational self-sufficiency in four months.
From the founder Med-Room.com in the long–term plans - the conquest of the whole of Siberia and the two capitals, as well as the launch of a mobile application with the same name. In the near future, he intends to attract the attention of public hospitals to his service. "Many of them provide paid services. It is interesting for us to work with such departments," the businessman says. But in order to realize global goals – to conquer million-plus cities, 3 million rubles is not enough. Now Mikhail Cherkasov is negotiating with venture funds (he does not disclose details). Moreover, he is not interested in "just money". "Smart finance" is another matter. The investor, according to the startup, should be "sick" of the idea – to use his connections, administrative resources and help in promoting the product. "We are interested in the scheme of a convertible loan, convertible note, with the transfer of a large minority stake to an investor," Cherkasov argues. – This scheme allows us to agree on mutually beneficial terms for all parties. Although we are aware that, most likely, we will attract funds from a private investor, because funds are more "formalized" when entering venture capital, and this process can take a long time, and speed is an important factor in a startup."
Without a single drop of bloodIn order to monitor the level of sugar, diabetics are forced to "give" a drop of their blood to the test strip of the glucose meter several times a day.
Piercing fingers with a needle is painful and extremely tedious. Dmitry Gavrilov, founder of the Inviewlab startup and researcher at the Department of Radio Electronics and Applied Informatics at MIPT, came up with how to make the procedure painless. Its non-invasive glucose meter, thanks to an adaptive algorithm, reads the glucose spectrum through the skin. The whole analysis takes a fraction of a second. The laboratory prototype is already working, but needs to be improved. However, this fact did not prevent the startup from taking second place in the rating of the Russian Startup Index in the nomination "Biomedical projects of Russia". Over time, Dmitry claims, his invention will greatly facilitate the lives of diabetic patients.
Gavrilov's team is not the only one developing a non-invasive blood glucose meter. Over the past few years, researchers from all over the world have been working in this direction – Grove Instruments, C8 MediSensors, Echo Therapeutics, Integrity Applications, Erbitek, etc. "A lot of projects have been announced," Dmitry notes skeptically. "But none of the companies presented a sample for testing, at exhibitions everyone is limited to posters or a device without a demonstration." According to him, the only company that has put a non–invasive glucose meter into mass production is Glucowatch. The first generation of these "wristwatches" was approved by the agency of the Ministry of Health and Social Services of the USA back in 2001. According to the documents, the device was used as a glucose monitoring system. The device took "readings" through the skin every 20 minutes and signaled, as on an alarm clock, if the blood sugar was off the scale or, conversely, dropped too much. Now "wristwatches" are not produced: the disadvantages – expensive consumables and mediocre measurement accuracy – outweighed the advantages.
But why is a young scientist from MIPT confident in the infallibility of his non-invasive glucose meter? Before launching the Inviewlab startup, Dmitry Gavrilov was engaged in science at his native university and in parallel IT business. In his spare time, he and his colleagues set up experiments – they refined the design of a traditional Raman spectrometer. The portable version of this device is used in the field of safety and ecology, as well as for monitoring the production process of pharmaceuticals. "The device works with scattered light, which, thanks to the effect of Raman scattering, carries an "electronic fingerprint" of the substance under study," explains Dmitry. In other words, through the transparent packaging, the device is able to detect explosives, drugs, gasoline, etc. As a result of research based on the Raman spectrometer, Dmitry Gavrilov and his team created their own portable device with built-in software. "We have improved the speed of work and the accuracy of identification. The device is also not afraid of shaking and dust," the developer reminds of another advantage of the product.
Next came the idea to create a non-invasive blood glucose meter. "Globally, the same technologies are used in it and the spectrometer, but the execution is completely different – different reading schemes, lasers, matrices," says Gavrilov. The know-how, according to him, lies in a unique algorithm for filtering and identifying spectral data. The principle of operation of a non-invasive glucose meter is at first glance simple: a clothespin clings to the earlobe, the "receiver" picks up radiation, and the program processes the signal and determines the level of glucose in the blood. To stand out from the competition, Inviewlab is going to make a small device, with a revolutionary autofocus system, as Dmitry claims. "To increase the accuracy and capture the maximum amount of information, the device works simultaneously with several sources of exciting light," he clarifies. The creation of a demo sample cost his company $10,000. Now it remains for Gavrilov to add the finishing touches to the laboratory prototype. The next step is pre–clinical testing. It's too early to talk about mass production of the Inviewlab device – the startup operates in research mode. But if the company finds investments – while the project lives on Gavrilov's personal funds ($50,000) – diabetics will be able to buy non-invasive glucose meters in any pharmacy in a year and a half.
Genes are foreverAlexander Pavlov, while waiting for the Singapore – St. Petersburg flight, replays the latest events of the year in his head: cooperation with European laboratories, meetings with partners from Western medical corporations and today's conference on genetics.
On it, he, in a jacket and jeans, talked casually about the importance of his projects for the molecular genetic diagnosis of a person.
So where did this startup come from? Alexander Pavlov was born in Leningrad. Of all the school subjects, he loved biology the most. The teacher saw the scientist in him. The biologist, when it came time to decide on his future profession, insisted on Alexander's admission to St. Petersburg State University. So Pavlov ended up at the Faculty of Biology. After graduate school, he got a job in the Alcor Bio group of companies, which develops and manufactures test systems for clinical laboratory diagnostics. Soon he was appointed head of the laboratory of molecular diagnostics. Once in his native element, Pavlov began to come up with new concepts for genetic analysis. As a result of experiments, mental and practical, there were projects with complex names – "Personalized genomic diagnostics" and "Neonatal NGS-genodiagnostics".
"The genodiagnostic solutions we offer use next–generation sequencing technology to obtain a direct DNA sequence of the patient's genome," explains Alexander Pavlov. They differ from traditional genetic tests in that they can analyze several tens, hundreds, and even thousands of mutations at once. "In our developments, we use the method of direct DNA analysis. We read the genome like a line in a book – letter by letter," the researcher notes. Realizing that the employee is able to create a promising technology, GC "Alkor Bio" turned the project into a separate company Sequoia Genetics, and Pavlov was appointed its head. The biotech holding took over the operating expenses of the "daughter" (the hero does not name the exact amount), but the responsibility for finding capital investments fell on Alexander's shoulders.
While Sequoia Genetics solutions are "sharpened" for the study of three hereditary diseases, for which, by the way, all newborn babies are tested (cystic fibrosis, galactosemia and phenylketonuria). In the future, the scientist plans to expand the boundaries by suggesting that reference genetic centers themselves establish the spectrum of tested diseases, determine individual sensitivity to drugs, tell exactly from the mother's blood whether the fetus is healthy or not, and as a culminating denouement – diagnose the development of cancer and monitor the effectiveness of therapy.
In Russia, no one, except Sequoia Genetics, develops such a complex direction in the molecular diagnostics of DNA. In the West, however, similar technologies are being developed by Illumina, Ambry Genetics, AITbiotech, etc. "But so far such test systems have not been introduced into the world clinical practice," Pavlov says. – Most companies have chosen a promising, but long way – cancer diagnosis. We went a shorter and more obvious way – hereditary diseases. For example, the results of genetic screening for fermentopathies or congenital deafness are easier to interpret, besides, the market is clear – all newborns are tested for them, and all parents want to know if everything is OK with their children."
Unlike foreign colleagues who have not yet seen the horizons in similar studies, however, in the context of cancer, Sequoia Genetics has already launched a cycle of clinical trials of its test systems. At the end of the year, when they are over, a new round of clinical testing will start. The place of this large-scale action will most likely be the Medical and Genetic Research Center of the Russian Academy of Medical Sciences, with which Alexander Pavlov is actively establishing ties. As part of the partnership agreement, the research center transfers valuable DNA samples of people suffering from rare genetic diseases to the startup. According to Alexander, steps separate from the introduction of new diagnostic solutions of the MGNC of the Russian Academy of Medical Sciences. He does not need to upgrade his instrument base – it is enough to adapt the protocols and software developed by Sequoia Genetics specialists.
"To get into a specific biotechnology market, you need to identify the end user," the scientist shares his thoughts. In Russia, there are about five to seven national reference laboratories where doctors send patients with a complex medical history. In the West, these are healthcare providers: doctors, insurers, laboratories, pharmaceutical companies, etc. Pavlov's experience shows that medical innovations are closer to them. Russian venture funds are afraid to invest in biotech projects – it is too complex and dynamic a market, and therefore risky. But six months ago, the Sequoia Genetics test systems were so impressed by the diagnostic laboratories IPATIMUP and StabVida in Portugal, Genomnia in Italy and the Centre for Genomic Research in the UK that they offered to conduct clinical trials on their expensive and state-of-the-art equipment.
The startup was supported by American corporations Life Technologies and EMC. The first is engaged in the creation of biotechnological equipment, reagents and consumables used in the analysis of DNA, RNA, proteins, etc. The second positions itself as the largest player in the market of products, services and solutions for information storage and management. "In addition to multinational corporations, the Russian biotech business is interested in the project. The total investments of the partners amounted to more than 80% of all capital expenditures for the creation of an instrument base and conducting expensive research," Alexander Pavlov sums up, pleased with this course of events.
How to lose weight to a diabetic"I'm sorry, but I can't discuss these details publicly," Sean Duffy, co–founder and CEO of Omada Health, judging by the photo, is smiling and friendly, but deaf to questions about financial investments in his startup.
It is known that a venture company headquartered in Silicon Valley, U.S. Venture Partners, invested $4.7 million in the development of an American online service for the prevention and treatment of diabetes. Duffy, a former Google employee and former Harvard Medical School student, found the starting capital of $800,000, as he says, from other sources. One of them, by the way, was Esther Dyson, a famous writer, philanthropist and investor. Her investment portfolio is impressive: Yandex, space companies XCOR, Constellation Services, Zero-G, Icon Aircraft and Space Adventures, genetic startup 23andMe.
What Sean Duffy offers to the market is hardly a medical product. The online type II diabetes prevention program, called Prevent (translated from English means "prevent"), refers more to the field of big data, or "big data". All her prescriptions are based on a large sample. According to a study by the US Centers for Disease Control, 79 million Americans have prediabetes. From a business point of view, Omada Health has found its ideal niche. The service operates on the principle of a social network – participants gather in groups according to three criteria: place of residence, age and BMI (body mass index). In a group of 12 people, the course of prevention itself lasts 16 weeks. The progress of each prediabetic is monitored not only by a specially assigned health coach, but also by online scales. This is a diary program where indicators of a healthy and active life are entered - such as a calorie counter or a digital weight tracking chart.
"After completing the course, we help our "graduates" to maintain the achieved results," explains Sean. – In the Sustain program developed by us, they unite in a community, where they continue to monitor the weight and perform the lessons set by the coach." Of the main competitors, Duffy names reputable healthcare providers – Optum Health and Healthways. Their product line is much larger, the directions of online programs are also: diabetes, asthma, heart failure, etc. However, as part of the constitutional reform of the American healthcare Obamacare, it was the programs for the prevention of diabetes that were given the green light. "It turned out to be very useful for Omada," adds Duffy. It was more difficult for the startup to understand the mechanisms of the US healthcare system. "At first, it was like swimming in a soup of abbreviations – TPAs, PBMs, ASOs, HRAs and HSAs," admits Sean. – In the field of our healthcare, there are complex relationships between the participants, plus too many financial obligations." Duffy cannot discuss the vicissitudes of medical legislation in more detail – the conversation will take several hours.
He also refuses to talk about the stage of negotiations with new investors and the difference in the price of the Omada Health program for hospitals and private users. But he talks about his plans with pleasure. According to them, the entrepreneur wants to bring the company to self-sufficiency next year. In the not so distant future, Omada will generally turn into a stable, profitable corporation that affects the healthcare system. Because diabetes mellitus of the most common – the second – type has been walking around the world for a long time. Today, 6% of the adult population of the globe suffers from this disease. "We are looking closely at the European market," Sean says dreamily. "We haven't explored Russia yet, but we are planning to."
Portal "Eternal youth" http://vechnayamolodost.ru23.05.2013