Telemedicine. Three technology startups. The product is one, but different fates /Geek magazine
I continue my series of articles devoted to the problems of telemedicine - a topic that has significantly increased its relevance today.
In previous article I prepared the filling of the simplest electronic stethoscope, described the principle of its operation and the logic that guided the developer. The case of an electronic stethoscope was not chosen by chance - this is one of the most popular areas in which startups try their hand. During the preparation of the material, I counted almost a dozen attempts to “invent” the stethoscope anew.
In the early 2010s, there was a remarkable prospect for the explosive growth of Telemedicine. The elemental base of electronic components has reached a qualitatively new level. Broadband data channels became available. The development and standardization of highly reliable protocols for telemedicine has begun. Venture investors, on the eve of the “spurt”, turned their eyes to technology startups in the field of healthcare, which began to grow like mushrooms after the rain. However, the revolution did not happen that time.
Too lazy to read the article, but have your own opinion about what are the main reasons for the failure of technology startups in the field of medicine? Please take the survey at the end of the article. Your opinion is important to us!
Astra Health Care, Inc. . In July 201? moving towards potential partners, CliniCloud announced that it was preparing to release new devices - a balance, a pulse oximeter and a blood pressure monitor, which were to be combined into a single system with existing devices.
After several months of communication with corporate clients, it became clear that two main factors hinder full cooperation with large businesses in the provision of medical services: 3-3-33567.
Firstly, to work with patients, doctors required full certification, and secondly, to work effectively with electronic devices, it is necessary to integrate into traditional, for medical workers, data storage and processing systems, including paper and film media. To fully exchange data with medical applications, the developers promised to prepare an API and SDK by the end of 2017.
Already in November 201? CliniCloud announced its intention to launch its own web portal for storing, viewing and controlling personal data obtained with a stethoscope. It was planned to access it not only using a mobile application, but also a computer.
First of all, the portal was supposed to be focused on doctors who could use it to safely collect patient data and stream the sound of a stethoscope.
On November 2? 201? the last video on YouTube channel was unexpectedly published. It was clearly provocative in nature - it talked about the wide possibilities of artificial intelligence in relation to a coffee machine, household scales, diet, and other things that have nothing to do with the project. And not a single word about a stethoscope and medicine in general!
This was the beginning of the end. The development dynamics of the project did not inspire investors too much, and the remaining money was already not enough to implement ambitious plans. Even small grants handed out at various startup support events began to expire. The startup’s age was approaching a critical five years, after which he had to either enter the stage of sustainable growth or die.
Finance is no longer enough even to pay cash rewards to employees. The team began to crumble rapidly. Marketers had to be reduced, a large group of students who occasionally took part in individual advertising campaigns 3-3-33413. for the most part for hype and free coffee breaks [/s] , quietly resolved by itself. Bloggers have returned to advertising nutritional supplements
Only the backbone of a team of several people, bound by obligations towards investors, continued to imitate activities. They supported sales through their own site of previously manufactured devices, but real activity switched to completely different tasks related to artificial intelligence and in a completely different project.
The result - in the second half of 201? a startup put up for sale the remaining one and a half hundred sets with a significant discount, completely stopped supporting sold devices and deleted the contents of the site. The company, apparently, was in a state of bankruptcy.
The development strategy of this startup is reminiscent of the first case. It would seem that they are doing everything right, but at the same time things are going wrong
We turn to the details of
The company began its long journey with a startup launched in the same 2012. Having gone through the Spanish business accelerator, she created a device that was very revolutionary for the European market at that time.
This is a wireless device with a WiFi interface, on which it, in online mode, was able to transmit data. The choice of interface affected both the size of the device and the type of power - batteries that are charged from standard USB charging. The design of the device turned out to be very peculiar and not too convenient in medical practice. Among the features we can distinguish the use of built-in digital filters for primary signal processing. You won’t surprise anyone today, but at that time it looked progressive.
The difficulty of certification is
As far as I understand, the first round of investment did not strike the imagination with its size. It was barely enough to create a limited batch of devices, but it was clearly not enough for a full-fledged certification process.
On the site you can find traces of complaints about the excessive complexity and high cost of this process.
I also have serious suspicions that the low quality of the sound signal also played a role. Otherwise, it would be possible to get positive feedback from doctors, which would help raise the second round of investment, already for certification.
For one reason or another, this did not happen. To save the situation and organize sales, the team was forced to change the positioning of the stethoscope to veterinary, since the path to the market for medical devices for people, in this situation, was closed. The result is the appearance of a device under the brand name eKuore Vet
The problem, however, was that it turned out to be very expensive for this market and was not in high demand. Nevertheless, the first sales instilled timid hopes in investors and they were enough to raise the next round of investments, which was enough to obtain a number of more advanced certificates, including ISO 13485. During this process, the electronic filling of the device was also improved.
The result was the appearance in 2016 of a new product that looks like two drops of water similar to its predecessor, but received a more solid name eKuore Pro.
However, by that time, serious competitors had already settled in this price niche. The main one is 3M Littmann. Electronic stethoscopes from this company cannot be called cheap, but they provide excellent sound quality. In addition, they have another huge competitive advantage - execution in the constructive format familiar to the doctor. However, we will talk about them a little lower.
The price is
Ekuore fell into the typical trap of underfunding and the need to fulfill obligations to investors following past rounds. Investors demanded the fulfillment of the declared indicators, without which they refused to continue to supportrzhku project. In an attempt to get out of chronic loss-making, product prices had to be lifted. As a result, the selling price of a stethoscope in Europe, in the simplest configuration eKuore Pro basic Kit amounted to € 482.7? which is literally 20 to 30 dollars cheaper than the flagship device of the market leader - 3MLittmann with Bluetooth.
For wealthy customers, it was decided to make an exclusive kit, which is additionally equipped with a cheap Chinese tablet and quick-change heads with a magnetic lock. However, it does cost crazy money.
The struggle for survival is
For the survival of the company had to apply anti-crisis measures:
An attempt was made to connect a South African startup specializing in cloud data processing and machine radiation as a partner to the project. They tried to attract him to create software for the extraction and analysis of heart murmurs. But something went wrong and full-fledged software did not appear. My attempts to access the site of the South African partners led to extremely strange browser errors:
I had to urgently create a simplified version of the software on my own. So there was a visualization function that tracks the dynamics of noise changes during patient auscultation over time. It allows you to recognize the appearance of new, uncharacteristic for the patient’s usual state of noise, but 3-3-33567 is not capable of making assumptions about their nature.
A search was conducted for partners among manufacturers of medicines and medical equipment. As a result, a couple of German firms showed interest in the project, but it seems that full cooperation did not work.
An attempt to break into the French market also did not produce impressive results.
Formally, the company has dealers in several countries of the world, on different continents, but apparently, they do not show much activity. So, for example, on the website of the Russian company Intermedika, which is listed as a dealer, no mention of eKuore and its products could be found
A boy with a finger in a hurry to help!
The culmination of anti-crisis measures designed to save the situation was the creation of a fundamentally new, extra-budgetary model of the stethoscope. eKuore ONE .
With its help, the doctor was invited to independently "finalize" his stethoscope model by cutting the auditory tube for installation in the gap of the body of this wonderful device.
It seems that this device did not have its own power source, but received it from the gadget's USB port. Via the same USB, data is also transferred to the tablet. For obvious reasons, I could not look inside this wonderful device, but judging by the dimensions of the case, two variants of circuitry are possible.
Most likely, a digital microphone and a cheap ARM microcontroller are located inside. All signal processing functions, including pre-filtering, are taken out to the application.
The second option is an analog MEMS microphone + codec with a USB interface.
How the circuitry of the device might look in this case is shown below, however, this option is much more expensive at cost and was hardly used.
The device is positioned as a kind of “parasite” on the body of a market leader.
The native application remains the same, with a minimum of functions. However, a certain API is offered complete with a stethoscope, which allows you to create a file format compatible with the program from 3MLittmann Bluetooth 3200. She is invited to use it to analyze them.
Despite the long-released announcement, the product itself on sale has not yet been discovered.
What is wrong with him?
The user will have to perform mechanical actions on his own, namely, cut the tube of an existing stethoscope and insert this product into the incision. Different stethoscopes have tubes that are slightly different both in diameter and in elasticity, and this complicates the task.
With a cheap stethoscope for $ 10 it’s unlikely to get a good result, and to perform an execution on an expensive phonendoscope for $ 200 not every hand rises
It is not a fact that from the operation of installing this device in a high-quality phonendoscope, its characteristics will not worsen.
It is unlikely to get a full medical certificate for such a device, because it is completely unclear why and how the end user will connect it, and what sound quality will be obtained as a result.
The actions of his own certificates will no longer apply to the modified stethoscope in such an innovative way, because cutting the tube is a significant modification. Theoretically, after that it can no longer be 100% legally used as medical equipment.
The cost price of the device itself is really relatively low, although lowering it to a “penny” level will not work. At a minimum, you must install a high-quality microphone and codec (or ADC), correctly design the power system to avoid noise. One thing is good - the microcontroller is quite cheap. The cost of the device at the exit from the factory in China can be lowered below $ 1? but only for parties of serious size, and this is a problem.
Using a wired USB connector introduces a significant element of unreliability, since it tends to “break apart” during a very short life. After several weeks of active use, it will become an essential element of insecurity, especially when using a cheap smartphone.
This device requires a gadget with a USB port and OTG support. Not every smartphone has such a port. In particular, such a device will not work with gadgets from Apple.
Latest news from the fields
The main material for this article was collected more than six months ago and, even then, I had good reason to doubt that this device would save the project and be able to attract serious investors to the startup that could decide on the next batch of cash injections. It seems I was right - looking at the company’s website a week ago, I did not find any mention of this device, but I found many interesting innovations.
In the base unit
When finances sing romances
The 8 years of the startup’s struggle for life have essentially weakened the creators. It was not possible to get money from venture funds for a clearly protracted project, and the founding fathers were forced to take a desperate step - to resort to an attempt to involve private investors in raising money.
The lower bar for entering investor status is lowered to 200 €. This closely resembles a crowdfunding company. According to information published on the site, has already been collected. € 36?377 out of € 50?000 .
The plan for further actions is as straightforward as it is daring: To raise 50?000 euros, to receive another ?00?000 bank guarantees for the business development program. Take a loan for full certification and production of a new, sufficiently large batch of devices, which will help to significantly reduce the final cost of the device and finally carry out full certification.
With sales growth, the company's capitalization should increase. Bringing it to 8 million euros, the founders hope to finally sell the company and by 2024 pay off investors five times more expensive shares!
Coronavirus to help
Not attracting attention to the topic of coronavirus today has become a bad form. Of course, our startups did not miss their chance either, and they did it in a creative manner - with the help of a comic strip.
Market leader 3M Littmann
Startup from the last century
It's time to tell the story of a recognized market leader in the production and sales of electronic stethoscopes. It began in the early distant 1960s. It was then that Dr. David Littmann, a professor at Harvard Medical School, developed the very first model of what we call a stethoscope today. Littmann was a cardiologist, so he realized the importance of the quality of the device for auscultation. In 196? the doctor described his vision of an “ideal stethoscope.” He presented it as a device with two bells: open, for listening to low-pitched sounds, as well as closed, with a rigid plastic diaphragm for filtering low-tones. Another important improvement was the use of a single tube emanating from the bell of a stethoscope and bifurcating at the proximal part. The stethoscope was made shorter and lighter for ease of use. In addition, Littmann invented to connect the ear parts with a springy metal arc, creating constant pressure necessary to maintain the apparatus in the ears.
So there was a modern stoichiometric double-sided stethoscope. Today's 3M Littmann Classic II SE very similar to this early model. Littmann founded a company called Cardiosonics , which was based in Cambridge, Massachusetts. To begin with, the company released two types of stethoscope - a stethoscope for doctors and a stethoscope for nurses.
Known to everyone today, 3M Corporation recognized the excellent acoustic quality of Dr. Littmann's stethoscopes and acquired his company in 1967. Dr. Littmann continued to work on 3M after the sale of the company, but already in the role of consultant. The combination of 3M funding and Dr. Littmann’s mastery determined the future of stethoscopes for many years to come.
However, progress did not stand still and in the late 1970s a new stethoscope model was introduced - 3-3-33516. 3M Littmann Cardiology [/b] . It was distinguished by a double lumen, a soft ear tip and a deeper bell to enhance low-frequency sounds.
3M could not stint on significant investments in research and development of new models. So in 198? the following revolutionary model of the 3M Littmann Master Cardiology stethoscope appeared. The patented 3M Littmann diaphragm was patented. The stethoscopes possessing it do not have a second bowl in the form of a traditional bell and are one-sided. This allowed the user to listen with a one-sided head to both high-frequency and low-frequency sounds, changing the level of pressure on the head of the stethoscope.
First electronic stethoscope
The next step in the development of 3M Littmann stethoscopes was the achievement in the field of electronic sound amplification.
3M Littmann Electronic E2000 was introduced back in 199? and 3M Littmann Electronic E4100 already in 2001.3-3r3509. Both electronic models are equipped with amplification and noise reduction systems, and are designed for advanced auscultation.
The 3M Littmann electronic models are specifically designed to detect hard to hear sounds of the heart and lungs. The E2000 delivers 14x sound amplification, while the E4100 already has 18x gain.
At the moment, models are mass-produced. Littmann 3100 and Littmann 3200 that have the ability to 24-fold increase in sound, as well as the ability to suppress up to 85% of extraneous noise.
Littmann electronic stethoscopes dominate the market today and are the quality standard that other manufacturers are guided by.
Secrets of success
Why, unlike a large number of similar devices from different manufacturers, are 3M Littmann products most popular? I give below a number of reasons that I can note:
By the time of the release of its first electronic stethoscope, Littmann already had an excellent reputation as a manufacturer of traditional products and an extensive customer base among
realizing the extreme conservatism of the medical community, the developers created a model that is as similar as possible in design to a traditional stethoscope. The main efforts of the developers were aimed at providing the most important functions for the medical worker, especially in the field of cardiology - a significant amplification of the sound and its filtering
the high price level for traditional 3M Littmann stethoscopes has provided sufficient demand for electronic stethoscopes. The price gap did not seem so significant 3-3-33945.
the stethoscope reproduced sound through traditional olives, not
Modern models of stethoscopes are able to record sound into internal memory, if necessary, transfer it to a computer via a wireless interface for saving and analyzing
The initial choice of bluetooth as an interface for data transfer was very successful. It is much more than WiFi, suitable for transmitting low-frequency sounds received during auscultation. It consumes significantly less energy, especially in sleep mode, which increases the battery life and allows the use of classic batteries instead of batteries. At the beginning of the session, as in the case of its breaking, the connection restores extremely quickly
3M Littmann did not stint on the remuneration of highly qualified engineers and industrial designers. The result is an excellent sound path with low noise, filters with adjustable bandwidthKania, and an intuitive control system. In terms of technical parameters and ease of use, the device exceeded all analogues on the market. The only AAA
format battery was used as a power source.
The company has developed a relatively simple program for displaying and analyzing auscultation data. She supported the option of simplified remote data exchange between colleagues over a secure channel and worked under the control of the widespread Windows OS. The data storage protocol was made open, which allowed a third-party developer to create their own specialized software. This has played an important role in increasing the popularity of the product.
It's time to take stock of
And why did the startup articles described at the beginning fail, as well as their numerous clones, of which I counted a total of about a dozen, failed? We will examine their errors in more detail, and at the same time we will try to talk about the general problems of telemedicine in the next article. In the meantime, I bring to your attention a survey whose results will help us do this:
Only registered users can participate in the survey. Enter , you are welcome.
What, in your opinion, are the three main reasons for the failure of technology startups in the field of medicine?
lengthy and costly
inertia of the medical community, poorly perceiving 3-3-33932 innovations.
poor knowledge by startups of the realities in which
medical professionals work.
Conscious sabotage of medical workers who see 3-3-33932 competition in modern technology.
imperfect legislation governing the use of medical devices at home 3-3-33932.
lack of open universally accepted data transmission standards for telemedicine 3-3-33932.
difficulties and legal subtleties associated with testing the developed equipment in humans
distrust of new technologies of potential patients 3-3-33932.
fear of personal data leakage by patients
non-viable and irrelevant ideas underlying the proposed
low level of developer qualifications and, as a consequence, the quality of the
the difficulty of integrating the collected data into the existing document management systems of medical institutions and staff training 3-3-33932.
lack of verified data for processing using statistical methods and
restrictions on the advertising and sale of medical products
counteraction of large manufacturers of medical equipment
another, I will indicate in the comments
No one has voted yet. There are no abstentions.
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