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Saving Lives With AI: How We Cut ICU Mortality by 40% | Dr. Dhruv Joshi (Cloud Physician)
212 Plays3 years ago
"The conventional solution to healthcare gaps—building more hospitals and training more doctors—is simply not a viable solution."
This powerful, contrarian view from Dr. Dhruv Joshi forms the basis of his entire mission. He argues that the traditional model of healthcare is too slow and expensive to scale , and the only way to provide quality care to everyone is through technology that acts as a "force multiplier."
Dr. Dhruv Joshi is the Co-founder of Cloud Physician, an AI-powered, full-stack critical care company. A prestigious Cleveland Clinic-trained intensivist , he returned to India to solve the massive shortage of critical care specialists. Today, Cloud Physician has raised over $14.5M in funding and scaled its operations to manage over 2,400 ICU beds across 200+ hospitals , caring for more than 100,000 patients and reducing ICU mortality by up to 40%.
In this conversation with host Akshay Datt, Dr. Joshi reveals the journey of building a life-saving health-tech company from the ground up.
Key Insights from the Conversation:
- Clinician-Led Innovation: The company's most significant advantage is that it was built by deep domain experts who intimately understood the problem before building a solution.
- The Power of a Pragmatic MVP: Cloud Physician’s value was first proven using Google Sheets and off-the-shelf cameras, showing you don’t need a perfect product to get started.
- Technology as a Force Multiplier: The goal isn't to replace scarce specialists but to augment them, allowing one intensivist to manage 60-80 patients instead of the traditional 15.
- A Full-Stack Partnership Model: Cloud Physician doesn't just sell software; it embeds itself as an operational partner that improves both clinical outcomes and financial revenue for hospitals.
Chapters:
[00:00] Intro: Solving India's Critical Care Crisis
[01:54] The Motivation: Why a Top Doctor Left the US for a Bigger Mission in India
[08:05] 18-Month Listening Tour: Finding the Real Problem in Tier-2 & Tier-3 Hospitals
[13:13] The Expertise Gap: What is an "Intensivist" and Why Are They So Scarce?
[18:20] Hacking the MVP: How to Build a Tele-ICU with Google Sheets & Off-the-Shelf Cameras
[25:22] The Vision: Building an AI Co-Pilot to Free Doctors from Repetitive Work
[29:38] Building RADAR: Using Computer Vision to Solve the "Unsolvable" Device Problem
[40:43] More Than Tech: The Critical Role of Change Management and Process in Healthcare
[46:56] The Business Flywheel: Improving Patient Outcomes & Hospital Revenue Simultaneously
[53:58] The Future is a "Virtual Hospital": Cloud Physician's Global Ambition
Hashtags:
#FounderThesis #StartupPodcast #Entrepreneurship #IndianStartup #HealthTech #DigitalHealth #AIinHealthcare #Telemedicine #TeleICU #CriticalCare #CloudPhysician #DhruvJoshi #HealthcareInnovation #MedTech #StartupIndia #MakeInIndia #AkshayDatt
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Transcript
Introduction and Zencastr Shoutout
00:00:00
Speaker
Before we start today's episode, I want to give a quick shout out to Zencaster, which is a podcaster's best friend. Trust me when I tell you this, Zencaster is like a Shopify for podcasters. It's all you need to get up and running as a podcaster. And the best thing about Zencaster is that you get so much stuff for free. If you are planning to check out the platform, then please show your support for the founder thesis podcast by using this link, zen.ai slash founder thesis.
00:00:27
Speaker
That's zen.ai slash founder thesis. Hi,
Introducing Cloud Physician Healthcare
00:00:33
Speaker
my name is Dhruv Joshi, and I'm one of the founders of Cloud Physician Healthcare, which is a healthcare solution company that addresses shortage of expertise in hospitals. Take me, Dhruv Joshi. Take me, Dhruv Joshi. Take me, Dhruv Joshi. Take me, Dhruv Joshi. Take me, Dhruv Joshi. Take me, Dhruv Joshi. Take me, Dhruv Joshi. Take me, Dhruv Joshi. Take me, Dhruv Joshi. Take me, Dhruv Joshi. Take me, Dhruv Joshi. Take me, Dhruv Joshi. Take me, Dhruv Joshi. Take me, Dhruv Joshi. Take me, Dhruv Joshi. Take me, Dhruv Joshi. Take me, Dhruv Joshi. Take me, Dhruv Joshi. Take me, Dhruv Joshi. Take me, Dhru
00:00:57
Speaker
Hi, I'm Akshay. Hi, this is Aurob. And you are listening to the Founder Thesis Podcast. We meet some of the most celebrated sort of founders in the country. And we want to learn how to build a unicorn.
00:01:14
Speaker
running
Challenges in ICU Management
00:01:15
Speaker
an ICU is extremely hard and expensive. The ICU team needs a combination of highly specialized doctors. This is the reason why often tier 2 hospitals will turn away patients because they are simply not equipped to run an ICU. But just as technology has solved so many access problems, this is also something that can be solved with technology. And this is the key insight that is driving Dr. Thruv Zoshi, co-founder of Cloud Physician,
00:01:44
Speaker
Dr. Zoshi is among the most elite doctors in the world in the intensive care space with his last stint at the prestigious Cleveland Clinic in the US before deciding to come back to India to fix the deep healthcare challenges he saw. Cloud physician offers
Innovative ICU Solutions by Cloud Physician
00:01:59
Speaker
hospitals at any location a plug-and-play solution to start running an efficient ICU by using a combination of IoT, cloud technology and machine learning.
00:02:10
Speaker
and they have an ambitious roadmap to build a cloud operating system for hospitals that would allow any hospital anywhere to offer best-in-class patient outcomes. Here's Dr. Zoshi telling
Founder's Motivation and Vision
00:02:22
Speaker
Akshay Dutt about the journey of building cloud physician.
00:02:27
Speaker
It just seemed to me at that point in time that I had been, along with Dilip, who was my colleague in Cleveland, we had been looking at this space of healthcare delivery, the challenges associated with healthcare delivery.
00:02:40
Speaker
how technology can be an enabler to help solve some of these problems. It just seemed to us at that time that this is the way that healthcare delivery needs to evolve because the conventional forms are simply not cutting it.
00:03:00
Speaker
And if we were to get into this and be at the forefront of leading some of this transformation, it would allow us the opportunity to move the needle significantly more than just taking up a conventional position in the hospital. And it was that sort of motivation that led us moving back to India and going down the route that we eventually took.
00:03:25
Speaker
So two things I want to ask here. First is when you said you wanted more, what do you mean by more? Was it more in terms of being able to do more, being able to have more control over what you do?
Need for Impactful Healthcare Solutions
00:03:41
Speaker
I mean, you know, what do you mean by more? I think, you know, again, I was just speaking for me personally, I think you need to sort of be able to make, you know, meaning of what you do.
00:03:53
Speaker
And just doing what's already there in a very conventional manner didn't appeal to me as a very impactful thing to do at that point. And so when I say doing more, it was just
00:04:21
Speaker
The fact that we had already identified that there are problems in the way that this healthcare delivery system works and either we can just sort of go into it as is and try and just maybe make some very sort of incremental changes in wherever we are.
00:04:41
Speaker
Or we take a different path and and go at it in a completely different manner and make a much bigger sort of impact. And I think that was when when do more. I think that's what it was that more impact. Yeah. Yeah. Got it. OK. So.
00:05:02
Speaker
What were the problems you identified? You told me that you saw that the way it's happening currently is not good enough.
Access to High-Quality Healthcare
00:05:10
Speaker
And are you talking of the US or India? Both. I had seen the healthcare delivery system in India and I had seen the healthcare delivery system in the United States. And in both, you have the ability to deliver
00:05:27
Speaker
High quality care is limited to a few places and what it takes for those few places to deliver that high quality care is to put in place a lot of people with a lot of expertise and a lot of processes in place.
00:05:46
Speaker
over a long period of time to be able to deliver that high quality care. So whether you have, like where I was in the US, I was at the Cleveland Clinic, one of the premier institutions in the United States, or whether you're in a large corporate hospital in India or in Ames or something like that.
00:06:09
Speaker
or even the college and hospital I was at Bangalore for St. John's. Again, what you needed to be able to provide this high quality care was this model where you put together in a small confined space, a relatively confined space. A lot of people, a lot of professors,
Technology's Role in Revolutionizing Healthcare
00:06:30
Speaker
a lot of expertise. And that is limited because that location can only cater to so many people, right?
00:06:40
Speaker
As a result, you have these large, large number of institutions, whether they are in India or in the United States, that don't have that amount of expertise concentrated in one place where you're not able to deliver the quality of care that people deserve.
00:07:00
Speaker
Considering that when this was happening in the 2015-2016 years, there had been significant advances in technology that we had seen in multiple other industries that had already taken place.
00:07:15
Speaker
that were enabling those industries to be more efficient, to be better, to ensure a better customer experience for the people that were in those two. And if you were to consider an equivalent to an airlines industry where safety was much better and the people using that system were much safer due to how technology was being used. It was also clear that
00:07:43
Speaker
You know, healthcare had simply not adopted technology to the extent that it could, to enable the system to be more robust, to be more accessible to people because you had connectivity more and more now, and to make a more streamlined system that ensured access and ensured quality to people. And so that was what we were looking at when we looked at the healthcare system.
00:08:09
Speaker
So when you're saying quality of care, you're referring to intensive care specifically, or like, you know, what are you referring to when you say that to provide high quality of care is expensive and takes a long time to build.
00:08:21
Speaker
Yes, I'm talking about intensive care, which is the domain that I specialized in. And also other forms of higher acuity care, where patients are sicker. So the other thing that was becoming clear was that hospitals should primarily be limited to higher acuity care. When I say higher acuity care, I'm talking about care that requires
00:08:49
Speaker
you know a higher amount of monitoring and a higher amount of expertise and closer you know so that's where hospitals come in place again with the advent of technology we're finding that perhaps lower cutie care maybe does not even need a hospital you know perhaps could be done at home you can access people at home and if you just got a minor cold and cough you.
00:09:13
Speaker
probably should not be going to a hospital. You should be able to access the care that you need wherever you are, even if it's not a hospital. And then hospitals should be limited to higher acuity care and critical care and surgeries and similar things like that, procedure-related care. So I think in terms of access to quality, the problem is across the board, but
00:09:40
Speaker
Our domain expertise being in that, we were looking more at the higher acuity care space that we wanted to address. Okay, got it. So then what next? You identified that there is a problem. How did you proceed in building a solution?
Choosing to Start in India
00:10:03
Speaker
Identifying the problem then identifying where you want to solve the problem again you know it. I think we realize that the problem statement not only existed in the united states and india both but.
00:10:18
Speaker
perhaps existed at far greater scale in India and the paucity of solutions was also far greater in India. And so it seemed like that would be the place to start. And in India is reflective of also, I think, most of the developing world where you again have a similar problem statement and it bears a lot of resemblance to many other countries that are in that developing world profile.
00:10:46
Speaker
And so that's what made us move back to India. Again, we, both Dilip, my co-founder and I had already experienced with how technology was being utilized to solve some of these problems in the United States. Now the solution could not be the same because hospitals in India are very different from hospitals in the United States.
00:11:12
Speaker
people using are very different in India than in the United States. So we knew that the solution would have to be different and would need to be specific to the setting that we are going to be solving the problem in. And so that's how we started then architecting the solution. So in fact, we moved back to India and we spent a good year, year and a half just traveling to hospitals,
00:11:42
Speaker
Everywhere, so all the way from large hospitals in urban centers like Bangalore to tier 2, tier 3, North India, East India, West India, just going there, talking to the doctors, talking to the nurses, seeing the hospital settings, just deeply understanding what the problem statement is a little bit more.
00:12:06
Speaker
At a high level, we already knew what the problem statement was, but as we build a solution and what would work in these places, we wanted to understand the exact pain points that the nurses and doctors would have here. And so we spent a fair bit of time doing that and then gradually it was like, okay, you know, we can keep doing this or we just sort of get started somewhere and then
00:12:31
Speaker
you know, iterate and iterate and keep problem solving along the way. And so then we just decided to get started and do a pilot at a hospital that we identified in Mysore which is, you know, a few hours from Bangalore.
00:12:46
Speaker
And it was a small hospital and the main doctor there was a surgeon, a very well trained surgeon who was very keen on, you know, it was a cancer hospital.
First Successful Pilot in Mysore
00:13:01
Speaker
So he was doing surgeries for cancer patients. But he had a big problem statement in that, you know, whenever he did any complicated surgery or something that the patient needed
00:13:11
Speaker
you know to be in an ICU and needed close monitoring he was having challenges there because he didn't have the expertise so he had the expertise of doing the cancer surgery but but managing the patient in the ICU was not his expertise and as a result he would either avoid doing some of the more complicated surgeries in that hospital or you know
00:13:35
Speaker
Try to minimize doing that and so we approached him we talked to him we would like you know just assume that. I am part of your team helping you manage the ICU the only thing is that we're not here physically we're going to be in Bangalore.
00:13:51
Speaker
We are available 24-7 and you just do your thing and we will help you manage these patients in the ICU. He was like sure let's try it and we tried it for three months. He found it extremely helpful.
00:14:08
Speaker
You know, he was able to do more complicated surgeries. He was able to do more complete surgeries. At nighttime, if there were issues, you know, previously he sort of wouldn't sleep because he wouldn't know like, hey, is something going to happen or not? And so he sort of come in fresh in the morning. Earlier, if he was doing a slightly more complicated surgery, he would do it early in the morning.
00:14:31
Speaker
so that he could finish it in the afternoon so that you know in the evening is afraid what would happen at night so now he started doing multiple surgeries in the day you know so so all of that the entire sort of machinery of the hospital.
00:14:46
Speaker
sort of picked up his practice and started doing more surgeries. The hospital started seeing more patients as well because their ability to manage these more sicker patients and higher acuity patients increased. They were able to build on more services along with this. Now that they had a steady flow of these patients coming in, they were able to invest in their laboratory, in other ancillary, in their radiology,
00:15:17
Speaker
just keep building more and more services for the clientele. And so that was the pilot. And then eventually with that pilot being that successful, then we, of course that became a partner hospital and a customer hospital of ours. And that was our first hospital. And then gradually we were like, okay, this can work. We started building a team.
00:15:45
Speaker
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00:16:06
Speaker
Before we talk of that scaling beyond that first one, I want to go down into the weeds. I mean, we've talked generalities that critical care is expensive, time consuming, needs to be fixed. But can you give me examples? What were the things in that hospital that they did not have? What was your specific ways to solve it?
00:16:31
Speaker
So firstly, there's a shortage of intensivists. Intensivists are super specialist doctors who have specialized in the management of critically ill patients or patients who are admitted to the ICU. So that's my specialty. So there's a general shortage of such doctors.
00:16:53
Speaker
across the country and they are primarily concentrated in larger centers in metro cities. And even within those cities to the more larger centers because it's only those centers where these specialists end up going and working and also only those centers have the scale to be able to employ an entire team of these doctors that will be available 24-7.
00:17:22
Speaker
So, in this hospital, same problem, there's a surgeon and there's an anesthetist who basically is the next best intensivist, you could call it, since there isn't one.
00:17:37
Speaker
And so what happens is that the surgeon does and there's an ICU because you need it, you're doing these surgeries, complex surgeries, the patient needs to go to the ICU, be monitored, maybe there for a few days, may sometimes be on a ventilator for a few days, etc.
00:17:56
Speaker
So the way that the hospital functions is that the surgeon and the anesthetist are managing the ICU in the absence of this intensivist, right? And so that's where the problems start because that's where the surgeon is like, hey, I can't do.
00:18:13
Speaker
a very
Complexities of ICU Management
00:18:14
Speaker
complex surgery here because I need to manage this guy in the ICU post that and that's not in the best interest of the patient because I am going to run into problems that are going to be beyond what I can manage or beyond what the anesthetic can manage as well, right? So the patient needs to be on a ventilator for a couple of days and has some trouble there. I can't do anything. That's not my expertise. That's not my domain. So ICU management is like pretty complex.
00:18:42
Speaker
Yes, ICU management is so think about ICU as the place where the sickest patients go, right? So that's where in any hospital, your sickest patients are admitted to the ICU. Because those are the patients that have the, you know,
00:19:01
Speaker
organ failure whichever organ it could be your lung failure so you're on a ventilator it could be a heart failure so you're on some support machines to keep your blood pressure up it could be a brain failure you have a stroke or you're unconscious or something like that and so you need.
00:19:17
Speaker
It could be a liver failure or it could be a problem with your blood. You are bleeding uncontrollably. So these are all failures of some organ system of your body and when it gets to a point where it is extremely severe,
00:19:34
Speaker
You need to be in an ICU. Intensivists are those doctors that have specialized in treating this organ failure when it reaches that extreme. So if you just have a cold and a cough, you have a general physician that can address it. But if you have a cold and a cough that then progresses to a pneumonia, your oxygen levels go down and the pneumonia gets much worse to the point where you need to be on a ventilator because you cannot sustain your breathing by yourself.
00:20:04
Speaker
then you need to be in an ICU and that's where an intensivist comes in, that a general physician is not trained to do that. So that's an example in the case of a lung failure, but similar to that, every organ system, so if your kidneys fail and you need to be on dialysis continuously and you need to be closely monitored, the intensivist comes in because he's the one who's trained to manage all of these organ systems when they reach a point of extreme failure.
00:20:33
Speaker
Intensivists have multidisciplinary expertise so that they are able to take care of multiple organs and probably they also understand beyond first order effects. What will this lead to? How will this affect other organs? The interplay?
00:20:50
Speaker
Exactly, in a complex. Okay, got it. That's the reason why that expertise is needed is because now if you only had when your body starts going into this extreme end of organ failure, there's an interplay of multi organs at that point in time.
00:21:09
Speaker
So if you have a kidney specialist doctor, he can help you with the kidney, but he won't be able to help you if the patient has kidney failure and is on a ventilator, and also has low blood pressure and there's a heart problem. And similarly, a cardiologist won't be able to help you with the kidney or with the lung. So the infectious is a multidisciplinary person that
00:21:30
Speaker
takes care of all of those and will call on a specialist as in when the need for that specialist is there. Okay. Got it. Okay. Okay. So what you were offering to that hospital was expertise on calls.
00:21:45
Speaker
Yes. Okay. So it was purely like a service offering. There was no product in it as such, like purely as consulting on call kind of a... So also what we realized is that this is the solution cannot be a on call solution, right? You can't wait for the nurse or the surgeon at that hospital
00:22:09
Speaker
to identify the problem that's gonna happen because again, he's not a specialist in ICU care, right? So if you're going to wait for that person to alert you, it's probably already too late, right?
00:22:25
Speaker
So whatever solution that you bring forth here needs to address that problem. So you need to be able to preempt these problems very often and you can't wait for the surgeon to identify the problem. You could perhaps still help him but your help will be limited as opposed to you having been available 24-7 preempting the problem and addressing it even before it happens.
00:22:50
Speaker
So that was one thing that we realized that this can't be an on-call service, right? So we literally need to be a part of this ICU system 24-7, right? So there was no product at that point. So we would like see, you know, for us to do this and for us to do this at scale, we'll have to build the technology that would allow us to do this.
00:23:18
Speaker
And we don't have that technology at that point in time. So we're just going to hack whatever we can together to make it work for this pilot, which obviously won't work if we need to do it for 10 hospitals. But for one hospital, we can still do this, right? So we spent a lot of time, actually, in identifying the... So we had seen a few of these solutions work in the United States.
00:23:48
Speaker
In the US, you had a large multinational player that had made the solution and the components of the solution included a high-definition video camera, a platform that had this data coming through on a continuous basis allowing doctors to interact. We knew we needed a high-definition video camera.
00:24:11
Speaker
And we had seen the cameras that were being used in the US so we were like okay let's see if we can use those and very quickly we realized that there's no way that we can use that. The hospital that camera was like just there's no way that we can put it in this hospital.
00:24:26
Speaker
So we spent a few weeks just in Bangalore. There's a road where you have a lot of electronic stores. So we were just there doing trials on different cameras. What can we find? So you go there.
00:24:43
Speaker
I want to try this so we spent a couple of weeks actually just trialing all the different cameras understanding what capability which has you know does it have so we wanted an IP camera we wanted a pan tilt zoom camera we wanted a certain amount of
00:25:06
Speaker
You know zoom capability of the off the camp many things then you know we had to decide is it going to use an indoor camera out of camera what are the features of the indoor camera but then indoor cameras are not really working so perhaps maybe you should use an outdoor camera better suited for this.
00:25:25
Speaker
So at the end of it, I identified, okay, this one makes sense. We can use this. We needed a technology platform. To get the data, like the readings. Yes, to get the data. Again, we didn't have a technology platform. So we just, initially we used an Excel sheet, and we brought on board one of our team members to just keep inputting data on the Excel sheet.
00:25:55
Speaker
Then we realized that, you know what, Excel is not a very good collaborative tool. So we're like, let's switch this to Google Sheets. It's better here since there are multiple people here. So then we switch it to Google Sheets. And again, even in that data sheet itself, what is the data that we want? How do we structure it in the best way for us to get that? So constant inflation on that. So we were just using Google Sheets then. We were like, OK,
Initial Tech Solutions and Future Plans
00:26:21
Speaker
let's just use Google Sheets, get this data here.
00:26:24
Speaker
Uh, you know, get it in a printable format so that we can print it for the bedside team. Let's get the camera, the camera that allows us to do what we need to do. Let's use people where we don't have the technology to help us. Um, and so that's, that's how we, we got started. But, uh, at the end of the day, let's remember the problem. The problem is that there's no intensive is there. And so whatever it needs to ensure that
00:26:54
Speaker
And at that point, and Dilip and I were the intensivists that we're there and addressing the problems that need to be done. So that's how it started. So we were there 24 seven available. So between the two of us, we split days and nights and.
00:27:13
Speaker
And we had, you know, our team members inputting data on this, we were giving recommendations, we were talking to the nurses and the doctors that telling them what needs to be done, preempting a lot of situations. So there were many, you know, there was one of the early cases I remember was a case of a patient that he had done a surgery on and post-surgery had a problem with the heart rate of that patient, right?
00:27:40
Speaker
So, he's like, hey, you know, this is a problem, so we need to get an ECG, we need to interpret the ECG, we need to tell him this is the medication that needs to be given, this is what needs to be followed in like 10 minutes, 15 minutes, 30 minutes, we are following, we are watching, so we will tell you as things change what needs to be done. And so he's like, yeah, I would never have been able to do this, right?
00:28:04
Speaker
And this was done remotely. This was all done remotely. And so that's where he saw the value of the solution was that his problem was being solved. His problem was that he didn't have an intensivist and as a result he could not do these surgeries. And if these patients had these complications, he was out of his depth.
00:28:34
Speaker
And so that problem was solved. Now he concentrated on doing surgeries, doing more surgeries, being able to take care of the patients.
00:28:43
Speaker
previously he couldn't and we were taking care of all of these issues. So it was just, you know, from a technology and product standpoint, it was a hack UK that we put it together, but we got what he needed. Yeah, I mean, it worked like that. So like, essentially, what an intensivist needs to do his job is a lot of data, right? To look at looking at data and then based on the data, give recommendation and then see how that recommendation changed the data.
00:29:12
Speaker
There's an aspect of, you know, we spent a lot of time on the camera part because that's also pretty key. There's a data component, but you also want to be able to see the patient. You want to be able to see, you know, for example, what is the breathing pattern of the patient. I would say pretty much every doctor is at some point in time.
00:29:35
Speaker
I would say that all doctors should be data-driven. There's components of healthcare that are beyond data, understanding the psychosocial
00:29:51
Speaker
parts of healthcare delivery, communication, understanding the value system of the patient, what they would want, communicating to them, addressing, being empathetic. These are the parts that doctors should spend more time on and less time on the data. There are better ways that data can be processed than the human brain. So I think if you were to ask me, I think doctors should spend more time on
00:30:17
Speaker
communication on understanding and empathizing and being able to address those aspects and utilize all the help they can get with the data. So I see the long term play here. What I see as the long term play here is that you would increasingly productize the
00:30:38
Speaker
information, how it flows to you. So instead of a man entering on a spreadsheet, it would become IoT enabled devices so that the information reaches you more seamlessly, more real time, no delays in that. Instead of having a nurse check the temperature, it could be a wearable. Somebody is wearing a device which is giving you real time temperature. So stuff like that. And I mean, there are more and more innovations happening in variables.
00:31:06
Speaker
And then you could have all of that data, initially there would be manual supervision and recommendation but then that could feed a machine learning algorithm so that a lot of these recommendations are auto-suggested by your algorithm.
00:31:22
Speaker
Even for the visual stuff you could have vision learning algorithms there which automatically raise a red flag when it seems like something could go bad. So I see that long-term play. Is that the long-term play which you have in mind?
00:31:40
Speaker
Yes, yes. That is the way that this needs to go. I think, again, just from my experience as a doctor, as a clinician, just as an intensivist as well, I would say that when I went and saw a patient, I probably spent a majority of my time
00:32:03
Speaker
doing things that a machine could do better than me. And less time on doing things that perhaps a machine could not do better than me. And that does not lead to ideal efficiency of productivity. But I would say more importantly, I don't think that that's in the best interest. That's not the most patient-centric way to solve the problem.
00:32:28
Speaker
And so I think just to your point, the way that we see this progressing is, of course, more pervasive automation of the entire data gathering part. So there's one component of the first component of it would be to digitize all the data.
00:32:51
Speaker
And it could be readings from a machine or it could be video. So one is the digitization component and the second is just building the intelligence on digitized data that you have. And best enabling the clinician, the doctor to then be able to provide
00:33:18
Speaker
the best care to the patient and spend more time on maybe communicating and talking and training things. How far along are you on this journey? From that first version of a human being entering data on a Google Sheet, tell me about that evolution.
00:33:39
Speaker
Yeah,
Development of the Radar Platform
00:33:40
Speaker
so so we did that. And I think even for hospital number two and three, we were still on the Google Sheets because even, you know, then you keep putting in, you know, more and more intelligence as much as you can into the Google Sheet as well. But still, there's only so much you can do. And it was clear that, hey, you know, OK, we're running out here of what we can do here. So let's
00:34:05
Speaker
do what we had always planned to do, which is start putting the platform together. And so far, this was no external funding, like just built on your savings and probably the subscription which you are charging, I guess it could have been a monthly fees kind of a... Yes. Okay. And was that enough to leave some money to reinvest or that monthly fees or did it all go into operational?
00:34:31
Speaker
No, no, no. It still required us to put in more than what that could sustain. No, it would not. So, Dilip and I used to do some consulting work in our individual capacity for hospitals in the US and so that was what allowed us to
00:34:51
Speaker
keep investing into what we're doing here and so then we start moving towards building the technology and so we brought on board
00:35:07
Speaker
another colleague of ours well not a colleague of ours but his name is also Dhruv he's a colleague now he wasn't there and he came into lead at engineering he was also an engineer who was in the US had spent a long time you know working at
00:35:22
Speaker
a large healthcare technology company that built EMR software called Epic Systems in the United States and he had moved back to India and was trying to figure out what he wants to do next. So we brought him on board to lead our engineering and then he started building his team and working with him we started putting together our platform which was called Radar. Okay. So what you built was purely a software thing or was it a software hardware combination?
00:35:52
Speaker
purely, purely software. Okay. But how do you get data from the machines? Like say, there's a monitor there, do they give data or is it just a paper that comes out of it? Like, you know, I don't know yet how modern these devices are in ICUs, whether it comes out as a bits and bytes or it comes out as a visual or a printout.
00:36:16
Speaker
So depending on the ICUs that determines how modern these are, the newer devices can actually give you data. And there are standards by which data comes out of the devices. And so they are interoperable. And so if you build a platform that can speak to those devices, you can get the data.
00:36:42
Speaker
In India, very few hospitals have those types of devices. The majority of the devices are, you know, the hospital owner is not really, when he goes to buy a device, he's not like, you know, give me an interoperable device that is compatible with candles. He's like, yeah, just get me a device. It could be a third hand, you know.
00:37:04
Speaker
Chinese made or made somewhere else where there's no way that you can get data out of that. So then there's different ways in which you need to get data out of that. So we started using computer vision to get that data. So we knew that visual existed and we had these high definition video cameras that we were utilizing. So we're like,
00:37:27
Speaker
you know if we can't if this is not an interoperable device we still need that data we still need to digitize this so we don't just go this route and at the end of the day I need that data to be able to help how I get that data is I need to figure it out.
00:37:42
Speaker
So just point the camera at the ECG monitor and that data then gets converted into bits and bytes through vision learning. Yeah, amazing. Okay. So these were all again, these were all things that that we did because so when we were building the platform and of course, you know, we spoke to all the multinational folks that were building platforms. And they were like, yeah, you know, if it's not an interoperable device, you can't do anything.
00:38:09
Speaker
yeah, you can get it that way. So you need to get it some other way. But I think it was, you know, that's the I guess that's the advantage of actually being on the ground, understanding the problem and solving it there. Because if you have an engineer who is building a solution for a multinational company who does not understand that 90% of the devices are not interoperable, he's not really going to consider any solution other than a solution that
00:38:40
Speaker
No, in the US, all the hospitals have interoperable devices. You don't have to consider any other solution. So you just can't do that. And so then when you talk to the guy who's selling you this, he tells you that, yeah, but there's no other way. You can't do it in this hospital.
00:38:57
Speaker
I don't think your engineer has ever been to a hospital that you're selling the solution in. So maybe you should start with that. But these were all the things that we realized. But I guess these were the advantages that we had as startups that were intimately involved and understood the problem statement and going up against guys that had a brand and a sales force that you can't compete with.
00:39:25
Speaker
So Radar was essentially a platform where the data would come in, it would get organized, and it would go into dashboards so that you can see real time. Every patient has a dashboard where you can see all the data about that patient in a standardized format and then take decisions quickly. And does it also now do intelligent recommendations? Does it give you a red flag or stuff like that? Has that started?
00:39:55
Speaker
Yes, it has. So like I said, the first component is to digitize, get the data in a digital format. And then once you've got the data, then you start building intelligence on that. So that's where we are. And that's something that I guess we will never stop doing because you can always get more intelligent. But yes, we have started now has moved to a point where
00:40:21
Speaker
It's not just a data collection and data dashboard that shows you the data that's collected, but now has started intelligently processing the data to either improve the quality or improve your efficiency or improve your experience, all of those.
00:40:39
Speaker
Okay. You would probably also have to, I mean, to make it intelligent, you would have to feed it with so much stuff, like the knowledge base. It's like what you learn as a doctor over 10 years or 15 years of education. And there is so much, like maybe it would need to know every medicine which exists and what is the symptom of each medicine and what is the medicine good for and when should it not be given? And when can a combination of two medicines work? Which combination does not work? How do you do this?
00:41:09
Speaker
All of those, all of those, all of those things and more, right? All the things that you learned as an intensivist, like if there is a certain disease and, you know, what's, what's the protocol that you need to follow for this disease? You know, so, so we've built in, like, you know, protocols for 50 diseases now, and we'll keep adding to that. So we will keep adding to that. But tell me the process you went about in terms of creating this knowledge base, like, was it like hiring a doctor and then
00:41:39
Speaker
putting it down on a word document for us and then that word document getting. Both of us were already doctors.
Creating a Knowledge Base for ICU Protocols
00:41:48
Speaker
And so at some point in time, you know, we we also had to divide our work. And so so the leap took the lead on on the product part of it. And and he is one of the best intensivists in the world. So nobody better to be working on it than than him. And
00:42:08
Speaker
So he took the lead on that, putting in place what data needs to be there, everything from medications to which are the protocols. And of course, by then we had brought on other members of the team, other intensivists and other doctors.
00:42:24
Speaker
And among our team as well you know the different people were interested in different things some people were interested in technology so the folks that were interested in technology amongst our doctor we were like okay you know you guys will work with the technology team.
00:42:38
Speaker
and the leap in putting this together. So everything from lists of medications to, like I was telling you, which are the diseases that we're encountering in the ICU. So what's the protocol? What's the evidence for that? Then making protocols for that. But not only doing it, so doing it in the technology
00:43:00
Speaker
Part is fine but you still want to make it a way that is you know make sense to the nurse or the doctor who may not know as much as you to be able to utilize this right so so then putting explaining that protocol.
00:43:15
Speaker
to putting on the platform the explanation for each protocol that you know this is the protocol this is how it's being followed this is step one you know if the patient's blood glucose is so much this is what we do if it's not what we do this is why we do it this is the evidence for why we're doing this so you know just putting this sort of help modules on so that even a junior doctor who is at the hospital and can see a cha
00:43:43
Speaker
This is why it is you know so for for each and everything that's that's and that's one one component of it then it would be things like okay you need to document so doctors need to document everything that you're doing so.
00:44:02
Speaker
And one of the challenges with adoption of electronic records in the healthcare space has been generally that documentation gets so onerous that it starts taking away and adding more work to the clinicians than making it easier.
00:44:24
Speaker
build a documentation system that would not be so onerous. So what we started doing was let's automate a majority of the documentation that the doctor needs to do, which
00:44:38
Speaker
he doesn't really need a meter. You can take information from this patient's chart and automate all these components. So he just needs to put his input, which may be a couple of lines, maybe edit a couple of things based on his judgment. But he does not need to sit and write out or type out all these things, which is what's making him not
00:44:59
Speaker
take on this form. So let's do that. And so we know what in an ICU, what is the documentation that's required, which are the parts that we can automate just by the data that we have. And so that was another part of it. So these are some of the things that we were doing for nurses. So nurses are an essential component of health care delivery.
00:45:27
Speaker
even in the ICU. They are the ones that are actually there at the bedside, 24-7, implementing the things that need to be done, picking up things, making sure, assessing things.
00:45:41
Speaker
The challenge with having them move to a digitization has also been similar that the documentation gets onerous, there's double documentation, etc. And so they're just very comfortable with just writing things down. If you ever go to a hospital, you'll see that the nurse will always be writing things down, maybe the blood pressure, maybe the heart rate, all of those things.
00:46:03
Speaker
So we wanted to ensure that we made it easier for the nurses as well. So of course one was to digitize the data that is from the devices which previously they would be writing down. So if they didn't have to write that down then it would be much easier.
00:46:24
Speaker
even things like, you know, a lab report will come from somewhere else from outside and then they need to write down everything. So we wanted the data from that lab report. So what we started, we started, we built modules that would allow the nurse to just take a picture of the lab report and just OCR and convert that automatically onto the platform. So just these easy workable things that just made the life of the people using
00:46:54
Speaker
technology easier was what would eventually determine whether they adopted it or not. So I think that's the route that we took it. And we'd seen a lot of things that had just been engineered to a point of
00:47:13
Speaker
not being practically very usable or very friendly to use. And so we wanted to avoid those aspects of things. So these were some of the things that
00:47:26
Speaker
you know, we started building on the platform just to enable, ensure the user experience is better, adoption gets better. Okay, cool. So like broadly, there were two things that you were fixing at the ICU, like on floor, so to say. One was data entry, so that the human beings on the floor don't need to do too much of data entry simplifying that. And the second is,
00:47:55
Speaker
giving them easy to follow instructions, like SOPs and stuff like that, which helps them, A, to know what to do next, B, if they need to communicate why they're doing it, then that also makes their life easy, like telling the patient why they're doing something or deciding what to do next. So these are the two things which you're building. And is it through a mobile app or is it on the laptop? What is used typically at the ICU?
00:48:24
Speaker
It is a laptop, there is a mobile app, there is a web app and there is a tablet version of it as well. So different settings, some places are
00:48:40
Speaker
you know, lean more towards mobile. Some places where they have some amount of infrastructure, they already have some laptops. So there's a web app that they could use. Some places mobility is critical. They use tablets. So we've sort of built the solution to be agnostic from that point. Yeah. I just say, you know, to your point,
00:49:07
Speaker
what you said is right, but I just sort of stress the importance here that what we
Implementing Solutions and Change Management
00:49:14
Speaker
were doing was a pretty big sort of change management in these ICUs, right? So there's a huge, huge component of process here and everything from how you communicate, you know, how you respond when there's an emergency
00:49:32
Speaker
you know how do you people are busy people are not used to something so you just need to work on the process of how you gonna make this seamless and effective as well so it requires training of nurses you know so we would we give them weekly training when we onboard them we train them for the doctors will conduct sessions you know if there's some for example if there's
00:50:01
Speaker
If there's some unforeseen or unexpected outcome of a patient, we would conduct a review of that and understand all the processes that perhaps go the way that they should, give recommendations to the hospital, to the management, to the administration. So outside of just the technology and having the availability of a doctor,
00:50:24
Speaker
I think what people fail to realize is that there's actually a huge process change that needs to take place that would enable a completely new system and a new way of working to come in and replace the old and conventional way. And so that requires a lot of process changes, a lot of people skills and a lot of interaction to take place.
00:50:53
Speaker
I think that's what we are able to also bring, which only just somebody who just builds technology and just gives somebody, okay, if I build this app and I've given you this app and you take it and run, it will not be able to take it and run. It's just not going to happen because it's a pretty complex system. It's operationally complex and ICU.
00:51:23
Speaker
It's been functioning in a way that's not the best way, but it's been functioning like that for years and decades perhaps. And so if you're going to upend that system, then you need to build an entire change management process that will take a few months along with the technology and the access of the doctors remotely to do that.
00:51:43
Speaker
So when you deploy today, what is part of that deployment package? Do you also deploy people or do you deploy? Obviously you deploy the product and you do that integration so that the data comes to your central hub. But do you also deploy people or the people are more consultative in nature where they come in for the trainings for educational purposes and stuff like that?
00:52:11
Speaker
So, no, we don't deploy people on the ground. But as part of our onboarding, when we initially deploy, we have a team that goes there, consisting of some of our nurses, some of our doctors, some of our IT folks, all of them that work with the team there, understand what their existing
00:52:34
Speaker
situation is what their existing problems are and then sort of help onboard them on to how the system will help address them. So there'll be training sessions. Since it's a new system and there are a lot of doctors in place, so our doctor will go and talk to the doctors, you know, will wrap up with them, explain to them how the system is going to help them. They may all be
00:52:58
Speaker
have different use cases in which this is going to help them. So there's a few day process that the entire onboarding process involves all of these things to happen. And again, these are things that we've learned over a period of time that if you're going to set this up for success, then you want to do all of these things and get all of these things in order. And then once you've done that, then we're
00:53:26
Speaker
only remote there and then all the support that we provide is remotely. So including the trainings, including all of those things. And sometimes we would send a team back maybe a few months or a year later.
00:53:46
Speaker
if there's some new change that's happened in the hospital or the deployment is being increased or there's been a huge change in the people that were there initially to who are there now. So some of these things, of course, we're able to on the fly understand the problem and solve for that.
00:54:04
Speaker
wouldn't you get better at outcomes by also deploying people? Because then, you know, as you said, change management is a big challenge. So if you have people on your payroll who are on the floor, so to say, it would, I mean, change management would happen relatively. I mean, there will be less resistance to change because that person is trained by you on your payroll, whereas someone who's on the hospital payroll
00:54:30
Speaker
May I discount some of the things you're saying? You're not his boss or her boss, so to say. Yeah, no, you're right. I think that's certainly something that we've considered a few times over the last few years and maybe something that we may consider again and maybe something that we may even do.
00:54:55
Speaker
We started to see that the challenge is always people, right? I think that's always the challenge and we're trying to be able to provide this to anywhere, wherever they are. So our focus remains on how can we best do this without having to put people on the ground because that's always going to be the limitation.
00:55:21
Speaker
That does not mean that that's not something that we may consider doing but i'm just telling you that we're still trying to build a system and a solution that would best allow us for for us to do that what's doing that we've you know i started six month courses for.
00:55:36
Speaker
our partner hospital, the nurses on the ground there where it's like a certification or something. It's actually a certification course that we created along with a
00:55:51
Speaker
University here in Bangalore called IIHMR, and it's an integrated digital intensive care management six-month course that we provide for them. These are all, again, efforts of ours to enable people locally to upskill them, for them to understand what this takes.
00:56:14
Speaker
And if that requires us to go there and do that in person or through the course or through other ways or through remotely, we do all of them and we'll continue to do what it takes to get the job done. Got it. Okay.
00:56:32
Speaker
So, you know, let's like also talk some numbers like what are the number of places you're currently deployed at and like what kind of revenue are you currently doing? Tell me some stuff like that.
Cost-Effective ICU Solutions Across India
00:56:48
Speaker
So we're we're deployed at about 40 hospitals across the country today in we're in about 15 states.
00:57:00
Speaker
of the country where as far as we have a hospital in Leiladakh, in Kerala we have hospital in Assam, we have hospital in Gujarat, so pretty much four corners of the country and in between as well. So that's, we've taken care of about over 30,000 critically ill patients since we started.
00:57:25
Speaker
having shown significantly improved outcomes in many if not most of these hospitals over that period of time. What do you charge? What is the pricing like?
00:57:41
Speaker
I won't go into too much of the specifics, but just to give you a sense, see, there's a one-time setup fee where we go install, onboard, train, et cetera, all of that. And then there's a monthly recurring charge, which is typically linked to what the capacity utilization of the hospital is.
00:58:08
Speaker
So it will be like the monthly charges. Yeah, something like that. And also, the goal of this was to make this cost effective as well. You just can't provide access and quality here because if it's not cost effective, then you may as well set up a Manipal hospital in that location.
00:58:32
Speaker
So, it has to be cost effective and we are significantly, significantly more cost effective than if these people had to hire a team of intensivists or even if they could find that team of intensivists. In many of these cases, you won't even have them, but even if you could find these places, we would be much more cost effective. And I think our goal has been
00:59:00
Speaker
to see the current construct of, you know, if you had to provide a health care, a quality health care in the way that like a Cleveland Clinic did it or a Manipal did it to everybody in the country today.
00:59:21
Speaker
I don't think there's enough money in the world to do that. So the goal is that if you want to be able to provide that quality of care, can you do it in a way that does not require you to spend so much money? And that's what we're trying to do here. And that's what we're saying is that if you use this model of technology augmented care, we'll be able to provide
00:59:49
Speaker
you know, similar, maybe better, but at least much better than the existing care that there is without having to incur much, much higher costs, which traditionally the centers that deliver high quality care require. You just have to pay that material. That's how much it costs them. For like say a 10 bedded ICU, would it cost equivalent of like say one person's salary, one doctor's salary, like on a monthly basis?
01:00:17
Speaker
it would probably cost less. Okay. Got it. Right. And to run a 10 by rice, you, uh, 24 seven, you'd need more than. Yeah. You need more than one person. Right. Right. Right. So you need a team of guys and also we're, we're pretty cost effective. Uh,
01:00:38
Speaker
And what kind of hospitals buy this? I mean, you know, I'm sure there is always a question that why should I spend on this? So what kind of hospitals are willing to spend? What do you find in your...
01:00:57
Speaker
Yeah, so different sort of customer segments that you find. Of course, there are the ones that are like, hey, I want to improve quality. How can I improve quality of care? They aspire to be the best community hospitals in their communities.
01:01:19
Speaker
And they want to find out how they can do that better. So that's one segment of hospitals, which is, you know, which I would call like, those are the earlier doctors, if you can identify them there, they will see value in what you're doing it, and we'll do that. Then, of course, you know, like we were discussing, then there are hospitals that that have a problem already, right. So, so that
01:01:44
Speaker
that are not able to optimally utilize all the services, all the physical infrastructure that they've invested in because of the shortage of expertise. So they're like, Hey, you know what, if I have this solution, this, this will help me. And so those are, this will just help me from that standpoint. So that's that. So if I had to break down the, the segments of hospital, so there would be the small and medium sized hospitals.
01:02:09
Speaker
you know, there are, you know, 50 to 150 bed hospitals, these could be located. If they are in an urban location, they will be smaller, you know, 50 to 50 beds. If they are in, you know, tier two or tier three city, it could be anywhere from 50 to 150 beds. Now, these are hospitals that have
01:02:31
Speaker
already invested in the physical infrastructure. So they've reached a scale in terms of their size where they're like, we've got 50 beds. I already have a ventilator. I have a few ICU beds. I've got a 24-7 laboratory. I've got a CT scanner.
01:02:48
Speaker
you know 24-7 pharmacy because that's what you need to do to any way to a 50 bed size but I'm not able to optimally utilize all these I'm not able to you know provide the confidence to my consultant doctors to send patients here or admit patients in the size because I don't have that expertise available right so that's
01:03:10
Speaker
one segment of hospitals that we are able to come in and be like, okay, this is what we've got. And we are able to provide you that quality of care because we have one of the best intensivist teams in the country, which you will not perhaps get access to where you're located. And if you were to get access to that level of talent, it would probably be cost prohibitive for you to hire them
01:03:40
Speaker
who to manage right so that's one segment the other segment of hospitals is the enterprise segment of hospitals that have their own icus and have their own intensivists there but
01:03:56
Speaker
They either associate maybe a chain of hospitals where they have intensivists in one location but not in the other or even within one large hospital, they may have intensivists in one unit and they may not have the same in the other. So they want to optimize their own ICU network. So they don't need our intensivists but they want our technology
01:04:24
Speaker
To do for their own team to be able to utilize so those are that's the other segment of enterprise hospital That would be like a different type of offering like with a separate pricing and that's that's a stop Got it. Okay. Okay. Okay
01:04:39
Speaker
And what is your revenue split between this pure software offering versus software plus service offering? We are heavily still into the software plus service offering. 90% is still in the service plus software offering because
01:04:58
Speaker
Again, what we found, at least in India, is that people still need the service. We've not reached a point where... That's a much bigger problem to solve. Yeah. So what's the roadmap for, like, say 2025?
01:05:13
Speaker
I think our vision is to build a... So let me tell you what my take on this healthcare delivery is going to be. And I had hinted at some of these things earlier to you as well, in the sense that
01:05:34
Speaker
The current healthcare delivery system does not provide for access to high quality care everywhere. Also, the construct of hospitals will move towards providing more high acuity care because lower acuity care perhaps does not merit being in a hospital and perhaps a hospital is not the best place to be.
01:05:58
Speaker
So in this construct as hospitals move towards providing more high acuity care, there will be a move towards virtualization of some of the expertise and the services the hospitals need because it's not going to be possible for the hospitals to have all of the expertise in every field that they needed quite high acuity care all the time they needed.
Vision for a Global Virtual Hospital
01:06:23
Speaker
And so our goal is to build a virtual hospital where we can be the virtual backbone for hospitals wherever they're located and provide them with the technology and the services and the support that they need to be able to manage optimally the patients in their communities. And our goal is to build this virtual hospital at a global scale.
01:06:44
Speaker
So we believe that this problem statement is not unique to India but is one that is prevalent world over. And if you're going to address access to quality care for all, we'll have to move towards a model that allows for virtualization of care to take place. And so we want to be at the forefront of this.
01:07:07
Speaker
this virtual hospital that we're creating. And so over the next few years, 2025, our goal would be to continue to expand our presence here in India.
01:07:23
Speaker
and also to grow in you know to some of our neighboring places you know southeast asia the middle east other parts of the subcontinent then eventually over a period of time even more west than that so that's how we see this and and in doing this we will provide.
01:07:44
Speaker
the technology to the partners that need the technology to be able to provide us this care in this virtual manner to their patients and provide the services where the services are needed. Are you looking to go beyond just ICU management to like everything else also like the OPD or the EMR? No. So we won't go to the OPD space because like I was telling you, we want to stay in the high acuity space.
01:08:12
Speaker
So the OPD space, there are already plenty of folks and that's not the space that we're going to go into. But when you have patients that are in hospitals, admitted in hospitals as inpatients, there are other requirements. So ICU space, we are going into the neonatal space. So again, this is a huge shortage. You've got babies being born that need
01:08:36
Speaker
you know neonatal icus and there's not nearly enough expertise there pediatric icus but when you're admitted in a hospital icu very often you need the services of a nephrologist sometimes you need the service of a cardiologist.
01:08:53
Speaker
So, the entire spectrum, so, you know, we're going to be going towards creating a virtual hospital where the hospital, we can provide all of the services that patients who have high acuity care are admitted in hospitals need the support. That's the direction.
01:09:11
Speaker
post-operative care that you're talking about, right? Like that you would... Post-operative, post trauma, post, you know, ICU care, just if you have a bad pneumonia, you're on a ventilator, all of this, it covers the spectrum. But you would not be looking at like the pre-operative stuff and the actual, like providing technology around that, like from when someone gets admitted till the procedure is done, till he gets discharged, like... So I think
01:09:41
Speaker
The technology of course will be there. So the technology will span the journey of the patient in the facility. So that technology backbone we will bring or we will integrate with if there is already some technology existing for certain parts of it.
01:10:04
Speaker
What we want to be in is we want to be in like OPD space where, you know, you have a cold and a cough and you're looking for a doctor, call a doctor, sort of, that's not a space that big. Got it. Okay. Amazing.
01:10:18
Speaker
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01:10:38
Speaker
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01:11:02
Speaker
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