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Pioneering the Indian digital health records stack | Vikalp Sahni @ Eka Care
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Vikalp Sahni is the man responsible for building the Aarogya Setu app in record time. Building the Aarogya Setu app inspired him to create Eka Care, a platform for managing personal health data. Eka Care's ambitious mission is to provide individuals with easy-to-understand line graphs, similar to tracking financial health, but for monitoring personal health metrics.
Read the text version of the episode here.
Read more about Eka Care:-
1.Eka Care health app incorporates HRM, medical record management
2.Eka Care Health App Brings Heart Rate Monitoring and Medical Record Management to Your Fingertips
3.Eka Care releases Health Report 2022
4.Eka Care, a startup helping digitize health records of Indian patients, raises $15 million
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Transcript
Introduction of Vikalp Saini and EkaCare
00:00:00
Speaker
Hello everyone, I'm Vikal. I'm a developer at heart, a technologist. At this moment, I'm acting as a founder CEO of EkaCare. It's a personal health record app for patients and an electronic medical record app for doctors.
The Arogyasetu App: Development and Impact
00:00:27
Speaker
Do you remember downloading the Arogyasetu app during the Covid lockdown? The Indian government was one of the early adopters of contact tracing app and this app was proof of India's tech talent. In this episode of the Sound Athesis podcast, your host Akshay Dutt talks to Vikab Saini, the man responsible for building the Arogyasetu app in record time. Vikab has had a fascinating journey with a front row view of the evolution of the Indian startup ecosystem.
00:00:53
Speaker
He was the CTO and co-founder of the travel startup GoIbibo, which was eventually acquired by MakeMyTrip. The experience of building this Aroki Setu app changed his trajectory and soon after that, he launched Eka Care, a health data management platform. If you wanted to track the financial health of a business, you would be easily able to see line graphs showing historical performance of different metrics.
Vision of EkaCare: Health Metrics Tracking
00:01:17
Speaker
Now imagine being able to do this for your personal health metrics. And that is the audacious mission of EkaCare and Vikalp. Stay tuned and subscribe to the Founder Thesis Podcast on any audio streaming app to hear from startup founders chasing large audacious goals.
Vikalp's Educational Background and Early Programming Passion
00:01:41
Speaker
So my father is a banker, was a banker, he is retired now, and I have studied in seven different states, used to transfer from one state to the other state. So I have seen like lots of cultures, have friends across different geographies. And basically, I'm a KV product and after schooling, I did my engineering from an IT culture. And since then, I had this engineering in computer science.
00:02:09
Speaker
I have done engineering in civil engineering, but since my 10th, 11th standard, I was quite fascinated with this whole tech and computers and all of that. I was not the most studious one, obviously, but I was quite interested in programming. And I remember my father got this 386, which was a machine that his bank was using. They wanted to upgrade their machines.
00:02:33
Speaker
And he bought me that 386 for I think 2-3,000 bucks at that point in time when I was in 10 standard. And I learned a lot on how to program, how to basically work with computers. And that's how the journey started for me. Since then, I've loved the format of this creative writing to build products that can be used by multiple people right from small games that we used to do in school and colleges.
00:03:01
Speaker
to actually building projects in college where I used to get gifts such as phone. My first phone that I bought was basically a small project that I did for a freelance project. One of my friends cousin wanted a website.
00:03:17
Speaker
So that's how my journey started with programming. And I mean, I wanted to build something on internet. I got placed in IBM in college, but then from IBM, I was, I was not an enterprise sort of person.
Career Transition: From IBM to Internet Startups
00:03:31
Speaker
So started looking out where I can contribute. As in you, you couldn't relate to the kind of.
00:03:37
Speaker
work that you were doing there, the kind of products you were working on. No, see, I love, I was programming. I used to work on C sharp, good team. All of that was all fine, but I was fascinated with internet. And that is how my journey also started looking at
00:03:54
Speaker
the internet products. And incidentally, my senior, they were doing, they were from Yahoo. I knew them, they were doing their own startup called bixi.com. And that got acquired by Masper's MIH India. And that's how I started my journey with Ivybo Group. And that's how the whole startup ecosystem and entering into it and all of that started for
The Evolution of GoIbibo
00:04:20
Speaker
me.
00:04:20
Speaker
So you were an employee at Bixi when it got acquired or you were one of them? No, no, no, no. One of the guys who used to like work with these founders at that point in time, they knew me well, especially Ruban. He was one of the founder. He was earlier part of Hot Jobs Yahoo. And so yeah, I knew them, but then when they got acquired by M.I.H and NASPERS,
00:04:45
Speaker
they wanted to build a larger team. And obviously I wanted to also participate in building internet products. That's how the whole journey started. What is MIH? MIH was the name of NASPER's investment vehicle at that point in time. Okay. Okay.
00:05:00
Speaker
Okay. And how do you spell Bixi? It was a vertical search engine. You could have, you would have seen search engines like monster or indeed where you search for jobs or Yahoo hot jobs and so on and so forth. So this was a vertical search engine. The primary objective earlier was to do search for jobs across the various websites, but the full technology was built in such a way.
00:05:26
Speaker
that you can leverage that technology to create various vertical search engines. Like if you look at Google today, you can do an image search, you can do a video search, and so on and so forth. So our belief was that there will be multiple search engines that will solve for specific vertical needs, be it matrimony. I mean, you'd be surprised to know at that point in time in 2008, when we used to build Big C, there were close to 400 matrimony websites.
00:05:56
Speaker
And I have called them all and indexed them and created a. And we've got actually patent for the technology that we've built post the acquisition. And we believe that that would be one of the big stories. And we worked there. So, but what happened to it then? Like, you know, the thing is, it was the early days for Indian internet, right? 30 million Indian internet users.
00:06:19
Speaker
There are multiple products that we started. One was search, other was social. And the idea was that we will be India's Baidu and Renren and WeChat, right? That's the story that China has seen. But India was very different from a market standpoint and China was more world set up while India is, India has shown very different path, which is far more formidable path, which is of platforms. You see it UPI and all of that, but that was very early.
00:06:46
Speaker
Right. At that point in time, Indian internet population was also quite early. So we haven't seen that kind of attraction to our product that we wanted to and monetization also after three years down the line was seems like we have to see how we can monetize better. And that's where the whole pivot started for us.
00:07:04
Speaker
And the pivot started from being certain social company to more of a transactions company. And that is where we transformed travel.bixi product to goivibo.com. And we built a small payment gateway for goivibo.com that we built it as an IBO pay. So that's how the transformation happened for us.
Strategic Merger: GoIbibo and MakeMyTrip
00:07:29
Speaker
And that's why you don't see any bixi.com or ibibo.com anymore, while these were quite fantastic products at that point in time. Wow, interesting. Essentially, out of all the vertical search sites, microsites that you were running, you saw travel as the one which was most promising to convert it to transactions and decided to bet on it, basically.
00:07:52
Speaker
Yeah, see many things were happening at that point in time. This was 2009 now. 2009 Flipkart was basically becoming prominent, right? Which means that transaction story was coming together. Yatra clear trip were already like a decent player and India has seen first set of their online transactions on travel.
00:08:11
Speaker
Make My Trip might have got listed by then. Exactly. That was I wanted to share. Make My Trip got listed. And it was a brilliant listing, right? So I think Indian company going there, listing NASDAQ is a dream come true for everyone. And we basically said that, okay, this is a right thing to do. And travel.exe anyways had traffic, which was more of a meta search engine at that point in time.
00:08:37
Speaker
We used to like Ixigo, which was an Ixigo. Ixigo now does even flight cookings. Yeah. So this was a meta search engine and we said that it's a lowest hanging monetization opportunity and we started getting into travel.
00:08:52
Speaker
Okay. And how do you build the transaction layers and do you have to go and integrate with each airline? So see, we were a little smarter there, so to say, and like any other internet startup, we first said that we will use a B2B partner and we will integrate with a B2B partner at that point in time. It was via.
00:09:11
Speaker
where we leveraged that partnership. And we said that if this entire fulfillment works for us or not, and Ashish and Sanjay, Ashish Kasher was the CEO of Sanjay. He was looking after the whole flights business. Ashish was the CEO for Ivy Bo Group. We all came together and we built it. Once we started seeing the early traction, right? And so this we wanted a payment gateway also. So we built Ivy Bo Pay, which was to facilitate the transaction.
00:09:38
Speaker
Once we started seeing Traction, we ended up scaling it up. And that's when my current co-founder Deepak has also joined us from Yatra. He was looking after the business side of Yatra. He joined. Okay, the alliance is in all.
00:09:54
Speaker
Yeah, he joined GoiBibo along with, so me, Sanjay, Deepak, Ashish, all of us started then scaling up the GoiBibo's flight business. We started with flights and that basically, from that B2B partnership, then we ended up doing the airline partnerships as well once Deepak joined. But that was like a long journey because you have to start integrating with GDSs, start integration with individual airlines. But we started off nimble.
00:10:21
Speaker
And GTS is this like SAS tool which airlines use to run their ticketing. See, these are global distribution systems. So they are distribution engine. Obviously they have a SAS tool as well that airlines can use, but this is like pretty early days. Like at that point in time when these companies have been built, SAS was not even a word.
00:10:42
Speaker
Mohammedia, Sabre, Travel Fusion, all of these are large-scale transaction engines that are built to distribute travel content across. So these are like B2B e-commerce sites, basically. Like, this is where a travel agent can buy tickets from an airline. You're right. So earlier, the travel agent used to use a terminal without a UI to actually punch in. But eventually, OTA, such as GoIbe, Bo, Make My Trip, all of them started integrating with the APIs.
00:11:12
Speaker
Okay. Got it. Okay. And so, like, what about building the supply for the other stuff? The airline stuff is like, I mean, while it's not easy, but it's not that hard also because it's like other companies have done it and so on. But what about like on Go by Ivy where you have hotels and even like homestays and all of that? Yeah.
00:11:32
Speaker
No, that is what was our claim to fame. Flights were, so to say, pretty sorted. But when we ended up building, we saw many other opportunities as well. And two big opportunities were bus and hotels. So after a lot of contemplation, bus, we went the inorganic route.
00:11:49
Speaker
where Ibiza Group acquired Redbus and Redbus became part of Ibiza Group. But on the hotels, this was, I think, 2011-12. We actually figured that India was not doing hotel bookings online. When we started, the internet online booking would be, what, 5-10,000 a day. When I was leaving, we were doing close to 200,000.
00:12:09
Speaker
So, so that's the opportunity that we saw. And I think kudos to the team and the leaders. We ended up investing in the right areas there. And two key areas were one to build a software for hotels so that they can distribute their content. And we built an amazing tool. We used to call it in Goibibo.
00:12:28
Speaker
Still, it's a call in Go MMT now after the merger. And then we also invested into supply, which is like a human sales team so that they can onboard these hotels onto selling inventory online. And I think that is where the whole claim to fame of Go IV Go started. Hotels is where we have created a big mark.
00:12:49
Speaker
in the whole travel ecosystem. And I think that's that's how the whole merger and the story with make much up also started growing. Wow. Okay. So in in go I believe it was like a hotel ERP, where a hotel can manage its bookings distribution system, see hotel ERP, when you say ERP does many things, they will do housekeeping as well, they will do payrolls also all of that, but we were more distribution focused.
00:13:14
Speaker
So there are so many people who are, want to book hotels online, how this booking will happen. So hotels has to come up. They have to put in their inventory. They have to put in their content. And then the booking will happen on go IV boat.com, which is the P2C site. Okay. Okay. Okay. Got it.
00:13:31
Speaker
This was not like a pure play distribution where a hotel can go to multiple places to sell the inventory, but it's just a way for connecting their inventory to GoiVivo. Indeed. So it was to connect their inventory to GoiVivo. Then GoiVivo has released APIs. People can use those APIs from GoiVivo. See, if to book hotels, you have to first have the inventory online. There was nothing online at that point in time.
00:13:54
Speaker
And that is how the whole journey for us started. And we, at one point in time, this was 2016, there was Fears competition and Make My Trip, amazing company, great founders. They also know that hotels is like a big play with lots of gross margin and perishable inventory and so on and so forth. So hotel margin is better than Flint's?
00:14:16
Speaker
I mean, that's written on the wall. Flights is a low margin, but high consumer interest or a traffic acquisition channel. Like, for example, trains, like you can get consumer interest, create a good experience and so on and so forth. But the money that you would make there will be far lower than the money that you would make on hotels because there the margins are far higher.
00:14:37
Speaker
Because the market is unorganized and there is more like, I mean, it's not like a clear pricing, like say with the train, it's like very standard pricing, so not much scope for version. It's a fragmentation game, Akshay. Look at it, right? I mean, how many airlines we have in the country and how many hotels we have in the country, right? One is that. Second is it's very easy to distribute inventory, but that is not fragmented, but it's very difficult to distribute.
00:15:05
Speaker
And then you have, you can play far more. I mean, can I rate an airline on reviews and ratings and so on, so forth on seed capacity and all of that? No, but from a hotel perspective, you can do a far more, far better product so that consumer would use you beat for using reviews, ratings or content and so on and so forth. So in totality, if you see that all of this is the right markers for a business model, that is that'll give you far more gross margins.
00:15:35
Speaker
As a general lesson, if you go after a fragmented market, that will always give you better margins. If you can curate and distribute in a fragmented market, that would... I believe fundamentally, and that's what my learning was, market fragmented very good. But more importantly, what is the value that you are creating? If the amount of value that you are creating as a stack
00:16:00
Speaker
is high. Like when I am selling a flight, it's basically an inventory that is being sold, which is very commoditized, right? But when I am selling a hotel, there is a lot more discovery that needs to be done. Location is far more important, right? How do I reach that place is important. Content is important. What people are saying is important.
00:16:21
Speaker
So what kind of value you are able to add? So these two things, a fragmented market and is the problem is such that you can add a lot of value by putting in your beta technology or an offline business, whatever is your model. If these two things sits together, you can command higher business value for your solution. Okay. Interesting. Got it. So coming back to the story of the merger. So you were saying that there was fierce competition. Yeah.
00:16:50
Speaker
It was fear's competition and eventually Deep, Rajesh, Ashish and Naspars all of them have thought that it is the right way to not undercut each other but actually build the ecosystem together and that's how the whole merger story happened because the India market is huge and still it is under penetrated when it comes to hotel booking online. There is a lot
00:17:18
Speaker
that we can still do. It's like Deep keeps saying this quite a lot, that the best is yet to come. And I fundamentally believe that in Deep, the founder of Make My Trip, that best is yet to come for travel in our country, especially on hotels. It was the right thing rather than bleeding through the nose and creating a competition, which is not on product values, but more on discounting and price value. It's better to actually merge and build the ecosystem together. So I think very smart decision.
00:17:48
Speaker
all the leaders to get to that level. Is there still juice in the hotels market? Because you have these different ways of fixing fragmentation like Hoya rooms and Airbnb. So what's your take on this hotel market? India hotel, this still I would online sales is still I feel is under penetrated. There is a lot
00:18:09
Speaker
that one can achieve. And if I look at travel as an industry and hotel specifically, we have just touched the tip of an iceberg of a consumer side. There is a large corporate side business that also happens in the country, which still I believe is not organized.
00:18:26
Speaker
Right. And make much of this trying to do a lot of stuff there. Many other companies are also doing and there is a lot of last minute bookings that happens on hotels that again and hotels is such a commodity that it has a perishable inventory. Right. If the room is not booked, not booked for tonight, you're done.
00:18:43
Speaker
Right. So, there is a lot of innovation that can happen in hotels, be it a day room. Like recently I saw on Goi Weibo, I was able to book a lemon tree in Mumbai for a day, starting 9 a.m. in the morning to 6 p.m. in the evening for one fourth of the price of where I can just go for work. So, I mean, it's a crazy market and the amount of innovation that can happen. Pure play on hotels is just immense.
00:19:13
Speaker
Okay, so coming back to your own journey, so what happened once the merger got done? See, I'm a, as I keep telling, I'm a lucky guy or a fortunate guy to get right people during my tenure. I got empowered when I was building GoIBGo. I got super empowered again when I was, when the merger happened and when two teams are coming together, which is GoIBGo make my trip, even Redbus.
00:19:39
Speaker
So I stayed there for three years and merged a lot of technology stack, started, as I said, in GoIbibo eventually became in GoMMT where a lot of optimizations have happened. Also learned from each other. There's a lot of good stuff that has happened on Make My Trip on flight. So we, as in GoIbibo took that. So empowered even to build new products and so on and so forth. So my journey was beautiful.
00:20:06
Speaker
But the group continues to run both brands separately. Yes, the group continues to run both brands separately. There is, I mean, the group sees that there is a value in both the brands because there are loyal customers to GoIvo. There's a way people see GoIvo. So is with Make My Trip.
00:20:24
Speaker
And these are pretty large brands, more than 50 million app downloads, like high monthly active users. Why would anyone wants to kill anything? Kill, kill off anyone of them. Got it. That's when September 2019, I had this candid conversation that I think it's my time to start something up new and the whole journey to building something else started from there, but I had a great time. Okay.
00:20:50
Speaker
So you second round, once COVID hit like 2019, like, did you leave before COVID? See, I started discussing with Deep and Rajesh about my exit and then strategizing, but I told them that I'm not going anywhere. I'm not joining something. And I was, I just wanted to stick around till the time they want me so that everything is in a, in a safe space. And it was like six, eight months that I continued, did my best, whatever I can do.
00:21:19
Speaker
So yeah, before COVID itself, I started researching on my ideas and discussing it with people.
Volunteering for Arogyasetu Development
00:21:26
Speaker
And COVID was the time when I was, so my announcement of exit was in January, 2020. And so that's how it all happened. Okay. Okay.
00:21:37
Speaker
So like, tell me that the journey of discovering the next idea. While I was leaving in March, 2020, I got this unique opportunity to build for the country and me and my team delivered Arogya Setu for government of India. So this was, oh, well, okay.
00:21:54
Speaker
As in this was under MMT or this was like you and a team of volunteers. It was volunteers, but obviously volunteers were all part of Go IBB and Make My Trip team. So, I mean, and it started off also with a very small POC that happened in my cabin where one of my senior VP Rahul, he came up with this thought that, okay, let's the contact racing. I remember he came up with this advertisement, a newspaper in Kerala.
00:22:21
Speaker
which says that, okay, these are the specific areas. If you have been to any of these areas at this point in time, please come and visit the public health care center. We will test you for COVID because a COVID patient was all there, right? Now look at it, doing it at a scale of million people. You cannot, right? And it's not possible to contact trace. And that's when we started dabbling around on this idea of building something. There are a couple of developers who just got collected. They wanted to build.
00:22:49
Speaker
something to solve a problem and I think our thesis was very simple. Whatever we knew on technology, can we put together like a hack around it so that we can trace the contacts and we can help and that was a talk of the town, right? Covid was all there. Kerala started seeing that was in the month of March.
00:23:10
Speaker
So, Rahul, a couple of my developers at GoIbgo, Android, back-end, we all came together, we delivered a small product and Deep Kalra, our CEO, founder, make my trip, he liked it and he shared it with Neeti IO. They also loved it. And then after a lot of rigorous tests and trials, and I think I will give it to the government.
00:23:32
Speaker
on the amount of help and the overall focus that they had put in making sure that we are building a robust product, not only from scale perspective, but on the privacy and security as well. After many, many interviews with NICT, Métis, where they not only grilled us on technology, but also on integrity. Finally, they said that, okay, let's build for the country. And I think the need was such
00:23:58
Speaker
that they also wanted like a team coming together and solve for it as a pure volunteer, not associated with companies as such. For me, the fortunate thing was I was anyways out. So, but Make My Trip, Goai, we both they sponsored these engineers and kudos to Deep and Rajesh and everyone there who sponsored these and then we built it for the next three, four months along with NIC, Government of India, Métis and everyone.
00:24:26
Speaker
Wow, amazing. So that actually changed my perspective from corporate travel or a travel product to a health. And that's how, just to answer your question, I mean, and long answer to the question of how I ended up being here where I am.
00:24:43
Speaker
When you build a product for the government, who wants the IP for it? And where is it hosted? Is it hosted on a government server? And how do all this? Everything is all government. Everything is government. We are just volunteer developers who are developing for the country. This is getting all kinds of, and along with NIC, developers from NIC, which is National Informatic Center, they now run future of ROGUS-E2. And it is basically that
00:25:11
Speaker
you need, it was more like an open source contribution and actually the product is open source. So, but the running of it, the scaling of it, everything happens on the infrastructure, which is owned by government. It is, it is, has nothing to do with the private part. Okay. Did you face any sort of backlash? I remember there was some sort of privacy backlash about it, like not very mainstream when there was like, did you personally face any of it and all of that? Like.
00:25:38
Speaker
Personally, why would anyone attack an individual? If you look at it, anything that government does, you will have naysayers and you will have people who will say good about it. What I realized is, and that's the learning that I had, many of the naysayers work on partial knowledge.
00:25:57
Speaker
Right. They don't understand the entire architecture or the complexity or the things that are basically being done and delivered. So you would see a lot of these backlashes and so on and so forth. What I fundamentally loved about the whole project is there was no ulterior motive anywhere. The only motive was to deliver a service that can help a person who in a
00:26:22
Speaker
remote location in, let's say, Dhota Balpur is 60 plus and suffering from COVID and actually need help. And be it a very simple mental help where someone can go ahead and talk to them. And apart from that, letting people know that you should quarantine or you should not quarantine and so on and so forth. So it was very earnest attempt. And that is why we as a team also work like mercenaries at that point in time to make sure that
00:26:51
Speaker
we solve for it. How did contact tracing work in it? That was the core objective, right? Contact tracing. Yeah. See, contact tracing is all about the way. So let's say if I'm sitting with you across the table, right, there are two key markers that can be leveraged from your device. One is location and one is GPS, second is Bluetooth. Now the core fundamental of ROGUS-E2 was this information is private. And if this information is private, they should remain
00:27:18
Speaker
with users. Hence the contact tracing capability that ROGI-SEDU has built was all completely local. One thing is works without internet and second is it never sends any data to backend. So it basically tracks the Bluetooth proximity of other devices that are hosting ROGI-SEDU app.
00:27:38
Speaker
And all of these devices are anonymous devices. No one knows who is it. These devices were nothing but a code. So your code will be ABCD. Mine could be PQRS. And there is a contact book that gets created locally on device that ABCD and PQRS have came in contact and vice versa for this period of time. And it's a local information stored locally, not being sent to any of the backend services. So that's how the whole contact tracing works.
00:28:04
Speaker
No, but how would I know that I've been exposed for like, let's say there is a, I mean, there is ABC, which I met where then after three, four days, he's positive and on his app, he updates it. He's positive. How would that be information? Yeah. When he updates is, and that's how it happens when he updates that he's positive. Now we know that he is positive, which means that that PQRS is positive. So we send a broadcast.
00:28:31
Speaker
Wherever in the local contact book, again, this happens locally on the device, wherever you see PQRS as a contact that has happened, you basically market basis the model to red or yellow or orange and so on and so forth.
00:28:46
Speaker
And how does that algorithm work of which color to assign? Like how duration of exposure or number of seats? Yeah, it's a, it's a very scientific thing, which is being done by ICMR that your exposure, see the thing is if I'm going by let's say a car.
00:29:05
Speaker
right, and asked for quite a signal and then there was another person on that signal. Now Bluetooth can actually put that person in a, but then the duration was very low. If the duration is low, the person is at a very low risk.
00:29:22
Speaker
So, and these specifics are being delivered to us by like a very senior scientist. And we actually develop algorithms to make them execute at the scale. Okay. So does this rely on self-reporting? I have to report I'm positive. Yes, it does rely on self-reporting. Yes.
00:29:42
Speaker
Okay. That's like a loophole there. Like if people are not updating on their app, then they are positive. Yeah. It does rely on self-reporting and people generally would update on what exactly and there's a lot of emphasis around people. So we used to send push notifications to them. We used to send a lot of these things and all of that
00:30:05
Speaker
to encourage people to report. Yeah, to encourage people to report. And also, for example, in case of in many cases, when it's a government mandated things, right, if we get an information that a particular phone number is a positive, then we leverage that information also, because many cases you won't self report, but you would go to a PhD and the PhD will report on your behalf, and so on and so forth, because you're talking
00:30:30
Speaker
People who got COVID, you don't want them to end up, you might want to give them care. So there are multiple such models where the whole contact tracing effort was. And how does GPS help in this? GPS was of very less use, to be honest. It was because GPS signals is more, so Bluetooth was, is the right thing to do. Okay. Got it. So how did this lead to
Inception of EkaCare: From Travel to Healthcare
00:30:52
Speaker
Eka care? Tell me about the birth of Eka care.
00:30:54
Speaker
Yeah. So see, that's what, so I got transformed from travel to health. Suddenly after this, I thought that there are very simple things. And if you look at it, my family, my father is diabetic, right? And I realized that he basically takes this needle every week once. And he puts that value into a piece of paper in a diary, right?
00:31:16
Speaker
And then I started looking at other use cases as well. If you look at, like if you want to find a date today in five kilometer radius, it's super easy, right? You swipe left, swipe right. There are many apps and you might get a date, like a person like you is charming as well. Easy.
00:31:34
Speaker
But God forbid, if you want to have a person, if you want to be positive blood or no positive blood, like what would you do? You would basically send a mail to your HR or put a WhatsApp status or a Twitter. It's so strange that such an important thing is not digital. And many stories you have, my sister got
00:31:55
Speaker
thalassemia minor as a as a diagnosis once she got pregnant and in India we basically are giving more weightage to that before getting married you look at people's Janam Patri and all those kind of things.
00:32:11
Speaker
But incidentally, if both parents are thalassemia minor, there could be a complication to the kid. And nobody knew about this. Even individually also, if you are a thal minor, if you continuously pop in iron tablet, you might end up getting stones in your gallbladder because your body is not comfortable in digesting iron the way the other bodies are. And she never got to know about it because no one looked at three reports together.
00:32:40
Speaker
Right every time after six months used to visit a doctor doctor says okay he'll be in iron low let's have let's have these tablets and then you're done so all of these started coming to my mind when i was doing this whole journey around health and i don't you say to.
00:32:56
Speaker
I said that's fundamentally without a longitudinal record. You cannot, you're shooting in dark, right? You are not now, then you are basically just living it to the fate that let's give this medicine. If something works great, if nothing works, then we'll change the medicine and so on and so forth. Right. There was a nice presentation that an endocrinologist gave in one of these conferences that we follow. Any like non data driven approach is basically shooting in the dark.
00:33:26
Speaker
to get the right outcome and you look at it there's nothing today in the world i'm not sure how you store your medical records right i'm not sure if you have ever even seen your yeah if i ask you a very simple question how your tsh or a thyroid hormone moves over a period of last
00:33:45
Speaker
three, four years, you would have definitely have reports, but you cannot give that answer. And we expect who are doctors to actually go ahead and read through those documents to give you the right outcome while you and I look at the revenue numbers in a nice graph. So it's a pretty strange setup. And I said that this needs to be solved. So that's how the
00:34:05
Speaker
Birth of Eka care happened and we fundamentally believe that this is how the world will evolve over and over. I like that term used for longitudinal record. So longitudinal record means like time with an axis. Longitudinal record is like I have done my
00:34:22
Speaker
at least CBC in last five years at least six times right for various reasons somebody some doctor have prescribed sometime I did a regular self-help checkup right now these are point in time transaction at that time what was your body right but if your body says that your cholesterol is high in the last five years every time your diagnosis will change
00:34:44
Speaker
your way of approaching a particular problem will change because your body is such that it has an inherent tendency of creating that particular marker and your outcome and your medication and everything will basically depend upon that. So that's how the longitudinal. So you want to go away from these looking at a human body at that point in time to looking at a human body, how it has behaved over the period of time.
00:35:10
Speaker
Okay. Okay. Fascinating. So essentially what you wanted to build was like a single source of truth, which has all the data about your health markers. Absolutely. About you. So that you are, I mean, it's so imperative today. If you look at my father, my mother, I have Eka care. I have all of their records in Eka care and I feel in peace because I can go to a doctor and I can say that, okay, here is the last eight years records.
00:35:38
Speaker
And you can now see that all of these vitals have been moved like this over the eight years. So we have built technology that can not only store these medical records, but pass and process that information to create these insights for doctors and patients. So, so that's, that's where I will be also at peace that, okay, doctors have seen all the information and now the outcome is far more data driven.
00:36:03
Speaker
rather than more like a statement. Tell me about the first version of the product you built. You had zero to one journey. Once you had the idea, then how did you execute? We are a one and a half year old startup. The product was out in the market in the month of May, June 2020.
00:36:20
Speaker
One, so, so we basically are in that zero to one journey. And I think one of the product that we started off with is EMR. See this information that you are creating as a user, how would a doctor get that information? Right. We fundamentally said that there are two things that we have to solve. One for doctors where they can look at this information, they can generate prescription, they can manage their appointments. Right. And also for us, doctors, not for hospitals. We are very specific to doctors.
00:36:49
Speaker
for their clinic, for their staff and themselves. So there are these doctors that have started coming in, they started using us and this product has started seeing a lot of success on prescription and appointments. So it's like a free to use product for them. If you look at it, we don't see this as a SAS, SAS tool, but there is a small fee that we take. A fee? Like what kind of fee? See, there are many doctors, they pay us a thousand bucks and that's how we basically... Like a per month per year? It's a yearly subscription.
00:37:18
Speaker
Okay. Yeah. Very negligible. Okay. Which is in a way, it ensures seriousness. Like if you give it free, then people may not use it also because you don't value what you get for free. You are right. And see how the model from revenue and all of that pans out. We are too early on that journey.
00:37:36
Speaker
And this is something that we are right now discussing and figuring out what fundamentally we want is to digitize this so that we can have a far better outcomes over a period of time. And so there's like the in go and be more approach, right? So you, you want both parties to use it. So the doctor product is a way for doctors to kind of start using it and there would be a patient product so that
00:38:01
Speaker
It really adds value. Yeah, but very different from hotels. See, yeah, obviously hotels is very different. See, we work for, if you look at it from our team's perspective, we work for doctors far more because eventually that is where the outcome will be driven. Right. And we make sure that whatever we do, we have an outright trust with doc. For example, we don't do things like I would have done at OIVO if
00:38:26
Speaker
there is a hotel that comes in. I mean, you as a buyer of a hotel, you want to stay in multiple hotels, right? Sometime you'll experience this, but as a patient, you want to go to a same doctor all the time. And that's the right thing. I mean, I would like to go only to two, three doctors. I don't want to experiment with multiple doctors and so on and so forth.
00:38:46
Speaker
So, we remain true to that fact that we build a solution where we create a health journey for patients, but we don't end up becoming a discovery tool for patients, for doctors, right? We basically connect them with one doctor and they have a long-term journey with that doctor and the same doctor will now be able to give a better outcome because of longitudinal journey and being able to communicate to you because there is an EMR side of story, there is a patient side of story.
00:39:16
Speaker
which was very different when we don't do reviews and ratings. We don't believe in things such as, I mean, if you don't give a doctor all kinds of information, right? You won't get, get the right kind of an outcome. And then you rating that her doctor is not the right thing. Like in case of hotel was very easy, right? Same room, same clean linen, all of that doctor is very different. So, so from a outside, it looks the same, but the way we operate is very different from what we have learned.
00:39:43
Speaker
Got it. So essentially you are a product for doctors. It just so happens that patients are also on the product, but your core focus area is doctors like empowering them. See, our core focus area is to provide for better outcome, right? Now, the better outcome cannot happen without both the parties in the ecosystem.
00:40:04
Speaker
So that's why for us, patient and doctors both are important. And it's a play where we have to do a lot of hard work because we practically are building two products. But so be it. There are ways in which industries are solved and health is very different.
00:40:20
Speaker
So here, a patient acquisition is not happening directly, but it's happening via a doctor. Essentially, the doctor creates a patient account every time a patient comes to him or a patient can, the doctor would share some link to book an appointment and the patient would, when he's booking the appointment, then he would create his record there, something like that. Both ways. So today we have 5 million plus app downloads, right, without doing marketing.
EkaCare's Digital Health Innovations
00:40:45
Speaker
The patient app.
00:40:46
Speaker
patient app. These are not the number of prescriptions that has create on Eka. And why that happens is because people do care for their health. We believe that people care for their health. People download Eka care app. They start their process of uploading their medical record, not only by scanning and storing it, but also by syncing their Gmail account.
00:41:08
Speaker
So every day and because of our technology and all Google has given us, we are the only healthcare company where Google has given us the access to scour through the mailbox because we use kind of a tech privacy security enabled. And after a lot of security assessments, we got that approval where people are coming and they're storing their medical record. And I think if you haven't stored your medical records yet with Eka care,
00:41:34
Speaker
you are losing on better outcome whenever you need it. So we have seen a lot of organic traction there. So it's not only the doctor acquisition. There's a lot of organic acquisition that happens. Yeah. Okay. So one kind of patient is somebody who like me has
00:41:50
Speaker
Somebody like me, who has mostly paper records and wants to digitize them, have it available on an app. So he would download scan and through Gmail integration, then it will automatically import. If like I get a mail from Lal Path Labs, it will recognize this is a report and it will import it. And so I will get like a longitudinal record of my medical markers on the app. And probably there would be some sort of.
00:42:15
Speaker
recommendations and so on based on how you see that moving and like some sort of algorithmic recommendations. Yeah, see, so you said it right on the first part, there are very ways and see on from on patient side, we see it two ways. One is your health record that get generated from healthcare provider. So which means that your medical record, you can scan and upload, we have a functionality where you can WhatsApp your medical report to our WhatsApp number.
00:42:43
Speaker
and it will go into your account. We have a feature such as if you don't want to share your Gmail account with us, you can forward to your phone number at the rate aka.care. We have created an email address for each one of our customers. So the records will come to you. The app also has profiles so that you can segregate them into your family's individual record so that these records are not muddled with each other.
00:43:08
Speaker
But apart from that, see your health is not only about the document that you got from your providers, right? And I shared with you many ways to integrate that your health is also how you are feeling today. For example, if I'm a female.
00:43:23
Speaker
I should definitely record my menstrual cycles history because that's one question that will be asked every time you go to a gynecologist, right? If you are a diabetic patient, you have to record your diabetes values inside the app that is not coming in from any document. If you, many people in India uses Apple watch or any other things for their heart rate monitoring, we have baked it into the app itself. You can put a finger on the camera and we give you a heart rate, which is as accurate as your Apple watch.
00:43:52
Speaker
And this is a data that you want to generate for yourself. Today, I am having a migraine attack. Tomorrow, I had an asthma. So, all of these things also, patients generate on eCage. Do you also integrate with smartwatches? That's also in the plans that we will integrate with all kinds of devices.
00:44:11
Speaker
So all of this information becomes your health marker. Example, we integrate with ABHA, which is the health ID and Ayushman Bharat's health account. The government's initiative, very similar to UPI, where this entire ecosystem will get digitized. So that's how we get all of this information. And then we store it, consumers can go ahead and by consent, share this information to their doctors and so on and so forth. Okay. Got it. It's like, how does a doctor use it to manage his practice?
00:44:41
Speaker
See, there is an EMR tool. EMR, what is EMR? Electronic Medical Record System. So this is, and we call it the lead doctor's tool. So let's say you visit a doctor. Today, doctors basically can have two ways of providing you with care. One is they first take down your phone number and registration detail on a piece of paper, be it a register or something. Or there are people who can use a digital tool. So we come there as a digital tool, where as soon as you walk into the clinic or you phone,
00:45:11
Speaker
your information gets added so that you can now schedule further appointments, you can do changes, you can do follow-up, you'll get notifications that this is the time when you should come in and all of that, right? So that's one problem that we solve and I'll take you through that. So first is this appointments journey where when a user is coming in, be it a walk-in or on a phone or does it on online, we have an online presence, digital presence for doctors where you can take an appointment. Once you do that,
00:45:38
Speaker
And once you visit a doctor, doctor can do two things. One is they can write a prescription on a piece of paper, or they can write this prescription on a digital tool, which is EkaCare. And when a doctor is creating this prescription on EkaCare, be it the medication, your symptoms, your history.
00:45:55
Speaker
All of that information becomes part of your medical history, your prescription, your longitudinal journey. And when a doctor basically hits the send button, the information gets delivered to the patient, be it on WhatsApp or wherever. Now it's patients' prerogative, whether he wants to use EGA as their channel of keeping medical records or not. And there are many who choose not to.
00:46:21
Speaker
many who have not been exposed to and so be it. So that's how the whole ecosystem works on the doctor side. Now what happens is if Akshay or Vikkal goes back again to the same doctor and you haven't used or I haven't used Eka care on the patient side, the doctor can still search for that phone number, that person and see what was the prescription that I have created last, when he visited last, what was the diagnosis and so on and so forth.
00:46:47
Speaker
And that fundamentally saves a lot of time, especially for the doctors who see a lot of patients in a day. And there you don't have to ask questions that are like what happened last time and so on and so forth. And your outcome can be far more driven with empirical data that you have collected last time.
00:47:07
Speaker
Okay. For patients who don't download the ICA can have when a doctor hits send, they get what an email or something like with the prescription. You get SMS, WhatsApp prescription. Okay. Okay. Okay. So like, do you also then have like a pharmacy integration? That would make sense, right? See, again, as I said, Akshay, we see there are a couple of things that everyone asks me why you don't have right pharmacy, why you don't have labs, why you don't have doctor discovery.
Technology's Role in Healthcare
00:47:35
Speaker
Eka is not about providing insights. The question that you ask, I uploaded a medical report and I'll give insight. Eka will not do that. Eka is an information company. For me, I don't know how can I treat you? I know this is you. And that is very, very important. So if you look at it from that perspective, I cannot tell you that, Hey, you should visit an endocrinologist and so on and so forth. That is your doctor to tell and refer. What I can show you is your thyroid is always up.
00:48:05
Speaker
and borderline and what does thyroid mean, right? So that is where we come in. And we dread this very carefully. We are a technology company. We are not a healthcare provider. Hospitals are healthcare providers. Clinics are healthcare providers, right? We are a facilitator for a better outcome by leveraging the technology.
00:48:26
Speaker
And that is where we don't end up sending you a notification that go for a blood test or a B3 and then start monetizing it. Or I will give you a discount of 30% in these medicines and so on and so forth that happens elsewhere. And that's why we don't have pharmacy or labs the way it happens across the board.
00:48:48
Speaker
What would that look like when you work with your doctors? No, see, for example, if a doctors are prescribing medicine or a doctors are prescribing a lab, how can we facilitate a transaction there so that a doctor and patient are doing conversations and rather than patient going ahead and scouting for discounts is basically between the doctors that what would be the right kind of a test and where you should go.
00:49:13
Speaker
I'll give you another example of how it happens in the US. So US, when you create a prescription, doctor asks you which medical, which pharmacy you want to get your medicines from, right? And then doctor just presses a button and then the prescriptions gets delivered there. And then there is a pharmacy next door who will basically facilitate that transaction and so on and so forth.
00:49:36
Speaker
which is a behavior that is a right behavior rather than saying, okay, don't take this medicine, take another medicine, which is a substitute and so on and so forth. Yeah, that's true. Yeah. In almost like 50% of prescriptions, I end up buying a substitute because the chemists are in stock, what the doctor wrote. Yeah.
00:49:54
Speaker
Yeah, you end up buying a different medicine, even in the lab test, right? You go to the doctor with a specific lab test and then doctors would be like, Oh my God, what is it? Right? It's not what I have prescribed and so on and so forth. See that the thing is this is so not transparent and so not sort of not digitized. If there is a tool that can come in to actually make this a journey that is transparent, have doctors at the center of it and patients get the right kind of a benefit out of it.
00:50:24
Speaker
Now, the thing is my question to this industry is generally when you go to a doctor, you pay him 400 500 rupees as a consultation fee, right? But when you go to a lab, you basically pay them 1000 rupees for a CBC or an 800 rupees for an x-ray. The cost of that x-ray is not even 10 rupees.
00:50:43
Speaker
The cost of that CBC is not even 200 rupees. It's just a device where you have to put some chemicals or a camera that is kept in a dark place. It's far more. And if we tell today that let's pay 1000 rupees to the doctor,
00:50:59
Speaker
as a consultation fee and pay less to the x-ray and the lab, right? The doctors will have a lower foot fault, right? And that's why they create these clinics where they actually are able to leverage a lot of these revenue potentials and so and so forth by actually, and it's very hard. Look at it. The idea of a doctor is not to basically run a business, right? The idea is to provide for the best outcome for that patient.
00:51:24
Speaker
and get the data collected from the various other sources. But in this industry, incentives are misaligned. And you don't want to enter into a situation where we model. Yeah, you would be taking away the doctor's revenue if you start doing pharmacy and diagnostics. It would eat away. See, in plain simple terms, yes.
00:51:45
Speaker
We don't want to do it. Are there a better way of making sure that every party in the ecosystem is, is within the realm of it's a win-win for all right. So that's where we would basically work in and we are very clear with that specific philosophy and thought process.
00:52:04
Speaker
All right. Amazing. Okay. So your target audience for the doctor product is just like enix and like small practitioners. You don't want to do something. Anyone, anyone, non hospitals, nursing homes, we don't solve for bags. We don't solve for inpatients. We don't solve for, uh, services where you need to do housekeeping and so on and so forth. We solve for outpatients. We solve for appointments. So that's where
00:52:32
Speaker
But, so if the vision is to have seamless exchange of medical records, how would you make that happen with when patients are going to hospitals?
Future of Health ID Systems and Competition
00:52:42
Speaker
Like if I, as a patient have all my history on echocare and I'm going to a hospital, how would you enable that doctor to access? Yeah. Yeah. I'll, I'll, I'll give you, so two things that are happening in the ecosystem. One is when I mentioned that if a doctor has their own pharmacy, has their own clinic lab.
00:52:59
Speaker
It's seamlessly integrated because now the report is getting generated at the clinic itself and that adds a lot of value for doctor. That's why he would recommend and he should. That's why all the hospital recommends that go to my lab, which is there itself. So that is solved to some extent when you are going to the same doctor, same hospital and so on and so forth. But that doesn't happen. You go to a different doctor at times or a different hospital.
00:53:24
Speaker
So what is happening in the ecosystem is, I'm not sure if you have heard about this, just called ABDM, Ayushmaan Bharat Digital Mission, which is coming up with a concept of health ID, where your medical records are linked to a health ID. When you go to a hospital, you have to show your health ID, which is nothing but your name at the rate and DHM or tomorrow, and so on and so forth.
00:53:47
Speaker
which is like a UVA. Now, all the records will get digitally associated. And if you use Acacare as a PHR app, which is your personal health record app, all this information get digitally assigned to you. I'll give you a small experiment, right? If whenever, I don't know if you have taken your booster dose or not, download Acacare app, create your health ID, which you can do it. And we've created more than 2.7 million health IDs now. And you go to the coven and you use the same phone numbers, same demographic information.
00:54:17
Speaker
to get your booster dose. You will get your certificate on to Ekacare app digitally. You don't have to do anything for that. So that's the way the ecosystem is shaping up. And we are a big sort of, we are giving a big push to that ecosystem along with government so that this entire
00:54:37
Speaker
medical records sharing stuff can happen seamlessly. Got it. So you are like the Google payer basically of UPI. You hit the nail on the dot. Yeah. So we would like to be the BHR app, which is equivalent to a phone pay or a Google pay on the consumer side.
00:54:53
Speaker
Are there other competitors in the space yet, like the Google pillars? People have started doing it. I think PTM have started creating health IDs. They do it. So they are, they are, I think after us, so we have created some 2.7 million health IDs. They have done some 250K health IDs. So they are decent when it comes to the numbers. Like you have Veeam, that is ABDM app or an Abha app, where that's like some
00:55:20
Speaker
From overall numbers perspective, they would be the top. I think we are the top in terms of the private players. And I'm sure there will be tons of more, I mean, there's an interoperable play, like you can do a UPA on Truecaller as well, and ICICI bank app as well, and Google Pay, Phone Pay, Beam also. So it's all about execution.
00:55:40
Speaker
How would the data flow in? Every time you go to a diagnostics lab, you give them your ID or they would ask for your ID so that they can automatically, their systems would become mandatory for them. The government would make it mandatory that diagnostic labs have to upload this data to ABBA ID or the
00:56:00
Speaker
See, mandatory is not the right word, Akshay. There was a news article that AIMS will go completely digital using the Abha Rails from 1st of January 23. So, and I think like UPI, anything that has a clear value for both sides, be it a business or be it a consumer, that will take its own flight as soon as the whole platform is ready and it has got right kind of a transparent understanding.
00:56:25
Speaker
What are the incentives for hospitals to go on to avarins, hospitals, diagnostic labs, people who generate the data? What are the incentives for them to like customer demand? How will you give an outcome? One is generate data.
00:56:41
Speaker
Now, let's say you go to a hospital like Manipal and you want to now get yourself treated for an ailment. You go to the doctor. The doctor would want to see your records, right? How would he see the records? He will then again ask you for your ID. When you give the ID, as soon as you give the ID, you will get a consent on an e-care app that Manipal Hospital Whitefield is requesting for these last three documents of yours. And when you say approve, then the doctor will get that information digitally so that he can look at it.
00:57:08
Speaker
and give you the right sort of outcome. So it's both ways, right? So any system that works both ways will definitely have its own flywheel working. The Ava data includes prescriptions also are only diagnostics.
00:57:25
Speaker
No, no, everything, including even discharge summaries to any kind of notes that you want to share, advices. Is it like similar to like a team of volunteers, like yourself, who are building them? It's a pretty fantastic and thought through setup.
00:57:46
Speaker
The paper was written, I think about the health ID or this blueprint of the entire health exchange was written like three, four years ago by I spirit. And then, yeah, so a lot of volunteers again.
00:58:01
Speaker
the way UPI has been built, or Hope can back and all of that. So this is basically that team. And then it got post COVID. Obviously, every single government started thinking a lot about health. And that is a fundamental difference that I see when we look at India versus China. India said that we are a platform nation. We will build platforms such as Adhar, such as UPI. And we will build Indian companies on top of it.
00:58:29
Speaker
while Jana said that I'll wall the whole thing. So we are far more thoughtful for far more long-term sustainable in that sense. And ABDM Abha is one such platform that I am super excited about. And I wish that soon it will reach the same level of adoption as Adhar and UPI. And that brings us to the end of this conversation.
00:58:51
Speaker
I want to ask you for a favor now. Did you like listening to the show? I'd love to hear your feedback about it. Do you have your own startup ideas? I'd love to hear them. Do you have questions for any of the guests that you heard about in the show? I'd love to get your questions and pass them on to the guests. Write to me at ad at the podium dot in. That's ad at t-h-e-p-o-d-i-u-m dot in.