Taking Healthcare Tech to the Patient’s Bedside

TECHNOLOGY FOR PEOPLE

From startups to transnational giants, firms are creating affordable, point-of-care technology which can bring healthcare right to your doorstep. An analysis

ecallfor a minute the swine flu scare of 2009. If you were one of those suspected of contracting the H1N1 virus, or even not, you will surely remember the woefully few centres that could test for the disease as well as the long wait for results. Now imagine if your family doctor could have been able to test reliably for swine flu in his or her clinic and get the results almost immediately. In Bangalore, Bigtec Labs is wrapping up trials of a portable, battery-operated device that it claims can detect swine flu and other infectious diseases like chikungunya in under half an hour. It is several times smaller and cheaper than the large and bulky 'real-time PCR' machine that occupies pride-of-place in India's testing laboratories. The PCR machine costs lakhs, it needs skilled technicians to run but is known for its accuracy. Bigtec's 'micro-PCR' claims comparable accuracy as the PCR, costs a fraction of it, and doesn't need special skills to run. It a can radically lower the cost of a test – to potentially as low as Rs 500 --compared to between Rs 5,000 and Rs 10,000 for real-time PCRs. It expects to launch the product later this year. For too long, crucial medical technology -- from laboratory testing to imaging diagnostics like ultrasounds -- has been centralised and expensive, needing special skills to use. They have been the preserve of large institutions or specialist doctors. However, aided by an underserved but growing healthcare market, there is a minor revolution brewing. Small firms like Bigtec and large corporates like GE Healthcare are attempting to decentralise technology and take it as close to the treating doctor's clinic or better still, to the patient's bedside. Industry jargon refers to this segment as the socalled 'point-of-care' (PoC) market: technology that is placed literally at the place where treatment or care is given. The concept like many others in healthcare, originated in the West. It is now gaining traction in India. But with some key differences. The western markets have well-developed medical infrastructure and the accent is on capturing problems early. So, "point-of-care meant expensive, high-end products at a doctor's desktop or at a clinic for quick decisions," said Natarajan Sriram, director of the Goabased Tulip Group which is researching ways to miniaturise the PCR machine. But developing countries have the added challenge of affordability, and inadequate medical infrastructure like small laboratories, or very few doctors, nurses and technicians to use advanced technologies well. "For developing countries, it means simple, affordable tests to be done where there isn't normal infrastructure." Not surprisingly, a lot of innovation is entirely indigenous. For instance, Bigtec received funding from the government's apex laboratory organisation, the Council for Scientific and Industrial Research (CSIR) and collaborated with the Indian Institute of Science and other government research institutions. Tulip, a homegrown manufacturer of diagnostics, is collaborating with the Defence Research and Development Organisation (DRDO), among others, for miniaturising the PCR. Achira Labs, a start-up founded last year in Bangalore to research a lab-on-a-chip has been spun-out of homegrown Bangalore company Connexios. Achira's technology should help it use just a fraction of the blood and testing chemicals or reagents used conventionally to test for several diseases such as dengue, malaria, and chikunguya at the same time. 

Parallelly, multinationals like GE and Roche are taking a long, hard, look at their own imported PoC offerings to tailor them to the unique Indian market. Consider, for instance, the V-Scan, GE's hand-held ultrasound with the look and feel of a cellphone. Hailed as the stethoscope of the 21st century, the V-Scan - launched in 2010 - freed the ultrasound from its console. Its aim was to aid early diagnosis of a heart attack or an unborn baby in distress. The gadget, priced at around Rs 5 lakh, has been welcomed by early technology adopters - mostly specialists -- in cities. 
But it is in the hinterland, where specialists and hospitals are scarce, that such a product is urgently needed, says Ganesh Prasad, director (ultrasound business), GE Healthcare, South Asia. 
"Here it is not a luxury but a compelling need. But there is a barrier to adoption," says Prasad. GE has commissioned a survey of general physicians in tier 2 and 3 towns to understand "their preferred price point," he said. One way to reduce cost, he said, was to reduce the tasks the device can perform to only that which is most used – such as detecting a heart attack. 
At GE, the focus on decentralizing technology is integrated into an overarching effort to penetrate India's mass market better. This has led to the launch of relatively low-cost, locally-made no-frills versions of CT scanners, baby warmers, and ECG machines from GE's stable in the last three years. Imported and expensive versions of the same products have been in the market for years before GE decided to do this. But with the VScan, given its potential, there's barely been any time between its global launch and the attempt to finetune it for the Indian market. Similarly, Swiss diagnostics firm Roche Diagnostics, a subsidiary of the eponymous Swiss firm, is in advanced talks with state governments to make PoC tests for glucose, lipids, kidney and heart attacks available at primary healthcare centres. 
While the company said two states were planning to "seriously implement" some of this, it did not provide details. 
Decentralised technology is now globally being seen as an effective way to cut costs and improve access to healthcare in socalled "low-resource" settings. "There is an absolute convergence of views worldwide that we need easy-to -use, point-of-care, lowcost diagnostics," says Chandrasekhar Nair, co-founder, Bigtec. As a result, global organizations are coming forward to fund or facilitate such technologies. For instance, this is one of 14 Grand Challenges in Global Health identified by the Bill and Melinda Gates Foundation. And not-for-profits such as PATH and the Hyderabad-based Centre for Technologies in Public Health are keen to help develop and testing them. 
Consider, for instance, a self-sampling screening system for HPV, or the human papillomavirus that is known to cause cervical cancer, a leading cause of cancer in Indian women. PATH is right now testing this system in India and Uganda. The system, called careHPV, has been developed in collaboration with Qiagen, a leading American test provider and is expected to be launched in India this year. It needs neither running water, nor mainline electricity, and needs nothing to be sent to a laboratory. It can also be operated with basic training eliminating the need for lab technicians. 
While there is now a trickle of products in the market, it is too early to predict a flood. But it is definitely a start.