There is definite urgencyto upscale and enhance cancer care across India

Tata Medical Center and IITKharagpur recently launched fully annotated,relational, de-identified cancer image bank – CHAVI. Dr Sanjoy Chatterjee ,Senior Consultant Clinical oncologist,Tata Medical Center and Principal Investigator from Tata Medical Center for CHAVI in an interaction with Kalyani Sharma talks about this image bank and the objective behind it

Tell us about CHAVI?

CHAVI is a unique platform which allows open access collaborative research opportunity to develop futuristic India specific strategies to combat cancer. CHAVI was jointly developed by Tata Medical Center Kolkata, Department of Radiation Oncology and Indian Institute of Technology, department of Computer Sciences. Currently CHAVI allows access and banking of annotated clinical and radiological images which can then be analysed using cutting edge Machine Learning and Artificial Intelligence. Such analyses can provide valuable complimentary information to the currently available laboratory and imaging tests, such that a more personalised and a more accurate prognostication can be made.

What is the objective behind launching it?

The first image bank from India, CHAVI will provide annotated, structured imaging data from Indian patients, something that was completely lacking. Given that it is open access, the database images can be used from across the globe to find solutions for cancer. Importantly other centres from across India can use the structured CHAVI databank to enhance the CHAVI library such that more robust models for cancer care can be developed.

Can you throw some light on the technologies that can revolutionise cancer care in India?

Indian patient specific models developed using Indian data is likely to allow more personalised care. CHAVI is a scalable open access database allowing collaborative BIG DATA related research to help cancer patients. CHAVI does not allow national but international collaboration to see how western models fair on Indian image signatures. Collaborative work on developing federated radiomic models has already started. MOU between Indian universities as well as Internationally renowned centres like University of Cambridge and University of Cardiff is in the final stages. In all, CHAVI has triggered tremendous interest globally and opens up possibilities that can allow precision medicine and personalised therapy for cancer in the near future.

What are your views on the scalability and accessibility of technology in cancer care in India?

The technology used for developing CHAVI is simple but safe and secure. Investigators have used open-source tools and components for developing CHAVI and the CHAVI databank is available as a public resource. The CHAVI repository is also deployed as a docker container which can be combined with modern cancer research.

How strong is our cancer care infrastructure and what is the need of the hour?

There is a definite urgency amongst governments and NGOs like the Tata Group to upscale and enhance cancer care across India. However, a lot more needs to be done to quality assured futuristic personalised allow care near patients’ home. CHAVI is an important cog in the wheel to provide such futuristic solutions.

Kalyani.sharma@expressindia.com journokalyani@gmail.com technology to scale the deployment in the future as required. Open sourcing of the CHAVI de-identification code is in process, and this should enable development of an open-source ecosystem to be developed around CHAVI.

Do you think cancer is ‘Next pandemic in the making’?

There is little doubt that cancer is a pandemic. Unfortunately, it is resource intensive draining patients mentally, physically and disrupting psychosocial aspects. Given the intensive strain it brings on resources of individuals countries, especially Low- and MiddleIncome countries must look at cost effective solutions of their own. CHAVI allows exact that as it provides the perfect platform free of cost to drive low-cost

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Innovations brought in by medtech players can be vital in improving healthcare delivery and meet underserved needs

ByKalyani Sharma

In the Union Budget 2023-24, the government has allocated Rs 283.5 crore for the Startup India Seed Fund Scheme in additional to a National Data Governance Policy which will be brought out to unleash innovation and research by start-ups and academia.

Nirmala Sitharaman in her budget speech mentioned, “Entrepreneurship is vital for a country’s economic development. We have taken a number of measures for start-ups and they have borne results. India is now the third largest ecosystem for start-ups globally, and ranks second in innovation quality among middle-income countries.”

The pandemic itself presented an opportunity before healthcare start-ups. Especially, the innovations brought in by medtech players, helping in improving the overall healthcare delivery. While the last two years brought the much-needed attention to the start-ups ecosystem via medtech players mentoring them, it is now important to stabilise this progress. Hopefully, the slew the measures announced in the budget will also help in nurturing an ecosystem for sustainable medtech innovation for India and the world.

The budget also announced the implementation of dedicated multidisciplinary courses for medical devices to be supported by the government in institutions to ensure skilled manpower for futuristic medical tech and high-end manufacturing and research.

While talking about the medtech innovations, Gaurav Srivastava, Co-Founder & COO, HaystackAnalytics said, “Medical technology majors can revolutionise the healthcare industry by designing and creating cutting-edge medical technologies and devices that enhance patient care and outcomes. They can also utilise their knowledge and abilities to optimise healthcare delivery systems, resulting in cost savings. Additionally, they can apply their expertise to conduct research and create new treatments for various medical conditions. Some potential

Medical technology majors can revolutionise the healthcare industry by designing and creating cutting-edge medical technologies and devices that enhance patient care and outcomes

Gaurav Srivastava

Co-Founder & COO, HaystackAnalytics

The new crop of medtech start-ups is creating novel technologies and proprietary,patented products for healthcare challenges facing the ordinary Indian

Dr Swadeep Srivastava

Co-Founder & President, India Health Link

Despite the pandemic's increased use of digital interventions,many medtech businesses have been hesitant to adapt to the new digital landscape of healthcare

Dr Vaibhav Kapoor Co-founder, Pristyn Care

Medtech startups can fast-track the digital revolution in India’s healthcare sector and extend the sector’s reach beyond tier I and II cities

Deepak Tuli

Co-Founder, Eka Care areas of focus for medtech majors include telemedicine, AIbased diagnostic tools, the development of new medical devices, and the enhancement of clinical trial efficiency. Overall, with their unique skills and understanding, medtech majors are well-equipped to lead advancements in the medical field and make a substantial impact on healthcare.”

Dr Swadeep Srivastava, CoFounder & President, India Health Link also highlights, “The new crop of medtech start-ups is creating novel technologies and proprietary, patented products for healthcare challenges facing the ordinary Indian. This new wave of medtech is driven by purposeful innovation associated with economic opportunities seen in Indian healthcare.”

Dr Vaibhav Kapoor, Cofounder, Pristyn Care stresses, “In India, innovations created by medtech start-ups are revolutionising primary and secondary care. A number of healthcare innovations have emerged in recent years in response to changing customer expectations, as seen in India's steady transformation of primary and secondary care. At this stage, digital treatments are successfully addressing patients' pain areas and improving the overall patient experience across the nation.”

Current landscape

IBEF predicts that the Indian medtech sector will stand at $50 billion by 2025. The entry of start-ups in this sector is changing and revolutinising the business models of the companies. The most prominent being the integration of start-ups working in this sector with tech companies which is expected to give a much-needed boost to 3As (Accessibility, Affordability and Availability) of how healthcare is delivered in India.

Sharing his views on the role of medtech startups in revolutinising the 3As of healthcare, Deepak Tuli, Co-Founder, Eka Care said, “Medtech startups can fast-track the digital revolution in India’s healthcare sector and extend the sector’s reach beyond tier I and II cities to the vulnerable pockets of the nation. Indeed, suppose the government and India’s strong network of medical supply chains can keep on contributing to the acceleration of healthcare innovation. In that case, India has the potential to become a global medtech hub in the coming years.”

Throwing light on the current landscape, Rashmi Pimpale, CEO, RICH (Research and Innovation Circle of Hyderabad) mentions, “According to a market analytical study, the global market size for healthcare IT was around $167.4 billion in 2022. But more importantly, it is expected to grow at a compound annual growth rate (CAGR) of 17.9 per cent, reaching $609.1 billion by 2030. This figure is a testament to the size of the opportunity for medtech start-ups. This is especially true for India, where medtech start-ups are only in their nascent stage. According to a market trend analysis of medtech innovators by Deloitte, has shown that most medtech start-ups focus on the early stage of the patient’s journey (prevention, wellness, and diagnosis), instead of treatment. Many of these start-ups—almost 25 per cent—are leveraging AI or machine learning in their products or services. Notably, there’s been a shift from traditional inpatient settings (like clinics and hospitals) to home and point-of-care settings. Also, start-ups are showing a strong preference for SaaS, subscription-based, single-use, and disposable revenue models.”

Sharing his views on this, Amrit Singh, Co-founder, and CRO, Loop highlights, “There is a growing demand in India for healthcare products that provide real-time diagnosis, reduce healthcare costs and give accurate data for further analysis. This is what medtech startups need to focus on - creating costeffective, high-end, technologyenabled healthcare solutions, which can help improve the wellbeing of millions of people in partnership with the healthcare service provider network.”

Eshika Phadke, Core team member-Pharma Healthcare and Digital Health Practice;

Darren Punnen, LeaderMedtech and Digital Health Practice and Dr Milind Antani, Leader-Pharma healthcare Medical device-Digital Health

Practicefrom Nishith Desai As- sociates also commented, “It is said “Crisis brings Opportunity”. The pandemic has provided that much needed fillip to a number of innovative and meaningful start-ups in the medtech space, penetrating almost every aspect of the healthcare ecosystem –from drug delivery to home care. Bridging the gaps that were felt in the healthcare delivery system, there has not only been a spurt in devices that are intended to improve patient care, but also technologies that make both healthcare and wellness more accessible to the general population. Using technology, www.hmdhealthcare.cominfo@hmdhealthcare.com the “accessibility” component of patient care is being achieved. Further, the government has not only been actively incentivising innovation, but has also began developing and implementing a regulatory framework to provide a boost to the Indian medtech industryon a global scale.”

Top trends and opportunities for medtech start-ups

As mentioned earlier, integration of tech with the startups in medical devices sector has been the top most trend in previous years and is expected to boom more in 2023 and beyond. AI on medical images, low cost point of care diagnostics have the potential to create impact with a force multiplier effect when deployed along with digital public goods launched by the government like NDHM.

Vinay K Mayer, DirectorMarket Research & Consulting, Asia Research Partners LLP shares, “The medtech industry has seen tremendous growth in recent years, and it shows no signs of slowing down. Innovation is vital to help maximise the potential of some start-ups, but thought needs to be given when analysing what developments are propelling this dynamic sector forward.”

He also highlights some of the key areas with greatest opportunity for medtech startups (see box)

Runam Mehta, CEO, HealthCube also stresses that in 2023, the emphasis of the medtech sector has to be on creating interoperable solutions that are advanced, easy-to-use. She added, “Medtech start-ups are rapidly integrating advanced technologies such as AI, data analytics, IoMT, and mobile communications to create solutions for a wide range of challenges. In 2023, the emphasis of the medtech sector has to be on creating interoperable solutions that are advanced, easy-to-use for anyone with a basic understanding of technology, and capable of operating in different climates and network coverage variations. There are specific trends that have gained momentum in recent times and will be pivotal for the growth of medtech startups. Over the years, we have seen how X-ray, USG, radiology, the growth of wearable technology, remote patient monitoring, integrated electronic health records, and genomics has benefited healthcare delivery and improved patient experience. With more than 1.4 billion people to take care of, most of whom reside in rural and remote areas, these medtech trends are truly going to be a game-changer!”

Mentorship and scalability of medtech start-ups

Scalability and mentorship programmes together can play a major role in smooth development and growth of start-ups, where mentorships can give easy access to required resources and more importantly the guidance.

Neetha Joy, Director, ACT for Health believes that, “For innovations to reach India's mass population, it is important that they are able to demonstrate value to the government in order to become a part of the public health system. For this, it is essential for the medtech startup to have a very clear value proposition as well as enough clinical and real work evidence to demonstrate efficacy. The cost aspect is also extremely important as public health is a zero sum game. Startups should engage government stakeholders early on in order to ensure their pilot studies factor in the needs of the public health systems and can act as effective evidence to influence the government procurement and adoption.”

Commenting on the mentorship programmes, Gaurav Srivastava added, “A start-up may be developing a low-cost diagnostic device for detecting a specific disease that can be used in resource-limited settings. With the support of a medtech major, this start-up would additionally be able to gain access to the resources and expertise needed to bring their diagnostic device to market and make a meaningful impact on healthcare delivery in India.”

“Another area where medtech companies are mentoring healthcare start-ups is by providing guidance and support throughout the product development process. This includes help with product design and testing, regulatory compliance, and manufacturing and distribution. Medtech companies are often able to provide start-ups with the necessary expertise and resources they need to navigate the complex and often confusing world of healthcare product development”, he added.

Dr Kapoor stresses, “Despite the pandemic's increased use of digital interventions, many medtech businesses have been hesitant to adapt to the new digital landscape of healthcare. Medtech businesses still have a lot of ground to cover even while there is a great possibility for them to spur new forms of growth and enhance patient care through digital solutions. First movers are likely to be among those most positioned to alter the sector and capture value. Both large tech firms and smaller start-ups sense the opportunity in the market.”

The spokespersons from Nishith Desai Associates' digital health practice emphasises, “Traditional healthcarecompanies are increasingly looking to medtech start-ups to explore synergies to contemporise their own portfolio, as well as providing the start-ups with guidance or opportunity to scale up. Collaboration would be the Mantra.

Digital health: The utilisation of mobile apps,wearables,and other digital health technologies is rising dramatically as consumers become keener on managing their well-being.This is being propelled by the profusion of data from wearable devices and the requirement to make this data effective.We anticipate a high reception rate in wearable devices.However,cyber security remains one of the chief deterrents to lowering the acceptance rate.

Healthcare costs: The rising cost of healthcare is a major concern for patients, providers,and payers alike.There is a need for innovative solutions that can improve the quality of care while reducing costs.

Home healthcare: Home healthcare startups focus on providing personalised plans by leveraging AI.Startups in this segment offer cheaper alternatives to consultations, reserve consultations on a need-to-know basis,and aim to reduce unnecessary hospital traffic.These startups ride the fear of 'potential illness'' wave to profitability. As per our forecast,with rapid innovation and the introduction of ease of use,this subsector can promise favorable returns for investors.

(Source:VinayKMayer,Director-MarketResearch&Consulting,AsiaResearch Partners)

In addition to the appeal that the industry presents due to the increasing importance that is being placed on health and wellness, investors are especially bullish about this industry due to the state of relative regulatory certainty that has been established in the past few years. Other factors that are likely to play a role are innovations that are likely to take place and organic and inorganic growth. At present, the level of preparedness with the compliance requirements are paramount for anyone considering investing in a medtech business.”

Investors criteria for medtech start-ups

Investors want to know the firm behind a potential product is also worth their time in addition to the product itself. Investors will commit if the management team has experience in both business and the medical and healthcare ecosystem.

“Philanthropy has traditionally played an important role in de-risking science based innovations in their early stages by providing non-dilutive capital. It is important to increase the participation of philanthropic funders in helping innovations create real world evidence and support them on their journey as they iterate and make their solution ready to cater to very diverse types of stakeholders. Startups should engage government stakeholders early on in order to ensure their pilot studies factor in the needs of the public health systems and can act as effective evidence to influence the government procurement and adoption”, Joy adds.

Talking about the paradigm shift on the investment front, Pimpale said, “Today, pre-seed rounds have become more common. The step-up in average round size has increased, but the financing continues to experience a small runway. Investors have noticed the difficulty of obtaining significant returns and have become more conscious of spending. A proofof-concept is not enough for Series A rounds—reimbursement potential has become more important. Investors are inching toward scalable technologies that can address unmet needs in large markets, products and services that can reduce overall healthcare costs in the long term, and companies with intelligent business models that can create profits with little investment.”

Sharing the investors approach of evaluating the medtech start-ups, Joy mentions certain parameters. Firstly, the solutions should be capital efficient solutions that scale without significant capex. Secondly, the solutions should be relevant and scalable for India 's 1.3 billion population and lastly, the medtech startup's leadership teams should have the knowledge, ability and passion to execute, deployment ready solutions and high leverage solutions that can be used long term in a low cost and affordable manner.

Wayforward

Medical technology being an interdisciplinary field should focus on developing products that serve as effective solutions. The right amount of collaboration between engineers and medical professionals is the need of the hour to address current challenges and navigate them with innovative, new age solutions. Hopefully, the slew of measures announced in Union Budget 2023-24 for start-ups and medtech training programmes, along with existing ones, will give the much-needed boost to the sector.

Kalyani.sharma@expressindia.com journokalyani@gmail.com