Report of field survey for the e-health Observatory in the ... · Lifetrack Medical Systems is now a profitable start-up which generates financial profit through its tele-radiology

FIELD REPORT PRODUCED BY STARTUPBRICS FOR ODESS 2017

Report of field survey for the e-health Observatory in

the Southern countries of the

LIFE TRACK MEDICAL SYSTEMS, TO FIGHT AGAINST

THE SHORTAGE OF RADIOLOGISTS IN DEVELOPING

COUNTRIES

Perrine Legoullon, StartupBRICS March

2017, Manila, Philippines

The Actu Tech and Start Up of the Emerging Countries


I. Performance of the field survey

The Lifetrack Medical Systems project field survey was held in Manila on 19 and 20 March,

with Dr Eric Schulze and his team present.

Arrival in Manila, bustling capital of the Philippines. On 19 March, I meet Dr Eric Schulze for a

first encounter and a first meeting. It is Sunday, few employees were present (for those who work

on Sunday, many work from home, thanks to the solution developed by Dr Schulze and his team).

Dr Schulze spends several hours explaining how the technology developed by his team works. The

solution seems simple, intuitive, and quite revolutionary for the profession.

The next day, I return to the doctor's office to clarify some points and meet the rest of the team. I

talk to the radiologists working for Dr Schulze, as well as developers. I also have the opportunity to

meet Carl Ng, who has just joined the team and is working on business development.

Perrine Legoullon with Dr Eric Schulze


II. The genesis of Lifetrack Medical Systems

Dr Eric Schulze, a trained radiologist, started with a simple observation: there is a critical shortage

of radiologists in many parts of the world, particularly in developing countries, and even more so in

rural areas. In fact, the proportion of doctors in relation to the number of inhabitants in rural and

urban areas is almost reversed.

In parallel, another problem is surfacing: the number of radiologists in emerging countries

(which are often more populated) is much lower than in developed countries (where the

population is smaller). This creates a global imbalance of health resources.

In addition to these two factors, the middle class is booming in many developing countries

(China, India, Indonesia, etc.). Populations are aging, getting richer and are confronted with

more and more non-communicable diseases (often related to lifestyle). There is therefore a

growing demand for medical care such as radiology consultations. However, many

governments are struggling to cope with these new expectations, particularly in terms of

quality of care, when they sometimes have to manage small budgets and resources for the

country's health.

There is therefore a clear opportunity to create a radiology department or a system providing

better access to quality care in areas where there are no radiologists. With all these elements in

mind, Dr Eric Schulze has thought of his solution, creating Lifetrack Medical Systems (the

company) and his RIS/PACS LifeSys. (*)

(*) RIS = Radiology Information System; PACS = Picture Archiving and Communication

System.


So far, Dr Schulze tells me, the solutions have been limited because of several factors:

- A lack of radiologists in many developing countries

- There is a real lack of skills and efficiency of radiologists, and also support and quality

improvement tools

- The existing RIS/PACS platforms are expensive to deploy, maintain and use, have no

educational elements, and are not made for developing countries

- Most 2D imaging systems still use film

The data is clear, especially with regard to the gap which exists today between developing and

developed countries:

Country Population Radiologists Ratio Beds /

1,000

United States 319 Million 34,000 9,400 : 1 2.9

Australia 25 Million 1,500 16,667 : 1 3.9

India 1.1 Billion ~5,500 200,000 : 1 0.7

Indonesia 250 Million ~1,000 250,000 : 1 0.9

Philippines 100 Million ~1.500 150,000 : 1 1.0

Nigeria 173 Million 220 786,000 : 1 0.5

Developing countries spend less on health, despite rapid economic development. The good news is

that many governments have become aware of this problem, and are committed to expanding their

health infrastructure. In addition, film imaging is slowly replaced by digital. However, it is difficult

to find more radiologists overnight, training requires long years of study.

Dr Schulze and his team then identified three potential solutions:

1. - Making existing radiologists more efficient.

2. - Expanding access to an international group of radiologists.

3. - Training radiologists faster and at less cost

These are the results of Lifetrack Medical Systems, the company of Dr Eric Schulze, who has

developed radiology software, as well as tele-radiology services.


III. What is the solution of Lifetrack Medical Systems (LifeSys)? What is

operation?

The solution presented in this report is version 2.0 developed by Lifetrack Medical Systems,

which was released in early 2016.

Dr Eric Schulze introduces me to LifeSys.

In order to address the problems identified (described in section II of this report), Lifetrack

Medical Systems has implemented two products:

The first is a radiology software entirely based on the peg, LifeSys. This software is a

RIS/PACS platform which requires no installation, just a web browser and an internet

connection. It works on PC, Mac, tablets and even on smartphone. Data can be recorded on

site and/or in the cloud.

This software follows a principle invented by Dr Schulze, it is SEPI: "Simple and Elegant, yet

Powerful and Intuitive".

The software includes ‘active templates’: pre-filled forms depending on the medical case

presented. The radiologist then sees a checklist of what is usually seen during the analysis of

such a case. Each option or item to be analysed is present in the form of a button, on which

the radiologist can click if the element is present in the case. He can thus spend more time

analysing the images of the case, rather than thinking about all the elements he should not

omit from his report. The radiologist can also use the voice recognition option (which is based

on Google functionality) to add items to his report without manually including it. Once all the

buttons are clicked and the consultation finished, the report is generated automatically thanks

to the software. Thanks to the software, the process is very fast. During my visit, I had the

opportunity to see Dr Schulze treat several cases. Each consultation took about 5 minutes, and

the process seemed very intuitive, even for someone like me with no medical experience.


The software is designed so that each case passes through a double or even a triple reading (by

two or three different radiologists). If the second radiologist (usually more experienced) does

not agree with the opinion given by the first, he can modify the report directly on the software

(thanks to the "active template"). Once the report is sent, the first radiologist receives a feedback

on his work, and can study the different opinions. This is an essential point according to Dr

Schulze, because according to him many radiologists in developing countries lack continuous

training, and are generally less well trained than in the United States for example. This feature

allows them to learn in each case, and continue to train continuously.

Dr Eric Schulze's team of radiologists, in their offices in Manila

LifeSys customers also have access to a Dashboard which retrieves data from the beginning of the

use of the software: number of cases per radiologist, average case processing time, etc. The system

also offers a system of SMS notifications for each new case, ideal for radiologists wishing to work

from home (which is possible, since the software works with a simple web browser!). This is the

case for many radiologists working for Dr Schulze.

In terms of costs, the solution offered by LifeTrack is much cheaper than its competitors. in

addition, Lifetrack has been able to reduce software costs by adopting a cloud-only system. This has

also had an impact on the cost of the equipment, which is reduced since LifeSys works on any

computer, provided that the screen is good quality enough for reading radios.


Lifetrack Global Players

Workstation $2,000 - $2,500

• i7 Workstation

• 8 GB Ram

• 8 MPX Samsung monitors

• For low-res CT images,

tablet is sufficient

$7,000 - $12,000

• Standard PC ($2K)

• Custom monitors ($5K)

• Obsolete dual-head DVI-D

video cards

Software License $30,000 - $100,000

• Price depends on site size

• Unlimited workstations

• 15% annual service fee

• $0.50 fee per read

• Optional - $3,500 / local

server

~$1.4 million1 (aux Philippines)

• Studies must originate on

licensed site

• 5 workstations maximum

• No formal radiological

report generation

• Unable to modify templates

/ software

The second product developed by Lifetrack is a tele dermatology service. Lifetrack Medical

Systems has a team of 24 radiologists in the Philippines, 3 in India and 26 in the United

States. The service is based in Manila, and uses LifeSys for case reading. The service offers a

double case reading (a first local reading, then a second international reading for an

assessment of the quality of the first reading). The team currently manages more than 500

radiology cases per day, from the United States, the Philippines, Kazakhstan, India, Indonesia,

etc.

The team was also able to significantly reduce the consulting costs, thanks to the increased

efficiency associated with the use of LifeSys. In most countries, radiology costs are high:

between $30 to $50 for an MRI/CT reading, and $1 to $12 for an X-Ray reading (Capex is

less than for the first one).

Lifetrack has adopted a financial compensation model based on a fixed salary (per hour) with

an efficiency bonus for local radiologists and by work unit for radiologists who are certified

by the American standards. The salary is 300 to 600 pesos, or $6.50 to $13 an hour for locals,

and $18 an hour for Americans.

Thanks to the increase in efficiency when reading cases (using LifeSys), this model becomes

very profitable. There is a 93% marginal rate for a local radiologist (who reads 90 X-ray

cases per hour, this amounts to $0.07 per case, compared to $1 in traditional rates), and 50%

of the marginal rates for a US radiologist.


IV. What benefits in health matters?

1/ For patients living in areas where there is a shortage of radiologists, Lifetrack allows them to

access quality tele radiology services at a lower cost. What is more, the simple and inexpensive

platform developed by Lifetrack allows more and more small hospitals to have a lower-cost

radiology system, meeting the needs of patients directly on site.

2/ The developed tool simplifies and accelerates the work of the radiologist, giving him more time

to focus on the images he needs to analyse. The feedback system (after a second reading by a

second radiologist) also allows continuous education or upgrading.

3/ For the hospital or medical facility adopting the solution, it represents a much lower cost than the

other solutions that currently exist on the market. This allows small hospitals, which in the past

would not have had the means, to be equipped with radiology software.

Dr Schulze in full consultation in Manila.


V. What about financing and the business model?

Lifetrack Medical Systems has completed a first round of fundraising, with a number of strategic

investors, including Kickstart Ventures, Inc.

Lifetrack Medical Systems is now a profitable start-up which generates financial profit through its

tele-radiology services, so it is independent of external institutions. In terms of revenue, the start-up

has developed a dual subscription system: annual subscription or subscription per scan (i.e. by

reading one radiology case).

Lifetrack Medical Systems now has about twenty radiologists who use LifeSys on a daily basis:

about 14 in India and the rest in Indonesia. LifeSys is also used by some radiologists (notably Dr

Hubert Vesselle) to train radiologists from other countries (in the case of Dr Vesselle, Vietnam and

Cambodia).

Since launching its version 2.0 in 2016, Lifetrack has worked with many healthcare partners across

the region: AyalaHealth, ActiveOne, Healthway Medical, Bethsaida Hospital, Providence Hospital

and also Calamba Medical Center.

The impact of using LifeSys is considerable, especially if we look at the time spent on a case study.

1 month after the implementation of LifeSys, there were 19% of cases reviewed in less than 15

minutes. After only 5 months, this figure increases to 79% of cases reviewed in less than 15 minutes

by the radiologist!

VI. What impact to date?


VII. What objectives for Lifetrack Medical Systems?

Lifetrack Medical Systems is currently preparing a Series A fundraiser, and is looking for

investments to accelerate the development of the company. The team is aiming for about 5 to 10

million fundraisers.

When I met the team, they were still aiming to get their FDA, which would allow them to speed

up their sales around the world. They have just obtained it on 18 April.

Lifetrack Medical Systems is also looking to enter the ‘Enterprise customer India merchant

market’, targeting large Indian groups such as Columbia Asia Hospitals, Fortis Hospitals,

Apollo Hospitals, etc.

The Lifetrack Medical Systems advisory board

VIII. What relevant support and partnerships for Lifetrack?

What Lifetrack Medical Systems needs most to fulfil its mission are:

- Investors interested in the solution developed by Lifetrack, and ready to engage

in Series A fundraising.

- Connection with medical institutions (hospitals), particularly in India

IX. Conclusion

The solution developed by Lifetrack Medical Systems is simple, intuitive for the radiologist,

and very economical. It allows an isolated hospital to integrate the solution at a lower cost,

which is not possible with today's traditional solutions. It is a system which requires little

hardware and no installation, and is therefore ideal for a tele-radiology service. This solution

aims to make quality radiology services accessible to all. Having already significantly

reduced operating and consulting costs, it is well on track to become the preferred solution for

developing countries.

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Report of field survey for the e-health Observatory in the ... · Lifetrack Medical Systems is now a profitable start-up which generates financial profit through its tele-radiology