Place both the thumbs on the glass slots and just wait for the readings on the mobile app,” says Rahul Rastogi, demonstrating the credit-card sized device Sanket. In 15 minutes, the phone displays crests and troughs on a red graph — the ECG, thankfully, is normal. “We have been found to be 98% accurate when tested against digital ECG machines,” he says.
Sanket 1.0 as Rastogi calls it doesn’t stop at producing an ECG. It also calculates stress levels. “In the next version, you will be able to send it to our doctor for a quick review. We will also be able to predict diseases by observing user patterns, and caution users about 17 diseases,” says the co-founder of Agatsa Software, which has developed the device.
There is little doubt that heart disease is on the rise in India. But it was his father’s own heart condition that prompted Rastogi to build Sanket. Diagnosed with a heart condition in 2012, he couldn’t be operated on because he was diabetic. “Someone had to be around him all the time,” recalls Rastogi.
Ideally, a patient with a possible heart issue should get an ECG done in an hour. “That’s the golden window but in India it takes 6-8 hours. About 4 crore people die each year because they don’t reach the hospital,” he says. When Rastogi and his wife looked for a solution that could detect heart trouble in time, that’s what they experienced. “We couldn’t find any device that produced ECG in time and conveniently,” says Neha Rastogi, co-founder, Agatsa. Even in hospitals, the process is cumbersome. Moreover, she adds, 70% Indians live in rural areas, away from diagnostic centres or hospitals.
That’s when the couple, both engineers from Aligarh Muslim University, decided to build Sanket by putting their experience across companies such as LG, Samsung, Hewitt and CSC India to use. But the challenge was to bring down the cost. A conventional digital ECG machine costs anywhere between 40,000 and 200,000. Sanket, on the other hand, is priced at 11,999. “Conventional machines are hardware heavy. The innovation on our part was that we were able to transfer the intelligence built in the hardware to the software. For us, the hardware is only required for the voltage flow/regulation,” says Rastogi.
It was, however, difficult to find investors who understood the vision, say the duo. “We thus followed a frugal approach, didn’t spend too much money initially. In fact, for our initial prototypes we used cardboard and even matchboxes to give the doctors an idea of the product,” recalls Rastogi.
The bootstrapped start-up though assimilated a lot of what the doctors had to say. What they wanted was a device based on the conventional 12-lead ECG. At that point, some Chinese devices were available that worked on single lead, which were expensive. In the conventional 12-lead ECG, ten electrodes are attached to obtain results from 12 different angles. So that’s what Sanket did. Besides the thumb slots, users have to place the device at conventional ECG points to get accurate results.
The more Sanket got this part right, the more recognition came its way. Its office has poster size cheques won from start-up contests, including the Anjani Mashelkar award in 2015. The recognition, in turn, brought investors like Tata Trusts and the Biotech Industry Research Assistance Council (BIRAC). “We work closely with Tata Trusts and Sanket has been utilised in their projects,” shares Rastogi. The company has also been working with Reliance Venture Hub and is exploring how Sanket can be integrated with Reliance Jio.
Gradually, Agatsa has changed its frugal approach. “We bootstrapped initially but now we raise funds a year in advance,” says Rastogi. The team has also grown from four members to 15 now. Neha adds, “We could have hired a doctor if we had raised money initially. But it was good that we didn’t because that meant talking to hundreds of doctors on the ground. That helped make the product better.” Dr Kamal Ahmad, MD, Indraprastha Apollo Hospitals in Delhi was one of the doctors that helped them. Ahmad was treating one of Rastogi’s family members for cardiac ailment. “Even then Rahul was curious about the possibilities of manufacturing an ECG device. I would brief them on its applications, how it helps detect heart problems and the technicalities that go into reading an ECG.”
Doctor at hand
While Sanket was commercially launched in March 2016 on Amazon, Agatsa has already sold 250 devices. “A product like this is the need of the hour given that India is the capital of heart disease. There is nothing like Sanket in the market today,” says Jitender Singh Minhas, CEO, STEP business incubator, who is an investor.
Ahmad adds, “The best thing about Sanket is that it is user-friendly and can be used in distant towns where you don’t have a cardiologist. Where long-term monitoring is required, it can be done by patients themselves and post-surgery follow-ups can be done by sharing the report on the mobile — there is no need for patients to travel long distances to see the doctor.”
A for-profit company, Rastogi says he wants to be like Apple and not Samsung. “We don’t want to be only a product company, we want to be a data company,” he says. While he doesn’t reveal the start-up’s revenue, Rastogi says Agatsa might turn profitable by end-2017. “We are for profit, but we are not guided by that,” says the co-founder. He, however, counts Anil Gupta, vice chairman, National Innovation Foundation and Dr Raghunath Mashelkar as mentors. “We got inputs on market connect, product focus and business modeling, which are crucial. Earlier, we had plans to add more sensors such as the one for measuring blood pressure. But our mentors asked us to focus only on one niche, the cardiac space,” says Rastogi.
While, as of now, the revenue comes by selling devices, the long-term plan is to tap the vast amount of data collected. Rastogi says the company can suggest lifestyle changes by analysing the data. Minhas, however, has a different point to make. “You can do a lot with that data. Probably, a stage can come when you can give the device for free and data from their ECGs can be utilised by life, health insurance companies and companies in preventive healthcare,” he says.
For its next version, Rastogi is targeting a wearable with the capability of detecting 17 diseases such as diabetes, epilepsy, obesity, anxiety, neuropathy etc. “For example, for a person regularly using the wearable, we will be able to caution him/her about the likelihood of a disease months in advance,” claims Rastogi.
But isn’t there a direct challenge from wearable giants like Fitbit and others? Rastogi doesn’t feel so. “Fitbit is only based on the heartbeat and is single-lead based. That doesn’t tell the entire story of your heart. You can’t foresee any heart disease with that data. Fitbit gives you details about heartbeat, steps, calories burnt and sleep duration etc, but Sanket is a more diagnostic and cardiac care device.”
Nevertheless, Agatsa will have to win over doctors. Rastogi understands that. “Making a product is only 10% of the job. One has to find a market for it,” he says. The start-up has thus already tied up with distributors. It is also working on getting approval from the Indian Council of Medical Research (ICMR), which works closely with doctors from AIIMS, a process that is underway. The medical body is likely to test the product on a large sample size over the next few months to check Sanket’s accuracy. But Rastogi is ready to wait. “We have also applied to the FDA in the US. An approval by ICMR will help us there,” he adds.
While it doesn’t need these approvals, the company believes it is a way to fast track its progress and add credibility. “There are only seven devices, all to be placed inside body, whose sale requires government approval. Sanket can be sold like a thermometer,” says the co-founder.
Already, Sanket is being sold in countries like Singapore, South Africa and Australia as and when the orders come. The long-term plan for Agatsa though is to operate through licensees in foreign countries. The company is also shifting its manufacturing base from China to India next month. It hopes to get at least 50 million people to use the product in the next couple of years. If it does, it might just become a leading player in cardiac care.
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What is the vision guiding Agatsa? Please share with us how the company came into existence?
Agatsa is focused on becoming a pioneer in cardiac care wherein we promise easiest and quickest method to detect, diagnose and manage cardiac problems. Unlike other health problems, time is of great importance when it comes to cardiac issues. A small delay can lead to surgery or even death.
The idea to start Agatsa was conceived when we saw members of our family and dear ones being detected with heart diseases. There was no mechanism to detect a problem like a heart attack in a timely manner, except to go to a diagnostic centre for an ECG.
ECG is the first test being done to detect a possible heart problem. But conventional methods of ECG are costly, time consuming and tedious.
We thought of the idea of having a portable and easy to use ECG monitor which can be connected to a smartphone, quickly take ECG, share report to a doctor and get a quick diagnosis, and hence save crucial time. We started working on developing a prototype of such device and named it SANKET which means signal in Hindi.
How important is cardiac care in Indian context?
In a developing country like India, high economic growth and urbanisation have caused a large section of population to move towards unhealthy lifestyles with decreased physical activity, increased stress levels coupled with high intake of saturated fats and tobacco. Cardiovascular Diseases (CVDs) are the largest cause of mortality, resulting in almost half of all deaths caused by Non-communicable Diseases (NCDs). CVDs are expected to be the fastest growing chronic illnesses, growing at about 9.2 per cent annually. The rate of CVDs among Indians, particularly young men, is almost twice as high as their Western counterparts. Young population is increasingly falling prey to these deadly diseases.
What is Sanket and how does it measure stress?
Sanket is a credit card sized ECG monitoring device which measures 12-lead ECGs without any leads or wires or electrodes. You just have to place your thumb on sensors or place the device with sensor touching at different positions of chest leads to measure accurate ECG in just 15 seconds on a smartphone. The report is generated and shared via mobile with a doctor for quick review.
The report contains not just the ECG graph but also various heart parameters like heart rate, QTc in tervals, R-R intervals, etc. With the heart rate and R-R intervals, we have developed our algorithms to calculate heart rate variability, which predicts up to 17 diseases and also the clinical stress levels of an individual when compared to his resting R-R interval. This is being used now in various researches to develop a correlation between mental stress and cardiac problems.
Any person can purchase and use this device easily at home, record his ECG and share the report to doctor or family. Plus, we have also rolled our unique ECG interpretation services where any ECG report can be uploaded on our platform and shared and can be interpreted by our panel of experienced cardiac medical practitioners. Hence, now only in five seconds any ECG lead position can be traced out and analysed for diseases like MI, AF. This gives a tremendous advantage to general practitioners, who can take a data driven conclusive call on patient management.
General practitioners are the first point of contact in most cardiac cases, but at present they either don’t have ECG machines, or they cannot interpret complex conditions using ECG. Our platform provides them both in a very cost effective manner.
Using heart rate variability, we can even predict the vulnerability of an individual for 17 possible diseases. We call this Stress Analysis and this has been used very effectively in various NGOs. Several IITs are using our platform to further enhance their research work on relating mental and cardiac problems through relevant data.
Having developed devices like Sanket ECG monitor and Stress Smartapp that measures ECG and stress, which other products Agatsa Healthcare is planning in near future?
Cardiac care mainly comprises of three stages – prevention, detection and maintenance. We look forward to launch complete end-to-end solutions to provide a unique combination of pocket sized ECG monitor to quickly detect heart issues through full 12-Lead ECG on a smartphone, get timely medical interventions and assistance and services to provide personalised coaching programmes to post operative patients by bringing together cardiac healthcare providers, dieticians and physical therapists.
We successfully kicked off our pilot project under the National Health Mission programme of Tripura in association with Tata Trusts in September last year. Doctors in 45 PHCs in remote areas are successfully using our devices to quickly scan patients for cardiac problems
We are gearing up to Beta launch our extended cardiac health platform called “Sanket Coach Programme.” This programme is of three months to six months duration and will provide support to heart patients (diseased or post operative) by helping them with right food choices, lifestyle modifications, physical exercise and online medical support.
How Agatsa plans to scale up?
Our Sanket devices are in the market for the past one year now and are receiving some really good feedback from heart patients, doctors, general physicians, diabetologists and general fitness providers. Even the people who just want to monitor their heart for prevention of any disease are buying Sanket. Anyone can purchase Sanket from our website or online portals like Amazon, Snapdeal and Flipkart.
We successfully kicked off our pilot project under the National Health Mission programme of Tripura in association with Tata Trusts in September last year. Doctors in 45 PHCs in remote areas are successfully using our devices to quickly scan patients for cardiac problems.
We plan to scale up the sales of our devices and Sanket services platform in the first quarter of 2017 by reaching out to various hospitals, cardiac clinics, diagnostic centres to use and recommend our devices and Sanket Life platform to their patients for better monitoring and management of heart diseases. Agatsa intends to reach out to post operative patients who are in dire need of constant support and monitoring, patients on medication and finally to high risk patients.
What are the key challenges you face as a health device maker?
Key challenges in India include lack of standard certifications and regulations around patient-centric medical devices. Shortage of technical expertise in terms of electronics manufacturing and prototyping is another big challenge for device manufacturers in India. Finding high skilled professionals in designing and engineering areas is also tough. Support from academia to guide young students and professionals towards real innovations must be stressed upon.
How can government policies help medical device manufacturers to increase their global reach?
Regulations around patient-centric medical devices like Sanket must be brought in for better innovations, products and services in healthcare.
Commercialisation grants or even debt on low interest rates to scale up and not just support for research and development would help startups like us to stand on their own, rather than depending on equity investments alone.
Better infrastructure support for R&D and prototyping and manufacturing will be a huge boost to Indian medical devices industry.
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Tata Trusts and Government of Tripura introduce initiatives in healthcare and education to improve access through technology
- Virtual learning centres set up in 11 high schools of Tulashikhar, linked by VSAT connection to a central studio at SCERT at Agartala
- Emergency Medical Services Plan for Tripura to ensure quick and life-saving response to emergencies and disasters
- Mobile ECG machines in 39 primary health centres for emergency cardiac care
|(From right) R Venkataramanan, Managing Trustee, Tata Trusts, with other officials at the inauguration|
Tripura: The Government of Tripura and Tata Trusts today inaugurated virtual classrooms to enable learning at secondary and higher education levels across six blocks of Tripura at SCERT, Agartala this morning. Furthermore, announcing the setting up of an Emergency Medical Services Plan for the state to ensure timely and life-saving response to emergencies. As part of this initiative, mobile ECG machines will be provided in 39 primary health centres for emergency cardiac care. This initiative parties was announced by both parties at a training and facilitation event held at the capital’s Pragya Bhavan.
Establishing VSAT-enabled and IT integrated smart classrooms, Tata Trusts shall provide technical support in six blocks: Tulashikhar and Padmabil, Khowai; Manu and Chhamanu blocks in Dhalai and Kathalia and Mohanbhog blocks in Sepahijala. The first leg of the work launches in all 11 High Schools of Tulashikhar block where the Trusts has been working to improve the quality of education in all 97 Government schools.
These virtual learning centres will allow remedial teaching of students and teachers in a centralised manner through organised seminars and special input workshops. The main objective of this initiative is to see an increasing number of students successfully pass in high schools and to encourage more teachers to integrate e- learning contents and modules in everyday teaching. Tata Trusts’ technology partners will ensure equitable access to state resources.
In keeping with the benefits obtained from advancing technology Tata Trusts has endeavoured to integrate its use in a number of projects. The ability to monitor, identify and react real-time is a feature best suited to healthcare.
Remote locations and a lack of available equipment, is often a challenge when offering ECG monitoring facilities to patients in Public Healthcare Centres (PHCs). The Trusts through a health initiative outlined under the MoU signed a year ago are working towards bridging this divide by introducing Sanket, a small easy-to-use portable ECG recording device in 39 PHCs across the state, thereby covering all the PHCs in the three districts of Dhalai, Khowai and Sipahijala. Through cutting edge technology, this device aims at providing affordable and timely cardiac care to even remote communities. Training will also be provided to health workers in usage, cardiac emergency care and effective primary level health planning.
By combining technology, operations and processes, Tata Trusts is bringing integrated Emergency Medical Services (EMS) to Tripura to ensure swift life-saving response to emergencies. Through this, Tata Trusts is working to strengthen existing pre-hospital care and life-saving skills among healthcare personnel; bolstering trauma care facilities; and using technology to improve coordination between EMS and various Govt. departments.
Under the Memorandum of Understanding (MoU) signed between Tata Trusts and the Government of Tripura in July 2015, Tata Trusts has been working to augment, strengthen and supplement systems across livelihood, education, health and nutrition in the state. Tata Trusts has been assisting the State Government in building capacities of various sectors through on ground implementation of projects such as Internet Saathi, livelihood through fisheries and dairy as well as skill building efforts for increased employment opportunities for the states youth.
About Tata Trusts
Tata Trusts is amongst India’s oldest, non-sectarian philanthropic organisations that work in several areas of community development. Since its inception, Tata Trusts has played a pioneering role in transforming traditional ideas of philanthropy to make impactful sustainable change in the lives of the communities served. Through direct implementation, co-partnership strategies and grant making, the Trusts support and drive innovation in the areas of education; healthcare and nutrition; rural livelihoods; natural resources management; enhancing civil society and governance and media, arts, crafts and culture. Tata Trusts continue to be guided by the principles of its Founder, Jamsetji Tata and through his vision of proactive philanthropy, the Trusts catalyse societal development while ensuring that initiatives and interventions have a contemporary relevance to the nation. For more information please visit http://tatatrusts.org/
“Sanket is a credit card-sized heart monitor, which acts like a portable ECG machine, making it possible to monitor the heart condition, making it as simple as monitoring the body temperature. The high-tech 3-lead ECG recorder connects to a smartphone wirelessly, and displays and records ECG graphs on a smartphone. The ECG report can be shared instantly with a doctor via e-mail, Bluetooth – or even via WhatsApp! The affordable device marks a dramatic shift in the way we approach cardiac care – doing away with expensive ECG machines, distant hospitals or laboratories, and skilled technicians. Sanket is all set to bring about a revolution in cardiac care and disrupt this space.”