Saturday, 6 December 2014

India's New Health Tablet Performs 30+ PoC Diagnostic Tests

The Swasthya Slate ('Health Tablet') is a portable diagnostic device that enables users to conduct 33 diagnostics tests with a simple box, power source, test sensors, and a smart device using the Android OS. The videos on this page give an excellent view into how the testing, analysis, and reporting process works. Of the 120m or so smart phone users in India, about 80% are using an Android OS, so the technological infrastructure is already in place for Slate to quickly scale up.
Photo Credit: Swasthya Slate
Launched in March, 2014, the Slate is the work of the Public Health Foundation of India, which also manufactures the device. The project is led by Dr. Kanav Kahol, formerly a bioinformatics professor at Arizona State University. With all sensors included, the device is being manufactured in India for only $800, a price expected to drop by 20% as it further scales. At this price, the primary target customers are health ministries, agencies, and clinics who will purchase the devices for public health management, putting them into the hands of community health workers (CHWs) who canvas the country as frontline care providers. The new diagnostic processes enabled by the device show the real value it's created, described in the following steps, and enabled by the components illustrated in the photo below:

  1. CHW visits village
  2. CHW conducts PoC diagnostic tests within minutes per individual
  3. Diagnostic box sends test results to smart device via Bluetooth
  4. Smart device uploads patient EMR to secure cloud
  5. Slate's data management software analyses data
  6. Slate's software communicates results to stakeholders via multiple channels

Photo Credit: Forbes India

The time and cost savings resulting from this process are substantial. Not only do the patients avoid costly travel for multiple tests when needed, but Slate only charged $1.25 for a panel of 10 standard biometric tests during their pilot. Referencing the table below, this is nearly 1/20th the cost of what the government was charging before at subsidized prices for the same 10 tests. Theranos, a highly disruptive lab diagnostics company featured in an earlier post, charges in the range of the government prices, but does not appear to offer Urine Glucose tests or the more manual tests like blood pressure, temperature, ECG and Malaria. And standard laboratory diagnostic test prices are sky high in comparison, as the prices from anylabtestnow.com show. Slate's measurement accuracy performance is within 99.9% of the traditional path lab technologies, and they continue to publicly track their clinical evaluation data to improve the device's performance. 



How Transferable is the Slate Device to U.S. Healthcare? 

Theranos is valued at $9 billion because they are providing essentially the same laboratory diagnostics as traditional labs at a fraction of the cost (often 1/10th-1/20th), using less invasive methods, and at much faster speeds. Slate appears to provide PoC diagnostic test results even faster than Theranos using RDT strips, at another huge price discount (1/20th of Theranos's prices from the chart above), and in similarly non-invasive methods. They have also developed 18 apps so far to fulfill the true meaning of 'software as a service.' On the other hand, Slate only offers 33 tests, whereas Theranos is set to offer the full range of possible laboratory diagnostic tests, which number into the thousands. Convincing the medical establishment that the diagnostic results from Slate represent medical grade data would be difficult. EHRs have been slow to become truly personal due to hospital policies and HIPPA. Many of Slate's apps are culturally-bounded, and would need to be re-written.

Nevertheless, I am optimistic of Slate's potential to disrupt clinical laboratory diagnostic testing in the U.S. Here's why:

Firstly, there are encouraging signs that both the FDA and the medical establishment are beginning to approve diagnostic biometrics from wearables, and if from wearables, why not from Slate? At any rate, Theranos is operating as a CLIA-approved lab without FDA approval due to the unique classifications for laboratory diagnostics, and because Slate is already tracking their clinical evaluation data carefully and cheaply, this may not be such a large barrier even if their system does require approval. Secondly, apps are relatively easy to write. Thirdly, if Slate's battery of tests represent the most commonly ordered tests, then it could disrupt Theranos even as Theranos is disrupting Quest and LabCorp. After all, the device is affordable, portable, and modular enough for use by school nurses, the smallest retail clinics, and even by patients themselves. If a device like Slate becomes the go-to for routine diagnostic tests, how commonly will people need to level-up and go to a Walgreens to order a Theranos test that costs 10x the price, or to a hospital where the test will cost 200x the price? 

According to Dr. Kahol's Twitter feed, he has already received requests for the device from both emerging and developed health markets, such as Pakistan, South Africa, Malaysia, and the UK. Field workers from at least 8 different countries, representing both developed and emerging markets, are already using the device on a pilot basis, as this usage map shows.


Question for Comments: 

  • What barriers prevent Swasthya Slate from transferring to U.S. healthcare markets, and how might you recommend they reduce these?  




90 comments:

  1. Austin,

    Thanks for keeping this blog - your entries are very educational and inspirational. Keep it up!

    Have some thoughts on this piece.

    Swasthya Slate (SS) certainly seems like what I'd call a "market-creating innovation". If it really can provide diagnostics at a fraction of the cost that even Theranos could deliver it, then it brings massive scale for disruption. Not to mention social impact and job creation.

    But there are also many examples of products with similar potential that have failed to live up to the hype...

    I think the core of the issue boils down to what job-to-be-done (JTBD) a potentially disruptive product goes after in its initial phase. Granted, it seems obvious to us that a cheaper diagnostic tool should be a no-brainer for the kinds of customers and end-users SS is targeting. But there are often emotional and social elements of the JTBD that are not immediately apparent. I faced this issue when trying to sell solar powered lamps in Nigeria. Amongst other things, we underestimated how much social status was a part of a buyer's considerations.

    This also brings me to the question of whether SS should pursue international expansion to more developed nations like the US right away. There's no doubt it could be disruptive there, with such a significant cost differential. But there's also a significant risk that going international first will distract from the singular focus needed to figure out the JTBD properly. (Not to mention that there will be a slightly different JTBD in a different market).

    Thoughts?

    ReplyDelete
  2. Great thoughts, Bryan. I agree that understanding ALL stakeholders' JTBDs are the foundation of any successful endeavor, and that this goal gets first priority. I read a good piece on that today for medtech: http://medtechplaybook.com/avoiding-the-1-reason-for-startup-failure/

    That said, I think JTBDs are multi-faceted, and that some benefit can be derived from considering them comparatively. By looking at JTBDs in different markets simultaneously, an entrepreneur may better understand both sets, and be able to weed out irrelevant demographic factors.

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