Techpreneurs Take Healthcare To The Masses

Devika Rao and Ankita Sahni

SigTuple and Forus Health are leveraging technology—cloud, artificial intelligence, machine learning—to reimagine the healthcare system. The two startups are creating devices and systems that bring down the cost of diagnosis and treatment and extend the reach of healthcare.

The Indian healthcare industry is a plethora of opportunity seeking solutions. Ours is a country of too many people and too few healthcare professionals. There are only 20,000 ophthalmologists, for instance, for India’s 1.3 billion residents. Most of the Indian population lives in remote, hard to access areas. Many of them are too poor to pay for health care. Only 17% of Indians have health insurance. Public hospitals may be free but they are overcrowded, poorly maintained and cash strapped to provide drugs and equipment. Private ones are prohibitively expensive for most.

Yet this is precisely a situation crying out for “frugal innovation”—creating devices and systems that bring down the cost of diagnosis and treatment and extend healthcare’s reach. Both the startups featured in this section use technology to do just that.

Indeed, both are the brainchildren of techies, not doctors—techies who have thought long and hard about India’s healthcare problems. K. Chandrasekhar, co-founder and CEO of Forus Health, spent 24 years in the semiconductor and embedded software business. A tech conference, which he attended while working with Philips revealed that the India has the highest population of blind in the world, but that 80 per cent of the blindness was preventable if detected in time. This proved to be his road to Damascus moment and led to the setting up of Forus Health. The founders of SigTuple, Rohit Kumar Pandey, Apurv Anand and Tathagato Rai Dastidar, met up while working at the American Express Big Data lab in Bangalore.

Forus health preprogrammed

What it is: Forus (“for us”) Health is a Bangalore-based technology company, set up in 2011, with a mission to eradicate preventable blindness. Forus manufactures “3nethra.” three allied devices that diagnose eye disorders. They are called 3nethra Classic, 3nethra Flora, and 3nethra Neo.

What it does: 3nethra Classic takes pictures of the retina and the cornea. Images of the retina assist the doctors in diagnosing diabetic retinopathy, glaucoma, retinal detachment, etc., while images of the cornea assist in diagnosis of cataract and other corneal disorders. 3nethra Flora carries out a process called fluorescein angiography by which a dye is injected in the eye to highlight abnormalities. 3nethra Neo detects the presence of a condition called Retinopathy of Prematurity (RoP) which is the detachment of the retina which can potentially lead to blindness in premature newborns. All three devices were developed entirely in-house. From common problems like Diabetic Retinopathy to corneal disorders and major eye complications, all can be detected using 3nethra Classic and Flora. 3nethra Neo provides invaluable service for newborns, as RoP, if left untreated, soon develops into permanent blindness.

Main advantages: 3nethra’s USP is that it can be operated by technicians with minimal training. It is portable and can be easily carried to remote areas by a technician, who can then transmit images of the affected eye back to the ophthalmologist. The devices are integrated with a unique cloud-hosted telemedicine application called Foruscare. “We must have done over 300,000 remote diagnoses using the cloud so far,” says Chandrasekhar. The portability, ruggedness and compact design of the 3nethra devices allow their use in all kinds of places and circumstances – optical store kiosks, mass screening programs in slums, and mobile eye clinics in remote, non-motorable areas. 3nethra is also much cheaper than its market alternatives. Before 3nethra Neo was developed, for instance, detecting RoP, which requires wide angle imaging of the eye, required a US-manufactured device which cost $100,000-120,000. 3nethra Neo is available at one-fourth the price. 3nethra Classic, the flagship device of Forus Health, diagnoses retina related problems, such as diabetic retinopathy or macular edema.

We must have done over 300,000 remote diagnosis using the cloud so far. The devices are integrated with a unique cloud-hosted telemedicine application called Foruscare. — K. Chandrasekhar, founder, and CEO, Forus Health

Impact: In just six years, 3nethra has touched the lives of around 2 million people across 26 countries and averted blindness in about 300,000. “It is operational in countries like Philippines, Mexico, Thailand and Brazil,” says Chandrasekhar. In India, only 40 per cent of Forus’s customers are from Tier 1 and 2 towns; the rest are equally divided between Tier 3 and 4 towns and villages.

Future: Forus will continue innovating in ophthalmology to create solutions that benefit the less-affluent sections. “The retina is considered a marker for many other physical problems too,” says Chandrasekhar. “I strongly believe that at some point in time it will be possible to identify the health of other organs of the body by studying the retina. We want to start working on that.”

Team and backers: Forus was set up by K. Chandrasekhar and Shyam Vasudev who together defined the products and set the technology roadmap. Currently Chandrasekhar is CEO and Vasudev, director. Other key members are Arun Krishnan (CTO, head of R&D and engineering) and Srikumar Venugopalan (CFO). Among the marquee investors who have supported Forus Health are Accel Partners, IDG Ventures, and The Asian Health Fund.

Takeaway: In just six years, 3nethra has touched the lives of around 2 million people across 26 countries and averted blindness in about 300,000. “It is operational in countries like Philippines, Mexico, Thailand and Brazil,” says Chandrasekhar.

With the data already stored, a trained pathologist has taught Shonit to read the blood smear images, break them down into red blood cells, white blood cells and platelets, recognize abnormalities and draw conclusions from them.

Nearly 60% of Forus’ customers are equally divided between Tier 3 and 4 towns and villages.

SigTuple Technologies

What it is: SigTuple, set up in 2015 and also headquartered in Bangalore, has built an artificial intelligence (AI) platform as a base for creating robots to carry out diagnostic tests. Its first solution is out, a robotic pathologist’s assistant called Shonit.

What it does: Diagnostic tests are presently carried out by technicians in pathology labs. SigTuple has built an AI platform called Manthana, that aims to increase the efficiency of medical experts in five areas– blood, urine and semen anal- ysis, taking of chest X-rays and eyescans.

Takeaway: In just six years, 3nethra has touched the lives of around 2 million people across 26 countries and averted blindness in about 300,000. “It is operational in countries like Philippines, Mexico, Thailand and Brazil,” says Chandrasekhar.

Manthana has three layers: Kurma, Mandara, and Vasuki. (The names are taken from Hindu mythology and relate to the well-known tale of the churning of the oceans by the gods and the demons; here, it is the ocean of data that is churned for insights.) Kurma is the back-end engine that enables training and execution of multiple AI models. Mandara is the reporting engine and Vasuki is the interface used to capture different kinds of data.

Using the three layers of Manthana, SigTuple has created Shonit, whose eyes are a smart digital scanner and brain is in the cloud. So far, Shonit has been confined only to blood testing. Teaming up with diagnostic labs and hospitals in Bangalore, and using smart microscopes, SigTuple founders have digitized the images of thousands of blood smear tests conducted in the labs and fed them into Shonit’s brain. SigTuple has a panel of 24 medical experts helping it to annotate the data accurately. With the data already stored, a trained pathologist has taught Shonit to read the blood smear images, break them down into red blood cells, white blood cells and platelets, recognize abnormalities, and draw conclusions from them.

Main advantages: The likes of Shonit can make up for the shortage of pathologists in the country. It has speed on its side – while a human being would take around 30 minutes over an abnormal blood sample, Shonit does the job in less than 10. While 35 human analysis always has an element of subjectivity, Shonit’s analysis is much more objective. This is because every blood diagnosis stored in Shonit’s brain requires the consent of at least three different experienced pathologists.

Blood smear images generated by Shonit, along with their interpretation, can reach pathologists anywhere across the globe in less than three minutes on the cloud platform, enabling them to make their own diagnoses as well, without ever having seen the original blood sample. And Shonit is forever ready to learn more – to give it more features, no new hardware is needed, only upgrades in the cloud. As the cloud gets better, so will Shonit. “Advancements in the field of cloud computing will improve the efficiency of the platform and in turn reduce the cost of the solution, especially on recurring usage,” says Pandey of SigTuple.

Shonit costs less than a tenth of the international products providing comparable services. In India, no product of this kind is being made anywhere.

Impact: It is early days yet, but Shonit has undergone three clinical validations and is in pilot mode in a few labs.

Our ultimate vision is to revolutionize healthcare delivery by bringing data-driven solutions that will completely digitize the healthcare industry and bridge the abysmal doctor-patient ratio by improving the efficiency of medical experts.

— Rohit Kumar Pandey, co-founder, and CEO, SigTuple Technologies

Future: Shonit will be followed by the robot Shrava, which will conduct urine analysis; Aadi, which will do the same with semen; Dhristi, which will focus on the eye, carrying out fundus photography and optical coherence tomography (OCT) scans; and Vaksha, which will do chest X-rays. While Shrava and Aadi are nearing the clinical validation stage, Dhristi is still in the product development stage, while research on Vaksha has yet to be completed.

Team and Backers: Rohit Kumar Pandey (co-founder and CEO), Apurv Anand (co-founder and CTO), Tathagato Rai Dastidar (co-founder and chief scientific officer). Investors include Accel Partners, IDG Ventures India, Endiya Partners, Pi Ventures, Venture Highway Axilor, Sachin and Binny Bansal of Flipkart and Amit Singhal, formerly with Uber and Google.

Takeaway: The likes of Shonit can make up for the shortage of pathologists in the country. It has speed on its side – while a human being would take around 30 minutes over an abnormal blood sample, Shonit does the job in less than 10.

Though Forus Health bestrides 26 countries and SigTuple has barely stepped out of the lab, both have vital features in common. They are both expanding the reach of healthcare, ensuring that health testing is available to – and affordable for – more and more people. Both also depend crucially on the cloud for their innovations. Indian pharma’s contribution to combating the global AIDS outbreak is well known. At the turn of the century, when antiretroviral drugs, all manufactured by global pharma behemoths, cost patients US$40 day, Cipla sold generic versions of the same drugs charging a dollar a day. It sidestepped the patent violation charge by using processes different from those of the multinationals and thereby saved millions of lives, espe-cially in Africa. Forus Health and SigTuple have shown how techpreneurs too can identify such opportunities in healthcare and devise low-cost solutions for them.

For more on healthcare technology, see A (Big) Data-Driven Approach To Healthcare Innovation.


Devika Rao

About Devika Rao

Devika Rao is an entrepreneur and writer based in Bangalore. She has over 15 years of work experience in research, marketing and communications.

Ankita Sahni

About Ankita Sahni

Ankita Sahni works on branded content and strategic initiatives at FactorDaily. Prior to this she worked with mainstream television channels as a content producer and anchor.