This blog first appeared as Steve Wunker's piece for Forbes
By Steve Wunker
The Swasthya Slate is a remarkable device. Crammed into the footprint of an Android tablet, the Slate's electronics monitor electrocardiogram measures, blood pressure, blood sugar, urine protein, and several other biometrics. The data is reported to be within 99% of the accuracy of far more complex machines. Furthermore, the Slate collects data input by users and communicates this to a central server, both creating a reliable record of patients' health and enabling download of recommended therapies. With all of its sensors included, the Slate is being manufactured for $800, a cost that its creators expect to drop to perhaps $150 with volume. It is available only in India.
How can its Indian backers do this? A comparable device sold in the United States would often be orders of magnitude more expensive -- tens of thousands of dollars. But the sensors, processors, and other components in the device are inherently cheap, and the low-cost model is bolstered through using off-the-shelf platforms such as an Android tablet. Much of the cost of US medical devices stems from proprietary engineering, which aids in obtaining patent exclusivity and can provide an extra boost in performance for highly-demanding users. Then add the big cost of extensive studies required by regulators. Don't forget sales and marketing. For Medtronic , the world's largest medical device manufacturer and arguably the one that could have the best scale economies, sales, marketing, and general administration consumed about 34% of revenues in Fiscal 2014.
Swasthya Slate's inventor, Kanav Kahol, returned to his native India in 2011 from teaching at Arizona State University's department of biomedical informatics. He knew a thing or two about what these technologies can do, and that the basic electronics were reasonably straightforward. Unfortunately, because of the cost model that predominates in developed countries, the information these devices obtain was out-of-reach for the great majority of Indians -- not just the poorest of the poor. Kahol understood the value of this data, and indeed early results have been startling. To take one result, screening for preclampsia (the cause of 15% of maternal deaths during childbirth in India) quadrupled, and because the condition was detected earlier than using previous methods deaths were eliminated in the study group.
Critically, the Swasthya Slate is not just low cost. It is also designed to be easy to use and to save time for patients and healthcare professionals alike. In the case of antenatal testing, mothers often had to go from clinic to clinic for tests over a 14 day period. This was impractical and costly. With the Slate, the tests are done in a single location in 45 minutes. For the individuals administering the tests, the time spent recording data and completing forms shrunk from 54% of the day to 8%. Given the shortage of healthcare workers in most emerging markets, this is a major achievement.
The Slate is designed for simple use. Rather than the complex read-outs of machines in advanced economies, which require specialized training to use, data is read in a straightforward manner that low-skilled technicians can easily embrace. The vision for the Slate is to couple this simple data collection with sophisticated back-end tools that support medical decision-making.
Kahol's Swasthya Slate is far from alone in attempting such a revolution. Just in India, devices such as 3nethra (eye conditions), Lifeplot (a 12-lead electrocardiogram), and Wello (an iPhone case that tracks cardiovascular health) are all aiming for a huge market.
Exciting inventions -- that will not be seen in the U.S. or other advanced economies for a long time. Costly regulatory approvals are only part of the story. Disaggregated healthcare buyers, whether they are hospital groups or regional/provincial purchasers, require a complex sales process that adds cost. Moreover, purchasing is influenced by physicians who want the finest technology. Even the nurses and other technicians who commonly administer diagnostic tests have motivations to avoid having lesser-skilled staff perform their duties, and licensing boards can preclude such people from gaining these privileges.
Disruptive innovations -- a term coined by my mentor Clayton Christensen -- make what is previously costly, complex, or hard to access far more available to consumers. While the term "disruptive innovation" is often misapplied and over-used, these diagnostics are disruptive innovations in the most accurate sense. In US healthcare, disruptive innovations such as retail clinics, at-home diagnostics, and ambulatory surgical centers were resisted by established powers not interested in decentralizing the provision of care. And yet, one by one, barriers fell. For the Swasthya Slate to take off in the United States, many such barriers would need to be tackled -- not just regulation, but also creation of low-skilled technicians to use the machines and acceptance of decision support algorithms to guide medical recommendations. Don't hold your breath. But in India and other economies that can't wait for everything to perfectly align, courageous inventors and healthcare administrators are forging ahead. We can learn from their example: good-enough care for everyone is better than perfect care for the few.
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