Transforming The Future With Deep Tech

[00:00:00] Transforming The Future With Deep Tech

[00:00:05] Scientific and technological inventions make an impact on society when they are taken to

[00:00:11] market with innovation.

[00:00:13] A solution that works for India will work for half the world's population, and this

[00:00:18] can be a huge win-win for India and the world, says Chris Gopalakrishnan, co-founder

[00:00:24] of Gopalakrishnan Deshpande Center for Innovation and Entrepreneurship and Padma Bhushan Awardee.

[00:00:31] Deep Tech startups aim to solve complex problems by providing technology solutions based on

[00:00:37] significant scientific or engineering innovation, with a transformational blend of new and

[00:00:44] emerging disruptive technologies such as artificial intelligence, AI, machine learning, ML,

[00:00:51] natural language processing, robotic process automation, RPA, blockchain, Internet of Things,

[00:00:59] Big Data and 3D printing.

[00:01:02] Deep Tech is breaking barriers once considered impossible to breach.

[00:01:07] In a country like India where the socioeconomic and development challenges are unique, Deep

[00:01:13] Tech is the need of the hour as it has the potential to meaningfully address various

[00:01:19] aspects of these problems using new technologies.

[00:01:23] Fortunately, there has been a steady increase in the number of Deep Tech startups in the

[00:01:28] country.

[00:01:29] India's Deep Tech ecosystem has grown 53% in the last decade and is at par with developed

[00:01:36] countries like the US, China, Israel and Europe.

[00:01:41] Of the 27,000 technology startups in the country, 3200 are solely focused on leveraging

[00:01:48] Deep Tech.

[00:01:49] Although Deep Tech startups account for 12% of India's overall startup ecosystem, they

[00:01:55] have managed to raise $2.7 billion in venture funding in 2021 according to the 2023 NASCARM

[00:02:03] strategic report.

[00:02:05] The report also points out that while there has been a growth of Deep Tech startups all

[00:02:10] over the country, Bengaluru in Karnataka has emerged as the most favored city.

[00:02:16] The city accounts for 25-30% of India's Deep Tech startups, with 15-20% of the country's

[00:02:23] Deep Tech companies Delhi NCRCAM second followed by Mumbai at 10-12%.

[00:02:31] Statistics show that the Indian Deep Tech ecosystem has truly come of age, contends Devjani

[00:02:37] Ghosh, President NASCARM.

[00:02:40] The ability to innovate and the speed with which it is done determines the possibility of

[00:02:46] overcoming the challenge she revealed at a recent meeting on Deep Tech and critical

[00:02:51] innovations.

[00:02:53] Part 1 Revolutionizing Health Care With Innovation

[00:02:58] One such Deep Tech startup is Aadai Biosciences.

[00:03:02] This Bengaluru-based startup co-founded by IIT Madras Alamnes has made a crucial

[00:03:09] breakthrough by indigenously developing a state-of-the-art 3D bioprinter that can print

[00:03:16] human tissues.

[00:03:17] Unthinkable as it may seem, this means that the long wait for patients needing organ

[00:03:23] donation may finally be over in the near future.

[00:03:28] A lack of organ donors is likely to lead to the death of 500,000 persons due to

[00:03:34] organ failure in India in 2023.

[00:03:38] It is estimated that more than a million people suffer from end-stage organ failure.

[00:03:44] Medical experts say that at least 16 patients die every day waiting for an organ and that

[00:03:51] every 10 minutes a new name is added to the waiting list.

[00:03:55] The alarming statistics reveal just how critical this innovative 3D bioprinter will be in

[00:04:02] revolutionizing healthcare in India.

[00:04:07] In addition to the shortage of organ donors, there is a possibility of rejection by the

[00:04:12] recipient's immune system as well as a risk of infection once transplantation has been

[00:04:18] done.

[00:04:19] The 3D bioprinter could provide safer alternatives.

[00:04:23] The 3D bioprinting technique is a unique gift to humanity by science and technology.

[00:04:29] This is because this technique is a potential alternative to organ transplantation.

[00:04:36] Some years down the line 3D printing of organs will be at a stage where successful transplant

[00:04:42] will be possible without any complications.

[00:04:45] The patient will not have to wait for the donor and can actually get the organ 3D printed

[00:04:50] and the transplant can take place smoothly, says Manish Amin, co-founder and CEO of

[00:04:56] AyurBioSanSys.

[00:04:59] Turning Dream into Reality

[00:05:02] The thought that they could develop a life-changing device came to Manish and his friends Aditya

[00:05:07] V.S. and Surhidhi Sundaram, both alumnus of IIT Madras, while they were working together

[00:05:13] on additive manufacturing technologies like thermoplastic 3D printing, concrete 3D printing

[00:05:20] and related technologies.

[00:05:22] Their goal of venturing into the medical domain got a boost when they received

[00:05:26] a grant from the Central Government's Biotechnology Industry Research Assistance Council, BIRAC,

[00:05:34] to develop a bioprinter and a chip model for skin printing.

[00:05:39] They developed the first prototype of basic bioprinter that could print hydrogels within

[00:05:45] six months.

[00:05:47] This prototype, named Mitoplas, was installed at the Indian Institute of Science, Bengaluru,

[00:05:53] where it was successfully tested under the guidance of Dr. Vikramjit Basal and his team.

[00:06:00] But the real work to make their dream into reality was to begin a little later.

[00:06:05] Once they realized that the availability of cost-effective bioprinters was an essential

[00:06:09] step in developing artificial organs, they decided to take a leap of faith.

[00:06:15] Tech savvy friends loosely collaborating would not do anymore.

[00:06:19] A dedicated startup was needed to develop the prototype into a product that could be

[00:06:24] used effectively to save lives and was commercially viable as well.

[00:06:30] After close interactions with Dr. Basal, the three engineers decided that to develop

[00:06:36] and incorporate his inputs on advanced features like temperature control, HEPA filter system

[00:06:43] and multi-material printing, they would need to expand their team.

[00:06:48] So in 2021, they founded Aware Biosciences and brought in experts in manufacturing, biology,

[00:06:55] design and marketing.

[00:06:57] A year later, an advanced version of the prototype Mitoplas, a bioprinter ready to print

[00:07:03] human tissues, was launched.

[00:07:07] Printing tissue currently means using bioinks.

[00:07:11] Bioinks constitute cultured cells and biocompatible materials like a hydrogel and are specific

[00:07:18] to the tissue being transplanted.

[00:07:21] These are used to create scaffolds.

[00:07:23] These live scaffolds are then incubated, providing the right environment and time for the cells

[00:07:30] to multiply and make connections resembling tissue.

[00:07:33] The scaffolds are 3D printed, maintaining structural and functional compatibility with

[00:07:39] human tissues, ranging from soft tissues to bone which are the most commonly transplanted

[00:07:45] tissues, says Manish.

[00:07:48] He further points out that work by researchers was still ongoing to verify that these complex

[00:07:54] scaffolds actually behave identically to real tissue.

[00:08:00] Identifying these differences would lead to huge steps forward in understanding and

[00:08:05] artificially growing entire organs, something we are aspiring to do.

[00:08:09] In Sanskrit the word Aware broadly means organ.

[00:08:14] This is the reason the company was named Aware.

[00:08:17] Our approach to the creation of new organs begins with the journey of creating new tissue

[00:08:22] samples, a critical stepping stone to achieving this dream, he states.

[00:08:30] Developing a life changing device.

[00:08:34] Bioprinting is a type of 3D printing that can potentially produce anything from bone

[00:08:38] tissue and blood vessels to living tissues for various medical applications, including

[00:08:44] tissue engineering, drug testing and development.

[00:08:49] A 3D bioprinter works almost exactly like a printer does.

[00:08:53] It uses a digital file as a blueprint to print an object layer by layer.

[00:08:59] The software converts the digital file into printing instructions called G codes which

[00:09:05] are sent to the printer via wifi or USB.

[00:09:09] The printer reads these instructions and builds the model in 3D accordingly.

[00:09:14] This is how a 3D bioscuff fold is produced.

[00:09:18] The only difference is that instead of plastic, metal or powders, bioprinters use human cells

[00:09:25] and biomaterials as bioink to print layers of new functional human tissues like skin.

[00:09:33] It is essentially a way of artificially replicating human tissue that temporarily or permanently

[00:09:40] supports and nurtures living cells.

[00:09:44] Explains Manish.

[00:09:46] Since bioprinting uses biomaterial and bioinx as its core requirements to create functional

[00:09:52] human tissues such as skin and entire organs, it is extremely important that these materials

[00:09:59] are of high quality.

[00:10:02] Bioprintering works as gels or pastes which contain two key components.

[00:10:06] The first are the cells for the type of tissue that are being targeted and the other critical

[00:10:12] component is the biomaterial that can support the cells and aid their growth.

[00:10:19] Bioinx are materials engineered to allow the specific type of cells to grow and multiply

[00:10:25] while supporting the tissue structure.

[00:10:29] This can be divided into the following categories.

[00:10:33] Structural.

[00:10:34] These inks are used to create frameworks or supports for the structure.

[00:10:39] Sacrificial.

[00:10:41] These inks are aimed at supporting structures during the printing process but are later

[00:10:46] removed or consumed by the cells to be replaced by their own materials.

[00:10:53] Functional.

[00:10:54] These inks are used to guide a specific function like cellular growth, development and differentiation.

[00:11:03] Biomaterials like gelatin and collagen are made from natural sources like meat, bones and

[00:11:09] cartilage using chemical processing.

[00:11:12] They imitate the cells environment as it would have been within the body and so are used

[00:11:18] as support structures or scaffolds upon which cells grow and connect.

[00:11:24] According to Manish, biomaterials are one of the main and most critical components of this

[00:11:31] bioprinter.

[00:11:32] This is where Avae has shown its innovation and uniqueness by developing its own biomaterials.

[00:11:40] This was done thanks to Dr. T. Pawani's expertise and her skills in developing biomaterials.

[00:11:49] If you look at most of the companies, they rely on third party vendors for procurement

[00:11:53] of biomaterials.

[00:11:55] We on the other hand have developed our own biomaterials.

[00:12:00] This is a long process and needs very specific expertise to optimize the biomaterials

[00:12:06] before sending it to the end user.

[00:12:09] Dr. Pawani has been giving inputs to our bio team on how to develop, formulate and repeat

[00:12:16] the whole process without disturbing the compositions.

[00:12:21] These biomaterials are compatible with other bioprinters too.

[00:12:25] This makes us a unique team as we provide a whole set of bioprinting solutions.

[00:12:31] He adds.

[00:12:33] But being unique also came with its own challenges.

[00:12:37] The first big test was to convert the prototype into a product.

[00:12:41] This meant overcoming the hurdles of software bugs, ensuring smooth and repeated printing

[00:12:47] and developing high quality parts and features.

[00:12:51] The overarching concern was the availability of resources needed to fund such a capital

[00:12:56] intensive innovation.

[00:12:59] Since the technology was very new, it took some time to figure out the product market

[00:13:04] fit.

[00:13:05] We had to demonstrate the product to a lot of scientists and doctors to get their feedback.

[00:13:11] DeepTech research requires a lot of capital to even start the research as it needs specialized

[00:13:18] talent as well as expert knowledge in more than one domain to develop and validate a science

[00:13:25] based innovation.

[00:13:27] BIRAC was very helpful in giving us a kickstart to the project.

[00:13:33] We raised a pre-seed round after receiving the BIRAC grant.

[00:13:38] This helped us hire a few good resources and build our team of specialists.

[00:13:43] Recalls Manish.

[00:13:46] What's unique about their innovation?

[00:13:49] Mitre Plus is not only unique but is also one of the most advanced bioprinters and

[00:13:56] a wide range of biomaterials can be printed with it, claims its developers.

[00:14:02] Some of its unique features comprise an inbuilt UV curing option, HEPA filters and temperature

[00:14:09] control facility which allow the print head and the print bed to be cooled up to 4 degrees

[00:14:16] Celsius as well as heated up to 80 degrees Celsius.

[00:14:21] These features facilitate the process of bioprinting as many biomaterials are temperature sensitive

[00:14:28] and require precise environmental conditions.

[00:14:31] The viscosity of the biomaterial can be controlled to an extent by managing the extrusion temperature

[00:14:39] according to Surid Sundaram, Chief Operating Officer of Aibaya Sciences.

[00:14:45] This allows researchers to adjust the printing parameters and fine-tune it for precise

[00:14:50] scaffolds.

[00:14:52] Some materials also cure or harden when exposed to UV light.

[00:14:58] Since these materials are gels, such curing is needed to achieve more layers or the bottom

[00:15:04] layers get compressed and do not maintain structural integrity, he says.

[00:15:11] Collaborations for Solutions

[00:15:13] Aibaya believes collaboration and partnership with institutions focusing on science, technology

[00:15:20] and research will provide better outcomes in terms of developing solutions.

[00:15:26] These collaborators with organizations like the Institute of Chemical Technology ICT Mumbai,

[00:15:33] IIT Madras, IISC, National Institute of Pharmaceutical Education and Research NIPER, Hyderabad and

[00:15:43] Bitspilani has helped it to add new features and building better software.

[00:15:50] We are working with Bitspilani on developing bone tissues where Ava is providing the

[00:15:55] machines and the software for research.

[00:15:58] In turn, the institute is working on optimizing the material and testing it in our system.

[00:16:05] Once the material is stabilized, trials will be conducted.

[00:16:09] Then it will open for commercial use.

[00:16:12] Points out Manish

[00:16:14] While the collaboration with IIT Madras is to develop biomaterials for different

[00:16:18] end applications, the startup has signed a memorandum of understanding with NIPER, Hyderabad

[00:16:26] to develop solutions for pharmaceuticals by using bioprinting and drug 3D printing.

[00:16:33] Mitoplus can be used for pharmaceutical drug discovery, testing applications and cosmetology

[00:16:39] applications.

[00:16:40] The machine can bioprint human skin cells and use them for cosmetic testing reveals

[00:16:46] Manish.

[00:16:48] In fact, it has recently collaborated with ICT Mumbai whose scientists are using 3D bioprinters

[00:16:54] to develop skin, the most common type of flared tissue that could help victims of severe

[00:17:01] burns.

[00:17:03] These tissues can also be used for toxicology screens and various other testing mechanisms.

[00:17:09] Ava is also developing cancer models for drug testing companies.

[00:17:15] In this model, the tissue that is created with bioinx and biomaterial will mimic the real

[00:17:22] tissues inside human bodies.

[00:17:24] This can accelerate the process of drug development in the country, reduce dependence on animal

[00:17:29] testing and increase the accuracy of drug testing.

[00:17:34] Experts say that many drugs fail in the advanced stages only because human bodies

[00:17:39] are very different from animal bodies.

[00:17:44] The way it is used for cancer biology is by replication of a tumor in the same way it

[00:17:50] is formed inside a human body.

[00:17:52] The replicated tumor can be used for drug testing.

[00:17:56] This technology can aid the researchers in creating cells and organs that mimic the

[00:18:02] actual human cells.

[00:18:03] In other words, replicate the tumor the same way it is formed inside the human body

[00:18:10] and use that for drug testing or to better study cancer cells and tumors.

[00:18:16] This will help to replace the need for animal testing.

[00:18:20] Says Manish.

[00:18:23] Hopes for a brighter future.

[00:18:26] Ava is claimed that it can develop artificial organs and create implants for medical

[00:18:32] professionals in accordance to their demand augurs well for medical science.

[00:18:38] We know that an individual who suffers an injury to the head and spine due to an accident

[00:18:43] would need CT scan or MRI.

[00:18:47] This CT scan or MRI can be converted into a 3D printable file.

[00:18:53] When this file is sent to a printer, it will print the implant according to the

[00:18:58] patient's CT scan.

[00:19:00] Neither this nor production of patient specific tissue patches through bio printing for other

[00:19:06] organs like the liver or cornea implants is possible with any other technology.

[00:19:13] He explains.

[00:19:14] In fact, the recent transplantation of a 3D bioprinted cornea into a rabbit's eye by

[00:19:20] a team of Indian researchers is a validation of this groundbreaking technology.

[00:19:26] The artificial cornea printed from human donor corneal tissue is biocompatible and

[00:19:32] free of animal residue.

[00:19:35] What raises hopes further now is with Avaibhaya Sciences pioneering the 3D printing of

[00:19:40] artificial living tissues.

[00:19:43] The possibility is clear and present that millions in need of organ and tissue

[00:19:48] transplant can look forward to a fresh lease of life.

[00:19:53] Part 2 A Second Chance At Life

[00:19:56] Not many get a second chance at life, especially patients admitted in the intensive care

[00:20:01] unit or ICU.

[00:20:03] The situation becomes grave in hospitals facing acute shortage of intensivists or

[00:20:08] specialists in critical care.

[00:20:10] In India, there are approximately 5000 ICU super specialists tending to over 300,000

[00:20:17] ICU beds.

[00:20:19] What has exacerbated the problem is that a majority of these specialists are located

[00:20:23] in large hospitals in metro cities.

[00:20:26] Consequently, the life of patients admitted in ICUs in small and medium sized hospitals

[00:20:33] or in medical facilities in tier 2 or tier 3 cities hangs in the balance as they do

[00:20:38] not have access to ICU specialists around the clock.

[00:20:42] This is what intensivists Dr. Dhruv Joshi and Dr. Dilip Raman wanted to change.

[00:20:49] As ICU specialists, they believed that no patient should have to suffer from a

[00:20:54] lack of adequate and specialized care particularly with the advent of deep

[00:20:58] technology.

[00:20:59] So high was their motivation and belief that they could combine technology with their

[00:21:05] skills to save lives, that they gave up their lucrative jobs at the prestigious Cleveland

[00:21:10] Clinic in the United States and returned to India.

[00:21:15] We saw that the current model of healthcare delivery for ICU patients ensured that quality

[00:21:20] care was only delivered to a very limited number of patients that had access to centers

[00:21:26] that had the physical availability of highly trained specialist doctors.

[00:21:31] We realized building a solution for those facing such circumstances would impact a far

[00:21:37] greater number of patients.

[00:21:39] The opportunity to significantly move the needle for care delivery to a very large

[00:21:45] number of patients motivated us to move back to India, says Dr. Dhruv.

[00:21:51] It was a decision that was to bring many changes.

[00:21:54] Not only would it lead to the founding of cloud physician and innovative telemedicine

[00:22:00] startup but more importantly to the development of India's first tele-ICU platform.

[00:22:06] A technological transformation of intensive care units into smart ICUs was

[00:22:12] about to begin and bring with it a second chance at life for the many

[00:22:17] patients desperately awaiting critical care.

[00:22:20] Thinking Out Of The Box

[00:22:23] It was clear to them from the very beginning that the solution lay in developing a new

[00:22:28] technology because the existing technology was unable to fully solve the problem at hand.

[00:22:34] The fact that less than one in ten critically ill patients in India get the care they

[00:22:40] deserve is unacceptable.

[00:22:43] High quality critical care must reach every ICU bed in the country and given the

[00:22:48] current skill and people constraints, technology is the only effective solution

[00:22:53] possible, contents Dr. Dilip, co-founder and chief of healthcare cloud physician.

[00:23:00] They decided the only way forward was to transform ICUs into smart ICUs by using

[00:23:06] technology in a way that every patient could be closely monitored around the

[00:23:11] clock and given appropriate intensive care treatment at the exact time needed.

[00:23:17] Since the shortage of specialists meant this could not be done by their physical

[00:23:21] presence, the tool hit upon the idea to leverage technology to provide 24-7

[00:23:26] care virtually from a team of specialized doctors and nurses.

[00:23:32] Both held extensive experience of using technology platforms used for tele-ICU

[00:23:37] services across the world.

[00:23:40] They had already seen how the virtual presence gave specialists their ability

[00:23:45] to view and be a part of the care of a patient at times when it was not possible

[00:23:50] to be physically present.

[00:23:53] In 2017, Dr. Dhruv and Dr. Dilip joined hands with another friend, Dhruv Sood,

[00:24:00] a software engineer with over 10 years of experience in healthcare technology

[00:24:05] domain to start cloud physician in Bengaluru.

[00:24:08] Its focus and aim was to leverage its pioneering tele-ICU platform to

[00:24:13] provide medical help virtually from a team of ICU specialists helmed by Dr.

[00:24:19] Dhruv and Dr. Dilip as well as to anticipate, prevent and respond to any

[00:24:25] emergencies that might arise during the patient stay in the ICU.

[00:24:31] Patient Spays

[00:24:33] Interestingly it took two years from the time the duo returned to India to

[00:24:37] launch their startup. Despite being aware of the powers of telemedicine

[00:24:42] having worked in hospitals using this technology and seen its positive impact

[00:24:47] on many of their patients, they wanted to explore the ICU ecosystem in the country

[00:24:52] before deciding the exact contours of their tele-platform that would be suitable

[00:24:57] for the Indian healthcare environment.

[00:25:00] It was to take patience and time.

[00:25:04] Their quest took them to ICU's across the country.

[00:25:07] They visited states with poor health indicators like Madhya Pradesh and Bihar

[00:25:12] as well as to Karnataka and Kerala where the healthcare system is considered to be

[00:25:17] of a high standard to assess the situation.

[00:25:20] One of their main learnings at the end of their two-year journey was that while

[00:25:25] a lot of data was available that could help improve the management of the

[00:25:29] patient, technology was not being used to the extent possible to monitor

[00:25:34] and prevent critical incidents.

[00:25:38] Technology had no role to play in the vast majority of hospitals we visited.

[00:25:42] They were dependent on paper documentation while some were using

[00:25:46] systems that did not talk to each other, the awareness among providers was also low.

[00:25:52] In fact I clearly remember an instance where a doctor once told me that

[00:25:58] handwritten paper documents are less error-prone than digital records,

[00:26:02] recalls Dr. Dilip.

[00:26:05] It was experiences like these that made them realize that healthcare lagged

[00:26:09] behind significantly with regard to the adoption of technology.

[00:26:14] This had led to several inefficiencies in the current system.

[00:26:18] Both doctors were convinced that the only way to eliminate errors in care

[00:26:24] arising from such inefficiencies would be by adopting well-designed

[00:26:28] platforms that enhance the doctor and the patient experience.

[00:26:34] If the ability to improve the outcome of a patient

[00:26:37] even while not being physically present could be engineered into a solution

[00:26:42] it would be a foolproof means to ensure that ICU patients

[00:26:46] irrespective of their location or time of day or night

[00:26:49] could be assured of quality critical care.

[00:26:52] This is what we decided to design and develop.

[00:26:55] Our technology platform radar or RADAR an acronym

[00:27:00] is the outcome of our efforts to reimagine critical care delivery

[00:27:05] explains Dr. Dhruv co-founder and CEO cloud physician.

[00:27:10] Blending technology and medical expertise

[00:27:13] once any hospital expresses its readiness to transform its ICU into a smart ICU

[00:27:20] the first step is activation that lasts about two weeks.

[00:27:25] The cloud physician team is introduced to the hospital staff

[00:27:28] and creates a structured plan with their inputs

[00:27:32] on how ICU processes can be better.

[00:27:35] During this time the cloud physician team goes to the bedside of these hospitals

[00:27:40] and installs their innovative technology and networking equipment

[00:27:44] including a high definition camera connecting the hospital with cloud

[00:27:48] physicians command care center.

[00:27:51] The next step is augmentation which lasts for six weeks

[00:27:56] wherein the cloud physician team works in real time

[00:27:59] with the hospital to suggest measures to help improve health outcomes of their ICU patients.

[00:28:06] This is called augmentation because we augment the capabilities of the bedside teams

[00:28:12] and provide them with a real-time 24 seven level of expertise

[00:28:16] that they do not have.

[00:28:18] We do not replace any of the staff at the bedside required to manage these patients.

[00:28:23] They are imperative to delivery of our services in the last mile.

[00:28:27] We only improve the quality of care that their patients receive.

[00:28:31] We provide an extra layer of safety for the sickest patients in the hospital.

[00:28:36] Contents Dr. Dhruv.

[00:28:38] Digitization helps to bring transparency and automation into the process.

[00:28:44] It also helps reduce the workload of bedside caregivers

[00:28:48] make the healthcare process more alert

[00:28:51] and ensure that everything is being documented.

[00:28:54] This process lasts for around 12 to 18 weeks.

[00:28:58] Importantly training to use cloud physicians technology platform radar

[00:29:03] is also given to ensure that their ICU becomes a smart ICU

[00:29:08] and achieves the end goal of saving lives.

[00:29:11] Behind the scenes

[00:29:14] The key to this clinically designed solution is the camera.

[00:29:18] It captures images from patient monitors and uses a computer vision algorithm

[00:29:23] to analyze the image and interpret the numeric data on the cloud.

[00:29:27] Subsequently, the machine learning algorithm analyzes the numbers

[00:29:32] and compares it with previous data that is already there

[00:29:36] on the electronic medical record and enters those values into radar.

[00:29:41] Additionally, it analyzes complex ventilator waveforms

[00:29:46] and interprets these values and graphs to assist the clinician

[00:29:50] with respiratory physiology and interpretation of patient ventilator interactions

[00:29:56] using machine learning tools and support systems.

[00:29:59] In this way, it combines attributes of machine learning

[00:30:03] with computer vision to improve patient care.

[00:30:07] The system helps monitor the health of a patient

[00:30:10] by determining physiological parameters that include blood pressure,

[00:30:15] body temperature and respiratory rate.

[00:30:18] Since it works non-stop, the system's machine eye continuously monitors

[00:30:23] the patient's and triggers actionable alerts to clinical providers if required.

[00:30:29] In other words, if the condition of an ICU patient suddenly takes a turn

[00:30:34] for the worse at a time when there is no doctor or nurse around,

[00:30:38] the message will be instantly conveyed to the specialists

[00:30:42] present at the cloud physician's command center.

[00:30:45] Immediately, their intensivists will intervene

[00:30:48] without waiting for the availability of doctors on duty at the hospital.

[00:30:54] The idea behind this concept of a smart ICU is to act as a force multiplier

[00:31:00] that allows an intensivist to help multiple critically ill patients at the same time.

[00:31:07] This was done by combining technology with proper systems and processes

[00:31:11] that enhance the caregiver's ability, productivity and quality of care.

[00:31:17] Our camera systems augmented by computer vision and state-of-the-art platform

[00:31:22] ensure that patient data is continuously streamed to the command care center

[00:31:28] where an intensivist can give timely inputs to optimize outcomes for patients

[00:31:33] whose health indicators can change rapidly within the course of minutes,

[00:31:38] points out Dr. Dilip.

[00:31:40] Saving lives virtually

[00:31:43] Just how critical a role their innovative platform would play

[00:31:48] became clear soon after its launch.

[00:31:50] In fact, if it wasn't for the timely intervention by the cloud physician team in 2018,

[00:31:56] the life of a 14-year-old boy battling severe pneumonia

[00:32:00] at a small hospital in Bihar would have been difficult to save.

[00:32:05] The boy was admitted to the ICU after his blood oxygen levels plummeted

[00:32:10] and his condition deteriorated drastically.

[00:32:13] In such circumstances, he would have been transferred to a big hospital

[00:32:17] in state capital Patna about three hours away for intensive care by ICU specialists.

[00:32:23] However, given the severity of the lung disease,

[00:32:27] he would not have survived the trip as it required advanced interventions

[00:32:31] on the ventilator and changes in body positioning

[00:32:34] to keep his oxygen levels up during the journey.

[00:32:38] Even with so much going against him,

[00:32:40] there was one big factor in the young boy's favor.

[00:32:43] The hospital he was in had shown the foresight to sign up with cloud physician.

[00:32:49] Fortunately, we were able to do these maneuvers by guiding the bedside team

[00:32:54] because they were a partner for our smart ICU services.

[00:32:58] We were able to guide them to make minute changes on the ventilator

[00:33:03] and in the positioning of the body to allow his lungs to function better.

[00:33:07] Over the course of the next few days,

[00:33:09] he made a gradual recovery and was finally taken off the ventilator.

[00:33:13] He returned to school in a few weeks time.

[00:33:15] Remember Dr. Dilip, a pulmonary and critical care medicine specialist.

[00:33:21] It was this cutting-edge technology of a smart ICU in Nadiad,

[00:33:26] a small town 60 kilometers from Ahmedabad, Gujarat

[00:33:30] that led to a successful organ donation for the first time in that region.

[00:33:34] When a road accident case reached the hospital at 5 in the evening,

[00:33:39] immediate critical care was given.

[00:33:41] However, he was later declared brain dead after protocolized testing

[00:33:46] and evaluation by the bedside team.

[00:33:49] As his family expressed their desire to donate his organs,

[00:33:52] doctors had to swing into action immediately

[00:33:55] to make harvesting possible.

[00:33:57] Thanks to cloud physicians state of the art critical care support,

[00:34:01] the bedside team was able to keep a minute-to-minute watch

[00:34:05] on the accident victim and maintain the liver and kidneys under optimal condition.

[00:34:10] This was done by relaying vital patient data to the cloud physician team,

[00:34:14] which in turn prescribed suitable treatment protocols

[00:34:18] and guided local doctors to ensure the vital organs remained in good condition.

[00:34:24] The next morning, specialist teams from Ahmedabad reached Nadiad

[00:34:29] and took the kidneys and liver.

[00:34:31] Dr. Dilip recalls that because these organs were in optimal health,

[00:34:36] they could be transplanted successfully in the bodies of waiting patients

[00:34:40] within the next 24 hours.

[00:34:43] The COVID Life Saver

[00:34:45] The real test for tele-ICU services came when COVID-19 struck.

[00:34:50] The pandemic demonstrated two critical facts.

[00:34:54] First, it acted as a stress test on the critical care infrastructure of the country.

[00:35:00] It clearly showed that the Indian healthcare ecosystem

[00:35:03] did not have the required number of ICU beds,

[00:35:06] nor did it have adequate expertise to manage critically ill patients at scale.

[00:35:11] Meanwhile, at the time of the pandemic,

[00:35:14] there were less than 5000 ICU specialist doctors in the country

[00:35:18] that had to manage more than 300,000 ICU beds across a diverse healthcare system.

[00:35:24] Ideally, the doctor-patient ratio in an ICU is about 1 to 10.

[00:35:30] The doctor-nurse ratio is 1 to 1 for those who are very sick

[00:35:34] and 1 to 3 for other patients.

[00:35:38] Secondly, the treatment of over 5000 COVID-19 patients

[00:35:43] with the help of the tele-ICU system showed

[00:35:46] that if applied correctly with the proper operational frameworks,

[00:35:50] technology could be a powerful and scalable tool to solve complex healthcare problems.

[00:35:56] We were able to rapidly deploy our services in over 450 government ICU beds across the country,

[00:36:04] ensuring that life-saving critical care reached these beds

[00:36:08] in the shortest amount of time possible,

[00:36:11] As opposed to the ratio of 1 to 15 intensivist at hospitals' bedsites,

[00:36:16] cloud physician makes possible one intensivist per 60-80 sick patients

[00:36:22] through its tele-ICU platform, says Dr. Dilip.

[00:36:26] Many hospitals started stocking ventilators during the pandemic,

[00:36:30] but unfortunately not all medical practitioners knew how to operate it,

[00:36:35] but the tele-ICU's teleconferencing facility

[00:36:39] helped overcome this operational hurdle by providing virtual training.

[00:36:44] One of their main challenges was to train enough doctors and nurses to work in an ICU

[00:36:49] at the time when the number of COVID cases was rising.

[00:36:53] The need of the R then as well as now is to leverage technology.

[00:36:57] The center has accelerated the process and got doctors and nurses to enroll

[00:37:02] for a three-year specialized course so that more medical professionals are trained over time

[00:37:07] to use technology in healthcare.

[00:37:10] The telemedicine society of India has begun conducting training and webinars for doctors

[00:37:15] in tier two cities to use technology.

[00:37:18] We too have commenced training through webinars to assist as many doctors and nurses as possible,

[00:37:25] says Dr. Dilip.

[00:37:27] Crossing the first hurdle

[00:37:29] Cloud Physician today supports both government and private hospitals.

[00:37:33] It has tied up with 70 hospitals in 18 states across the country

[00:37:38] and its tele-ICU services have reached far-flung and remote areas in Ladakh and the Brahmaputra Valley.

[00:37:46] Initially, there were very few takers.

[00:37:48] However, neither Dr. Dhruv nor Dr. Dilip lost heart.

[00:37:53] They realized that since it was a concept that was hard to understand,

[00:37:57] it was initially challenging for doctors and nurses to grasp that there was a solution to their problems.

[00:38:03] They decided that the only way to cross this first hurdle was to demonstrate its efficacy

[00:38:09] and let the results speak.

[00:38:12] The proof is in the pudding.

[00:38:14] We initially piloted our services at Mysore where we supported a seven-bed ICU

[00:38:20] with round-the-clock critical care services.

[00:38:23] When we supported the bedside doctors and nurses to take better care of their patients,

[00:38:29] the results were obvious with improved outcomes.

[00:38:32] Once the key uses were demonstrable, convincing them was easy as most doctors we talked to

[00:38:38] only wanted the best for their patients.

[00:38:41] We continued to add value-added services like training and education

[00:38:46] that further empowered bedside teams to help the patients as much as possible,

[00:38:50] states Dr. Dilip.

[00:38:52] Since then, there has been no looking back.

[00:38:55] Ensuring affordable critical care

[00:38:59] In the last five years, cloud physician has touched the lives of 45,000 ICU patients

[00:39:06] and helped hospitals decrease mortality rate by 40%.

[00:39:10] TELI ICU helps patients in remote areas and small towns

[00:39:14] and saves them the trouble and expense of traveling to metros

[00:39:18] and spending 80,000 rupees a day for intensive care.

[00:39:22] This way, they get the same treatment from the same doctors for one-fourth the cost.

[00:39:28] Our charges are designed in a way that patients can get the same quality of care

[00:39:33] in the comfort of their community that they would get in a Metro City hospital.

[00:39:38] This is a significant cost saving for the patients,

[00:39:41] both from a healthcare angle and from the social angle of having to move to a new city

[00:39:47] and stay there.

[00:39:48] The patients must get the care they need where it is most appropriate for them.

[00:39:53] This can be an ICU in their community or even their home.

[00:39:58] Explains Dr. Dilip.

[00:40:00] In keeping with this philosophy, cloud physician has partnered Nightingales,

[00:40:05] a reputed home healthcare provider to deliver intensive care services

[00:40:10] for critically ill patients in the comfort of their home.

[00:40:14] Here, clinical and home site assessment will be followed by a detailed care plan

[00:40:20] drawn up by senior intensive care specialists and the patients treating doctor.

[00:40:26] Based on the patient's medical requirements,

[00:40:29] a complete intensive care setup along with medical equipment is installed.

[00:40:35] Like in the hospital setup, the patient will be regularly monitored

[00:40:38] by a multidisciplinary team of doctors, nurses and caregivers.

[00:40:43] The service currently in place in Bengaluru and Mumbai

[00:40:47] also ensures round the clock monitoring by cloud physicians,

[00:40:51] intensive care specialists and an experienced bedside nurse.

[00:40:56] Winds of change.

[00:40:58] The Indian eHealth market is expected to be worth $10.6 billion in 2025,

[00:41:05] growing at a CAGR of 39.6% with telemedicine being the biggest contributor to the market size.

[00:41:15] Investors like Elevah Equity have understood the potential of innovations like cloud physician

[00:41:21] and boosted its operations with $4 million in pre-series A funding.

[00:41:27] Cloud Physician 2 has lived up to the faith shown in their abilities,

[00:41:32] their recent success in bringing down neonatal mortality in a remote area of Uttar Pradesh

[00:41:39] has validated their impact.

[00:41:42] We partnered with a hospital where there was at least one sick baby dying every day

[00:41:47] in the neonatal ICU.

[00:41:49] We ensured that the hospital could help these babies

[00:41:53] after transforming it to a smart NICU in a matter of three months.

[00:41:58] This was the first time the hospital team used advanced respiratory management techniques

[00:42:03] made possible under the expert guidance of the cloud physician NICU team.

[00:42:09] We will keep striving to improve it further.

[00:42:12] It was really gratifying to see the change we had brought about in a relatively short period of time.

[00:42:18] Not only are we helping to save lives,

[00:42:20] but in the case of these newborn babies, we are actually saving lifetimes,

[00:42:26] says a happy Dr Dhruv.

[00:42:28] Part 3. Mapping Safety

[00:42:31] The wish to save lives has also been the driving force behind road metrics,

[00:42:36] the technological innovation developed to promote road safety.

[00:42:41] In India, over 1.5 lakh people died from road accidents in 2021

[00:42:48] as per the Ministry of Road Transport and Highways.

[00:42:51] India topped the list of the top 20 countries for road accidents

[00:42:56] according to the 2019 World Bank report.

[00:42:59] Experts say that road accidents are the leading cause of hospitalization,

[00:43:04] disabilities and deaths.

[00:43:06] One of the main causes of these road accidents is the poor condition of roads.

[00:43:12] Deepen Babaraya and Nishal Jarivala realized they could have become accident victims as well

[00:43:18] when they set out to a friend's house in Surat.

[00:43:21] When they took the route suggested by Google Maps,

[00:43:24] they found the road was full of potholes without any street lights,

[00:43:28] making it difficult and unsafe to travel.

[00:43:31] Although Google Maps had indicated the shortest and fastest route,

[00:43:36] not the safest one.

[00:43:37] It took the two college friends twice the time to reach their destination.

[00:43:42] It was their good fortune that they did not meet with any road accident.

[00:43:47] It got the duo thinking about creating a solution that provided road and street level data.

[00:43:52] They worked on developing software using artificial intelligence

[00:43:56] to map road conditions for two years in college.

[00:44:00] When they submitted their solution and won the best project award in the final year of college,

[00:44:06] Deepen and Nishal realized their work had potential.

[00:44:10] Their confidence received a fillip when the Surat Municipal Corporation asked them

[00:44:14] to conduct a pilot road assessment for the city so that it could assist them

[00:44:20] in road maintenance and town planning.

[00:44:24] What started as a project in college became the genesis of road metrics,

[00:44:29] a deep tech startup to provide AI based data for road management plans.

[00:44:35] It has so far collected data on more than 50,000 kilometers of road across the country

[00:44:42] in cities like Delhi, Bengaluru, Mumbai, Jamshedpur and Patna.

[00:44:47] Making Indian roads safer and pothole free.

[00:44:51] At present government bodies in India have no technology

[00:44:55] that can efficiently monitor its road infrastructure.

[00:44:59] This was an additional factor that motivated the two friends to put their thinking caps on.

[00:45:04] At that time they were still pursuing an engineering degree with a specialization in AI.

[00:45:11] The first plan was to develop an application for mobile phones

[00:45:15] that would inform the user about the condition of the road.

[00:45:19] So the two moved to Bengaluru to try their hand at entrepreneurship

[00:45:23] as the city is home to hundreds of startups.

[00:45:25] This is where they met Nikhil Prasad Maroli, an industrial and operations engineer from Texas A&M

[00:45:32] University who had returned from the US after working with automotive car companies

[00:45:37] like Velodyne, Lidar and Tesla.

[00:45:40] When he showed the same enthusiasm about developing their idea for road safety

[00:45:46] the three decided to found road metrics.

[00:45:49] Fine tuning safety.

[00:45:51] Within the first two months of incorporation in 2019,

[00:45:55] the startup received great interest from investors

[00:45:59] and got its first funding from 100x.vc headed by Sanjay Mehta.

[00:46:06] I was very excited and a little nervous.

[00:46:09] While I had worked on projects in college,

[00:46:11] this was going to be my first entrepreneurial exposure.

[00:46:15] Road safety is an essential area which does not have any software

[00:46:20] that provides information about the health of roads.

[00:46:23] This is true for India and even countries outside India.

[00:46:28] Says Deepin.

[00:46:29] The trio started to develop their initial idea of making mobile based software.

[00:46:35] While the sensor based technology that would work as a mobile application sounded good,

[00:46:40] it was not feasible as we would have to drive on every part of the road to capture the vibrations.

[00:46:46] The vibrations would then be assessed to find the potholes.

[00:46:50] He says.

[00:46:52] So on further research, Deepin and his co-founders found an even smarter solution.

[00:46:58] We developed an image based or computer vision based software.

[00:47:02] It uses the camera of the mobile mounted on the windshield of the car.

[00:47:08] Once the mobile is mounted, we start our data collection application.

[00:47:13] It records video data along with GPS data, coordinates and timestamps.

[00:47:19] This was uploaded to our servers where there are millions of such data stored.

[00:47:23] Our trained AI software then identifies the road defect.

[00:47:28] He says.

[00:47:30] The pain adds.

[00:47:32] Our AI algorithm can identify 10 types of road defects ranging from minor cracks

[00:47:38] and surface deterioration to major problems such as potholes.

[00:47:44] Fixing Problems

[00:47:46] Other than the AI algorithm, the startup also has developed road metrics maps,

[00:47:51] which helps consumers find the fastest and most comfortable roads.

[00:47:56] Identifying that the solution to the problem was not just navigating a pothole free route,

[00:48:01] but also fixing them. The company switched from a B2C to a B2B model.

[00:48:08] The data collected from the maps is also fed into our servers.

[00:48:12] The maps are currently functional only in Bengaluru, he informs.

[00:48:16] But since this was very labor and capital intensive, we decided to take another route.

[00:48:23] The software is a B2B model where we help municipalities and private players

[00:48:28] to identify the problems in the road and fix them.

[00:48:33] The company has already mapped the entire city of Bengaluru

[00:48:37] and Mumbai while they are working in Assam and Bihar.

[00:48:41] On the basis of damage reports assessed by our software,

[00:48:45] the municipalities and private companies can decide how much allocation of funds is needed.

[00:48:51] We are working with the Tata Group in Jamshedpur,

[00:48:54] where we are helping them identify the issues on the road.

[00:48:58] He says, Taking a 360 degree approach,

[00:49:01] a manual survey takes nearly four to five months and another couple of months to finish the planning.

[00:49:08] By the time the survey is completed, the entire condition of the road changes.

[00:49:12] The plans made might not be suitable for the new damages.

[00:49:16] Our technology is capable of surveying 1000 km within a week's time.

[00:49:22] Therefore, it has less time consuming and also more detailed.

[00:49:27] In Jamshedpur, there was a road called MP Road that would always be in a bad condition

[00:49:32] even after maintenance.

[00:49:34] Turns out, there was a small stream nearby

[00:49:36] and the water was sweeping below damaging the road.

[00:49:40] He continues, We identified this problem

[00:49:43] and then the contractor was able to plan the roads repair accordingly.

[00:49:48] Similarly in Bengaluru, the company has collaborated with the Electronic City Township Authority

[00:49:54] or ELCITA to fix potholes.

[00:49:59] Deepen says the startup is currently working with private players

[00:50:02] like the Tata Group, Mahindra Group etc.

[00:50:05] They are also at discussion to collaborate with government municipalities.

[00:50:10] After covering thousands of kilometers in India,

[00:50:13] the company has no plans of stopping.

[00:50:16] We have already started to map the city of London as we have a client there.

[00:50:21] Says Deepen.

[00:50:23] The startup has also been showered with a lot of awards since its incorporation

[00:50:28] including the Mobility AI Grand Challenge by the Telangana Government

[00:50:32] and the award for Best AI Startup for Smart Cities

[00:50:36] by the Ministry of Electronics and IT.

[00:50:39] Unnecessary innovation

[00:50:42] According to the World Bank, road accidents cost the Indian economy 3-5% of its GDP each year.

[00:50:49] Considering every death caused by a road accident leads to the depletion of nearly

[00:50:55] 7 months household income in poor families and pushes the family of victims into a cycle

[00:51:01] of poverty and debt, there can be no compromises on road safety.

[00:51:05] Saving lives by improving road management and infrastructure is a priority.

[00:51:11] Through its innovation, road metrics have shown that if there is a will, there is a way.

[00:51:16] Government as Enabler

[00:51:19] Government support for deep tech startups, especially in the very early stages, is a key enabler.

[00:51:25] The Biotechnology Industry Research Assistance Council

[00:51:29] and the Department of Science and Technology have provided support through various programs.

[00:51:35] The Ministry of Micro, Small and Medium Enterprises has also launched several government schemes

[00:51:42] designed to empower startups. Some of the programs include Tide 2.0 Scheme

[00:51:48] Technology Incubation and Development of Entrepreneurs Scheme was initiated in the

[00:51:54] year 2019 to promote tech entrepreneurship through financial and technical support

[00:52:01] to incubators engaged in supporting ICT startups using emerging technologies such as IoT, AI,

[00:52:10] Blockchain, Robotics etc. The scheme is being implemented through 51 incubators

[00:52:17] through a three-tiered structure with an overarching objective to promote incubation

[00:52:23] activities at institutes of higher learning and premier R&D organizations.

[00:52:29] The scheme is expected to provide incubation support to approximately 2,000 tech startups

[00:52:35] with an overall outlay of 264 crore rupees over a period of five years.

[00:52:43] Domain-specific Centers of Excellence

[00:52:46] Over 26 centers of excellence or COEs in diverse areas of national interest have been instituted

[00:52:55] to encourage self-sufficiency and create capabilities to capture new and emerging technology areas.

[00:53:03] These domain-specific COEs act as enablers and aid in making India an innovation hub

[00:53:10] in emerging through innovation and development of prototypes.

[00:53:16] Atal Innovation Mission

[00:53:19] AIM promotes innovation and entrepreneurship by serving as a platform for innovation hubs

[00:53:25] grant challenges, startup businesses and other self-employment activities particularly in technology

[00:53:32] driven areas. To inculcate innovation and creativity among children at the school level

[00:53:39] the government has also launched Atal Tinkering Labs or ATL across India. At these labs

[00:53:46] the students can take part in various activities and work with tools and equipment

[00:53:51] to acquire hands-on knowledge on the concepts of STEM that is science, technology, engineering and

[00:53:58] maths. Another program set up by AIM is Atal Incubation Centers with an aim to build innovative

[00:54:06] startup businesses as scalable and sustainable enterprises. They provide various facilities

[00:54:12] with the right amount of physical infrastructure on the basis of capital equipment and operating

[00:54:18] facilities. Startup India

[00:54:22] Launched in 2016 the scheme has successfully provided a great start to a number of potential

[00:54:28] startups in the country. The initiative has provisions for various methods to learn and

[00:54:33] know more about startup growth including research parks, incubators and startup centers

[00:54:40] among others. Apart from this the scheme has also created a fund of funds which helps

[00:54:46] startups in gaining access to funding. The primary motive of this is to build an environment

[00:54:53] in which startups can innovate and evolve without any obstacles.

[00:54:58] Startup India Seed Fund Scheme

[00:55:01] Easy availability of capital is essential for entrepreneurs at the early stages of the

[00:55:07] growth of an enterprise. Funding from angel investors and venture capital firms

[00:55:13] becomes available to startups only after the proof of concept has been provided.

[00:55:18] Similarly banks provide loans only to asset backed applicants. It is essential to provide

[00:55:25] seed funding to startups with innovative ideas to conduct proof of concept trials.

[00:55:32] The Department for Promotion of Industry and Internal Trade, DPIIT, has launched the

[00:55:38] Startup India Seed Fund Scheme SISFS. With an outlay of 945 crore rupees the SISFS aims to provide

[00:55:49] financial assistance to startups. It will support an estimated 3600 entrepreneurs through 300

[00:55:56] incubators in the next four years. Aspire

[00:56:01] To improve the social and economic aspects of life in rural areas of India a scheme for

[00:56:07] promotion of innovation rural industries and entrepreneurship, Aspire or ASPIRE,

[00:56:15] was launched to set up a network of technology centers and incubation centers

[00:56:21] to accelerate entrepreneurship and also to promote startups for innovation in the agro industry.

[00:56:28] Support for international patent protection in ENIT that is SIP EIT scheme

[00:56:36] The government has initiated a scheme titled support for international patent protection in ENIT

[00:56:43] or SIP EIT that encourages international patent filing by Indian MSMEs and startups

[00:56:51] to encourage innovation and recognize the value and capabilities of global IP. Reimbursement

[00:56:59] provided under the scheme is up to a maximum of 15 lakh rupees per invention or 50% of the total

[00:57:08] expenses incurred in filing and processing of patent application.

[00:57:13] Genesis Gennext Support for Innovative Startups

[00:57:18] The Ministry of Electronics and Information Technology, MEITY or METE, has launched an

[00:57:25] umbrella program Digital India Genesis to discover, support, grow and make successful startups in

[00:57:33] tier 2 and tier 3 cities with emphasis on collaborative engagement among startups,

[00:57:40] government and corporates for promoting digitization based on the principles of inclusivity,

[00:57:46] accessibility, affordability, leading to growth in employment and economic outputs.

[00:57:52] India can reap the benefits of the startup revolution by becoming more self-reliant and

[00:57:58] emerging as a global powerhouse and exporter of deep tech innovation. Deep tech startups concentrate

[00:58:05] on solving significant and fundamental problems as is evident from the fact that 97% of these

[00:58:12] ventures contribute to at least one of the UN's sustainable development goals.

[00:58:19] Efforts of the government and initiatives such as the Deep Tech Club Program by NASCOM

[00:58:25] and other major enterprises and industry bodies are crucial to tap the full potential of these

[00:58:31] deep tech startups. Igniting Ideas for Impact is an audiobook published by the Better India

[00:58:39] in association with Accenture India. Find out more about Accenture India's initiatives at

[00:58:46] www.accenture.com slash in-en.

[00:58:53] Author Swapna Majumdar, edited by Divya Setu and Tanya Singh