Healthcare by 2028 will be doctor-directed, patient-owned and powered by visual technologies

Visual assessment is critical to healthcare – whether that is a doctor peering down your throat as you say “ahhh” or an MRI of your brain. Since the X-ray was invented in 1895, medical imaging has evolved into many modalities that empower clinicians to see into and assess the human body.  Recent advances in visual sensors, computer vision and compute power are currently powering a new wave of innovation in legacy visual technologies(like the X-Ray and MRI) and sparking entirely new realms of medical practice, such as genomics.

Over the next 10 years, healthcare workflows will become mostly digitized, with wide swaths of personal data captured and computer vision, along with artificial intelligence, automating the analysis of that data for precision care. Much of the digitized data across healthcare will be visual and the technologies that capture and analyze it are visual technologies.

These visual technologies traverse a patient’s journey from diagnosis, to treatment, to continuing care and prevention.They capture, analyze, process, filter and manage any visual data from images, videos, thermal, x-ray’s, ultrasound, MRI, CT scans, 3D, and more. Computer vision and artificial intelligence are core to the journey.

Three powerful trends — including miniaturization of diagnostic imaging devices, next generation imaging to for the earliest stages of disease detection and virtual medicine — are shaping the ways in which visual technologies are poised to improve healthcare over the next decade.

Miniaturization of Hardware Along with Computer Vision and AI will allow Diagnostic Imaging to be Mobile

Medical imaging is dominated by large incumbents that are slow to innovate. Most imaging devices (e.g. MRI machines) have not changed substantially since the 1980s and still have major limitations:

  • Complex workflows: large, expensive machines that require expert operators and have limited compatibility in hospitals.

  • Strict patient requirements: such as lying still or holding their breath (a problem for cases such as pediatrics or elderly patients).

  • Expensive solutions: limited to large hospitals and imaging facilities.

But thanks to innovations in visual sensors and AI algorithms, “modern medical imaging is in the midst of a paradigm shift, from large carefully-calibrated machines to flexible, self-correcting, multi-sensor devices” says Daniel K. Sodickson, MD, PhD, NYU School of Medicine, Department of Radiology.

MRI glove-shaped detector proved capable of capturing images of moving fingers.  ©NYU Langone Health

Visual data capture will be done with smaller, easier to use devices, allowing imaging to move out of the radiology department and into the operating room, the pharmacy and your living room.

Smaller sensors and computer vision-enabled image capture will lead to imaging devices that are being redesigned a fraction of the size with:

  • Simpler imaging process: with quicker workflows and lower costs.

  • Lower expertise requirements: less complexity will move imaging from the radiology department to anywhere the patient is.

  • Live imaging via ingestible cameras: innovation includes powering ingestibles via stomach acid, using bacteria for chemical detection and will be feasible in a wider range of cases.

“The use of synthetic neural network-based implementations of human perceptual learning enables an entire class of low-cost imaging hardware and can accelerate and improve existing technologies,” says Matthew Rosen, PhD, MGH/Martinos Center at Harvard Medical School.

©Matthew Rosen and his colleagues at the Martinos Center for Biomedical Imaging in Boston want liberate the MRI.

Next Generation Sequencing, Phenotyping and Molecular Imaging Will Diagnose Disease Before Symptoms are Presented

Genomics, the sequencing of DNA, has grown at a 200% CAGR since 2015, propelled by Next Generation Sequencing (NGS) which uses optical signals to read DNA, like our LDV portfolio company Geniachip which was acquired by Roche. These techniques are helping genomics become a mainstream tool for practitioners, and will hopefully make carrier screening part of routine patient care by 2028.

Identifying the genetic makeup of a disease via liquid biopsies, where blood, urine or saliva is tested for tumor DNA or RNA, are poised to take a prime role in early cancer screening. The company GRAIL, for instance, raised $1B for a cancer blood test that uses NGS and deep learning to detect circulating tumor DNA before a lesion is identified.

Phenomics, the analysis of observable traits (phenotypes) that result from interactions between genes and their environment, will also contribute to earlier disease detection. Phenotypes are expressed physiologically and most will require imaging to be detected and analyzed.

Next Generation Phenotyping (NGP) uses computer vision and deep learning to analyze physiological data, understand particular phenotype patterns, then it correlates those patterns to genes. For example, FDNA’s Face2Gene technology can identify 300-400 disorders with 90%+ accuracy using images of a patient’s face. Additional data (images or videos of hands, feet, ears, eyes) can allow NGP to detect a wide range of disorders, earlier than ever before.

Molecular imaging uses DNA nanotech probes to quantitatively visualize chemicals inside of cells, thus measuring the chemical signature of diseases. This approach may enable early detection of neurodegenerative diseases such as Alzheimer’s, Parkinson’s and dementia.

Telemedicine to Overtake Brick-and-Mortar Doctors Visits

By 2028 it will be more common to visit the doctor via video over your phone or computer than it will be to go to an office.

Telemedicine will make medical practitioners more accessible and easier to communicate with. It will create an all digitized health record of visits for a patient’s profile and it will reduce the costs of logistics and regional gaps in specific medical expertise. An example being the telemedicine services rendered for 1.9M injured in the war in Syria.4

The integration of telemedicine into ambulances has led to stroke patients being treated twice as fast.  Doctors will increasingly call in their colleagues and specialists in real time.

Screening technologies will be integrated into telemedicine so it won’t just be about video calling a doctor. Pre-screening your vitals via remote cameras will deliver extensive efficiencies and hopefully health benefits.

“The biggest opportunity in visual technology in telemedicine is in solving specific use cases. Whether it be detecting your pulse, blood pressure or eye problems, visual technology will be key to collecting data,” says Jeff Nadler, Teldoc health.

Remote patient monitoring (RPM) will be a major factor in the growth of telemedicine and the overall personalization of care. RPM devices, like we are seeing with the Apple Watch, will be a primary source of real-time patient data used to make medical decisions that take into account everyday health and lifestyle factors. This personal data will be collected and owned by patients themselves and provided to doctors.

Visual Tech Will Power the Transformation of Healthcare Over the Next Decade

Visual technologies have deep implications for the future of personalized healthcare and will hopefully improve the health of people worldwide. It represents unique investment opportunities and we at LDV Capital have reviewed over 100 research papers from BCC Research, CBInsights, Frost & Sullivan, McKinsey, Wired, IEEE Spectrum and many more to compile our 2018 LDV Capital Insights report. This report highlights the sectors that power to improve healthcare based on the transformative nature of the technology in the sector, projected growth and business opportunity.

There are tremendous investment opportunities in visual technologies across diagnosis, treatment and continuing care & prevention that will help make people healthier across the globe.

The Pill Club raises $51M as VCs find new opportunities in women’s health

Through telemedicine and direct-to-consumer sales platforms, startups are streamlining the historically arduous process of accessing contraception.

The latest effort to secure a significant financing round is The Pill Club, an online birth control prescription and delivery service. Consumer-focused investor VMG Partners has led its $51 million Series B, with participation from new investors GV and ACME Capital (formerly known as Sherpa Capital), and existing investors Base10 Partners and Shasta Ventures. The Pill Club declined to disclose its valuation.

Launched in 2016 in San Carlos, California, The Pill Club couples healthcare services with at-home delivery, reaching customers in all 50 states. With a team of doctors, nurses and patient care coordinators, the startup operates its own pharmacy and is licensed to prescribe medication in 35 states. With the new funding, which brings its total raised to $67 million, founder and chief executive officer Nick Chang said he plans to scale the business 50 percent and expand its prescription service across the entire U.S.

“At the end of the day, our company is about empowering women,” Chang told TechCrunch. “What does that mean? It means empowering our patients to make their own healthcare decisions and making reproductive healthcare more common — something to not be shy about or worried about.”

Chang, who has spent his career in medicine and holds an M.D. from Duke University, previously founded Ganogen. The business, which sought to facilitate patient’s access to organ donors, ultimately shut down but was a catalyst to The Pill Club’s formation, as were experiences from Chang’s youth.

“I [grew] up with an older sister who was on birth control since she was 14 for menstrual regulation,” Chang said. “She really felt embarrassed to pick up the medication and to talk to anyone about it and that was really insightful for me. There are so many hurdles in accessing birth control besides clinics being around.”

Some 67 million women between the ages of 13 to 44 live in the U.S.; 19 million of them live in contraceptive deserts, or areas that lack reasonable access to public clinics. The Pill Club wants to eliminate those deserts, as do other companies in the digital health arena.

Digital health has remained one of the hottest destinations for VC investment. In 2018, investors put about $4.5 billion into U.S. companies in the sector, a 17 percent increase year-over-year, according to PitchBook data. Telemedicine startups garnered a record $1.25 billion in funding in that timeframe thanks to large financings for industry leader Oscar, a health insurance startup that raised $540 million in 2018 alone; as well as an $88 million Series A for newcomer Roman, which offers a cloud pharmacy for erectile dysfunction.

Startups focused on women’s health, meanwhile, have continued to garner more attention from VCs. These companies, including The Pill Club and comepetitor Nurx, have not only benefited from the rapid rise of telehealth, but also from a societal shift sparked in part by President Donald Trump and Republican lawmakers’ attempts to limit women’s access to birth control.

“People want to talk about this,” Chang said. “With so much happening from Hollywood to politics … it’s really got some people to say ‘ok, we really need to talk about what we are prioritizing as a society.'”

In addition to accelerating the expansion of its 260-person team, The Pill Club plans to use the investment to explore launching more services within women’s healthcare and to broaden the educational content it offers its customers.

“This is just the beginning of a much broader and bigger movement,” Chang said.

Fuzzy Pet Health launches a $10-per-month telemedicine vet care plan

A new subscription service will now let you chat with a vet from your smartphone for $10 per month. This telemedicine vet care plan is the latest from Fuzzy Pet Health, a subscription vet care service providing in-home vet visits to subscribers in the greater San Francisco Bay Area. But while in-home pet care may take time to properly scale, on-demand vet Q&A is something that can be offered nationwide.

Fuzzy Pet Health Connect, as the new telemedicine service is called, works over the Fuzzy Pet Health mobile app, allowing customers to send text, pictures and videos to a vet at any time, then receive real-time medical help.

The vets can help with behavioral advice, training tools, new pet questions, or other concerns that may have normally required a vet visit to diagnose – like a cat that just vomited, or a dog with runny stool.

As Fuzzy Pet Health co-founder Eric Palm explains, the new service can serve as the initial triage that may actually save pet owners a visit to the vet, at times.

“It turns out that 80 percent of the time when people think there’s an emergency issue, it’s not actually critical,” he says. “We can triage – we can share pictures and videos, and that’s really helpful.”

If the issue requires an in-person visit, the vet will recommend it.

Unfortunately, laws in most states won’t allow for diagnosis and medications to be subscribed over telehealth services when it comes to pets – a bit unusual, given that people now have access to a variety of video chat doctors-on-demand offerings. But Palm says laws are starting to change.

“Each state has its own Veterinary Medical Board, and there are active discussions on most of these boards on how to relax the rules around telemedicine,” Palm notes. “Our lead veterinarian and co-founder [Dr.] Robert Trimble is part of the conversation with the state boards, and how to best shape the laws to enable better care for pets.”

Today, there are only three places in the U.S. that permit this – Washington D.C., Alaska, and Connecticut. The U.S.’s neighbor to the north, Canada, also allows vets to diagnose and prescribe digitally.

In the meantime, vet chat is the best most U.S. pet owners can hope for. But at $10 per month, it’s not too expensive to gain access to that additional level of vet care.

“The average pet parent goes to the vet only 1.6 times a year, while our members get in touch with us roughly once a month. We’re excited to expand telemedicine across the country, and provide pet parents the peace of mind and education that come with easy and unlimited access to high quality care,” said Dr. Trimble, in a statement.

Fuzzy Pet Health is one of several startups capitalizing on advances in technology to offer more affordable care to pet owners. A Swedish startup, FirstVet, also announced its funding today to expand its own local operations. There’s also Seattle-based Petriage, UK’s Pawsquad, as well as providers of telehealth tools to existing vet clinics, like TeleVet, to name a few.

But many vet-on-demand services have already failed.

“We’ve learned a lot from those that have come before us in this space. On-demand vet care is super hard – just like any sort of on-demand business,” says Palm. “The amount of staffing you need to do that is sort of prohibitive from a unit economics or margin standpoint,” he continues. “So our on-demand product is telemedicine. That allows us to be much more efficient with scheduling and staffing.”

Longer term, however, Fuzzy Pet Health plans to scale its housecall subscription service, albeit fairly slowly. (Its head of operations, Alex Aguilera, comes from Lyft and Wash.io, and understands market expansions like this.)

“We know if we go to six markets tomorrow, we’ll fail…we have to build demand and awareness ahead of launch, and we have to have on board a veterinarian team to service that market,” adds Palm.

That said, the company is already talking to vets in larger cities like L.A., New York and Chicago to see where it might go next.

To date, Fuzzy Pet Health has raised $4.5 million in funding from Eniac Ventures, Precursor Ventures, Crosscut Ventures, SV Angel Accelerator Ventures, and FJ Labs.

 

 

Kry bags $66M to launch its video-call-a-doctor service in more European markets

Swedish telehealth startup Kry has closed a $66 million Series B funding round led by Index Ventures, with participation from existing investors Accel, Creandum, and Project A.

It raised a $22.8M Series A round just over a year ago, bringing its total raised since being founded back in 2014 to around $92M.

The new funding will be put towards market expansion, with the UK and French markets its initial targets. It also says it wants to deepen its penetration in existing markets: Sweden, Norway and Spain, and to expand its medical offering to be able to offer more services via the remote consultations.

A spokesperson for Kry also tells us it’s exploring different business models.

While the initial Kry offering requires patients to pay per video consultation this may not offer the best approach to scale the business in a market like the UK where healthcare is free at the point of use, as a result of the taxpayer funded National Health Service.

“Our goal is to offer our service to as many patients as possible. We are currently exploring different models to deliver our care and are in close discussions with different stakeholders, both public and private,” a spokesperson told us.

“Just as the business models will vary across Europe so will the price,” he added.

While consultations are conducted remotely, via the app’s video platform — with Kry’s pitch being tech-enabled convenience and increased accessibility to qualified healthcare professionals, i.e. thanks to the app-based delivery of the service — it specifies that doctors are always recruited locally in each market where it operates.

In terms of metrics, it says it’s had around 430,000 user registrations to date, and that some 400,000 “patients meetings” have been conducted so far (to be clear that’s not unique users, as it says some have been repeat consultations; and some of the 430k registrations are people who have not yet used the service).

Across its first three European markets it also says the service grew by 740% last year, and it claims it now accounts for more than 3% of all primary care doctor visits in Sweden — where it has more than 300 clinicians working in the service.

In March this year it also launched an online psychology service and says it’s now the largest provider of CBT-treatments in Sweden.

Commenting on the funding in a statement, Martin Mignot, partner at Index Ventures, said: “Kry offers a unique opportunity to deliver a much improved healthcare to patients across Europe and reduce the overall costs associated with primary care. Kry has already become a household name in Sweden where regulators have seen first-hand how it benefits patients and allowed Kry to become an integral part of the public healthcare system. We are excited to be working with Johannes and his team to bring Kry to the rest of Europe.”

As well as the app being the conduit for a video consultation between doctor and patient, patients must also describe in writing and input their symptoms into the app, uploading relevant pictures and responding to symptom-specific questions.

During the video call with a Kry doctor, patients may also receive prescriptions for medication, advice, referral to a specialist, or lab or home tests with a follow-up appointment — with prescribed medication and home tests able to be delivered to the patient’s home within two hours, according to the startup.

“We have users from all age groups. Our oldest patient just turned 100 years old. One big user group is families with young children but we see that usage is becoming more even over different age groups,” adds the spokesman.

There are now a number of other startups seeking to scale businesses in the video-call-a-doctor telehealth space — such as Push Doctor, in the UK, and Doctor On Demand in the US, to name two.