Diversifying within tele-medicine

Teleradiology Solutions, a provider of outsourced interpretation of diagnostic reports for global hospitals, has now diversified into e-learning, technology platforms and even a social entrepreneurship venture

DR. ARJUN KALYANPUR AND DR. SUNITA MAHESHWARI, FOUNDERS, TELERADIOLOGY SOLUTIONS PVT. LTD.

During the 2004 U.S. elections, when media and the public viewed outsourcing as a key detriment to their economy, the founders of India-based Teleradiology Solutions Pvt. Ltd. (TRS), whose primary business model relied on interpreting diagnostic reports outsourced by the U.S.-based hospitals, decided to tackle the negative publicity head-on. They opened up to the media about their insecurities, while holding on to the conviction that the teleradiology model will stand to benefit in the long run.  The company now offers its services to 130 hospitals across 25 countries and records a 15 per cent year-on-year growth in revenues.

Since our last interaction with the founders, Dr. Arjun Kalyanpur and Dr. Sunita Maheshwari, in November 2011, TRS has established a strong footing in the U.S. and Singapore, and has expanded into 20 other countries. It has particularly ventured into a few countries in Africa, including Tanzania, Nigeria and Zimbabwe. WHO estimates suggest that there is a dearth of radiologists in close to 14 countries in Africa. Though a few NGOs are doing good work, they have low physician staffing to deliver the required medical services. “Realising the crisis that these regions are undergoing, we decided to provide a combination of reporting and technological services to address the shortage,” explains Kalyanpur.

Moreover, apart from its existing off-shoot businesses, Telerad Tech, RxDx, RadGuru.net, and Telerad Foundation, the company has setup an Imaging Core Lab, in July 2012, with an aim to provide drug and clinical trials with an imaging component to the measurements, to pharmaceutical and biotechnology companies. Until now, the company has partnered with Biocon and has completed its first trial with them, carried out collaborative research and development projects with companies such as Siemens and General Electric (GE) and conducted a workshop on imaging and clinical trials, in partnership with the Drug Information Association (DIA). In the future, it plans to collaborate with pharma and biotech companies across the globe, to provide diagnostic reporting services for clinical trials.

Betting on related diversification

Since 2011, TRS has seen significant developments in each of its off-shoot businesses. Telerad Tech, which designs products to address the gaps in healthcare IT, has deployed its technology in Poland (Europe) and Brazil (South America) and its flagship product, RADSpa, has been deployed across several hospitals in India. “TRS uses RADSpa on its own platform and leases it out to other radiology groups too, for practice or to help extend its diagnostic services to hospitals in remote locations,” says Kalyanpur.

On the other hand, RadGuru.net has moved from being an internal training portal to an open platform, where the company’s internal staff and international faculties can deliver lectures, in real-time and free of cost, to postgraduates and teleradiologists across the globe. In fact, the founders are in the course of developing an in-depth online radiology curriculum for postgraduates. “There is a shortage of radiologists in the country and typically, most of them are often busy with clinical responsibilities. They don’t have the time to teach their students. Thus, we are developing this resource as a supplement to what they learn on the field or during their course of study,” states Kalyanpur.

As for RxDx, apart from opening a paediatric multi-speciality outpatient clinic for children at Whitefield, Bengaluru, the founders are now offering remote online consultations using Cisco’s technology. In fact, TRS is currently in the process of connecting all the healthcare centres in Tibet and deploying telemedicine services, in partnership with the Tibetian government.  Coming to the Telerad Foundation, which offers subsidised clinical reporting services in partnership with hospitals in tier-II and tier-III regions, it has crossed the 30, 000 free scans mark this year. Moreover, in terms of academic research, the foundation is now supporting RadGuru’s teaching activities by developing continuing education programs for postgraduates, in partnership with Sri Sathya Sai hospital.

Overcoming infrastructural hurdles

Today, TRS sees one of it’s primarily challenges arising from the poor state of infrastructure in Bengaluru. “Timing is very crucial to a service business such as ours. We have a 30-minute turnaround time for emergency reports. Given this, if the city is faced with a strike, power outage or political clashes, it will impact the quality of our services,” reasons Kalyanpur. As a means to tackle the infrastructural challenges, TRS has developed a global footprint, so that it is not dependant on one geography alone, to deliver its services. Moreover, diversifying its portfolio from just clinical delivery to operations, technology and the e-learning space has also helped the company de-risk its client base.

A second challenge he highlights is the economic cuts that are being implemented in the U.S. markets. While he is skeptical about the cost cuts in healthcare and outsourcing activities, Kalyanpur also sees this as an advantage because hospitals will turn to more affordable service providers like TRS to deliver their services, at a lower cost.

Structuring an unfragmented market

“We’ve often been asked, why do you sell your proprietary technology instead of keeping it for your own use? We realised that it’s because services are not infinitely scalable, but technology is,” recalls Kalyanpur. This is why he sees a huge opportunity in taking Telerad Tech and RADSpa to evolving markets such as Asia and Africa. With respect to Imaging Core Labs, he believes that there is an opportunity for companies to take best practices from the U.S. and European markets and bring them to an environment where the solutions can be delivered at a much lower cost.

Lastly, he reasons that telemedicine per se is a promising space.  “In the West, it’s because of population ageing, while in the East, it’s because of infrastructural challenges. But, the solution for both problems is the same, which is, increasing need and reach for healthcare through telemedicine. With the right technology and service, we believe we can make a big impact,” states Kalyanpur.

Future outlook

On the technology front TRS is looking to record higher sales in Africa and South America, through joint ventures or co-branding opportunities with existing companies. In terms of education, the company is planning to develop content and extend its reach to a larger audience and also to connect with more postgraduates. The company has recorded a y-o-y turnover growth of 15 per cent and expects to continue to grow at this pace in the years to come. “But, more than revenues, our target is to expand the reach of teleradiology and to benefit more patients globally,” concludes Kalyanpur.

Then

Now

Catered to 100 hospitals in 20 countries of which 20 are in India Caters to 130 hospitals across 25 countries and 27 hospitals and 22 sites in India
Specialisations: Spinal, brain and cardiovascular diagnosis Specialisations extended to oncology (including PET-CT), musculoskeletal MRI, and breast imaging (mammography, sonomammography and MRI)
Focus was on building off-shore businesses Launched Imaging Core Labs for clinical and drug trials, Telerad Tech deployed in Poland (Europe), Brazil (South America), RADSpa deployed in a few regions in India, RadGuru.net made an open learning platform with access to all, RxDx multi-speciality paediatric clinic introduced, 30, 000 free scans offered by Telerad Foundation
Aggressive expansions in international markets Partner with Tibetian government to offer remote consultations to the localites

STARTUP SCHOOLS WITH THE FOUNDERS OF TELERADIOLOGY SOLUTIONS 

After graduating from the All India Institute of Medical Sciences and spending almost a decade at Yale, Dr. Arjun Kalyanpur and Dr. Sunita Maheshwari came back to Bengaluru in the 1980s with a dream of setting up a business of their own. While Maheshwari pursued paediatrics in Narayana Hrudayalaya; Kalyanpur, in his search for a radiologist opening, struck upon the idea of founding a teleradiology company. The founders share with us some valuable lessons they learnt during their decade old journey in this industry.

Healthcare, for all

Telerad Foundation, the not-for-profit arm of TRS, offers academic research and clinical reporting services, to hospitals in remote locations such as Itanagar (Arunachal Pradesh), Vrindavan (U.P.) and Gulbarga (Karnataka). The founders outline the key aspects of setting up a telemedicine company in a tier-II/ tier-III regions:

In a rudimentary environment, there are several technological and infrastructural challenges involved in setting up a telemedicine company. Companies have to be willing to do every piece of installation, right up to plugging the cord into the socket, because the client will often have no idea what is to be done and how it is to be done. In our case, since we partnered with existing hospitals, which have some form of primary healthcare infrastructure in place, all we had to do was to take our technology and install it at their centres.

On-site staff training is another key factor in setting up a telemedicine company in rural markets. Today, telemedicine is not just about seeing a video image of the patient. There are equipments such as the digital stethoscope, which if placed on a patient’s chest, can record a cardiac murmur from 5, 000 kilometres away. It is important for the on-ground staff to be trained on how to handle the various equipments, so that relevant information can be obtained. The advantage here is that the training is quite simple.

We offer two levels of training – clinical training and public health education. Clinical staff training is either conducted by the technician who installs the equipment at the hospital or by our internal staff, through remote online education. And, public health education is typically carried out by our specialists, assigned at the hospital or by a group of specialists through our e-learning portal.

Our patient consultation fee in tier-II and tier-III cities is about 10 per cent to 15 per cent lesser than in the metros. In fact, the patient will additionally save up to seven per cent because long travels to receive medical treatment are eliminated.

Taking the bull by its horn  

During TRS’s early days, many healthcare institutions at the U.S. were still sceptical about the concept of outsourcing, especially to India, due to its infrastructural backwardness. As TRS directly competed against well-placed teleradiology firms in other developed countries, every step of the way, the founders had to reassure the clients about the quality of their deliverables. The entrepreneurs share some lessons here:

One of our most challenging clients was a U.S. based tertiary care academic centre.  Although they were our marquee client and were a source of good testimonials for years, they gave us a large number of workflow and technology challenges. We had to customise our workflow and technology to theirs, supervise their postgraduate students and meet their stringent quality and turnaround time expectations. Despite it being a huge adjustment, there were several lessons to be learnt here:

By going the extra mile and focussing on the client’s needs, we can convert our most unhappy customers into the happiest ones.

By raising the service levels to meet the expectations of the most demanding client, we effectively exceed those of all other clients simultaneously.

The culture of always respecting a client (especially a demanding one) is one that needs to be constantly worked on and reinforced among all our employees.

The second challenge we faced was in 2004, during the U.S. Presidential elections.  During that period, outsourcing was one of the hot topics of debate in the media.  Since we were a company in that space, we were being hounded by the U.S. media and scientific journals. After a while, we decided that we need to approach this practically and so we opened up to the reporters and about our insecurities but held a firm belief that the teleradiology model was truly one that stood to benefit. As the story evolved, we found that a large share of the media took a positive view of things and the coverage actually began to work in our favour and gave us good visibility. What we learnt from this experience was that;

We should approach adversity practically, without trying to avoid it or shun it away. Eventually it may turn into an asset.

We need to be open and candid with the media about the challenges we face, rather than to present an artificial image or try to evade an issue. It shows us as what we are.

Getting the right fit   

Although radiology is a highly competitive postgraduate degree today, lack of enough teaching hospitals and centres and, high capitation fees for postgraduate seats is a cause for concern. As a result, there are ery few radiologists who hold a strong fundamental knowledge of the subject. The founders share their hiring strategy:

At TRS, we never conduct batch recruitment. We always recruit only based on specific needs. The foremost trait we look for in an interviewee is their willingness to learn. Since we operate in a space where technology and clinical practices evolve every day, it is crucial for our practitioners to stay up to date on every development in the industry.  In fact, at TRS, every employee, including me, undergoes a quality assurance and peer review process from time to time, which analyses errors and helps us learn from them.

The other important trait we look for in an interviewee is the passion they hold for the job, which is more important that just their knowledge and competence.  We are a relatively young organisation and we would like the employee to fit into our culture without much ado.

Getting the mars-venus equation right 

The founders and husband-wife duo, Dr. Arjun Kalpyanpur and Dr. Sunita Maheshwari tell us how they run a business together and share their thoughts on how they strike a work-life balance:

The solution here is to not separate business and personal life. We adopt a policy where we allow the two to flow into each other, without making it seem like an intrusion. For instance, my wife and I go for a long walk everyday where we catch up on our day’s work and share ideas and get feedback on how we can handle certain assignments. Our personalities are also such that, there are certain things that we both are better at, so we respect each other’s capabilities and give the other person the lead to take forward what their strength is.