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Published on: Sept. 22, 2023, 12:18 p.m.
How Tricog saw the future
  • Bhograj: making a tangible difference

By Lancelot Joseph. Executive Editor, Business India

In today’s rapidly evolving world, artificial intelligence (AI) stands out for its transformative potential, altering landscapes across sectors, from finance to retail. However, the most profound impact can arguably be seen in the realm of healthcare, where the fusion of AI and medical science is redefining boundaries and bettering healthcare. Leading this shift, particularly in the domain of cardiovascular health, is Tricog Health – an Indian-origin, AI-driven juggernaut, which is reshaping the global healthcare narrative.

Way back in 2015, when AI was still finding its feet in mainstream applications, Tricog was already harnessing its power to construct algorithms and building products aimed at early detection of cardio-vascular diseases.

Tricog is now ‘building the future’, wherein AI will predict your heart attack at least two days in advance, allowing the patient to take preventive measures. Such a prescient approach, one would say, laid foundation for the leaps we witness today in AI-driven diagnostics. It is building the largest cardiology network across two continents, with an aim to screen 100 million patients by 2027. This start-up has screened more than 14 million patients till date, saving 492,000 lives in the bargain.

Today, Tricog’s network comprises 6,000 plus centres across two continents, including clinics, community hospitals, diagnostic centres that undertake specific tests, such as ECG, ECHO, Rhythm, etc, and tertiary hospitals and governments that fall under the STEMI Grid. In a later development, Tricog is now part of the US Health Care Systems in terms of tertiary care hospitals, via its newly launched TriCare services.

This early investment in AI has allowed Tricog Health to remain at the cutting edge of innovations. But it is not just about utilising AI’s power; it is also about how seamlessly and effectively Tricog has blended technology with medical expertise. At one end of the spectrum is Charit Bograj, a renowned cardiologist having worked at Fortis, Manipal Hospital and Vikram Hospital, who represents medicine. On the other end there is Zainul Charbiwala, a hardcore hardware engineer from IIT Bombay, ULCA and IBMer.

Besides, there is Udayan Dasgupta, algorithm expert, ex-IIT Bombay and Texas Instruments. This blend of tech and medicine, with its founders having a long history in research and medicine, has facilitated the accurate, timely and consistent diagnosis of heart conditions, saving countless lives in the process. And, this is not just in India, but the world over.

Legacy of a vision

At the heart of Tricog’s mission is its passionate founder, Bhograj. “Our journey with Tricog Health is not just about pioneering technology,” Bhograj articulates, while speaking about the essence of Tricog. “It is about humanity, compassion and a genuine desire to make a tangible difference. Each heart-beat we monitor, each life we save, reinforces our belief that technology, when employed with empathy and vision, can transcend boundaries, overcoming challenges and reshaping healthcare for generations to come. Our goal has always been, and will always be, to ensure that every individual, no matter where they are, has access to the best technology, diagnostics and care, as possible”.

The underpinnings of this ethos go back even further. While growing up, the corridors of his home echoed with stories of lives touched and changed. Not from any story book, but from the life led by his father, a renowned surgeon. “I witnessed my father treating the elite – politicians, celebrities, and influential personalities”, Bhograj reminisces. “But what truly inspired me were his Sundays. Each week, he dedicated his day to visiting villages, treating hundreds of patients with the same care and dedication he would for any high-profile individual. As he recently celebrated 50 years of this commitment, I was reminded of the power of one individual’s potential to impact the masses”.

  • Charbiwala: bridging the technological divide

Bhograj’s path seemed destined. He studied cardiology, as his prowess as a cardiologist was evident even in early days. “By all measures, I was doing well as a cardiologist,” he submits. But, in 2009, a pivotal case would shake him to his core and ignite a new path. A 40-year-old man was struck down by pain in his chest. His GP, like many others, failed to detect the severity of his condition. The man’s condition worsened and by the time he was brought into the ER, he had no pulse, no blood pressure – the aftermath of a severe heart attack. Bhograj had the gut-wrenching task of telling his wife they had come in several hours too late”.

However, it was not just the anguish of this one incident that gnawed at Bhograj. It was the systemic issue it highlighted. “Every cardiologist will attest to this”, he asserts. “These stories of coming in late are not isolated incidents. This patient was one of the few who made it to the hospital. It is a sobering thought that 50 per cent of individuals with massive heart attacks do not even reach a medical facility”.

This case, among others, became the catalyst for Bhograj, prompting him to try and bridge the glaring gaps in early diagnosis and intervention. And thus, from the crucible of such experiences, Tricog Health emerged – not just as a company but also a mission. Bhograj’s past, coupled with his expertise and passion, gave birth to an initiative that today stands at the frontier of AI in healthcare, dedicated to a vow to ensure that the story of the 40-year-old man is not repeated for the others.

From that pivotal moment, Bhograj realised the potential of technology to revolutionise cardiac care. He envisioned a solution that could harness the power of modern tech to address the painful gaps in early cardiac diagnosis. But realising such an ambitious vision required more than passion; it required expertise in realms beyond his own.

In his pursuit, Bhograj’s path crossed with that of Charbiwala. A prodigy in his own right, Charbiwala was making waves at IBM, one of the leading tech giants globally. His reputation preceded him – he was among the elite few, who had earned a spot at IBM’s labs as a researcher. At IBM, Charbiwala had been deeply engrossed in medical technology research, which aligned serendipitously with Bhograj’s vision.

Initially, Charbiwala was sceptical. The healthcare domain, with its myriad complexities and the weight of human lives at stake, was no ordinary challenge. But Bhograj’s conviction, coupled with the tangible need for such a solution, began to resonate with him. After many dialogues, and deliberations, Charbiwala agreed to embark on this journey.

Together, they set out to develop a remote heart health detection device, which could potentially change the cardiac care landscape. However, even for a mind as brilliant as Charbiwala’s, the real gravity of the situation became clear only under unfortunate circumstances.

During the development phase, he witnessed a patient having a heart attack, a jarring experience that profoundly impacted him. The real-time experience of seeing someone go through what Bhograj described fuelled his determination.

Speaking about the transformative moment, Charbiwala admits: “Experiencing such a catastrophic event first-hand was a wake-up call. At that moment, the statistics, the research and the data were overshadowed by the raw, tangible reality of human life, hanging by a thread. It underscored the importance of our mission. We were not just building a device; we were crafting a lifeline. The urgency, the relevance and the purpose of our work crystallised in that singular event”.

  • Each heart-beat we monitor, each life we save, reinforces our belief that technology, when employed with empathy and vision, can transcend boundaries, overcoming challenges and reshaping healthcare for generations to come

With renewed vigour and a deepened understanding of the stakes, the initial partnership between Bhograj and Charbiwala took on a new dimension. Their combined expertise and shared commitment laid the foundation for what would soon be a global revolution in AI-driven cardiac care. The trajectory of Tricog Health was further enriched when another visionary joined the ranks – Udayan Dasgupta.

As the co-founder and chief data scientist of Tricog Health, Dasgupta’s illustrious background and passion for impactful technology acted as a catalyst for the mission. His academic pursuit had led him to earn a PhD in electrical engineering from Texas University. Yet, for all his technical achievements, Dasgupta’s heart yearned for more – a tangible, human-centric impact through technology.

By2015, drawn by the transformative potential of the other partners’ vision, he became a pivotal part of the Tricog Health journey. Their camaraderie, rooted in mutual respect, was further solidified by the challenges and victories of their start-up venture. Reflecting on this journey, Dasgupta says: “In the dynamic landscape of healthcare, Tricog Health has charted an inspiring journey, guided by the principles of creating an impact through innovation. From my return to India in 2011 to my association with Tricog Health, the pursuit of making a real difference in healthcare has been a driving force. Our focus on cardiac diagnosis and management, coupled with cutting-edge algorithms, has led us to re-imagine healthcare delivery. We are not just building state-of-the-art tools; our core focus remains on achieving meaningful outcomes,” says Dasgupta.

Seeds of innovation

Enveloped in the fervour of their shared vision, the Tricog Health team has embarked on a journey to evolve and enhance their technological offerings. Tricog launched the 12-lead ECG machine in 2016 as its foundational product; later also built new echo-diagnostics and launched the same in 2020. They were not just content with a singular device; they envisioned an ecosystem of inter-connected devices, powered by AI, that could promptly diagnose and perhaps pre-empt heart conditions. The objective was crystal clear: early detection in a matter of mere minutes.

Pooling resources from personal sources and leveraging the trust of close friends and family, they managed to garner the necessary financial backing. This enabled them to delve deeper into research and development, thus churning out prototypes at a commendable pace. Also, the team was engrossed in devising algorithms, which were designed to swiftly sift through hundreds, even thousands, of medical images, aimed to pinpoint even the minutest anomalies that a human eye might overlook.

Over time, their persistence and ingenuity bore fruit. They crafted a 12-lead ECG machine, an advancement from standard devices. As against a standard electrocardiogram (ECG or EKG), which is a representation of the heart’s electrical activity and a single lead ECG can offer a basic view, a 12-lead ECG provides a comprehensive view of the heart. This broader perspective aids in detecting a plethora of conditions, from myocardial infarctions (heart attacks) to various arrhythmias, ensuring that clinicians receive a holistic picture.

Tricog’s ECG has integrated cutting-edge AI with human medical expertise. Over the years, the devices have diagnosed 14 million ECGs, and are now a key factor in diagnostics for over 5,000 healthcare professionals. And, they have helped save 492,000 lives.

The innovation did not just stop at the device’s design. The team has ensured that these machines are AI-powered to substantially reduce the diagnosis time, ensuring that actionable insights could be delivered promptly to medical professionals, potentially making the difference between life and death. The data that is generated from these scans can further be leveraged across the medical world to develop more accurate diagnosis.

  • None

Scaling new heights

Tricog’s holistic approach is evident in its strategy. While the hardware facilitates seamless data transition into the cloud, its software segment not only aids the in-house medical team, it also empowers large accounts and partner hospitals to do diagnosis on the go.

Tricog also created a diversified yet integrated suite of products and services. This includes the diagnostics technologies and services, as also the computation medicine division’s (CDM) technologies and services.

“Our mainstay products are the ECG and the Echo, but it is the synergistic blend of hardware and software that sets us apart,” clarifies Charbiwala, who has played a pivotal role in hardware and medical device development at Tricog. “We are not just providing cutting edge medical devices to those who need, but we are also providing clinical services to hospitals that do not have the necessary expertise to examine the many different heart reports. Thus, we are bridging the technological divide to ensure every hospital, regardless of the extent of their internal resources, can deliver top-notch cardiac care”.

But Tricog is not stopping there; it continues to build new products. Another development in the works from Tricog’s innovation hub is the ‘Atom’ product, designed to facilitate regular heart check-ups at home with accuracy. Tricog has already prototyped a device that connects to smartphones, enabling at-home cardiac diagnoses and making cardiac care as accessible as possible.

Another feather in Tricog’s cap is the strategic alliance with Omron Healthcare, which has also invested in the company, underscoring its commitment to also assist people with ailments like hypertension, where Tricog also offers its heart-related diagnosis. “Every year, heart failure impacts 65 million people worldwide, which is intertwined with hypertension,” Charbiwala explains. “While the onset of hypertension often has roots in lifestyle, its management is critical. Our partnership with Omron in India is an extension of this belief”.

The company’s footprint in Africa underscores its global ambitions and the scalability of its model. Catering to large accounts, projects and major hospitals, Tricog is not just a product provider but a partner in cardiac care innovation. It is also developing a new product for the US market.

As the winds of these devices have blown wide, it has brought with it a tide of investors, driven by a shared vision and the potential for global impact. Sure enough, Tricog commenced its journey, powered by the trust of close-knit circles and family and friends. But, now, its burgeoning promises and the fact that the devices needed to go all over the world have drawn the attention of many significant financial backers.

One such voice of endorsement comes from a name synonymous with healthcare innovation – Omron Healthcare. “Tricog’s existing business is valuable in solving the social issue of the lack of specialist doctors in India,” acknowledges Katsuyuki Yamamoto, Omron Healthcare, when asked about the allure of Tricog Health. “They are also looking to extend their services to patients at home. We are confident that this Tricog initiative will improve the future of healthcare in India. Its new business is uncharted territory that no other company has tackled. I think it is important to quickly tap into the needs of the market, while taking on a series of small challenges. Tricog’s new service to reduce the recurrence rate of events in heart failure patients is well-suited to India’s social challenges”.

  • While the onset of hypertension often has roots in lifestyle, its management is critical. Our partnership with Omron in India is an extension of this belief

After some rounds of funding, Tricog raised $30 million – a capital injection that served as a springboard. This dedication to global well-being is further highlighted by Tricog’s strategic collaborations. Partnering with several governments and government bodies across India and several governments across continents in Africa and Europe, Tricog is ensuring that its devices and quick heart diagnostics can reach even the most remote corners of the world and have access to top-tier cardiac diagnostics.

Over the years, the company has shown strong growth in revenues, which have more than doubled from $2.6 million in 2020-21 to $6.02 million in 2022-23 and is estimated to cross the $9 million (Rs75 crore) in 2023-24. The company has reorganised itself into two divisions – diagnostics and chronic disease management – which are structured around four distinct verticals, namely, Tricog Diagnostics Technologies (hardware), Tricog Diagnostics Services (software), Tricog CDM Technologies (hardware) and Tricog CDM Services (AI-based futuristic disease management).

Seeing its strong growth and huge potential, Tricog’s investors have further reposed their faith in the company. The company has raised $8.5 million in 2023, through a Series B2 round from Omron Healthcare and Sony Innovation Fund, with which it is researching to position itself as a game-changer in the med-tech landscape. This round fetched a total of $30 million.

The team is also diligently working on more wearable-like devices, amplifying their potential to save lives as quick as possible. This dedication has not gone unnoticed and, globally renowned hospitals and chains are seeking collaboration, drawn by Tricog’s pioneering work and transformative devices.

“I never dreamt of becoming an entrepreneur,” says Bhograj. “But when you are driven by a vision, not for personal gain, but for the greater good of the society, even the universe conspires to make it a reality.” 

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