Virog

Revolutionizing patient logistics, care, and early threat detection in hospitals for suburban and rural India through cost-effective and accessible medical technology.

In India, a significant portion of the population is limited to government healthcare facilities due to financial constraints and geographic remoteness. These facilities are often ill-equipped and understaffed, leading to a disparity in healthcare access. 

Our group initially discussed the prevalence of anemia in India, which affects 52% of women, with even higher rates for expecting mothers. Patients with severe anemia require hospitalization and treatment involving blood transfusions or injections. However, lack of proper hygiene during treatment in rural and sub-urban areas leads to high morbidity and mortality. Lack of access to cost-effective diagnostic testing in rural and remote areas can make diagnosing anemia difficult, particularly in its early stages. However, our research discovered that these issues extend to various other diseases and are rooted in the country's dysfunctional healthcare systems.

We observed that the primary cause of patient mortality in hospitals is not their primary disease but secondary or hospital-contracted morbidities. The causes include a lack of continuous monitoring of patients after diagnosis and a lack of hygiene, leading to contamination of sterilized apparatus that results in infections. Up to 93% of patients in the neurology wards can experience choking after tracheostomy, which is fatal in a significant number of cases. These issues can interfere with the patient's treatment and leave them disabled, often financially as well. 

Another issue in rural and sub-urban healthcare is the constraint of resources, both material and human. The sheer volume of patients that government healthcare systems treat daily is higher than they can manage. This number is partly owed to patients repeatedly visiting due to improper treatments and partly to the affordability of subsidized government healthcare. 

In summary, our research has revealed many neglected problems in the Indian healthcare system that we propose to tackle without investing considerable extra resources. 

Virog is an approach to optimize existing healthcare facilities by integrating low-cost sensors, categorization, and management algorithms into the system.

From pre-diagnostic patient classification, hospital vacancy management, and tech-optimized nursing to post-diagnostic follow-up, we have an entire suite of innovative solutions for the most pressing issues and a way to integrate and scale them into our overloaded healthcare infrastructure.

We have the following products under development as part of our Virog Proposal:

VADE:

• It is primarily intended to be used as a low-cost continuous monitoring system to track pregnant anemic women's and other hospitalized patients' health and alert associated healthcare professionals of abnormal changes in measured vitals via text notification.
• Along with other intelligent and cost-effective med-tech devices, VADE is intended to be used in pre-diagnostic clinics, where people will be offered preliminary tests to substantially reduce the chances of an erroneous diagnosis [1]. 

UV4:

• This is targeted towards preventing secondary antibiotic-resistant infections that creep into the wound created by the I/V (intravenous) insertion, which is the primary cause of worsening patient condition and death at the hospital. 

Transcutaneous tracheal electrode:

• The device is designed to alert the nurse station in case an abnormal activity is measured by the electrode placed on the glossopharyngeal nerve, a cranial nerve responsible for swallowing, allowing timely and efficient intervention to stop patients from asphyxiation caused by dysphagia following tracheostomy. 

Virog Web Services:

• Our web services are designed to match patients with appropriate medical practitioners based on availability, distance, cost, and specialization. Post-matching, the doctor gets a standardized patient report, a summarization of patient history, and symptom description, plus patients are flagged on the basis of severity.
  Such a system will allow effective management of the humongous patient loads in Indian hospitals and improve accessibility and reduce disparity in services obtained.

Through VIROG, we are mainly trying to serve people in areas where the patient load to healthcare resources ratio is very high, such as the rural areas (with meager healthcare resources) and also the densely populated region around the city, such as slums (with very high patient load). Also, our solution aims to provide medical assistance to the nurses by making it easier for them to monitor patients and their vitals.

Ways the solution impacts peoples' lives:

• Before diagnosis, we wish to optimally direct patients to the appropriate medical resources quickly and efficiently. Optimization algorithms [1], [2] can help segregate critical patients from the bulk and provide them with immediate and potentially life-saving assistance by intimating the concerned medical personnel.
• Post-diagnosis, for hospitalized patients, our solution aims to prevent avoidable deaths through sudden, otherwise unnoticed changes in the patient's vitals via continuous monitoring and transmitting systems.
• In more severe cases, our small but innovative designs can help prevent contamination via IV (intravenous) and blood transfusion, hypoxia, asphyxiation, and many other neglected patient mortality causes. This would significantly help hospitalized people with weak or compromised immune systems, such as the elderly or heavily sedated patients.
• The information obtained from the patient's vitals makes it possible to detect anemia cases.
• Continuous monitoring via cost-effective, low-technology devices would help the medical personnel avoid resource-intensive tests repeatedly. This would also allow for taking on a larger pool of patients simultaneously and efficiently.
• Creating a centralized database of patient records helps reduce paperwork and makes it easier for them to continue their treatment in other places, as earlier records are readily available. 

Growing up in an industrial town, I (Dhruv) have been surrounded by infections, injuries, and death that plague the slums surrounding the industry owners' bungalows.  It was not uncommon to hear of workers losing their wives and children during pregnancy. I later learned that a significant factor in such deaths was undiagnosed/unmonitored anemia. The intense loss of these people, some of whom I knew by name and even used to play with as a kid, left a powerful impression on me.

During my teens, my father's best friend passed away due to being matched to an ENT clinic by google maps while having a heart attack. The tragic nature of his demise illustrates the urgent need to optimally direct patients to the appropriate medical resources. 

Our team consists of like-minded people who identify with such experiences, draw inspiration from the tragedy we've been exposed to and are driven by a desire to help and make a difference. It comprises six undergraduate students majoring in Biology, Physics, Mathematics, and Material Sciences. We have people skilled in web development, electronics, statistical analysis, and human resource management. 

Our lead, Dhruv, has a background in MedTech devices due to his internship at the Yodh Lab at UPenn, where he studied non-invasive optoelectronic probes. He has also contributed to future-forward newsletters on technology-driven healthcare under the guidance of former UNDP office holder Ugo Bot.

• During the summer of 2022, I, Dhruv Gupta, interned in the Neurology ward at Sri Ganga Ram Hospital in New Delhi, a semi-private entity. The two-month internship was intended to serve as an excellent opportunity for me to talk to the patients and the nurses about the problems they face in the current healthcare system. 
• The inputs they gave us in the initial stages of the product ideation helped us identify a whole new suite of problems we were unaware of: post-diagnostic monitoring and nursing of hospitalized patients for safe recovery. After more research by my team about these issues, we shifted our focus from innovating med-tech for doctors to innovating the same for nurses and hospitalized patients. 
• We have developed our solution, through all stages of its maturation, in consultation with patients, their families, and most importantly, nurses who shall use them.

Since the genesis of Virog, we have characterized our innovations by making them small but deeply significant. The following points illustrate the uniqueness of our solution:

VADE:

• While the idea of a wristband measuring important vitals like SpO2 and temperature seems commonplace, its usage in real-time monitoring and crisis management makes it innovative. 
• We changed our model to an armband to include two important new parameters: temperature and perspiration. These parameters were included after intensive consultation with the Neurology staff at Sir Ganga Ram Hospital.
• This is an unorthodox approach and allows a more comprehensive, rbst and reliable analysis with significantly reduced false positives than PPG alone. 
• Further, we combined machine-learning-based data analysis (based on deviations from dynamic individual normals rather than static population averages) with lower-precision but highly affordable technologies to approach the level of accuracy of ECGs and other highly expensive devices in the market, but at much lower costs. 

UV4 Sterilizer/Transcutaneous Tracheal Electrode:

• Here, the two med-tech devices proposed are entirely novel innovations designed to prevent unnecessary deaths. 
• The solutions have been carefully designed to be as inexpensive as possible and also support workshop/small-scale manufacture. 
• The key innovation in UV4 is the use of kaolin which is ubiquitous and has unique bacterial adsorption properties and also blocks UV light from reaching the hand. Kaolin further links with detergents which lyses the adsorbed bacteria. It's never been used for bio-containment before but we got positive results in the lab. 
• Kaolin costs 50 dollars a metric tonne. It's dirt cheap, because it is clay itself. Secondary infections are an extremely important killer. We are one of the first initiatives to target this problem. Our solution to them is incomparable in price and ease of implementation. 
• The tracheal electrode further targets a completely ignored problem: that of death due to dysphagia. Our solution is non-invasive, and inexpensive and works in tandem with the nurses and not as a replacement for them, by acting as an alert system. 
• This allows us to keep costs low and not impede on the role of the human staff in hospitals, merely helping them be more efficient. 

Web Services

The unique feature of our web services is the generation of a standardized patient report received by the doctor on matching.

This is based on the centralization of patient past records and flagging keywords entered in the symptom description entered by the patients to generate a series of tags that route that help categorize and route the patient to appropriate medical services with a filter for cost and distance. The patients are also sorted in terms of severity inferred. 

This interface between the doctor and patient helps overcome communication barriers and make efficiently presents patient information to doctors.  

Our investors all found this framework incredibly promising both in terms of social impact and market opportunity. 

Virog as a reinvention of the Indian MedTech market 

We've developed prototype models of our devices and plan to extensively test them in public and private hospitals and clinics to train the ML-based analysis model that evaluates and summarises the continuous monitoring input from our devices. 

The data trends obtained hold high potential for research purposes. 

There is immense value in using the concept innovation in Virog to drive the Medtech market in the country.

Whilst the doctor's market is saturated, grassroots innovation targeting nursing holds great opportunity for social and economic impact.

Virog holds the potential to significantly change the Indian MedTech market and streamline upcoming breakthroughs into an integrated framework that simultaneously targets the system's biggest problems at once.

Given the nature of the proposal, it's best to discuss our impact goals in the context of each proposed solution.

VADE:

• At places of implementation, VADE targets to reduce the number of anemic women by 1% and sharply reduce maternal deaths in which anemia is a significant factor by the end of the year.
• As part of a partnership with AIIMS Delhi (India's premiere Medical institute and govt. hospital), we plan to deploy Virog in the blood cancer ward of that hospital as part of an alert and analysis system.
• Based on the success of the above, we shall set up VADE as a general-purpose long-term monitoring device in government hospitals across the national capital region. 

UV4 (IV-UV) Sterilizer and TTE (Transcutaneous Tracheal Electrode):

• The combination of the two devices targets secondary morbidities (i.e., diseases/injuries contracted from the hospital). By December, we plan to reduce their number (as recorded in nursing reports) by 20% in each hospital where these devices are implemented. 
• Indirect goals are:
  •  Significant reductions in costs incurred by patients during their hospital stay (treatment of secondary morbidities can make up to 85% of the net costs!),
  • Reduce patient deaths (secondary morbidities are a significant cause of death in over 75% of cases),
  • Increase the patients' quality of life and reduce recovery time measured as faster discharge and higher patient satisfaction with treatment in feedback. 

Web Services:

We plan to reduce patient traffic hours, improve the matching of patients to hospitals based on distance, specialization, and affordability, and optimally segregate critical patients from the bulk based on standard reports generated through compiling past patient records and flagging keywords in patient statements obtained.

Pre-diagnostic Clinics:

• Our goal is to make healthcare accessible to rural places by allowing long-term remote monitoring and relaying medical advice from professionals. We can measure its impact in terms of reduced mortality due to diseases in areas of implementation. 
• We further aim to reduce the number of unnecessary OPDs and reduce hospital loads. We plan to measure the same in terms of the reduced overtime hours spent by the medical staff of associated hospitals.

Virog:

Virog as an initiative has far-reaching consequences for improving medical infrastructure and re-inventing the MedTech market in India. By the end of this year (or by mid-2024), we seek a larger, more diverse, more integrated MedTech market in India. We plan to keep track of this goal by tracking the government investment in MedTech over the next financial year. 

VIROG is a collection of technologies that we glued together coherently to serve a very pressing problem of our community.

VADE:

• It's a PPG (Photoplethysmography)-based armband that can transmit SpO2, pulse, temperature, and armpit perspiration to a smartphone interface. (The parameters have been carefully chosen after consultation with doctors and paramedics).
• We compute the SpO2 and pulse and detect anemia by calculating the absorbance ratio of IR vs Red and plugging the value into an empirical equation with statistically/population-derived coefficients. 

• We employ maximum likelihood estimator (MLE) based statistical techniques to categorize the patients based on their criticality. This "criticality index" is used to assign priorities to patients.
• We have designed a graph algorithm that is being used to redirect medical attention from the closest available source to the patients based on the real-time status (doctors' location, possible medical assistance needed, etc.).

UV4:

• This consists of a clip-on UV Led and a solution of Kaolin clay, oil, and detergent.
• The UV LED is to be clipped onto I/V insertions at the end near the patient's arm, and the solution is to be painted onto the bandage in the area where the UV light falls.
• The UV light disinfects the illuminated area, and the solution helps this by slowing the bacteria down (Kaolin adsorbs bacteria) and the detergent helping in killing them. It also prevents UV light from reaching the skin. 

Transcutaneous tracheal electrode:

• This consists of an electrode, an amplifier, and a transmitter and reports the activity of the nerve which controls swallowing, via a smartphone interface.

• The glossopharyngeal nerve approaches the skin at the top of the pharynx, just over the voice box, and is redundant to the vagus nerve in swallowing. Damage to the Vagus nerve blocks swallowing, but a signal is still produced at the glossopharyngeal nerve when excess saliva accumulates.  
• This signal can be measured and reported non-invasively and raise an alarm in case of appropriate deviation in measurement. 
• Texas Medical Centre has also created a device (Neurastasis) based on similar technology (for very different purposes). It is being successfully tested out in clinical trials, giving us confidence that our devices will create the same impact on the market.

Virog Web services:

• Includes a VLDB system like Hadoop, which helps store the semi-automated data recorded by the VADE armbands.
• A real-time updated website containing patient records, facilitating collaborative work across country-wide or global-scale medical personnel, depending on accessibility.
• Local "Virog servers" running an optimization algorithm for patient traffic management can efficiently streamline people to the correct resources as soon as possible. They will be synchronized in real-time from our overall network within hospitals.
• Post-treatment follow-up will be automated. This will provide early warning against relapse of certain diseases like cancer, CoVID, etc.

Given a huge beneficiary population and keeping in mind our limitations as undergraduate students, we have devised a stepwise ladder approach:

1. Bengaluru, Karnataka (Delivery to beneficiaries): As step one, we have initiated communication with the state's health ministry. 10 government hospitals across the city shall be supplied with our products, each serving ~4000 people a month. 
   This shall be done immediately after the prototype testing is finished, in April. We plan to serve about 40,000 a month by May.
2. Karnataka and Delhi (Going public): Based on product performance and making necessary changes with feedback, we shall launch the devices as commercial entities by for private hospitals to purchase across the state of Karnataka.
   At the same time, we shall launch the web services in Delhi after having trained our RL (Reinforcement Learning) model on appropriate datasets.
   Delhi has been chosen due to the appropriate market and government schemes and mindset to implement the same. 
   This is expected to increase the number to over 1 million (a year) by November, keeping in mind a 60% acceptance figure. This includes thousands of healthcare professionals who benefit from reduced unnecessary OPDs and improved patient management.
3. Setting up the first pre-diagnostic clinics (Refocus on anemia): The end of the year should see the setup of the first 10 pre-diagnostic clinics in rural Bengaluru. The delay is to ensure we have the necessary amount of surplus funds to do so. While this would barely change the number served, adding about 2000 (monthly) beneficiaries, it marks a critical step for bringing into the fold our primary beneficiaries: anemic mothers in rural India, and sets up our vision for the following year. 

As a team of Undergraduate Students from India, these are a few of the barriers we currently face:

Marketing: 

• We as a group of science undergraduates have most of our mentors being scientists and doctors themselves. 
• While the tech is very finely worked out, we need mentorship and guidance to develop sound market strategies and to help us navigate through legal procedures to kick off this project.

The Virog Pre-diagnostic clinics:

• The Virog pre-diagnostic clinics are challenging to implement in terms of the funds and skilled personnel required to set up such centers at the rural grassroots level. 
• A particular barrier we face for the same is convincing a sect of  our beneficiary population to use the service, due to mistrust against medicine and technology in orthodox rural provinces.
• We shall need  to conduct workshops and awareness initiatives to encourage use and acceptance in some such places. 

Virog currently partners with two organizations for incubation and driving our product to the market:

• SID: SID is the incubation cell for the Indian Institute of Science (IISc Bangalore). They provided us the seed funds, a workstation, access to institute resources, and primary business guidance.
• Tata ELXSI: Tata ELXSI is the tech giant's med-tech development division helping us design and lease our devices.

Upcoming partnerships:

• Bangalore Bio-innovation Centre: The primary government-funded med-tech incubation facility in perhaps all of India, we have initiated contact with them for mentorship, future device development, and reaching out to a diverse community of med-tech entrepreneurs for a collaborative venture into the Virog setup. 
• Health Ministry of Karnataka: We have initiated talks and are expected to reach an arrangement soon on implementing Virog with government help. This partnership shall be critical to ensure fair access and fast-tracked distribution of Virog. 
• Delhi government: The Delhi government has made outstanding strides in improving its healthcare infrastructure over the past few years and is open to innovation. Further, there is a vast beneficiary population and a more extensive private hospital customer base in the national capital. Hence, we seek to secure a strong partnership with the Delhi NCT (National Capital Territory) government. 

Our business model can be described as follows:

Application:  Long-term patient monitoring, routing, categorizing, and matching to hospitals; product manufacture intended for patient care and a campaign against anaemia.

Beneficiaries: Anaemic women, especially expecting mothers, population using government healthcare facilities, and medically vulnerable population which faces hospitalization, Nursing staff.

Customers: General Public, The government, all hospitals, small clinics, MedTech enterprises

Revenue: Med-tech devices and web services

Surplus: Opening of Virog clinics for pre-diagnostic testing and post -diagnostic long term monitoring in semi-urban and rural areas. 

Collaboration: There is an excellent opportunity to create a collaborative and streamlined market under Virog for all emerging MedTech-based startups.

Breakdown of products under Virog:

One continuous monitoring device and two devices to prevent patient morbidity and mortality during hospitalization.

All devices are cost-optimized and readily affordable for even the poorest government hospital and are designed to allow local manufacture and maintenance.

Web services which include categorizing patients and matching them to hospitals based on optimized cost, distance, and hospital specialty.

Virog as a collaborative venture:

Virog as an initiative offers a focused, profitable arena for innovation and entrepreneurship in MedTech to thrive.

The problems we're trying to solve will be best taken on by a community of solvers rather than a single group.

Pre-diagnostic clinics proposed will do best with a diversity of medical devices and collaborative innovation in the sphere of nursing seems to have the potential to be even a tool for nationwide revolution in MedTech services, bringing in new ideation, products and promoting indigenous design and manufacture of scientific products. 

Employment:

1. Team Virog: We have space for motivated and qualified members to join our team and help with service development and product design. We are seeking marketing and executive members primarily.
2. The pre-diagnostic clinics are expected to generate a new field for skilled and semi-skilled workers to join.
3. There is a unique opportunity for mothers in rural India to participate in the initiative as clinic staff to create a safe and accessible environment for the target anemic expecting mothers' population.  

Investment in Virog:

We're actively seeking investors. Some of our investors/mentors are as below:

1. SID (Institute investment)
2. Siddharth Dhodhi, Senior Financial Advisor at Google
3. Tata ElXSI
4. Bangalore Bio-innovation centre (Upcoming)

Partnered hospitals: 

One of our motivations for joining Solve is to seek better visibility among investors and to get financial and business mentorship. 

Revenue Model -

Virog devices are designed to be very cost-effective to fit any budget and the expected cost (once in production) should be less than 200 to 500 Rs or 3 to 7 US $ only. Thus, it will easily fit in all government schemes and hospital budgets as its usage would greatly increase efficiency and quality reducing costs and troubles faced by patients and nursing staff. 

Buyers:

Government: Virog fits into 4 major government investment schemes and should be able to generate significant government attention and funds.

Hospitals: The principal buyers for our web services and devices shall be hospitals (Both private and govt run). Clinics can be pulled into the market with more devices.

Large Medtech and Biotech firms: There seems to be a significant opportunity for synergy between Virog and large enterprises which purchase IP in the POC phase from smaller startups and bring them as finished products to market.

 Revenue Generation -

Virog Web services: Web services will have maximum impact and require little investment.

Medtech devices: The devices are designed in such a way that they will be very cost-effective, useful, and simple to install, and thus we expect high sales and revenue.

Intellectual Property: We plan on manufacturing only a limited number of devices. The rest we plan to sell as IP after developing proof of concept. This opens up several new avenues for collaboration and also allows us to focus on further innovation rather than manufacturing and marketing.

Revenue generated at the prediagnostic clinics: this is a long-term proposal that is only possible under government implementation. The small fee charged at such centers shall help recover the cost of setting them up.

Further, for us, we seek collaboration primarily in two areas:

Setting up small Virog Manufacturing Facility and leasing product manufacture and marketing to enterprises with an existing customer base and machinery.