SAVE - Screening Assisted Virtually Early for CRDs

Chronic Respiratory Diseases (CRDs) such as COPD, ILD, Post TB, Long Covid, Asthma are a huge challenge globally . There are more than 750 million patients with symptoms for one or more CRD conditions. More than 50% are estimated to be undiagnosed. Countries especially underdeveloped and developing countries have a huge economical burden of these diseases - in India, it is estimated that the annual economical burden is more than USD 20 Billion and in Europe more than USD 75 Billion. 

Chronic Respiratory Diseases (COPD, ILD, Post TB Lung Impairment, Asthma, Long Covid) are #2 Killer in India and are considered as Highest Economical Burden in NCDs for public health. More than 50% patients are Un-diagnosed or diagnosed at a very late stage of the disease progression. About 50%of patients who are successfully cured of TB have lung impairment issues

There are numerous research studies published which identify Misdiagnosis or Un-diagnosis or delayed diagnosis of such CRDs is directly proportional to the the disease's economic burden, number of deaths, shortened lifespan, and poor quality of life. 

There is a huge unmet need and a global challenge for "Early and Precise" Screening and Diagnosis of such CRDs.

This challenge becomes much more complex in the Fragile Environments. Access to secondary and tertiary care facilities is very difficult (time, cost, impact on daily earnings) for patients from fragile settings. 

While there are well defined methods such as Spirometry, Impulse Oscilometry, XRay, CT Scan, Clinical Diagnosis for a precise diagnosis of these conditions - the practical use of such objective methods is very limited. For example in India - only 20% of symptomatic patients are advised and offered to do Spirometry, which means the remaining 80% either remain undiagnosed or get mis-diagnosed resulting in delayed treatment, disease progression, increased economic costs, poor quality of health related life and early deaths.

Especially elderly, Tuberculosis recovered, handicapped, daily wage workers, unorganised labor, uneducated or socially deprived women, members of LGBT community, people constantly on move for labor work in agriculture and people who have lost their livelihood and earnings due to war, climate change impacts, local conflicts etc. find it very difficult to access Secondary or Tertiary care for diagnosis and treatment of Chronic Respiratory Disease. In most cases such patients are either misdiagnosed or never diagnosed with correct condition in primary settings and get only symptomatic assistance. Over a period of time as the disease progression increases, such patients then reach to Secondary/Tertiary care and need to be put on more expensive treatment and many a times end up loosing their daily earnings or become a huge burden to already choked tertiary care facilities in such fragile environments.

Briota is working on solving this problem of "Early and Precise Diagnosis of CRDs" at Primary Care or Point of Care especially in fragile settings.

To solve this problem - Briota is solving the root causes of delayed and missed diagnosis of CRD patient in resource constrained settings. These root causes are:

1. Absence of trained technicians to use the complex instruments of Spirometry and Impulse Oscilometry

2. Higher costs of purchase, maintenance and calibration of these instruments

3. Unavailability of an expert doctor such as pulmonologist to interpret the test results for an accurate diagnosis

Briota has designed and developed India' first Point of Care Portable Respiratory Diagnostic Kit. This kit includes portable digital Spirometer - SpiroPRO®, portable Impulse Oscilometer IoSPRO®, a Mobile Application NEHA™ - Nurse Educator Health Assistant.

The kit can be used by the healthcare worker in primary healthcare settings to conduct a high quality spirometry and impulse oscilometry test with minimal training. 

NEHA™  app is available in multiple languages - to help the healthcare worker conduct the test with a simple process and workflow. NEHA™ also uses a comprehensive algorithm to give real time feedback to the healthcare worker and also to the patient to enable them with a high quality of test. The system has 2 modes - 1 Minute Quick Screening Test and 20 Minute Full Test. Both these modes come with a Mobile Application providing features of Clinical Decision Support System (CDSS) which includes a Machine Learning powered AI algorithm to read and interpret the results for accurate screening and diagnosis of COPD, Asthma, ILD, Long Covid, Post TB Lung issues etc.

Our solution also includes a complete workflow for doctors, nurses, ASHA workers at the primary care settings for screening, diagnosis, and management of these chronic respiratory conditions. The solution is currently being used under project SAVE - Screening, diagnosis and management Assisted Virtually and Early in remote and rural parts of India. Here is a 1 minute Video Clip of how our technology is helping patients in Dindori, Nashik - a tribal and rural area : 

Our solution is serving those patients who do not get screened early and diagnosed early for chronic respiratory conditions. Especially those patients who can not afford to go to district hospitals or expensive private practices for early diagnosis. In India - spirometry or impulse oscilometry in a private hospital costs anywhere between US$10 to US$40. At Government of Hospital patients will always face issues of availability of a working instrument and availability of a technician to conduct the test. 

Especially elderly, Tuberculosis recovered, handicapped, daily wage workers, unorganised labor, uneducated or socially deprived women, members of LGBT community, people constantly on move for labor work in agriculture and people who have lost their livelihood and earnings due to war, climate change impacts, local conflicts etc. find it very difficult to access Secondary or Tertiary care for diagnosis and treatment of Chronic Respiratory Disease. In most cases such patients are either misdiagnosed or never diagnosed with correct condition in primary settings and get only symptomatic assistance. Over a period of time as the disease progression increases, such patients then reach to Secondary/Tertiary care and need to be put on more expensive treatment and many a times end up loosing their daily earnings or become a huge burden to already choked tertiary care facilities in such fragile environments.

The patient on average needs to travel 3 times before getting the final diagnosis. Considering the cost of travel, loss of pay etc. this test costs average US$30 to a patient.  

Apart from costs the availability of Spirometry test is a huge constraint for rural population, tribal population and underprivileged sections of the society. With Briota's Spirometer - a normal healthcare worker such as ASHA worker can also perform the screening and then the full spirometry can be conducted at Primary Healthcare Center by the regular healthcare staff. Even spirometry could be conducted in health check up camps with diagnosis and treatment plan made available. Our calculations show that the complete spirometry test could be now offered for less than US$1 per patient. 

Early diagnosis means a lot to every patient but especially for the underserved - early diagnosis of COPD, Post TB Lung Impairment, ILD and Asthma means how long they could remain productive and reduce loss of wages or loss of school days. This also means the disease progression could be slower than in normal scenario. With slower disease progression, optimal disease control is a possibility which means less hospitalisation and reduced deaths.

I personally decided to get into solving this problem because I have seen the suffering an Asthma patient goes through due to incorrect and delayed diagnosis. My mother is Asthma patient for last 3 decades whereas she was diagnosed with Asthma only in the severe stage. For last 3 years me and my team are closely working with hospitals, ASHA workers, PHC doctors, General Practitioners, Government Agencies, Municipalities, schools, patient support organisations like PATH, Karma Healthcare etc. to enhance and develop our solution in the most robust fashion. Our solution was "redesigned" based on ground realities community health workers and PHC doctors faced during covid19 pandemic. Our mobile application and some part of algorithms (as our solution is for Lungs and Covid19 impacts lungs) was used during pandemic to help more than 40 thousand patients most of them from industrial labor colonies and slum areas. During this project - code named "SAVE - Screening Assisted Virtually and Early" we have got lot of insights about the difficulties experienced by healthcare staff in remote, semi-urban and factory settings in helping patients with early diagnosis and offering a treatment plan. Our team members are currently based in Pune, Bangalore, Hyderabad and Nagpur in India and Copenhagen, Denmark. 

Our technology is offered under a comprehensive program called SAVE - Screening Assisted Virtually and Early for CRDs. We are working closely with National Health Mission, Government of India, JanCare program on project implementation. We have signed a MOU with Mahatma Phule Backward Class Development Corporation of Government of Maharashtra to train 500 marginalised youth from SC/ST community as SAVE Coordinators. These coordinators will then work closely with the Primary Health Care facilities.

55 Thousand+

Our solution is battlefield tested, regulatory approved and medically appreciated. Our efforts are recognised by BIRAC, Govt of India and we are incubated with AIC CCMB India and Healthtech Hub Copenhagen. We have also won various awards and recognitions for building innovative equitable health solutions from OPPI (Bayer Pharma), Qualcomm Design In India, AIM PRIME top 10 national innovations on health, JanKare award, The Most Disruptive Healthtech Company in India (ZS Prize 2023) etc.

Our next challenge to solve is make it "scalable operationally in India and then at global level". The technology developed is scalable but we need to make sure that it reaches masses. The main goal for applying to Solve is to establish right partnerships and get the ecosystem support to take our solution to grassroots - across the globe especially in fragile contexts where access to affordable screening and diagnosis is desperately needed for COPD, Post TB Lung Impairment, ILD, Long Covid and Asthma. 

Chronic Respiratory Diseases are currently managed in Secondary or Tertiary care facilities when disease is at a late stage of progression. 

In fragile environment - patients can not reach Secondary or Tertiary care facilities and in normal circumstances also it becomes very costly for the patient to avail services from secondary and tertiary care facilities especially when disease has reached a late stage. Our solution provides a comparative level of diagnosis and treatment plan as offered by Secondary or Tertiary care at Primary level using innovative technology of AI, Machine Learning and IOT. We have also used some simple but innovative features such as Position Sensor and Auto Calibration Trigger in the Spirometer device to assist Primary Care staff for achieving higher quality of Spirometry tests. Our Clinical Decision Support System (CDSS) software is powered by our proprietary and  Machine Learning algorithms that are designed to work "locally" based on the initial screening data to be collected in each demographics.  The algorithms continuously improvise the Machine Learning Models used for Diagnosis based on local data collected during screening stage. This means the diagnosis is more specific, easy to generate and easy to interpret. Our algorithms refer to our proprietary Lung Health Index (LHI™) score to generate a Functional Respiratory Imaging simulation for easy interpretation of reports.
We also provide

Next Year Goals:

• Conduct 1 million screening and diagnostic tests in partnership with various agencies and organisations in India especially under National Health Mission and JanCare programs of Govt of India
• Get FDA, CE and other regulatory approvals for a global launch

Next 5 Year Goals:

• Help more 10 million patients improve their lung health globally

1. How many health workers - midwives, nurses, PHC staff can use our technology to do screening and diagnosis of Chronic respiratory diseases

2. How many At Risk patients from fragile settings are screened and diagnosed with COPD, Asthma, ILD, Post TB, Long Covid etc.

3. Reduction in pressure on secondary and tertiary care, reduction in Hospitalisation and Deaths

4. How many patients could be managed at Primary Care versus Speciality Care

5. Increased lifespan for patients

Impact - What will change in long term?

Primary Healthcare Infrastructure across the globe will be empowered with Briota's technology for Early Screening and Diagnosis of CRDs. In long term, patients will not be required to travel to Secondary or Tertiary care facilities in big cities and districts, in unsafe conditions in fragile settings with risks of personal safety and loosing their daily wages. Briota's innovative technology will be fully integrated seamlessly with local healthcare solutions and systems. The solution will help millions of patients diagnosed early and precisely, saving huge costs and lives.

Outcomes - What will change in the medium terms?

Primary Healthcare in India will be strengthened to do early screening and diagnosis of CRD patients especially in fragile settings for elderly, women, children, daily wage workers, LGBTQ+ community who do not reach to secondary or tertiary care early and only get symptomatic treatment today at primary care for chronic respiratory conditions. We aim to reach out to 10 large and 20 small states in India by year 2030.

Outputs - What will change in the short term?

With 500 SAVE Coordinators (trained and recruited by Mahatma Phule Backward Class Development Corporation) we can reach out to 2.5 Million patients annually in Maharashtra State in India. With population of 130 Million, the prevalence for CRDs in Maharashtra State is 11% i.e. 14 Million and we can cover 7.5 Million patients (half of affected population) by year 2025.

Activities - What are we doing to bring the change?

1. Training more and more youth as SAVE Coordinators to conduct Spirometry and Impulse Oscilometry

2. Partnerships with Hospitals, Research organisations and government agencies to reach to large population in India

3. Dialogue with partners in other countries in Africa and Asia for scaling up with Briota technology

4. Pivotal clinical study in Nashik Maharashtra for a population of 10 thousand high risk patients

Inputs - What are we investing in the project to bring in the change?

1. Founder Money

2. Grant Money

3. Prize Money

4. Foundation CSR funding

5. Team of full time 40 Engineers, Researchers and Technocrats working from Pune, India and Copenhagen Denmark

Our team in India is led by our chief of operations and cofounder - Ms. Aditi Pais and more than 60% staff is women team members.

We work in B2B2C space. We offer Per Test Model to Government Agencies, Hospitals, Corporates, Social Enterprises. We charge between US$3 to US$5 per patient for a full services model - technology, consumables, technician, diagnostic report, treatment plan recommendations etc. For technology only we offer per screening, per diagnostic test starting at US$1. Our key customers include state exchequer responsible for public health. Currently spirometry and impulse oscilometry is available only in secondary and tertiary care and many a times runs into availability issues due to unavailability of technician or a pulmonologist. Hence our services and solutions are and will be in high demand for both primary and secondary care facilities.

We are a revenue stage company. The organisation is also supported financially with Founder Money, Grant Money, Pirze money, Foundation CSR Funds. We have plans to raise our external investments by Q4.

We have received multiple grants, prizes worth US$300K+ both in India and Denmark so far. These grants and prizes have come from BIRAC Govt Of India, JanCare Department of Health Government of India, Department of Science Govt of India, Qualcomm, Bayer Pharma, Innovation Foundation Denmark and Danish Life Science Cluster Denmark.