Heart Warriors
Tricog’s unique technology helps save lakhs of lives in the remotest of locations, through accurate, quick ECG interpretations.
By Rosy Jose
Prominent physician and cardiologist Dr. Ramana Rao, whose elite patient list includes the likes of actor Amitabh Bachchan, the chief minister of Karnataka and a host of bureaucrats, is well-known in Bengaluru. Every Sunday for the past 44 years, no matter what the weather, Dr. Rao and his family travel to his farmhouse located in his ancestral village of T Begur (90km from Bengaluru). He runs a free rural clinic there, treating over 1,200 people at every visit. Apart from free consultations, the patients receive medicines for a week, nebulization, injections, and free cataract surgery. The weekly expenses for running the clinic amounts to around Rs 2 lakh, which Dr. Rao pays from his own pocket Rao is a social-minded caregiver and has inculcated the same values in his children. His son, Dr. Charit Bhograj, an interventional cardiologist, is one of the co-founders of Triton Health Services.
His experience at the rural clinic helped him realize that most ailments could be diagnosed easily by analyzing the symptoms; however, heart problems could not be differentiated from simple heartburn without an ECG. In 2014 alone, 5 million Indians suffered a heart attack, out of which 3 million did not survive; this translates roughly to one death every 33 seconds. Many of those who did survive sustained irreparable damages to the heart. “For an optimal chance of survival, heart attack patients need to be diagnosed in the first hour, which we call the golden hour,” explains Dr. Bhograj. However, the average time between symptoms appearing and treatment in India is over 6 hours.
Heart attacks can be detected by a quick test called an Echocardiogram (ECG). Unfortunately, most primary care clinics cannot afford ECG machines. The problem is further aggravated as many primary care doctors do not receive sufficient training in ECG interpretation. What our health system truly lacked was an integrated system of immediate diagnosis and response coordination.
Dr. Charit knew his expertise alone would not be enough to find a solution to this problem. In 2011, he invited Zainul Charbiwala, an electrical engineer with a Ph.D. from UCLA (IBM India & Microsoft), Udayan Dasgupta, an algorithms expert (Texas Instruments), and Abhinav Gujjar, a software platform architect (Thomson Reuters & Microsoft) to form the multidisciplinary core team of Tricog. In just four years, the visionaries successfully developed and launched a ground-breaking solution using machine learning algorithms—a cloud-connected ECG device. To put it simplistically, a physician’s 24/7 access to a ‘virtual cardiologist’.
Tricog has developed a small interfacing hardware box that can connect to most ECG machines. As the ECG machine records the reading, the hardware box transmits the ECG signals via the internet to the central Tricog AI hub. The AI system analyzes the ECG readings, comparing it to past data to gauge the risk level of heart disease and generates a report. To eliminate errors, checks are built-in at every level of the algorithm. Moreover, every report is double-checked by Tricog’s in-house cardiologists who interpret, verify and send back the final diagnosis through an SMS as well as a message on the Tricog mobile app. All this, in a matter of 6 minutes.
If it is found that the patient requires immediate care, they are rushed to a hospital where the medical personnel is provided with the patient information even before they arrive. “A 45-year-old bus conductor walked into my clinic with chest pains. We rushed him to the OT after Tricog reported it as Acute Myocardial Infarction in just 6 minutes. Today he is alive only because of the timely medical intervention which was made possible by the efficient and accurate diagnosis,” recollects Dr. Chandrasekhar of Bengaluru, who has been using Tricog since 2015.
In three years, Tricog has diagnosed close to 10 lakh ECGs and claims that it has not reported false results. Today, Tricog is one of the world’s largest healthcare AI companies operational in over 1,300 health centers and 200 hospitals across 12 countries. This scale of operation would ordinarily require a minimum of 1,000 cardiologists, but Tricog is able to deliver the same with only 50 doctors. This unique platform ensures efficient and accurate diagnosis for patients in remote locations as well. Tricog has adopted a unique pay per use model, which increases the affordability for even a humble general practitioner. In 2016, Tricog joined GE Healthcare’s Five. Eight healthcare accelerator programme aimed at improving healthcare outcomes for the world’s developing economies.
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In fact, it was the first company to be invited by GE to join the programme. Tricog was selected to be part of the 2017 summer edition of Think Next, the 10th cohort of Microsoft Accelerator. It was also one of the finalists of the 2017 World-Changing Ideas Awards in the developing world technology category. “We are fortunate to be part of the Five. Eight and Microsoft’s Accelerator,” says Dr. Charit. “The medical and technological infrastructure of these two giants will help us access their worldwide strategic advice and sales support system, which would in turn help hasten the process of delivering the Tricog Communication Technology to more hearts worldwide.” Tricog has filed a patent for this technology, which was completely developed and built-in Bengaluru. “The next step will be to unleash the potential for the algorithm to be used in personal health devices and wearable devices,” says Dr. Charit.
