Waqaas Al-Siddiq, PhD, MSc is founder and CEO of Biotricity of Redwood City, CA.
Tell me about yourself and the company.
I’m an engineer by training. I got interested in remote patient monitoring because I did a bunch of work at my grad school in remote monitoring. One of the applications was healthcare. I took a weird road through my career, as I think all entrepreneurs do. But I really felt that the future of healthcare was going to be in remote monitoring. I founded Biotricity and the rest has been history.
How are clinicians using real-time ECG monitoring and how does that compare to old-school Holter monitors?
There’s an application for both areas. We just recently got into the Holter space as well. But our focus has been chronic patients, patients where you have a risk of a heart attack or a stroke and where 87% of patients are asymptomatic. Many of these issues are happening at nighttime while you are sleeping. Traditional solutions are recording your data, but they are not monitoring. It’s called Holter monitoring, but the “monitoring” name and nomenclature in the industry is misleading. It is recording your data, which you then download later for analysis the week after that report.
If you are sleeping and you have chest pain and wake up in the middle of a heart attack, the real-time monitor is looking at your data continuously and analyzing. It’s a smart monitor. When it detects that you have crossed a threshold, it sends a message with that strip of data to a call center, where we have nurses who know how to read ECGs and who can deal with emergency response. You can solve the problem for high-risk patients where if they are sleeping, you can get them in, you know what’s going on, and and you can treat them.
How do outcomes change with having a clinician on the other end of a real-time monitor versus consumer phone apps, where users have to initiate the reading and then react to vague “call your doctor” warnings when the app sees something resembling atrial fibrillation?
AFib is a good example, because a lot of people have chronic AFib. A clinician on the other side knows if you need to go to the hospital, such as if you’re in heart failure and won’t survive without immediate help. The clinician has enough data and can interrogate the device to get more data. By the time you get into the hospital, they know what’s going on.
Many times with our products, we see the patient’s heart going through pauses, or AFib burden that is increasing. That means that the patient’s heart is going to stop, or they are going to end up having a stroke if the AFib burden is increasing. You get an alert at 2:00 in the morning, the nurse calls the on-call doctor, and they get the patient in. But they already know that the patient is going to stroke out, or they know that patient needs an emergency pacemaker put in. The diagnostic and the treatment has already been concluded before the patient is even there.
You are saving the patient’s life. But more importantly, you’re avoiding muscle damage. The big part of rehabilitation is that you have a catastrophic event, you survive it, but now you’re debilitated and you have to go through rehabilitation. Or maybe it’s been so catastrophic that you are going to have to live with a worse organ or a worse condition for rest of your life because they treated you, but got there late. This is where smart monitoring can really make a difference.
Patients at home call 911 and wait for first responders to evaluate and transport them. How does the process work when your monitoring center detects a problem?
They patient won’t always even know. We have had cases where patient is taking a nap, something happens and the alert goes in, and the call center looks at it and decides, this patient is going to go into heart failure or have a stroke, so we need to get them in. The doctor is called, looks at the data, and says yes, get the patient in. Usually there’s either an on-call doctor or a prescribing doctor, depending on how they set it up, so some physician is called once the threshold is met. They will say, call the patient’s family and tell them to come to the hospital immediately. Or they will say to call 911, depending on what is happening. The physician is directing it.
Many times you call the family member and tell them to bring the patient in for an emergency intervention and they say, “Oh no, that can’t be. They are taking a nap.” We say that we understand that they are taking a nap, but you need to wake them up and get them to the hospital because they are having an emergency event.
Smart phone atrial fibrillation apps trigger a lot of false alarms and send patients to cardiologists who determine that treatment isn’t necessary. How can that process be improved?
The bare minimum for effective diagnostics in the heart world, in the ECG world, is 24 hours of continuous analysis. Apple Watches and consumer products collect 30 seconds of data. They are not providing a holistic view of the patient, and even 24 hours doesn’t give you a good chance. Holter monitors and mobile telemetry monitors are being used from seven, 21, or 30 days of continuous recording. False positives and warnings about non-issues could just be random occurrences within that 30 seconds, but in the broader spectrum of 20 days of data, it’s a blip.
We all have these blips, but our core health is solid. Smart monitors can track and watch this, and if the blips hit a threshold, the doctor sees that. Sometimes the doctor will say, this is not an emergency and I’ll see the patient when they come in. The event doesn’t meet the requirement for an emergency intervention, but they are making that call remotely.
That also happens when the device alerts for something, it goes to the call center, and the nurse looks at it and decides that it’s an issue, but not a life-threatening one, so they might not even need to call the doctor. Or they decide that it could be life-threatening, they call the doctor, and the doctor decides that it’s not an emergency and books them an appointment within the next couple of days.
What was the business case for developing the non-prescription Bioheart chest strap monitor that is sold in the competitive consumer market?
What we see is there’s 15 million Americans, maybe 17 million now, who are diagnosed with cardiac issues. We are part of that diagnostic flow. Once they have been diagnosed, it’s a lifelong condition. Whereas diabetics have glucometers, cardiac patients have nothing.
We created Bioheart to take the technology that we use to diagnose patients and provide it in a simplified, non-diagnostic scenario for personal use. It can collect long-term data on that individual so that patients can better manage their lifestyle. It targets individuals who are diagnosed or at risk for cardiovascular issues so that they can get that broader insight, because cardiac issues are intermittent and most patients and individuals are asymptomatic.
They don’t have any insight. Diabetics can prick a finger, collect their glucose, and now can use continuous glucose monitoring without even doing the prick — it tells you your level and you can make adjustments to your lifestyle to manage that. Cardiac issues are way more complicated because they are intermittent and many patients don’t have symptoms. You have to collect a long amount of data to determine what you should or should not be doing. We introduced the Bioheart because we felt that individuals needed a tool, and in the marketplace, 30-second and one-minute data collections are just not good enough. You really need long-term data, and that’s why we built Bioheart.
Your website mentions pain management, which is fascinating since pain is monitored as subjective patient perception rather than a physiologic measurement, with limitations that can lead to undertreatment or addiction. How do you see your cardiac issue model applying to pain management?
Exactly right, pain is very subjective. One of the reason we started looking at pain and some of those issues is because pain can manifest itself with an elevated heart rate or elevated temperature. It will show up in certain metrics, including how you are moving. With our Bioheart product and how we are moving in terms of remote monitoring, we looked at how can we quantify and align pain.
The other thing with pain is that everybody’s concept of pain is different. One person’s pain level of seven might be a pain level of two to someone else. How debilitating it is subjective. One way to contextualize that and provide some objectivity to it – it will still have to be individualized — is to look at their biometrics. Someone may have a pain of seven, another a pain level of two, but both of them have elevated heart rates. One person has a natural tendency to deal with a certain kind of pain better than another. Another thing is the types of pain that individuals have. Some people can handle throbbing pain, other people can handle sharp pain. It’s all over the map.
Our focus is to try to provide objectivity and link it to remote monitoring so that we can use data to support and provide insight to individuals so that they can better manage their conditions.
How do you see pain monitoring evolving into a business?
As we grow and as we continue to make inroads from a business perspective, it’s a service that we are providing to bring in that objectivity. We are not really focused on the nuts and bolts of revenue, rather that we have the technology, it’s helpful, and let’s make it available and we will provide it at free of cost.
Long term, how it will transform into a business is that a lot of pain docs need a data point that individuals are engaged with. If they can do that, then they can bring that as a part of their way of managing pain for those patients. The commercialization, the business, will align pain specialists and make it a part of their assets and toolkit to help manage individuals’ pain. In that regard, we can create reporting and ink that to reimbursement. If we can achieve the goal and show outcomes that this tool is effective and offers objectivity that makes sense, then that is something that will become commercialized with insurance and we will have a commercialization pathway.
What are the company’s goals over the next three or four years?
One is to build our diagnostic product. We have multiple products coming out with the Bioheart and with the Holter solution. The next year or 18 months is about transforming into a platform company and building the entire cardiac ecosystem so we can track a cardiac patient from diagnostic all the way to disease management and have multiple touch points with them through their cardiac journey. We are with them every step of the way, and so building that brand.
Then 18 months after that, to democratize cardiac care and delivery across the United States. There aren’t many cardiologists — 70 million people at risk, 17 million diagnosed, and 25,000 cardiologists. It’s just too many patients. Many of these individuals have no access. In the smaller suburbs and rural areas, your access to the specialist is limited at best. We create time if we can make cardiologists who use our platform and technology more efficient. It allows them to focus on the patients that matter and the patients that are stable. We enable them with the tools to manage their conditions and we create time. Creating time and efficiency for cardiologists allows us to improve access. We can use digital help and virtual care to do remote diagnostics and deliver care across the spectrum. That’s our goal and our vision.
In three or four years, you will see a very different company. We are laying the groundwork today. I always joke with my team internally and my reps that everybody thinks Biotricity is playing checkers, but we are playing chess. We are releasing components of a broader picture that will create a domino effect three or four years from now, where we provide accessibility to cardiac solutions and cardiologists in an easy way by big technology, as a conduit for not only those individuals who are stable, but also to create efficiencies so that access is improved.