Dr. Charit Bhograj
Company: Tricog Health
Co-Founders: Dr. Charit Bhograj (CEO), Zainul Charbiwala (CTO)
Headquarters: Singapore
Markets of Operation: India, Southeast Asia and Africa
Investors: Blume Ventures, Inventus Capital, University of Tokyo Edge Capital (UTEC), TEAMFund, Omron Health Care, Sony Sony Innovation Fund, SGInnovate, Aflac Global Ventures and Dream Incubator
Most Recent Funding: USD9m Series C (2023)
Tricog Health is a Singapore-based health AI company providing remote cardiac diagnosis and care coordination in healthcare centers across India, Southeast Asia and Africa. To date, Tricog health has screened over ten million cardiac care patients across India, Africa and Southeast Asia, and referred over 500,000 to critical care. Patients visiting one of Tricog’s 5,000 locations have access to the InstaECG solution and a remote team of cardiologists which, in combination with Tricog’s AI, diagnose cases in under ten minutes and refer critical patients to care at nearby facilities. The business is at break-even, with USD30m in total funding to date, and operating in 16 countries.
Tricog Health received GPCA’s inaugural Better Tech Award in November 2022. We spoke with CEO Dr. Charit Bhograj about combining remotely available cardiologists with AI technology to dramatically reduce diagnosis time, and how the business has expanded access to cardiac care in 4,000 healthcare centers across 16 countries.
Origin Story
Dr. Charit Bhograj: Most startup founders are smart, super driven, tech founders, serial entrepreneurs, but if you’d met me 15 years ago and said that in the future, I would be the CEO of a company, I would have laughed. I spent all my adult life doing only one thing: training to be the best in angioplasty. My love, passion and training were interventional cardiology. It took a long time to become one of the best. I thought I had it all: A huge practice, lots of money, a big car, a happy family… on the track to believing I would rule the world.
Looking back, I remember one incident in 2009, when I was practicing at one of the leading hospitals in Bangalore. A young 40-year-old software engineer decided he had acid reflux. Like any 40-year-old who thinks they are invincible, he took antacids and kept quiet.
But it didn’t get better. His GP – most GPs in India don’t even have an EKG machine – said, “What could be wrong,” and gave him some meds.
It got worse. The local community hospital did an EKG and said to come back when the specialist was there. Three hours later, this man couldn’t breathe. His wife said she would not listen to him anymore and brought him to the hospital where I was working. It was late at night. She brought their nine-year-old. I remember it vividly. He had no pulse and no blood pressure, he’d had a massive heart attack. I had to sit her down and tell her, “He’s in cardiogenic shock. The chance of surviving is 5%.”
In my mind, I was angry, shouting, “Why could you not have come earlier?” The cath lab was activated, we put a stent in, and he is one of the lucky ones who survive a massive heart attack and makes it to the hospital.
We all know that treating a heart attack within 60-90 minutes will save a life. But in India, the average time from the onset of chest pain in India to entering the hospital is 360 minutes. And from entering the hospital to treatment is an additional 53 minutes.
What changed that day for me was the realization that I was the luckiest person on earth, not because of my bank balance, car or house. If something were wrong with me or my family, with one phone call, we would get the right diagnosis and treatment. It doesn’t matter if you’re rich or poor, living in a big city or a town; whether you will live or die depends entirely on your access to healthcare.
“Heart disease kills 20 million a year.
What if we could save half?”
Heart disease is the world’s #1 killer: 20 million lives are lost a year, close to three million a year in India alone. But what if I told you there is a way to save 50% of those lives lost, if only we could diagnose them quickly enough. What would you do if you knew how to solve the problem? That was my burning question. I said, “I know how to solve this problem. It’s solvable.”
India will spend USD2t on cardiovascular disease by the end of this decade, and in every country you go to, the single largest spend in healthcare budget is cardiovascular disease. But specialists who exist only in the high towers of tertiary care are unable to serve those who need the most. There are only 5,000 like me in India, and I was only treating patients who were very rich or influential. In multiple regions where we’re working in Africa and Southeast Asia, even getting access to an appointment is a month’s wait.
The Product
The way we save lives at Tricog Health is to enable early diagnosis. Our customers are every place a patient would go as their first point of medical contact: Nursing homes, community hospitals, tertiary care centers, and government centers.
Our InstaECG solution is used in over 5,000 of these locations across 16 countries. An ECG device made by GE scans the patient, and the Tricog Communicator extracts data and sends it to the cloud, where our core IP lies. The core focus is not the hardware – it’s the AI element that enables us to scale the medical team and treat more patients.
We process the data and come up with one of about 140 diagnoses about your heart. A heart attack is just one of them – and a team of 50 remote cardiologists verifies that diagnosis. The medical team works 24/7; there has not been a single day since 2014 when there was a single gap or downtime in our service.
“It’s an AI + MD team”
The final, verified report goes back to the remote health center in any corner of the world in six minutes. It could be a healthcare worker in the Philippines, a family doctor in India or a nurse practitioner in Kenya. We can diagnose someone with a heart problem in six minutes, so treatment can start immediately.
It’s not enough to diagnose. The key is to enable positive patient outcomes. Identifying patients is great, but the aim is to close the loop and connect them to a treatment center. We link them to a tertiary care center where they can transfer the patient if needed; each step focuses on saving time and saving lives.
Next, we are tackling heart failure with our InstaEcho solution. Heart failure has the same or worse mortality rate as cancer, and it’s not diagnosed fast enough. In the UK, for instance, it takes close to 800 days before heart failure is diagnosed. 50% of cases are diagnosed at the ER. Now imagine the state of the situation in emerging markets. The one-year mortality is close to 60%. With this heart failure diagnosis product, we partnered with Astra Zeneca and started screening and diagnosing patients with heart failure in Mexico, Egypt, Malaysia, Philippines.
Impact
My goal is to save the 20 million lives that are lost each year. To do that, I need to screen 100 million people per year. In October 2022 we completed the screening of ten million patients. We started in India, then to Southeast Asia, the Philippines, Malaysia, Myanmar and Indonesia, and then we moved to Africa: Kenya, Nigeria, Rwanda and Cameroon. In India, four percent of heart patients are diagnosed with our technology.
Of those 10 million screenings, we know exactly the diagnosis: 50% were normal. 45% had some abnormality that may require further testing; 5% were critical and needed to go to the ICU. So nearly half a million critical patients have been diagnosed by Tricog service. (The trend holds worldwide since we started, irrespective of the country of operation.)
We have our devices deployed in over 5,000 locations across 16 countries. 98% of those locations did not have access to ECG machines before they partnered with Tricog. Our goal is to make our solutions affordable and accessible. We price our product to charge providers about one-third of what the end customer pays in the form of a monthly subscription that covers a set number of patient screenings. Providers do not pay out of pocket for the hardware; we build the cost of the ECG device into the subscription.