Again, we are looking at a promising start-up, which uses blockchain technology to develop a platform in healthcare, called “Sunny Lake”, based in beautiful Paris. It is built with the Ethereum blockchain and aims to offer an exchange platform for different stakeholders in the healthcare system like patients, physicians, researchers or laboratories. Their goal is to provide a toolkit, data and experts in order to conduct health and life science studies, in an efficient and effective way. What the benefits for patients/users are and why Sunny Lake is not a typical start-up, Jean-Christophe Despres (President and Co-founder) shared with us in an interview.

By Tram Trinh and Sunjoy Mathieu

Jean-Christophe, you are a French globetrotter and serial entrepreneur in the marketing field. Why did you decide to enable clinical studies with an emerging technology like blockchain ? Can you tell us more about you?

Jean-Christophe Despres: My entrepreneurial journey started back in the mid 90’s working on online communities. I later created the first ethnic marketing agency in France where I had to deal with public health campaigns targeting migrants. Once again, I’ve used a community-based approach. Later on, I’ve participated in a think tank, Club Jade, which launched those amazing projects on Big Data and Cancer, and an open source portable echograph. They happened to start from my office at the time and I had many opportunities to see the power of their growing communities. Talking with patients especially experts dealing with chronic diseases convinced me that a health community using blockchain technology would address major challenges in health and life science studies such as transparency and data privacy.

What is your Sunny Lake product?

Sunny Lake is an e-health platform based on Ethereum blockchain on which patients, physicians, researchers and labs can collect, share data and therefore build and test future health and life science studies in an accelerated mode.

This platform should become the meeting place for sharing between patients, physicians, research and lab organizations where everyone can find at an affordable and controllable cost, the tools, the data, the experts and the communities necessary to finalize the first steps of such studies. Our initial version of the Sunny Lake has just been launched and now we are developing an enhanced version, expected to go live in June 2018.

You mentioned Etherum is underlying your blockchain. Why select this one, since there are several other existing blockchain technologies?

Ethereum was designed to enable users to build smart contracts. Those contracts are algorithms which enable stakeholders to exchange data or counterparts, commonly referred to as tokens, in a secured and simple way. As our ecosystem involves many interactions with different entities (pharmaceutical companies or public labs) or individuals (experts or patients), we think that Ethereum is a fundamental layer for future applications. In addition, as a platform, we wanted to work on a public blockchain.

We understand that the benefits for patients and for the medical is a trustworthy reliable and traceable universe of questionnaire protocols, data and consent that can accelerate medical research findings. Is our perception correct?

With blockchain, there’s already a feature which is not questioned much, it’s timestamping. Bitcoin is running for many years with not a single fraud or bug on that matter. We are therefore quite confident with our business proposal regarding informed consent for instance. But there is more to it which is as important maybe as the internet revolution: the tokenization of our economy. This simply means that everybody in a community should be entitled to be rewarded for their participation through a common process. For Sunny Lake that means that there will be strong incentives for sharing data. We expect to receive massive feedback from patients not only because they will be rewarded but most of all because they will be able to measure up their own impact on research.

How do you envision the speed to adoption as everybody relies on trust and for the time being your direct customer is a business organisation, that will then reach out to the end user patient/consumers?

Well, this is why we are not a startup like others, always rushing. We need to build our own circle of trust, explain the impact of technology on business and change habits, participate in creating new standards. As long as we are moving forward, implementing our technology step by step, it’s ok. We can perfectly understand that the industry is watching us with interest and doubts. Hopefully, there are some pioneers and we are glad to receive more and more trust. Meanwhile, patients are eager to see this new age coming. It going to take a couple of years but we think it will bea fundamental change.

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It seems trust is a non-negotiable condition to impact a scaleable volume of questionnaires and consents not only in France but also globally?

The only issue is of a legal nature and it’s barely affecting us for what we are doing at the moment. For other matters, technology doesn’t care about borders. People suffering from rare diseases are already used to communicating with each other worldwide. What we want is us to have a greater voice and empowering them to initiate new research.

Jean-Christophe Despres, President & Co-Founder of Sunny Lake

What is the profile of companies using Sunny Lake? And why in your opinion do they trust you as all is based on Ethereum technology that other blockchain solutions could use?

Many pharmaceutical companies now understand they need a new deal with patients. It’s not always in their corporate culture and sometimes difficult in their highly regulated environment but they are eager to participate in trustworthy protocols. One of our client has challenged us because they didn’t want to have any record of patients public keys. It helped us a lot in designing the platform. If a company wants to use blockchain as a process, it doesn’t require Ethereum and we did that too. But most of them value this concept of community where a public blockchain makes full sense.

What are the concrete use cases you have been working on and was is the outlook for Sunny Lake?

Some real life science studies in Switzerland with the goal to create a tool for online consent, transparent, reliable and traceable. Every patient in the study could download on a third-party website the pair of encryption keys they would use for their consent. They are the only owners and holders of the keys. In order to have real consent, design of the protocol, training through simple videos were key to ensure complete understanding of the study purpose. The main investigator of the clinical study and himself could only receive the consent form to sign himself through e-mail and get the signature notarized by the blockchain. A first of its kind in real-life conditions.

As next steps, we will even receive more reliable data thanks to a methodology of registry based on transparency and unfalsifiable protocol, hence a stronger engagement from patients who can control their data and their traceability and enrollment probability.

Also, we’re launching an Initial Coin Offering. It directly relates to what I’ve mentioned regarding the tokenization of economy. Concretely, issued tokens will not only be displayed only to Sunny Lake but also to strategic partners that will contribute to build an improved ecosystem of clinical research. Patients will benefit from it but it may also involve other start-ups as well as pharmaceutical companies.

In a nutshell, what’s your critical life mission?

Contrary to many projects, we are not a portal, nor a “DMP” (Patient Medical Record) but an actor and conductor of an ecosystem. Our mission is to contribute to the best flow of quality data serving the future medicine based on big data and artificial intelligence. We want to facilitate data interoperability by creating meta data standards and by systematically notarizing exchanged data on the blockchain.

Thank you, Jean-Christophe!

Learn more about Sunny Lake and their projects:

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With the highly-valued support from your business partner, Tram Trinh (CEO VITAnLINK, A Health Tech Accelerator in Paris), we have the chance to look over the Swiss start-up border and follow some international companies who are engaged in the area of healthcare and the opportunities the blockchain technology can offer in this field, as a benefit for people and patients.

I’m proud that we can provide our HEALTHINAR followers with a glimpse of the exciting times and dynamic team spirit of Iryo, a very promising start-up. With a patient-driven approach, they are developing an open-sourced EHR platform, that gives patients, hospitals, and medical research institutions complete control over their healthcare data. Their goal is to create a global and participatory healthcare ecosystem, based on the values of data security, maximum interoperability, and privacy.

Enjoy this week’s read, an interview with Vasja Bočko, (CEO Iryo) and Tjaša Zajc (Business developer and Communications Manager, Iryo).

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“We take best practices learned in developed countries and bring it to the developing ones” – or: How Iryo is creating a global participatory healthcare ecosystem

Being from the world of IT, what urged you to tackle the highly regulated healthcare sector coming from the advanced IT world?

Tjaša: Compared to other industries, IT in healthcare is years behind in offering healthcare providers and patients a good user experience. Most IT providers provide vendor lock-in systems, making the exchange of data and interoperability extremely difficult. We are creating a system that is built on a standard that can increase interoperability (openEHR). Moreover, Iryo will be open-sourced, making sure there that vendor lock-in is non-existent. Blockchain adds a layer of transparency and immutability that will make the system more secure and trustworthy.

And so, why do you believe that Iryo will be able to outperform the big players in this space?

Vasja: I would say they all are facing the innovator’s dilemma, in reference to the book of The Innovator’s Dilemma: When New Technologies Cause Great Firms to Fail by Clayton M. Christensen. Because these traditional players have always been successful in existing models, they can’t get out of this legacy mode easily and quickly.

The markets we believe we can have the fastest impact on are developing markets such as Africa and/or parts of the Middle East, where the markets and regulations are less developed, leaving space for new players.

How does Iryo turn this vision into reality?

Tjaša: We are currently working with a non-profit organization called, Walk with me, that is active in refugee camps in the Middle East. It was introduced to us by one of our advisors, Brian de Francesca. Facing a severe lack of resources, most needs are tended to before an EMR system in a refugee camp. On the other hand, patients with chronic conditions tend to spend many years in these camps. Offering a system, in which they will be able to have their medical data stored on their smartphones is a step forward to improving their continued care. When they leave a refugee camp, they will be able to take all their medical data with them. Blockchain technology will be the primary solution enabling them to become the decision makers around their data. They will be able to grant or revoke access to their medical records based on their needs.

Vasja: Refugees have minimal resources, but one thing that holds a significant amount of to them is their smartphones and having internet access. The turn over of healthcare professionals in refugee camps is high, as they come through various NGOs. We are building an IT system that will be user-friendly for healthcare professionals and patients alike, consequently helping with the accuracy of medical records.

Given the number of refugees, and the capacity of smartphones, how can they store all this data?

Vasja: Big files such as imagining diagnostics results, will not be stored on the phone directly. Iryo provides a cloud-based platform that can store the additional data from the patients free of charge. The refugee project is our pilot project to prove the concept and eventually design a model for scaling to other places with similar challenges regarding connectivity and infrastructure.

What are your target segments and business model?

Vasja: Our software will be available as a SaaS freemium service. If a healthcare provider has IT capabilities for maintenance, they can use it as such or pay us to service them. Additional revenue streams will be local customization, tailor-made solutions. The most prominent potential we see is for Iryo to become the global platform for researchers who would have to pay for the access to patient records by incentivizing patients to open their medical files in exchange for Iryo tokens.

What is your unique message that you would like to send to entrepreneurs, investors, healthcare providers, researchers, here and today?

Tjaša: We will need to ramp up our development team in the near future in order to further develop a robust and reliable product.

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The core Iryo team with some of the advisors

What tenacity and long-term commitment! What drives you guys?

Vasja: We have all worked in IT which generally benefits from quick progress. A few of us initially worked in healthcare which is where we observed the inefficiencies concerning IT infrastructure across the board. The gap is massive, and unacceptable in this day and age. We want to bring the best practices and approach in IT to the healthcare world.

Tjaša: My personal interest in healthcare derives from being a chronic patient for more than 15 years now. As a former healthcare journalist, I follow closely where healthcare system inefficiencies are and what solutions could address them. We want to be the catalyst for change.

So this is what makes you wake up every day?

Tjaša: Yes, striving to create a meaningful social impact.

Kind of a Robin the Hood in healthcare?

Tjaša: I wouldn’t quite say Robin Hood as that would mean we would have to steal from the rich to give to the poor, but yes we attempt to take best practices learned in developed countries and bring them to the developing ones.

Learn more about Iryo and their projects:

By Tram Trinh

Bayer announced a new global head for digital health and finished its 3rd accelerator batch. Merck has officially doubled the size of its venture unit and is launching its 3rd accelerator batch in 2017. Many ‘big pharma’companies including Roche, Pfizer and Takeda have started to reach out to the startup world, attending most of the key European digital health events (Health 2.0, ECHAlliance, FT healthcare, Frontiers Health etc.). Not surprisingly, these initiatives created a flow of digital health entrepreneurs rushing towards partnerships with the big pharma companies in hope to engage with a potential exit candidate.

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Pilot-isis – a typical infection of the pharma companies

Nevertheless the path to exit with a big pharma can be a daunting journey that can last a minimum of 2-3 years. Like any big corporations, they are huge organizations. Disseminating new digital health products across a base of a minimum of 100,000 employees (scattered around the globe) is a serious long-term effort that requires a lot of attention and time.

One of the major pitfalls a startup can fall into are pilots that end up getting stuck in one country/division/function and never scale globally. For example, if startups knock at the marketing door, chances are that their job priority in an affiliate or region is to launch a drug and deliver targeted numbers. Their focus is miles away from scaling up a newly experimented digital health innovation, often perceived merely as an add-on to their drug-selling business model (unless it’s an app that can be used immediately as a marketing channel to support drug branding).

“There is some unavoidable investment time”, says Fredrik Debong, co-founder of mySugr, a startup focused around diabetes. “It is important to define and agree on the KPIs with your C-level pharma contacts right from the start and maintain an up-to-date discussions you will most likely shorten the timeline.” If you start the relationship with no incentives for the pharma management to drive a project with vague uncertain envisioned results, you can be guaranteed your pilot remains a pilot for a long time.”

One success of mySugr with Novo Nordisk relies on the clarity of the promise from the start: educating the market fast based on a trusted loyal base of patients. MySugr B2C model represents a recurring loyal user base of close to 1 million patients. And recent news proved it right: Swiss Pharma € 50 bn Roche acquired MySugr in June 2017 at an estimated € 70-80  Million sale prices to advance with MySugr Roche’s own digital strategy on the diabetes market.

Medtech – alternative gate way to the health care system?

However, with medtech it appears that pilots are not needed and the timeframe between the date of initial discussions to rolling out the digital health solution can go down to 6 months, as demonstrated by mySugr in partnering with Roche. Traditional medtechs are currently in transition: they must adapt to several metrics shifts in reimbursement regulation, consumer empowerment, digital enablement and their competitive landscape. As a result they are opening up faster to increasing partnerships with the digital health startup ecosystem. Here are the 7 driving factors:

1)   New European MDR Medical Device Regulation

The 5th April 2017 EU Medical Devices Regulation requires more information transparency to consumers, vigilance and market surveillance, safety and reliability in medical devices. This is leading to portfolio rationalization at medtechs and represents an urgent incentive to invest “in new capabilities such as data analytics” EY 2016 medical technology report

2)   Shrinking revenues, pricing pressure from influential payers and hospital systems, in European socialized markets

This has forced medtechs to co-develop and partner with tech companies outside of their traditional boundaries to deliver shared-risk and value-based outcome to payers and patients. Omar Ishrak, CEO Medtronic, at JP Morgan Health Care Conference January 2016 already mentioned his “New Partnerships and Business Models based on Joint Accountability”. A few months later, Medtronic partnered with the digital brain of IBM Watson to improve diabetes treatments.

3)   Data as a common language

Christian Krey, CEO of Emperra, explains to us that “Medtech companies in our ecosystem have always been familiar with creating and using data for patients’ benefit. They understand the value of data and how to use and combine them to find new business models. Most Pharma companies still see their future in selling molecules, having a longer way to data-driven business models. For a digital health startup a partnership with a medtech company will leverage both partners.

patient centered care

4)   A “patient-centric offer” as the baseline

between medtechs and digital health startups, says Gabriel Enczmann, Director Business Development at mySugr. “They are both allowed to market and speak to patients directly while pharma is highly regulated on what can be said or not said about their product to patients “

5)   Moving “beyond the product“ into long-term Integrated health solutions.

Andreas Joehle, CEO & Chairman of the board of directors at Hartmann, stipulates clearly that his industry must re-think healthcare to create sustainable solutions: “we need to drop individual agendas and have an open-minded conversation about how to make real improvements. This needs to involve stakeholders from the entire healthcare value chain, as well as having people from outside the industry to bring new perspectives”. “Mobile apps have quickly established themselves on the healthcare scene and can help monitor everything from blood sugar levels to heart rates and cholesterol levels”

At Frontiers Health 2016, Dierk Beyer, Partner and co-founder of TransAct Advisory who see real-life digital health exit transactions confirms “If you combine a gadget with an IT platform, this can be interesting for both Medtech and startups. The links to disease monitoring represents a tremendous value to Medtech”

6)   The unique value of proximity and relationships built by startups with their end-users

Pritt Krus, CEO of Dermtest, from Estonia emphasizes how relationships catalyze sound  discussions: “As a digital health startup employing software and hardware solutions we have several potential cooperation points; yet quite often the extent and relevance of cooperation possibilities become clear only after a good relationship has been established with our main stakeholders first – doctors and patients – and there is initial traction with the service.”

This growing loyal community of doctors is what Touch Surgery, founded by CEO MD Jean Nehme, succeeded in building. Its cutting-edge surgery simulation app helps surgeons train ahead of complicated surgery procedures, or to familiarize themselves with new surgical procedures. Jean highlights that “The key to startup success is the ability to articulate the “new” and the “old” way in the startup “pain killer” value proposition to your Medtech partner. The winning agreement between both sides lies somewhere between the new disruptive way and the traditional model looking at long-term and existing practice”, which Touch Surgery did with J&J Ethicon, Stryker, Smith& Nephew and Zimmer to name just a few.

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7)   Medtechs and Digital Health Startups are ready from both an organizational and investment perspective to build strategic collaborations

Creating a global and local synergy in the partnerships

As Gabriel Enczemann from mySugr reveals, their successful startup approach has been on two levels as they are expanding from Austria, to the US, Germany, Italy, Belgium and Canada with the big Medtech Roche Diabetes. Speaking with champions and affiliates from two continents did help them build a global offering service that includes as well ready-to-pick options for country affiliates.

Synergy between startup R&D and medtech Regulatory know-how

“Partnering for a startup with a big medical device organization is like having an external regulatory department, and the startup is like the medical device organization’s innovation External lab” says Frederic Lordachs, co-founder and partner at Doctoralia from Spain.

One thing is sure: Roche’s acquisition of MySugr predicts further digital health acquisitions by Life Sciences companies, increased digital health valuations and investor interests. What digital health startups have recently built with Medtech companies will pay off in a shorter timeframe.

tram

About the author
Tram Trinh combines executive entrepreneurial and corporate health tech industry experience, as well as non-executive roles across Fortune 500, Privately-held Medium-Sized Business to Not-For-Profit organizations. She has lived and worked worldwide and founded VITANLINK to bring societal impact, co-founding and co-developing ventures in Medical Devices & Diagnostics | Telemedicine | Digital Health-eHealth | Artificial Intelligence

Picture sources
https://medtechboston.medstro.com/blog/2015/02/23/massachusetts-bets-on-digital-health https://www.healthcare-informatics.com/blogs/rajiv-leventhal/are-consumers-ready-patient-centric-healthcare
http://www.kpcb.com/blog/six-truths-digital-health-entrepreneurs-need-to-know