Is there a medical test that you ought to do but that you have been avoiding for years? What would happen if you were told that the test will come to you in the next few days, and that you can carry it out independently, using a smartphone? That's the idea behind Healthy.io.
The company has developed a urine test to be carried out at home for identifying deterioration in diabetes and in kidney diseases. According to its figures, only half the patients in Britain (outside London) with these disorders turn up for a test once a year as demanded by their medical protocol. When a test kit is sent to their homes, the proportion rises significantly.
After the kit is sent to the patient's home, Healthy.io can send a reminder to carry out the test, worded so as to suit the specific patient, with the aid of a machine learning algorithm. Man or woman? IPhone or Android? Address? It turns out that all these variables affect health behavior. "This approach replaces a stern telephone call from the doctor, which is something to which people do not respond well," says Healthy.io CEO Yonatan Adiri. "The smartphone, on the other hand, is a positive experience."
When the patient presses on the link in the message, he or she receives step-by-step instructions on how to open the box, how to use the test receptacle, to give urine, to dip the dipstick in the receptacle for a period of time that isn't too short and isn't too long, to photograph it using a smartphone under adequate lighting, and the results are then analyzed and sent to the patient's medical record.
The company made history in July when it became the first to receive US Food and Drug Administration (FDA) approval for selling a clinical-grade test in the US, carried out using a telephone with no additional scanning hardware. There are other companies that offer online diagnosis, for diseases such as melanoma, but no medical decision can really be made on the basis of their tests.
What are the technological challenges in developing the test?
"The multiplicity of telephones and the multiplicity of lighting conditions. The dipstick for the urine test has small squares, each of which reacts to a different substance to produce a color. The result is not binary for each square, but depends on the precise shade. Today, the dipstick is placed under an optical scanner, and that was part of the reason that we chose to start out this way – all that was required was to demonstrate that we also offer a scanner, via the telephone."
For laboratory scanners, however, conditions are fixed, whereas out in the world the shades are affected by the photography and the lighting. It requires a complex algorithm to calibrate the picture from every telephone and in all lighting conditions in every possible home (unless it is simply too dark, in which case the patient receives a notification to switch on a light), such that the test will always yield accurate results.
Adiri founded the company as a sole entrepreneur in 2013. He has a unique resumé – he studied international relations, specialized in the war against terrorism for his second degree, and established his credentials when he served as head of technology in the bureau of President Shimon Peres.
He later worked as business development manager at electric car venture Better Place, and was a co-founder of online car-sharing service Getaround. "When I founded Healthy.io, no-one believed in us; the talk was of wearable products and telephone add-ons. I realized that smartphone cameras were improving, and I based the business on that. I called it "Kardishianomics", because for me Kim Kardishian represents the world's growing desire for pictures, for visual representation. This trend is insatiable, and I exploit it to do something good."
The company's turning point, Adiri says, was the recruitment of Ron Zohar, formerly product manager at Fiverr, as chief product officer. "When Ron arrived, he told me, 'I'm prepared to work here if the company's guiding value is tradeoff.' He meant that you can't set unrealistic goals, and that for everything you do, you also have to decide what you won't do. If I go into a new field, how will that affect my existing field? If I shorten the timetable by two weeks, I have to decide what I'll forego. That is the company's guiding principle to this day, and I communicate it upwards as well, to the investors."
The company's leading investor is Idan Ofer, with a personal investment of most of the $15 million that it has raised. It is currently in the midst of a further fund-raising round, which includes investors who are experts in the field. "Even when we failed in an initial clinical trial, Idan didn't abandon us and didn't do a down round on us, but gave us a further amount on similar terms so that we could continue," says Adiri.
"After that happened, I feared that the team would break up; every startup fights over them. But they stayed, and we managed to review the incident openly and without recrimination, which enabled us to carry out a highly successful second trial. When you're not a doctor and you develop a medical device, something like that undermines your confidence. Only now, after receiving positive feedback from the investors and from the FDA can I finally manage to breathe."
What will your next product be?
"Cataloguing of chronic wounds. At present, a nurse has to measure them with a ruler. We will make it possible to photograph them and obtain an immediate estimate of their size, and facilitate documentation of them over time."