An interview with Marko Höynälä, Founder & CEO Kipuwex'Revolutionizing patient monitoring and pain assessment at a fraction of cost'

Marko is an experienced Finnish entrepreneur and innovator with a number of game-changing Internet of Things (IoT) products to his credit. His latest venture, Kipuwex, which he leads, has made entry into the Pakistan market. On his maiden visit to Pakistan, BR Research got a chance to pick his brains to discuss about the product, which aims to be a game changer in the private and public medical industry, by introducing low-cost pain assessment and patient monitoring portable devices. Below is an edited excerpt from the conversation.

BR Research: How did Kipuwex start and what brings you to Pakistan?

Marko Höynälä: I have always believed there was a need to do something innovative for the healthcare. In 2017, Oulu University Hospital, conducted a study on issues faced by their doctors. One of the problems faced was pain assessment, which caught my interest. There was no such solution in the world at that time. I worked hard on my idea and submitted the proposal and won that competition. This is how it all got started.

We bring very good value for both professionals and patients, and we fortunately had a contact point that brought us to Pakistan. Our aim is to help both professionals and patients globally, and Pakistan offers us a great opportunity, given the size, which brings in the element of scalability.

BRR: Is Pakistan the first country that Kipuwex has been introduced into? Or is the product in the market already?

MH: We have customers in Finland and China, and the product is about to hit the market in Pakistan very soon. In Pakistan, we have been visiting hospitals, both private and welfare, to demonstrate the product and the interest from all hospitals has been pleasantly surprising for us.

Kipuwex provides a massive cost advantage to the hospitals, which are mostly equipment centric. With just a fraction of cost, Kipuwex allows hospitals to replace six or seven different equipment, with a wireless one.

BRR: Are there any unique use cases specific to Pakistan?

MH: Very surprisingly, hospitals have come with their own unique use cases. For instance, when an ambulance picks up a patient in Pakistan, there is no data monitoring while in transit, for what could be some of the most crucial minutes, in terms of diagnosis and treatment. With Kipuwex, just connecting the device would give access to all the data, which is otherwise lost, and helps start the treatment process, in a swifter and more precise direction.

And the beauty of the device is that it does not require any additional IT infrastructure to be laid in order to use it. The data can simply be accessed on a mobile phone or any other digital display screen, by the medical staff.

One use case that the hospitals have come up with is for the outreach programs as community service. Hospitals treating the underprivileged arrange frequent medical field trips to far flung areas. Going door-to-door in such areas means that carrying such heavy machines is not possible, and the routine checkups must be done manually, largely based on observations. The missing link in the outreach program is the inability to collect basic physiological parameter data.

Now with Kipuwex, a lot of data can be gathered, and children can be treated accordingly, by using a handful of devices, on potentially hundreds of children, in one locality. Mobility has a great advantage in the outreach program of the community service.

BRR: Does the Kipuwex device measure only pain-related data?

MH: It does measure pain, but in order to do that, one needs to measure a number of other parameters. We measure heart rate, temperature, HRV, movement, noise, ECG, and respiratory rate of the person. You would usually get these measurements from several different machines. We do the same with a small and portable, easy-to-connect device.

Kipuwex's own idea conception was not built around use cases for people coming into the hospitals in ambulances. Such patients are still, largely, able to inform the doctor about the pain, or the condition they are suffering from. Kipuwex is especially handy when it comes to measuring and monitor data for new-born babies, because he or she cannot tell.

In Europe, the key requirement was pain assessment, but in Pakistan, that is not the ultimate goal. It is the same product in Pakistan, but the use case is different. There are terminally ill or pediatric patients, where monitoring of physiological parameters is a good determinant of the efficacy of treatment. There aren't systems in place today to measure the pain, as it is all done manually.

Another use case is aimed at older, terminally ill patients, where the device is attached to a patient, who is at home. The device will help identify the difference between a physical and a psychological pain, and it will be monitored by the hospital, and the patient could be advised accordingly.

BRR: Do the big hospitals not have machines for the purpose of pain measurement?

MH: The machines would not tell the pain levels; it only provides the physiological measurement. The nurse assigns values to each of those readings, based on interpretations of the patient's state or response. Secondly, this has to be done on hourly or two-hourly basis. Whereas, with Kipuwex, you can have continuous and accurate monitoring.

For instance, if a child comes to the hospital, the staff will normally assess by the crying intensity. There will be a lot of interpretation and physical guesswork to ascertain the extent and cause of pain. Since it is a human assessment-based mechanism, no matter how standardized the process is, the results would differ based on a variety of reasons.

Kipuwex will record the physiological parameters of the baby, such as the intensity of crying, the muscle tension, the heart rate, and so-on and so-forth. The device assigns a number to the pain, which is based on the same standards applied globally, but the result is automated, and removes human bias.

BRR: If pain monitoring is not the key demand trigger in Pakistan, are the vital signs going to drive the demand?

MH: Nearly 70 percent of the interest we have seen in Pakistan is the vitals monitoring. That said, we have met doctors in reputable hospitals, who specialize in pain management.

Pain monitoring by the conventional method is very time-consuming. Specially in the case of pediatrics, assessing the impact of pain killers is very critical. Timeliness is priceless in treatment generally, but it is increasingly important, while treating infants.

Incubators for new-born babies is a huge problem in Pakistan, as they are very expensive. Children who are in nursery can be effectively monitored with this device, without having to go to bigger hospitals with incubators.

BRR: How is vital management in such huge demand, given all hospitals carry at least a minimum set of services?

MH: Vitals management is very much there across the length and breadth of the country, but it is the cost component that matters the most. One to two machines usually make rounds, catering 15-20 people. You need to have trained staff to run the machine and have a biomechanical department to maintain and calibrate the machines. Most importantly, machines are a capital-intensive investment. And the cost differential is massive, that it should not even come down to sot-benefit deliberations. For more accurate results, at substantially lower costs, it should be a no-brainer to have the device installed.

BRR: Where do you see the scalability coming from in Pakistan? Is it going to be the pediatric?

MH: The scalability is built on more than one use cases. Pediatrics is right up there, with a very solid case. Secondly, across Pakistan, in the private sector, it is for hospitals with sizable outreach programs. In the public sector, the use case is the ambulances, which are mostly just carriers in Pakistan.

On the rural public sector side, there are basic two-room healthcare units, and slightly bigger district hospitals - lacking sophisticated high-end equipment. In my opinion, a basic healthcare unit in rural areas, can make the best use of Kipuwex devices, at a fraction of the upfront and maintenance cost of conventional machines.

BRR: Are you building a case for the bigger hospitals to replace the existing infrastructure with Kipuwex devices?

MH: We are not talking about replacing, but it will certainly complement the existing equipment base. In emergency departments, the traffic is usually massive, which could mean all equipment constantly at work. In such a scenario, the Kipuwex device will come in handy, for an emergency patient waiting for his or her turn.

BRR: How long has Kipuwex been out there in the market?

MH: A product has to be invented to be in the market. The product is now done with all clinical approvals in place. Now, we have a contract with hospitals in China, which treats 9000 children per day.

BRR: Is there any direct or indirect competition for Kipuwex?

MH: There is no direct competition.

BRR: In terms of manufacturing the device, do you have the capacity to scale up on short notice?

MH: As far as manufacturing is concerned, we can produce a minimum of 100 devices to as many as 10000 devices per order. The factory line is there, which means production is not an issue. We are a Finland based company - a country with 5 million people with a declining birth rate. Finland is the Silicon Valley of technology, which comes up with fantastic products.

BRR: Are you in talks with the government sector?

MH: We do have government sector in pipeline, but on our first visit, we came with a clear mandate of reaching out to the leading private sector hospitals and those serving the underprivileged.

BRR: Are you suggesting that you would not necessarily need the government sector in order to scale up?

MH: If you look at the product, the positioning is fantastic as regards the government sector. The health sector has investment and infrastructure as two key challenges. Then there is the issue of staffing and recording patient history. This device is a one-stop solution to all those issues. With the present government's focus on healthcare, it is an ideal fit for us. The first visit was all about introducing the product, getting the feedback, and then come back later with proof of concept.

BRR: How soon can the product hit the market?

MH: If all goes well, Kipuwex could be in the market in two months.

BRR: On the technology side, does it involve data sharing with the third parties? How are you going to ensure data privacy, considering not everyone is as comfortable with data being shared on health matters?

MH: We do not need to keep any of the personal data of the patient at all. The data belongs to the hospital. We do not store any personal data in our Cloud, but the hospital cloud can store what they want. In Europe, we need to be very strict, with the information we are receiving. That is why we do not store any personal data, except for the age and gender.

The gender and age data are critical because it helps us improve and continuously fine-tune our algorithm. Every hospital has its own Information Management System. The Kipuwex device takes one global ID, which can be referenced through a hospital's IMS.

If you want to anonymize data globally, the identifiers that you need to remove are name, address, and contact details. The others are internationally allowed, but we are only using age and gender. As per the EU guidelines, we will be very strictly following our policy on data storage matters. We are not in the business of data monetization.

BRR: Who are yours healthcare and technology collaboration partners in Finland?

MH: Business Oulu and Oulu University Hospital are our partners on the medical front in Finland, who are active players in the ecosystem. On the technology front, one of our partners has been focusing in IoT for seven years. We have a partner in China with whom we have been operating for two years.

The Finish government supports product innovation with finance on the table. The product development is supported with grant from the Finish government.

BRR: How realistic is the threat of a bigger and more established player replicating the product?

MH: From a technical standpoint, reverse engineering is very common these days, and it can happen. But in healthcare, the biggest roadblocks are certifications, which is a very time -consuming process. We are expecting our certification as a medical device in a month. We are very excited about the business prospects in Pakistan and believe that our product can go a long way in reducing the costs associated with pain and physiological parameters assessment and will also help expand the outreach to the underprivileged.