The Foundation for Polish Science (FNP) celebrates its 25th anniversary this year. To mark the occasion, we have invited 25 beneficiaries of our programmes to tell us about how they “practise” science. What fascinates them? What is so exciting, compelling and important in their particular field that they have decided to devote a major part of their lives to it? How does one achieve success?
The interviewees are researchers representing many very different fields, at different stages of their scientific careers, with diverse experience. But they have one thing in common: they practise science of the highest world standard, they have impressive achievements to their credit and different kinds of FNP support in their extensive CVs. We are launching the publication of our cycle; successive interviews will appear regularly on the FNP website.
We want to be the biggest player
Marek Dziubiński, PhD, the inventor of the technology used in a remote heart rate monitoring device, talks to Olaf Szewczyk.
OLAF SZEWCZYK: You are the founder and CEO of the Polish company MEDICALgorithmics, which has been hugely successful on the US medical services market. The device offered by MEDICALgorithmics, the PocketECG, which is basically a pocket-sized electrocardiograph, is the most advanced piece of medical equipment for monitoring the heart. Could you tell us something about the idea behind it?
MAREK DZIUBIŃSKI: Calling it a pocket electrocardiograph is slightly misleading. The PocketECG is a device for remote cardiac monitoring, it’s used to monitor cardiac rhythm disturbances. It works in a similar way to a Holter monitor, collecting ECG signals, but over a very long time, if necessary even three or four weeks. During that time the device records and transmits huge amounts of data, unlike a Holter; it is currently the only device in the world which transmits the entire signal. The data is processed on an ongoing basis and synthesized into statistics that a doctor can use to make the right decision on what treatment to give a patient. Therefore we offer not just a device, but an entire complex software system.
Tests using our devices sometimes take a long time, because arrhythmias can occur infrequently, once a week or once every two weeks. It’s important to see how the heart works during an arrhythmia as well as what happens between arrhythmias. If you feel your heart beating irregularly and visit a cardiologist, the doctor will perform an ECG and tell you that the test shows everything to be normal, but that doesn’t mean it actually is: it only means that the heart is beating normally after an arrhythmia. That’s why monitoring the heart over a long period of time is critically important. Some arrhythmias occur infrequently, paroxysmally, and then more often, until finally the heart beats only arrhythmically. Disturbances such as those need to be detected as soon as possible, when the attacks are rare and brief, without waiting for them to develop. Weeks-long diagnostics make sense in those cases, and are reimbursed in the United States, where we’ve been operating successfully for years.
Is the main difference between a PocketECG test and classic Holter monitoring the opportunity to carry it out over a long period?
With a PocketECG a patient can be monitored for a long time, above all for as long as is necessary. The system carries on working until a diagnosis is made, which could be as soon as the second day or not until the fourth week. A Holter usually works for a short time, such as 24 hours, although there are also Holter systems which work for much longer than that. But the problem is that a Holter records the data, the patient has to deliver that data to the doctor together with the device, and the doctor analyses it after the fact. That’s inefficient. It can turn out that the monitoring was carried out for too short or too long a time. Or the doctor might find that the Holter failed to collect any data because the patient didn’t notice that the electrodes weren’t properly attached. That is a waste of money. When monitoring via a PocketECG we keep checking remotely whether the patient is properly connected to the device. We can call them by phone to help them find and fix any technical problems that might occur.
Is saving lives the purpose of the PocketECG?
The PocketECG hasn’t been certified as a life-saving device, but it does happen on a regular basis that we discover something important and as a consequence a patient is urgently fitted with a pacemaker. Just recently we received a letter of heartfelt thanks from a US clinic that was able to save a patient’s life thanks to our device, because a very dangerous arrhythmia was discovered in time.
How often are arrhythmias the cause of death? How many lives a year can be saved as a result of monitoring via the PocketECG?
It’s hard to give an accurate number. There are relatively few cases of death caused directly by arrhythmias. It’s more important to prevent the complications caused by arrhythmia, which is a very common disorder.
It’s phenomenal that a Polish company has entered the US market and is such a spectacular success. How was that possible? Was there no competition?
There was, and that was a good thing, because it meant there was already a market for this service, we didn’t need to build it from scratch. Most importantly, the competition there had already dealt with the reimbursement codes for the service. Payments had been agreed and the rules were transparent. We obtained certification in 2009 to 2010. Our success was the result of several factors.
First of all, we offered a better product, one which is a generation more advanced than those of our US rivals. We had developed our device in Poland assuming a higher level of expectations from the American market. And we’ve managed to maintain our competitive edge to this day. Luck also helped, as our timing was good. American companies were not selling devices, but instead providing the medical services themselves, taking the reimbursement money. Thus, they were both the developers of the technology and the service providers. Quite a few companies that had been offering older-technology heart monitoring devices for many years started losing their market share to the technologically more advanced competition. So, there was no shortage of prospective buyers for our equipment.
With time, MEDICALgorithmics took over a US company, a strategic partner that used your equipment to provide medical services. How did that come about?
Initially we worked with different companies, and one of them stood out. We signed a strategic alliance agreement with that one, and thanks to that agreement our business grew. In 2014 that company split into two, and we took over one of the resulting companies. We replicated an existing business model: a technology company develops equipment and provides services based on it, making its living from reimbursements.
One could say you have conquered the United States. What percentage of the market do you control?
Our equipment monitors somewhere between ten and twenty percent of all patients, which puts us probably in third place in the US market. But that is not the limit of our goals: we want to be the biggest player. We are just now finally breaking free of the legal red tape and so on linked to the takeover of one of the two companies that our strategic partners in the US split into. There are already prospects for taking over the other one. That would give us the number one position.
Are you entering markets in other countries as well?
We have been working on diversifying our business for several years. We are present in the Americas, Australia, Asia and Europe, but the US market is definitely the most important one for us and the one we are concentrating on. The problem with entering other countries is often the same as in the case of Poland: there is no reimbursement for long-term cardiac monitoring, which means that our device can be used mainly like a Holter.
We plan to expand our offered range in telemedicine to include home-based cardiac rehabilitation. We want to develop a reimbursement code for that service in the United States. Today only about twenty percent of people who should receive cardiac rehabilitation actually take advantage of such a service, mainly due to problems with getting to it.
Lately the trendiest terms in the world of new technologies have been “Internet of Things” and “wearables”, which include pulse measuring bracelets, for example. Do you plan any expansion into this area, or are you afraid of competition from giants already operating there, such as Apple and Samsung?
They are no threat to us. We’re not afraid of competition, not even from Apple. The technology alone is not enough: the key factor is providing medical services. We offer a specialist service, the accurate data we deliver – collected by a set of sensitive electrodes and not just one sensor – is analysed by a cardiologist. This is a completely different business area. It also means we’re not planning any confrontations in unfamiliar fields.
You founded a company providing medical services with no medical experience of your own. How did you get to where you are today? And what was the decisive factor in your success?
I was a rather unruly child in primary school. Not a hoodlum by any means, but I sometimes preferred to play truant in order to be able to read a book than be bored during a dull lesson. I think it’s quite a widespread model among entrepreneurs: substantial independence in childhood, obstinacy, unwillingness to adjust to the system, going one’s own way, a passion for something. So, I was never a top student, but I had interests. At university I became fascinated by electronic music, and since I had a musical education as well as a flair for mathematics, I decided to create some kind of technology linked to it. After obtaining my master’s I applied to a company in Germany that did cool things in the field of sound technology. I came from nowhere, but I argued convincingly that I was really interesting, and they hired me.
I was working on my doctoral degree at the same time; that’s how I learned about signal processing. With time, I became more interested in the mathematical side of the problem and it no longer made a difference whether the signal was a music signal or some other kind. And since I also had some business acumen, as well as an inclination to go my own way, I finally set up my own company. I didn’t have any great business ambitions. At first I simply wanted to work on the things that interested me, namely signal processing, and make a living in Poland somehow from my cool ideas; I didn’t want to leave the country. That was when the internet bubble burst, and also piracy was rampant – the software market wouldn’t stabilize until later – which ended the operations of the German company I was working for. I thought about the medical sector being resistant to piracy and having great business potential. And that’s how it started.
A slightly anarchistic attitude towards the system, a passion, business acumen, going your own way. What other common features do you see in people who achieve success with start-ups? And what advice would you give to those who want more?
Persistence in pursuing your goals is definitely important, as is the ability not to lose sight of them. In my case super-inquisitiveness plays a special role. Advice? I mentioned how I applied to a company I wanted to work for, convincing them of my passion. Today that’s rare, but it’s very important. I think it’s a good way of finding an interesting job, gaining the knowledge and experience enabling you to achieve more later.
Was there any kind of watershed moment in the history of MEDICALgorithmics? For example, would this success have been at all possible if it weren’t for the PLN 450,000 grant you received in 2006 thanks to the FNP’s Innovator programme?
That was a critically important event. We were struggling with a shortage of funds at the time: for many months we weren’t sure if we’d be able to pay our employees their wages. The grant helped us hold out until the stage when we were able to support ourselves. Perhaps without it we wouldn’t have survived.
As a start-up did you take advantage of other forms of financial aid as well?
Yes, more than once. Our first investor was a fund from the Polish-American community in New York, then came quite a lot of money from EU funds, and we also received support from the Foundation for Polish Science.
What can you say about the system for helping start-ups in Poland? What should change?
It’s a complex problem. The most valuable thing is not an idea, or a proposed technology, but commercialization skills, knowing how to turn it into big business. Know-how and access to markets: those are crucial conditions for success. Contrary to appearances, money is the easiest part.
Young entrepreneurs in Poland usually don’t have a clue how to run a business, do they?
Regrettably, such knowledge is negligible. And just how important it is can be seen, for example, in the phenomenon of Silicon Valley. When investing in start-ups the incubators there know how to turn them into big business. This is knowledge that has built up over decades. In Poland we are still at the start of that road. The first wave of start-ups was financed from EU funds; some of those businesses survived. The veterans now have some experience gained from earlier mistakes: this will enable them to help their successors.
MEDICALgorithmics has received Bloomberg Businessweek Polska’s Luminatus – Innovation as the Future of the Polish Economy award. However, your company shines mainly in the US market. What about Poland?
First of all, every bit of the technology comes from Poland, this is where the software is developed. We make the PocketECG in Gdańsk. Current monitoring and ECG signal analysis is conducted by an ECG technician team at our clients’ headquarters, but also at a telemedicine outsourcing centre in Warsaw. We have a market here as well, though it’s incomparably smaller than our US market.
How many employees does MEDICALgorithmics have?
After taking over the US company, just under 400, most of them in the United States. We started in 2005 with just two people.
How can foundations that today help promising researchers and technology innovators with grants provide even more effective support on the path to success?
I think it would be very helpful to set up programmes encouraging collaboration between young people from what are two different worlds: business and science. Moreover, if instead of, or in addition to mandatory classes in economics universities offered workshops which simulate turning an idea into a business, some form of start-up founded jointly by young researchers and their fellow students studying economics, that would be more practical, interesting and inspiring. It would also be of value to share knowledge on intellectual protection of original achievements: when to publish, when to register a patent, how one relates to the other, and so on. I also think universities shouldn’t take over the rights to the patents of their students and employees, it simply doesn’t work. Universities should encourage scientists to obtain patents for their achievements themselves and help them with the process. That translates into improved innovation, productivity, increased motivation, a chance for interesting businesses to emerge, a purpose to people’s work. Unfortunately, the predominant way of thinking at Polish universities is this: they use our infrastructure, so we’re entitled to the patent. But that’s like allowing the National Insurance Institution to conduct business operations: it just doesn’t make sense. A university is not capable of doing that, it doesn’t know how to and it simply shouldn’t be doing that.
Organisations that support building bridges between science and business could think about how to initiate changes going in this direction. That would benefit the economy, young scientist entrepreneurs and the universities themselves.
MAREK DZIUBIŃSKI, PhD (born 1976), founder and CEO of MEDICALgorithmics, a beneficiary of the FNP’s INNOVATOR programme (2006).