Dr Vani Ravikumar has been a pathologist for almost three decades. Her daily routine involves going through samples, one after another, one after another, day in and day out. Recently, Bengaluru-based AIndra , an artificial intelligence-based cervical cancer screening startup, reached out to her. Its proposition was simple— apply AI to screen and identify samples. Only those samples indicating a risk of cancer would be sent to the experts for further examination.“My first thought was, ‘you are going to replace me, your algorithm will say if cancer is present or not.’ If the computer does this job of mine, what will happen to me? You are trying to pull me out of my seat,” said Ravikumar, cofounder of Karnataka-based diagnostic chain RV Metropolis.After a few more interactions, Ravikumar’s apprehensions began to wear out. Screening by AI, she sensed, could help her examine more samples in less time as the algorithm would allow her to concentrate on the ones that require her expertise. “In the hands of clinicians, it will become a force multiplier, it will make them supermen,” said Adarsh Natarajan, cofounder of AIndra.AIndra is one of a handful of startups that are pushing the envelope applying emerging technologies such as artificial intelligence virtual reality and 3D printing to healthcare This new wave of emerging healthcare technologies promises something unique—real-time and personalised care. “Doctors do not know what is happening in realtime. Imagine that a patient has suffered a series of cardiac attacks. (Now) I am seeing a pattern and I can say he is going to go down in three hours. You can now do what you need to do, (say) withdraw or add a certain drug,” said Sudhir Borgonha, cofounder of ten3T.The company makes ‘Cicer’, a 9 cmwide wearable patch with multiple embedded sensors. Cicer, which can fit into an adult’s palm, tracks ECG and respiration and rhythm anomalies in real-time. Signals are gathered from the patch, integrated and then transferred remotely to doctors. ten3T is also working on integrating temperature, oxygen sensors and a way to track blood pressure in real-time.Both globally and in India, the healthcare startup ecosystem is advancing from one breakthrough to another. Using advanced technology that were more in the realm of academics, say, even a decade ago, startups are designing artificial limbs specifically suited to one’s body type and structure; enabling students wearing VR headsets to observe surgeries as if they were standing next to the surgeon; and developing various predictive and diagnostic applications.Singapore- and Bengaluru-based Supercraft 3D, funded by Flipkart cofounder Binny Bansal, among others, develops patient-specific visualisation tools that provide hospitals, doctors and academics deeper perspective about the human anatomy. The company also makes additive manufactured customised body implants using bio-compatible titanium alloy. “The uniqueness of 3D printing is it is designed for individual application. One reason why we started was that the rest of the world was getting into this tech. A country like India has unique diversity and body structure. We felt there was a unique opportunity. 3D printing allows customisation of services and at an affordable cost hitherto not possible in India,” said Maltesh Somasekharappa, cofounder of Supercraft 3D.If Supercraft 3D is into customising body implants, Pandorum Technologies is into 3D printing of tissues, While the immediate business use case is for pharma company research, the next step is human implantation. “We were focussing on the liver tissue initially. It was closer to our revenue stream. We are moving to other tissues. We are working on cornea implants, now. We are into tissues because for pharma companies, who need to test a lot of drugs, they need it for research. Using the same technology platform, the same tissue can be used for human implantation, but that is a slightly long term plan,” said Arun Chandru, chief executive of Pandorum Technologies.According to Geetha Manjunath, chief executive of Niramai, a breast cancer screening startup, AI can also help bridge the skill gap in the country. “In emerging markets, (a lack of) skill sets is an issue. Having tools that are AI-enabled will ensure that even lowly skilled people can take hard decisions.The AI tool will tell the person if the confidence in a decision is low, in which case the technician can call in the highly skilled doctors. It also helps to improve the efficiency of the expert as his time is used only in important cases,” she said. Niramai is building a noninvasive, non-touch, non-radiation approach to detect breast cancer.The startup’s hardware-software technology solution, called Thermalytix, uses artificial intelligence over thermal images for early detection of breast cancer and removes technological, logistical, and cultural barriers that hinder breast cancer screening.India’s healthcare systems are concentrated in the cities, amd large hospital chains and other medical centres are vying for the same pie. Startups working with new, emerging technologies could open up a larger and mostly unaddressed demographic that desperately needs personalised and low-cost healthcare.“Large expensive systems are not suited for emerging markets because accessibility is very low. Farther down from urban centres, people do not have access to highquality healthcare. Legacy systems are centralised. Technology that enables healthcare systems to be decentralised are the ones that will drive the accessibility part of the equation. Since all people cannot come to urban centres, quality healthcare needs to be taken to the people,” said Natarajan of AIndra. “All healthcare players are fighting for an oversaturated market.But there are markets that do not have access to these facilities.” This can be made possible without hospitals or doctors having to pay a bomb to add or upgrade infrastructure. Expanding or reaching remote centres can be as easy as updating an app on your personal smartphone. “(The solution) will be digitised, a cloud-based platform. It will extract objects of interest and the AI model will generate a holistic report and not just numbers. If you have to add new features, (you) upgrade the model on the cloud,” said Rohit Kumar Pandey, CEO of SigTuple.The core product of SigTuple is Manthana, which using visual medical data such as blood sample images can classify various objects of interest, detect diseases if any, and compute the metrics for reporting. The metrics provided by the platform are supported by visual evidence, which eliminates the need for a medical expert to be physically present next to a patient, medical device or biological sample. Currently, SigTuple uses Manthana to provide solutions for automated analysis of blood.It is developing technology to also analyze urine and semen samples, retinal scans and chest x-rays. Another startup, Buzz4health, offers continuing medical education credit courses to doctors. Its virtual reality technology allows doctors to go visually closer to surgeries.The company’s first application is a VR-based training and education module for young cardiologists and medical students, in partnership with medical devices maker GE Healthcare. “A lot of people want to learn new procedures in specific environments... (not just for doctors) but for nurses or tech support. That kind of infrastructure is there in tier I cities but not in other places,” said Hitesh Ganjoo, CEO of Buzz4health.Dr Anshu Mahajan, an associate consultant fellow in the department of neurointervention surgery at Medanta, a medical college and hospital, uses Buzz4health’s VR technology to learn complex procedures. “I am a trainee in this field. I wanted to have a feel of the equipment and the procedure.With VR, I can remove the risk of mistakes, it helps build confidence. Before going into actual practice, we can do it in a safe way. It is a teaching aid. It is helpful for trainees and residents to see and feel the depth of perception in this complex procedure,” he said. Buzz4health is working on more tools. “We want to do a mix of VR and AI. We can customise userexperience.For VR, we are working with doctors and trying different concepts. With VR and AI, we can look at problems across the journey of a patient’s life,” said Ganjoo. Ganjoo and his team have tied up with hospitals to create in-house VR labs. The idea is to provide immersive and experiential training and education for doctors and paramedics so they can learn through simulations. The startup is also in early-stage talks with a major medical technologies firm to simulate conditions in emergency or intensive care units. If the deal goes through, the firm’s development teams will be able to use Buzz4health’s technology to understand ICU environments and design products.For Manish Singhal, founding partner of AI and IoT-focussed fund pi Ventures, the emergence of such technologies is a “leapfrog moment in healthcare.” “If (the startups) get it right, and market adoption happens, these companies will become valuable. (This is) definitely early, but we are seeing some really good work. As compared to the Valley, it is definitely early, but the growth rate is rapid,” he said.The rapid growth rate could potentially mean that India could give unique ideas for dealing with complex medical problems. “Monitoring will rapidly become mainstream. Diagnostics, say predictive ones like ‘I will have a heart attack’… that will require a testing, say, two-three years until doctors trust it. Tech in India is becoming more common, a lot of heavy data is coming into play. India is not a follower of the West. It is, in fact, a leader because of the volume. India will begin to play a bigger lead,” said Borgonha of ten3T.But there are roadblocks in terms of ‘trust issues,’ such as acceptance from patients who might want doctors to be physically present, and the elderly, who are likely to have an aversion towards technology. “Culturally, the feel of a doctor is important and the elderly, who need care more, will be less adaptive to remote care. Incentive model of provider and emotional contentment of patient is also a part of this,” said Muralidharan Nair, partner, Life Sciences, EY India.Nair believes India is different from advanced economies in terms of medical technology as the country is seeking to solve core issues such as accessibility and affordability. “Our key driver is affordability,” he said.