Irish company Critical Healthcare has signed a deal worth €10 million over five years with the leading international private provider of emergency services in Europe. The announcement was made by Minister of State for European Affairs Helen McEntee at a St. Patrick’s Day reception hosted by the Irish Embassy in Copenhagen at the weekend.
Critical Healthcare provides a comprehensive range of medical products and services to ambulance providers and the pre-hospital market across Ireland, the UK and Europe.
It has completed the deal with Falck, who has over 100 years of history within emergency, assistance, safety and healthcare services. Falck is the leading international private provider of emergency services and the only intercontinental ambulance provider.
Headquartered in Denmark, Falck has operations in 35 countries and its 2,500 ambulances respond to four million emergency calls every year. The company also provides many other pre-hospital services, including emergency helicopters and rapid response units with paramedics, nurses and doctors.
Rapid growth at Critical Healthcare
Founded 18 years ago by Seamus Reilly and Anne Cusack in Ireland’s midlands, where it is still headquartered, Critical Healthcare employs 22 full-time staff. That figure is set to at least double over the next five years as a result of the deal, which centres on Critical Healthcare’s multi award-winning procurement platform Medlogistix, in addition to other projects.
Medlogistix has dramatically improved the supply chain and procurement landscape for the National Ambulance Service of Ireland, as well as multiple emergency service providers in the UK.
Critical Healthcare will now be rolling out Medlogistix for Falck across four countries – Denmark, the UK, Germany, and Spain. Critical Healthcare will become Falck’s single managed service provider for medical consumables and will be responsible for managing some of Falck’s key manufacturers and producers.
The deal is estimated to be worth approximately €2 million per year over a period of five years, with a total contract value of €10 million.
Dr. Anne Cusack, Managing Director and Co-founder, Critical Healthcare, said:
“We are absolutely thrilled with our collaboration with Falck and look forward to a long and fruitful relationship with them. This is a massive commitment by them to entrust this business with us and we are looking forward to being able to repay that trust by delivering a world-class, quality service to Falck across Europe.
“The impact of this collaboration is an important milestone in the company’s progression and represents significant growth for us over the coming years. We have 22 directly employed staff in Westmeath, where our business is growing strongly. But with the new Falck deal, and other ongoing work, that number is set to increase further – by around 30 new hires over the next five years.”
Seamus Reilly, Operations Director and Co-founder, Critical Healthcare, said:
“We have already established an office in Germany, opened in January 2019, and initiated our first employee there. We have recruited four further people specifically as a result of the Falck deal. We are currently building the platforms for Germany and Denmark and our aim is to have all four countries operational no later than April. We were able to compete for and win this European contract because we were able to demonstrate the savings our package could offer across all elements of the procurement process.”
Critical Healthcare also especially wanted to thank Enterprise Ireland, the trade and innovation agency, for its help during the procurement process, as well as for its Business Process Innovation grant, which assisted with the development of the Medlogistix.
Helen McEntee T.D.,Ireland’s Minister of State for European Affairs, said:
“It is heartening for me to witness an Irish Small and Medium Enterprise such as Critical Healthcare achieve such fantastic growth through its commitment to innovation and customer service. The fact that Critical Healthcare is forging strong links in Denmark, the UK, Spain and Germany, while at the same time continuing to maintain its dominance in the Irish market and hiring significant numbers in the midlands is a credit to the management and I wish them further success into the future. It is a wonderfully positive story for Ireland and for the Midlands.”
Marina Donohoe, Director of Enterprise Ireland’s UK and Northern Europe Operations, said:
“Across the globe, Irish companies are achieving international sales at record levels and bringing the Irish Advantage to business partners. Internationally, Irish companies are driving innovation and leading across a wide range of sectors including the medtech sector, with Ireland being the second largest exporter of medtech products and services in Europe. Critical Healthcare, an Enterprise Ireland-supported client, is a great example of the success and innovation that is emerging from Ireland and the deal announced today is hugely significant for the company and their Danish partners Falck.”
North America’s healthcare giants are opening up to new innovations.
The best way to align hospital clinicians and innovation experts is to establish the value of the innovation and then secure a champion to advocate for it at the highest level, “someone who is comfortable about breakthrough insights and acting on them,” said Chris Coburn, Chief Innovation officer at Partners HealthCare, and a former founder of Cleveland Clinic Innovations.
Based in Boston, Partners HealthCare includes community and specialty hospitals, a managed care organisation, a physician network, community health centres, home care and other health-related entities. Several of its hospitals are teaching affiliates of Harvard Medical School, and Partners is a national leader in biomedical research.
While it is easier for large organisations to ‘dock’ with other large organisations, the challenge for innovative start-ups looking to sell into them “is to create a shared understanding, and ultimately a shared reward,” he said.
US healthcare must integrate hundreds of solutions
While for a start-up technology being pitched is its sole focus, for the healthcare system it is just one of hundreds of solutions. “Making sure there is the right level of attention to that technology in the big organisation should be the day and night focus. Getting that cultural alignment takes effort,” said Coburn.
The key to doing it is to clearly identify where the decision is being made. In health IT, that could occur in one of many units whereas, with a medical device, you are likely to be interfacing with just one, from which a likely clinical champion is easier to find.
“Do your reconnaissance to try and figure out who is going to be making the decisions and have a realistic view of timelines,” he said.
Avoid “death by pilot” by agreeing clear end points.
The areas of healthcare innovation about which he is most excited are immune therapy and, on the IT side, machine learning and artificial intelligence. “According to a recent report, 86% of healthcare organisations, whether industry, academic or government, are not yet using AI. In 10 years from now, care is going to look a lot different than it is today,” he said.
Interest in biosensors is already increasing, said Iris Berman, VP telehealth services at Northwell Health. “There is still a little way to go yet but we are looking very much forward to the predictive analytics that go along with that,” she said.
This chimes with the shifting emphasis from reactive medicine to a more proactive approach to health. At the moment “we’re taking care of very sick people,” she said. “If we can take care of that population using AI and sensors, it is in those populations that the best bang for our buck will come in terms of capital spend.”
Through her work in telemedicine, predictive analytics is already helping Northwell Health become more proactive. It’s also enabling people to have more control over their care. The result is treatment at home, which is less expensive and allows patients the support of loved ones. Telemedicine can also help in those parts of the population unable to access care, for a variety of reasons.
Berman debunked the myth that older patients are tech-averse. “Very few senior citizens don’t have a phone. We are all about ‘BYOD’, bring your own device. If you develop things that use a device they are familiar with, they are fine with it. There are programmes we use that integrate with their television, for example. If you integrate healthcare with TV or phone, they are very comfortable with that.”
For Robyn Muzeka, Technology Innovation Lead at Adventist Health System in Florida, the move is on to get physicians away from ‘pyjama time’ – the time spent working on electronic health record systems out of hours.
One way is through the use of devices that enable them to use ambient technology and machine learning/AI to document information and pull up charts. These are in room but are not as invasive as a microphone they have to speak into. “That’s where I think there is a lot of value,” he said.
Adventist is partnering with GE on its mission control applications, using methods of sifting through and analysing data for failings in a way not unlike air traffic control, ensuring patients get to the next level of care as efficiently as possible.
Technologies that help with the social determinants of healthcare are also required, particularly as hospitals spend so much time working with people who don’t have insurance, or have limited insurance. Opportunities exist for niche applications for AI such as in scheduling too.
For start-ups looking to engage with health systems, the biggest challenge is one of scale, said Muzeka. “In the US, we have small markets and large markets, and sometimes we can’t roll out the same technology in each market. We have to flex, each market has an individual take. Be open with your solutions, be adaptable. If you have something you are willing to pilot we can figure out those other pieces, but remain flexible and open,” she said.
Be device agnostic, said Iris Berman. “Interoperability is huge”, as is understanding that hospitals will have a series of legacy systems in place. “Be ready to integrate into existing systems,” she said.
Muzeka agreed: “Where we have been most successful with vendors is where they are willing to co-develop with us, instead of having a turnkey product.”
Partnering with Enterprise Ireland is giving US giant Northwell Health an innovation advantage.
Northwell Health is the largest provider of healthcare in New York State, twice the size of its next competitor, with 23 hospitals and 700 outpatient locations. At 68,000 employees, Northwell is also the largest private employer in the State of New York.
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Innovation plays a key role at the organisation, both in relation to research activities, investment in external companies, and internal spin-outs.
A pioneer in its field, Northwell was the first entity in New York to create an integrated health system and today has revenues of close to US $12 billion.
Pressures on US healthcare systems
Despite its unique position, Northwell faces the same pressures as many other US healthcare systems, said CEO and President Michael Dowling, in Dublin recently to deliver the keynote address at the North America Healthcare Forum.
Organised by Enterprise Ireland, the flagship event brought together leaders from many of the biggest names in the US and Canada’s healthcare sectors.
Each faces challenges such as consolidation in their markets, growing use of technology, increased consumerism, greater accountability and financial pressures, he said.
“We all need to transform, to disrupt ourselves before somebody else disrupts us,” said Dowling. “If you are in the healthcare business these days and you are not a disruptor, not continually trying to disrupt yourself, you are probably in the wrong place.”
How Northwell competes against the world’s best-known healthcare provider brands
Not alone is Northwell competing against some of the world’s best-known healthcare provider brands, such as Columbia Presbyterian, Mount Sinai, and Sloan Kettering, “but now we have to deal too with Amazon, with Google, and with pharmacy chain CVS,” which is looking to take over US health insurer Aetna and turn its retail units into ambulatory locations.
Competition is coming from players who “look at the world very differently than we do”, said Dowling. The aim for Northwell, as for all US health systems, is “to be at the forefront of change, not the victim of it.”
At the same time, the sector is increasingly transforming from medical care to healthcare systems, putting a growing focus on the social determinants of health such as lifestyle, behaviours and social issues.
Developing partnerships and alliances is an important way of ensuring innovation at Northwell, he said. In December 2016, Northwell signed a partnership agreement with Enterprise Ireland which allows Irish companies early stage access to its clinicians and key decision makers, aiding the development of new products and services for the wider US healthcare market.
Such partnerships are highly valuable, bringing fresh insights and innovation to both parties, he said, “If it’s done right it’s a win-win situation.”
Why Northwell Health partners with Enterprise Ireland
Dowling partners with Enterprise Ireland because Ireland is, he said, “an epicentre of innovation”, with a young and dynamic population, an excellent education system and an “extraordinary amount of entrepreneurship.” Since the partnership with Enterprise Ireland was established, Northwell has worked with around 90 Irish companies.
Dowling offered advice to others looking to sell into the US healthcare sector.
“A company can have wonderful ideas but doesn’t understand fully the delivery systems of how healthcare is actually delivered on the ground.” Partnering with Northwell enables Enterprise Ireland companies to have a greater understanding of challenges such as regulatory issues, legal matters and reimbursement practices.
“The technology alone won’t solve it unless you understand the process of care,” he said.
“We have worked with 90 Irish companies and it has been a great experience,” said Dowling, citing physical therapy applications developer Salaso, clinical diagnostics company Technopath and medical technology company i360 as examples of innovative Irish companies Northwell is working with.
Patient care is at the centre of all its innovation. “At the end of the day, it’s all about what benefits the patient,” he said, advising companies wishing to succeed in this market to be careful of how they pitch to major healthcare systems in the US.
“Don’t come across trying to tell us that you know how to solve every problem. No you don’t. You think you do, but you don’t. You have a little bit of the solution, it’s great, it helps, but it’s a lot more complex than you think. So do that piece and let’s work on the other pieces.”
Technology alone won’t solve healthcare challenges
Be aware that technology by itself doesn’t answer most problems. “When you are in the business of taking care of people, you use technology to augment what you do, not to replace it. You don’t want to become a prisoner of technology. The technology people who understand the human element are the people you give more traction to,” he said.
The future of healthcare solutions is likely to be increasingly consumer focused. “Healthcare has never been consumer focused the way it should be, it has been patient focused. There’s a subtle difference,” said Dowling.
The doctor/patient or nurse/patient relationship has traditionally been imbalanced, with an assumption that all the power or knowledge is on the side of the medical professional.
“A consumer is more knowledgeable. They now have more access to information, they are more tech savvy. They Google everything and they visit chat rooms before they come in, they question more. So healthcare is making that transition from patient to patient/consumer. It’s not ‘what’s the matter with you’, it’s ‘what matters to you’.”
Technology facilitates this. “We have patients involved in determining their own care. We have technology that allows patients do things at home before they come in. We also understand better, or appreciate better, that the patient’s social circumstances are as big a determinant of health as whether they see a doctor or not.”
Northwell Health already practices telemedicine extensively, for example, across psychiatric, stroke and ICU services. “The combination of consumer and technology is going to drive healthcare change much more than anything else,” he said. “The provider that doesn’t listen to the consumer who is empowered with technology is going to be left behind.”
Founded in 1998 by CEO Frank Madden, Crest Solutions has grown to become a leading provider of machine vision, serialisation and managed services to the European life sciences industry. The company specialises in assisting companies in the sector to implement digital technologies and services that will enable them to become more compliant and competitive.
Crest Solutions numbers some of the world’s largest pharmaceutical companies among its blue chip customer base. From vials, blister packs and cartons to labels, packs and pallets, Crest systems inspect, mark, verify, track and trace components and their associated packaging through the entire supply and distribution chains.
Madden recalls starting up the firm with more than a hint of humour. “I set up Crest with another guy,” he says. “We were both operations managers with Apple, which was closing part of the factory in Cork at the time. We had been writing software to make the factory more efficient. We sold our Apple shares because we figured the company was going nowhere. We set up back then providing solutions to the manufacturing industry, focusing mainly on the pharmaceutical industry. Our aim now is to build the world’s leading provider of Industry 4.0 solutions to the life sciences industry – we are digitalising the life sciences industry.”
Crest counts 40 of the world’s top 50 pharma companies as customers
Crest is engaged in the development of a range of advanced products in the area of industrial automation. These include augmented and virtual reality, robotics, machine vision, and Internet of Things (IoT) solutions.
A conscious decision to focus on the life sciences sector was taken early on. “We don’t go outside the industry,” says Madden. “It’s a very highly regulated sector. Once you start working with the industry you become very specialised. Our key customers include 40 of the world’s top 50 pharmaceutical companies and we now have offices across Europe – in Ireland, the UK, Benelux and Sweden. Our group sales stand at more than €35 million and we employ 200 highly trained and experienced people. At the moment, we are a pan-European company at the point of moving into the US market.”
The highly regulated nature of the life sciences sector has meant that it has traditionally been quite slow to adopt new technologies, but this is changing, Madden explains. “The industry was almost forced to be deliberative and slow, but a major change has come about in the FDA. It is now encouraging companies in the sector to be more innovative and to move to Industry 4.0.”
Crest is well positioned to provide the innovative solutions required in this new reality. “We have been in the industry for 20 years now and have been the largest industry vision supplier for the past 15 years. We are in there already, helping the industry comply with things like serialisation requirements.”
Tracking life sciences products through the entire supply chain
This is the assignment of unique, traceable numbers to individual items produced by the life sciences industry. “It’s putting a number plate on every product, so that you can track it through the entire supply chain,” he explains. “The legislation requiring this is coming into force in Europe in February 2019. It’s the biggest transformation in the industry in 30 years. Industry 4.0 is the next wave, it’s a logical progression.”
Interestingly, cost is not the key driver here. “The motivation in the life sciences industry is improved compliance. It’s not about cutting jobs or costs. There is an awful lot more plant and equipment than people in the industry in any case. Industry 4.0 is about augmenting human capabilities, helping people make better decisions. It will also take away the boring repetitive jobs and allow employees do higher-value work and it will enable the industry to become even more compliant and produce better-quality products.”
The firm’s strategy is to combine its own technologies with the best in class from around the world. “We spend €1.2 million a year on R&D,” says Madden. “We have a hugely talented team of software developers and we hire about 20 graduates each year. We have very close relationships with the colleges and have been very well supported by Enterprise Ireland, especially in our expansion on international markets.”
Investment in innovation is crucial
This investment is crucial if Crest is to stay ahead of its competitors, he continues. “We have a suite of Industry 4.0 products that we are either already providing or which are at various stages of development. We also put a lot of work into finding new technologies. We always go out in search of the best of breed. If the technology is way ahead of where we are, we will seek to represent the company involved.”
This strategy has paid dividends for Crest. “We have been growing at a compound rate of 35% per annum,” says Madden.
The majority of this growth tends to come from existing customers. “We build very close relationships with our customers. We don’t add a lot of customers each year. It’s more a case of supplying more services to our existing base.”
Madden credits Enterprise Ireland with a key role in Crest’s success over the years. “Enterprise Ireland has been a partner from the very beginning. The first week we left Apple we went on an Enterprise Ireland programme. We have used every programme they have. It’s not just financial support, their advice and programmes have been hugely important to us. Enterprise Ireland has always helped us in the right way at the right time.”
When patients around the world are being tested for tropical diseases such as the Zika virus, dengue fever or yellow fever, it is highly likely that the diagnostic kit will utilise products developed and manufactured by Dublin company Aalto Bio Reagents. Founded in 1978 to supply raw materials to the global diagnostics industry, the company now has a range of 300 different reagents – 150 antibodies and 150 proteins – which are used for the identification of a vast range of pathogens.
CEO Philip Noone, an entrepreneur with a long track record in the diagnostics space, acquired the company in 2014. “I began my career in the area with a start-up company called Biotrin,” he says. “It was a small spin-out from Trinity College Dublin which made biomarkers for kidney and liver conditions. I worked there for six or seven years, during which time its turnover went from zero to €10 million. I then joined Quest Diagnostics in the US, where I built up its business there. That grew from a turnover of a couple of hundred thousand dollars to $53 million and a suite of more than 50 diagnostic products.”
Noone was attracted by the company’s existing product set as well as its potential. “Aalto Bio had some interesting diagnostic products and I wanted to look at other areas, including dengue fever and the Zika virus,” Noone recalls. “I also thought a good area to look at was the chikungunya virus and we launched a material for that in 2015. We then targeted the Zika virus, and the late 2015 outbreak in Brazil triggered enquiries from hundreds of companies around the world. When the noise died down, we were left with five or six key players building diagnostic solutions for the virus and we are working with all of them. The mosquito which carries the Zika virus also carries chikungunya and dengue. We have the materials to test all the diseases from that vector.”
Aalto Bio supplies all main global players
He describes Aalto Bio as akin to an engine builder for a leading automaker. “Our brand doesn’t appear anywhere, but we make the key component,” he explains. “When someone goes to be tested for a tropical disease the assay will probably use an Aalto Bio biomaterial. We supply the materials to all the main global players. They build the assay and coat our material onto a plate in it. If the sample reacts with that material, they have a positive diagnosis. What’s happening now is that our customers are asking us to build biomaterials specifically for them. They will identify a disease. We will go out, inoculate an animal, take a sample, grow the virus, build the antigen and then produce it synthetically to the scale required.”
The company has grown rapidly, with staff numbers doubling and turnover rising in double digit growth to €3.3 million. “Our target is to double the size of the business within the next five years through a combination of new product development and new customers,” he says. “We are interested in looking for solutions to emerging pathogens and building materials that help patients get diagnosed faster. If you want to be at the leading edge you’ve got to move fast.”
The development cycle is quite long, however. “By the time you identify and build the biomaterial and get it through approval processes with the FDA and so on, it can be 18 months,” Noone notes.
The focus will continue to be on export markets. “As a company, 93-94% of our sales are exports. Almost all of our business is generated outside of Ireland,” he says. “Enterprise Ireland [the national export agency] has been very helpful. We are setting up partners in China at present and took part in an Enterprise Ireland trip there earlier in the year. We have set up our first China partner as a result. We are now doing the same thing in Japan and we have just signed up a partner there as well. We are also working with a manufacturing partner in Brazil and are targeting Germany and France for future growth.”