Hello everybody, welcome to another session of the Imagineer Tech Showcase. My name is Roy John, I'm an electrophysiologist at the North Shore University Hospital and I'm a committee member of the Heart Rhythm Society Corporate Relationships and Program Development Committee, and it's my pleasure to bring on yet another Imagineer tech firm. Today we have Mr. Rajen Dalal from Overread Inc. who's going to be telling us about some of their newer technology and innovation. Mr. Dalal? Hello everyone, HRS Imagineer virtual attendees. My name is Rajen Dalal and I'm the founder of Overread Inc., a new startup in San Francisco, California. Let me just, there we go. I should start perhaps by asking, you know, what does Overread do? In answer to the question that Overread has developed a responsive website, overread.io, Apple Watch users can go there to have their ECGs read by a qualified provider, such as an advanced practice clinician, to confirm an atrial fibrillation and AFib notification, or to check any other arrhythmias that the user may be symptomatic with. It is also where doctors' practices can go to manage remote monitoring of their patients and billing for RPM codes. It's always good to start with a broad-based mission statement. Yours is to triage the patient-derived ECGs and help manage the data deluge faced by doctors. Why is this so important, you may ask? It's important because wearable devices, such as the Apple Watch, provide enormously useful and valuable over-the-counter data. But there's a big however, and that is that the data needs a medical overread in order to make a medical diagnosis. And wearables are generating gigabytes of data, too much data for most doctors today. So we've created this website. It is up and running in the beta release form. We invite you all to register now. You can push your personal patient-generated data in a PDF format by clicking the link that will normally show up on an iPhone to share it with your doctor. And you can upload it to upload.overread.io by emailing it. Your ECG will be stored on our website, where data analysis will be conducted, and it'll be stored in your personal account. And only with your permission will it be read by a professional for a fee. Your report will then be stored in your secure and private personal account, where you can share it with your doctor in one of several formats. What can this be used for? We present three use cases today, a clinical research use case, a remote patient monitoring use case, and a use case for over-the-counter direct-to-consumer use. The first use case, using it for clinical research with an Apple Watch or another wearable device, frankly, because any single lead, the ECG data can be transmitted. And clinical research can be conducted independently of the manufacturer to study, for example, a comparison of a wearable device with a traditional monitor, a customized study format for your own patient population, if you're a clinician, or to study some other heart condition, which can be diagnosed with a single lead ECG and an overread. In each case, the study team's qualified personnel can read the ECG, and of course, we help them with certain algorithms. The second remote patient monitoring, look, we all understand how important diagnostic testing in the home can be for chronic conditions, and COVID-19 has changed all that and moved the adoption curve from what we thought would be years into months. And remote patient monitoring's time has come. And finally, we do offer our product and our service for the OTC and direct-to-customer. Let me spend a minute or so talking about how to enable ECG arrhythmias for clinical research with commercially available wearables. It can be used, for example, to study monitoring post-ablation AFib yield. It could be used for paroxysmal AFib screening, other cardiac arrhythmias. And as I mentioned earlier, we can customize the back end for the investigator's unique needs. For example, you will be familiar with the Apple Heart Study and the Heartline Study. The former is a big study sponsored by Apple with Stanford University, and the second is a big study for over 65-aged individuals with Johnson & Johnson. What is unique about OverRead is that it is customizable. It can be used for small studies or large studies, and it provides off-the-shelf a great deal of flexibility in the design of such studies. So that's one use case, which we believe that many of you in attendance in this conference may find appealing. The other is patient care and remote patient monitoring. At least in the United States, it has accelerated and will become a larger part of the post-COVID healthcare delivery system, and we believe contribute to a greater percentage of a doctor's practice's income as the center of gravity shifts from in-hospital and in-practice visits to more patient care in the home setting. The codes are well known to you. These were issued over the last couple of years. They will evolve annually, as they should, yet the implementation of a decentralized patient-driven process needs an efficient system, and that's what we provide. Some of the key features that we provide, if you look at the second checkmark, it can be used on either a mobile or a laptop interface. The fourth checkpoint, agnostic platform for any FDA-approved ECG device. Our initial focus is on Apple Watch for all the right reasons. It is the most widely used wrist ECG single-lead device, and therefore, we want to provide the service where it's being used. And then leaving the last one out, the last three, the arrhythmia dictionary, frequently asked questions, and better prepare for your next doctor visits, are very strong patient support to enhance the interaction with the physician in this patient care application. The direct-to-customer or over-the-counter application, the patient can use their Apple Watch, any version four or above, to self-monitor ECGs and heart rhythms. Often there will be a message. You may have AFib, and that could be of interest to the user to have triaged by a professional immediately for peace of mind. There's also the other, which is the false negative, meaning a user may experience an arrhythmia, such as a PVC following intense exercise, and be concerned about it, but the watch will not notify that as being an arrhythmia. However, the patient can send that in and have a professional over-read it. Perhaps most importantly in this entire equation is that the doctors, if they do not participate, if they do not partake in this new model of healthcare, because there is too much digital data, which we hear is a major concern, then it's not going to work. Our system spares the doctor the digital data deluge, and then of course the support to prepare for the next appointment. How can you use it? Here's a quick start guide. Our website is pretty self-explanatory. You can go to www.overread.io and register with your email. You can then send a PDF from your iPhone or your device, and send it to upload at overread.io from your registered email, and it'll be saved into your account. If you request an over-read in the beta version, a response will be provided in 24 hours. As we scale this up with over-readers present in all 50 states, we expect that the turnaround time will be in minutes, which we are sure will be appreciated. They will issue a report. The report will land in your personal, private, secure account. You'll get a notification, and you can share it with your doctor in a variety of ways that are HIPAA compliant and secure privacy. So in conclusion then, we'd love to work with you in some form or the other, whether it's use case one or two or three. Three, we're ready right now, and it will give your patients peace of mind with the ability to monitor their arrhythmias. All of this while managing the data deluge. And I'll just add in conclusion, you know, we are a private, small company, and we'll be raising a small convertible note in a pre-series seed round. If you might have any interest, please email me at rajan at overread.io. Well thank you very much for listening, and back to you, Dr. John. Mr. Dalal, that was a great presentation. Thank you very much. Very interesting service that you provide because it's, you know, obviously from the physician point of view, we just don't have the capacity or the bandwidth to deal with all of these patients' rhythm abnormalities and their anxieties mostly. So the first question that I have for you then is, how do you deal with the off-hours call or the patient, you know, who's clearly anxious about their heart rhythms who, you know, set up calls at three o'clock in the morning? Do you have personnel who can actually deal with this on a 24-7 basis? Yes. In fact, we have a very powerful, we've invested in creating a very powerful engine, which the back end can really operate in a manner of speaking the way, let's say, an Uber model is, which is individual APCs or PAs or others who would be doing the overread can opt in from wherever they are in the 50 states at any time, and over time it may be possible to spread this out in certain geographies outside the United States as well, so that whenever a patient sends in an ECG, somebody from the other end can opt in to read it. I see. Okay. Well, that's good. And what about patient confidentiality? I mean, you have all systems in place to kind of make sure that their data doesn't go astray and it doesn't get into their own hands. Indeed. There are a few different standards that we have to live up to. Of course, there's the HIPAA standard, which as far as the patient is pushing it, there are certain requirements. And then on the other hand, we avoid emails of the data, the reports or anything like that. Beyond that, there is the real security of the system. We use some of the very large backend cloud services that invest a lot of money in the security of individual patient information. And our view is that this service needs to focus on privacy above everything else. This is patient driven, not hospital driven, not EMR driven, not manufacturer driven. This is a patient portal and therefore it has to be a private database. And now what about if somebody, you know, I'm more concerned about the liability issues. So somebody has an episode of ventricular tachycardia that's potentially life threatening and that's transmitted to you. What process do you have in place to take care of that acute situation where somebody could be potentially life threatening? I think this field of liability, you know, it's been discussed with lawyers and experts quite a bit. Our initial focus is on the chronic AFib area. So as we progress, we will have to factor that into account. For example, if in the next iteration, the single EDCG is being read for a non arrhythmia use, for example, a QT interval, we would have to make sure that those liability issues are completely addressed. At this point, we're dealing with atrial fibrillation and similar arrhythmias that are not immediately life threatening. And then finally, one last question. In terms of the fee structure, what happens? I mean, does a patient have, can you bill for it every time a patient sends something in or, you know, are they liable for the payment? Of the three use cases, the last two involve some billing and transaction that involves the patient, the patient's insurance, or an intermediary group like the doctor who would be doing the billing. In the RPM model, the patient's obligation would be limited to what the remote patient monitoring code requires. There may be a copay, there may be some minimum obligation. And hopefully over time, that'll become lighter and lighter. In the over-the-counter model, we put the onus on the patient entirely. This model has been tried, the price elasticity has been studied somewhat. It's not for everybody, but there is a group of users who would pay, you know, somewhere between $10 and $20 for an overread in order to get, have that peace of mind in a very short turnaround time. Great. Thank you very much. That was a great presentation and we enjoyed it. Have a good day. Thank you, Dr. John.

Overread Inc.

overread.io

Apple Watch

electrocardiograms

remote patient monitoring