VB Group Interview No.6 | PalmECG · Song Yinfeng: Patient-Centric Approach — How Mobile ECG Products Address Key Pain Points of Atrial Fibrillation Patients

Song Yinfeng

Guest of the Issue: Song Yinfeng, Co-founder of Nanjing Xijian Information Technology Co., Ltd.
Time: August 12, 2015, 20:00–21:00
Moderator: Zhao Zhanshi

Guest Introduction: Song Yinfeng, male, has over 15 years of experience in the medical technology industry. He formerly served as the Director of the Science and Technology Department at the Wu Jieping Medical Foundation, where he led multiple “clinical research projects.” He is a co-founder of Shenzhen Weidian Biology, responsible for marketing, and a co-founder (angel investor) of Nanjing Xijian, overseeing the marketing of handheld ECG devices.

★ Topic Sharing
Requirements: In the era of mobile internet, the primary needs of patients with atrial fibrillation include: (1) daily monitoring and regular testing of relevant indicators; (2) interaction with professional healthcare providers; and (3) long-term intervention, as patients spend limited time in hospitals and the majority of their time outside clinical settings.

Overview: Atrial fibrillation (AF) has a high prevalence in China, with an estimated 8 to 10 million affected individuals, meaning that nearly 1% of the adult population suffers from AF. Approximately one-third of AF patients develop thromboembolism, and about three-quarters of those with thromboembolism experience cerebral infarction, affecting at least 3 million people.
Atrial fibrillation is primarily classified into four types: first-diagnosed atrial fibrillation, paroxysmal atrial fibrillation, persistent atrial fibrillation, and permanent atrial fibrillation. Among these, paroxysmal atrial fibrillation poses significant challenges for detection and diagnosis. Wearable ECG monitoring devices offer a highly effective approach for capturing paroxysmal atrial fibrillation events, holding particular clinical value.

Furthermore, atrial fibrillation poses significant health risks and can precipitate various cardiac conditions, such as angina, or lead to more severe outcomes like stroke or sudden cardiac death. The incidence of stroke in patients with atrial fibrillation is more than five times that of the general population, and their mortality rate is more than double.

Current diagnostic methods for atrial fibrillation are primarily limited to electrocardiography (ECG) and long-term Holter monitoring. Treatment options fall into two categories: pharmacological and non-pharmacological. While pharmacological therapies will not be discussed here, this article focuses on how mobile ECG products can address patient pain points and effectively enter the market.

Pain Points and Solutions: Currently, no medication can completely cure atrial fibrillation (AFib). Pharmacological management of AFib must be accompanied by monitoring, which represents the most significant application scenario for electrocardiography (ECG). Mobile ECG technology reflects contemporary trends; in particular, handheld ECG devices are positioned as tools rather than disruptive innovations. They serve to facilitate clinical practice more conveniently, for instance, by providing patients on medication with a tool for self-monitoring.

The handheld ECG device was not developed with a product-centric approach, but rather emerged from the genuine needs of atrial fibrillation patients, who require daily monitoring.

Centered on patient needs, the collaboration between Palm ECG and Xingshulin Medical Record Clip focuses particularly on patients with atrial fibrillation. Whether through pharmacological or non-pharmacological treatments, healthcare professionals can provide tailored interventions primarily aimed at preventing complications, especially stroke. This partnership also offers case management services to numerous health management companies, while our seamless integration ensures that patient information is transmitted to the backend in a timely and effective manner.

From the patient’s perspective, there is a need for compact, elegant, and user-friendly products; for healthcare professionals managing backend operations, the priority is accurate data acquisition, ideally from devices that comply with medical device standards. Accordingly, we developed the handheld ECG device.

From both the perspective of clinical diagnosis and backend data feedback, single-lead monitoring is fully sufficient for patients with atrial fibrillation.

★ Featured Q&A

I. Detailed Explanation of Handheld ECG:
1. Who pays for the product?
Song: The key lies in establishing reasonable value-added services, preferably from the perspective of out-of-pocket expenses for atrial fibrillation patients. Customers do not merely seek hardware products; what they truly need is follow-up care and support.

2. What substantive improvements does mobile ECG detection of atrial fibrillation bring to patients?
Song: Chronic disease management is not an emergency, and mobile ECG is mainly used for disease course management.

3. After data collection, who holds the ownership and usage rights?
Song: The data is shared. In the era of mobile internet, the primary emphasis is on decentralized services, where the backend is not owned by the company but is instead established by physicians themselves.

4. Is the handheld ECG device intended for use by physicians or patients?
Song: The handheld ECG is a home-use device. Thanks to the partnership between Xijian and Apricot Forest, measurement data can be uploaded to the Apricot Forest app. Physicians can directly review patients’ conditions via Apricot Forest’s medical record folder, and the app also facilitates direct communication between patients and physicians.

5. Do patients with known atrial fibrillation require mobile ECG monitoring, or is handheld ECG primarily focused on prevention?
Song: The more focused we are, the better we can understand what customers need. Patients with known atrial fibrillation have a particular need for mobile ECG monitoring, especially during pharmacological treatment. Electrocardiograms can reveal whether recurrence is likely and whether there are any prodromal signs.

6. How many hours of continuous recording are typically performed each day?
Song: Mobile health serves merely as a tool, and the primary methods of documentation vary from person to person, depending on the patient’s specific condition; therefore, there is no standardized timeline.

7. What were the considerations behind partnering with Xingshulin and Kangkang Blood Pressure?
Song: Our collaboration with Apricot Forest encompasses both “soft” and “hard” elements. Atrial fibrillation (AF) patients have specific needs, and we encourage our partners to establish their own health clubs, health service centers, and even follow-up services. The “soft” aspects include follow-up systems, while the “hard” components involve partnerships such as our collaboration with Kangkang Blood Pressure. Some AF patients also suffer from hypertension, placing them at a significantly higher risk of stroke; therefore, they require more comprehensive monitoring. Centering on patient needs is our fundamental starting point, and our collaboration models are diverse, spanning soft and hard solutions as well as horizontal and vertical integrations.

II. Analysis of the Smart Medical Hardware Sector:
1. Is mobile healthcare essential?
Song: For certain diseases, particularly chronic cardiovascular and cerebrovascular conditions, mobile health solutions can make patient services more efficient, but their greater impact lies in improving the efficiency of health maintenance.

2. How to Increase User Stickiness?
Song: From the perspective of human nature, people are inherently lazy. As service providers, we need to proactively engage customers rather than wait for them to come to us; our approach should be service-driven.

3. Regarding medication guidance, has a corresponding module been established? Alternatively, how do you assess the intensity of patient demand for this service?
Song: Medication guidance is a critical long-term intervention. From Xi Jian’s perspective, we do not provide this service, as Xi Jian serves solely as a provider of mobile medical devices or systems. This responsibility is primarily assumed by major pharmaceutical manufacturers or pharmacists. Patients often have knowledge gaps and misconceptions regarding medications and the relationship between their conditions and drug therapy. Therefore, we advocate for proactive services delivered by pharmacists, rather than relying on patients to actively seek out such services.

4. Is the product primarily targeted at patients who already have abnormalities, or is it intended for preventive purposes?
Song: It is recommended that mobile healthcare initiatives start by targeting known patient populations.

5. Some hospital equipment has lower detection capabilities than mobile devices. What accounts for this, and why do hospitals permit such a situation to persist?
Song: It is recommended to start with out-of-hospital services. Portable mobile ECG devices serve as a supplement to traditional hospital medical equipment. In terms of measurement performance, mobile devices are not superior to traditional ones; however, their inherent characteristics make them more effective in capturing arrhythmias, paroxysmal atrial fibrillation, and intermittent arrhythmia. In short, the development of mobile technology can help physicians make more accurate and efficient clinical diagnoses.

6. Is there equipment homogenization in the cardiovascular and cerebrovascular market?
Song: The market for ECG products is highly saturated, and ECG technology is relatively mature, resulting in a plethora of homogeneous and similar products. The key lies in how to serve customers and address their true needs; in other words, those who excel in service will win the market.

7. Can it be understood that the current competition among cardiovascular and cerebrovascular products hinges on the user-friendliness of their app interfaces and the underlying service support?
Song: In the market, startups are not primarily competing on who has the better app or device. The mobile internet era is an age of altruism; the enterprise that can achieve genuine B+B win-win outcomes with its partners is the one likely to win the market.

8. With no breakthrough advancements expected in the ECG field in the short term, is competition primarily driven by resource integration? Since neither technology nor accuracy poses significant challenges, is service the key differentiator?
Song: The key lies in “who has a stronger customer-service orientation.” It is unlikely that there will be breakthrough advancements in the ECG field in the near term; what truly matters are “entrepreneurs’ capabilities in resource integration and market operations.” In the mobile internet era, it is rare for a single player to dominate the market; rather, it is an era where each company can leverage its respective strengths.

9. How is physician credentialing assured in the cloud?
Song: We advocate for acquaintance-based health management and medical services, where patients’ trust in both products and physicians must stem from offline, face-to-face interactions.

10. Number of users? Profitability?
Song: It is premature to discuss profitability and user numbers at this stage. Our current focus is on market cultivation and user education, as we are still exploring our business model; profitability and user acquisition are not our top priorities. Within one year, the number of users for Palm ECG has exceeded 10,000 across China, which is a relatively rapid growth rate. Profitability is not a concern for us at present.

Finally, I hope all group members will adopt a user-centric mindset. Set aside your focus on the product itself; leave product development to professional technical personnel who can execute it according to requirements. The previous era was centered around products, whereas today’s mobile internet era emphasizes a people-oriented approach, with user needs at its core. Therefore, what I wish to share with you is the importance of keeping pace with the times. Thank you all.