Reverse innovation in mHealth. Innovating in emerging countries to impact in the global market.

Recently, doctors in Austria implanted into a patient the first pacemaker which does not require surgery. Medtronic says it is the smallest pacemaker in the world. The device is 24 millimeters long and 0.75 cubic centimeters in volume—a tenth the size of a conventional pacemaker. Earlier this year, another device manufacturer, St. Jude Medical, bought a startup called Nanostim that makes another tiny pacemaker, and St. Jude is offering it to patients in Europe. This device is 41 millimeters long and one cubic centimeter in volume. The main advantage of the reduced dimesions of this pacemaker is that doctors can implant it into the heart through blood vessels, via an incision in the thigh. They use steerable, flexible tubes called catheters to push the pacemakers through a large vein.

Moreover the novel features of this pacemaker extend beyond its innovative implantation. The mini-pacemaker’s telemetry might facilitate a development in the future that would allow healthcare professionals to control the device and monitor patients using a standard programmer via smartphones, thereby providing individual treatment to patients in the most rural of areas. –

Why did Medtronic start working on this?. This post at the Harvard Business Review addresses the topic very well. It explains how Medtronic started working on this tiny pacemaker to fit the requirements of emerging markets such as India. Eventually, they come up with an innovative product for the global market.

Sixty-nine percent of deaths in the developing world are due to chronic disease, yet only 2.3% of international aid is allocated to chronic disease. In the United States, hospitalization of chronic disease patients accounts for the majority of health care costs. But innovation in managing chronic disease is happening faster in emerging markets such as India as a result of the scarcity of physicians.

At this point, few specialists are actually trained to monitor this device, or other Medtronic devices. In addition, the fragmentation of India’s healthcare system means that clinical outcomes aren’t monitored and evaluated in a standardized way. This increases the potential for device failure, and personal-injury lawsuits — a serious concern for Medtronic in a market with millions of customers. Medtronic recently paid $268 million to settle cases stemming from fracture-prone cables used to connect hearts to defibrillators, which earlier recalls could have avoided.

But Medtronic anticipated these institutional voids in the healthcare regulatory system. To preempt poor clinical-outcome monitoring, Medtronic placed passive remote sensors in the stent and pacemaker that transmit signals via any mobile handset to a cloud computing infrastructure — “patient care in the cloud.” The technology is being adapted for remote monitoring and adjustment of other products, including neuromodulators for Parkinson’s patients, and glucose modules.

At this point, few specialists are actually trained to monitor this device, or other Medtronic devices. In addition, the fragmentation of India’s healthcare system means that clinical outcomes aren’t monitored and evaluated in a standardized way. This increases the potential for device failure, and personal-injury lawsuits — a serious concern for Medtronic in a market with millions of customers. Medtronic recently paid $268 million to settle cases stemming from fracture-prone cables used to connect hearts to defibrillators, which earlier recalls could have avoided.

Actually, this process is known from some time ago as reverse innovation :

The process of reverse innovation begins by focusing on needs and requirements for low-cost products in countries like India and China. Once products are developed for these markets, they are then sold elsewhere – even in the West – at low prices which creates new markets and uses for these innovations.

We can see it as another consequence of globalization, medical device innovators have been embracing the notion of making products simpler, stripping out costs to make devices affordable for those who have very little income, and adapting devices to make them invaluable for healthcare professionals who don’t have the state-of-the-art facilities of a Western hospital. For sure, we will continue to see this process in the coming years.

Stephen Oesterle, Medtronic’s Vice President for Medicine and Technology, announced the development of the mini-pacemaker at the 2010 TEDMED