Case 3.2.

Tomorrow options Remote monitoring in healthcare

Ndia Lemos, CEIM BIC Madeira

The beginning
When Catarina Aroso Monteiro and Paulo Ferreira dos Santos started a Masters in Innovation and
Technological Entrepreneurship in September 2004, they never thought that would lead to a technology that
would change their lives forever.
While doing their course, the two students became aware of the existence of a technology developed by Miguel
Velhote Correia and Srgio Reis Cunha, two lecturers and researchers from the Faculty of Engineering at the
University of Porto (Portugal). Conscious of its potential, particulary in the medical field, Correia and Cunha
invited Catarina and Paulo to elaborate a business plan for developing and commercially exploiting this new
technology.
From the academic plan to the reality was just a small step. The four decided to establish a company for
designing innovative electronic devices to address global needs based on a B2B approach, with the main focus
on medical applications.

The first product

The companys founders were the two students, the researchers and INESC Porto, a Portuguese R&D Institute
with an international reputation. Tomorrow Options was created in March 2007 as a spin-off company of the
University of Porto. The specialized human resources working in partnership with the scientific-technological
system was the key to boosting the companys potential.
As a fast-growing company there was a constant need for significant capital to support product development. To
face this need, in November 2007 they obtained their first seed-capital from Ciencinvest27. In June 2008
InovCapital, a Portuguese venture capital society, joined the board of Tomorrow Options and they were able to
leverage the business for the coming years.
In December 2009, with an investment of approximately 800,000 they began to do business with some British
hospitals. The United Kingdom was chosen as the companys market platform and in May 2009 they established
a subsidiary in Sheffield. We chose England because it is an extremely competitive market. So, either we would
die very quickly, which was not necessarily bad because it would save us a lot of money, or we would grow very
strong, explains Paulo Santos. The first product launched was WalkinSense, a unique device to prevent foot
disorders especially in patients with diabetes.

The technology
The idea of developing a new complementary diagnostic tool was born after the business partners discovered
that the existing devices for diabeticfoot disorders were so expensive and complex that they were only being
used in laboratory environments. Diabetes has a high direct cost to the health system. It can cause foot ulcers and
lower limb amputations and reports estimate thatdiabetes is responsible for one limb amputation every 30
seconds, at a cost of $30,000 to $40,000 per amputation. Every year 15% of diabetes patients will develop foot
ulcers and 15% per cent of those will have no choice but to face amputation. It was these facts that motivated the
company to develop a technology targeted at fighting the problem by preventing foot ulcers at an early stage to
avoid more drastic steps and save money.

27
A company working in the field of the economic valuation of research results.
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 Figure 1 Foot ulcer formation

A Portuguese patent was issued in January 2008 (PT 103933) and one year later it was converted into a PCT for
the European Union, USA and Canada.
WalkinSense allows real-time monitoring of a patients lower limbs. The device works, through sensors placed
on insoles or directly on a patients socks, which collect, store and process data (activity, plantar pressure and
motion) that can be easily analysed by medical staff. The accuracy of the data allows the rebalance of weight
distribution on the sole of the foot and the reduction of pressure in areas at risk of ulcers through the prescription
of custom-made insoles or shoes adapted to each patients condition.

Figure 2 Amputations related with diabetic foot are normally in slices: usually after the first one the patient
must be amputated again in less than 3 years and dies after 5 years.

The portable device processes live information and sends it for analysis to a computer (or another portable
device), via Bluetooth or USB. The software is very simple to operate and allows the dissemination of
information among the medical staff, encouraging a multidisciplinary approach to medical interventions. This
simple and easy approach also benefits the patients since their daily activities can be monitored for up to seven
days, without them being confined to a laboratory environment. When the information is collected the patient
can even send the device by post to the clinician, reducing the need for visits to medical centres.

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 Figure 3. Left: software for reading patient data
Right: Lower limb monitoring

The advantages of the use of this device to avoid major medical complications and increase patient welfare are
undeniable. The advantages for health systems are also obvious. But why is WalkinSense such a tremendous
success?
For Paulo Santos there are several answers to this, but the fact that this technology filled a gap in the market
should be taken into account. In the market we found many types of equipment to analyze mobility, motion and
plantar pressure. But a technology that brought together all these complementary analyses was new in the
market. Combining all these functionalities in one compact portable device was a major innovation providing
clinicians with a cost-effective way of taking actions based on quantified information rather than visual
inspection and of immediately assessing their effects instead of waiting for a laboratory report. It also helped
increase the number of patients with access to up-to-date technology.
The core technology used to develop WalkinSense is considered as perhaps the best in the world for monitoring
lower limbs. The company is now developing it to explore other applications in the health market, like
simultaneous monitoring of lower and upper limbs in post-stroke patients for rehabilitation purposes,
physiotherapy or occupational therapy, and in sports medicine to correct athletes posture, improve performance
or avoid injuries. There are other products and services under development that will be launched shortly to solve
other health problems, like the avoidance of bedsores (pressure ulcers developed by some patients who stay in
bed for long periods).
Tomorrow Options is clearly an innovative high-tech medical device manufacturer with a well established
direction.

Open Questions for debate

1. What is a fast-growing company?
2. To be global, does a business only need to have an internationalization strategy? How can it address
global needs?
3. What is disruptive innovation?
4. What is the role of the entrepreneur in achieving success for a project?
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