Improving Patient Outcomes Through Better, More Inclusive Skin Assessment
Friday, August 6, 2021
Rubitection is making skin health evaluation better, easier, and more reliable to prevent chronic conditions and improve quality of life through innovative, inclusive technology. We recently spoke to Rubitection’s Founder and CEO, Dr. Sanna Gaspard, about the importance of diversity in medtech, the need for more innovation in and investment for technology to support an aging population, and what the government can do to advance these goals.
What in your background led you to launch Rubitection?
Three things led me here: my passion for healthcare, wanting to have a real impact on society, and wanting to have some control over the direction of and type of technology I worked on.
As someone with a Caribbean background—I spent my formative years in Saint Lucia —the idea of entrepreneurship was already embedded within my community. It was not outrageous to think you could run your own company. I saw it first hand through my dad who owned a construction company and my grandmother who owned the community bar. Within my town, everyone found a way to create their own business—what Americans might call “hustling.” I took on this mindset and these principles for myself when I immigrated to America at the age of six.
As a biomedical engineer, I wanted to work on topics that I was passionate about and where I could have a real impact. By the time I had started my graduate studies at Carnegie Mellon, I had already invented a robotic infant massaging system. While I was in graduate school, I founded a medtech startup around robotic pediatric device called TLneoCare. It was a smart massager that delivered therapeutic touch for preterm infants. It improved their survival rates by helping infants gain weight. It’s hard for a startup to get support from investors for such a high risk group, like preterm infants, though. Their high risk requires the most stringent Food & Drug Administration (FDA) regulation. It would take too long for investors to see a return on their investment. There were not many ways for me to get financial support. With a better understanding of the investment landscape, I stayed focused on the entrepreneurial path to bring my future inventions to market through Rubitection. I appreciated the degree of control over the trajectory of the vision, impact, and operation. It wasn’t something I believed I would find working for a larger corporation.
Rubitection focuses on early skin health and care management. Can you tell us what impact the Rubitect device and Rubitect Assessment System has on these areas?
The Rubitect measurement device and Rubitect Assessment System can support care in wound care, dermatology, and surgery. In the area of wound care, we can support early diagnosis of preventable chronic wounds such as pressure injuries, also known as bedsores, and diabetic foot foot ulcers. Catching these conditions early can prevent large, severe wounds that would usually inevitably lead to amputation, and sepsis – a blood infection, that can be deadly. This is extremely important because once you have an amputation, the five-year survival rate is only around 50-60 percent.
In the dermatology space, our assessment and care management system enables objective monitoring of treatment progress for medicated skin conditions like psoriasis and eczema. For patients using a skin cream treatment for several weeks, it can be tough to see incremental changes and disappointing to not see progress. Our solution can support physicians and patients in determining if their current treatment plan is effective by reliably monitoring changes not easily observable with the naked eye. Patients can be monitored remotely or during visits to their doctor. By enabling the easy monitoring of incremental changes our goal is to improve patient treatment compliance, aid in cost reduction, and support the patient in improving their quality of life overall.
In the realm of surgery, the Rubitect probe is able to monitor associated perfusion to assess the vitality of a skin graft or flap to determine if it’s receiving sufficient blood flow and detect early signs of tissue failures or infections. For surgeons, this is incredibly useful for procedures like amputations where adequate perfusion of blood to the site and skin is critical to the surgery’s success.
I’ve seen you speak about how current skin assessment systems are archaic and not inclusive of darker skin types. How are Rubitection’s products breaking down that barrier?
Currently, the health disparities in skin assessment have led to skin evaluation tests that do not work for people of color. This is well documented. As a person of color developing this technology, that was one of the main things that got my attention. With Rubitection, I wanted to (and did) create a tool that works for everyone. There generally is a lack of diversity on teams developing the code or the device. This creates a myopic outlook and requirements by people developing these technologies, which reflects many systemic disparities and lack of exposure.
As an example of the problem, there was a video going around a few years ago about a disparity with an electronic soap dispenser. When individuals with light complexions put their hand under the dispenser, it worked as expected. But when those with darker complexions attempted to use it, it did not recognize their skin and didn’t release soap. The sensor needed a wider range because it had been developed on the assumption that it would only be used on white hands/palms. It’s simple situations like this that demonstrate the lack of consideration by product developers. This is also highlighted by the Time article of the limitations of pulse oximeters for darker skin tones which was disproportionately putting people of color life’s at risk during COVID.
Another complicating factor is that it can be hard to get access to images of people of color to train or test the technology. The historic deceptions in clinical testing on people of color have created reluctancy to participate in research studies, which are needed to ensure system work well for that community.
Diversity should always be a focus in developing tech. This not just inclusive but is good business. The global market is diverse. To really address this problem, first we need more people of color in the development teams and in the focus groups. However, in the absence of having a diverse team, it is the responsibility of the product development team to prioritize including people of color in their focus group testing to ensure they are building to appropriate technical requirements that will result in an inclusive product. With that being said, I would also urge and encourage members of minority communities to participate more in the development and research process to aid the process of making products that are inclusive.
I know Rubitection recently participated in the inaugural class of the Techstars Future of Longevity Accelerator. What was that experience like, and why are programs like this important for combating elder care-related issues?
People often think of longevity as a problem of the future but there’s not enough focus on truly setting up and preparing systems for an aging population today. This is the importance of the Techstars program. It supports the development of longevity technology needed for the future today. It’s projected that we’ll have 85 million elderly adults by 2040! Unless we get ahead of conditions (including skin breakdowns and bed sores) and systems that are affecting the elderly and their care management, we as a society will be in a situation where there’s a huge and growing healthcare cost and void of tools needed to support the elderly. You only need to manage the care of an elderly family member to find out the system is broken. Without building the tools and putting the infrastructure in place now, a lot of families will be struggling to find resources, tools, and support. This is the problem the TechStars longevity program aims to solve. But right now, while people know the issue is important and is inescapable, there are not a lot of investors focused on supporting longevity tech and the care economy. In five to ten years, there will be as the benefits and return are more apparent.
Techstars is ahead of that curve, serving as a stepping stone to bring impactful solutions for senior adults. During my time in the program, I was able to create relationships with other professionals within the industry, including AARP, and Pivotal Ventures. I also met other innovative startups in this space addressing problems like isolation, housing, and care coordination. It was wonderful seeing how they were working to transform the space. Techstars longevity program and its participants are going to have a big impact on healthcare and the development of elder care in the future.
How can policymakers better support entrepreneurs in the health/tech space?
There are a few things that come to mind. First, we need more grant funding. As I mentioned earlier, there aren’t many investors or corporations that invest in medtech startups during their early stages. There are also not a lot of investors focused on longevity or the care economy. Unless you come from a rich family, money is hard to come by. Especially with apprehensive attitudes from investors due to the timeline of FDA approval, a lot of early medtech startups die in the valley of death because they don’t have the financing to get to profitability. For the US to remain competitive globally its important that we provide a variety of options including investors and grant funding. On a global scale, you’re competing against companies in, for example, Canada and Asia, where the government has invested in supporting startups and research them in their early stages. This makes it harder for U.S. startups to compete for investment dollars as they cannot show comparable progress within the same time frame. Investors often invest in companies that are further along, regardless of their geography. It reduces risk of failure.
Second, it would be good to have a startup program at the Food and Drug Administration (FDA) and allow startups to begin pre-sales of their medical solution prior to full market launch. Unlike standalone startups, larger corporations have the internal structure to support the longer FDA timeline. Within six months to a year, a startup could be dead from lack of funding but still be waiting for FDA approval. The government should put more resources into supporting startups through the approval process. While waiting for FDA approval the ability to make initial pre-sales would allow startups to raise money from investors as it would provide data to validate future potential revenue and support market demand. A demand that can be filled once FDA approval is provided. If the U.S. wants to remain competitive, policymakers need to address this issue and properly set up our startups for success. Addressing this issue would also support the US in being competitive on the international level.
Finally, the government should support and encourage medtech-facing professional organizations. There are only a select few organizations that medtech startups can go to for support (AdvaMed and MatterHealth are a few to name). But these organizations can help innovators connect with healthcare stakeholders, institutions, and insurance companies. These connections also go a long way to improving solutions because without access to people, innovators end up trying to solve a problem in a vacuum. When you develop a product without testing it on the target market, it creates problems and leads to additional cost.
The connections gained through professional organization is also important for getting access and sharing critical information. For example, to develop a pricing strategy and understand market adoption, it is important to understand the potential ROI. Determining the cost of a condition or a procedure for a facility is currently very difficult – almost impossible unless you have an inside connection.
Greater transparency around how hospitals are spending on various conditions or care management would allow startups to illustrate the ROI of their product or service. Greater access to the contact information for a doctor or health administrator would allow startups to efficiently develop their products with necessary stakeholder feedback. In the health tech filed we need real data and access to all types of people to develop new solutions to change the status quo to improve care. Policymakers can solve this problem by creating policy that require transparency to big hospital data on incidence of conditions, associated cost based on insurance reimbursement or lack thereof, and provider (e.g. administrators and doctors) contact information. Greater access to healthcare stakeholders, investors, funding, and data will open up innovation in the healthcare space and allow it to move quickly.
Do you have any thoughts on how federal policymakers can better advance the goals of diversity in the tech sector?
There is a problem of exposure, support networks, and economic stability. Minority students tend to come from economically depressed areas, cannot always afford to do the “training,” may lack adequate support at home or at their school, and are in need of “fast” money to survive or assist their family. Overall, policy should focus on an ecosystem approach. The problem is not singular. This means supporting after school tutoring and STEM programs from K – 12, providing career counselors that can provide exposure and path to particular care, economic support in the form of competitive internship and training programs during school and the summers, and providing access to professional networks from middle school to college. Note these are important but the most is providing quality educational opportunities within the community and supporting the family. It is hard to learn or thrive when you are hungry or dealing with lack of support at home. Building and supporting a healthy ecosystem – the same the top 10% of students have access to – is what is needed to prevent diverse students from falling through the cracks. It is that simple.
A few proposed solutions: 1) Provide and fund extracurricular/after school programs focused on tech and STEM, starting in kindergarten through high school, with a focus on economically disadvantaged areas. Parents are often working several jobs and as such do not have time to help with homework, child care, etc. 2) Create federally-funded internships and job shadowing programs for diverse founders starting as early as middle school, so students can shadow professionals at large corporations, in healthcare, and at startups to start learning about different fields. 3) Change the public school funding system, so schools have independent funding not associated with property taxes—which was based on racial disparities and redlining—so that all schools are properly funded and staffed to provide quality education. 4) Pay students in low economic environments for good grades and professional level internships as an alternative to low paying jobs at McDonalds that distract them from their education. 5) Establish exchange programs where middle school students can visit colleges, technology labs, corporate labs, etc in the US and internationally. 6) Provide school counselors and life coaches to help guide professional vision, goals, milestones, and pathways for students as early as middle school. In wealthy families this is generally provided by parents who understand how to navigate the system as they have completed it prior. 7) Fund scholarships for vocational schools and colleges focused on tech and STEM. 8) Provide scholarships for adult retraining programs focused on STEM. I am open to speaking with policy makers. 9) Help to keep their neighborhoods safe from violence.
What is your goal for Rubitection moving forward?
My vision is to support longevity globally by providing a solution that empowers caregivers to manage care around chronic preventable skin-related conditions to preserve quality of life and reduce costs. To achieve that vision our short term goal is to secure additional clinical collaborators (e.g. hospitals, nursing homes, and home care), corporate partnerships in the dermatology, surgery, and wound care, and to connect with global investors in the longevity and medtech space to bring our solution to market. We are actively connecting to stakeholders and investors to bring our solution to market. We are currently fundraising a seed investment round and are identifying investors. We look forward to supporting quality of life and saving lives globally as the society ages around the world.