What does the future of telecardiology look like? Mr Sun, a 73-year-old retiree from China, caught a glimpse recently when he sought help for sudden abdominal pain at his local clinic. A doctor there recorded Mr Sun's ECG, which was uploaded to the cloud and interpreted by an AI module. Another doctor – one based in a hospital elsewhere – then manually confirmed the report before it was sent to the clinic.
Mr Sun’s ECG pointed to acute myocardial ischemia, an emergency condition that occurs when there is reduced blood flow to the heart. He was quickly conveyed to a hospital where further tests were ordered. Soon after, Mr Sun received emergency Percutaneous Coronary Intervention (PCI) surgery, which ultimately saved his life.
In China, ECGs are mostly performed in large urban hospitals, so Mr Sun's access to it at a local clinic is highly unusual. The timely diagnosis and subsequent medical intervention he received was possible thanks to Cardiocloud, a Beijing-baser startup that’s revolutionising how ECGs are performed.
Cardiocloud’s core product is its medical-grade 12-lead ECG device, which can record both static and continuous ECGs without medical supervision. This offers both the convenience of a consumer wearable and the efficacy of a clinical-grade ECG. Complementing this hardware is a suite of diagnostic software and services backed by both AI and human physicians, as described in Mr Sun’s experience above. With this ecosystem, ECGs can now be recorded and interpreted just-in-time outside of the hospital setting, making home- and community-based ECGs a reality.
Cardiocloud’s device has already been commercialised. In China, the company has a strategic partnership with the China Chest Pain Centre to equip 3,000 county-level rural hospitals with 100 sets of hardware each, for grassroots doctors to perform out-of-hospital ECGs for their patients. Elsewhere, home-based diagnostics is being explored with AstraZeneca and other insurers, while a major hotel chain has also expressed interest in equipping its properties with Cardiocloud’s device.
The company is currently conducting a Series B+ round of fundraising to finance further expansion, with plans for domestic IPO by the end of 2026, and expansion into the international market in the mid-term. We speak to Mr Chen Liheng, Cardiocloud’s founder and CEO, on progress so far and the milestones to expect in the years ahead.
On the surface, Cardiocloud’s device doesn’t actually seem very different from what’s already available in hospitals. Why has it taken so long for an out-of-hospital ECG device to be developed?
There were three main problems to solve, and they don’t just concern the hardware. The first is useability – it’s difficult for rural doctors or non-medical professionals to perform traditional ECGs properly because they lack the necessary training. Where and how to place the electrodes, for example, is already an issue that can affect the accuracy of the results. We solved this by designing our device as a wearable that’s easy to wear and operate.
The second problem is the interpretation of results. Unlike blood glucose monitors or blood pressure monitors, which give quantitative results that are easily understood, ECGs must be interpreted by a specialist, just like how CT scan results require a radiologist. To solve this, we developed a system with AI interpretation backed by human doctors.
The final problem is timeliness. There were actually companies before us that offered similar telecardiology services, but they couldn’t achieve quick turnaround times for their ECG reports. This becomes a problem very quickly, because users may be okay with waiting for their reports the first few times, but they will lose their confidence and stop using a service that is slow, since cardiac events are very time-sensitive. Our system was developed to address this by providing a report within minutes.
Time is of the essence in this context.
Yes, you’re right. For a cardiac event, the first 120 minutes is the golden window when medical intervention will provide the best outcomes. We are not just talking about survival here, because timely diagnosis and treatment will also reduce various complications that can impact a patient’s quality of life, so every second counts.
Cardiocloud’s diagnosis currently involves AI-powered interpretations that are then confirmed by human physicians. Do you think the system will ever improve to the point of not requiring doctors?
Logically speaking, the AI module alone should suffice once we have accumulated enough data for machine learning to reach a certain point. Users, however, are a variable that we must also consider. Will a patient trust a report that’s generated by a programme? Or will a patient only trust a report that’s signed off by a doctor? There’s a psychological barrier here, and we must recognise that the human element plays a very strong role in medicine. You can’t ignore the importance of empathy and the human touch here.
What do you think is your greatest triumph at Cardiocloud since starting the company?
In 2018, we embarked on a strategic partnership with the China Chest Pain Centre to deploy our device and services across China’s 3,000 county-level hospitals. It was very challenging initially because we had to convince doctors of what we had to offer. This is, after all, long-distance diagnostics, so there were doubts about whether a physician who is so far away can properly understand the symptoms and provide an accurate diagnosis.
In time, however, we got the buy in of physicians at China’s top hospitals, who saw this as the way to build a comprehensive ECG diagnostics network across the country. They then became our strongest advocates and helped to convince their peers by serving as the key opinion leaders for this initiative.
I think that the success of this project is our greatest triumph. In 2022, we began the actual deployment of our device and services and reached 60 hospitals for US$6 million in sales. This will extend to 200 and 400 hospitals in 2023 and 2024 respectively, for expected revenues of US$20 million and US$40 million.
Do you think your device will one day replace full-size ECG machines currently deployed in hospitals?
Hospital administrators will see little benefit from replacing their current equipment with ours, even though they achieve the same results. At this point in time, I will say our company’s device is meant to complement, not replace, the ECG machines that are currently used in hospitals. There are many unmet needs anyway, and addressing them will already create an immense market for us.
Do you see an endpoint for your device and system?
We believe that diagnosis and monitoring will gradually become home-based, while hospitals continue to provide treatment and further investigative work. Self-diagnostics is a trend that was accelerated during the pandemic, with pulse oximeters suddenly seeing high demand. The blood glucose monitor, which I mentioned earlier, has also gone from clinical settings to home settings.
The eventual goal is thus to develop an everyday ECG device, so you will be able to monitor yourself continuously, and be alerted to any changes to your baseline results. To get there, we will iterate on our device to upgrade its convenience and portability. Of course, the potential of having our device in every home also means that Cardiocloud has much room for growth and expansion in the years ahead.
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