Weekly Startup Profiles > Teleradiology Solutions
|A patient takes his X-ray in a US hospital. Within half an hour, his report is ready. Incidentally, the report came from India - from the HQ of Telerad.|
Outsourced teleradiology services company
When Sunita Maheswari and Arjun Kalyanpur moved to India from the US in1999, they had no plans to become entrepreneurs. With a specialization in Pediatric Cardiology, Sunita wanted to help children born with coronary problems. Arjun, a radiologist, wanted to improve diagnostic processes in India.
But things didn't go according to plan.
Instead of doctors, they became pioneers of teleradiology in India by founding the company Teleradiology Solutions (Telerad). They didn't begin their company with a business plan, feasibility report or even a clear dream. They did it because, well, upon their return to India, Arjun suddenly found he was too overqualified to get a job!
For the first two years in India, Arjun searched, frustratingly, for a career opportunity that would excite him. In 2001, while setting up the radiology unit at Sathya Sai Hospital at Whitefield, a conversation with his doctor friend in the US led to his life's turning point. His friend, troubled by the shortage of radiologists on night shifts in the US, wondered if Arjun could join his team. Arjun put forth his terms - he would only if he can remotely interpret diagnostic imaging reports from India. The deal finally fell through, but the idea stayed.
He experimented with this 'radical' concept with Yale University, where Yale University sent him cases through the internet, and Arjun analyzed and prepared the diagnostic reports from Bangalore. Eventually, this program too ended, but this exercise gave them their first glimpse of the future. That's when they decided to build Telerad.
From that first conversation he had with his friend, Arjun knew that he had struck upon a win-win idea. Despite the tough teething troubles - they only got one client in their first year and three in the second - the couple had complete faith in the opportunity they had discovered.
Ten years of practicing medicine in the US made the couple familiar with the practices and problems in US hospitals. They realized there were several hospitals in the US who required accurate, high quality diagnostic reports but were not in a position to invest in building a radiology department, thanks to the high cost and effort involved. Recruitment, infrastructure, technology and training required for running a radiology unit meant too much investment. Also, as Arjun's friend had mentioned, there were not enough radiologists working night shifts to handle emergency cases in the US.
Around the same time, India, especially Bangalore, was emerging as the global outsourcing hub, and outsourcing radiology - a function that doesn't require the physical presence of the doctor - seemed like a feasible idea for their US clients.
"Our business premise is solid - Only if you have a correct diagnosis can you be correctly treated. Though we were clueless about several aspects of running a business, we promised to deliver high quality, accurate reports," recalls Sunita.
The couple started their company from their home office, interpreting X-rays, scans, MRI, Spects and PETs through the internet for US clients. Their 'Nighthawk' services utilized the time zone advantage, filling in for their clients' night shifts. They hired Americans in their sales force to connect better with US hospitals. By providing half hour turnaround time, 99.8 % accuracy in reports and personalized service, their reputation grew by word of mouth, and today they have grown from a mere six contracts to cover 75 hospitals in the US, nine in Singapore and three more in Puerto Rico.
"We are nimble and open to changing our work flows to meet customer demands. Very slowly and organically, we grew and scaled up. Today, we can provide diagnostic solutions to any part of the world. So the learning has been immense," shares Sunita.
With the Indian health imaging market expected to double from the existing $350million in the next five years (according to London-based market research firm Tekplus), competition in this space is heating up. Wipro, Reliance and Apollo Group have recently entered the fray, but the couple is not excessively worried. Telerad clearly holds the early mover's advantage - it still enjoys a 90 % market share in the country.
"Wipro and Reliance are still newcomers in the industry. Smaller companies in India don't have the scale. Our competitive edge lies in the fact that we have been in this field for six years, gathering immense domain knowledge and building goodwill. The feeling that Telerad is 'doctor-run' and not 'corporate-run' has also helped," says Sunita.
Telerad has been growing 50 per cent year on year, and the duo has invested almost Rs 30 crore into the business. "We started by using up our savings, but now we are ploughing back profits," says Sunita.
Telerad is a vision of Arjun and mine, and we remain the prime decision makers, reveals Sunita. Arjun looks after reporting, teaching and training, while Sunita deal with business development, HR and finance. Initially, the couple depended on circumstance and gut feel while making their business decisions. "You have money, buy. No money, no buy. No contract, no recruit. Only recently we started keeping people on bench," says Sunita. The couple relies heavily on their founding team of 25, out of which 23 are still with the company. The company presently has 180 employees, including 40 radiologists.
The beginning was very tough as there was lack of awareness and people were resistant to use new technology. On the other hand, infrastructure in India in terms of power, internet connectivity and bandwidth was dismal. But we fought our way through, with Arjun working endlessly from home while I did the balancing act between Telerad and Narayana Hrudayala, where I worked part-time, shares Sunita. Telerad has come a long way since then, and riding high on its recent success, is now planning to introduce tele-pediatrics, tele-dermatology and tele-echo in the near future. "We also have a software team working on creating low cost radiology solutions. We want to focus more on small towns and rural India, but broadband connectivity remains a challenge," she adds.
Initially, we stayed awake wondering if the business will take off at all. Today, we worry for all the good reasons: How do we scale? How do we ramp up? How do we make the best of our growth? These are good pressures to work under, she says.
Entrepreneurship brings out passion and mental energy like no other career does. There is not a single dull moment. An entrepreneur can't afford to have a 'chalta hain' attitude, and this makes him stretch his own limits and fly.
Most of us are limited by our own mindset. My experience has taught me to believe in my own instincts, to carry on even if everyone else around me thinks I am crazy. I've learnt to give my beliefs a shot.
"When we went to register the company, the Registrar asked us the company's name, and we realized we didn't have any! Teleradiology Solutions was a name we thought of in a second."
It is a tough job to be pioneers. As any venture capitalist would tell us, the leading edge is often the bleeding edge. Telerad bled. Friends scoffed at Arjun and Sunita's idea; changing mindset wasn't easy and dismal internet connectivity frustrated them to a point where they almost lost hope. But they fought on, broke almost every conventionally held maxim and emerged as champions of uncommon wisdom. They didn't get a seasoned management team; instead they chose to be doctor-led. They scaled up without taking any venture capital. Their plans were led more by their own practical instincts than business concepts. In the end, it was their undiminished entrepreneurial spirit that led them to success.
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