Healthcare innovation - what does it take? An interview with Richard Iles

Revolutionising lung function diagnosis

Thursday, May 26, 2016

  • We speak to Dr. Richard Iles about the development of Thora-3Di; a non-invasive, contactless way to measure lung function
  • He tells us what inspired him, and how he overcame challenges on the journey from concept to prototype to market

Hi Richard. ‘Innovation’ is quite a broad term, even within respiratory health where addressing patient need and delivering quality improvement are priorities. In a nutshell, as one of the country’s healthcare entrepreneurs, what have been your principal drivers?

In respiratory medicine, I think innovation is first and foremost about patient need, you’ve got to have patient insight to achieve anything worthwhile. I’d also argue for the importance of left-field collaborations and networks outside our specialty. Thora3Di happened because I involved people who didn’t work in medicine, such as engineers.

And, innovation demands determination! You’ve got to persevere with what may seem to many to be a completely crackpot idea. Have faith in your concept from day one.

You also need to be able to explain simply what your innovation does in less than a minute – which is about all the time you will get from a venture capitalist, a hospital manager or your head of department.

Tell us a little more about the origins of your Thora3Di (Pneumacare, Cambridge, UK)

It was proving almost impossible to measure respiratory function in very sick children because they wouldn’t or couldn’t wear a mask or blow into a tube. So I wanted to come up with something that didn’t require any contact, that was non-invasive, could be undertaken in a clinical setting and give a result in under five minutes. 

When we showed [the concept] to both clinicians and investors, the look on their face was one of amazement, like a light bulb
Richard Iles

Importantly, it had to provide similar quality and clinical outcomes to traditional devices, and might be able to assess severity and predict discharge. Last but not least, ideally it might also work for long-term monitoring of conditions such as cystic fibrosis.

That’s quite a tall order! Where did you go from there?

Indeed, but I’d seen something that looked promising at an ERS Annual Congress. It relied on a suite of cameras that tracked reflective dots stuck on the patient’s chest. But it was expensive, took a relatively long time (and a special room) to set up. And it was unsuitable for one of my key patient groups of patients - premature babies - because their friable skin would tear when the adhesive dots were removed.

Did you have a single turning point, a creative epiphany when the solution presented itself?

I didn’t want to drop the idea completely; clearly the clinical challenge wasn’t going away. So I described the problem to a friend of a friend who worked in the computer gaming industry and he suggested the solution might lie in signal processing. He introduced me to some engineers who specialised in this field within Cambridge University’s engineering department.

Within three months, we had a working prototype of what we now call the Thora3Di.

It’s a non-invasive, contactless way to measure lung function that analyses the image of a chequerboard pattern projected onto the patient’s chest. Without going into the physics, analysis of the distortions of this "grid" as the patient’s chest moves during tidal breathing provides information on lung function.

in medicine we understand which of our patient’s problems most urgently needs solutions and are driven to find them
Richard Iles

Investors often talk in terms of ‘prototype development’, ‘proof of concept’ and also of the importance of determining a product’s market.

Do these stages sound familiar to your development process? What stage have you reached with Thora3Di and how long has it taken to get there?

Yes – I think that it is very important to have a working prototype to show investors, something that they can see in action, even if in our case it was a pair of security cameras on a drip stand with a projector in the middle. Proof of concept is harder, and there is a long journey from prototype, via proof of concept to a FDA approved device. For us that took just over 7 years. It was very difficult to find equivalence with a predicate device, as there was no predicate device! We had to change tack more than once.

Could you tell us a little more about who or what has inspired you along the way? Did you source other expertise - and investment - to fulfill your ambition?

I think that we know the concept should work, and that when we showed it to both clinicians and investors, who appreciated the concept, the look on their face was one of amazement, like a light bulb. The harder task was to try to convert concept into validated data.

It can be difficult to persuade clinicians to become early adopters of a device, many academic institutions have their own areas of interest and focus. There is also an expectation that the early devices will be as robust and reliable as the fully commercial devices, that you might buy off the shelf. Many teams have been fantastic with their time and support, and feedback ways of improving or implementing it. Sometimes the suggested “improvements” are too off beam, and too far from the innovation development plan, and on a small budget are not affordable, so have to remain on the shelf for a later date. This can lead to frustration.

One of the most supportive partners is a major European distributor, who had spent his early career researching respiratory physiology and tidal breathing. He was able to lead us to long forgotten publications that moved the project out of some of its darkest holes.

We are under increasing pressure to keep up with the opportunities and challenges presented by digital technology. But what can we still learn from previous generations of healthcare innovators?

Yes, it’s important to note that people make innovation happen, not technology.

Innovation can still come from repurposing existing discoveries. Certainly in medicine needs evolve and priorities change quite quickly so it often comes down to having a new insight about something that’s been around for a while.

Broadly speaking, we often see some of the cleverest innovations being adapted from seemingly left-field origins. Do you think this is as true of healthcare innovation?

Healthcare innovation differs from other entrepreneurship in one very important aspect – the latter often brings us something we never knew we needed but now find indispensable. But in medicine we understand which of our patient’s problems most urgently needs solutions and are driven to find them. 

by widening your networks, you increase the chance of finding the elusive piece of knowledge that will lead you to a sudden and crucial insight.

Whatever the setting, what three qualities or characteristics do successful innovators share?

First, they have deep expertise - they really know their subject inside out. Conversely, being an expert can make you blind to the obvious. It’s vital to have the confidence to communicate your idea to someone with no knowledge of your specialty because they can have extraordinary insights.

Innovators are also intensely curious. They are interested in many things outside their sphere of work, read widely, have open minds and, perhaps unsurprisingly, tend to have eclectic networks.

This access to wider networks means your problem can be seen by fresh eyes. You don’t know what you don’t know as they say! But, by widening your networks, you increase the chance of finding the elusive piece of knowledge that will lead you to a sudden and crucial insight.

Many of the most successful innovators I have met seem to be made of some sort of super material – how else could you explain their resilience under pressure and their determination to plough on, no matter what problems they encounter?

Yes, resilience and determination are probably key attributes because having meaningful and sustained engagement with your project is the only way to make it succeed. There are many people with a great idea, but you can’t push it forward and then choose to take a break from it for whatever reason. Constant pressure has to be applied to keep the momentum until you’ve got it right or find it’s not viable.

How important is it to be flexible and open minded?

The best innovators are persuasive communicators. You need patience to overcome the more negative of forces, because you will encounter the ‘if it’s not invented here it can’t be any good’ syndrome! And there’s a slight tendency for some to dismiss others whose skills lie in a different area as being ignorant and therefore not worth listening to. More fool them.

Being open minded is, I believe, a critical skill for those who truly want to innovate.

Thanks, Richard, we look forward to hearing about your next great idea!

More information on Thora3Di can be found here.

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