Meet the Startup: CUSH Health – data-driven fall prevention

Grant-funded AI start-up CUSH Health targets falls that cost the NHS £2 billion annually.

The impact of falls on the elderly population is significant. In the UK, falls are the most common cause of injury related deaths in people over the age of 75. British start-up CUSH Health is focused on addressing this challenge using the power of data, artificial intelligence and remote monitoring technology.

The company is co-founded by Kalon Hewage and Dr Sam Fosker, and we recently caught up with Hewage to find out more.

Longevity.Technology: How did CUSH Health get started?
Kalon Hewage: CUSH Health was founded when Sam and I were flatmates working at the same hospital as junior doctors in East Sussex.

After one particularly bad day on call, we had both seen so many patients who had been admitted with broken hips following falls that we thought there had to be something we could do about it.

Speaking to these patients and their families, there were some quite clear warning signs and risk factors for these falls occurring. Despite these warning signs, no one had picked up on them and more importantly there was no good system in place to be proactive rather than reactive to the problem of falls.

We were initially driven by coming up with a solution for our own grandparents and parents to keep them mobile and independent while detecting any deterioration early so that it can be acted upon.

We purchased some off-the-shelf inertia measurement units (IMUs) that have three axis accelerators and gyroscopes and began looking at how we can measure mobility and gait and integrating this into a machine learning model to predict when disturbances in normal gait occurred.

Longevity.Technology: How significant are falls in terms of the elderly population?
Kalon Hewage: Currently it is estimated that one in three people over the age of 65 will have at least one fall each year, with one in 10 falls resulting in a serious injury such as a hip fracture. Hip fractures are the most common injury and the single biggest cause of accidental death in the older population and are associated with a 30% risk of mortality within the first year.

20% of patients will sadly lose the independence they once enjoyed and require long term nursing care. Annually there are over 64,000 hip fractures in the UK alone which accounts for 1.5 million bed days at a cost to the NHS of over £2 billion. And these are just the effects we can measure.

Consider the common case of an independent elderly individual who lives alone. They may have had a couple of stumbles, but nothing they want to worry their family about and certainly nothing they think is bad enough to visit the GP. They are convinced that they will be OK, but just in case, they’ve decided not to go for a walk everyday around the park and maybe a trip to shops can be done every other week.

Until they fall again. This time they seriously injure themselves and get admitted to hospital. There, healthcare professionals react by assessing their risk of falling and needs and put interventions in place to stop this happening again. But, for many, this can all be too late, and the damage is already done.

Current healthcare models are under strain as the population ages, chronic health conditions increase and resources shrink. A recent Royal College of Physicians study showed almost two thirds of doctors believe that patient safety has deteriorated.

But what if we used a proactive solution rather than reactive one to tackle this problem? What if we could identify at risk patients and put in place targeted interventions and prevent an event from occurring in the first place? And what if we could automate this whole process so that patients received help when they need it and healthcare professionals can concentrate on the most vulnerable?

Longevity.Technology: What is unique about what you have developed?
Kalon Hewage: Data-driven technologies have the ability to transform healthcare. At CUSH Health this is exactly what we aim to deliver.

We believe our AI-assisted remote monitoring and telehealth system to be a disruptive technology for the falls and mobility sector. Our algorithm utilises machine learning to analyse an elderly person’s gait using commercially-available edge devices such as smart phones and watches.

Patients are given an objective overview of their data and needs. Bespoke strength and balancing programs can be delivered in the community as well as a market-place for aids and services can be accessed all via the app. We aim to dramatically increase patient concordance with therapy as they will receive continual feedback on their progress, thus the self-motivation and self-control to improve.

Healthcare providers will be able to use the remote monitoring system to manage their patient population in real time with outliers automatically highlighted for review or intervention, thus reducing time and costs associated with continual visits and follow ups.

As well as the proactive approach to falls prevention, the telehealth capability will enable falls clinics and rehab services to monitor and improve flow from acute hospital beds back into the community.

Thus, allowing continuity of care and bridging the gap between care services and patient autonomy. As adoption grows, we hope our system will create a clinical audit and an educational research tool similar to the National Hip Fracture Database, from which national and international policies for best practice can be designed.

Longevity.Technology: What is your commercialisation model/route to market?
Kalon Hewage:  We have been working closely with local hospitals and falls clinics to ensure the platform improves the flow of data and their patients as well as being user-friendly for the patients themselves.

Through our current research projects, we will be able to complete an economic use model to be able to show the savings available to falls clinics and GPs by having a better streamlined service and better user engagement. The platform will then be available to individual users who will be able to upgrade from a basic package to increase their functionality and see more in-depth metrics and have access to a wider range of exercises and regimes.

Longevity.Technology: Where does the business stand today and what are your growth plans over the next year and beyond?
Kalon Hewage: We are currently undertaking our second Innovate UK funded grant that builds on our developed model to monitor users in the community over a longer period of time. We are comparing this with a gold standard gait lab assessment to ensure our measured gait metrics our scientifically corroborated.

Alongside this we have developed our user and clinician platform and are currently in the process of trialling this with multiple user groups to improve the user interface and functionality.

By being accepted onto the AgeTech Accelerator program we have been able to access multiple focus groups from four EU countries to ensure our platform will integrate into different healthcare models.

From here we will be undertaking the required regulatory requirements to be able to integrate the platform within the NHS and private user homes.

We plan to grow our team to consolidate our technical team and further our current connections with healthcare teams (such as local CCGs and falls clinics) to test the platform on a much wider population.

Longevity.Technology: What are the main business challenges you face?
Kalon Hewage: Technology can often feel daunting or alien to an elderly population and so ensuring that individuals actually engage with our solution has been paramount since the inception of the project. We have worked with and consulted with our end users at every stage of development so far to ensure that what we build is not only intuitive but also solves a problem that matters to them.

This has been helped through the EU funded AgeTech Accelerator, where we have engaged with elderly individuals and their relatives along with healthcare professionals involved in the treatment and prevention of falls in the UK, France, Belgium and the Netherlands.

Longevity.Technology: What are your funding plans?
Kalon Hewage: Our first clinical study was funded by Innovate UK and we were awarded a £54,000 grant which was 70% funded. We were extremely lucky to have a good relationship with our local Academic Health Science Network (Kent, Surrey and Sussex AHSN). When we first came up with the idea and had a project that we wanted to run to explore the concept,

they helped us cover some of the funding gap that we needed to run the study, the rest we funded ourselves. We have also been lucky enough to be successful on a second larger Innovate UK grant which has enabled us to progress our project further and develop our platform with elderly users and clinicians.

As with any early stage start-up we are looking to raise more funding to help scale and grow our project as we progress towards a market ready solution.

Towards Q2/Q3 2020 we are looking to raise to run a large scale project testing our solution across an entire test area. This will include testing within individual user homes, care homes and integrating this by working with local CCGs to include GP practices and other local healthcare professionals. From here we will look at further private funding to scale the platform and access a much wider audience.

Longevity.Technology: If you had the power to change one thing about the world to help improve global Longevity, what would it be?
Kalon Hewage: Improved understanding and education of health risks in chronic disease. Prevention in the majority of cases has been shown to be more effective than cure and would ease the burden across the board on an already over stretched healthcare system. Clearer and better distribution of healthcare risks would allow for individuals and communities to address these at a much earlier stage.

Often people can be unaware of not only their own personal healthcare risks but what they can do about them. As we get older these are even more important and by acting on these risks we can prevent health decline and improve independence and quality of life for many years.

Our Meet the Start-up articles profile emerging companies in the Longevity sector, with a focus on their funding plans, commercialisation strategies, partnerships and routes-to-market. If you know of a startup that we should be talking to, let us know!

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