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Zebra Academy Ready to Market Feasibility Study

Periodic Reporting for period 1 - LAB2MARKET (Zebra Academy Ready to Market Feasibility Study)

Reporting period: 2016-09-01 to 2017-02-28

Stroke is a rapidly developing loss of brain function due to a disturbed cerebral blood supply. Stroke is the second cause of death world-wide and the second cause of disability-adjusted life years in high-income countries. This condition poses a growing global health problem with major individual and societal impact. Acute stroke is a time-critical medical emergency requiring immediate specialized treatment. During the acute phase of an ischemic stroke, approximately two million brain cells die per minute. The adagio ‘Time is brain’ refers to the need for rapid recanalization of the occluded vessel and protection of nervous tissue. The slogan ‘Competence is brain’ points out that stroke patients treated by specifically trained professional caregivers have a better outcome.

From a socio-economical point of view, the direct and indirect cost of stroke globally can easily exceed $100 billion. Stroke patients require high levels of hospital care, long term extra-mural support, community support and typically suffer from extended work disability.

Speed of diagnosis and prompt treatment brings dramatic economic and social savings. Despite evidence of clinical effectiveness and international recommendations, only a minority of stroke patients receives stroke unit care and recanalization therapy. The major opportunity for acute stroke treatment is to reduce the unacceptable delay between stroke onset and initiation of therapy. Recent studies have shown that telemedicine is a valid, accurate and reliable tool to shorten the onset-to-therapy time, with beneficial effects on outcome. Over the past years, our team has built up unique expertise regarding telemedicine and we were the first to deliver 24/7 in-ambulance telemedicine for stroke care.

In September 2016, we were granted the SME Instrument Phase 1 from the European Commission. Through the period of the grant we have had the opportunity to learn and step-up as a company on following topics:
• Business Development & market study
• CE-Marking of our in-ambulance telemedicine solution
• Finalization of design & partner search for scalable production
• Refinement of current business plan

We are currently defining our growth strategy over the coming years. Therefore, learnings and conclusions of the work done over the past months through the SME phase I instrument are of the outmost importance as they will help us identify the needed resources to further develop Zebra Academy.
Through the SME Instrument Phase I feasibility study we have learned the following:
• We are dealing with a very complex sales process. Therefore, we need to make sure that our business proposal (e.g. business model, pilot phase, …) allows as much as possible to start experiencing our solution under acceptable conditions.
• Hospitals are interested in our in-ambulance telemedicine solution and are even proposing new use cases. Therefore, even if our current focus is on our in-ambulance solution, we need to make sure that our solution can be adapted for these use cases.
• With the information gathered today on other European markets then Belgium we cannot decide yet where we should go once we have strong references set in our country of origin. The information gathered together with economic representatives should be completed with local visits to hospitals that are considered as key opinion leaders in Stroke in their respective countries. This will give us information on their readiness to start using our solution which could allow us to implement a first reference in that country to further built-on.
• Even if we are now close to finalizing our CE-marking, design adaptations and partner search of our current hardware, we must recognize that those activities have been highly time consuming as we encountered unforeseen challenges with EMC levels of radiations to respect. This is the activity on which we have learned the most over the period of the feasibility study. This is of tremendous value for the company as we now have much more experience in the domain.

Following next steps are foreseen in the near term:
• We are targeting to finalize the CE-marking of our solution as soon as possible
• We will further push business development in Belgium to set strong successful references before expanding to other European markets
• We are currently defining our strategic expansion plan for the coming years. All the work done through the Phase I of the SME instrument will be integrated in this exercise in order to:
o Revalidate/adapt our core activities to focus on
o Identify needed human resources to support our growth (e.g. A software developer, A Sales, …)
o Identify needed financial resources to support our growth
• Based on our new strategic plan we will:
o submit a proposal for the SME Instrument Phase II
o submit new proposals to Brussels region grants
o enter negotiations with Investors
We have recently closed the following deals:
• A deal to implement two devices inside an emergency room of two hospitals which are part of the same network. Within this network, a neurologist is on guard for both hospitals at the same time while the transport duration between both is of minimum 30 minutes. Our solution will allow them to already diagnose the patient through audio-video before going to the hospital in order to reduce the time to treatment for the patient.
• Two deals with the Belgian state to test our solution together with a reimbursement scheme within the scope of the action point 19 (mobile health: ) of the Belgian e-health plan.

Our solution will be used for:
o In-ambulance telemedicine (4 ambulances from 4 different hospitals will be equipped with our solution)
o Post-hospital follow-up of patients who already had a stroke (4 hospitals will be included in this project)

All of this means that Belgian hospitals will start to beneficiate from in-ambulance telemedicine in a very near term. The deal closed with the Belgian State also intends to test a scheme of reimbursement for in-ambulance telemedicine which means that after the project such a scheme could be a standard in Belgium which would further support the dissemination of in-ambulance telemedicine.

With the identification of new use cases of interest for hospitals, we intend to extend our business scope and the usage of our solution in the hospital and for the follow-up of patients at home in order to guarantee an end to end follow up of stroke patients through telemedicine which is a unique approach.