In a first of a kind move in the academic history of the city, the big four universities of Cluj-Napoca, Romania, gathered their forces to organize Innovation Days (iDays), an innovathon dedicated to healthcare, which took place in Cluj between 1-2 November 2019. This is the first time such an event was organized by all the big universities in Cluj as equal partners, bringing together their knowledge in the benefit of the patients, the healthcare system and the community as a whole. Cluj-Napoca (often referred to simply as Cluj) is the unofficial capital of Transylvania and one of the most vibrant and cosmopolitan cities in Eastern Europe, a cultural center, an academic hub, and of one the most important innovation hubs of the country.

The participating universities were Babes-Bolyai University (UBB), the University of Medicine and Pharmacy (UMF), the University of Agricultural Sciences and Veterinary Medicine (USAMV), and the Technical University (UTCN), with the support of the Liver Research Club and the Student Entrepreneurship Association “Iuliu Hațieganu”. The 8 hours long innovathon was part of the EIT Health iDays, an event which took place in 31 locations within several countries across Europe, during which students met to develop and present their digital health projects. The event aims to show how innovative ideas targeting the health sector can be transformed into real life projects, with impact on the patients and the healthcare system. During the program, students are presented with practical tools for health innovation and work in multidisciplinary teams to address real health challenges.

iDays is a unique annual series of events designed to promote innovation in healthcare among students, through a 2 day program conducted within academic institutions in Europe. The event was held in some of the top universities in Europe, like Oxford and Imperial College in the UK or the University of Tartu in Estonia (ranked as one of the best in Eastern Europe). Romania is one of the 20 EU countries where iDays were organized this year, with the support of FreshBlood HealthTech Community, the EIT Health RIS hub for Romania. EIT Health is an European network of 140 leading medical, pharmaceutical, technology companies, research institutions and universities, supported by the European Union.

Making an impact together

The host of the event, UMF, already had a group which was working on innovation and digital health, but decided to co-organize this event when they noticed that within their incubator they were lacking the know-how from the technical part or some other input that could be complimented from people with different backgrounds, more likely to be found in this kind of competitions.

“I think it’s a first step of bringing all the universities on the same table and to actually realize that we have the knowledge to properly impact our communities.”, said Radu Pirlog, PhD student at the University of Medicine and Pharmacy, member of the jury and representative of university hosting the event.

While for the universities its important to know each other, to see what kind of projects they are each involved in and to apply together for funding to support their research and innovation, from the point of view of the innovation ecosystem, there is a big need to put together the research part with the practical aspects of the research, to create a link between the academia and the startups environment ecosystem, and the students are seen as having a great potential, as they can be a link between these two, as they are more open minded and more eager to develop their ideas.

“I believe that’s the role of universities, as hubs and accelerators of knowledge producing, and I believe we need to move into to the next steps, not just doing business as usual, doing education, as we did until now, but we need to step it up, to actually push the students to face real life problems and try to generate real life solutions”, said Razvan Chereches, professor of Public Health at Babes-Bolyai University of Cluj.

During the event, the students formed multidisciplinary teams (with medical, technical or economic backgrounds) and tried to solve real healthcare challenges, focusing on the medical care outside the hospital, at home. To address the challenges, they used their business skills and digital health ideas, while mentors with experience in the field of healthcare innovation helped them build their projects. At the end of the event, the teams presented their ideas and were judged by a group of experts who used standardized scoring criteria to award the best teams.

“For students I think it’s really important to see that they get support, and that the faculty acknowledges them, their potential in doing more than learning in different classes, on taking exams. For our faculty this is really important because if they succeed, we succeed.”, said Adina Rus, from the Faculty of Economics and Business Administration, Babes-Bolyai University of Cluj, and member of the jury at iDays Cluj.

Bringing change by addressing real life problems

The jury chose as the winner of the competition a project called Simply Care, a personal health assistant, a wristband that will give advice based on the condition of the patient. Simply Care targets old people which don’t understand their disease and need support in a situation where the medical doctors don’t always have time to follow them and to give them explanation on a day to day basis. 

“It was really nice to make something really from nothing, in just one day. It was a lot of pressure, because you have to do a lot of research, to be sure that your solutions attacks the problem, and it’s relevant and a strong one. And you have only one day to build a business, which is really hard, but also exhilarating when you succeed.”, said Beniamin Matei from the winning team of the iDays Cluj, with project Simply Care.

The winning team will participate to the Winners Event, which will take place in Paris on December 1st, 2019, where they will meet with colleagues from all the participating universities. During the event in Paris, the students will be provided with support and resources to further develop their ideas and will also receive additional training in innovation methodology.

“We have a lot of work to do, in food, in health, in public services. We have to change a lot of things, and with this involvement of the students, we can do more for the community of Cluj, and our region.”, said Lucian Cuibus, from the University of Agriculture, Food and Veterinary Medicine of Cluj.

The civil society creates the glue of the innovation ecosystem

As EIT Health is trying to establish and promote the cooperation between universities and industry, the significant glue for an ecosystem to foster innovation is seen as the self organized element of the ecosystem, the civil society. And this is where Cluj, compared to other regions of Romania and even compared to other cities in the CEE, makes a significant difference, by having a good cohesion between the key players of the ecosystem, mostly because the vibrancy of its civil society. This makes the whole communication between the partners not about what is in the research department of the universities, or what is in the technology departments of the industry, but it’s building up from the actual needs of the market, which are the patients, which is the unmet need, where the whole ecosystem should be built around.

“I believe that innovation is about private individuals and Cluj happens to have some very strong, very dedicated private individuals. That’s one of the most important factors for innovation, because if you don’t have dedicated private people who have the ambition to make the system better, then it will not work. The civil society is very present in Cluj and I am missing this one, even in my own ecosystem in Budapest, because that is the glue, that is what is taking the whole system together, the catalyst, which makes it move. Everybody is very happy in the status quo, and everybody knows the change is painful, change is difficult, change will help some, and change will deprive some from the rights from the status and everything, but change is inevitable, the digital has come, up on our necks, you cannot resist it, so it’s better just to get in front and just start a change”, said Marton Kis, Health Innovation Expert from the Semmelweis University, Budapest.

FreshBlood, a Cluj based NGO which aims to support health-related startups is now seen by most of the key players in the local ecosystem as the main catalyst for healthcare innovation, and an expression of the involvement of the local civil society. FreshBlood is also one of the hubs of the EIT Health in Romania, and in May 2019 has become connected to the European Connected Health Alliance, a European network of ecosystems, forming the regional network Transylvania Digital Health Ecosystem, with the purpose of increasing the quality of the regional health services, through European collaboration and technology. The vision of the Transylvanian Digital Health Ecosystem is to become a dedicated healthcare focused innovation accelerator for Eastern Europe. 

A win – win situation for the universities, the students, the patients, the local community, and the businesses

For the universities, an event like iDays brings visibility and new opportunities for collaborations, both with the local and international partners, while for the students it brings opportunities to work in an multidisciplinary environment, opening their minds, finding new ways of approaching their ideas of healthcare. For the students of medicine in particular, events like this makes them understand what healthcare is outside of the patients and outside of the disease, by approaching healthcare in a more holistic way. For the local community the hope is that some of the ideas that are going to be generated in such events, can be applied in the future, for the benefit of the community.

“I think for the local community, it offers an opportunity for students to innovate. Students need events where they can innovate. An event that’s taking place each year, can have a good impact on community because some of the ideas can be can can become startups, real products on the market, and this is something interesting for community, to have their own products, which are innovative and started from here from Cluj.”, said Valentin Sita from the Technical University of Cluj.

Thinking of EIT Health, its main mission and vision, to facilitate the conversion of the research and the conversion of the technology of research of universities and technology and product scopes of industry, for long time, due to a rusty mentality, this two tended to speak in parallel, not matching their ideas, not getting into actual production. That’s why for the ecosystem it’s important to catalyze the transition and the communication, and to put into the scope the actual need of the patient, the unmet need, so that the two main players, the academia and the industry, can align, and the final result to become useful and sustainable.

As a next step for the ecosystem, the idea of a healthcare innovation incubator in Cluj is starting to take roots, and has attracted supporters from outside Romania too. Roel Kamerling, managing coordinator for public-private innovation programs at the Technical University of Delft (TU Delft), the Netherlands is one of them. During a visit to assess the health innovation ecosystem of Cluj, Roel endorsed the idea of creating a innovation incubator in Cluj, a place where startups from the HealthTech area could develop, receive support and get connections to relevant partners, based on the model of the YES!Delft incubator, ranked the best business incubator affiliated with a university in Europe, according to the UBI Ranking, and number 2 in the world.

For Cluj, the future of innovation looks bright, as Razvan Chereches sees the ecosystem strongly coming together, and the universities transforming themselves and becoming a force for innovation in the city: “In Cluj we have the ferment for a real culture of innovation. There are a lot of forces are coming together and they’re starting to complement each other. We have a chance here to transform the university into what it was meant to be initially: integrating the community and pushing the community forward.”.

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In May 2019, Cluj-Napoca based FreshBlood, a community which aims to support health-related startups, has become connected to the European Connected Health Alliance (ECHAlliance), a European network of ecosystems, forming the regional network Transylvania Digital Health Ecosystem, with the purpose of increasing the quality of the regional health services, through European collaboration and technology. Cluj-Napoca (often referred to simply as Cluj) is the unofficial capital of Transylvania, Romania and one of the most vibrant and cosmopolitan cities in Eastern Europe, a cultural center, an academic hub, and of one the most important innovation hubs of the country.

As part of the ECHAlliance, Transylvania Digital Health Ecosystem will explore the opportunities and challenges faced by Transylvania in the medical field and will benefit from know-how through the international network of health and technology ecosystems. The Transylvanian ecosystem will work with other European ecosystems to implement innovative solutions that improve the quality of citizens’s health and well being by increasing the efficiency of the health system and creating new business opportunities.

I’ve talked with Dr. Ion-Gheorghe Petrovai, co-founder of FreshBlood and coordinator of the Transylvania Digital Health Ecosystem about e-health and the Transylvanian ecosystem.

So what is Transylvania Digital Health Ecosystem? What is its purpose? What do you want to achieve with this network?

Transylvania Digital Health Ecosystem is an opportunity for people that are interested in healthcare, innovation, and in the improvement of healthcare, to get together, to collaborate, to build projects that can improve their businesses, and the healthcare in our region, taking benefit of the very strong technological advance that everybody is witnessing now in healthcare on a global level.

FreshBlood is the catalyst organization of the healthcare innovation ecosystem in Cluj, in Transylvania, and in Romania, and we want to be able to invent solutions which the hospitals in the US, in Europe or in Asia can use at one point in their medical practice. We want to be not only the ones that receive innovation, but also the ones that can build innovation and can share innovation all over the world.

“Our aim is to bring everybody around the same table, it will be a very big table”

The intention is to build on the collaboration that we have with the ECHAlliance, an organization which is strategically aligning together all the stakeholders of the healthcare system. We have in the middle the patients and the relatives of the patients, then the doctors, the hospitals, the companies, the universities, the local and central administration, the patient associations, the health care insurance house, etc. There are 12 stakeholders around the patients that can be involved in such a development, which any project will deal with when it is on its way to growth and impact.

Our aim is to bring everybody around the same table, it will be a very big table. First of all, we need to get aligned on the local page. And then, if we can grow projects on the local stage, with the help of ECHAlliance, we can bring these projects at European level. Also, some of the projects at the European level can be implemented in Transylvania.

Everybody is fighting for a limited amount of resources, and that’s one of the big drawbacks that we have, while actually to grow you need to be able to collaborate and need to be able to get access to much larger resources outside of your area. I like a lot a proverb which says: “if you want to go fast, go alone, if you want to go far go together”. Our principle is to go together in order to build something which is sustainable, and will continue to develop over time. It’s not a sprint, it is a marathon.

“In order to see the real impact, we will think in terms of 10 to 20 years”

In order to see the real impact, we will think in terms of 10 to 20 years, as we have seen how other ecosystems have developed. Silicon Valley is, for example, besides a very strong IT ecosystem, a very strong medical ecosystem, one quarter to one third of whatever is invented in healthcare is actually invented in California. We also had the chance to travel to Israel, which has an ecosystem started 20 – 25 years ago, and now we can see the global impact of Israeli medical startups. We have traveled to Nuremberg / Erlangen where is also a “medical valley” and a strong ecosystem of collaboration between different stakeholders, local administration, the university, the big companies, the small startups.

Our aim is to accelerate, because now we are much better technologically compared to where we were 20 years ago, where others were 20 years ago, and we can learn from the others. That’s one of the objectives of getting connected to the European level, to reduce the number of mistakes and be able to move faster. 

“Transylvania Digital Health Ecosystem it’s a milestone for us, it’s a milestone for the region, and it’s a milestone for the country”

Getting connected to an organization which supports innovation and digital transformation, means taking some engagements towards being part of the organization, and there are also some actions that need to happen.

Being part of ECHAlliance, we have been able to engage people outside of FreshBlood, representatives of the universities and of the IT ecosystem in Cluj, and also representatives from Bucharest, which is a proof that what we do is valuable, and that those people wanted to be part of this kickoff.

Transylvania Digital Health Ecosystem it’s a milestone for us, it’s a milestone for the region, and it’s a milestone for the people in Romania that want to see healthcare innovation developing. I won’t say we were the first but we were the first to put people together at the same table and on around the same topic, and we begun to build projects and partnerships with those people. 

We have now a number of actions, a number of projects ongoing, we just confirmed that everybody is connected and engaged, and our aim is to move even faster.

What’s happening now in Transylvania related to e-health?

We have witnessed in the last period an increased interest into e-health solutions and into e-health initiatives in Transylvania. For example, in the last three years, there has been an idea competition organized by the Medical University in Cluj, with prizes and with recognition of the best students and ideas that resulted, some of which became awarded startups, building their own teams.

“In the Innovation Labs 2019 Cluj, three of the five startups selected at regional level were healthcare startups”

What we have seen in the last years is that in the Innovation Labs local program, the healthcare startups have been a majority in terms of application and on the podium. Just during the last program, three of the five startups selected at regional level were healthcare startups. And this is something that we have seen coming from the students of different faculties and from the IT community. 

We have started to see an interest from smaller companies and larger companies to explore this medical field, as they see value and potential collaborations. There are many IT companies in Cluj that have healthcare projects, usually built for external customers. Some of the people that work on these projects begun to see potential problems to be solved in the local market, and they begin to come to us and say: “I’m interested to solve this problem. Let’s see what we can do”.

We are working with those people and companies through collaboration with the IT clusters in Cluj and this is extremely encouraging, people no longer ask for permission, they just begin to build something that they see relevant. Of course, this requires additional understanding of the market, additional connections and further evaluation, but the first seeds are already here. And we are quite pleased to see this happening. 

In terms of digitization there is also an interest from several hospitals in Cluj, as they start to see the value that such an initiative can bring. We had several meetings, through the Transylvania IT Cluster EHealth working group, with one of the hospitals, exploring the potential problems that technology could solve for their patients, for the doctors, and for the administration in general. The software systems at the hospital level have been built especially for reporting and they see more and more the need of using the data that they have and the technologies that they see in other fields of activity as a help to their work.

Universities have begun to get involved as well, at the Babes Bolyai University there is now under development a Center for Innovation in Healthcare, coordinated by Professor Razvan Chereches, which created the HIVE project, an innovation program with a focus on e-health.

Overall, in the last few years, I have seen more and more people starting to believe that we can build something relevant for the healthcare world. And I like one of the quotes of the mayor of Cluj, Mr. Emil Boc, which says that we should move from “made in Cluj” to “invented in Cluj”, which of course requires a different level of expertise and capabilities.

What are the strengths of the ecosystem?

E-health in Transylvania is first and foremost supported by the IT community. As pretty much everybody is aware, Cluj has strong technical capabilities. The nice surprise is that in many situations, we discuss with the IT guys and they are telling us they are working on projects which have a European, US or global impact, also in healthcare.

“Technology, good doctors, hospitals and universities, provide a very, very strong base to build”

Besides the technical knowledge, Cluj also has a number of dynamic doctors and good hospitals, and compared to the national level we have some of the most appreciated hospitals, according to some rankings.

And not the least, we have the universities, which are actually attracting talent from all over Romania, and even from all over Europe, as we have a lot of foreign students coming to study to Cluj.

So this would be our strengths: technology, good doctors and hospitals and good universities, a very, very strong base to build.

What are the biggest challenges?

The biggest challenge is collaboration. One of the mantras of developing healthcare innovation is that you need a multidisciplinary team. According to Stanford Biodesign, which one of the most structured ways to innovate in healthcare, as part of a team you need a medical person, a technical person, a business person and the user experience / design person, which makes total sense for an IT guy, but for the researchers, it makes very little sense because they just see the value in their research. So in order to build those teams, the best way is to build them when they’re you have something to share, which means an innovation project or even a startup.

“We see collaboration as the main challenge, main weakness and the main opportunity to build, and usually this requires external support”

The vision of FreshBlood is to foster collaboration between people that feel they need to get additional competencies. Like for example, you are a doctor and have an idea. You don’t know who to talk to. And you don’t know what is the business potential of your idea because, as a doctor, you don’t understand how the healthcare business works. Or you are an IT guy, you begin to be fed up by what you see in the, for example, the scheduling or the way that documents are managed in the hospital and you say: “I will do something about it”. You understand that you need to start something but you don’t know how the doctor is deciding, how the administrator is paying for the solution and what is the patient getting as a benefit. 

FreshBlood has been built as a platform of collaboration between those different people and entities, and we bring also investors looking for opportunities to invest in a solution that will have financial return and impact.

We see collaboration as the main challenge, the main weakness and the main opportunity to build and usually this requires external support. This is why we got connected with the ECHAlliance, and one and a half year ago to EIT Health, which has provided us the external reference to which we can link the universities, the IT companies, the local administration, the patient associations, and the startups. In healthcare, the needs are never ending, it’s a constant changing field. So the best way to be prepared is to be connected, and that’s the highest value that we can provide.

Which are the key players in the ecosystem?

We are quite optimistic about the involvement of universities, because in the last 6-12 months, I have seen an interest in the healthcare ecosystem within each university I’m talking to. And this is due to the fact that their students showed an interest and also some of the teachers there. So an opportunity to move beyond theoretical approach towards a more practical and more applied approach, which is extremely relevant and extremely powerful. Also, because everybody’s watching the universities as the reference points, then the IT companies begun to get involved, and the fact that you have IT companies supporting startups with know how and with development, it’s also very, very powerful.

“We are quite optimistic about the involvement of universities, and I also see the hospitals beginning to be interested, and willing to be connected”

I also see the hospitals beginning to be interested and willing to be connected, linked also with the local administration, which we want to involve too, since health care is one of the important priorities, human priorities. 

Which are the startups the most interesting to watch for the near future?

We have seen an increased number of startups, and each of the startups that were presented at the Innovation Labs are interesting to watch. There were five, and each team has the drive to move further.

WakeZ, focused on sleep management is a startup that has a very good team in their field, which is the most important. Wello, focused on family nutrition, is a startup coming with a more experienced and wider team, now in process of being rolled out.

Mira Rehab, focused on rehabilitation games, is the most impactful healthcare Cluj-based startup so far. They have been recognized by the National Health Service in the UK, which positioned and promoted Mira Rehab as one of their used innovations, which is I think, is a big recognition. They have also been able to do studies with their product in the UK.

Then at the national level, we see a strong evolution of Reflex, which is a Bluetooth connected physical recovery monitoring system, which is now in the clinical studies in Europe. And they are able to execute extremely well. And they are able to punch already at the international level. They went to competitions all over the world and they won prizes and recognition. And they are visible at this level, because their solution is performing as now in the rollout phase. 

We are extremely happy to see those startups and to provide them support and sharing experience with other startups. There are a lot of things and experiences that are very personal and very discouraging building a startup, so it’s very important that startups and founders learn one from another, maybe even more than they can learn from textbooks, from the internet or from experts.

Last question is about your vision for the future

Our vision, as we started three years ago, was first of all to be a community, meaning that we share resources, and we grow together, and our vision for the future is to become a structured pre acceleration program, as for the startups and for all people with innovative ideas that are at the beginning, it’s very important to understand what it’s expecting them, and we cand identify their first potential collaborators.

We now have a network of mentors and collaborating doctors, IT guys, and people with valuable healthcare business experience. We also have access through EIT Health to an European pool of mentors and to European startup programs. In the spring we had 19 programs for startups accesibile for any level, even just with an idea, and we had teams going through the whole process provided by EIT Health. There are also programs like Jumpstarter, two days working for an idea: you have a team of two people, you are going to evaluate an idea, and they will help you go through the process, and then you would have the opportunity to go into a boot camp for one or two weeks, or for example, HVLab in Budapest, which is four months. And then we have event competitions for startups for those that want to scale up at European level and the international leve.

In order to access the opportunities, it’s important to have a local pre-acceleration and support program, focused on the healthcare field that can run all year long, in which people can get connected and prepared in order to be able to grow. We see it important to have it as a program because what we see are mostly acceleration programs that are focused on the IT or the technological part.

In the autumn we are preparing another innovation program with focus on researchers and PhD’s that will help them give more value to their work. 

“Our vision is to become a dedicated healthcare focused innovation accelerator for Eastern Europe”

Sometime in the near future, we want to be able to build a startup accelerator focused on healthcare, which would have not only a Romanian footprint, but a dedicated healthcare innovation accelerator for Eastern Europe, because there are several ones well funded in Western Europe, but none with a big focus on healthcare in Eastern Europe.

In parallel we will to build the community and the connection with the stakeholders, as we see it vital for the ecosystem development. This is why we wanted to connect Transylvania Digital Health Ecosystem to ECHAlliance, and we are also helping the stakeholders or the institutions that want to implement healthcare innovation programs, to connect and to drive the impact of these programs.

We are also working on developing our collaboration with universities, and we foster collaboration between universities because, as I said, for a team to succeed, it’s important to have a multidisciplinary approach so we need to facilitate communication between technical students from the Technical University, business students from the Babes Bolyai University, medical students from the Medical University, helping them work together and keeping them on track in order to solve a healthcare problem.

The students that now test their mind and skills in a startup, will be doctors in 10 years or they will be professionals who will be able to have a more mature approach and they will be able to build their own teams. We are doing a lot of education, through the startup support programs and through the innovation support programs. 

Summing it up, it’s all about the people, the projects and the partnerships, a constant strife to improve healthcare, impacting our lives.

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