On a Saturday morning, an RV covered in skin cancer statistics and a startup logo pulled up to San Francisco’s Dolores Park, a sloping green expanse sandwiched between the city’s Mission and Castro neighborhoods. Soon a trim, bespectacled man with a slight side sweep to his blond hair began handing out sunscreen and hawking free skin cancer screenings. For that, he wielded a specially rigged iPhone capable of taking high-resolution images of the skin and delivering them to a pool of 20 dermatologists waiting in six countries.
To the clusters of self-consciously hip young people and in-the-know tourists who had come to the park, Dr. Alexander Börve could easily have looked like any other startup guy staked out in a highly strategic location, wearing a logoed shirt and sprinkling promotional swag and services in exchange for a few moments of strangers’ time to talk up a new-fangled mobile app called First Derm. But not many other apps have the potential to save lives.
Acting as an intermediary triage between people and providers, the app lets people submit anonymous images for $25 to $100 to board-certified dermatologists. The faster the opinion, the higher the cost. If such triage became the norm, Börve contends, the entire system would be vastly more efficient.
Few may have realized they were chatting about sketchy skin growths with one of the foremost experts on telemedicine.
“There’s not enough dermatologists,” says the 39-year-old. “Let’s filter away the ones that don’t have to go to a dermatologist and get them to go to Walgreens, and the ones that really have to see a dermatologist, they can go in and get treated.”
Börve and his team encountered 2,000 people that weekend and found four suspected melanomas. Few of those people may have realized they were chatting about moles and sketchy skin growths with one of the world’s foremost experts on telemedicine — in layman’s terms, the use of technology to deliver health care without face-to-face interaction between patient and provider.
SOURCECourtesy of Alexander Börve
“He’s a pioneer,” says David Aylward, senior adviser for global health and technology at Ashoka, which identifies and invests in social entrepreneurs. While Börve, an orthopedic surgeon by trade, is hardly the only person incorporating telemedicine into public health these days, Aylward pegs him as “one of the only leading people on the skin side.”
Some might wonder, though: What’s really all that groundbreaking about taking a picture of yourself? There are only a handful of startups in the teledermatology space, and although they all say they’re different, “basically what they’re doing is figuring out some way for you to take a picture with your phone and send it to somebody in a secure environment,” says Matthew Holt, co-chairman of Health 2.0, a conference organizer.
But Börve says his own studies of 1,500 patients show that the technology cuts the time between diagnosis and treatment of malignant melanoma from an average of 35 days to nine. “If you can hasten the diagnosis of melanoma even by a few weeks or months, you can save a lot of lives,” says Julia Walsh, a professor at the University of California, Berkeley’s School of Public Health who’s advising Börve’s research into the use of telemedicine for lowering health care costs.
The space Börve is in, like the exposed skin of people splayed out on the park lawn that Saturday, is getting hotter and hotter. Buoyed by growing interest in digital health from governments, health care institutions and investors, telemedicine is on a march toward the mainstream. During the first half of 2014, digital health funding rose to $2.3 billion, more than the entire previous year. Helped by the Affordable Care Act’s embrace of technology standards, the adoption of smartphones and the rising burden of noncommunicable diseases, telemedicine is an area that startups and major corporations alike are clamoring to get a piece of.
First Derm app.
A new playground for many, the intersection of medicine and mobile technology is a place Börve has inhabited for years. And that’s not something he can say about many locales. Norwegian by birth and passport designation, Börve grew up moving as his father, a chemical engineer with an MBA, pursued jobs in laser technology and high-grade cobalt production. He’s lived in Norway, Germany, England, Switzerland, Spain and Sweden. With an accent that’s distinctly European but otherwise hard to place, he speaks English, Norwegian, Swedish, Danish, German, Spanish and French.
Influenced by electronic music’s rise during his teenage years in the U.K., Börve came up tinkering with technology. He was also, he says, a little bit of a hustler, talking his way into nightclubs before he was of age. As an adult, he uses the same entrepreneurial persistence and knack for networking to push his ideas about telemedicine, first from within the Swedish health care system (where he worked before coming to the U.S.) and, more recently, as a hybrid academic-startup guy.
Since August, when he received an O-1 visa status granted by the U.S. to individuals with extraordinary skills or achievements, Börve has been building his team at the Runway Incubator in San Francisco and creeping ever closer to profitability with his trio of bootstrapped telemedicine mobile apps. (He says he’s about 10 percent away from breaking even.) Though he’s never remained in one place very long, Börve is, for the time being at least, staying put. “In Sweden, the mentality [is] like you’re crazy, don’t do that, you’re going to fail,” he says. “But here, it’s completely the other end.”
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