Haema-Surg

Haemophilia is characterized by low levels or the absence of coagulation factors – most notably, factors VIII and IX – therefore exposing patients to high risks of severe haemorrhage in their daily lives. To date, haemophilia prevention involves the control of these coagulation factors by means of intravenous intake. However, this approach has not yet proved to be totally effective and, most importantly, remains inaccessible to 70-80% of the global population. Physical traumatic events can generate severe conditions to a person with haemophilia, such as joint bleeding – also known as haemarthrosis – or even haemophilic arthropathy, depending on the impact level. In such cases, orthopaedic surgical interventions will be required.

The decision-taking process as to the definition of the most suitable surgical intervention requires the consensual agreement of a multidisciplinary board of health professionals – haematologists, orthopaedic surgeons, rehabilitation physicians and physiotherapists, among others. Such a decision involves the comprehensive evaluation of the traumatized joint and the best surgical technique to be deployed, which is based on multiple types of data: clinical, biological, and medical imaging. The exhaustiveness expected by these multidisciplinary meetings requires access to continuous multimodal data, to determine the best intervention, in particular, for the most complex clinical cases. One of the main challenges for good therapeutic decision-making is real-time access to the most recent data in the patient file. Indeed, due to the lag between decision-making and access to the latest information on the evolution of the patient's clinical condition, we find that approximately 14% of the opinions issued by multidisciplinary boards are not turn out to be more relevant and, therefore, are not applied.

To our best knowledge, there are no solutions currently available allowing the simultaneous visualization of all the multimodal data that is required to support decision-taking during multidisciplinary board meetings. Indeed, health professionals must deal with multiple solutions that are deployed in hospital settings to the collection of the necessary data, and most of these prove not to be interoperable. In such, the development of structured digital systems allowing the integration and storage of this heterogeneous information is a critical unmet medical need as it will ease treatment decisions making and continuous quality assessment In this context, Haema-Surg can be deployed in different stages of patient’s healthcare pathway. During the presurgical phase, it will support therapeutic decision-aid according to the patient’s case, and provide valuable images that will ground the surgical planning. At post-surgical phase, the solution will allow the evaluation of the surgical outcomes and improve patient’s follow-up.

Haema-Surg is a unique Visualization Tool (Smart Surgical Board - medical device class I) allowing the dynamic integration and management of data necessary for the decision-taking as to the most suitable surgical intervention during multidisciplinary board meetings. More than a simple dashboard, Haema-Surg will be able to (i) allow the automated querying and visualization of multimodal data (clinical features, imaging modalities, histology, molecular biology) and, (ii) integrate the different data sources in the hospital environment and allow their simultaneous visualization. The solution will display 4 quadrants, each one addressing a specific data modality:

• A “Clinical” quadrant featuring a header where the main information of the patient profile (Electronic Medical Record - EMR) is displayed, including all the stages of the patient's management, including, treatment changes, adverse effects, relapses and pharmacokinetic information.
• A "Radiology" quadrant including all the imaging modalities (surgical videos, x-rays, scan, PET scan, MRI, ultrasound...) used for the patient’s management as well as the images’ relevant quantitative parameters (segmentation, for instance).
• A “Digital pathology” quadrant hosting digital histological slides and allow the tool will their annotation of images; and
• A “Molecular” quadrant including all molecular data used to tailor treatment strategies, including molecular and genetic alterations.

Behind the scenes, the simultaneous display of different modalities of data requires the implementation of a complex data workflow within the hospital IT environment. Indeed, each data modality is stored in different data sources (EMR for clinical data, PACS and RIS for imaging data and reports, laboratories, genomic platforms…), each one requiring the installation of connectors to our visualization tool.  The communication between the hospital’s data sources and Haema-Surg will be implemented thanks to Medexprim SuiteTM, a software suite composed of a set of tools overarching all steps of data workflow, namely: (i) identification, (ii) extraction, (iii) structuring, (iv) data harmonization and (v) deidentification. Our main goal is to constitute enriched and multimodal datasets that will be displayed on each multidisciplinary meeting, as to support therapeutic decision-taking, surgical planning, and patient follow-up.  

In such, Medexprim SuiteTM will be installed within the information system of each of the hospitals participating at project, taking into account the following steps: 1) assessment of the information system’ architecture; 2) configuration of Medexprim SuiteTM to accommodate the specificities related to each hospital’s imaging archiving system (PACS) and  3) opening of ports in hospitals’ local networks to allow their communication with Medexprim’s platform (r-Wide), if additional data analysis will be required. Existing modules will be used for image indexing and collection (IndexaTM and Radiomics EnablerTM).

Haema-Surg is addressed to health professionals involved in the decision-making of the most suitable surgical intervention. Such a decision is made in the framework of multidisciplinary surgical board meetings, involving the participation of different medical specialists: hematologists, orthopedic surgeons, rehabilitation physicians and physiotherapists, at least.

The decision-taking process involves many aspects of the patient’s condition and healthcare pathway, such as the therapeutic regimen (undertake of inhibitors, for example); the patient’s history (adjuvant therapies, past events of joint bleeding or physical traumas, comorbidities, genetic mutations…), and the severity of the physical trauma. This comprehensive evaluation requires a large variety of data modalities – clinical, laboratory, medical imaging, digital pathology, and molecular biology. To date, to gather all these data modalities, hospitals are equipped with multiple data collection software solutions, which are deployed independently within the hospital IT environment and, in most cases, are not interoperable. This situation implies in an incomplete use of data health during decision meetings and considerable manual time of health staff in gathering data.

Also, data must be permanently updated, in order not to miss out on any relevant information. In fact, therapeutic decision-taking grounded upon non-updated data must be revised, therefore requiring the scheduling of new meetings. Such inefficiencies in the management of health data requires additional staff time and yields in important delays in patient’s access to the therapeutic intervention.

The aim of the Haema-Surg project is the development of dedicated software solution – a Smart Surgical Board - with on-board solutions that will allow automated data querying, visualization, and structured storage of multimodal data to improve decision-making concerning the most suitable surgical intervention. Such integrative approach is key to avoid "wasting” the data collected during multidisciplinary boards and will serve as a platform for telexpertise for non-expert centers. 

Also, it is important to emphasize that the Haema-Surg project is part of an evolutionary process, with the planned addition of new functionalities to the medical device – the smart surgical board – over time. Indeed, we envisage, in the long term, the development of a flexible solution, capable of responding to problems in the context of routine care, but also in terms of clinical research. From the point of view of routine care, we wish to develop a therapeutic decision support tool, equipped with functionalities of  prediction, assistance with surgical planning and monitoring of the response to treatment, during future developments. As to the deployment in the context of clinical research, this surgical board will allow a better definition of the profile of the patient to be recruited in the context of clinical trials, thanks to the tools analyzing personalized data and making it possible to compare individual clinical cases with populations targeted. Our approach in Personalized Medicine will thus allow a better performance of clinical studies.

Medexprim presently partners with a network of 50 European university hospitals which not only provide clinical expertise but also facilitate the cooperation with patients’ associations. Also, in the framework of the academic projects (please see further details in Question #43) we work in close collaboration with patient communities, as to define strategies to improve better communication between physicians and patients, as well as the collect of patient-centered questionnaires that will participate in the evaluation of outcomes improvement; most notably, the quality of life.  Most recently, Medexprim has been partnering with the European Liver Patients Association (ELPA) in the framework of a European consortium aiming at the development of digital twins to improve the prediction, treatment and follow-up of patients suffering from Metabolic dysfunction–associated fatty liver disease (MAFLD). Our ambition in the middle-term is to improve the quality and exhaustiveness of real-world datasets, by integrating patient-reported experiences and outcomes to the datasets generated within hospitals and reference centres in rare diseases, starting bv Haemophilia.

The technological readiness level (TRL) at the start of the project is that of a minimum viable product (MVP), i.e. a TRL equivalent to level 4. This level of maturity corresponds to the average of the different stages of development of the elements that constitute the technical architecture: (i) the collection infrastructure; (ii) visualization tools specific to each data modality; And; (iii) the orchestration tool for data feeding, and (iv) data curation. Among these elements, the retrospective data collection tool and the visualization tools specific to each type of data (open source building blocks that already exist) are those with the highest level of technological readiness (TRL 6). As for the routing tool, which will allow the population and the curation of the multimodal database in a dynamic way, this is in the more upstream stages of technological development, i.e. a TRL6. It is also important to emphasize that the development of a single interface allowing simultaneous navigation between the four quadrants has not yet been started. We therefore consider the current TRL of the Navigation tool at level 3.

The versions of the product will be tested, evaluated and clinically validated by the medical teams of a French partnering Haemophilia centre. Similarly, we plan to obtain CE marking (class I) for the medical device whose procedure is self-certified.

Medexprim is a European Start-up that developed an expertise in providing healthcare professionals informatic tools to ameliorate their daily routine and help them in providing the best care to patients leveraging Live Real World Data. With a footprint into the Hospitals, and a strong footprint at the Healthcare professionals sides, we are now working to ameliorate routine care for all patients as well as accelerating Clinical research for unmet medical needs and Rare Diseases.

We expect to start developing Data Driven software to gather a 360° vision of each patient in a snapshot to have physicians taking therapeutic decision with the highest level of information for each patient. Starting with our European Hospital partners in Rare diseases, we expect then to extend globally and support International collaboration between private and public sectors for the sake of underserved populations.

The MIT Solve Challenge as a renowned institution for global innovation would come as a strong validation of our strategy and a great financial support to support the Proof of Concept for our Smart Surgical Board. In addition, the entry to the US market will be challenging for a startup coming from Europe. There we want to start to acculturate with the US Healthcare system as well as starting a first step to confront our solution to the US culture and competitive landscape. The MIT solve challenge will be a great experience for us both in cultural and institutional support to elaborate further on our strategy, and innovation development in the long journey to reaching our Market and Growth strategy

Our Team Lead is connected to 3 reference centers in Haemophilia and other constitutional disorders in clotting proteins in France, which have excellence in health care and clinical research on these rare diseases. All these centers participate in the French network of rare diseases for inherited bleeding disorders (MHEMO). They work in close collaboration with the Haemophilia community – patients, families, and close friends – with a view to improve therapeutic strategies and to promote the development of innovative treatment approaches. In terms of healthcare, patient-centered questionnaires addressing issues related to quality of life, patient-reported outcomes (PRO) and patient-reported experiences (PRE) have been increasingly participating in routine care.  As for the fostering of clinical research projects, effective recruitment and patient retention in clinical essays on Haemophilia issues constitute a particular challenge, as in any other rare disease research. We have learned from previous clinical projects that the constitution of high-quality health data is crucial, both in routine care as in research. The onset of the Internet of Things (IoT) has greatly contributed to the follow-up of patients in their daily lives, as well as to a better understanding of their experiences and quality of life, in face of the constant fragility and physical trauma threats posed by Haemophilia. In such, these solutions will play a core role towards the promotion of patient-centered clinical trials grounded upon inclusive research protocols based on the collection of patient-generated data. Medexprim mission is to collaborate closely to the Hemophilia community and the reference centres participating in MHEMO as to promote patient-centered healthcare and research strategies. 

Firstly, Haema-Surg focuses on the early detection of hemophilic joint disease, aiming to identify and address the condition before it progresses to a stage where orthopedic surgery becomes the only option. This approach facilitates more frequent screenings, and a wider use of diagnostic tools, and monitoring systems that empower healthcare providers to identify joint bleeds and other issues in their initial stages.

By adopting a multidisciplinary approach, Haema-Surg enables collaboration among hematologists, orthopedic surgeons, physical therapists, psychologists, and other relevant healthcare professionals. Through coordinated interventions, this approach ensures a more comprehensive and patient-centric care, ultimately leading to improved treatment outcomes. Moreover, this collaborative effort allows for the development of personalized treatment plans tailored to the specific needs and experiences of individual patients.

The establishment of such a sustainable platform contributes to the prevention of further orthopedic surgeries and provides long-term rehabilitation and support for patients with existing joint damage. At the patient level, rehabilitation programs encompass various components such as physical therapy, pain management, assistive devices, and adaptive strategies. These interventions aim to enhance joint function and improve the overall quality of life for patients.

On a broader scale, Haema-Surg plays a vital role in advancing the field of orthopedic surgery prevention in haemophilic patients by actively contributing to research and development. Investing in research studies, clinical trials, and technological innovations can lead to the discovery of novel treatments, improved prophylactic approaches, and better long-term outcomes for patients.

To ensure accessibility for a wide range of haemophilic patients regardless of their geographical location or socioeconomic status, Haema-Surg plans to expand its capabilities in a later phase to incorporate telemedicine. This expansion will enable the integration of data from wearable devices or mobile applications, collected outside of the hospital setting. It will facilitate telexpertise, remote monitoring, real-time data collection, and communication between patients and healthcare providers . By doing so, Haema-Surg brings expertise and care to patients regardless of their location, including those in low-resource settings.

Our impact goals are to contribute to the development of a comprehensive approach to managing haemophilic patients, with a focus on preventing orthopedic surgery and improving long-term outcomes. It involves a combination of awareness, education, research, collaboration, and equitable healthcare practices to achieve the desired impact. Here is an attempt to dispatch some goals addressable immediately and some that will be tackled later.

Year 1:

• Enable multidisciplinary care teams to share a common platform with patient-relevant data that have been in silos for too long, providing holistic care and foster personalized treatment plans.
• Accelerate research projects focused on identifying biomarkers or imaging techniques that can aid in early diagnosis.
• Support and invest in research and development efforts to improve prophylactic treatment strategies. This involves facilitating patient recruitment in clinical trials for exploring gene therapy options to minimize joint damage and reduce the need for orthopedic surgery.
• Revisit rehabilitation and support programs that encompass physical therapy, pain management, assistive devices, and adaptive strategies to improve joint function and quality of life for patients with existing joint damage.
• Collaborate with rehabilitation specialists to design evidence-based programs tailored to individual patient needs.
• Promote global accessibility and equity by working towards ensuring that all haemophilic patients, regardless of their geographical location or socioeconomic status, have access to proper care and preventive measures. Advocate for policy changes, telemedicine initiatives, and partnerships to extend medical expertise and resources to underserved regions, making orthopedic surgery prevention more accessible worldwide.

Next five years:

• Support and invest in research and development efforts to improve prophylactic treatment strategies. This involves facilitating patient recruitment in clinical trials for exploring gene therapy options to minimize joint damage and reduce the need for orthopedic surgery.
• Revisit rehabilitation and support programs that encompass physical therapy, pain management, assistive devices, and adaptive strategies to improve joint function and quality of life for patients with existing joint damage.
• Collaborate with rehabilitation specialists to design evidence-based programs tailored to individual patient needs.
• Promote global accessibility and equity by working towards ensuring that all hemophilic patients, regardless of their geographical location or socioeconomic status, have access to proper care and preventive measures. Advocate for policy changes, telemedicine initiatives, and partnerships to extend medical expertise and resources to underserved regions, making orthopedic surgery prevention more accessible worldwide.

First of all we should monitor and evaluate patient health outcomes, such as the frequency and severity of joint bleeds, joint function and mobility, pain levels, and overall quality of life. We can find indicators by interrogating the patient medical records or ask patients to provide feedback especially with regards to quality-of-life assessments (ePROMs).

Since the objective is to prevent as much as possible the requirement for surgical intervention, we will look for a possible decrease in surgical intervention rates. 

With regards to rehabilitation outcomes, we shall evaluate their effectiveness in improving joint function, reducing pain, and enhancing overall mobility and quality of life for patients with existing joint damage. This could be done by comparing the outcomes of new patients with retrospective data, or comparing with patients that still benefit from “one fits all” rehabilitation programs

To assess benefits on research & development we will measure the number of studies conducted, new treatment approaches developed, and the adoption of innovative technologies in clinical practice.

Finally, to measure better access and equity we should document the availability of new preventive measures, resources, and support for hemophilic patients across different regions and socioeconomic backgrounds.

We expect the impact of Haema-Surg to be twofold, for, in the one hand, it will facilitate health professionals to deliver faster and more suitable therapeutic interventions; and, on the other hand, to help Haemophilia patients who have suffered high-impact physical traumas to have a better understanding of their surgical interventions, at the same time facilitating the dialogue with their physicians. From the healthcare professional’s standpoint, the smart surgical board will provide updated and comprehensive data that is the core of their therapeutic intervention decisions. Our solution will allow for an automated collection of data and a unique tool allowing for their simultaneous visualization (4 quadrants displayed simultaneously). As a result, it will allow for considerable gain in medical staff time, faster and reliable data collection and overcome the technical hindrances imposed by the lack of interoperability among the multiple software solutions (whenever available in hospital settings) that are currently deployed. As for Haemophilia communities, Haema-Surg will facilitate the understanding of their clinical status, through the real-time visualization of all relevant information. As previously mentioned, multiple data modalities are necessary in the decision-making of the most suitable intervention to be held (please see Question #9). This is a complex subject which can be sometimes overwhelming to such patients, which are already burdened by the physical and emotional constraints imposed by their condition. We do believe that imaging is an exceptional source of information and knowledge, and far mor accessible than the medical lexis. In such, patients will be empowered by the information provided during their pre-surgical and monitoring clinical consultations and will become active actors in their own healthcare pathway. 

Our solution is powered by a software suite – Medexprim SuiteTM - deployed in the management of real-world data generated within and towards hospitals, in association with 4 viewers (quadrants) displaying different data modalities.  Medexprim SuiteTM is composed of a set of tools encompassing all steps of data workflow, namely: (i) identification, (ii) extraction, (iii) structuring, (iv) data harmonization and (v) de-identification. The solution is installed on the premises of hospitals’ IT environment and the necessary dataset that will be used during medical consultations of multidisciplinary meetings is archived within the hospital IT architecture, as indicated herein below:

The implementation of Haema-Surg in the hospital settings will take place through the installation of Medexprim SuiteTM on premise and will be placed as part of the IndexaTM module. In addition, Indexa will be connected with our OrchestraTM module, an EIA (Entreprise Application Integration) tool allowing data exchanges with external environments, as to allow telexpertise sessions with non-reference centers and other hospital facilities located in low-resource settings. 

Total: 8 members 

Full-time staff: 6 members

• CEO: market strategy and international expansion
• Scientific Director: Project coordination and relation with partnering hospitals
• COO: Coordination of R&D and product roadmap
• Product Owner Imaging
• Product Owner Digital Pathology and Molecular Biology
• Senior Data Scientist

Half-time staff: 2 members 

• R&D Engineer
• Technical coordinator

Some modules comprised in our software solution (Medexprim Suite) used for image indexing, collection and visualization were developed 5 years ago and undergo continuous versioning as to improve its performance and ameliorate its integration to hospital IT environments. Since 2021, we've been working on the development of (i) the visualization interfaces addressed to molecular biology, digital pathology and genomic data; (ii) the imaging enrichment tools and  (iii) the 4-quadrant integration module. These developments are ongoing.

Medexprim was born within a leading University Hospital in France and has kept on its DNA the desire to participate in clinical research projects which will allow access to treatment to all patients, by means of a more efficient, affordable and Personalized Medicine approach. As a Data Tech start-up, we’re proud to have a team comprising 62% of women dedicated to different activities in the health data management, some of them participating in high-level, strategy making and decision-taking positions. Also, our full-time staff come from different geographical origins, including 8 nationalities, which constitute a major force as to the establishment of an innovative and creative working environment.

One of the main pillars of Medexprim’s mission is to actively participate in academic projects that promote open-access technology to the benefit of patient healthcare. To date, Medexprim rejoices to have joined forces with 3 major European consortia dedicated to inclusive strategies towards accessibility of high-quality, harmonized health data in the fight against cancer (pediatric and adult):

• As the Technical Coordinator of the Chaimeleon project (H2020 project) which mission is to accelerate the lab to market transition of AI tools for cancer management. CHAIMELEON will set up an EU-wide structured repository for health imaging data as an open source for artificial intelligence (AI) experimentation in cancer management.
• As a member of the Primage project (H2020 project) along with 16 European countries aiming at the development of an open cloud-based platform to support decision making in the clinical management of two paediatric cancers, Neuroblastoma (NB), the most frequent solid cancer of early childhood, and the Diffuse Intrinsic Pontine Glioma (DIPG) the leading cause of brain tumour-related death in children; and
• As a member of the  European Cancer Imaging Initiative (EUCAIM project), a consortia aimed at making large amounts of cancer images and linked clinical data easily accessible to European clinicians, researchers and innovators in line with the European data strategy and supporting the goals of the European Health Data Space.

We wish to deploy our data management solution towards other clinical projects involving vulnerable populations, including paediatric patients, orphan diseases and facilitate access to treatment in locations where medical access is challenging. In such, we strive to promote diversity within our team but also in our attempt to facilitate access to health data; equity by participating in projects that will promote facilitated access to a better healthcare and inclusivity by embracing new technologies and associating them to our solutions.

Medexprim will have 2 revenue streams, sequential over time, none of which requiring the patient to pay.

The first and foremost model relies on software licences, collected from the hospitals using Haema-Surg. We will apply a SaaS model, with flat annual running fees. Medexprim will distribute the solution either directly, or via distributors, depending on the geography, providing all solution users with appropriate maintenance and support services.

The second and complementary model, applicable once we cover a significant and diverse number of patient cases, consists in leveraging the value of the data generated and structured through Haema-Surg. Data structured by Haema-Surg stems from standard care. It belongs to the HCP (Health Care Providers). With the consent of the HCP owning the data, Medexprim will structure, logistically and contractually, privately sponsored research projects using Real World Data. This is the main activity of Medexprim, who has become a leader in the European Real World Data market.

This second revenue stream, related to RWD, will logically be split with HCP, leading to a virtuous cycle and a diminution or compensation of the license fees charged fo the solution. It is difficult to speculate about the balance for HCP of costs using our Haema-Surg solution, and revenues for sharing data for privately sponsored RWD research projects. However, as applied today in Europe, Medexprim commits to transparency and fairness in the business model for sharing research revenues, and to duplicating the Haema-Surg solution and dual business model to other rare-disease where applicable, thus mutualizing the solution development costs, and potentially improving the HCP’s balance of costs and revenues. 

Medexprim has gathered significant experience in building solutions similar to Haema-Surg, in which the major challenge is to ergonomically summarize a bundle of disparate clinical, genomics, radiology and AI driven information, and make it fit for efficient & complex multidisciplinary clinical decision-making, in a “cockpit like” integrative medical device.

Medexprim will therefore leverage this experience and apply it to the use case of hemophilic patients, with the ambition that Haema-Surg will improve the multidisciplinary board meetings in Haemophilia centers among HCP’s.

Further, Medexprim is going to reach profitability in 2023, and the coveted grant shall suffice to build a proof of concept/ minimal viable product (POC/ MVP) for Haema-Surg, from which to develop further. Indeed, our technology is sufficiently developed and mature, and our EU network of academic centers is sufficiently established, to work with expert Haemophilia reference centers towards a functioning POC/ MVP.

• Develop a minimum viable product (MVP) with the MIT-Solve grant leveraging past experience
• Deploy and commercialize this MVP at expert centers in our network and gather user’s feedback to improve it to the point of distributing it globally.
• In parallel, initiate the structuring of the resulting data into commercializable datasets fit-for RWD research. Use Medexprim’s existing sales force dedicated to RWD for Pharma & Medtech, to find business opportunities for curated & stuctured data resulting from the use of Haema-Surg
• Tailor Hemae-Surg for the use case of tele expertise, and expand usage to non-expert centers so that they can benefit from a decision support tool connecting them to reference centers, by means of tele-expertise. Explore this additional market and deliver this complementary solution to centers lacking expertise.
• Replicate this approach to other rare-disease use cases than hemophilic patients

Medexprim, created in 2015 as a spin-off from the Toulouse University Hospital, is a software house providing data mining solutions to hospitals, and European Clinical Real-World Data (RWD) to Life-science companies. Since its inception Medexprim has sustained significant growth, tripling or doubling sales every year since 2017, to exceed 3M$ in 2023. In the meantime, Medexprim has raised less than 3M$ of capital, and has secured over 2M$ in grants for large collaborative research programs in Europe. Medexprim will reach break-even in 2023.

This capital-efficient business model has relied on the combination of solid expertise in imaging & Hospital IT, astute grant-funded project and product development to refine interoperability and data consolidation for research in hospital settings, and commercial acumen in order to leverage its network of software-using hospitals to produce a valuable RWD business base with large life science companies.

With hospitals, Medexprim has succeeded in establishing a network of 50 pan-European top teaching hospitals and cancer centers using its software solutions for research, and to convert over 50% of those to data partners, i.e. hospitals ready and able to share data for privately sponsored RWD research projects

With Life-Science industry, in the years 2018-2021, Medexprim began to work on RWD projects in the field of radiology AI companies and digital health. Since 2022, Medexprim has succeeded to establish commercial relationships and win deals with 5 of the top 20 Pharmaceutical companies in 2023, and to enjoy repeat business with several.

Consequently, Medexprim has been repeatedly successful with its hybrid business model with both HCP’s and life science industry, and intends to apply the same skills to succeed with Haema-Surg.