Apian: Driving healthcare’s physical AI transformation
Alex Trewby sees a fundamental gap between the demand for healthcare, and the human ability to meet that demand.
The WHO forecasts an 11M person healthcare shortage by 2030. And while he saw autonomous logistics delivering pizzas and sorting parcels, he saw none of that innovation in the healthcare industry.
That’s what led him to found Apian, whose mission is to make medical logistics invisible and autonomous. This involves integrating healthcare providers with drones, ground robotics, and software automation, bringing everyday on-demand delivery services to the healthcare industry at a national scale and, eventually, to other markets.
He sees the UK’s National Health Service (NHS) as the perfect arena for hospital-scale physical AI. In Alex’s own words, “it provides a competitive advantage no fragmented market can match”: shared standards, governance, and clinical workflows mean you can quickly scale at a national level.
Apian’s achievements to date have showcased the potential for innovation within the NHS. This includes the world’s first chemotherapy flight, the UK’s first prescription medicine delivery, and the first remote-operated drone delivery of blood packs. The NHS has already expanded its use of Apian’s drone across London, which cut journey times by 15x.
Apian’s focus now turns to the bigger challenge: from clinical mile to clinical metre. Namely, retrofitting the NHS and live healthcare environments with robotics and automation to remove the human bottleneck to efficiency. Their partnerships with the likes of Great Ormond Street Hospital is enabling them to create simulated environments that can rigorously train and evaluate future robotic systems before they ever hit the real world.
In this Voices that Matter interview from our Red Book Series, Alex shares how he built a pioneering autonomous logistics platform that serves the complexities of the healthcare market and delivers a fresh approach into the NHS.
Q: Alex, you've had an interesting entrepreneurial journey. You got started 30 years ago building the first websites for British MPs at Westminster in the 1990s. You were with Morgan Stanley for 10 years. You co-founded Divide, a mobile device management firm you sold to Google in 2014. You stayed on at Google seven years as a product manager. What was it about autonomous logistics that made it the next challenge you wanted to solve?
A: Having done the commercial thing, it was time in my career to do something slightly more worthwhile. I'd helped set up the Google Health team and founded the consumer health team there, so I knew the challenges of monetising in the NHS. For most health startups, you really need to derive your evidence of impact within the NHS, but go on to monetise internationally. I didn’t want to repeat that challenge. Now, I grew up in an enterprise computing software era and developed an absolute fascination with electronic health records (EHR), the data storage platform where all patient data is kept. EHR is very dull to very many people. Going through the front door and working with patient data remains a challenge, so I came up with a model to focus on back-end logistics for the NHS.
“Apian is looking to build an autonomous healthcare logistics platform at national scale. It's really about moving physical items as quickly and efficiently as the internet moves information.”
Q: In a nutshell, tell me what Apian does and why something like this is necessary?
A: Apian is looking to build an autonomous healthcare logistics platform at national scale. It's really about moving physical items as quickly and efficiently as the internet moves information. So how do you get something from A to B autonomously, without human involvement, so that those good humans that are working within healthcare can focus on the true priority—the patient?
When you have got burritos and bombs being delivered by drones, surely we can use that technology and others to support our healthcare system in a meaningful and impactful way.
Q: The name Apian conjures up swarms of bees and forms a powerful visual metaphor for the medical logistics software and drone delivery services of your company.
A: The name Apian refers to everything in the world of bees. But that's not the reason why we're called Apian. We're called Apian because we are an API. We're the application programming interface that integrates all the necessary logistics fulfilment – be it ground transportation, ground robots or drones – with the clinical systems.
Q: What are the challenges you face as you turn your vision into reality, and how are you addressing those?
A: As we were flying drones, it became clear to us that there was a challenge of actually getting the payload, pathology, medical device or medicine, from the drone into the lab. That invariably involved the hospital porters, who were very busy anyway. How could we optimise that version of the “last-mile problem”?
“We're called Apian because we are an API. We're the application programming interface that integrates all the necessary logistics fulfilment – be it ground transportation, ground robots or drones – with the clinical system”
In the context of healthcare logistics, we call that final, short distance the “clinical metre” where supplies or samples must travel from a central delivery point to their ultimate clinical destination such as a ward or specific patient. The way to solve that problem was to bring in ground robotics. You've got drones flying from A to B, then you've then got ground robotics taking it from the drone to the lab. And we have robotic process automation (RPA) – essentially software robots – sitting on hospital staff desktops, interacting with the clinical systems as well. It’s end-to-end automation.
The company's mission is to use technology to improve patient care and reduce the burden on healthcare professionals.
Q: Though drones are central to your operations, Apian does not directly operate the drones. Do you foresee that changing?
A: We don't operate the drones ourselves because we have so many different use cases up and down the country. Some scenarios require heavier payloads, some lighter payloads, and while some are long distance others are shorter distance. You need horses for courses. We need to use different organisations in order to do that. We now work with a number of different drone operators, including Alphabet’s Wing, Zipline and Matternet, to name a few.
Having said that, there are definitely use cases or requirements to develop a proprietary UK healthcare drone service. We're researching how we might use drones in the same way that you see ambulances on the road. We may not be averse to doing that ourselves.
Q: You've demonstrated there's a need for a platform like Apian. How is it doing as a business?
A: I think that we are laying the tracks for a new industry here. Therefore we need to get our logistics network up and running so we can benefit from the economies of scale that enables us to become profitable. At the moment, we have regulatory challenges, technical challenges and public acceptance challenges to establish that network, in order to ensure we can have sustained operations. First, we have to convince the two largest bureaucracies in the UK, the CAA (Civil Aviation Authority) and the NHS, that drones can be operated safely and routinely.
So far, we have been flying drone deliveries between Guys and St Thomas's hospitals, south of the Thames. We're going from that one drone delivery operation now to five or so operations, creating a network within London.
Each of those deliveries is starting to get paid by the NHS and indeed, other private pathology companies. We will be deploying quadruped robots within the NHS later on this year, as well. We are seeing a huge amount of interest not just in delivering to the pathology lab, but actually around hospitals, helping the portering staff out getting their deliveries from point A to B.
Q: How did the partnership with LocalGlobe come about?
A: So I have never actually raised money from a UK VC before this company. I've been founding and failing for about 30 years but always with money from fantastic Sand Hill Road VCs. This time, it needed to be different. I wanted Apian to be built in the UK, funded by UK VCs, or European VCs who understood the emotional connection we have in the UK to the NHS.
That's not simply a question of who is the most successful venture capital firm within Europe, and who heads up their healthcare team? I wanted someone who would be a good fit for me and my founding team, someone we would spend a considerable part of our lives working with and that took us to Julia Hawkins, Phoenix Court's general partner for healthcare and deeptech.
With Julia, I don't spend time educating her. She gets what we are doing and is essentially part of the team. I've been an entrepreneur for 30 years, so I'm pretty goddamn optimistic and ambitious. But actually she pushes me sometimes to be more.
Q: How does that compare to the other VCs you’ve worked with?
A: LocalGlobe has a rich, colourful culture. It holds on to a sense of the adventure possible in venture capital. The outreach it does to founders is well beyond what other VCs do. It goes back to the founding team. Sitting in the Phoenix Court office, you can just feel the energy that resonates. There's heat you can feel that trickles down across the whole organisation.
Another thing we've discovered with Phoenix Court is the level of access they have into the UK government. A company like ours has to be very concerned with regulation where policies can heavily impact the organisation. I've never met a venture capital firm as well connected in those circles as LocalGlobe is. That's truly full stack.
Q: When you think about creating value from Apian, what potential routes are you considering? You previously sold your company Divide to Google. Would you look at another acquisition? Or would you consider going public?
A: There's that adage that any room you enter, you've got to look for the exit routes straight away. That becomes part of the conversation you certainly have with investors right out the gate, and also with your team in terms of hiring. One must always think strategically about those questions.
But first and foremost, we're trying to work with the NHS and build an autonomous logistics system at national scale. I think that we would all be very proud if this company was one that didn't go abroad and remained fiercely British. Ideally, I would love for this to be a public company within the UK, and for it to demonstrate how the NHS and our private healthcare system in the UK are at the very forefront of healthcare logistics.
Q: What is your ultimate goal for Apian?
A: We first noticed how in the pandemic, hospital staff, the NHS lab technicians who hadn't seen the light of day for weeks and months, coming out of their labs to watch our drone deliveries. What that did for morale was very interesting; NHS staff loved it. Now, AI may prove wonderfully transformative, but drones or physical AI are innovations people can actually see.
Our ultimate goal is to see the creation of a new means of transport and new means of moving things around. Years from now, when I'm dribbling out of the corner of my mouth in my wheelchair and looking up at the sky, I want to see a delivery network of drones ferrying medical supplies to and fro and know my team and I made an impact on everyone around us.
In the meantime, I want to get the clinicians off their screens and to be looking patients in their eyes again, with a lot of their drudge work taken care of by automation.