TriNetX just recently raised another $40 million. The Cambridge, MA-based venture’s newest investors include Merck Global Health Innovation Fund, Mitsui & Co., Ltd., ITOCHU Technology Ventures as well as existing ventures including MPM Capital, F2 Ventures and Deerfield Management. Founded in 2013 the venture’s growth has been impressive.
The funds will fuel expansion efforts worldwide in addition to ongoing R&D to further develop their analytics platform. Much like Uber or Airbnb, TriNetX represents a technology-driven disruption in the industry. It utilizes the concept of sharing to unsettle the status quo and possibly support industry transformation.
TriNetX platform interfaces with provider and research site-focused electronic health records as well as other relevant patient data systems. They purport to support data-driven methodologies to clinical trial design, site selection and the generation of real-world evidence (RWE).
They tout that their web-based, on-demand access to harmonized clinical and claims data now affords access to over 300 million patients available through the TriNetX network. They have mapped patient data to controlled terminology and seamlessly include clinical data points from hundreds of providers, enabling deep accessibility and insight across therapeutic areas—all linked to medical claims, pharmacy and EMR data. The net result if real-world follows theory—sponsors can more efficiently and effectively design protocols based on real-world data elements.
TrialSiteNews estimates that total TriNetX employment is approximately 120. We estimate their cost structure to be approximately $20-$25 million per year; but that could be higher factoring in technology offerings and their associated cost of goods sold. It is not clear if this firm has achieved breakaway profitability as of yet. We don’t think so.
This most recent capital raise is large and undoubtedly, they truly seek sales scale now in rest-of-world. Although key employees on LinkedIn tout that they are producing revenues “well into the 8-digits” this can be interpreted in different ways. Another metric shared is 200% year over year growth with access now to 135 million patients from more than 90 healthcare institutions worldwide. Their cloud-based subscription service enables real-time analytics into key activities such as patient recruitment—one of the clinical trials industry’s biggest bottlenecks.
TriNetX was founded by ex-Microsoft employee David Fusari who apparently envisioned the solution while working with Microsoft on attempting to solve health and life science data challenges. Key stakeholders in the company report that nearly 50% of tier 1 pharma and CROs are subscribers to the TriNetX analytics service. It all represents remarkable progress in just a handful of years.
Much like Uber, TriNetX is a technology company representing in essence, a clinical research consortium. An advanced creative federated-like methodology represents the “secret sauce” to the success thus far.
By 2018, their network was already extended to 55 HCOs, 84 million patients—primarily in the U.S. but expansion abroad was already unfolding. A brilliant idea which in all actuality is built on common sense—bringing the clinical trial ecosystem participants together to share and collaborate patient data. The revenue model we suspect, is premised on ever growing pharma and CRO paid subscription fees to TriNetX—it Is these fees that expand the ongoing R&D and system improvements.
We are not sure as to the revenue share arrangement between TriNetX network providers (e.g. academic medical centers, health systems, etc.). Installing an app on premise at the research site or provider, TriNetX harmonizes the data of each participating member. By early 2018 (only 5th year) TriNetX had already brokered 757 studies and supported the emergence of four data-sharing subnetworks among the network participants.
They announced the Snowflake partnership: based on a next-generation data warehouse supporting data sharing at cloud scale. TriNetX places a bet on the Silicon Valley venture which itself has raised nearly $1 billion in venture capital. Snowflake itself has bet big on AWS. By leveraging Snowflake, TriNetX i benefits including A) modern data sharing B) streamlined analytics C) consolidated storage and D) Instant elasticity (again AWS) is an underlying foundational technology.
TriNetX Director of Engineering noted: “Snowflake is helping us disrupt the traditional model of how people access healthcare data” thus, Konstantine Kruity continued “we can now improve liquidity of data and bring data silos together more efficiently.” Patient data liquidity represents a fundamental concept in the TriNetX world.
A “federated network of real-world data to optimize clinical trials operations” represents a driving core premise underlying the TriNetX offering. A published case study in 2018 evidenced this point. A clinical research collaborative platform—“deployed by a federated network of health care organizations (HCOs), pharmaceutical firms and contract research organizations” enabling “data-driven clinical research study design to reduce accrual failure and protocol amendment.”
They have designed two primary access points including (1) HCO, Pharma, CRO & end user and (2) HCO facility/Data center and their network. Under (1) above they have set up a virtual private cloud using Amazon Web Services (AWS). It should be noted that AWS is the market leading public cloud technology—only Microsoft Azure comes close. Their application architecture includes:
- Application services
- Terminology services
- Identity services
- Ubuntu OS
- Aggregation engine
- Query builder
- Pub/Sub queue
- Elastic search
- Teleport (remote access)
An app storage capability is built into the virtual private cloud domain.
The HCO/Data center domain (2) includes the IaaS and Onboarding of the Healthcare Provider Network Participants. They install the TriNetX appliance—a critical piece of technology that supports the federation process. The appliance includes A) secure communications B) system and data monitor C) self-updating software D) query processing and finally a TriNetX database.
Services introduced to move data back and forth include i2b2, file ingestion services and local monitoring services.
TriNetX has been established as multitenant software-as-a-service platform on Amazon Web Services (AWS). HCO data that are accessible through the TriNetX network—it resides on the appliance located at each HCO data center. During the onboarding process, these data are loaded onto the appliance with a simplified extract-transform-load process that leverages the existing capabilities and scripting of the TriNetX agent. In addition to i2b2, TriNetX supports the loading of data from other source systems with a combination of product and service capabilities.
See the white paper: they discuss concepts from data obfuscation to semantic mapping.
Based on publicly available information TrialSite News staff was able to review some key features and functions of the system. The University of Iowa Carver College of Medicine is an “HCO” participant. The TriNetX federated engine has tapped into the University of Iowa health record facilitating what has the potential to represent unprecedented systematic and scalable access for researchers with features including:
Feature highlights include:
- Researcher: Enables principle investigators at healthcare organizations to tap into and access patient populations based on key data such as therapeutic area, etc.
- Real-time: Scenario modeling for protocol feasibility
- PHI—All PHI remains local. This means that identifiable patient data is not shared across the TriNetX network in keeping with HIPAA , HITECH Act and other regulatory requirements
- Pre-Qualified—a form of patient lists—undoubtedly configurable based on data inputs
- Self-Service—Access to fresh patient data
- Predictive analytics—to project rates at which new patients match eligibility criteria
- Secure—complaint with international privacy regulations. Important to note as they expand to Europe, Russia, etc. each region maintains their own data protection and privacy standards. For example in counties such as Germany it is a best practice that local investigator data is kept in a local data base
- Network—within TriNetX HCOs can form collaborative networks with peer institutions and research the patient population of all collaborators. TrialSite News found this to be an incredibly powerful feature if it works well.
- Industrial sponsor—used to attract more industry-sponsored trials (e.g. biopharma, CROs)
They have a list of available and unavailable data. Undoubtedly there is considerable configuration to work to tap into major underlying electronic health records (Cerner, Epic) and research systems (e.g. Forte Systems, etc.).
We have plenty of questions about TriNetX. From business model to technology architecture. We would be open to interviewing clients to assess how much value-add the system affords. Doing business with big pharma is tricky. Developing a rock-solid professional services acumen is of Darwinian importance. Big pharma is demanding and needy—sometimes subscriptions aren’t enough. Professional services dollars—and lots of them—often represents a core cash flow engine. Is the subscription growth scaling at the right velocity and scale? Are they over-engineering their complex, interconnected solution? How does the site-level appliances really work if there are changes? Does the system need to be GcP validated? On the other hand in just a handful of years TriNetX has certainly built a sizeable network and what appears to be a force to be recognized with.