Nightingale Health Oyj

OMXH:HEALTH

Earnings Call Analysis

Earnings Call Transcript 2024-Q4

[Teemu Suna, executive]

Good afternoon, and welcome to the webcast for the financial year of Nightingale Health. So today, we will go through the financial year. We look at the key achievements. We go through the numbers. We see the business targets for the next financial year. And then we have the financial calendar and Q&A in the end.

My name is Teemu Suna. I'm CEO and Founder Nightingale Health. So let's start from the first agenda point. I will tell briefly what Nightingale is all about. So Nightingale Health exists to build sustainable health care and reduce health in equalities. So why do we need a more sustainable health care system -- because the current health care system is not equal. The health care system, if we look at the problem very briefly, the health care system is overburdened with too many sick people. And it's overburdened with diseases that could have been prevented.

Now we talk a lot about health care problems. We talk a lot about health care costs. And actually, it's the chronic diseases that is the core of the problem.

So let's look at this a bit more in detail. So the core idea with our health care system, our primary care system, is to promote health and prevent diseases. And actually, the health care system that we have today is doing it all the time. But the problem is really that the tools that we are using do not scale well. And because of this, the prevention doesn't work the way it should work. And interestingly, the kind of the goal to prevent diseases, it's in many medical guidelines.

It's something that everybody agrees about. But the problem really is that we don't have the tools to actually do it. And when we look at this in numbers, 90% of health care cost comes from chronic diseases. And the silver lining is the -- is that 4 out of 5 could have been prevented.

So I think it's quite clear that change is needed. So what can we do? The answer actually is -- very simple -- the primary care system, is better tools for prevention because with better tools, we can actually reach towards the benefits of prevention. And as I showed in the previous slide, we are now talking about the biggest problem in health care.;

We fundamentally know what is the reason of the problem. We have too many sick people. We know what is the kind of -- what are the diseases that are causing the problems. And we know that we can prevent the diseases. The only thing that we are really lacking are the tools to do the prevention better. And this is exactly what Nightingale is all about. This is what we mean when we say that we are building a more sustainable health care system. Because when we put prevention to action that's the road map to have less sick people. And when we have less sick people, we are actually initiating a chain reaction that is yielding better health outcomes. It's building a better health care system.

So if you look at this in a bit more detail. So as I said, the current primary care system, prevention is done all the time, but the tools require a lot of resources and they don't scale very well. And now if you look, the public discussion around health care, I think it's in the very core are the challenges with the resources. We don't have enough resources. We don't have enough health care professionals to take care of all the sick people.

And consequently, it doesn't scale very well because if you have to use a lot of health care professionals time, it doesn't scale very well. Now if we bring the better tools for prevention, we can do prevention more efficiently. We can offer preventative solutions to a broader group of people, even for entire populations. And then when we detect the risks when people are still healthy, we can help to reduce the risks. And with that, keep the healthy people healthy. So then this -- what we can achieve with this reduction, the reduction in the number of sick people -- then we have the cost savings. So ultimately, in health care, we can reorganize the way how we are taking care of the sick. And we should do that, of course.

We can implement different information technology solutions, different AI solutions, we can do various things to optimize the current system that is taking care of the sick. But if you really want to change how the costs are accumulating, I think the only logical -- only feasible solution is to have less sick people and that we can achieve with prevention. And then, of course, we need to build this in a sustainable and equal way.

So it's not -- what Nightingale is all about. This is not a technology for the wealthiest 1%, this is a technology for everyone. This is technology that you can take to a population. We call it the Nightingale Health Check and the Nightingale Health Check is an efficient and effective tool for large-scale prevention. And I will share with you like how does it work? Because what I just said, they are kind of big words. We are talking about the -- 1 of the -- we are talking about 1 of the biggest problems in the world because I mean eventually, if we have more and more sick people all the time, I mean, will if people are sick, who will go to work, how do we run the society.

So it's not only a health care problem that I'm talking about here. It's a broader societal problem that we have to solve. It's not optional. It's something that we really have to solve, and we need to take actions quickly. And this is where Nightingale's health check can make a significant contribution. So to give a bit of a context, let's have a comparison, a couple of comparisons here.

I think it's quite important to understand what the Nightingale Health Check is actually doing. What we are actually doing is that we are doing the same risk detection or risk assessment for the chronic diseases that is already being done by the current health care system. It's the same thing. But what we do, we do it in a much more fundamentally more efficient way and more scalable way, more cost-efficient way.

So the results that we provide, there is nothing new. It just makes the process much, much more efficient. And now if you go back to what I said earlier about prevention, this is the way how we can actually scale the prevention to an entire population. This is the way how we are not using health care professionals time for the risk detection anymore. And with this, we built the core foundation for the preventative health care system.

So let's compare. So -- here in the slide, on the left-hand side, we have the current risk assessment tools. And these tools are being used all the time around the world. We have for cardiovascular disease, here in Finland, we have FINRISK. The same thing in the United States, is ASCVD. We are using SCORE 2 in Europe. We are using Framingham Score in multiple countries around the world. This is for cardiovascular disease. And we have for every disease, we have these clinical standard risk tests.

So what do they do? The risk detection capability, they have good performance. The input that they require in order to do the test, you need to collect many data points. You need to do a lab test, you need to do questionnaires due to the clinical examinations, for example, with cardiovascular disease. You need to measure blood pressure. You measure BMI, you ask body mass index, you ask for the family history and then you do the lab work. So it takes a lot of like health care professionals time to evaluate the risk for the disease. Then the current way of doing things is also evaluating always 1 risk at a time. So if you are being -- everyone -- I think everyone knows this.

So if you go to see your doctor, value they evaluate your risk for cardiovascular disease, they don't evaluate your risk for -- this is risk for other diseases. One disease risk at a time and every disease risk that is being evaluated or assessed requires different data points to collect and the more risks you evaluate the more time you spend.

So in summary, the current way it's inefficient because it's very resource-intensive. It takes a lot of time for the health care professionals. That's why we don't run a risk assessments for like population widen some countries. This is being implemented. But I mean it's very expensive, and the scalability problem is still there. And the fact is that we would like to run this for everyone. Because the better we detect the risks, the better we can take the early actions.

So let's compare this to the Nightingale solution. So the risk detection capability, the performance, our test has equal or superior performance. So we match -- and as I said, it's the same thing. If you run ASCVD, if you run FINRISK to assess the cardiovascular disease risk, you can run also Nightingale, it's the same risk detection. You are doing the same risk assessment.

Now the difference why this scales in a completely different way than the current risk assessment tools. We need just a single blood sample, and we need age and sex as clinical parameters. Nothing else, nothing else. So it's a fundamental change how the risk can be assessed. And then there is more. So the current way of doing things, which assess only on disease risk at the time. It has a lot of challenges because what do you want to do? You want to create this like a holistic picture of the disease risks that people may have.

So now the Nightingale test, it detects multiple disease risks every time, automatically, still one blood sample, age and sex. So I mean the differences now if we compare make it a bit more concrete. So assessing the risk with current risk assessment tools, it takes 15 to 30 minutes per disease. With Nightingale because you don't need to collect any clinical data, it's basically like a couple of minutes. You just need to draw the blood sample and then you are good to go.

Now, so it requires way less resources from health care professionals. And importantly, now with the Nightingale approach, the time of the health care professionals can be targeted to people who actually need the help from the health care professionals.

Because when we know the risks, we can also target the health care services to the ones in need. And this is when you look this in the bigger picture, this is -- this is extremely important. I think we actually have enough resources in health care. The problem is that the resources are not targeted in an optimal way.

But to target the resources, you actually need to know how to target. And that's basically in the primary care side of things. is to know the risk. And now we can do this large scale even for entire populations. So what happens here is that Nightingale health check replaces the current risk assessment tools. And now this is not a vision like are we going to do this in 10 years and then amazing things happen. It's already nationwide use in health care, in primary care.

So it's already happening and the results are very strong. I want to show another slide about the same thing because I think this is the core thing about the Nightingale's technology. This is the core thing how we are helping to build a better health care system worldwide. This is all about the competitive advantage with this technology. This is something that, to my knowledge, no other company in the world can do in a similar level.

So let's compare again [indiscernible] taking as a use case the risk assessment in Finland. So in Finland, we have this technology in nationwide use in primary care system as a part of the occupational health care in Finland operational health care is part of the primary care system. So let's have the current risk assessment tools first. The same thing as in the previous slide, but now I'll go into more detail. So the current clinical methods to assess risks for chronic diseases in Finland. We have FINRISK, which is for cardiovascular disease. We have [indiscernible] which is for type 2 diabetes. Then we have a test for kidney disease, liver disease, lung diseases. How these tests are being done.

Now this is the clinical standard. This is from the guidelines. So here, you can see every disease. So with in risky you need to collect all of these data points that are being shown in there. So now if you imagine the time that it takes to collect those data points. With [ FIN derisk ] for type 2 diabetes risk assessment, you need to collect all of these data points in the slide. For chronic kidney disease, you collect the data points in the slide.

Now imagine that you do all of these tests, you test the risk for CVD type 2 diabetes, chronic kidney disease, liver disease, alcoholic liver disease, lung cancer, COPD. So nobody does it but it does it? I mean, come on, it's -- the time needed to do this is like unbearable -- it's -- you don't you don't really do this. And now I'm talking about primary care, national use. You may be able -- you can go to a private clinic and you can buy this if you have the money. But as a kind of scalable primary care tool. This is not -- this is not doable with the current risk assessment tools. However, this is something that should be done. And I think there is a very good alignment that detecting the risks early on should be done.

So now let's take Nightingale. One blood sample, multiple disease risks at the same time required clinical data to run all of these diseases, blood sample, the Nightingale blood test, sex and age, with equal or better performance. Of course, a bit biased to say this, but this is groundbreaking. This is like this changes the way how the health risks can be detected. And this is the core for the future of primary care in every health system in the world. I think it's quite exciting. And it's available today. We can scale this to national use. We are building the -- we have the capabilities in multiple locations around the world. And now we are scaling this to be adopted in different health care systems and here is -- just an example, like how this happens in reality, there is a picture of the risk assessment report.

You can look at this in more detail in our web page. And then in addition to the risks, many times, health care professionals are asking like, okay, but I want to see the LDL cholesterol, I want to see HDL cholesterol. I want to look at the different biomarkers that are being used to do -- to run diagnostics in health care. Now we also delivered this. So you don't -- you don't need to run your clinical chemistry. We also deliver the biomarkers aligned with the gold standard. So again, you use the Nightingale, they are not like nightingale biomarkers. They are the same biomarkers that are being used in medicine all the time.

So in addition to the risk detection capability, you also get the biomarkers. This is why this is a tool that can be -- it can be adopted to health care use like immediately. It doesn't take anything away -- it gives the same things on the table that are being used by health care worldwide all the time. But then it brings a layer with a risk detection that is like it's it's way more efficient than anything else in clinical use. We can also do this.

Of course, the majority of the business is with the [ veno ] samples because that's the standard in health care. But I think there are quite exciting applications with self-collected samples so a person can give the sample by themselves from a finger [ brick ]. I believe when we look health care like the -- in the next 5 years, I think these self-collected samples becomes more and more of a standard. It's just we can create a more distributed health system and create more efficiencies. And it's also nicer for people. You don't have to go anywhere. You just give the sample at home and then you get the results and then when you meet with your GP or the clinician, you already have the risk report on the table. It's just better for everyone. All right. So that was the recap of the Nightingale and the core value we are delivering.

Now let's have a review of the business targets that we had in the previous fiscal year. So we had 3 targets. Target #1, to win an international commercial contract with health care industry partner, Target #2 win a white label deal. Here, we mean the B2B2C business that we have based on this like self-collected samples and then Target #3 is with our research. There's a lot of scientists around the world using the Nightingale technology for medical science. So then we had there a contract value target.

Just as a brief summary, we reached all of the targets. I think especially with the First target, the adoption of Nightingale's technology, we made several important announcements, several important deals in the United States. The adoption of the Nightingale's technology is moving forward very strongly. I will talk more about this. I will go in more details in that area. We also had a target regarding the FDA approval in the United States.

There is a significant change in the FDA ruling. So in the rules, how -- what are the requirements in the United States. We will be talking about that in more detail soon. But I think the changes that has now taken place in the new ruling, I think puts us in a position that the international standards that we have approvals already, I think they are very applicable for the new FDA ruling.p

So I think we are in a very good position now to pursue the approvals also in the United States. And then the new ruling also takes a lot of the previous model has been a bit of like a lot of interpretation has been in the way how the rules are being interpreted. The new ruling makes the rules very, very clear. And we believe -- we think it's a very, very, very good thing. But I will come back to that. We will come back to that later.

All right. So let's go into the key achievements in the past fiscal year. Here, we have Here, we have the -- our international locations. I think the -- what is quite -- what I'm very proud about is that if you think about Nightingale as a company, we are a company with around 90 employees. And we run this business in 5 different geographical regions we have from all of the regions. We have very strong results. Of course, this is like the company journey is still in the early it's in the early stage in many ways. This takes time. That should be no surprise. It takes time. But I think now if you look all of the 5 locations and you look at the progress that we are making, it's pretty unbelievable that a team of 90 people can do this.

So I think the Nightingale team is like one of the most efficient teams in the world. If you look at the results, if you look at the team size, I think it's quite unbelievable. So huge, huge thanks to the Nightingale team. Once again, to reaching all of these achievements.

So in Finland, we have the partnership with [indiscernible] this is where we have the technology in nationwide use, 30% of the Finnish workforce in the country is being tested with this technology. And it is in occupational health, but importantly, in Finland, Occupational Health care is part of the primary care system.

In Japan, we made progress by wiring a company that puts us commercially in a new position I think we are now in Japan in a very good position to pursue growth. In Singapore, we made a partnership with [indiscernible] Quest Diagnostics. It's part of pathology Asia. Which is the largest diagnostic provider in Southeast Asia, covering like a population of 500 million people. So I think that's also a very strong progress in the U.K. We have the new laboratory started in there. We completed the analysis of the U.K. Biobank with Nightingale's technology, the largest health data repository in the world.

This is the kind of because the scale is so immense the results that we kind of the. When we do the data analysis with Nightingale's technology, the scale that we are operating in its it's massive. It's unprecedented. So that gives a lot of confidence then when we also do the health care implementation. And then we had some progress in -- with the self-collected samples in the U.K.

In the U.S., there was a lot of new deals announced. So we had the partnerships and deals with major health care organizations. So we are working with [indiscernible] Masinloc medicine, Kaiser Permanente, the Boston Hard Diagnosty23 [indiscernible] . And if you look this up, they are some of the most important health care customers in the world. not only in the United States, I think many of these organizations are also leading the way in medicine and health care.

So we are very proud that they want to partner with us. They want to adopt the Nightingale's technology. I think it demonstrates that what we have is something that is hugely important in answering the question, how do we build the future health care systems. So I will go a bit more detail in all of this. And we also have this in top part of the slide.

We have this progress bar. With the progress bar, we want to we want to indicate what is the status like? Where are we in the journey? And as I said earlier, the Nightingale journey these kind of companies it take -- it takes easily 10 years to build the validation, build the technology to get everything running and then you start step-by-step step going into adoption of the technology in the health care cases. It takes time.

So that's why we wanted to give a bit of understanding about how we see the progress in different markets. So in Finland, I think we are -- this is the most advanced use case of Nightingale health technology. We are in large-scale health care use. We -- the nice thing about this collaboration is that here, we directly replaced the kind of the old way or the previous way of doing the risk assessment. So we directly replace that with Nightingale, Nightingale solution and that, of course, also brings quite significant sample numbers right away because these are workflows and processes that are taking place already. And now when you just switch to Nightingale's technology, there are quite a lot of like samples involved. But I think it's a very strong achievement, and this is a very important reference also when we look at the -- look at our business in other countries. And it's -- after a very long time in building this technology and developing the company, it's great to see that there are hundreds of health care professionals using this technology on a daily basis.

I think it's something to -- it's a major achievement. Then in Japan, we are -- the progress for is that we are in the implementation phase. We acquired the Welltus Inc. to strengthen our business position. Now what we are -- this acquisition enables us to kind of work with the partnerships, provide the technology more broadly to different use cases in Japan. And it's already available in more than 200 hospitals.

So now the next step to get into the large-scale health care use is, of course, that we need to position the technology do the use cases where the scale is like where it can scale fast. But I think this Terveystalo collaboration in Finland is a great reference also to Japan because in the Japanese system, occupational health care has a huge role in how the whole health care system has been built.

In Singapore, as I mentioned, we made the deal with Innoquest and Innoquest is the leading clinical diagnostic service provider. So the reason why we built a partnership like this is that it helps us to get our technology where the samples are already being shipped. So in this kind of a business, collecting the samples and managing the logistics is quite a big thing to solve.

In Finland, we have sold it ourselves. But now in the international locations, we prefer the models where we built the Nightingale capability like lab-in-lab. And now we are Building the laboratory and the ramp-up is proceeding as planned. And commercially, we estimate the loans will happen in the last calendar quarter of this year. So we are making good progress.

And then regulatory wise, I think the HSA, the Health Sciences Authority in Singapore, we just announced the third approval in this. And well, I think it's pretty much aligned with our results from other regions. But I think it further demonstrates that Nightingale's technology basically is aligned with the gold standard in clinical medicine and the technology can be used in health care. I think it's a very important step also to get these approvals. And now we are -- I think we are very well positioned also in Singapore.

In the U.K., so the laboratory is there. We have a -- we have staffed it. The samples are already being analyzed. And now I think the -- what we are looking to do next in there, now we have the local capability in the U.K. Now there is a lot of commercial actions that we can do in there. The U.K. Biobank analysis was also a very important milestone for us. And if you look at the publications done with Nightingale's technology, I think it has like the number of published sciences going through the roof because many research scientists can access the data from the U.K. Biobank and then they can also get the benefits of Nightingale's technology in the medical science they are doing. And with this, we are actually step-by-step, helping to build also better tools in health care use.

In the United States, 5 important, very important deals maybe to mention a bit of the nature of the deals. So with '23 and me, we are, of course, they are 1 of the -- or they are maybe the biggest company in this like a consumer health area in genetics. And the Nightingale's technology is is a great addition to the genetic data. So with genetic data, you can look what you have inherited, things that you cannot change basically. And then with Nightingale, you get understanding and understanding what are the lifestyle? How are your lifestyle is, how your body is reacting to your lifestyle. And then when you put these data modalities together, you get like even better risk assessment. Of course, with the chronic diseases, the lifestyle side has a kind of -- that as the most important role to kind of to impact the risks, then another example like [indiscernible], Kaiser Permanente, they are huge health systems in the United States, some of the biggest. They are also, I would say, like global references in many ways.

So working together with them, I think it's a great step also forward to advance the adoption of Nightingale's technology in the United States. All of these deals, it will take time to bring these projects into production but we are making great progress with them pilot running with the Boston Heart diagnostics, for example.

So we are also moving to that direction, but we need to take it step by step. I think the important point is to look to kind of -- to see the customers and kind of how they are operating in the. What is their role in the health care system in the United States. And then we are building the laboratory in the United States. I think that's a very important step with these new customers also to be able to serve them also locally. And then finally, we announced that we acquired all the intellectual property assets of [indiscernible] with blood collection device.

So earlier -- so the change here was that earlier, we were holding a license to use and manufacture the device. But as I said earlier, I believe that when we look ahead like 5 years, these self-collected samples will become more and more important to make the health care system even more efficient. And this blood collection device so far has been the only one that yields very good results.

So in other words, it has a very good sample stability over a long time period. So the sample -- we can keep the sample cut like up to 3 weeks after collection. So this helps with the logistics and then we also wanted to acquire the technology because now we can fit it better also to the analysis. And we are the only company in this field that has the collection device and the analysis capability. So you can get from Nightingale, you get all the components from a single company.

I think that will be also a strong competitive advantage when we look forward. All right. So that's progress. And I think there are quite a lot of things that we have achieved. I would have used even more time to go through all of them, but I think it's just describes the great progress that we have managed to do over the past fiscal year, and I think we are like -- we have like excellent position to continue the rapid progress. With these cases, we have already announced and then also with the new deals that are proving in our pipeline.

So now let's go to the numbers, and I would like to ask Tuukka Paavola, our CFO, to join me on stage. And let's have the numbers review.

[Tuukka Paavola, executive]

Thank you, Teemu. Great to be here presenting the numbers from our last financial year. So let's actually start with the cost side of things. Because I think it is actually quite amazing that we have managed to achieve all the great things Tem was talking about, while actually keeping the same cost level as we've had for the last couple of years.

So it, of course, means that we are running a tight ship. We are really doing things in a focused manner in a really efficient way and also in an effective way, really making things happen. So the change in our liquid funds, meaning cash and certain short-term investments we are doing for liquidity management purposes. Was at minus EUR 14.6 million in the previous financial year, which is actually almost the same as in the earlier financial year, which means that at the end of the financial year, we had around 66 million liquid funds available, which means that we have a really strong financial position to continue executing our strategy and growing our business globally and giving us multiple years of runway.

Definitely enough for us to really, really scale the business globally. Then on the revenue, the revenue for the second half of last financial year was in the same EUR 2 million bracket as where it has been for the last couple of half year periods, landing at EUR 2.6 million, which is, at the same time, also the highest half year revenue -- revenue for half year period ever.

It's good to notice that still the largest part of the revenue comes from the research business, which is rather volatile in nature. So you should expect to see some volatility also in revenue going forward? But at the same time, we are building this other revenue bucket, if you will, a foundation from the health care revenue side, which is then more stable in nature. And now, for instance, we are seeing the first revenue coming into that bucket from this Terveystalo Occupational Health deal that commenced in early H2. And many of the deals Teemu was describing have a chance to actually start contributing to that more stable health care revenue bucket. And that is, of course, something we really want to grow going forward.

Then just to summarize the numbers for the financial year. So the revenue for the full year landed at EUR 4.358 million, which is a slight 4% increase year-over-year. But also actually, at the same time, it is the best full year revenue-wise to date. We also managed to improve our profitability slightly with EBITDA landing at minus EUR 10.4 million and net income at minus EUR 17.46 million. We are practically debtless. So yes, [indiscernible] no debt in our balance sheet.

Our net debt-to-equity ratio, it as minus 76%, which is fantastic. And we have a solid financial position with net cash at EUR 63 million. And the difference now between the liquid funds, I described 2 slides ago, our net cash is that cash is actually liquid funds where we take away then the interest-bearing debt and leasing liabilities.

So I think to summarize the, our financial position in 3. First of all, it's really solid, strong position to continue executing our strategy. and multiple years of runway remaining. Secondly, virtually, we have no debt in our balance sheet, which gives us possibilities in the future to leverage our balance sheet if needed, for certain our projects to scale up the business. And we are also on the path to improve our profitability, where both the increased top line, but also efficiencies across the board are contributing too. So we are on a good path towards our midterm target of becoming EBITDA positive in the future. I think that's a short summary from the numbers. Then back to you, Teemu.

[Teemu Suna, executive]

Thank you. So kind of now when looking at the numbers when looking at the progress, I think the Nightingale journey is moving forward as planned. We are managing the financial position, the financial side, the way how we've been planning to manage it. We have solid runway. We -- very strongly believe that it's enough to reach the positive EBITDA. We are winning deals that are very significant in promoting the adoption of the technology to health care use. In our plan, we know it takes time. But I think the the speed of the progress is very strong. So we are quite comfortable about the the position where we are. And I think it's a great situation to accelerate forward and reach towards the international ambitions that we have for this company.

With that, let's go to the business targets for the ongoing financial year. We continue with the primary focus with Target 1 in winning new large international deals, particularly in health care and aiming to these flagship quality deals. The journey, the Nightingale journey is still in the phase where we need to kind of -- we need to win the flagship deals. We need to win new deals because it's the new deals that are moving to adoption forward.

I actually believe that once we get Nightingale's technology implemented in couple of more large scale health care use cases. There is a strong possibility that this technology becomes something that -- it gives such a competitive advantage that if you are without it, how can you compete in risk assessment which puts us in a rather nice position. That's why we try to win large deals.

That's why that is the primary focus. Because what we are trying to do, we are -- we believe this -- we can build this significant player in international health care. And to go there, the target one, that's where we want to deliver. And that's why it's our primary target.

Target #2, we are now bringing also more of the numerical side on the table. It's not still the core priority. As I said, core priority is to win new deals. That is driving that is moving the company forward the best possible way. But also increasing revenue is our target.

So we also want to do deals that are helping us to bring the revenue up. As Tuukka was saying, some of the deals that we have announced, can also help to build up the revenue. And then when we move forward, the more we win the deals, the more we will give also a priority to the revenue side of things. But this is a journey. It takes some time, and we are evaluating all the time when -- where should our core focus be. And then target #3, improve efficiency. So we continue keeping the strong cost control and then aiming to improve the EBITDA. Same story with EBITDA. So when moving forward, we will give more focus and priority to this, but now it's still the time to win the deals that moves the story forward the best possible way. And then no changes to midterm business targets, long-term business targets in the mid-term, we aim to achieve positive EBITDA. And as I said, the runway that we have, we strongly believe that we have a solid road map towards that. And then in the longer term, what we try to do here, we try to build an international scale health care technology company.

Here, you can see the financial calendar and the date for the Annual General Meeting. And then we go to Q&A, and I would like to ask Satu Saksman from our management team to join on stage. And -- let's have a look at the questions.

[Satu Saksman, executive]

Yes. Thank you, Teemu, Tuukka. You guys talk so much that we have like 5 minutes for the questions.

[Teemu Suna, executive]

Its not because of that. It's because we have so many things that we need to tell.

[Satu Saksman, executive]

Okay, agreed. So a lot of questions, obviously, for obvious reasons, related to of our ongoing projects around the world, especially here in Finland, Terveystalo. A lot of these things has been discussed over the presentation, but maybe some highlights and clarifications.

So let's start with the Terveystalo. According to the public information as well as our internal resources the Terveystalo collaboration has started well. So how is this -- what is the role of Terveystalo share something about the revenue coming from the Terveystalo -- but what is it? I mean there's a big role in adding strategy and also the revenue, can you kind of clarify that 1 more time?

[Teemu Suna, executive]

Yes. So you said 2 words. Revenue and reference. And now the priority here is the reference. But this is, of course, when moving to Nightingale story forward, we need to win cases where the adoption of the technology goes to large scale. And for us, working together with Terveystalo has been like great opportunity in 1 hand to get the technology to be used in large-scale health care.

But then also, on the other hand, there's a lot of like collaboration and development together with them. And it's been something that a lot of learning has been exchanged in that partnership. And of course, there is the revenue component. But now we played the long game here. And in the long game, the meaning of this partnership is to have the reference, to have the possibility to build something great together with a great customer who is kind of really forward thinking how we build a better health care in the future.

[Satu Saksman, executive]

Okay. Let's continue on that strategic angle then. So internationally, how do you believe that Terveystalo type of health check or this use case can be adapted to the other markets and the other geographical areas that we've been talking here today.

[Teemu Suna, executive]

Well, I think the short answer is very well, but maybe to give a bit of like idea like beyond a single case. So with Nightingale, we have basically like 3 kinds of like use cases. So we have the first 1 is that where we detect the early risk -- early risk detection screening, it's all about like how do we find the risks as early as possible. This is the part of the preventative health care system. This is part of the health insurance system.

So there are a lot of use cases for this. So that's the first one. Then the second 1 is that actually, this technology can be used. We have not announced significant deals around this, but this technology can be used also to help treating people who already has a disease.

So this is more of like specialized health care application. I think there are good use cases in that segment 2. And then we have the third segment, which is using the Nightingale technology as a KPI. So now we talk a lot if you Google -- if you Google or if you write to Google, value-based health care, this is what is happening in the United States. So there is like a strong movement towards like paying and focusing in the health care outcomes.

So what is the performance of the things that health care is doing. So how they are creating value. But there is one problem is quite a big problem. How do you measure the progress, if you do something, how do you know that these actions have been impactful? And actually, Nightingale's technology can be used as a KPI because what is -- I don't know what is -- what would be a better for the health care progress than the change in risk.

So if you do something that reduces the risk, you are doing better, kind of you are building -- you're doing better health care.

So I think this kind of KPI use cases are also emerging. Not that we have deals in that area right now, but I think it's good to think about the technology like this. So risk-screening then helping to take care of the sick and then the KPI use cases.

[Satu Saksman, executive]

Okay. Then very frequently asked question about seeing up or probability of getting Singapore commercially available by the end of this year. Yes, no.

[Teemu Suna, executive]

Yes, it will be available commercially by the end of this year.

[Satu Saksman, executive]

Okay. Let's see then about that. Then maybe -- I mean I think we are pretty much out of the time.

[Teemu Suna, executive]

Let's have a couple of more.

[Satu Saksman, executive]

Okay. Let's have a couple of more. So this came maybe also Tuukka good share something related to that. So there was these focus areas, different market areas.

So no question, how much more laboratories and employees you need to grow bigger worldwide let's say, short midterm? And how do you then see the burn rate developing related to this?

[Tuukka Paavola, executive]

But if you then start from the number of laboratories we need.

[Teemu Suna, executive]

Yes, yes. So -- now when you saw in the presentation, you saw there like we have now 5 locations where we have put the Nightingale's technology or putting -- Nightingale's technology available. That is kind of the core because if you look at those markets, there is a lot we can do with these laboratories. Of course, if there is a customer case in some other regions where the deal size is just big enough we go there and we implement the laboratory. We can do it. We have quite a lot of experience about this.

But maybe to say as kind of a more general strategy. So we have believed from the very beginning, there's a lot of power with small teams. So we are now like 90 people. And what we try to do is that the point is not to let's hire another 100 people that creates also a lot of inefficiencies.

Now with the team size that we have, we can be like super efficient. And how do we manage how we manage that we also make progress? One word, focus focus, focus, focus. So we don't go to the United States and say like, "Oh, gold to top 100 customers. You just make a mess, [indiscernible] out of these top 100 customers, the 10 most important and the most viable cases windows. And then you kind of manage also the cost side.

[Tuukka Paavola, executive]

And maybe then I fully agree with what you said. And then maybe comment on the actual cost side. So naturally, we need some CapEx and OpEx investments, whether we set up new laboratories. But of course, we do them only when we have solid business cases in the pipeline and the revenue from those business cases should then offset the increased costs by far, which means that we should continue to be able to improve our EBITDA and achieve positive EBITDA.

Of course, there will be some time like there, but it's not going to be that long. But our solid financial position and the fact that we are debt free gives us the possibility to scale up.

[Teemu Suna, executive]

And even if we would need to invest in this, if we have a commercial deal and we would need to invest CapEx in those deals, we have the debt card, which we have not used at all.

So I think there's a lot of like flexibility then how we build up the growth. And I would say about the number of employees the day will come when we need to hire a lot more people if we are successful. But then that's -- then we built the company, there's a lot of changes that we then need to do. Then we do the changes when the time comes, but the time is not now.

[Satu Saksman, executive]

Okay. So then maybe something that has raised a lot of questions. I mean, this regulatory fields arise a lot of us questions in the U.S. but also elsewhere. Can you somehow summarize like how have the regulated projects in -- what's your experience about the regulatory project already now taking in other markets, what is the -- based on those, what is the expectations for new markets to come like when rolling out to the new geographical areas and all that.

[Teemu Suna, executive]

Yes. Yes. So I think the -- to summarize the situation briefly. So in the markets where there is the kind of the rule book is very clear how you need to do it and there is not a lot of like room for interpretation. The process typically like it's not something that it takes like years to build up. we have been very successful, I think recent achievements in Singapore demonstrate very well. I mean, the requirement level in Singapore is very strict. It's very strict. So when the rule book is clear, we have made very good progress with the regulatory approvals. And I think now in the United States with the new FDA ruling, I think that's why we think it's a very good change in the ruling because it makes the rules more clear than before. And we have certain elements in our current quality management system that are compatible out of the box with this new ruling. But we will -- this can go to very detailed very quickly.

So we will tell more about this soon.

[Satu Saksman, executive]

Okay. Maybe wrapping up the whole presentation and this question-and-answer session. So the last one, priorities, how Nightingale as priorities look like for this ongoing fiscal year and what's there to follow from our press releases and company releases from -- in the future for next 9 months.

[Teemu Suna, executive]

So look at the deals we do. Look at the progress we do in the deals that are now in the pilot phases. That describes how we are moving forward. And of course, we take -- we have a lot of priority and focus to take good care of the numbers. That's what we always have been doing. It, of course, it kind of takes investments and it takes time to build these kind of things up.

There is no shortcut in this kind of business and with these technologies, but I think like if you really want to follow the story and to see where we are going deals and the progress we are making in those deals.

[Satu Saksman, executive]

Okay. Thank you. I think that was pretty much capturing the questions, and we are...

[Teemu Suna, executive]

All right. So thank you everyone for the questions. And that's it. We will meet again. Have a nice day.