Prevention Is Not a Slogan. It Is an Operating System

Healthcare is full of brilliant ideas. It is also full of moments where brilliance arrives too late. That is why I keep coming back to the same belief. Prevention is the highest leverage investment we can make in modern healthcare.

Not prevention as marketing. Not prevention as a lifestyle trend. Prevention as a system. A set of tools, behaviors, workflows, and incentives that help us catch risk earlier, intervene faster, and reduce the human and economic cost of late-stage care.

On THE BRIDGE, I sit with leaders who understand that healthcare progress happens when science and technology serve people first. This means building solutions that stand up to clinical reality, regulatory scrutiny, and day-to-day use.

In this episode, I spoke with Miloš Tkáčik, CEO of Principal Engineering. Our conversation began with the story of an engineering company expanding across markets. It quickly became a discussion about something bigger.

What happens when an organization built for complex systems applies that discipline to care delivery?

And why telemedicine can be the bridge between what we can measure and what we actually do with that information.

The hidden advantage of companies that grew up in complexity

Principal Engineering started as an IT services company around two decades ago. Today, they are part of a broader group headquartered in Prague with branches in Slovakia, Germany, the US, and Canada. Their work spans government, banking, telecommunications, and utilities.

Some people hear that and think it is far from healthcare.

I see the opposite.

Healthcare is one of the most complex systems we have. It is not only medicine. It is data. Infrastructure. Compliance. Payment. Human behavior. Trust. And coordination across institutions that do not naturally share workflows.

A company that has delivered across ministries, regulators, banks, and national infrastructure knows something most early-stage health tech teams learn too late.

Building in regulated, high-stakes environments is not a feature. It is a capability.

Miloš described something that every leader expanding into new markets will recognize. A new market takes longer and costs more than you expect. Not because the programming languages change. They do not. Not because good engineering stops working. It does not. Because trust, relationships, and local context are the true barriers to scale. In healthcare, that insight matters even more. Technology can cross borders quickly. Healthcare systems do not.

Regulation is different. Reimbursement is different. Clinical workflows are different. And even when the problem is universal, like hypertension in pregnancy, how it is managed and paid for can vary widely.

This is where credibility and partnerships become non-negotiable.

Telemedicine is not the product. It is the pathway.

At some point, almost every conversation about digital health gets pulled into a debate about tools.

Which platform. Which device. Which dashboard. Which AI model? Those details matter, but they are not the starting point. The starting point is the pathway.

What happens before the patient reaches a clinic?

What happens between visits?

What happens when risk changes at home, not in a waiting room?

Telemedicine is not a replacement for care. It is a way to extend care.

When done well, it creates continuity. It reduces friction. It supports earlier intervention. And it makes prevention practical.

Miloš shared two motivations that brought Principal into telemedicine.

First, they had already worked on software projects in the medical sector. They integrated hospital systems. They saw the gaps.

Second, he invested in a senior house for Alzheimer’s patients. That experience led him to develop an application for seniors.

I respect this trajectory because it is grounded. It starts with direct exposure to a real need. It moves toward a solution. And it expands into a platform that can support multiple populations.

In healthcare, the best ideas rarely start as abstract product strategies. They start as lived friction.

One platform, many use cases. The pattern is the point.

In our discussion, the telemedicine applications covered a wide range. Support for seniors and cognitive health. A wellness and spa application that helps people maintain progress after they leave the facility. Veterinary telemedicine in remote regions. And the project that brings Miloš and me together. A study for pregnant women at high risk of hypertension and preeclampsia. At first glance, this looks like a scattered portfolio. It is not. It is a platform strategy grounded in a single principle. Use the same core building blocks to support different care pathways.

In other words, do not rebuild the engine for every new vehicle. Build a trusted engine, then tailor the vehicle for the population and workflow. This is how you scale responsibly.

It also aligns with how regulation and adoption work in healthcare. A platform built with privacy, security, auditability, and clinical usability in mind can support multiple validated use cases without starting from zero each time.

The benefit is not only technical. It is strategic.

It lowers the cost of expansion.

It accelerates iterations.

And it makes cross-border scaling more realistic.

Why high-risk pregnancy monitoring matters

Now let’s talk about the use case that matters deeply to me.

High-risk pregnancy, particularly hypertension risk and preeclampsia, is an area where early signals can be the difference between stability and crisis.

Preeclampsia is not always dramatic in its earliest stages. It can escalate. And it can do so quickly. When we think about prevention-first healthcare, this is one of the clearest examples.

We are not talking about vague wellness optimization.

We are talking about avoiding emergencies, protecting mothers, and improving outcomes for babies.

In many systems, prenatal care still relies heavily on scheduled visits. That structure can miss what happens between appointments. Remote monitoring changes that.

It allows clinicians to see patterns.

It allows risk to surface earlier.

It allows patients to feel supported, not alone, at home.

But only if the solution is designed for real clinical workflows.

This is where many digital health tools fail. They generate data without integration. They add burden instead of removing it. They create anxiety rather than clarity.

Prevention is not just about collecting more information.

Prevention is collecting the correct information, interpreting it appropriately, and enabling action.

This is the standard I hold for any technology I support.

Evidence first. Always.

In my work across clinical research and business development, one lesson stands above the rest. Healthcare does not forgive hype. Investors may forgive a bold pitch in consumer tech. Healthcare systems will not.

Overpromising creates reputational risk. Under-delivering harms patients, clinicians, and partners. And it slows the entire field because trust is expensive to rebuild.

That is why I care about studies.

That is why I care about outcomes.

That is why I care about regulatory pathways.

When Miloš mentioned they are close to finishing the studies for the preeclampsia app, I immediately focused on what comes next.

How do we take evidence and translate it into adoption?

Because the most painful outcome in healthcare innovation is not failure. It is success that never reaches the people who need it.

A validated solution that stays trapped in pilots is not impactful.

It is unfinished work.

Scaling across borders requires more than ambition

Principal has expanded into the US and Canada, and recently into Germany. Miloš described a key difference.

In the US, it can be easier to reach people and start conversations. But the economic structure is different, and competition includes large global vendors and offshore providers.

In Germany, demand is high, but language and local expectations can be barriers, especially in government projects.

These realities are familiar to anyone operating in healthcare. Markets are not only defined by regulations. They are defined by culture, procurement patterns, and trust networks. And in healthcare, trust networks matter more than any feature list.

This is also why my work often sits at the intersection of investors, innovators, and policymakers.

Networks close deals, but in healthcare, they also save time, money, and lives.

When a solution is evidence-based and aligned with real system needs, the goal becomes finding the right bridges.

Partners who understand local workflow. Institutions open to innovation without compromising safety. Investors who value credibility over hype. Policymakers are willing to modernize standards without lowering the bar.

Spa care and the continuity problem

One moment in our conversation surprised some listeners, but it should not.

We spoke about spa care in the Czech Republic and how telemedicine can extend its benefits after the stay ends.

This matters because it highlights a common challenge. Healthcare often performs well inside the facility. Then the patient goes home, and continuity breaks. Whether we are talking about spa rehabilitation, chronic disease management, or postpartum monitoring, the same pattern appears.

Outcomes require follow-through.

A well-designed app can help people maintain routines, track progress, and stay connected to support. It can also help providers or facilities improve retention by offering ongoing value. But again, the point is not the app. The point is continuity. Continuity is a prevention tool.

Veterinary telemedicine and a lesson about access

We also touched on an unexpected application.

Veterinary telemedicine for remote ranch settings, where a vet may be far away, and travel is difficult. This is not a side story. It is a reminder. Access challenges exist everywhere.

In human healthcare, they show up in rural areas, underserved communities, and regions with specialist shortages. In animal health, they show up across vast geographies. The core question is the same.

How do we deliver expertise where it is needed, without forcing travel or delay?

Telemedicine is one answer, but only if designed with reliability, simplicity, and user trust in mind.

What investors should actually look for in digital health

Many investors tell me they are interested in digital health, AI diagnostics, and preventive care. Then they ask the right question.

Will it scale and deliver ROI?

I agree with the question. I would add two more.

Will it deliver outcomes that withstand scrutiny?

Will it protect the reputation by avoiding hype?

In this episode, several signals matter to investors and partners.

A company with deep experience in regulated environments.

A platform approach that supports multiple validated pathways.

A focus on studies and evidence, not only product claims.

A clear intent to work with insurers, hospitals, private clinics, and cross-border partners.

If you are evaluating opportunities in telemedicine, I encourage you to prioritize the following:

Clinical relevance: Does the product solve a meaningful problem with measurable outcomes?

Workflow fit: Does it reduce burden for clinicians or add tasks?

Regulatory readiness: Is privacy, security, and auditability designed in from the start?

Evidence strategy: Is there a plan for studies, real-world data, and continuous validation?

Partnership capability: Can the team navigate different markets, languages, and reimbursement models?

The winners will be the teams that treat healthcare as the system it is, not as an app category.

What this conversation reinforced for me

I have spent over 20 years in global clinical research and business development, across Europe, the US, China, and beyond. I have seen extraordinary technologies succeed, and I have seen good technologies fail because they did not align with adoption reality.

This conversation reinforced three truths.

First, prevention is not a trend. It is the direction healthcare must take to remain sustainable.

Second, telemedicine is most powerful when it creates continuity, not when it creates more data.

Third, the bridge between innovation and impact is built from evidence, trust, and partnerships.

That is the work I care about. That is why THE BRIDGE exists.

The invitation

If you are an investor looking for evidence-based, prevention-first health innovations, I want to hear from you.

If you are a policymaker or system leader working on modernizing care pathways without compromising safety, let’s talk.

If you are building telemedicine solutions and want to navigate clinical trials, regulatory strategy, or cross-border adoption, I can help connect the right people.

Progress in healthcare happens when science and technology serve people first.

Let’s connect to make prevention the standard, not the exception.

Timecode:

00:00 Introduction and Guest Welcome

00:35 Overview of Principal Engineering

01:12 Global Expansion and Market Challenges

02:08 Principal Engineering's Diverse Services

07:42 Telemedicine Ventures

14:24 Focus on Preeclampsia

16:56 Conclusion and Contact Information

Links:

Pavlina Walter: https://www.linkedin.com/in/pavlinawalter/

Website: PavlinaWalter.com

Guests:

Miloš Tkáčik : https://www.linkedin.com/in/tkacik/

Transcript:

Pavlina Walter: Good morning. I'm extremely happy today to welcome Miloš Tkáčik, who is the CEO of the Principal company Principal Engineering. Today we would like to actually discuss a little bit more your involvement in Principal and what Principal is doing, because together we are doing an extremely beautiful study for pregnant women with a high risk of hypertension. This is the topic which we'll be discussing a little bit later, but first of all, if you can introduce yourself to our audience. What is Principal doing?

Miloš Tkáčik: Good morning too. My name is Tkáčik. I'm owner of Principal Engineering, but not only, I'm owner of Principal Group, including the main company with headquarters in Prague, Principal Engineering, but we have also branches in Slovakia, Germany, US, and Canada. We started approximately 20 years ago as an IT services company. Now we are system integrators of warehouse and IT services provider. We have up to 700 people, mostly in the Czech Republic, but not only.

Pavlina Walter: What was the reason actually that you opened your offices in the USA, for example, or Germany?

Miloš Tkáčik: Our ambition is to expand with the best practice know-how and resources we have built here in the Czech Republic and expand to the west, meaning the US, Canada, and now the fresh branches in Germany. But also we have some activities to the east, for example, with South Korea, maybe Singapore, Saudi Arabia, and the UAE.

Pavlina Walter: So you are the CEO? Yeah. So what is your background?

Miloš Tkáčik: No, I'm, let's say, an entrepreneur. It's the closest, I guess.

Pavlina Walter: Great. And before we actually met, I would never imagine that Principal Engineering as an IT company could do these very beautiful projects with pregnant women. So what is actually your main scope of the work? What is Principal Engineering really doing? If you can explain more to our audience your main service and actually what you can do for a client.

Miloš Tkáčik: Yeah, exactly. We are not only an IT company, let's say. Part of our business is consultancy, for example. Now we are doing some regulatory business here in the Czech Republic with a regulation of gaming. But we are now a system integrator able to provide a whole, let's say, project lifecycle advice to the clients. So IT as in general is only, let's say, half of our business.

Pavlina Walter: What is the other business? So it means this advisory, but also you mentioned banking.

Miloš Tkáčik: Yeah. We work for, let's say, the whole economy. So we work for government, we work for banking. Let's say half of our business is for banking and finance. But we also work for telecommunications and utilities. For example, here in Central Europe, we work for O2, Czech Republic and Slovakia, and we provide for them backend for data services. Very briefly.

Pavlina Walter: So this is your biggest client, or who are your clients?

Miloš Tkáčik: Our biggest client now is Ministry of Social Affairs, I guess. But we have, let's say, a very wide portfolio. So we work for most of the banks here, for several ministries. We work also for O2 as a telco, but also for utilities, like companies like GasNet, a gas distribution company, ČEZ, and also ČEP, it's, let's say, a regulator for the energy sector.

Pavlina Walter: Now you are mainly located in Central Eastern Europe. If you can compare the service which you are providing here in Central Eastern Europe versus Germany or the USA, which market is the hardest, and what are the obstacles there?

Miloš Tkáčik: The hardest market is a new market. So when we expand, usually it's two times longer and two times more expensive than we expect. So for us, from, let's say, technological aspects, it's the same. You know, you can program in the same languages, you can deliver the same kind of projects. But it's much easier when you know a customer, when you are established in a country, for example, like here. Things are much quicker, much easier, and when you want to grow, it's not about like being at a standstill. It's easier with your home market. New markets are challenging.

Pavlina Walter: In this American market, what is the biggest challenge for you there? Is it the people to find sources or people?

Miloš Tkáčik: People are great there. For example, it's easier to call somebody in the US and have some call or meet. But economics works different. They are used to big international companies. So for example, we started as a subcontractor because it was easier. We have to compete with some, you know, Eastern near-shores and offshores, like Indians and Vietnamese, Chinese maybe. But especially for technological people, for developers, they know we have quality. Especially the former brand of Czechoslovakia is very well recognized in IT in the US and Canada. So there is no doubt we are able to deliver added values, for example.

Pavlina Walter: Okay. And in Europe, why you decided for a German market?

Miloš Tkáčik: Because it's close and it's big. Our idea, and we have also already some business there, is to expand to the east, but not so far because it's several hours. You can be in Munich or Frankfurt. We have some partners there and we are close to signing one big contract, for example, there. But the challenging point is, for example, German business requires German-speaking people for most of the projects, especially for government, for example.

Pavlina Walter: So it means that it's hard for you, it's challenging for you to find people in Germany in the IT sector?

Miloš Tkáčik: Challenging is to find a combination. Somebody senior, for example, in some programming language, able to travel there several times per month, for example, and speaking fluent German. This combination, you know, does not exist in big amounts. But we found a way. So we have partners in Germany and we are building these partnerships. It's best practice also from Canada and the US.

Pavlina Walter: And so in these regions also, you are still focusing on I.T., because nowadays you are a little bit shifting to telemedicine. Where actually came up this idea to start with telemedicine? It's totally different, like based on the different regulation. So where the idea came up to focus on telemedicine?

Miloš Tkáčik: You're right, it's much different. There were two, let's say, motivations from two sources. One, we took part in several projects here for like software projects, implementations for the medical sector, like central registers for example, of analysis. We integrated several hospital systems, for example. And my another investment was a senior house for Alzheimer's patients. So I decided to develop an app for the seniors. And after having like a first touch with this business, we decided to use our platform we built for several purposes in telemedicine. One is, for example, for pregnant women concerning risk of preeclampsia.

Pavlina Walter: So it means that you are the CEO of a big IT company and you are the owner of the Alzheimer house. This is also like two different worlds.

Miloš Tkáčik: This is coincidence, let's say. Because in the Alzheimer house I was a pure investor. And that was more ambition than like a purpose. So I decided to do that and have also some kind of business outside IT, outside general IT, let's say. So, and now we have product slash platform ready. So, yeah, this is excellent.

Pavlina Walter: So actually you came up from being an investor to develop your own application for Alzheimer people, which is I think extremely nice act. And then you have a different portfolio right now in your telemedicine. So I learned that you have also spa and then this risk of hypertension of the pregnant women. So you have Alzheimer, spa, and pregnant women.

Miloš Tkáčik: And there is another example. We had also one project of implementation of telemedicine in the US for animals. So the area of animal health. When you imagine like a ranch or how it's called in the US, like having 1000 cows there and a doctor, a veterinary doctor, is 1000 miles away. So we helped one partner to build up for this veterinary doctor using the same principles, let's say.

Pavlina Walter: Excellent. So now your clients or your future clients can be sure that you can take care of the Alzheimer patient, then about spa, about pregnant plus animal issues. Because the telemedicine and technology helps.

Miloš Tkáčik: You know, we can use the same parts of the solution. Sure. The app is different. Why spa business here in the Czech Republic? Spa is a very specific part of healthcare. It's not very common in Europe or US or so. And we found it's an empty market. So we decided to do one app for well-being, let's say. When we are a patient in a spa somewhere, you can get the ring or you can have your watches and it monitors you and says how you are doing. And when you are leaving the spa, you can see how it was great there.

Pavlina Walter: Because that's actually extremely great. Yesterday I was at a conference regarding longevity and health, where a spa was mentioned several times. There was a special presentation because it's also going to be one of the parts of longevity. As now with the age, we are increasing our age, so we would need, when we are going to be older, actually, to have some kind of services. And the spa is an extremely great part of it. But what was discussed yesterday, that patients are always great when they are like in the spa, but when they finish, who's going to observe them? Supervise them? How can they be sure that they can complete their targets? So I actually consider your application very useful, and hopefully, we can use it in the future when we'll be using the spa to see the results after the spa, not only during this wellness weekend, but when we take a longer period.

Miloš Tkáčik: We have a solution. So with one chain of private spa, let's say here in the Czech Republic, we are in negotiation, not providing only the app for the stay there, but the patient will keep the app and will continue with, let's say, well-being aspects, and will continue, you know, training and keeping well. And for this private spa chain, it's a bigger attraction because it will return, maybe to a different spa from their chain. So this is very close to this longevity you mentioned because he can keep the app his whole life, possibly.

Pavlina Walter: And this app, you can translate it to different languages? Sure. It could be used generally, or it's really specific just to Central Eastern Europe?

Miloš Tkáčik: Nowadays technology is so great that it's a question of not minutes, maybe hours, but you can have the app in Korean, for example.

Pavlina Walter: Great. I mean, that's great. So you have an app for the Alzheimer patient helping them to improve their cognitive skills. Exactly. Then you have a spa, which can actually supervise you even when you finish your beautiful time in a spa and to see your results, plus the veterinarian telemedicine. So now let's talk a little bit about preeclampsia or this risk of hypertension. So when this idea came up and why, because it's totally different from what you did before. So if you can mention it a little bit.

Miloš Tkáčik: It started because our first project in telemedicine was for Lázně Bělohrad, it's a state-owned spa resort in the Czech Republic. And very close is the city of Hradec Králové, and they have a private hospital, and the general manager of the hospital was ready to support us for a pilot. And they have a big part of the hospital focused on pregnancy, let's say for pregnant women. In the region, it is, I guess, the best hospital for that. So we agreed and we've done a pilot there. This started two or three years ago. Now we have, we... The pilot is over, and we have now a fresh, new app. We are applying for some subsidy to enhance it and to build it as big as possible, covering not only like basic principles of this preeclampsia, but maybe a wider range of, let's say, risks and illnesses. So that's why we started.

Pavlina Walter: So it's excellent. So you have a really broad portfolio which you can offer to the clients. Not just the IT service, consulting service, but also the banking, but now also the telemedicine. And the telemedicine, which could be divided into the Alzheimer or cognitive issues, or spa, pregnant, or veterinarian issues. So it's amazing.

Miloš Tkáčik: And now we are, you know, that we are close to finish the studies for the app for preeclampsia. And we want to offer this not only to government and government-managed hospitals and the insurance companies, but also to private ambulances and hospitals abroad, for example, in Germany. We are looking for partners. Exactly. Because there the insurance business works different, in the US, it's much different. So that's why we want to use our presence there to expand also with this very specific stream, I'd say. Okay.

Pavlina Walter: So for our audience, if you are interested actually either for a partnership or to use Principal Engineering as your service provider, contact Miloš directly. I think you can connect with you on LinkedIn. You're very active there as well. So, or you can visit Prague. So thank you so much for this very nice interview.

Miloš Tkáčik: Thank you too for your invitation.