Hi, Stian.
Hey. I think we're live now.
Yeah. It's 1:00 P.M., and warm welcome to the first actually trading update from PatientSky since we got listed on Euronext Growth. Super excited to be here and also to share our numbers for last year, and also the guidance for 2021. Can flip slide. Flip slide. I don't think we're going to spend a lot of time on reading the disclaimer. You will have it in the presentation package, so you can read it if you want. We can go to the next slide. I'm Johan Zetterström, and I'm the CEO of PatientSky. Together with me on the call today, I have Stian Husvæg. Let Stian introduce himself shortly on who he is.
Thank you, Johan. I'm excited to be on board and part of the PatientSky journey. I'm currently here on an interim basis from Cardo Partners, with experience from Nordea Bank Investment Management and Morgan Stanley.
Thanks, Stian. I've been with the company since last year. We've had quite a journey since I came on board. We've raised capital. We listed the company, super excited to sort of give you this presentation. We can go to the next slide, Stian. Looking at PatientSky from a sort of helicopter view. We were founded in 2014. We're around 170 employees in five offices across the Nordics. We're at the run rate of NOK 175 million in annual recurring revenue. We have 40% CAGR from 2018 to what we estimate in 2021. 4.9 million people have sort of used PatientSky services over the years. We also have an app that is downloaded over 2.1 million times. That's quite incredible since it only lives 5.4 million in Norway.
Last time we sort of talked about partners, we had 10 partners on the platform, and currently we have 15, and we also have a backlog of that. 90% of our revenue is recurring. We can go to the next slide. Maybe I should also say that you can write questions in the chat box, Stian and I will answer them the best way we can. Last year, key highlights. We landed on NOK 14.6 million in MRR. We also did an acquisition. H2 was slightly lower pace for us, partly during COVID. That slowed down our sales and migration efforts. The outlook for this year is that we see that we will increase the speed of migrations to the cloud from the legacy systems. That could be legacy system that we own or from competitors.
We also added, last year, strategic customers like Kry and Dr. Dropin in Norway. We see that we have a few of those similar opportunities coming to us. We also will try to expand with new types of larger partnerships and/or joint ventures. Last year, we actually focused on getting all the building blocks in place for our global PaaS opportunities that we see ahead of us. We also get new inquiries on a weekly basis. We also established an office in Finland, and we also launched in Finland. We did that in record speed. We're going to use some of the proceeds that we got from our shareholders to accelerate the PaaS initiatives, and we're targeting more PaaS revenue for this year. We will also see the first revenue coming from Finland during this year.
We spent significant both resources and efforts on sort of trying to complete and perfect our PatientSky 360 platform so it's ready for this year. We also did a significant improved and rolled out video and other sort of COVID-friendly features and functionalities for GPs and non-GPs last year. What we're doing this year, we're setting a new org structure with business units so we can even be more focused when it comes to the PaaS opportunity or the SaaS business we have. Also we will have dedicated business unit for the app. We also will establish a VAS business unit, that's value-added services. That's all the modules that sort of make up our SaaS business.
We need to make sure we can capitalize them and have them outside sort of the Norwegian business also. Last year, we established a group level management. We will continue this year to build that organization with adding more senior people, also key personnel. We've hired in Pelle Rosell as Chief Marketing Officer and also hired in Egil Natvik Noen to be the Chief Commercial Officer for our app. They are already on board and are driving further improvement initiatives. We closed the Infodoc deal in December. They are now part of our family. We're also working on the post-merger integration. Of course, Infodoc will deliver synergies and revenues to cover that. Of course, we will continue to look for more potential acquisitions since over the years, the history has shown us that we've done them successfully, and they really, really work for us.
We can just go to the next slide. If we just look at the adjusted EBITDA, that's a solid 170% increase from 2019 to 2020. That is despite COVID and some unforeseen revenue events. I think Stian will guide you through the more details on this slide.
Thank you, Johan. If we start by looking at the left-hand side, we see our cost base taking us from an adjusted revenue of 145 to an adjusted EBITDA level of NOK 46.6 million, or 32% EBITDA margin. Also here, it's worth noting that the scalability of our cost base, which is reflected, as Johan said, by the high year-over-year growth in adjusted EBITDA. Moving to the right-hand side, we show the bridge from our previous guidance of NOK 49.5 million. The revenue is roughly in line with our guidance, adjusted for a delayed project. The COGS came in slightly higher due to an increase in login activity from patients. Despite a higher COGS, it's a good sign that the patients are engaging more on our platform and our app. On the OpEx, we're slightly higher due to new feature requirements introduced during 2020.
On salaries, we came in roughly in line with our guidance. This leaves us at a NOK 46.6 million adjusted EBITDA level, which is, as Johan mentioned, a very healthy 170% increase year-over-year. Going to the next slide, we see that our KPIs continued to signal strong commercial momentum into 2021, which is why we're positive on the outlook. To the left, we can see that the MRR grew by 60% year-over-year, giving us a solid base to continue to grow from in 2021. In the middle, you see a strong upgrade speed of new clinics to the PatientSky system and platform. This is slightly below our guided 600 from the IPO. This is mainly due to the COVID restrictions, making both migrations and sales activities slightly more difficult during 2020. We expect the upgrade speed to normalize again when COVID conditions ease during 2021.
To the right, we can see that we continue to deepen our penetration with clinics. For example, clinics with video has increased above 500% during 2021. Over to you, Johan.
Yes. This year we're guiding at NOK 240 million for 2021, with also strong traction on new PaaS opportunities. With a starting point of the NOK 145 million plus the full year effect, since we're a SaaS business, we're at the NOK 175 million in MRR. We will continue to upgrade, and that will add another NOK 25 million to the business. We have around NOK 20 million in non-recurring revenue. That could be governmental projects or consultant income. There's no recurring revenue. We have the new potential PaaS partnerships that we're working hard on to drive some revenue on the platform. That takes us to NOK 240 million. We have the additional upside and potential. That could be joint ventures on the platform. It could be other sort of initiatives that we might fulfill to do.
We're working hard on trying to figure out how we can monetize on the traffic we have on the app. Of course, we have the M&A that could raise our guidance significantly if we do one or two or three M&As over the year or so. That basically is our guiding for this year. The business is in really healthy shape. We have quite good control over the most things, and super excited to having that growth from 2020 to 2021. We can go to the next slide. Why should you continue to invest in PatientSky? Of course, we believe that we are the leading e-Health SaaS provider in the Nordics. We have a proven track record of upgrading customers from our legacy systems into higher ARPU. We also have the advantage that we're the first mover with a full-service scalable platform.
You can almost say that we're a one-stop shop when it comes to GPs and non-GPs in Norway. We don't see any competitor that can offer everything that we can. Still, we believe that we are the only player in Europe with an e-Health landscape that can offer both SaaS and PaaS solutions, and soon also App and VAS, when we continue to build out those business units. Of course, we have the opportunity to expand throughout our SaaS offerings or agreements with partners on our highly scalable platform. We will come back later on this year with this. Would be good. Our long-term goal is to be the operating system for healthcare. Third-party vendors can come in and build apps on the ecosystem, and also as standalone solutions. Go to the next one.
Just to reiterate, if you haven't seen this slide before, why is our platform different to peers in the market? On the left-hand side, we have our competitors. They have a web browser, the web application, they have all the modules, that could be the EHR or the journal system or billing or online video modules or whatever it is. They run it on some hosting infrastructure. We have the similar setup, we've taken the majority of the logic to put it in the service layer here. Our modules are thinner because most of the logics are based in our service layer. We also built our own hosting services, there's a lot of people wondering why we have done that and not using any of the American players.
That is both for regulation and legal and compliance, because we would not be able to respond on a few tenders if we can't control where the data actually resides. Of course, in healthcare, there's two things that you have a lot of. That is you have a lot of data, and you have a lot of traffic, and that is the American players' business case. We think we can actually do this more economically than run on another sort of service provider. Can we go to the next slide? How do we benefit from the network effects that is initiated by the SaaS users and that will enable our long-term growth trajectory? New users on the platform that increase platform traffic. With platform traffic, we will attract more partners because they want to piggyback on that traffic that we have.
In Norway today, we at least have around 60% of the GP market, so we have a lot of that traffic that we can capitalize on. Those partners will join us on the partners, and we will grow with them. Their success is our success. It can lead us into new verticals. Let's say we want to enter a new segment, let's say the dentist segment. We have identified that we have five or six modules that we have already built that will fit perfectly for dentist clinic. What we don't have is the journal system or the EHR for the dentists. In terms of that, either we can go and do a partnership with a vendor that has that journal system for dentist, and then we can operate in different new segments.
At the moment, compared to our peers, we operate both in GPs and non-GPs, and most of our competitors, they operate in one segment. Either they operate in the GP space or in the non-GP space. We can just go to the next one. What are we doing? We're trying to future-proof the organization so we can capture the full benefits of the scalabilities and synergies in the years to come. The light blue we've already done, that's establishing the group structure. Now we're in the process of implementing the focused business units. We're in the finalizing of that. Next phase will be capturing the benefits of the scalabilities and the synergies. That is what we're working hard on. We can go to the next one. We also initiated a few important projects for us that is having one unified ERP solution.
We also identified that we're doing a data management project, so we actually can consolidate data across all systems we have, so we can make smarter decisions based on all that data we have. That's also in the start phase of that project. We also invested in a new CRM/marketing tool so we can actually start to nurture those leads we have, and also giving the right tools in the hands of our salespeople so we can actually start to close even more deals. Next slide. We'll also be contributing to the society during COVID. Just one example, we've delivered free video consultation softwares to all our clients that want to use it for the first months of the year. That has, of course, helped us when we drove up the number of users on the video. We can go to the next one.
That's it. We've got a few questions here. I can just answer the easiest question here. What CRM system did you choose? We've choose the HubSpot. That is for marketing and for the sales team. Another question we got here, how has the development in Finland proceeded? Did you see any increase in churn in H2? Two questions there. The development in Finland has proceeded according to plan. We've launched PatientSky Lite, and we're working on adding more functionalities to that service. We did that in record time. Took us just over six months from start to having something up and running. That's quite unheard of in healthcare. If we saw any increase in churn in H2, not a dramatic increase in churn we didn't see. Maybe you have some of the other questions here also, Stian, that you might want to answer.
On the EBITDA margin for 2021, our plan is to come out with the guidance for this on our full year reporting on April 15th. We'll come back to that one there. There's also the question on the operational cash flow and the free cash flow after investing. We can come back to specific numbers when we do the full year, but what I can say is that on the R&D capitalization, this is roughly in line with what we've guided for before. We'll be reporting the figure net of the rebates from the government.
Do you want to take that EBITDA question?
The one from Oliver?
Yeah.
The question is, Oliver says he thinks we've guided EBITDA around NOK 67 for 2021, including Infodoc. How do you see EBITDA outlook for 2021 under the new revenue guidance? The answer here is similar to the previous one, that we're working for EBITDA guidance that will come on April 15th, but we're very positive to the development and the synergies that we see in Infodoc. We'll come back to specifics on the EBITDA margin and cost level in April.
Another question is that we said NOK 200 for 2021 before we went public. Now we're guiding at NOK 240, including the acquisition on Infodoc. Since we had a slowdown in H2, we lost some sort of momentum during the COVID. It's not all those NOK 57 million that is recurring revenue from Infodoc either. That will take us to the revenue goal of NOK 240.
Yeah. There's also a question here about special costs for 2021, including incentive programs, recruiting, and so on. In terms of the incentive program, this will be lower going forward due to the fact that some of the incentive costs for 2020 was related to the IPO. Going forward, we'll have the normal management incentive program, which is an option-based non-cash expense, which will continue as normal. Then there will probably be some normal recruiting, but we don't foresee any major costs there.
We got a question on new partners for app creation. How many creators do you have working on apps for the platform right now, and how much has this increased since the IPO? How does the cost structure for these creators look like, revenue share or per app creation? The last question, that's our different commercial setups against those partners. It could be revenue shared by what they actually earn, or it could be a cost for them to access our platform through the APIs and the SDKs. Today, we have around 15 partners on the platform, and one of the reasons why we're splitting up in business units is that we can focus even more on onboarding more partners easier and faster. I think that was most of the questions.
For those that want to go into more details, we are of course prepared to set up individual meetings where we basically can discuss things in more detail on Tuesday and Wednesday.
That's just to reach out to us per email, and we'll try to schedule you in.
Perfect.
Sorry. Thank you for your time and interest and patience, guys.
Yeah. Thank you, Stian.
Take care.