Health Innovators
Health Innovators

Episode 104 · 4 weeks ago

Your Golden Opportunity: Challenges w/ Heather Underwood


Proving efficacy in a healthcare setting can be hard - try to do so with a pediatric solution and you can have your work cut out for you.

But when it comes to commercialization challenges, Heather Underwood, CEO of EvoEndo, sees each one as an opportunity.

With a career that reaches across continents, she’s learned a thing or two (or a thousand) about how to be creative when commercializing her solutions - and be successful while doing it.

We all know healthcare is its own animal, there are a lot of moving parts - but if you’re one of those entrepreneurs who likes a challenge, yet still struggles with commercialization, we hear you.

Shut your office door, grab a chair and turn up your volume because this week’s guest just might help you find your opportunity hidden inside a challenge!

Here are the show highlights:

  • Commercial success starts with identifying need (7:53)
  • How to find the flexibility and freedom to adjust your business model (9:52)
  • Winning at creative commercialization (11:03)
  • Getting through the limbo period of raising capital (13:17)
  • Successful assembly-line fundraising (18:56)
  • Identifying what makes a great team or partner (21:02)

Guest Bio

Dr. Heather Underwood joined EvoEndo as CEO in 2019, after completing the Stanford Biodesign Fellowship for medical device innovation.

Her work has taken her from the lecture halls of the University of Colorado Boulder's ATLAS program all the way to implementing clinical decision support systems for midwives and nurses in Kenya.

For the last 10 years, Heather’s career has focused on founding and leading medical device startups, non-profit life science organizations, and innovative academic initiatives including co-founding Inworks at CU Denver.

If you’d like to reach Heather directly, you can email her at, reach out to her on, or you can find her on LinkedIn at Heather Underwood.

You're listening to health, innovators,a podcast and video show about the leaders influencers and earlier doctorswho are shaping the future of health care on your host Doctor Roxey Movie Welcome Back Health Innovators ontoday's episode, I'm sitting down with Heather Underwood, who is the CEO of inVoind, O welcome to the show heather thanks so much it's it's really greatto be here. Yeah, it's nice to have you today, so tell our audience a littlebit about your background and what you guys have been innovating these days sure. So my background is actually incomputer science started my you know, career working at IBM, Microsoft, Siloand then really got interested in applying some of those skills to thehealth care space. So I did my phd at the University of Colorado Boulder inthe Atlas Program, which is an interdisciplinary program focused on a well everything and in pieve ythingin between, but I was specifically writing clinical decision supportsoftware systems for nurses and midwives in Kenya. So I was actuallyspending quite a bit of time in Neroberg and working with the nursesand midwives there, particularly around maternal health and of Steti, and howto improve the standard of care there. I just really fell in love with theintersection of Technology and health care and working directly with patientsand providers. So after complaining my PhD, I was aprofessor for a little while at see you Denver really focusing on buildinginnovative initiatives for students that were cross disciplinary focused oninnovation. Prototyping, an entrepreneurship wanted to get back into the start ofscene was his crazy. I know I know little massics IC, maybe no, but really wanted to get back tosolving those direct problems, and so I participated in the Stamford by designprogram, which is basically a very intense ten and a half months post TockProgram for medical device, innovators and then after completing that program.I knew I wanted to come back to Colorado and that's when I met Dr JoelFriedlander, who is our cofounder and chief medical officer at Evon, O andthe rest of his history, so I joined, joined the team at the end of twothousand and nineteen right before the pandemic right beforethe pandemic. Yes, we can definitely talk about how that impacted us. Well, let's just talk about it. Now. What were you thinking December, twothousand and nineteen January right, first quarter, two thousand and twenty,and then what? How did that? How did that transition? What changed yeah so alittle bit of contact somewhat Ebon o does an what we're innovating firstyeah. So we are a pediatric first Gasterini company and we are buildingsterile single use platforms to enable unseated, transmises Ope, so to break that down a little bit.Let's say that five Times Fast Right O. I know we did hear the name of theprocedure. I'll only say it once, but anyway, so right now the standard ofcare for pediatric patients if they need to go, get an upper endoscopy foranything. You know abdominal pain is to put them under general in Atesia, sothe full surgical procedure in the operating room, needles, fasting, thewhole nine yards- and these procedure is only take. You know five minutes,but it's a whole day lost of school at Er work. So I do there is so our co founder, Dr JillFriedlander and his colleagues in the...

Aro digested medicine program here atChildren's of Colorado, pioneered away to do an uncinate procedure on kidsthat still takes about five minutes, but the patient is awake. The wholetime M, so EVILENA was created to really build the system that theyneeded to do these procedures in a clinic or procedure room as opposed tothe operating room. So we have designed a sterile single use: transman gas forscope capable of going comfortably through pediatric nasal anatomy,looking at the ESOPHAGUS stomach and smaller test in doing biopsies. So youcan get that diagnostic test results and the patient, whereas avirtual reality had set during the procedure, no citation, no anesthesia,they go back to school right afterwards. So but that's really what mean is I'mfamiliar with that? So my outer was diagnosed with a Papilloma toses whenshe was around two and had ended up having twenty five plus surgeries andgoing to an ent, often and them having to do the endo copy. Now she had thelittle camera that went down and was it wasn't sedated wasn't in an operatingroom or anything? Maybe that's because she was as she got older. They weredoing that. Where was she was younger. She had to be sedated and that sure,but unfortunately, I'm all too familiar with the how awful that procedure can be yeah.So the gent doctors have been doing the transnistria without citation for along time, but their scopes are much shorter or scope applied to gastronomy.Our scope is the only one where you can actually do a full geogr proceduregoing transmute. That makes sense. Okay, all right, then, going back to the coved question,so I joined like I said right at the end of two thousand and nineteen head of the pandemic, and so we are asingle use platform. So the whole scope is disposed after each procedure. So inno scope every time which is great, they get the latest technology. Youknow, you're, not worried about reprocessing scopes and the FDA hasissued numbers guidance documents at this point about the infection risk ofremusat scopes after reprocessing, and so our scope system was really designedto mitigate that infection risk, and this was all happening before thepandemic. Right then, in terms of tail wins coved, you know both tilings and head winds,but for til wins. You know, I think the the focus on infection risk and how bigof an issue that is in hospitals as well as patients not wanting to be inthe hospital for a long periods of time for elective procedures. You knowreally, I think, push the field of single use scopes across the boardforward in a really big way. So I think we've gotten a lot more interest justin our singlest platform, because of Govin- that's great, I mean there'sthere. There are those that have suffered tremendously because of theheadwinds around Ovid and there's those that have had a lot of success becauseof those tail winds that you're just describing yeah yeah a wins for us. Youknow really had to do with FDA and then also with manufacturing delays on onparts. You know, I think we saw everything start to get a little funnywhen it came to inventory and timelines and e heverything from construction and house building materials. You know I was alsoin in my personal life dealing with that and then just delays on some of our keycomponents to actually build our system, but then the FDA two was also just veryspane. You know looking at new as and Covic vaccines and all of the importantstuff around the pandemic that was...

...coming out, so we got caught and kindof that delay a little bit as well sure. So earlier you touched on this medicaldevice, innovation, hub or community that you were a part of help me understand or help usunderstand. You know: are there what's changing? What's what's new andexciting when it comes to medical device, innovation and being able tocommercialize those, maybe more successfully or even faster yeah? It's a great question, and so I waspart of the Stanford by a design Agragrama, which you know is really onthe cutting edge of thinking about how to design really starting with the needs approach.You know, understanding those clinical problems, there's a you know clinical observation period,where you are working directly with physicians and patients, getting a deepunderstanding of his needs and then prototyping iterating validating yoursolutions, and so you know, I think, the more thatmedical device starts with that real clinical need and then drives thesolutions out of the clinical needs, the the more successful you're going tobe when you get to commercials commercializing those medical devices,and so you know, I think that that is one of the differentiators for Evelin.Do you know our system was really born out of this clinical need in pediatrics,where there are no systems, grove for pediatric use and the standard of carewas so traumatic for patients that we're needing these procedures. Yeah that we really developed a system to change that dramatically. You know,I think, a lot of a lot of the other single use. SCOPE.Manufacturers at this point are really just looking at the existing technologyand making single uspeshno of it. I at the lower cost and they're reallymissing that clinical need, which I think has always been our focus sowhich which is not rocket science and in one handright because it seems like you would start off with the need, but it's alsoworth just reminding our audience that are in the trenches, because some kind,sometimes we can get so caught up in the technology, that we build out asolution and then try to go out and find a problem as opposed to startingoff with the need. And that's something that I noticed early on when you- and Iwere talking before- is that you started off with that kneeto me, which is like one of the first steps of being able to have commercialsuccess, is being able to identify the need and then being able to test thatbusiness idea before you're pouring millions of dollars into it yeah. I think it also gives you a lotof freedom too, because you have a very clear mission in need, but then itgives you flexibility and freedom to adjust your business bottle or adoptyour product to really constantly better meet that need, as opposed tobeing really locked into a technology. And you know when you have a hammer,everything looks like a nail, so right, right, Yep, they old, add it. So obviously, commercializing medical devices takes along time and one of the things that I'm seeing is that leaders of medavie companies arebecoming more creative or innovative, even in their commercializationstrategy. In this period, where you don't haveFDA Claret, is there anything that you're doing to try to cultivate demandor anything that you're putting in place? So that way, when you do get the FDAclearance, you're ready to hit the ground running, and you maybe alreadyhave something in place?...

Yeah, that's a that's a great questionand we were definitely being creative. You know just because the FT process issuch a lengthy one yeah. So the TRANSMIS and aspe procedure, as youmentioned, has been around in ent for a long time and in Gi and other countries,the US Gi docks have not historically adopted transnate basketbeing very widely in the large part, because there hasn'tbeen equipment that makes that a comfortable procedure for patience yeah. However, we knew we were going to runinto some adoption issues just on the procedure side itself, so we have spenta lot of our time developing acomprehensive training kit, an online education platform and then building onour clinical specialist team, so that we can really support these giphysicians, who are learning a new procedure, largely do the patientdemand. So patients are really driving the adoption of this procedure among Giphysicians across the US, and they are coming to us wanting to know how to doit and wanting to know how to get trained up very quickly. Wow. That'sincredible! So you know we're spending a lot oftime going out. You know training these centers, helping them know how to talk topatience, how to talk about the procedure and how to grow that practicein their hospitals. Hey! It's Dr Roxy, here with a quickbreak from the conversation. Are you trying to figure out what moves youneed to make to survive and thrive in the new Co vid economy? I want everyhealth innovator to find their most viable and profitable pivot strategy,which is why I created the Co. Vid proof, your business pivot, kid. Thepivot kit is a step by step framework that helps you find your best pivotstrategies. It walks you through six categories. You need to examine for athree hundred and sixty degree view of your business. I call them the sixcritical pivot lenses, as you make your way through this comprehensive kit,you'll be armed with the tools, tips and strategies you need to make sureyou can pivot with speed without missing out on critical details andopportunities, learn more at legacy: Hyphen Daco Back Kit. So one of the things that I was talkingto an innovator about a couple of months ago was this kind of I don't I'd,say limbo period, but like this period within that we're talking about rightbefore the FDA approval, where you're trying to raise money, maybe trying toget some VC money in, but also having to be really mindful of the customeracquisition cost. So that way, it doesn't look like you, don't have aviable business model because no revenue is coming in, but you really do yeah it's a tricky time. I I likethinking about it as limbo. You know for us, there's a lot ofopportunity in this window. You know, I think that we have the luxury, I guess of spending alot of time on those market development out efforts. You know both physicianand patient outrage, but yeah trying to raise money when you don't have revenues coming inand you haven't betted your business model is a tricky one. We have partnered with distributionpartner. We had a press release come out yesterday, so micro check,endoscope is one of the I could say up and coming Gi, distributors andmanufacturers in the US. They have a large international presence as well, but you know, as a small Lens start upfor our commercialization strategy really makes sense to you know: Leverage a commercialpartners sales force so that when we go out you know they're the experts at thesale. You know- and we are the experts on the procedure and the technology andreally cultivating those pediatric Gi...

...connections and doing a lot of themarket development. So that has also been really, I think, essential to keeping our our cash runway verylean and also having a having a strong business model andcommercial sale strategy that we can pitch to Ambassaour. When we go out toresponds. I think that that's just so smart and I am seeing a lot more healthinnovators move in that direction. Because of all the challenges I meanit's it, sometimes, even when you're entrenched in health care, you canstill have challenges getting access to to to Gestalt Ers, but it certainly ifyou're haven't been in health care, or you haven't been in health care in thespecific sector that your that your innovation is focused on, even more so since ovid getting accessto providers and hospital systems and and keys keystane holders in thisecosystem, it is so challenging and so talk about being able to fast track oraccelerate the demand and adopt the awareness, a on the demand andpotentially even adoption. By going the distributor route yeah I mean it's, it's been key orstrategy, I would say- and it has allowed us to really focus on what ourexpertise says and then partner, with a great team that right yeeres withoutinvesting in the army of sales. People love sales people, but it can beexpensive, is erly at this stage. Yeah. Let's talk about the amount of moneythat not not necessarily the mount but yeah. Let's talk about the amount thanbut also let's talk about what this fundraising journey has been like foryou yeah. So we raise our seed round, which youare referring to earlier this year, and that was you know. That was our firstequity round. We had a lot of new investors coming inin that round, but also a lot of Ursis Ting investors who have been supporting and supportiveof us from the beginning, so being a pediatric focused company. Ithas been difficult in the past to raise traditional BC money, a lot of the vcs look at the pediatricmarket and don't see the returns that they'relooking for because it is a smaller market yeah. However, you know not onlyare we applicable the pediatrics, but anything that's going to be morecomfortable going into a pediatric and enemy is going to be a lot more comfortable for adults.So there is an a need in the adult population for our system and so trying to makethat case. When we've been going out to reas money. Talking to investors, youknow has been has been a challenge, a sick, the least. So a lot of ourinvestors to date have been philanthropic, family funds, familyoffices. You know people who really care or whoare personally invested in our pediatric mission, so making theseprocedures safer and and faster. So that was where a lot of you know a lotof our investment came from. We are going to be going out to Rasour seriesa which will be our commercial round early next year, and you know I think,the progress that we've made, even since we raise that seed round, hopefully, will really demonstrate tosome of those traditional obss that the pediatric market may be small. But ifyou have the whole thing, a very significant market share of over alland Oska the United States Watch, you... it right. So what are some of the lessons learnedalong the way? I know that there's a segment of our audience that are in thetrenches right now and they are pitching their company over and overand over, and it can be very it can be a very difficult, difficult anddeflating season. So what are some of the lessons thatyou learned a way along? The way that might be helpful to our audience, yeah when it comes to fun, raising Ilike to just turn it into a process, just kind of like a assemblyline, yeah yeah, no way so kind of taking out that emotional response thatthe rejection you know, if you don't get a call back or if they don't wantto continue doing no diligence with you, and so I really start with a list ofcomparable companies work backwards, and you know in pitch book or crunchface or whatever and find the investors in those comfortable companies create areally long list, go to Linton and see. If there's any share connections, youknow, because those are always better warminterest than than cold calls for, and then you just work your way down thelist, and at least for me you know you just practice the pitch, and you knowyou tailor at every time. You do your homework on who you're talking to then you just knock him down. You spend a couple hours in a weekendor something creating all these lists and putting all the contacts togetherand then I think it's been so important for me to hire a great team and then really relyon them to do their jobs and so that I can kind ofhave big chunks of time where I can go out and do this fundraising and andjust book call after calling for call. It is a raw. It is really il or not isa Rochow yeah and actually virtual has made it a lot easier right now. I think you know you can just contact morepeople faster because of the virtual world we live in. So so you touched ongreat team, great partners. What makes great team or great partners. Oh, so many things, you know: We've hired a number ofpeople this year following our rays in the spring, andyou know it's about cultural fit. I mean it's obviously about expertise intheir backgrounds. But for me it's about how well they work with the otherteam members. You know what they bring to the table and if they fit reallywell into our culture and if they really believe in the mission, you know if they don't have class to five Kexperience. You know in Gi, but you know, and their experience is more onPMMA products in cardiology, for example, you know, but they are reallystrong fit, and you know they just they bring that diversity of perspective tothe table. You know I'm going to hire that personover someone who maybe isn't as good of a cultural fit. You know, but has the exact rightskills, so that has worked out really well for us. You know, I think, being a good judge of character and youknow just trying to really get to know the person as opposed to just theirresume. You know, I think, there's a there's anadage higher slowly fire quickly, and you know I think, taking your time andreally knowing who you're hiring and getting the right people in is key tobuilding a great team. I think that's so important for every organization,but I think that it's even more critical when you're a start up oremergent healthcare company, because those are like the fun. That's thefoundation right. Those early. This higher decisions are like building thecompany, and so it's just so important...

...that we get that right. Yeah, and you know that that also iskind of my philosophy. When it comes to fundraising and being really capitalefficient, you know I will cut people last. You know peopleare what make everything work on a Tavan in a company, and so you know weare a really lean team, but that's where we invest our capital in thepeople that make it all possible so yeah. So so what are? What does the futurehold right as you're kind of looking into two thousand and twenty twobelieve it or not? I know we're Thun Twenty one go now remember we were so eager for twothousand and twenty to be behind us and we're like come on two thousand andtwenty one and we're like Jan two thousand and twenty one kind of stinksin a lot of ways to so come on two thousand and twenty two I know what's on the horizon as you're kind of looking at thedifferent new commercialization mile stones, or just some of those keydecisions that you're making in the future yeah. Well, you know optimism, twothousand and twenty two is going to be a very exciting year for us, we areanticipating of d clearance early next year and then launching with ourcommercial partner kind of rolling out to a few of our keyaccounts throughout the US and then doing a hard launch. You know mid midnext year to all the Gi is around the country. So it's it's a super exciting year for us veryexciting. So how so, as we just kind of wrap up here, is there anything elsethat you would want to share with our audience? Yeah I mean so much. I think we've covered a lot ofground just on you know, challenges and opportunities. I think there's twosides to every situation and looking at it as a challenge or seeing if as anopportunity- and I think that's really been one of the strength of our team-is that we have found the opportunity in every challenge that has been thrownour way, and you know, I would say, don't losehope. You know, there's there's a great community of mentors and advisers, andyou know you're not alone, is what I would share out there thatare trying to form health care in their own little way. Yeah, and so you know,I think that has been absolutely essential. For me. You know finding networks of otherstart of CEOS and you know, even if they're not directly in the same field,just building that community, so that when you do head hard times, you havepeople to, you, know, go or have a drink with, and you know share warstories about the process and it just helps helps to keep going. Youknow I was reading a book the other day and they had a chapter and it was notabout entrepreneurship at all, but the topic of this chapter was come backartist and I just really started to think that you know for all the hatsthat an innovator might wear or titles that they might have come back. Artistshould be one of them yeah. I love that it is a constant process of you know,redefining yourself, Yo, yes, resilient, yeah, yeah and actually on the bookrecommendation friend. I just started rereading the hard thing about hardthings by Ben Hoits. It's one of my favorite books because he just tells itlike it is and doesn't try and sugar coat how hard you know the start upprocesses- and you know you can only be so prepared.You know you're not going to have every situation perfectly mats out, so I would recommend that one to okay sosay the title again: The hard thing about hard things. Okay, all right! Youheard it here, I M:...

How do folks get a hold of you if theywant to follow up with you? After the show yeah, so you can reach out myemails just heather Ad Boendo, you can go to our website Evan Doom and on ourwebsite, there's a contact form. So if you are a physician or you know,hospital administrator that is looking to learn more about unceded ty andmaybe schedule a demo or training session, there's a contact form on ourwebsite. For that perfect. Thank you. So much for joining me heather. Thank you so much for listening. I knowyou're busy working to bring your life changing innovation to market, and Ivalue your time and attention to get the latest episodes on your mobiledevice automatically subscribe to the show on your favorite podcast tap likeapple podcast, spotify and stitcher. Thank you for listening, and Iappreciate every one who shared the show with friends and colleagues, seeyou on the next episode of Health Innovator, a.

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