Health Innovators
Health Innovators

Episode 104 · 1 year 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 early adoptors who are shaping the future of healthcare. I'm your host, Dr Roxy Movie. Welcome back health innovators. On today's episode I'm sitting down with Heather Underwood, who is the CEO of Invo Indo. Welcome to the show, Heather. Thanks so much. It's it's really great to be here. Yeah, it's nice to have you today. So tell our audience a little bit about your background and what you guys have been innovating these days. Sure. So, my background is actually in computer science. Started My, you know, career working at IBM Microsoft Still Oh, and then really got interested in applying some of those skills to the healthcare space. So I did my phd at the University of Colorado Boulder in the Atlas Program which is an interdisciplinary program focused on well everything and in everything between, but I was specifically writing clinical decision support software systems for nurses and midwives in Kenya. So I was actually spending quite a bit of time and they rob and working with the nurses and midwives. They're particularly around maternal health and of steat tricks and how to improve the standard of care there. I just really fell in love with the intersection of technology and healthcare and working directly with patients and providers. So, after complaining my PhD, I was a professor for a little while at see you Denver, really focusing on building innovative initiatives for students that were cross disciplinary, focused on innovation, prototyping and entrepreneurship. Wanted to get back into the start of scene. was as crazy, I know, I know, little masochistic, maybe no, but really wanted to get back to solving those direct problems, and so I participated in the Stanford Bio Design Program, which is basically a very intense ten and a half months post doc program for medical device innovators. And then after completing that program, I know I wanted to come back to Colorado, and that's when I met Dr Joel Friedlander, who is our cofounder and chief medical officer at Ebo Endo, and the rest is history. So I joined joined the team at the end of two thousand and nineteen, right before the pandemic, right before the pandemic. Yes, we can definitely talk about how that in facted us. Well, let's just talk about it now. What were you thinking? December, two thousand and nineteen, January, right, first quarter two thousand and twenty. And then which. How did that? How did that transition? which changed? Yeah, so a little bit of contact, somewhat evo, and it does. And what we're innovating? First? Yeah, so we are a pediatric first Gastro enterology company and we are building sterile single use platforms to enable unstated transnasal endoscopy. So, to break that down a little bit, say that five times, bast right. No, I know, way do you hear the name of the procedure? I'll only say it once, but anyway. So right now the standard of care for pediatric patients if they need to go get an upper endoscopy for anything, you know, abdominal pain, is to put them under general anesthesia. So the full surgical procedure in the operating room, needles fasting the whole nine yards, and these procedures only take, you know, five minutes, but it's a whole day loss of school to work. So I so there is. So our cofounder, Dr Jewel Friedlander, and...

...his colleagues in the Arrow digestive medicine program here at Children's of Colorado pioneered away to do an unstated procedure on kids. That still takes about five minutes, but the patient is awake the whole time. So Evo Endo was created to really build the system that they needed to do these procedures in a clinic or procedure room as opposed to the operating room. So we have designed a sterile single use transnasal gastroscope capable of going comfortably through pediatric nasal anatomy, looking at the ESOPHAGUS, stomach and small intestine, doing biopsies. So you can get that diagnostic test results and the patient wears a virtual reality had set during the procedure. No sedation, no anthesia. They go back to school right afterwards. So that's really is. I'm familiar with that. So microder was diagnosed with papalomatosis when she was around too and had ended up having twenty five plus surgeries and going to an eant often and then having to do the endoscopy. Now she had the little camera that went down and was it wasn't sedated, wasn't in an operating room or anything. Maybe that's because she was as she got older, they were doing that where 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 Yant doctors has been doing the transnasal procedure without sedation for a long time, but their scopes are much shorter our scope. Applied to Gastro enterology, our scope is only one where you can actually do a full geo procedure going Trans Nasily. That makes sense. Okay, all right then, in going back to the covid question, so I joined, like I said, right at the end of two thousand and nineteen, ahead of the pandemic, and so we are a single use platform, so the whole scope is disposed after each procedure, so in new scope every time, which is great. They get the latest technology. You know, you're not worried about reprocessing scopes and the FDA has issued numbers guidance documents at this point about the infection risk of re usable scopes after reprocessing, and so our scope system was really designed to to mitigate that infection risk. And this was all happening before the pandemic, right. So then, in terms of tailwinds Covid, you know, both tail winds and headwinds, but or tail winds. You know, I think the focus on infection risk and how big of an issue that is in hospitals, as well as hot patients not wanting to be in the hospital for long periods of time for elective procedures. You know, really, I think, push the field of single use scopes across the board forward in a really big way. So I think we've gotten a lot more interest just in our single use platform because of covid. That's great. I mean there's there are there are those that have suffered tremendously because of the headwinds around covid and there's those that have had a lot of success because of those tail woods that you're just describing. Yeah, yeah, that wins for us. You know, really had to do with FDA and then also with manufacturing delays on on parts. You know, I think we saw everything start to get a little funny when it came to inventory and timelines and, yeah, everything from construction and house building materials. You know, I was also in in my personal life dealing with that. Yeah, and then just delays on some of our key components to actually build our system. But then the FDA to is also just very swamp, you know, looking at you a's and covid vaccines and you know, all the important stuff...

...around the pandemic that was coming out. So we got caught and caught in that delay a little bit as well. Sure. So earlier you touched on this medical device innovation hub or community that you were a part of. Help me understand or help us understand, you know, are there, what's changing, what's what's new and exciting when it comes to medical device innovation and being able to commercialize those maybe more successfully or even faster. Yeah, it's a great question. And so I was part of the Stanford Bio Design Program which, you know, is really on the cutting edge of thinking about how to design, really starting with the needs of approach, you know, understanding those clinical problems. There's a you know, clinical observation period where you were working directly with physicians and patients getting a deep understanding of those needs and then prototyping, iterating, validating your solutions, and so, you know, I think the more that medical device starts with that real clinical need and then drives the solutions out of the clinical needs, the the more successful you're going to be when you get to commercials a commercializing those medical devices, and so, you know, I think that that is one of the differentiators for Eboendo. You know, our system was really borne out of this clinical need in pediatrics, where there are no systems proved for pediat trick use and the standard of care was 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 technology and making single use versions of it at the lower cost and they're really missing that clinical need which I think has always been our focus. So which which is not rocket science and in one hand right, because it seems like you would start off with the need. But it's also worth 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 a solution and then try to go out and find a problem. Is opposed to starting off with the need, and that something that I noticed early on when you and I were talking before, is that you started off with that need. To me, which is like one of the first steps of being able to have commercial success is being able to identify the need and then being able to test that business idea before you're pouring millions of dollars into it. Yeah, I think it also gives you a lot of freedom to because you have the very clear mission in need. But then it gives you flexibility and freedom to adjust your business model or adopt your product to really constantly better meet that need, as opposed to being really locked into a technology. And you know, when you have a hammer, everything looks like a nail. So right, right. Yet they old added. Yeah, so obviously commercializing medical devices takes a long time. YEA, and one of the things that I'm seeing is that leaders of med device companies are becoming more creative or innovative even in our commercialization strategy. In this period where you don't have FDA Clarets, is there anything that you're doing to try to cultivate demand or anything that you're putting in place so that way when you do get the FDA Clarence, you're ready to hit the ground running and you maybe already have something in place? Yeah,...

...that's a that's a great question and we're definitely being creative, you know, just because the FT process is such a lengthy one. Yeah, so the transnasal and ooscopy procedure, as you mentioned, has been around and e and t for a long time and in Gi and other countries. The US Gi docks have not historically adopted transnasal endoscopy very widely, in the large part because there hasn't been equipment that makes that a comfortable procedure for patients. Yeah, however, we knew we were going to run into some adoption issues just on the procedure side itself. So we have spent a lot of our time developing a comprehensive training kit on online education platform and then building out our clinical specialist team so that we can really support these gi physicians who are learning a new procedure, largely due to patient demand. So patients are really driving the adoption of this procedure among Gi physicians across the US and they're coming to US wanting to know how to do it and wanting to know how to get trained up every quickly. Wow, that's incredible. So, you know, we're spending a lot of time going out, you know, training these centers, helping them and know how to talk to patients, how to talk about the procedure and how to grow that practice in their hospitals. Hey, it's Dr Roxy here with a quick break from the conversation. Are you trying to figure out what moves you need to make to survive and thrive in the new covid economy? I want every health innovator to find their most viable and profitable pivot strategy, which is why I created the covid proof your business pivot kit. The pivot kit is a step by step framework that helps you find your best pivot strategy. It walks you through six categories you need to examine for a three hundred and sixty degree view of your business. I call them the six critical 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 sure you can pivot with speed without missing out on critical details and opportunities. Learn more at legacy DNACOM backslash kit. So one of the things that I was talking to an innovator about a couple of months ago was this kind of I don't if I'd say limbo period, but like this period within that we're talking about right before the FDA approval, where you're trying to raise money, maybe trying to get some VC money in, but also having to be really mindful of the customer acquisition cost so that way it doesn't look like you don't have a viable business model because no revenue is coming in, but you really do. Yeah, it's a tricky time. I I like thinking about it as limbo. You know, for us there's a lot of opportunity in this window. You know, I think that we are have the luxury, I guess, of spending a lot of time on those market development out efforts, you know, both physician and patient outreach. But yeah, trying to raise money when you don't have revenues coming in and you haven't fetted your business model is a tricky one. We have partnered with distribution partner. We had a press release come out yesterday. So microtech endoscopy is one of the I would say, upandcoming Gi distributors and manufacturers in the US. They have a large international presence as well. But, you know, as a small, lean startup, for our commercialization strategy, it really makes sense to, you know, leverage a commercial partners sales force so that when we go out, you know, they're the experts at the sale, you know, and we are the experts on the procedure, in the technology and really cultivating those pediatric Gi connections and...

...doing a lot of the market development. So that is also been really, I think, essential to keeping our our cash runaway of very lean and also having a having a strong business model and commercial sale strategy that we can pitch to investors when we go out to response. I think that that's just so smart and I am seeing a lot more health innovators move in that direction because of all the challenges. I mean it's sometimes even when you're entrenched in healthcare, you can still have challenges getting access to stakeholders. But it certainly if you're haven't been in healthcare or you haven't been in healthcare in the specific sector that you're that your innovation is focused on, even more so since covid getting access to providers and hospital systems and in key, key stakeholders in this ecosystem it is so challenging and so talk about being able to fast track or accelerate the demand and adopt their awareness and the demand and the potentially even adoption by going the distributor route. Yeah, I mean it's it's been key, or strategy, I would say, and it has allowed us to really focus on what our expertises and then partner with a great team that write. Yeah, the US, without investing in the army of salespeople love salespeople, but it can be expensive. Is there auly at this stage? Yeah, there. So let's talk about the amount of money that. That not necessarily the mount but yeah, let's talk about the amount that, but also let's talk about what this fund raising journey has been like for you. Yeah, so we raise our seed round, which you are referring to, earlier this year and that was, you know, that was our first equity round. We had a lot of new investors coming in in that round, but also a lot of our existing investors who have been supporting and supportive of us from the beginning. So, being a pediatric focused company, it has been difficult in the past to raise traditional BC money. A lot of the VC's look at the pediatric market and don't see the returns that they're looking for because it is a smaller market. Yep. However, you know, not only are we applicable the pediatrics, but anything that's going to be more comfortable going into a pediatric and atomy 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 make that case when we've been going out to raise funny talking to investors, you know, has been has been a challenge at least. So a lot of our investors to date have been philanthropic family funds, family offices, you know, people who really care or who are personally invested in in our pediatric mission or making these procedures safer and and faster. So that was where a lot of, you know, a lot of our investment came from. We are going to be going out to raise our series a, 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 to some of those traditional Vic's that the pediatric market may be small, but if you have the whole thing is a very significant market share of overall endoscophy of the United States. Just what you do it right. Yeah, so...

...what are some of the lessons learned along the way? I know that there's a segment of our audience that are in the trenches right now and they are pitching their company over and over and over and it can be very it can be a very, very difficulty, difficult and deflating season. So what are some of the lessons that you learned away along the way that might be helpful to our audience? Yeah, when it comes to fundraising, I like to just turn it into a process, just kind of like assembly line. Yeah, yeah, I know. Ways so kind of taking out that emotional response, that the rejection, you know, if you don't get a call back or if they don't want to continue doing due diligence with you. And so I really start with a list of comparable companies, work backwards and, you know, in pitch book or crunch face or whatever, and find the investors in those comparable companies, create a really long list, go to Linkedin and see if there's any shared connections, you know, because those are always better warm intros thing than cold calls. Sure, and then you just work your way down the list and, at least for me, you know, you just practice the pitch and you know, you Taylor at every time. You do your homework on who you're talking to HMM. Then you just knock them down. You've been a couple hours in a weekend or something creating all these lists and putting all the contacts together. And then I think it's been so important for me to hire a great team and then really rely on them to do their jobs and so that I can kind of have big chunks of time where I can go out and do this fundraising and and just book call after call after call. It is a way show. It is literally Aul or not, is a road show. Yeah, and I uctually virtual has made it a lot easier, right. You know, I think you know you can just contact more people faster because of the virtual world we live in. So so you touched on great team great partners. What makes great team or great partners? So many things. You know, we've hired a number of people this year following our rays in the spring, and you know, it's about cultural fit. I mean it's obvious about expertise in their backgrounds, but for me it's about how well they work with it the other team members. You know what they bring to the table and if they fit really well into our culture and if they really believe in the mission. You know, if they don't have class to K experience, you know, in Gi but, you know, and their experiences more on PMA products and cortiology, for example. You know, but there are really strong fit and you know, they just they bring that diversity of perspective to the table. You know, I'm going to hire that person over someone who maybe isn't as good of a cultural fit. You know what has the exact right skills. So that is worked out really well for us. You know, I think being a good judge of character and, you know, just trying to really get to know the person as opposed to just their resume. You know, I think there's a there's an added higher slowly, fire quickly, and you know, I think taking your time and really knowing who you're hiring and and getting the right people in is key to building a great team. I think that's so important for every organization, but I think that it's even more critical when your start up or emergent healthcare company, because those are like the fund, that's the foundation. Right, those early this higher decisions are like building the company, and so it's just so important that we get that right. Yeah, and you...

...know that also is kind of my philosophy when it comes to fundraising and being really capital efficient. You know, I will cut people last. You know, people are what make everything work on a tea even in a company, and so, you know, we are really lean team, but that's where we invest our capital, in the people that make it all possible. So, yeah, so, so what are what does the future hold? Right as you're kind of looking into two thousand and twenty two. Believe it or not, I know we're me twenty one go now. Remember who were so eager for two thousand and twenty to be behind us, and we're like, come on, two thousand and twenty one, and we're like Damn, two thousand and twenty one kind of stinks in a lot of ways to so come on, two thousand and twenty two. I know, look forward. What's on the horizon? Is your kind of looking at the different new commercialization milestones, or are some of those key decisions that you're making in the future? Yeah, well, you know, optimism. Two Thousand and twenty two is gonna be a very exciting year for us. We are anticipating FDA clearance early next year and then launching with our commercial partner, kind of rolling out to a few of our key accounts throughout the US and then doing a hard launch, you know, mid mid next year, to all the GIS around the country. So it's a super exciting year for us and very exciting. So how so, as we just kind of wrap up here, is there anything else that you would want to share with our audience? Yeah, I mean so much. I think we've covered a lot of ground just on you know, challenges and opportunities. I think there's two sides to every situation and looking at it as a challenge or seeing it as an opportunity, and I think that's really been one of the strengths of our team, is that we have found the opportununity and every challenge that has been thrown our way. And you know, I would say don't lose hope. You know there's there's a great community of mentors and advisors and you know you're not alone. Is what I would share. How there that are trying to, yeah, warm healthcare in their own little way. Yeah, and so, you know, I think that has been absolutely essential for me. You know, finding networks of other startup CEOS and, you know, even if they're not directly in the same field, just building that community so that when you do hit hard times, you have people to you know, go grab a drink with and, you know, share war stories about the process and it just helps, helps to keep going. You know, I was reading a book the other day and they had a chapter and it was not about entrepreneurship at all, but the topic of this chapter was come back artist, and it I just really started to think that, you know, for all the hats that an innovator might wear or titles that they might have, come back artist should be one of them. Yeah, I love that. It is a constant process of you know, redefining yourself for you still yance resilience. Yeah, yeah, and actually, on the Book Recommendation Front, I just started rereading the hard thing about hard things by bell. It's it's one of my favorite books because he just tells it like it is and doesn't try and sugarcoat how hard you know the startup processes and you know you can only be so prepared. You know you're not going to have every situation perfectly maps out. So I would recommend that one too. Okay, so say the title again, the hard thing about hard things. Okay, all right, you heard it here. How...

To folks get a hold of you if they want to follow up with you after the show. Yeah, so you can reach out my emails. Just how there it Evo endocom. You can go to our website, even Endocom, and on our website there's a contact form. So if you are a physician or you know hospital administrator that is looking to learn more about unsedated Tienne and maybe schedule a day demo or training session, there's a contact form on our website for that. Perfect. Thank you so much for joining me, heather. Thank you so much for listening. I know you're busy working to bring your life changing innovation to market and I value your time and attention. To get the latest episodes on your mobile device, automatically subscribe to the show on your favorite podcast APP like apple podcast, spotify and stitcher. Thank you for listening and I appreciate everyone who shared the show with friends and colleagues. See You on the next episode of Health Innovators.

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