Health Innovators
Health Innovators

Episode 104 · 2 months 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, apodcast and video show about the leaders, influencers and early adoptors who are shapingthe future of healthcare. I'm your host, Dr Roxy Movie. Welcome back healthinnovators. On today's episode I'm sitting down with Heather Underwood, who isthe CEO of Invo Indo. Welcome to the show, Heather. Thanks somuch. It's it's really great to be here. Yeah, it's nice tohave you today. So tell our audience a little bit about your background andwhat you guys have been innovating these days. Sure. So, my background isactually in computer science. Started My, you know, career working at IBMMicrosoft Still Oh, and then really got interested in applying some of thoseskills to the healthcare space. So I did my phd at the University ofColorado Boulder in the Atlas Program which is an interdisciplinary program focused on well everythingand in everything between, but I was specifically writing clinical decision support software systemsfor nurses and midwives in Kenya. So I was actually spending quite a bitof time and they rob and working with the nurses and midwives. They're particularlyaround maternal health and of steat tricks and how to improve the standard of carethere. I just really fell in love with the intersection of technology and healthcareand working directly with patients and providers. So, after complaining my PhD,I was a professor for a little while at see you Denver, really focusingon building innovative initiatives for students that were cross disciplinary, focused on innovation,prototyping and entrepreneurship. Wanted to get back into the start of scene. wasas crazy, I know, I know, little masochistic, maybe no, butreally wanted to get back to solving those direct problems, and so Iparticipated in the Stanford Bio Design Program, which is basically a very intense tenand a half months post doc program for medical device innovators. And then aftercompleting that program, I know I wanted to come back to Colorado, andthat's when I met Dr Joel Friedlander, who is our cofounder and chief medicalofficer at Ebo Endo, and the rest is history. So I joined joinedthe team at the end of two thousand and nineteen, right before the pandemic, right before the pandemic. Yes, we can definitely talk about how thatin facted us. Well, let's just talk about it now. What wereyou thinking? December, two thousand and nineteen, January, right, firstquarter two thousand and twenty. And then which. How did that? Howdid 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 buildingsterile single use platforms to enable unstated transnasal endoscopy. So, to break thatdown a little bit, say that five times, bast right. No,I know, way do you hear the name of the procedure? I'll onlysay it once, but anyway. So right now the standard of care forpediatric patients if they need to go get an upper endoscopy for anything, youknow, abdominal pain, is to put them under general anesthesia. So thefull 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 wholeday loss of school to work. So I so there is. Soour cofounder, Dr Jewel Friedlander, and...

...his colleagues in the Arrow digestive medicineprogram 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 wholetime. So Evo Endo was created to really build the system that they neededto do these procedures in a clinic or procedure room as opposed to the operatingroom. So we have designed a sterile single use transnasal gastroscope capable of goingcomfortably through pediatric nasal anatomy, looking at the ESOPHAGUS, stomach and small intestine, doing biopsies. So you can get that diagnostic test results and the patientwears 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 familiarwith that. So microder was diagnosed with papalomatosis when she was around tooand had ended up having twenty five plus surgeries and going to an eant oftenand then having to do the endoscopy. Now she had the little camera thatwent 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 thatwhere 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 fora long time, but their scopes are much shorter our scope. Applied toGastro enterology, our scope is only one where you can actually do a fullgeo 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 thepandemic, and so we are a single use platform, so the whole scopeis disposed after each procedure, so in new scope every time, which isgreat. They get the latest technology. You know, you're not worried aboutreprocessing scopes and the FDA has issued numbers guidance documents at this point about theinfection risk of re usable scopes after reprocessing, and so our scope system was reallydesigned to to mitigate that infection risk. And this was all happening before thepandemic, right. So then, in terms of tailwinds Covid, youknow, both tail winds and headwinds, but or tail winds. You know, I think the focus on infection risk and how big of an issue thatis in hospitals, as well as hot patients not wanting to be in thehospital for long periods of time for elective procedures. You know, really,I think, push the field of single use scopes across the board forward ina really big way. So I think we've gotten a lot more interest justin our single use platform because of covid. That's great. I mean there's thereare there are those that have suffered tremendously because of the headwinds around covidand there's those that have had a lot of success because of those tail woodsthat you're just describing. Yeah, yeah, that wins for us. You know, really had to do with FDA and then also with manufacturing delays onon parts. You know, I think we saw everything start to get alittle funny when it came to inventory and timelines and, yeah, everything fromconstruction and house building materials. You know, I was also in in my personallife dealing with that. Yeah, and then just delays on some ofour key components to actually build our system. But then the FDA to is alsojust very swamp, you know, looking at you a's and covid vaccinesand 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 communitythat 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 itcomes to medical device innovation and being able to commercialize those maybe more successfullyor even faster. Yeah, it's a great question. And so I waspart of the Stanford Bio Design Program which, you know, is really on thecutting edge of thinking about how to design, really starting with the needsof 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 adeep understanding of those needs and then prototyping, iterating, validating your solutions, andso, you know, I think the more that medical device starts withthat 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 commercializingthose medical devices, and so, you know, I think that that isone of the differentiators for Eboendo. You know, our system was really borneout of this clinical need in pediatrics, where there are no systems proved forpediat trick use and the standard of care was so traumatic for patients that we'reneeding these procedures. Yeah, that we really developed a system to change thatdramatically. You know, I think a lot of a lot of the othersingle use scope manufacturers at this point are really just looking at the existing technologyand making single use versions of it at the lower cost and they're really missingthat clinical need which I think has always been our focus. So which whichis not rocket science and in one hand right, because it seems like youwould start off with the need. But it's also worth just reminding our audiencethat are in the trenches because some kind sometimes we can get so caught upin the technology that we build out a solution and then try to go outand find a problem. Is opposed to starting off with the need, andthat 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 oneof the first steps of being able to have commercial success is being ableto identify the need and then being able to test that business idea before you'repouring millions of dollars into it. Yeah, I think it also gives you alot 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 adoptyour product to really constantly better meet that need, as opposed to being reallylocked into a technology. And you know, when you have a hammer, everythinglooks 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 companiesare becoming more creative or innovative even in our commercialization strategy. In this periodwhere you don't have FDA Clarets, is there anything that you're doing to tryto cultivate demand or anything that you're putting in place so that way when youdo get the FDA Clarence, you're ready to hit the ground running and youmaybe already have something in place? Yeah,...

...that's a that's a great question andwe're definitely being creative, you know, just because the FT process is sucha lengthy one. Yeah, so the transnasal and ooscopy procedure, asyou mentioned, has been around and e and t for a long time andin Gi and other countries. The US Gi docks have not historically adopted transnasalendoscopy very widely, in the large part because there hasn't been equipment that makesthat a comfortable procedure for patients. Yeah, however, we knew we were goingto run into some adoption issues just on the procedure side itself. Sowe have spent a lot of our time developing a comprehensive training kit on onlineeducation platform and then building out our clinical specialist team so that we can reallysupport these gi physicians who are learning a new procedure, largely due to patientdemand. So patients are really driving the adoption of this procedure among Gi physiciansacross the US and they're coming to US wanting to know how to do itand wanting to know how to get trained up every quickly. Wow, that'sincredible. So, you know, we're spending a lot of time going out, you know, training these centers, helping them and know how to talkto patients, how to talk about the procedure and how to grow that practicein their hospitals. Hey, it's Dr Roxy here with a quick break fromthe conversation. Are you trying to figure out what moves you need to maketo survive and thrive in the new covid economy? I want every health innovatorto find their most viable and profitable pivot strategy, which is why I createdthe covid proof your business pivot kit. The pivot kit is a step bystep framework that helps you find your best pivot strategy. It walks you throughsix categories you need to examine for a three hundred and sixty degree view ofyour business. I call them the six critical pivot lenses. As you makeyour way through this comprehensive kit, you'll be armed with the tools, tipsand strategies you need to make sure you can pivot with speed without missing outon critical details and opportunities. Learn more at legacy DNACOM backslash kit. Soone of the things that I was talking to an innovator about a couple ofmonths ago was this kind of I don't if I'd say limbo period, butlike this period within that we're talking about right before the FDA approval, whereyou'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 wayit doesn't look like you don't have a viable business model because no revenue iscoming 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 alot of opportunity in this window. You know, I think that weare have the luxury, I guess, of spending a lot of time onthose market development out efforts, you know, both physician and patient outreach. Butyeah, trying to raise money when you don't have revenues coming in andyou haven't fetted your business model is a tricky one. We have partnered withdistribution partner. We had a press release come out yesterday. So microtech endoscopyis one of the I would say, upandcoming Gi distributors and manufacturers in theUS. They have a large international presence as well. But, you know, as a small, lean startup, for our commercialization strategy, it reallymakes sense to, you know, leverage a commercial partners sales force so thatwhen we go out, you know, they're the experts at the sale,you know, and we are the experts on the procedure, in the technologyand 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 ourour cash runaway of very lean and also having a having a strong business modeland commercial sale strategy that we can pitch to investors when we go out toresponse. I think that that's just so smart and I am seeing a lotmore health innovators move in that direction because of all the challenges. I meanit's sometimes even when you're entrenched in healthcare, you can still have challenges getting accessto stakeholders. But it certainly if you're haven't been in healthcare or youhaven't been in healthcare in the specific sector that you're that your innovation is focusedon, even more so since covid getting access to providers and hospital systems andin key, key stakeholders in this ecosystem it is so challenging and so talkabout being able to fast track or accelerate the demand and adopt their awareness andthe 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, andit has allowed us to really focus on what our expertises and then partner witha great team that write. Yeah, the US, without investing in thearmy of salespeople love salespeople, but it can be expensive. Is there aulyat this stage? Yeah, there. So let's talk about the amount ofmoney that. That not necessarily the mount but yeah, let's talk about theamount that, but also let's talk about what this fund raising journey has beenlike for you. Yeah, so we raise our seed round, which youare referring to, earlier this year and that was, you know, thatwas our first equity round. We had a lot of new investors coming inin that round, but also a lot of our existing investors who have beensupporting 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 returnsthat 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 goingto be more comfortable going into a pediatric and atomy is going to be alot more comfortable for adults. So there is an a need in the adultpopulation for our system and so trying to make that case when we've been goingout to raise funny talking to investors, you know, has been has beena challenge at least. So a lot of our investors to date have beenphilanthropic family funds, family offices, you know, people who really care orwho are personally invested in in our pediatric mission or making these procedures safer andand faster. So that was where a lot of, you know, alot of our investment came from. We are going to be going out toraise our series a, which will be our commercial round, early next yearand, you know, I think the progress that we've made even since weraise that seed round hopefully will really demonstrate to some of those traditional Vic's thatthe pediatric market may be small, but if you have the whole thing isa very significant market share of overall endoscophy of the United States. Just whatyou do it right. Yeah, so...

...what are some of the lessons learnedalong the way? I know that there's a segment of our audience that arein the trenches right now and they are pitching their company over and over andover 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 learnedaway along the way that might be helpful to our audience? Yeah, whenit comes to fundraising, I like to just turn it into a process,just kind of like assembly line. Yeah, yeah, I know. Ways sokind 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 continuedoing due 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 comparable companies, create areally 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, atleast 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 talkingto HMM. Then you just knock them down. You've been a couple hoursin 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 greatteam and then really rely on them to do their jobs and so that Ican kind of have big chunks of time where I can go out and dothis fundraising and and just book call after call after call. It is away 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 becauseof the virtual world we live in. So so you touched on great teamgreat 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 inthe spring, and you know, it's about cultural fit. I mean it'sobvious about expertise in their backgrounds, but for me it's about how well theywork with it the other team members. You know what they bring to thetable and if they fit really well into our culture and if they really believein the mission. You know, if they don't have class to K experience, you know, in Gi but, you know, and their experiences moreon PMA products and cortiology, for example. You know, but there are reallystrong fit and you know, they just they bring that diversity of perspectiveto the table. You know, I'm going to hire that person over someonewho maybe isn't as good of a cultural fit. You know what has theexact right skills. So that is worked out really well for us. Youknow, 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, firequickly, and you know, I think taking your time and really knowing whoyou're hiring and and getting the right people in is key to building a greatteam. I think that's so important for every organization, but I think thatit's even more critical when your start up or emergent healthcare company, because thoseare like the fund, that's the foundation. Right, those early this higher decisionsare like building the company, and so it's just so important that weget that right. Yeah, and you...

...know that also is kind of myphilosophy 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 ona tea even in a company, and so, you know, weare really lean team, but that's where we invest our capital, in thepeople that make it all possible. So, yeah, so, so what arewhat does the future hold? Right as you're kind of looking into twothousand and twenty two. Believe it or not, I know we're me twentyone go now. Remember who were so eager for two thousand and twenty tobe behind us, and we're like, come on, two thousand and twentyone, and we're like Damn, two thousand and twenty one kind of stinksin a lot of ways to so come on, two thousand and twenty two. I know, look forward. What's on the horizon? Is your kindof looking at the different new commercialization milestones, or are some of those key decisionsthat you're making in the future? Yeah, well, you know,optimism. Two Thousand and twenty two is gonna be a very exciting year forus. We are anticipating FDA clearance early next year and then launching with ourcommercial partner, kind of rolling out to a few of our key accounts throughoutthe 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 excitingyear for us and very exciting. So how so, as we just kindof wrap up here, is there anything else that you would want to sharewith our audience? Yeah, I mean so much. I think we've covereda lot of ground just on you know, challenges and opportunities. I think there'stwo sides to every situation and looking at it as a challenge or seeingit as an opportunity, and I think that's really been one of the strengthsof our team, is that we have found the opportununity and every challenge thathas been thrown our way. And you know, I would say don't losehope. You know there's there's a great community of mentors and advisors and youknow you're not alone. Is what I would share. How there that aretrying 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 sothat when you do hit hard times, you have people to you know,go grab a drink with and, you know, share war stories about theprocess and it just helps, helps to keep going. You know, Iwas reading a book the other day and they had a chapter and it wasnot about entrepreneurship at all, but the topic of this chapter was come backartist, 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 stillyance resilience. Yeah, yeah, and actually, on the Book Recommendation Front, I just started rereading the hard thing about hard things by bell. It'sit's one of my favorite books because he just tells it like it is anddoesn't try and sugarcoat how hard you know the startup processes and you know youcan only be so prepared. You know you're not going to have every situationperfectly maps out. So I would recommend that one too. Okay, sosay the title again, the hard thing about hard things. Okay, allright, you heard it here. How...

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

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