Health Innovators
Health Innovators

Episode 95 · 1 month ago

100 conversations: How to spot a pivotal ‘aha’ moment w/ Josh Oppenheimer

ABOUT THIS EPISODE

You have an idea, a solution, a vision! And you know exactly how, when, and where that vision will fit in the market and make a difference.

Until you don’t.

You could have the most pivotal and impactful solution to come to market in decades - but if your market fit isn’t right, or is off - even just a little - that could mean failure.

Conversations with your customers can be the key to making sure your solution hits the market exactly where it needs to be for your target audience to utilize it.

Dr. Josh Oppenheimer can tell you a story or two about the importance of those conversations. (Hint: because if you have 99 of them, the 100th could reveal your ‘aha’ moment!)

Come hear how Josh and his company built a culture around conversations, and why those conversations - internally and externally - can make all the difference in finding success.

Here are the show highlights:

  • 4 lessons to keep in mind when trying to secure a healthcare champion (13:04)
  • What cross-country structuring looks like for a company (17:42)
  • This is how you increase your chances to secure funding (21:19)
  • The regulatory differences between SAMD and traditional medical devices (22:32)
  • Successfully pivot your business model (24:54)
  • Humility, transparency, and collaboration: building the right company culture (28:48)

Guest Bio

Dr. Josh Oppenheimer is an emergency medicine physician and the co-founder and CEO of Transformative, an AI-based predictive patient monitoring software company.

From the start of his career, Dr. Oppenheimer knew he wanted to be more than a physician - he wanted to make a difference and have a positive impact on the healthcare industry.

Josh immersed himself in the world of business academia and he further pushed the boundaries of the knowledge he could gain by attending business school in the UK.

He earned his AB from Princeton University, his M.D. from Icahn School of Medicine at Mount Sinai, and his MBA from Cambridge Judge Business School.

If you’d like to reach out to Dr. Oppenheimer, you can use the contact form on his website at transformative.ai, or you can find him on LinkedIn at Josh Oppenheimer, MD, MBA.
 

I 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 to the show healthinnovators on today's episode, we're sitting down with Dr Josh Oppenheimer,who is the CO founder and CEO of transformative. Welcome to the show, DrOppenheimer thanks so much it's pleasure to be here great. So I alwayslike to get give our guests an opportunity to kind of share a littlebit about what they're innovating these days and how their background or howthey got started awesome. So I'm an emergency medicinephysician and I still work at the hospital one or two shifts a week. Butthe thing that I'm most passionate about is how healthcare is changing andgoing to change over the next few decades and there's this hugeopportunity around predictive medicine that we are very excited about. Ittransformative and I think, is going to make a major difference in the lives ofpatience and the best way to think about. It is for the perspective ofwhat I do when I'm at the hospital, so I often have a patient who I'm takingcare of, who is already very sick, whether they have a very bad bloodstream infection or whether they are having a debilitating stroke or aboutheart attack. And the thing that I often think to myself is that I wouldhave been able to do so much more to help this patient. If I were seeingthem minutes ago hours ago days ago, depending on the particular patientsituation. There are so many things where you could have this patient'shealth dramatically better. If we would have intervened earlier- and I thinkthat we're reaching a point where, when you combine the opportunities ofmachine learning and wearables, we will reach the point where we can bemonitoring high risk patients for particular problems that could arise sothat we can identify. When that patience about to get much worse. Andwe can intervene earlier at a time when it's optimal to stabilize their bodyand their health and that whole idea of being able to intervene earlier and beable to keep someone healthy. Rather than trying to get them healthy againafter they get very sick is something that I just think is tremendouslyexciting, and I think that, with the the technologies that are already outthere, we really have the potential to make that reality to make make thatidea come to reality. So that's what we're overall working on with withtransformative and very excited to get the chance to talk to you about thattoday. Yeah, absolutely I mean I agree with you. I think there's no bettertime to be in health care and there's no more exciting industry to be in. You know, with all of the advances thathave been accelerated due with Ovid in kind of just the technology evolutionthat's happening so so tell us a little bit more about you know. It sounds likethis. This idea kind of came about from your personal experience in practicingmedicine, but what was that? What was that contemplation, or what was kind ofgoing on in your mind when you were considering becoming an entrepreneurversus maybe your original plan of being a physician sure. So when I entered medical school,I already had the idea that I wanted tohave a career where I was combining clinical medicine with something elsethat would be focused on improving the health system at a larger scale, and Iwasn't quite sure what direction that would take part way through medical school. I continued to feel that I wanted to havea sort of hybrid career and I was still not sure exactly what direction thatshould take, and I got some advice from a number of men tours. I ultimatelydecided that I wanted to get an MBA part way through medical school and I went to the University of Cambridge outin the UK in part because I wanted to...

...get exposure to a different culture, adifferent health culture with the NHS being totally different from the the UShealth system, and it was also nice because it was a one year program, asopposed to mainly two year. Programs in the US and medical training is alreadylong enough, so that was attractive as well, but I so I had the chance to go out toCambridge and while I was there, a couple things happened. First, I fellin love with the idea of entrepreneurship in particular, becauseit's an area where you can move relatively quickly in health care.Never nothing is super fast, so relatively quickly, is it still in theorder of years, but it's still a yeah. It's still a little bit easier to makemajor changes than in healthcare administration at a hospital level orin health policy at a national inter international level, where, wherethings really move out of the course of decades, and so entrepreneurship was very exciting asan idea, but I still wasn't sure exactly what direction I wanted to takeit. And then I had the chance to meet some really cool machine learningresearchers out at Cambridge, who were done on the the cutting edge of ofusing computers to generate insight out of out of data, and we were talkingabout the various directions that health care could take. Machinelearning and we got really excited about the idea of predictive monitoringin particular, because we were looking at other companies that were out therein the the machine learning health care space and a lot of companies werefocused on trying to get computers to do things that human physicians couldalready do. So. There are a lot of companies that look at the image from aCT scan and tried to make a diagnosis, as well as a human radiologist can orlook at a picture of a rash and try to figure out what that is, as well as adermatologist can, and while there are certainly major efficiency gains youcan achieve through that and opportunities to expand health care toto more people with with fewer physicians.It still doesn't really fundamentally move the needle in terms of thepossibility of health care and the possibilities to transform health and where, where you look at the predictive space,the idea that you can take monitoring data and predict an event in the futurethat actually gives you the opportunity to change the way that the health canreacts with people. And I the people can be empowered to take their life and totheir own hands, and so that was a really exciting idea that we alsocallussed around that there were some companies that were working on butfewer, and we, the next question, was identifying whatwould be our first product that we would try to build. And there were someresearchers that had already looked at the problem of cardiac arrestprediction and looking at continuous, cardiac monitoring data from an ekg andpredicting when a patient would have a deadly sudden cardiac rest event. Thepapers that were out there in the academic literature had looked atpretty small chunks of data from few patients for short time periods and andoften with relatively cleaner versions of datathat had removed some of the complications of the messy real world.So they weren't quite clinical grade, but they were already showing theinitial signals that there is something intrinsic in the heart that you couldidentify and that could signal. FICATION was about to have a cardiacarrest, and so we thought that if we could gather large amounts of data, dothe hard burk to build a a functioning algorithm. That could predict CardiacAras and we could prepare it for a clinical, great technology that wecould actualize that vision and allow for the identification of patients whowere about to have the single deadliest health condition in the world and allowfor better care for those Paciensian. So if they had a better chance ofsurviving and a better chance of surviving with good brain function. Sohere yeah I mean it's awesome, can't...

...wait till it's here right. So sospeaking of that, where are you in the innovation process right now yeah? Sowe got started in late, two thousand and sixteen, and we spent the initialfew months building a prototype of Viago rith based on some publiclyavailable data basis. And when I say to me I'm actually referring to my cofounders. I don't do any coding myself, but we first had to develop that proofof concept that we were building an algorithm, that they could makepredictions and show that it was better than some of the existing academicresearch. Then we were able to get some initial funding from in health ventures,which is a large private health system. In the UKthey have a strategic investment arm. So so they invested in us as well as aEggar that we were a part of entrepreneur first based in London andsome Angel Investors, and that gave us a little bit of starting capital to goout there and build a bigger database and be able to prove out the technology.And then, over the next couple of years we were able to go through a relatively long process ofparting, with hospitals to be able to prospectively collect data from theirpatients who were undergoing cardiac monitoring and critically. Have thenurses and doctors identify exactly when a patient had a cardiac arrest sothat we could be absolutely sure that we were training an algorithm based onhigh quality data of which were the true patients? Who have these events inwhich patients didn't and then once we built that database, we were able tobuild a better version of the algorithm, prove out that that was making predictions accurately and atthe point where we were able to show that we were then able to get someadditional funding from the welcome trust out of the UK, as well as fromsome additional investors out of the UK and Estonian around the world and withwithout funding we're now in the process of preparing our software forCommercia Ization, so preparing the final version forregulatory approvals and, at the same time engaging with various commercialpartners who will work with to bring the software to market so very exciting journey. It's great tosee that you guys have hit a number of really key mile stones over the last few years. I want to goback just the little bit to the fact that you kind of this hybrid model ofbeing an M D as well as getting an NBA. Do you think that that is going to be more common, or is itcommon now a lot of the physician innovators that I've talked to over theyears and even had on this show don't have a lot of business acumen,even though they have the medical experience and a lot of times. Thoseideas similar to you are birth by the problems that they see right andfrustrations that they experience with. You know the issues around them, and sothere seems to be a slight disadvantage on one hand for them that they aretrying to build a company and commercialize it a lot of times wherethey're working full time as a doctor, but without having the business acumenor sometimes I'll, see that they'll go back to school much later on when theydecide that they want to build a company and be an entrepreneur and goback to school and get an MBA. But you kind of had this foresight of beingable to do that really really early in your career, so just kind of share withus about that sure. So I think that there are, as you just put it out,there are so many different ways that you can build the skills that you needto be successful and I think that there isn't necessarily a better or worse wayof going about it. I think that you know for me with the knowledge that I wanted to have ahybrid career, it's sort of made sense to get as much training and knowledgeand perspective, and as early as I could in my career, so that I could tryto leverage that and then get started...

...with the the work that I was mostexcited about early, and I think that from the MBA experience there were, Iknow I had some phenomenal classmates from around the world and I had somephenomenal professors. I think that most of the material in an MBA programisn't super complicated, it's stuff that youcan learn either from the classroom or from life experience and fromconversations with with mentors and advisor. So I don't think it'sessential by any means to go through that type of trainingprogram to be not differenter. I think I very well could have pursued ontropen hip without an MBA, but I do think that it's it's helpful to have asort of consolidated time where you are drinking for the water hose of business,knowledge and research and being able to sort of emerge yourself in thatworld and that thinking. So it's worked out really well for me, but I don'tthink that there's necessarily a better a worse way to go about it. Yeah. Icompletely agree with you right. Entrepreneurship can be for almostanyone, if not everyone in every path. I think each one of our journeys lookreally really different and it's not necessarily wrong. So now I want to bounce forward to whatyou were saying before. Were you so kind of so casually talked about howand then we went. We got data from these different health systems and youknow that's not real easy. It's not like you're going to call oryou're going to email, someone and say hey. How can I get access to your data? So what was that like? And what aresome of the recommendations you would have for other people in the audiencetoday that are maybe experiencing some challenges are working through thatphase right now sure. So, at this point in time, we have partnerships with anumber of hospitals around the world and in Europe and North America and inAsia, but I'll, maybe drill down with the very first hospital that we wereable to get data from. Since that's always the things challenge and for forus we had to think about who were we? What advantages did we have that thatother people may not and what would be the sort of easiest path for us? And sowe first were thinking that, since we were in the UK, we would try to workwith a hospital in the NHS and we had a number of meetings with the numberfolks at a number of hospitals and those progressed at a very slow pace.But at some point during that process we also decided that we would look intohospitals in Estonia. And the reason for that is that my two co founders marks, Randi andMark Ray are both Estonian by nationality and they both have friendsin Estonia and one of the the friends O of one of my co foundersis someone who had previously worked at North Estonia, Medical Center, which isthe largest hospital in Estonia in their it department, and so she knew some ofthe people that we would have to work with in order to set up a a prospectivedata collection partnership and she was able to introduce us to acardiologist there and the the cardiologist ended up being anincredible champion of ours internally to help sort of navigate the back endbureaucracy to get all the approvals in place and then a little bit later. On te, the friend of my co, founder, Laura Crendi,who had been previously at the hospital. I T department and I did since moved onto a different company. She ended up joining transformative as an employeeand having her on the ground and tollen tobe able to work closely with the the...

...people in the t department at thehospital to make sure that everything was moving forward, ended up being anincredibly big advantage for us to have someone sort of on the ground who hadexperience at that hospital and had existing relationships, and so betweenthose different people were helping us out there. We were able to get throughthe approval process in Estonia more quickly than we were able to anywhereelse, and that allowed us to start collecting data and allowed us to both start building the database with withlonger term data earlier and also make it easier for us to than go tosubsequent hospitals to be able to show them. We've gone through this process.We know what it entails. We know how to do it and we're able to both provide aclearer map of what are all the steps that we need to do and also give youthe confidence that we're not figuring this out for the first time ourselvesright right. So a couple lessons I see in there one have a network and be niceto them, because you might need them one day secure a champion within the healthsystem. You know probably as early as possible and keep that connection, andthen it sounds like this. Third One. That kind of comes to mind is what youtouched on. Is that if you can have someone that's boots on the ground thatthat's going to be able to? You know maintain that productivity thatpresents that sense of urgency and being able to make things happen. I agree with all of those lessons andthe only other one that I would add to that list is the importance of nottrying to approach one partner at a time, but simultaneously trying toengage with as many people who could be the one person or the one partner whoends up being really helpful, because you don't know which of theserelationships in which of these possibilities are going to work out. Sothe more you can be pursuing it once the the more likely you are to makeprogress more quickly, very, very important. So you touched on Estonia,which I've been new Estonia, believe it or not, and that is a beautifulbeautiful country. I went on a cruise and it just was one of our stops andbefore that, honestly, I didn't even know that was a country so but beautiful country. So talk a little bit about thestructure of your company between you know us, the UK, Estonia and maybe anyother locations that you have sure. So we have we initially started out as a UKcompany, since my two CO founders were in the UK, and we first are loud aspart of the entrepreneur first incubator, which is based in London andfrom there we spent the initial period of time with it just the UK company andthen when we were pursuing the hospital partnership in Estonia, and we werethinking about trying to bring on Laura as an employee based in Estonia. Werealized that it would be a lot easier, just at a legist, ICAL and and legallevel to set up an Estonian entity and have or Reston based employee employedby that entity, rather than try to do cross country employment, which ends upbeing a lot trickier. And so that was just an organic process ofwanting to be able to set up that employee in Estonia. And then we spentthe next few years with just the the UK and Estonian and tides,and then in summer, two thousand and twentywe set up the US entity at the time when I was ready to join the companyfull time. So I had spent the the first four years or so of the company as aemergency medicine resident and during that time period I was a full timeresident and spending the bulk of my time in the hospital, and I was servingas the chief medical officer of transformative working on that in bitsand pieces. When I, when I had the time...

...so when I say you didn't sleep for fouryears, I I had a busy four years for sure,though, do be perfectly honest: emergency medicine, the the majority ofour months, are where you're spending sixty hours aweek in the hospital and while that's busy, there are surgeons who spend atplus hours a week in the hospital for their entire period. So I didn't evenhave it as bad as as some residents who weren't trying to start a business but the yeah, the the amount of time Ihad for the business was more limited, and so, when I finished up residencyand I was able to get a abidance medicine job where I wasonly working one or two ships the week, that's when I had the opportunity todedicate the majority of my time to the company and to join full time. I thenswitched over with my my partner mark, who had been the CEO he switched overto the C to roll. I switched from Juve medical officer to CEO, and that was asort, a very natural transition that we had been planning for a while. But atthe point where I I started to draw salary at that point from the companywe all similarly wanted to set up a US entity and the other advantage beyondemployment is also that it makes it easier to apply for grants and thosevarious geographies. So we initially were able to get some grantsfrom the UK, but we're now in a position where we can get grants fromthe UK from the EU and from the US which, which certainly helps out aswell yeah. 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 pivit strategy,which is why I created the Co. Vid Proof Your Business Piso Kid. The pivotkit 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 backslid. So when it comes to those grants, isthere anything that is just really important as you've gone through thatprocess? When you think about our audience being other innovators thatare in the trenches that may be looking at, where they're going to to get somefunding, any any advice for them. So I think it really helps to be able toapply for a grant with a health system as a partner and then be able to go togo to the grand funder and say that this startup company, plus this healthsystem, are looking to collaborate on a particular project that ends up beingsomething that's a nice package to be able to offer both because it providesthat sort of private public blend and also because it shows that you have afair amount of validation and at product market fit at a time whenyou're not able to actually have customers or or to sort of show thatyou are building something that people areare actively buying. If you can at least show that the people who would bethe users are really excited about the project, a willing to dedicate theirown time and energy, it goes a long way toward showing that you're buildingsomething that will be exciting for your users. Great, that's awesome sowhen to touch on software as a medical device s amd is. This is something thatwe haven't really talked on. The show a lot about this is kind of a, I want to say unique,but it's been around for a while now, but it's still in its infancy. I think...

...what is it like? Bringing a software as a medical device to marketcompared to maybe some of the other types of health care innovations ordigital health tools out there? What are some of the additionalconsiderations that you've had to think through and Parma part of your commercializationprocess? Sure? So I think that the easiest way to think about it is that,from the perspective of a regulator, software as a medical device just meansthat software is a medical device, and so the exact same rules that they haveset up for a physical product that is going to be used to treat a medicalcondition also apply to software. That doesn't have a hardware component thatis also being used to treat a medical condition, and so what regulators wantto see our number one evidence that the product works and that whatever you areclaiming you can do to helpsomeone's health. You have evidence to supportthat and number two. They want to see that the software works, and so youhave to have human factors, engineering, research, showing that when usersinteract with your software that they are able to do so in a way where itmakes sense to the user and they're able to avoid major errors. That wouldmake the product dangerous. So it's it ends up being more similar to aphysical product than different from a regulatory perspective and from adevelopment perspective. It simply means that we have some fewer elements to think about.From a from a like a physical manufacturingperspective, though, of course, we also have to ensure that we integrate withreal hardware devices and so from a product perspective. We have to do asmuch work at the hardware software inter vase, as you would, if you wereselling the hardware yourself, it's just that we're not thinking throughthe design and manufacturing of the hardware puce. So what about throughthe commercialization lends? What are some of the things that you can or can't do that you may or may not want to doright now, if you get FDA clearance and just kind of those, those that prelaunch expectation and reality so from a commercial perspective, italso means that you have to have a plan for how your users are going to workwith your software paired with the hardware and and make sure that it'ssomething that's ultimately going to work for those and customers, and thisis actually an area where, in our journey we have undergone a pretty large pivot. So whenwe started out, we thought that we would sell our software directly tohospitals with the idea that they could use their existing hardware. They couldbuy software directly from US. The software would be compatible with thehardware, it would probably show alerts on a separate screen and it would allowfor the hospitals to be able to takeadvantage of our barb software without having to use any different equipmentyeah, and that strategy had certain advantages in terms of maintaining profit and maintainingcontrol over the sales cycle. But the the major downside was that we had lotsand lots of conversations with various stakeholders within hospital systems,and we heard pretty consistently that they weren't that interested inbuilding relationships with a bunch of software companies. So from a precuredperspective, they have existing relationships with the Philips and theGes of the world on the device side, they have existing relationships withthe epics and the cernes of the world on the electronic health record sideand they're, not that excited about a future world in which they have to havea hundred different negotiations with a...

...hundred different software providers,arter to provide a full fledged software ECO system for their hospitalcampuses. And so what they want to do is by software products through theirexisting vendor relationships. And so what we have vivite toward is the ideaof partnering, with those patient Monteran companies and electronichealth record companies to be able to integrate arm software and alerts intotheir software ecosystems, so that from the user perspective it will feellargely like they are using a fillips product or a certainer product,whatever the case may be, but that, from the technologyperspective, we're building that separately, we're building itcompatible with with those other providers and then at a sales level.The software gets purchased through either a market place that the technologycompany, the larger partner, sets up or gets licensed from transformative tothat partner, and then that partner selves into the hospital, but eitherway it ends up being a little bit more integrated into the existingrelationships that those hospitals have with their existing vendors. And whilethat it has complexities and it has trade offs, we ultimately have tolisten to our customers and make sure we're creating a product that they wantto use and also allowing for a procurement process that they want touse to buy the product. That is huge. I mean that is the huge huge learning I'mjust curious. How many conversations did you have before you really got tothis a Ha moment that you really needed to pivot and Change Your Business Modeland some of your go to market strategy, hundreds yeah yeah? It's I mean. I think that I talk aboutta lot about customer discovery on the show, because I think that it's soincredibly valuable, so foundational to commercial success and every guest kindof shares a little bit different, their pathway or their journey, and soit's just a great conversation to have. What was that like for you when youwere kind of faced with that data? Did you wrestle with making that change, orwere you just more black and white, like Nope, we're just going to makethat change? So it was a much more gradual process. The sort of strategic decision ofwhether we should try to sell into hospitals versus whether we should tryto sell and partnership with with othercollaborators was a question that we identified as sort ofaccused Tra tegi question fairly early on in the process, and especially atthe point where we were talking to investors. They wanted to know what your go toMarcet strategy as even way before you have a product ready to go yeah, and sowe had identified these two core options very early on. We had a prettylong list of trade offs between the two and then the various risks and benefitsto each approach, and it was a gradual process of deciding that thescale ended up tipping toward the partnership model, and it was adecision that we wrestled with for a long time, and I think that it's you know I personally had theexperience of having spent a while, when we were fundraising specificallymaking the argument for the opposite case, about this exact question andpointing out all the downsides of the partnership model and all theadvantages of the the model where we maintain ourselves ourselves and so hadthe reality of what this journey is like. So I really appreciate you beingso candid about it yeah. So you know to...

...get to the point where we convinced ourselves that we've beenwrong and convinced ourselves that the the counterargument was actually betterthan the initial strategy. It took a combination of open, mindedness,humility and also consistency from from what we werehearing from from various stake holders and the other challenges that this. This is a sort of tough question.It's not a slam dunk that it's black and white ones, the obviously betteroption, and so even at the point where we are now sort of strongly piped in thatdirection. There are still times when I talk to investors and they make thecase to me for why we should actually be going the opposite direction and whythat would make more sense and the downsides to the apprecie partnershipand the risks with that in tails. So you know I I ha so ironic for you. Youknow, I think it's just the reality that when you have tough judgment,calls to make and when you're trying to make predictions about how the go tomarket strategy will play out at a time when you can't really test it. It'sreally challenging- and you know going back to your question earlier- aboutthe realities of being a company where you know that you want to go throughregulatory clearance, and you know that you can't ultimately sell until youhave gotten that approval. It means that you have to speculate a bit aboutsome of these decisions that you know were going to be essential, but thatyou haven't actually faced because by far the best way for us to have testedout, these hypotheses is to be actively trying to sell into hospitals with withone approach and to fail at doing that, and then say: OkayWell, we've tried it. It didn't work now we have to do the other thing, a ata point where you have to be trying to plan ahead and setting up partnershipsand setting up customer discovery opportunities outside the sales cycleitself. It's a much more challenging process to learn from, and I think thatfor entrepreneurs who have the luxury of being able to actually sell theirproduct and he have the opportunity to know what doesn't doesn't work in asales conversation that that would be a much more useful approach it and onethat I am sort of jealous of right, right, yeah exactly and the amount oftime that it takes. You know. So I see you as the CEO, the leader of theorganization, and you know, you're the one you know with your co founders aswell. You know, but you're the one, that's kind of steering the ship of,like rallying all of your team members around the specific vision for yourcommercialization strategy, as well as your investors and your advisors right.So you've persuaded all of your team, internal and external, to kind of getbehind you and this one strategy or this one plan and then all of a suddenyou've got to go. Wait a minute. Wait a minute wait a minute. We changed ourmind, legitimate reason. Why? But now I need to come back and I need to thewind is changed and now we got to rally around this completely new strategy anddirection, and I think that that's challenging to doyeah, and I think that it's not the execution of that pivot. That is thekey. It's rather the culture that you set up within the company yeah. So if,if we had been operating under the theories that we ought to be sellingone way, because that's what I say and that's what the vision is of thecompany I just sort of arbitrarily is the case, then I think it would be more challenging to say actually weneed to switch. But we, as a team, we have a culture of humility and aculture of trying to be transparent about ourdecision making and trying to be Colliver ed about our decision making.So everyone was looking at the same data together and it wasn't that I cameinto a team meeting and said: Hey we're actually going to make this majorswitch. It's that this was a conversation. We've had among our fullteam multiple times over the years, and...

...we had another conversation with theVole team about the the trade offs that we were facing and we weighed themtogether and we you know, as a team, we decided that it made more sense to makethis this transition. And so I think that when everyone is empowered to be part of that decision,making process and everyone scrutinizing the data together and andplaying devil's advocate together and we decide that it makes more sense tomake a pivot, that that's a process that everyone can get behind and and beexcited about and be an opportunity to actually increase confidence that wereon a positive path rather than to be an opportunity to worry that we're on thewrong path. Yeah Yeah- and I think that's so important- and I want to justkind of stress that again because there will be very likely unless your companyis a nominally there'll. Be many other moments like that. Right I mean it's any of our strategic plansare not a one and done and- and I think, having the humility to be part of thatculture. So we, I think what you're saying is that when you create aculture, it makes it a little bit easier to have the humility to be ableto say that you know my opinions are relevant and here's what the customersaid. Customers rule, and so this is the direction that we're going, and wemay do this many more times, and it doesn't mean that we don't know whatwe're doing or that we're just you know changing with the wind there's likewith your decisions, are really grounded in data. I think that's right, yeah yeah, sotalk about some of the pre launch. Maybe strategies and tactics that youmay be considered or may be implemented to kind of help, validate your messageto build an email lips to you know: do any of these types of things, thethings that you can do before you get that FDA clearance. Sure. So I thinkthat we have taken the approach of primarily trying to partner with various organizations inways that we can do now, and so we are laying the groundwork for a futurecommercial launch, but we're not so much trying to optimize. For the moment,a couple of years from now, when we're actively making sales and a sort ofbuilding backwards from a sales generation perspective, rather we'rewhat we're doing is focusing on what are the opportunities we have today topartner with with various people who ultimately be partners and customersand figure out how we can try to sort of sell these intermediatesteps. So, from a hospital perspective, we are still pitching hospitals oncollaborations to gather additional data and to be ableto execute pilots when we have the technology in place to do so in thefunning place. To do so and so trying to bring hospitals on board to applyfor grants and those various geographies has been something that wehave been selling hospitals on today. We also have active engagement with thepatient motoring companies and with electronic health record companiesabout potential collaborations to bring our product to market together,and even though we don't have something that's ready to sell today. We alsoknow that this is a process that to do it right is going to take some planningand going to take both coordination on the engineering and technical level,but also coordination on the sales and commercial level. So trying to set upsome of these partnerships and and get agreements in place for our go tomarket is something that is the sort of step that we can face today and thatcan allow us to make meaningful progress toward milestones. It will getus closer to market and then, at the time when we have reached market havingthese relationships in place means that we are setting ourselves up for success,so I or as flow in the future right becausesales cycles and health care are so...

...long, and so, although you're notselling you're doing a lot of that relationship, building and and a valuevalidation. So that way, when you do get FDA clearance, you're, not startingthat eighteen month sale cycle right exactly exactly so josh. It's been agreat conversation. Thank you. So much for joining me today is there anythingelse that you would want to share with fellow innovators that are in thetrenches fighting their way through this health care maze yeah. Well, I think that it's anexciting fight to be a part of, and I know that it is it something that takes a lot of effort,and so I have a lot of respect for everyone out there, who's WHO's, tryingto make progress on on health, Carenova Tion, and I have found that many of theconversations I've had that have been most useful. I've been with otherhealth care innovators, either working through similar challenges oridentifying potential collaborations ideas to help each other out. I'd behappy for anyone to reach out to me. You can contact us. We have a contactform through our website, which is transformative dot AI. You can alsofind me on linked in so you know, please feel free to to reach out I'dlove, to learn from your experiences and eventually collaborate- and youknow I'm just really excited that. There's such a great community ofpeople out there in health care novation and it's a great to be a partof it awesome. Thank you so much all right. Thank you. Thank you. Roxy! It's been a pleasure. 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 APP 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, innovators, T T.

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