Health Innovators
Health Innovators

Episode 95 · 1 year ago

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


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, or you can find him on LinkedIn at Josh Oppenheimer, MD, MBA.

You're listening to health innovators, a podcast and video show about the leaders, influencers and early adopters who are shaping the future of healthcare. I'm your host, Dr Roxy Movie. Welcome back to the show health innovators. 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, Dr Oppenheimer. Thanks so much. It's pleasure to be here. Great. So I always like to get give our guests an opportunity to kind of share a little bit about what they're innovating these days and how their background or how they got started. Awesome. So I'm an emergency medicine physician and I still work at the hospital one or two shifts a week, but the thing that I'm most passionate about is how healthcare is changing and going to change over the next few decades and there's this huge opportunity around predictive medicine that we are very excited about. It transformative and I think is going to make a major difference in the lives of patients. And the best way to think about it is from the perspective of what I do when I'm at the hospital, so I often have a patient who I'm taking care of who is already very sick, whether they have a very bad blood stream infection or whether they are having a debilitating stroke or about heart attack, and the thing that I often think to myself is that I would have been able to do so much more to help this patient if I were seeing them minutes ago, hours ago, days ago, depending on the particular patient situation. There are so many things where you could have this patient's health dramatically better if we would have intervened earlier, and I think that we're reaching a point where, when you combine the opportunities of machine learning and wearables, we will reach the point where we can be monitoring high risk patients for particular problems that could arise so that we can identify when that patients about to get much worse and we can intervene earlier at a time when it's optimal to stabilize their body and their health. And that whole idea of being able to intervene earlier and be able to keep someone healthy rather than trying to get them healthy again after they get very sick, is something that I just think is tremendously exciting and I think that with the the technologies that are already out there, we really have the potential to make that reality, to make that idea come to reality. So that's what we're overall working on with with transformative and very excited to get the chance to talk to you about that today. Yeah, absolutely, I mean I agree with you. I think there's no better time to be in healthcare and there's no bit more exciting industry to be in, you know, with all of the advances that have been accelerated, dude, with covid in, kind of just the a technology evolution that's happening. So so, tell us a little bit more about you know, it sounds like this, this idea kind of came about from your personal experience in practicing medicine. But what was that what was that contemplation or what was kind of going on in your mind when you were considering becoming an entrepreneur versus maybe your original plan of being a physician? Sure, so, when I entered medical school, I already had the idea that I wanted to have a career where I was combining clinical medicine with something else that would be focused on improving the health system at a larger scale, and I wasn't quite sure what direction that would take. Part Way through medical school I continued to feel that I wanted to have a sort of hybrid career and I was still not sure exactly what direction that should take, and I got some advice from a number of mentors. I ultimately decided that I wanted to get an MBA partway through medical school and I went to the University of Cambridge out in the UK, in part because I...

...wanted to get exposure to a different culture, a different health culture, with the NHS being totally different from the US health system. And it was also nice because it was a one year program is opposed to mainly to year programs in the US and and medical training is already long enough, so that was attractive as well. But I so I had the chance to go out to Cambridge and while I was there a couple things happened. First, I fell in love with the idea of entrepreneurship, in particular because it's an area where you can move relatively quickly. In healthcare. Never nothing is super fast, so relatively quickly is it's still on the order of years, but it's still. Yeah, it's still a little bit easier to make major changes than in healthcare administration at a hospital level or in health policy at a National Inn in a national level, where where things really move all the course of decades. And so entrepreneurship was very exciting as an idea, but I still wasn't sure exactly what direction I wanted to take it. And then I had the chance to meet some really cool machine learning researchers out of Cambridge. who were you doing on the the cutting edge of using computers to generate insight out of out of data, and we were talking about the various directions that healthcare could take machine learning and we got really excited about the idea of predictive monitoring in particular, because we were looking at other companies that were out there in the the machine learning healthcare space and a lot of companies were focused on trying to get computers to do things that human physicians could already do. So there are a lot of companies that look at the image from a CT scan and try to make a diagnosis as well as a human radiologist can, or look at a picture of a rash and try to figure out, wow, what that is as well as a dermatologist can. And while there are certainly major efficiency gains you can achieve through that and opportunities to expand healthcare to to more people with fewer physicians, it's still doesn't really fundamentally move the needle in terms of the possibility of healthcare and the the possibilities to transform health and where where you look at the predictive space, in the idea that you can take monitoring data and predict an event in the future, that actually gives you the opportunity to change the way that the health can reacts with people and the people can be empowered to take their life into their own hands, and so that was a really exciting idea that we all coalust around that there were some companies that were working on but fewer and we the next question was identifying what would be our first product that we would try to build, and there were some researchers that had already looked at the problem of cardiac arrest prediction and looking at continuous cardiac monitoring data from an ekg and predicting when a patient would have a deadly sudden cardiac arrest event. The papers that were out there in the academic literature had looked at pretty small chunks of data from few patients for a short time periods and and often with relatively cleaner versions of data that had removed some of the complications of the messy real world. So they weren't quite clinical grade, but they were already showing the initial signals that there is something intrinsic in the heart that you could identify and that could signal the patient was about to have a cardiac arrest. And so we thought that if we could gather large amounts of data, do the hard work to build a functioning algorithm that could predict cardiac arrest and we could prepare it for a clinical great technology, that we could actualize that vision and allow for the identification of patients who were about to have the single deadliest health condition in the world and allow for better care for those patient patients that they had a better chance of surviving, and a better chance of surviving with good brand function. Sure, yeah, I mean it's awesome.

Can't wait till it's here right. So So, speaking of that, where are you in the innovation process right now? Yeah, so we got started in late two thousand and sixteen and we spent the initial few months building a prototype of the algorithm based on some publicly available databasis, and when I say me I'm actually referring to my cofounders. I don't do any coding myself. But we first had to develop that proof of concept that we were building an algorithm that they could make predictions and show that it was better than some of the existing economic research. Then we were able to get some initial funding from in health ventures, which is a large private health system in the UK. They have a strategic investment arm, so they invested in us, as well as an incubator that we were part of, entrepreneur first, based in London, and some Angel Investors, and that gave us a little bit of starting capital to go out 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 of partnering with hospitals to be able to prospectively collect data from their patients who were undergoing cardiac monitoring and, critically, have the nurses and doctors identify exactly when a patient had a cardiac arrest so that we could be absolutely sure that we were training an algorithm based on high quality data of which were the true patients who have these events in which patients didn't. And then, once we built that database, we were able to build a better version of the algorithm prove out that that was making predictions accurately. And at the point where we were able to show that, we were then able to get some additional funding from the welcome trust out of the UK, as well as from some additional investors out of the UK and Estonian and around the world, and with with that funding, we're now in the process of preparing our software for commercialization, so preparing the final version for regulatory approvals and, at the same time engaging with various commercial partners who will work with to bring the software to market. So very exciting journey. It's great to see that you guys have hit a number of really key milestones over the last few years. I want to go back just a little bit to the fact that you kind of this hybrid model of being an MD as well as getting an MBA. Do you think that that is going to be more common, or is it common now? A lot of the physician innovators that I've talked to over the years 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 those ideas, similar to you, are birth by the problems that they see right and frustrations that they experience with, you know, the issues around them, and so there seems to be a slight disadvantage on one hand for them that they are trying to build a company and commercialize it, a lot of times where they're working full time as a doctor but without having the business acumen. Or sometimes I'll see that they'll go back to school much later on when they decide that they want to build a company and be an entrepreneur and go back to school and get an MBA. But you kind of had this foresight of being able to do that really, really early in your career. So just kind of tell share with us 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 need to be success us full, and I think that there isn't necessarily a better or worse way of going about it. I think that for me, with the knowledge that I wanted to have a hybrid career. It's sort of made sense to get as much training and knowledge and perspective in as early as I could in my career so that I could try to leverage that and then get started with...

...the the work that I was most excited about early and I think that from the MBA experience there were I know I had some phenomenal classmates from around the world and I had some phenomenal professors. I think that most of the material in an MBA program isn't super complicated. It's stuff that you can learn either from the classroom or from life experience and from conversations with with mentors and advisor. So I don't think it's essential by any means to go through that type of training program to be an entrepreneurn. I think I very well could have pursued entrepreneurship without an MBA but I do think that it's it's helpful to have a sort of consolidated time where you are drinking from the water hose of business knowledge and research and being able to sort of immerge yourself in that world, in that thinking. So it's worked out really well for me. But I don't think that there's necessarily a better or worse way to go about it. Yeah, I completely agree with you right. Entrepreneurship can be for almost anyone, if not everyone, in every path. I think each one of our journeys look really, really different and it's not necessarily wrong. So now, when a bounce forward to what you were saying before, we used to kind of so casually talked about how and then we went and we got data from these different health systems. And you know that's not real easy. It's not like you're going to call or you're going to email someone and say, Hey, can I get access to your data? So what was that like and what are some of the recommendations you would have for other people in the audience today that are maybe experiencing some challenges or working through that phase right now? Sure, so, at this point in time we have partnerships with a number of hospitals around the world and and Europe and North America and in Asia. But I'll maybe drilled down with the very first hospital that we were able to get data from, since that's always the biggest challenge and for for us we had to think about who were we, what advantages did we have that that other people may not and what would be the sort of easiest path for us, and so we first were thinking that, since we were in the UK, we would try to work with a hospital in the NHS and we had a number of meetings with the number of folks 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 into hospitals in Estonia, and the reason for that is that my two cofounders, marks Randy and Mark Ray, are both Estonian by nationality and they both have friends in Estonia and one of the Friends of one of my cofounders is someone who had previously worked at North Estonia Medical Center, which is the the largest hospital in Estonia, in their it department, and so she knew some of the people that we would have to work with in order to set up a prospective data collection partnership and she was able to introduce us to a cardiologist there, and the cardiologist ended up being an incredible champion of ours internally to help sort of navigate the back end bureaucracy to get all the approvals in place. And then a little bit later on, the the friend of my cofounder Laura Crundy, who had been previously at the hospital I t department and it did sims moved on to a different company. She ended up joining transformative as an employee, and having her on the ground and Talland to be able to work closely with the the people in the...

IT Department at the hospital to to make sure that everything was moving forward ended up being an incredibly big advantage for us to have someone sort of on the ground who had experience at that hospital and had existing relationships. And so between those different people who were helping us out there, we were able to get through the approval process and Estonia more quickly than we were able to anywhere else, and that allowed us to start collecting data and allowed us to both start building the database with with longer term data earlier and also make it easier for us to then go to subsequent 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 a clearer map of what are all the steps that we need to do and also give you the confidence that we're not figuring this out for the first time ourselves. Right, right. So a couple lessons I see in their one, have a network and be nice to them because you might need them one day. Secure a champion within the health system, you know, probably as early as possible, and keep that connection. And then, it sounds like the third one that kind of comes to mind is what you touched on, is that if you can have someone that's boots on the ground, that that's going to be able to, you know, maintain that productivity, that presents that sense of urgency and being able to make things happen. I agree with all of those lessons and the only other one that I would add to that list is the importance of not trying to approach one partner at a time, but simultaneously trying to engage with as many people who could be the one person or the one partner who ends up being really helpful, because you don't know which of these relationships, in which of these possibilities are going to work out. So the more you can be pursuing at once, the more likely you are to make progress more quickly. Very, very important. So you touched on the Estonia which I've been to Estonia, believe it or not, and that is a beautiful, beautiful country. I went on a cruise and it just was one of our stops and before that, honestly, I didn't even know that was a country. So but beautiful country. So talk a little bit about the structure of your company between you know, US, the UK, Estonia and maybe any other locations that you have. Sure, so we have. We initially started out as a UK company, since my two cofounders were in the UK and we first start allowed as part of the entrepreneur first incubator which is based in London, and from there we spent the initial period of time with the just the UK company and then when we were pursuing the hospital partnership in Estonia and we were thinking about trying to bring on Laura as an employee based in Estonia, we realized that it would be a lot easy year, just at a logistical and legal level, to set up an Estonian entity and have our Estonian based employee employed by that entity rather than try to do cross country employment, which ends up being a lot trickier. And so that was just an organic process of wanting to be able to set up that employee in Estonia and then we spent the next few years with just the the UK and Estonian entities and then in summer two thousand and twenty we set up the US entity, at the time when I was ready to join the company full time. So I had spent the the first four years or so of the company as a emergency medicine resident, and during that time period I was a full time resident and spending the the bulk of my time in the hospital and I was serving as the chief medical officer of Transformative, working on that in bits and pieces when I when I had the time and what kind of things. You didn't sleep for four years.

I had a busy four years for sure, though, to be perfectly honest, emergency medicine the the majority of our months are where you're spending sixty hours a week in the hospital and while that's busy, there are surgeons who spend eighty plus hours a week in the hospital for their entire period. So I didn't even have it as bad as as some residents who weren't trying to start a business. But the yeah, the the amount of time I had for the business was more limited, and so when I finished up residency and I was able to get a Britaancy medicine job where I was only working one or two chefs the week. That's when I had the opportunity to dedicate the majority of my time to the company and to join full time. I then switched over with my my partner mark, who had been the CEO. He switched over to the CTO role. I switched from Geo Medical Officer to CEO and that was a very natural transition that we had been planning for a while. But at the point where I started to draw a salary, at that point from the company, we all similarly wanted to set up a US entity, and the other advantage, beyond employment, is also that it makes it easier to apply for grants and those various geographies. So we initially be able to get some grants from the UK, but we're now in a position where we can get grants from the UK, from the EU and from the US, which which is certainly helps out as well. Yeah, 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 bable 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 and DNACOM backslash kit. So, when it comes to those grants, is there anything that is just really important as you've gone through that process, when you think about our audience being other innovators that are in the trenches that maybe looking at where they're going to get some funding, any any advice for them? So I think it really helps to be able to apply for a grant with a health system as a partner and then be able to go to go to the grant funder and say that this startup company plus this health system are looking to collaborate on a particular project. That ends up being something that's a nice package to be able to offer, both because it provides that sort of private public blend and also because it shows that you have a fair amount of validation at product market fed at a time when you're not able to actually have customers or or to sort of show that you are building something that people are are actively buying, if you can at least show that the people who would be the users are really excited about the project willing to dedicate their own time and energy, and it goes a long way toward showing that you're building something that will be exciting for your users. Great, that's awesome. So want to touch on software as a medical device, ESAMD is. This is something that we 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 market compared to maybe...

...some of the other types of healthcare innovations or digital health tools out there? What are some of the additional considerations that you've had to think through and part make part of your commercialization process. 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 means that software is a medical device, and so the exact same rules that they have set up for a physical product that is going to be used to treat a medical condition all to apply to software that doesn't have a hardware component that is also being used to treat a medical condition. And so what regulators want to see our number one, evidence that the product works and that whatever you are claiming you can do to help someone's health, you have evidence to support that. And number two, they want to see that the software works, and so you have to have human factors, engineering research showing that when users interact with your software, that they are able to do so in a way where it makes sense to the user and they're able to avoid major errors that would make the product dangerous. So it's it ends up being more similar to a physical product than different. From a regulatory perspective and from a development perspective, it simply means that we have some fewer elements to think about from a from a like a physical manufacturing perspective, though of course we also have to ensure that we integrate with real hardware devices. And so from a product perspective, we have to do as much work at the hardware software interface as you would if you were selling the hardware yourself. It's just that we're not thinking through the design and manufacturing of the hardware piece. So what about do the Commercialization Lens? What are some of the things that you can or can't do, that you may or may not want to do right now and if you get FDA clearance and just kind of those those that pre launch expectation and reality. So from a commercial perspective it also means that you have to have a plan for how your users are going to work with your software paired with the hardware and and make sure that it's something that's ultimately going to work for those and customers. And this is actually an area where in our journey we have undergone a pretty large pivot. So when we started out, we thought that we would sell our software directly to hospitals with the idea that they could use their existing hardware, they could buy software directly from us. The software would be compatible with the hardware. It would probably show alerts on a separate screen and it would allow for the hospitals to be able to take advantage of our our software without having to use any different equipment. Yeah, and that strategy had certain advantages in terms of maintaining profit and maintaining control over the sales cycle. But the major downside was that we had lots and lots of conversations with various stakeholders within hospital systems and we heard pretty consistently that they weren't that interested and in building relationships with a bunch of software companies. So, from a procurement perspective, they have existing relationships with the Phillips and the GE's of the world on the device side, they have existing relationships with the epics and the Sarners of the world on the electronic health record side, and they're not that excited about a future world in which they have to have a hundred different negotiations with a hundred different software providers in order... provide a full fledged software ecosystem for their hospital campuses. And so what they want to do is by software products through their existing vendor relationships. And so what we have pivoted toward is the idea of partnering with those Patient Monitoring Companies and electronic health record companies to be able to integrate our software and alerts into their software ecosystems so that from the user perspective it will feel largely like they are using a phillips product or a certainer product, whatever the case may be, but that from the technology perspective, we're building that separately, we're building it compatible with with those other providers. And then at a sales level, the software gets purchased through either a marketplace that the technology company, the larger partner, sets up or it gets licensed from transformative to that partner and then that partner cells into the hospital. But either way it ends up being a little bit more integrated into the existing relationships that those hospitals have with their existing vendors. And while that it has complexities and it has tradeoffs, we ultimately have to listen to our customers and make sure we're creating a product that they want to use and also allowing for a procurement process that they want to use to buy the product. That is huge, I mean that is the huge, huge learning. I'm just curious how many conversations did you have before you really got to this Aha moment that you really needed to pivot and Change Your Business Model in some of your go to market strategy hundreds. Yeah, yeah, it's I mean I think that I talked about a lot about customer discovery on the show because I think that it's so incredibly valuable, so foundational to commercial success and every guess kind of shares a little bit different their pathway or their journey, and so it's just a great conversation to have. What was that like for you when you were kind of faced with that data? Did you wrestle with making that change, or were you just more black and white, like, note, we're just going to make that change. So it was a much more gradual process. The sort of strategic decision of whether we should try to sell into hospitals versus whether we should try to sell in partnership with with other collaborators was a question that we identified as sort of a key strategic question fairly early on in the process, and especially at the point where we were talking to investors. They wanted to know what your go to market strategy as, even way before you have a product ready to go. Yeah, and so we had identified these two core options very early on. We had a pretty long list of tradeoffs between the two and then the various risks and benefits to each approach, and it was a gradual process of deciding that the scale ended up tipping toward the partnership model and it was a decision that we wrestled with for a long time and I think that it's you know, I personally had the experience of having spent a while, when we were fundraising, specifically making the argument for the opposite case about this exact question and pointing out all the downsides the partnership model and all the advantages of the the model where we maintain this as ourselves. And so that's the reality of what this journey is like. So I really appreciate you being so candid about it. Yeah, so, you know, to to get to the point where...

...we convinced ourselves that we've been wrong and convinced ourselves that the the counterargument was actually better than the initial strategy, it took a combination of openmindedness, humility and also consistency from from what we were hearing from from various stakeholders 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. They obviously better option, and so even at the point where we are now sort of strongly pivoted in that direction, there are still times when I talk to investors and they make the case to me for why we should actually be going the opposite direction and why that would make more sense and the downsides to the approach of partnership and the risks of that entails. So, you know, I don't know ironic for you know, I think it's just the reality that when you have tough judgment calls to make him, when you're trying to make predictions about how the go to market strategy will play out at a time when you can't really test it, it's really challenging and you know, going back to your question earlier about the realities of being a company where you know that you want to go through regulatory clearance and you know that you can't ultimately sell until you have gotten that approval, it means that you have to speculate a bit about some of these odd decisions that you know are going to be essential but that you haven't actually faced, because by far the best way for us to have tested out these hypotheses is to be actively trying to sell into hospitals with with one approach, and to fail at doing that and then say, okay, well, we've tried it, it didn't work, now we have to do the other thing, at a point where you have to be trying to plan ahead and setting up partnerships and setting up customer discovery opportunities outside the sales cycle itself. It's a much more challenging process to learn from and I think that for entrepreneurs who have the luxury of being able to actually sell their product and they have the the opportunity to know what does and doesn't work in a sales conversation, that that would be a much more useful approach and one that I I'm sort of jealous of. Right, right, yeah, exactly. And the amount of time that it takes, you know. So I see you as the CEO, the leader of the organization, and you know the you're the one you know with your cofounders as well. You know what. You're the one that's kind of steering the ship of like rallying all of your team members around the specific vision for your commercialization strategy, as well as your investors and your advisors. Right, so you've persuaded all of your team, internal and external, to kind of get behind you and this one strategy or with one plan, and now of a sudden you've got to go, wait a minute, wait a minute, wait a minute, we changed our mind. Legitimate reason why, but right now I need to come back and I need to the wind is changed and now we got to rally around this completely new strategy and direction, and I think that that's challenging to do. Yeah, and I think that it's not the execution of that pivot that is the key, it's rather the culture that you've set up within the company. Yeah, so if if we had been operating under the theory that we ought to be selling one way because that's what I say and that's what the vision is of the company. It just sort of arbitrary, is the case, then I think it would be more challenging to say, actually, we need to switch. But we as a team, we have a culture of humility and a culture of trying to be transparent about our decisionmaking and trying to be collaborate about our decisionmaking. So everyone was looking at the same data together and it wasn't that I came into a team meeting and said, Hey, we're actually going to make this majior switch. It's that this was a conversation we'd had among our full team multiple times over the years and we had another conversation with the whole team...

...about the the tradeoffs that we were facing and we weigh them together and we, you know, as a team, we decided that it made more sense to make this this transition. And so I think that when everyone is empowered to be part of that decisionmaking process and everyone's scrutinizing the data together and and playing devil's advocate to other and we decide that it makes more sense to make a pivot, that that's a process that everyone can get behind and be excited about and be an opportunity to actually increase confidence that we're on a positive path rather than to be an opportunity to worry that we're on the wrong path. Yeah, yeah, and I think that's so important and I want to just kind of stress that again, because there will be very likely and less your company is anomaly. The we many other moments like that right. I mean it's any of our strategic plans are not a one and done and and I think having the humility to be part of that culture. So we I think what you're saying is that when you create a culture, it makes it a little bit easier to have the humility to be able to say that, you know, my opinions are relevant and here's what the customer said. Customers rule, and so this is the direction that we're going and we may do this many more times and it doesn't mean that we don't know what we're doing or that we're just, you know, changing with the wind. There's like would your decisions are really grounded in data? I think that's right. Yeah, yeah, so talk about some of the pre launch maybe strategies and tactics that you've may be considered or maybe implemented to kind of help validate your message, to build an email us to, you know, do any of these types of things, the things that you can do before you get that a clearance. Sure. So I think that we have taken the approach of primarily trying to partner with various organizations in ways that we can do now, and so we are laying the groundwork for a future commercial 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 of building backwards from a sales generation perspective. Rather, what we're what we're doing is focusing on what are the opportunities we have today to partner with with various people who will ultimately be partners and customers, and figure out how we can try to sort of sell these intermediate steps. So, from a hospital perspective, we are still pitching hospitals on collaborations to gather additional data and to be able to execute pilots when we have the technology in place to do so, in the funding and place to do so, and so trying to bring hospitals on board to apply for grants in those various geographies has been something that we have been selling hospitals on. Today. We also have active engagement with the patient monitoring companies and with electronic health record companies about potential collaborations to bring our product to market together. And even though we don't have something that's ready to sell today, we also know that this is a process that to do it right is going to take some planning and going to take both coordination on the engineering and technical level, but also coordination on the sales and commercial level. So trying to set up some of these partnerships and and get agreements in place for our go to market is something that is the sort of step that we can face today and that can allow us to make meaningful progress toward milestones that will get us closer to market and then, at the time when we reached market, having these relationships in place means that we are are setting ourselves up for success. So I ash flow in the future right, because the sales cycles and healthcare are so long,...

...and so although you're not selling, you're doing a lot of that relationship building and in and a value validation, so that way, when you do get FDA clearance, you're not starting that eighteen month sales cycle right, exactly, exactly. So, Josh, that's been a great conversation. Thank you so much for joining me today. Is there anything else that you would want to share with fellow innovators that are in the trenches fighting their way through this healthcare maze? Yeah, well, I think that it's an exciting fight to be a part of and I know that it is. It's it's it's something that takes a lot of effort and so I have a lot of respect for everyone out there who's who's trying to make progress on on healthcare innovation, and I have found that many of the conversations I've had that have been most useful of been with other healthcare innovators, either working through similar challenges or identifying potential collaborations ideas to help each other out. I'd be happy for anyone to reach out to me. You can contact us. We have a contact form through our website, which is transformative dot AI. You can also find me on Linkedin, so you know, please feel free to reach out. I'd love to learn from your experiences and to eventually collaborate and you know, I'm just really excited that there's such a great community of people out there in healthcare innovation and it's a great to be a part of 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 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 colleague. See You on the next episode of Health Innovators.

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