Health Innovators
Health Innovators

Episode 95 · 4 months 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, apodcast and video show about the leaders, influencers and early adopters who are shapingthe future of healthcare. I'm your host, Dr Roxy Movie. Welcome back tothe show health innovators. On today's episode we're sitting down with Dr JoshOppenheimer, who is the CO founder and CEO of transformative. Welcome to theshow, Dr Oppenheimer. Thanks so much. It's pleasure to be here. Great. So I always like to get give our guests an opportunity to kindof share a little bit about what they're innovating these days and how their backgroundor how they got started. Awesome. So I'm an emergency medicine physician andI still work at the hospital one or two shifts a week, but thething that I'm most passionate about is how healthcare is changing and going to changeover the next few decades and there's this huge opportunity around predictive medicine that weare very excited about. It transformative and I think is going to make amajor difference in the lives of patients. And the best way to think aboutit 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 verysick, whether they have a very bad blood stream infection or whether they arehaving a debilitating stroke or about heart attack, and the thing that I often thinkto myself is that I would have been able to do so much moreto help this patient if I were seeing them minutes ago, hours ago,days ago, depending on the particular patient situation. There are so many thingswhere 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 theopportunities of machine learning and wearables, we will reach the point where we canbe monitoring high risk patients for particular problems that could arise so that we canidentify when that patients about to get much worse and we can intervene earlier ata time when it's optimal to stabilize their body and their health. And thatwhole idea of being able to intervene earlier and be able to keep someone healthyrather than trying to get them healthy again after they get very sick, issomething that I just think is tremendously exciting and I think that with the thetechnologies that are already out there, we really have the potential to make thatreality, to make that idea come to reality. So that's what we're overallworking on with with transformative and very excited to get the chance to talk toyou 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 bitmore exciting industry to be in, you know, with all of the advancesthat have been accelerated, dude, with covid in, kind of just thea technology evolution that's happening. So so, tell us a little bit more aboutyou know, it sounds like this, this idea kind of came about fromyour personal experience in practicing medicine. But what was that what was thatcontemplation or what was kind of going on in your mind when you were consideringbecoming an entrepreneur versus maybe your original plan of being a physician? Sure,so, when I entered medical school, I already had the idea that Iwanted to have a career where I was combining clinical medicine with something else thatwould 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 continuedto feel that I wanted to have a sort of hybrid career and Iwas still not sure exactly what direction that should take, and I got someadvice from a number of mentors. I ultimately decided that I wanted to getan MBA partway through medical school and I went to the University of Cambridge outin the UK, in part because I...

...wanted to get exposure to a differentculture, a different health culture, with the NHS being totally different from theUS health system. And it was also nice because it was a one yearprogram is opposed to mainly to year programs in the US and and medical trainingis already long enough, so that was attractive as well. But I soI had the chance to go out to Cambridge and while I was there acouple 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. Inhealthcare. Never nothing is super fast, so relatively quickly is it's still onthe order of years, but it's still. Yeah, it's still a little biteasier to make major changes than in healthcare administration at a hospital level orin health policy at a National Inn in a national level, where where thingsreally move all 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 of Cambridge. who were you doing on the the cutting edge ofusing computers to generate insight out of out of data, and we were talkingabout the various directions that healthcare could take machine learning and we got really excitedabout the idea of predictive monitoring in particular, because we were looking at other companiesthat were out there in the the machine learning healthcare space and a lotof companies were focused on trying to get computers to do things that human physicianscould already do. So there are a lot of companies that look at theimage from a CT scan and try to make a diagnosis as well as ahuman radiologist can, or look at a picture of a rash and try tofigure 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 opportunitiesto expand healthcare to to more people with fewer physicians, it's still doesn't reallyfundamentally move the needle in terms of the possibility of healthcare and the the possibilitiesto transform health and where where you look at the predictive space, in theidea 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 reactswith people and the people can be empowered to take their life into their ownhands, and so that was a really exciting idea that we all coalust aroundthat there were some companies that were working on but fewer and we the nextquestion 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 cardiacarrest prediction and looking at continuous cardiac monitoring data from an ekg and predicting whena patient would have a deadly sudden cardiac arrest event. The papers that wereout there in the academic literature had looked at pretty small chunks of data fromfew patients for a short time periods and and often with relatively cleaner versions ofdata that had removed some of the complications of the messy real world. Sothey weren't quite clinical grade, but they were already showing the initial signals thatthere is something intrinsic in the heart that you could identify and that could signalthe patient was about to have a cardiac arrest. And so we thought thatif we could gather large amounts of data, do the hard work to build afunctioning algorithm that could predict cardiac arrest and we could prepare it for aclinical great technology, that we could actualize that vision and allow for the identificationof patients who were about to have the single deadliest health condition in the worldand allow for better care for those patient patients that they had a better chanceof 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 rightnow? Yeah, so we got started in late two thousand and sixteen andwe spent the initial few months building a prototype of the algorithm based on somepublicly 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 thatproof of concept that we were building an algorithm that they could make predictions andshow that it was better than some of the existing economic research. Then wewere able to get some initial funding from in health ventures, which is alarge 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 partof, entrepreneur first, based in London, and some Angel Investors, and thatgave us a little bit of starting capital to go out there and builda bigger database and be able to prove out the technology. And then overthe next couple of years we were able to go through a relatively long processof partnering with hospitals to be able to prospectively collect data from their patients whowere undergoing cardiac monitoring and, critically, have the nurses and doctors identify exactlywhen a patient had a cardiac arrest so that we could be absolutely sure thatwe were training an algorithm based on high quality data of which were the truepatients who have these events in which patients didn't. And then, once webuilt that database, we were able to build a better version of the algorithmprove out that that was making predictions accurately. And at the point where we wereable to show that, we were then able to get some additional fundingfrom the welcome trust out of the UK, as well as from some additional investorsout of the UK and Estonian and around the world, and with withthat 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 engagingwith 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 anumber of really key milestones over the last few years. I want to goback just a little bit to the fact that you kind of this hybrid modelof being an MD as well as getting an MBA. Do you think thatthat is going to be more common, or is it common now? Alot of the physician innovators that I've talked to over the years and even hadon this show, don't have a lot of business acumen, even though theyhave the medical experience, and a lot of times those ideas, similar toyou, are birth by the problems that they see right and frustrations that theyexperience with, you know, the issues around them, and so there seemsto be a slight disadvantage on one hand for them that they are trying tobuild a company and commercialize it, a lot of times where they're working fulltime as a doctor but without having the business acumen. Or sometimes I'll seethat they'll go back to school much later on when they decide that they wantto build a company and be an entrepreneur and go back to school and getan MBA. But you kind of had this foresight of being able to dothat really, really early in your career. So just kind of tell share withus about that. Sure. So I think that there are, asyou just put it out, there are so many different ways that you canbuild the skills that you need to be success us full, and I thinkthat there isn't necessarily a better or worse way of going about it. Ithink that for me, with the knowledge that I wanted to have a hybridcareer. It's sort of made sense to get as much training and knowledge andperspective in 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 I knowI 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 experienceand from conversations with with mentors and advisor. So I don't think it's essential byany 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 Ido think that it's it's helpful to have a sort of consolidated time where youare drinking from the water hose of business knowledge and research and being able tosort of immerge yourself in that world, in that thinking. So it's workedout really well for me. But I don't think that there's necessarily a betteror worse way to go about it. Yeah, I completely agree with youright. Entrepreneurship can be for almost anyone, if not everyone, in every path. I think each one of our journeys look really, really different andit's not necessarily wrong. So now, when a bounce forward to what youwere saying before, we used to kind of so casually talked about how andthen we went and we got data from these different health systems. And youknow that's not real easy. It's not like you're going to call or you'regoing 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 youwould have for other people in the audience today that are maybe experiencing some challengesor working through that phase right now? Sure, so, at this pointin time we have partnerships with a number of hospitals around the world and andEurope and North America and in Asia. But I'll maybe drilled down with thevery first hospital that we were able to get data from, since that's alwaysthe 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 wouldbe 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 ahospital in the NHS and we had a number of meetings with the numberof 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 lookinto 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 bothhave friends in Estonia and one of the Friends of one of my cofounders issomeone who had previously worked at North Estonia Medical Center, which is the thelargest hospital in Estonia, in their it department, and so she knew someof the people that we would have to work with in order to set upa prospective data collection partnership and she was able to introduce us to a cardiologistthere, and the cardiologist ended up being an incredible champion of ours internally tohelp 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 LauraCrundy, who had been previously at the hospital I t department and itdid sims moved on to a different company. She ended up joining transformative as anemployee, and having her on the ground and Talland to be able towork closely with the the people in the...

IT Department at the hospital to tomake sure that everything was moving forward ended up being an incredibly big advantage forus to have someone sort of on the ground who had experience at that hospitaland had existing relationships. And so between those different people who were helping usout there, we were able to get through the approval process and Estonia morequickly than we were able to anywhere else, and that allowed us to start collectingdata and allowed us to both start building the database with with longer termdata earlier and also make it easier for us to then go to subsequent hospitalsto be able to show them we've gone through this process, we know whatit entails, we know how to do it and we're able to both providea clearer map of what are all the steps that we need to do andalso give you the confidence that we're not figuring this out for the first timeourselves. Right, right. So a couple lessons I see in their one, have a network and be nice to them because you might need them oneday. Secure a champion within the health system, you know, probably asearly as possible, and keep that connection. And then, it sounds like thethird 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'sgoing to be able to, you know, maintain that productivity, that presents thatsense of urgency and being able to make things happen. I agree withall of those lessons and the only other one that I would add to thatlist 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 personor the one partner who ends up being really helpful, because you don't knowwhich 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 youare to make progress more quickly. Very, very important. So you touched onthe Estonia which I've been to Estonia, believe it or not, and thatis a beautiful, beautiful country. I went on a cruise and itjust was one of our stops and before that, honestly, I didn't evenknow that was a country. So but beautiful country. So talk a littlebit about the structure of your company between you know, US, the UK, Estonia and maybe any other locations that you have. Sure, so wehave. We initially started out as a UK company, since my two cofounderswere in the UK and we first start allowed as part of the entrepreneur firstincubator which is based in London, and from there we spent the initial periodof time with the just the UK company and then when we were pursuing thehospital partnership in Estonia and we were thinking about trying to bring on Laura asan employee based in Estonia, we realized that it would be a lot easyyear, just at a logistical and legal level, to set up an Estonianentity and have our Estonian based employee employed by that entity rather than try todo cross country employment, which ends up being a lot trickier. And sothat was just an organic process of wanting to be able to set up thatemployee in Estonia and then we spent the next few years with just the theUK and Estonian entities and then in summer two thousand and twenty we set upthe 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 ofthe company as a emergency medicine resident, and during that time period I wasa full time resident and spending the the bulk of my time in the hospitaland I was serving as the chief medical officer of Transformative, working on thatin bits and pieces when I when I had the time and what kind ofthings. You didn't sleep for four years.

I had a busy four years forsure, though, to be perfectly honest, emergency medicine the the majorityof our months are where you're spending sixty hours a week in the hospital andwhile that's busy, there are surgeons who spend eighty plus hours a week inthe hospital for their entire period. So I didn't even have it as badas 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 Britaancymedicine job where I was only working one or two chefs the week. That'swhen I had the opportunity to dedicate the majority of my time to the companyand 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 transitionthat we had been planning for a while. But at the point where I startedto draw a salary, at that point from the company, we allsimilarly 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 thosevarious 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 aswell. Yeah, Hey, it's Dr Roxy here with a quick breakfrom the conversation. Are you trying to figure out what moves you need tomake to survive and thrive in the new covid economy? I want every healthinnovator to find their most bable and profitable pivot strategy, which is why Icreated the covid proof your business pivot kit. The pivot kit is a step bystep framework that helps you find your best pivot strategy. It walks youthrough six categories you need to examine for a three hundred and sixty degree viewof your business. I call them the six critical pivot lenses. As youmake 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 missingout on critical details and opportunities. Learn more at legacy and DNACOM backslash kit. So, when it comes to those grants, is there anything that isjust really important as you've gone through that process, when you think about ouraudience being other innovators that are in the trenches that maybe looking at where they'regoing to get some funding, any any advice for them? So I thinkit really helps to be able to apply for a grant with a health systemas a partner and then be able to go to go to the grant funderand say that this startup company plus this health system are looking to collaborate ona particular project. That ends up being something that's a nice package to beable to offer, both because it provides that sort of private public blend andalso because it shows that you have a fair amount of validation at product marketfed at a time when you're not able to actually have customers or or tosort 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 arereally excited about the project willing to dedicate their own time and energy, andit goes a long way toward showing that you're building something that will be excitingfor your users. Great, that's awesome. So want to touch on software asa medical device, ESAMD is. This is something that we haven't reallytalked on the show a lot about. This is kind of a I wantto say unique but it's been around for a while now, but it's stillin its infancy, I think. What is it like bringing a software asa medical device to market compared to maybe...

...some of the other types of healthcareinnovations or digital health tools out there? What are some of the additional considerationsthat 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 meansthat software is a medical device, and so the exact same rules that theyhave set up for a physical product that is going to be used to treata medical condition all to 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 youare claiming you can do to help someone's health, you have evidence to supportthat. 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 interactwith your software, that they are able to do so in a waywhere it makes sense to the user and they're able to avoid major errors thatwould make the product dangerous. So it's it ends up being more similar toa 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 afrom a like a physical manufacturing perspective, though of course we also have toensure 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 youwould if you were selling the hardware yourself. It's just that we're not thinking throughthe design and manufacturing of the hardware piece. So what about do theCommercialization 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 youget 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 aplan for how your users are going to work with your software paired with thehardware and and make sure that it's something that's ultimately going to work for thoseand customers. And this is actually an area where in our journey we haveundergone a pretty large pivot. So when we started out, we thought thatwe would sell our software directly to hospitals with the idea that they could usetheir existing hardware, they could buy software directly from us. The software wouldbe compatible with the hardware. It would probably show alerts on a separate screenand it would allow for the hospitals to be able to take advantage of ourour software without having to use any different equipment. Yeah, and that strategyhad 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 withvarious stakeholders within hospital systems and we heard pretty consistently that they weren't that interestedand in building relationships with a bunch of software companies. So, from aprocurement perspective, they have existing relationships with the Phillips and the GE's of theworld on the device side, they have existing relationships with the epics and theSarners of the world on the electronic health record side, and they're not thatexcited about a future world in which they have to have a hundred different negotiationswith a hundred different software providers in order... provide a full fledged software ecosystemfor their hospital campuses. And so what they want to do is by softwareproducts through their existing vendor relationships. And so what we have pivoted toward isthe idea of partnering with those Patient Monitoring Companies and electronic health record companies tobe able to integrate our software and alerts into their software ecosystems so that fromthe user perspective it will feel largely like they are using a phillips product ora certainer product, whatever the case may be, but that from the technologyperspective, we're building that separately, we're building it compatible with with those otherproviders. And then at a sales level, the software gets purchased through either amarketplace that the technology company, the larger partner, sets up or itgets 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 theexisting relationships that those hospitals have with their existing vendors. And while that ithas complexities and it has tradeoffs, we ultimately have to listen to our customersand make sure we're creating a product that they want to use and also allowingfor a procurement process that they want to use to buy the product. Thatis huge, I mean that is the huge, huge learning. I'm justcurious how many conversations did you have before you really got to this Aha momentthat you really needed to pivot and Change Your Business Model in some of yourgo to market strategy hundreds. Yeah, yeah, it's I mean I thinkthat I talked about a lot about customer discovery on the show because I thinkthat it's so incredibly valuable, so foundational to commercial success and every guess kindof shares a little bit different their pathway or their journey, and so it'sjust 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, or were you just more black and white, like, note, we'rejust 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 hospitalsversus whether we should try to sell in partnership with with other collaborators was aquestion that we identified as sort of a key strategic question fairly early on inthe 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 beforeyou have a product ready to go. Yeah, and so we had identifiedthese two core options very early on. We had a pretty long list oftradeoffs 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 towardthe partnership model and it was a decision that we wrestled with for a longtime and I think that it's you know, I personally had the experience of havingspent a while, when we were fundraising, specifically making the argument forthe opposite case about this exact question and pointing out all the downsides the partnershipmodel 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 Ireally 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 wrongand 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 wewere hearing from from various stakeholders and the other challenges that this this is asort of tough question. It's not a slam dunk. That it's black andwhite ones. They obviously better option, and so even at the point wherewe are now sort of strongly pivoted in that direction, there are still timeswhen I talk to investors and they make the case to me for why weshould actually be going the opposite direction and why that would make more sense andthe 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'sjust the reality that when you have tough judgment calls to make him, whenyou're trying to make predictions about how the go to market strategy will play outat a time when you can't really test it, it's really challenging and youknow, going back to your question earlier about the realities of being a companywhere you know that you want to go through regulatory clearance and you know thatyou can't ultimately sell until you have gotten that approval, it means that youhave to speculate a bit about some of these odd decisions that you know aregoing to be essential but that you haven't actually faced, because by far thebest way for us to have tested out these hypotheses is to be actively tryingto sell into hospitals with with one approach, and to fail at doing that andthen say, okay, well, we've tried it, it didn't work, now we have to do the other thing, at a point where youhave to be trying to plan ahead and setting up partnerships and setting up customerdiscovery opportunities outside the sales cycle itself. It's a much more challenging process tolearn from and I think that for entrepreneurs who have the luxury of being ableto actually sell their product and they have the the opportunity to know what doesand doesn't work in a sales conversation, that that would be a much moreuseful approach and one that I I'm sort of jealous of. Right, right, yeah, exactly. And the amount of time that it takes, youknow. 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 oflike 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 persuadedall of your team, internal and external, to kind of get behind you andthis one strategy or with one plan, and now of a sudden you've gotto go, wait a minute, wait a minute, wait a minute, we changed our mind. Legitimate reason why, but right now I needto come back and I need to the wind is changed and now we gotto rally around this completely new strategy and direction, and I think that that'schallenging to do. Yeah, and I think that it's not the execution ofthat pivot that is the key, it's rather the culture that you've set upwithin the company. Yeah, so if if we had been operating under thetheory that we ought to be selling one way because that's what I say andthat's what the vision is of the company. It just sort of arbitrary, isthe case, then I think it would be more challenging to say,actually, we need to switch. But we as a team, we havea culture of humility and a culture of trying to be transparent about our decisionmakingand trying to be collaborate about our decisionmaking. So everyone was looking at the samedata 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 thiswas a conversation we'd had among our full team multiple times over the years andwe had another conversation with the whole team...

...about the the tradeoffs that we werefacing and we weigh them together and we, you know, as a team,we decided that it made more sense to make this this transition. Andso I think that when everyone is empowered to be part of that decisionmaking processand everyone's scrutinizing the data together and and playing devil's advocate to other and wedecide that it makes more sense to make a pivot, that that's a processthat everyone can get behind and be excited about and be an opportunity to actuallyincrease confidence that we're on a positive path rather than to be an opportunity toworry that we're on the wrong path. Yeah, yeah, and I thinkthat's so important and I want to just kind of stress that again, becausethere will be very likely and less your company is anomaly. The we manyother moments like that right. I mean it's any of our strategic plans arenot a one and done and and I think having the humility to be partof that culture. So we I think what you're saying is that when youcreate a culture, it makes it a little bit easier to have the humilityto be able to say that, you know, my opinions are relevant andhere's what the customer said. Customers rule, and so this is the direction thatwe're going and we may do this many more times and it doesn't meanthat 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 ofthe pre launch maybe strategies and tactics that you've may be considered or maybe implementedto kind of help validate your message, to build an email us to,you know, do any of these types of things, the things that youcan do before you get that a clearance. Sure. So I think that wehave taken the approach of primarily trying to partner with various organizations in waysthat we can do now, and so we are laying the groundwork for afuture 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 sortof building backwards from a sales generation perspective. Rather, what we're what we're doingis focusing on what are the opportunities we have today to partner with withvarious people who will ultimately be partners and customers, and figure out how wecan try to sort of sell these intermediate steps. So, from a hospitalperspective, we are still pitching hospitals on collaborations to gather additional data and tobe 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 bringhospitals on board to apply for grants in those various geographies has been something thatwe have been selling hospitals on. Today. We also have active engagement with thepatient monitoring companies and with electronic health record companies about potential collaborations to bringour product to market together. And even though we don't have something that's readyto sell today, we also know that this is a process that to doit right is going to take some planning and going to take both coordination onthe 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 inplace for our go to market is something that is the sort of step thatwe can face today and that can allow us to make meaningful progress toward milestonesthat will get us closer to market and then, at the time when wereached market, having these relationships in place means that we are are setting ourselvesup for success. So I ash flow in the future right, because thesales 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 thateighteen month sales cycle right, exactly, exactly. So, Josh, that'sbeen a great conversation. Thank you so much for joining me today. Isthere anything else that you would want to share with fellow innovators that are inthe trenches fighting their way through this healthcare maze? Yeah, well, Ithink that it's an exciting fight to be a part of and I know thatit is. It's it's it's something that takes a lot of effort and soI have a lot of respect for everyone out there who's who's trying to makeprogress on on healthcare innovation, and I have found that many of the conversationsI've had that have been most useful of been with other healthcare innovators, eitherworking 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 freeto reach out. I'd love to learn from your experiences and to eventuallycollaborate and you know, I'm just really excited that there's such a great communityof people out there in healthcare innovation 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 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 colleague. See You on the next episode ofHealth Innovators.

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