Wayne, great to talk with you. Can you start off by telling us about iTriage – who uses the service and why? 

iTriage provides users with a symptom to provider pathway, giving them information on thousands of symptoms, diseases and medical procedures and directing them to the correct provider whatever their problem. We’re primarily a mobile app – we have apple and android apps – but we’re also on the web and we have microsites on other portals. Our users can check in to ERs and see the waiting times, which are fed to us via an RSS feed every 30 minutes so they’re kept updated. They can also make appointments. We also have a big database of medications. Users can look at side effects, doses, who prescribes those meds… and find out information such as side effects. We also have a pharmacy discount card. Now we make it possible for users to create a profile and log in and save their information to the cloud. It’s HIPAA secure, just like a personal health record. When users log in, based on their personal information, including their insurance company, the datasets change. It can tell you if you’re in or out of network and whether you should be pointed to a particular nurse advice line for example.

So what led you to found the company?

I co-founded the company with Peter Hudson. We were both physicians working in the ER at the time. We had extensive experience as emergency doctors and were frustrated that patients didn’t have the information they needed to make the best decisions for themselves. We saw a way to empower patients and make the system more efficient, leading the patient to the right care for both treatment and follow up.
We saw a real need to provide a symptom to provider pathway – based on the symptoms and causes we wanted to help people learn where’s the best place to go to seek care. The truth is, 20-70% of ER visits could be dealt with in a lower level of care. For the payer and employers this is costly. On the other hand, we knew that some things, like an MI or stroke, were going to a lower level of care than they should. I had friends who were smart people but didn’t know where to go and they would ask me, “Can I go to an urgent care center for this?” or “Can I go to a retail clinic?” They don’t know the answer. Again, after being seen in the ER, patients would often say to me “Doctor, could I have gone to an urgent care clinic for this?” There was a need for this information from multiple side – patients, providers, payers and employers. There’s an information gap that we’re trying to close.

How did you get started – did you launch the company whilst still practising as physicians?

We started in September 2008. We got things off the ground by writing our own information for the app – just enough for users of the app to make the next best decision. At the time we were ER doctors. Over here, a full time post in the ER is 14 to 16 days per month so we had time outside our shifts to do it. But yes, we were still were working while doing this.

How about fundraising – how much did you have to raise and at what points along the way?

We raised enough money in 10 days to give us a 9-12 month runway. We had previous business experience in a range of areas and our investors knew us and things we had done before so they had faith in us and liked what we were doing and believed we could achieve the goal. Then we brought on more money at different stages. We always used the money well, had milestones we planned to reach and could show our investors we had reached them. We went to them with more milestones and a plan. Over 3 rounds we raised a total of around $4m. We had angels and high net worth individuals come on board with amounts of $25,000 to $50,000. We then had strategic investors and sophisticated NYC angels and we were then bought by Aetna.

What’s your business model?

We partner with providers – health care organisations. Our provider partners pay an annual fee  and we list ERs, urgent care centres, retail clinics and so forth.  Physicians also pay a fee to be listed. The providers might be a specialist provider in specific fields – trauma care for example – and it’s really good for them to be able to reach potetntial customers looking for the expertise they can provide.  Nowadays an ACO might come on board and make a thousand listings at a time. We also work with health plans. We’re free to the consumer though – our apps are free to download and we’ve had 8 and a half million downloads to date and we have 3-4 million active users each month.

What’s been the biggest challenge for you as a company?

The biggest challenge has been finding good people. We don’t code. We wish we did! Also, building awareness and marketing. In the early stages, trying to create a market and recognition of the need. We had to create a whole new market. It was tough convincing providers they could bring in new patients using a mobile app – we had to create that need and then sell the product as a solution to that need. So that was an uphill struggle from the beginning. It’s much easier now though because every single report on mobile shows you have to do mobile. That was not true back in 2009.

What do you feel have been some of the key factors in your success as a company?

In the design of any product the user always has to come first. So we only show people in context, whether a spinal surgeon or a medical device company, we only show you that information if you’ve asked for it. We defend that user experience tooth and nail and we’ve done that from the very beginning, that’s sort of my job and that’s continued to be really really fruitful for us.

In the beginning we created some personas. We thought to ourselves, “Who is going to use iTriage?”. So we thought business travellers would, we thought busy moms would, we thought the invincibles would (our name for the millennials), the people that were very under-insured, young, tended to have smartphones, maybe even had no insurance so they wanted to find an urgent care if they could as they’re maybe paying all their healthcare expenses out of pocket. Also, people who are interested in patient empowerment and consumer engagement. So then we found a list of blogs, about 300 bloggers, blogging on this, and we would comment on articles. We would spend time and do it in a very thoughtful way and mention iTriage. And we had about a 10% pickup rate where the authors wrote back and were interested in reviewing the product and we would do a demo for them. So that was really great for us. It doesn’t cost you any money. It’s a lot of work but worth it. We were once in the first couple of comments in a New York Times article that was shared many many times and we got a lot of press for that. We reached out to reporters and befriended them. From very early on those people started writing about us, as a nascent company, so we built up those relationships. We made good relationships with Apple and Android and showed them, hey, this isn’t a game. This is something people are using to make healthcare decisions. We’ve been featured in those markets and that’s been great. We look forward to continuing to have those relationships.

You’re a business where one set of users relies upon another set of users to provide value – i.e. a business with network effects – so how did you solve that chicken or egg problem?

Each health system we signed on, we’d have a marketing plan for them. We’d market the application for them. They’d embrace it as their own app. They’d do billboards showing their ER wait times. Showing they could do them on the phone. We’d get on local news as it was a really interesting topic… two doctors created this application. I still go on the news every month or so. Sometimes about medical topics like getting a flu shot, sometimes about iTriage. The more awareness the more click rates. So we would build awareness in every health system and that would bring more users to the app.

You’re currently hugely popular in the USA. How do you think iTriage will work outside the US… in the UK for example?

So we recognise that that’s something we could work more on in the future. The app has to be localised – the names of medicine have to be changed for other localities for example. We have talked to people in the UK. It’s tricky. It’s likely to be more of the fee-for-service, pay-per-user model at the outset but I think there’s a lot we could do for the NHS too. To some extent the incentives have to change. If you can shift a population from going to A&E to instead seeing their GP, that’s worthwhile. But the incentives aren’t always there. That said, even just the content we provide can help enormously. Helping people organize their thoughts around a symptom and then deciding where is the place to go. A lot of times NHS patients are going to A&E just because they don’t really know better.

If you could change one thing about how you’ve managed the business since you launched, what would it be?

Well… we’re just about ready to put out multi-symptom processors which will allow us to also get some demographic information – “I’m a male or female”, “I’m 5 years old” (if someone’s searching for a child) for example, and then add symptoms. I’m ‘Q-A’ing’ it with the medical team right now and I’m really excited about it. It’ll be out in an update really soon. We do a lot of updates – please download it and look at it, I’d love to get your opinion on it. So if I could change one thing…  I would have done that a lot earlier.

What led you to make that decision – to add that update?

We have 75,000 reviews on the iPhone and Android market and we’ve used those reviews to build new features and that’s been a persistent request for a long time. But the reason we haven’t done it is that we didn’t have  a framework for doing it correctly. We didn’t want to just fake it – what we’re using is CDC biosurveillance data which represents millions of visits and then using the probability of a symptom related to a disease, basing it on statistics, and its really kind of cool. We have some very very smart people that understand machine learning and statistics that are helping us build that. So, we wanted to build it correctly, but I would have done that much much earlier. I would have said, “Guys we’ve got to figure this out… we’ve got to do this right now!”

So, you’re personalizing the advice based on demographics?

Yes, but also on a couple of symptoms. Because if you have that cough, do you also have a fever? Because maybe that cough’s allergy-related or from gastro-oesophageal reflux. So whether you have a fever or not really changes the lists of things.  We’re certainly not diagnosing anyone, because we don’t do that, that would take much more complex technology, a Watson-like technology.

Yes, well I work in exactly that area, diagnosis support, so its very interesting to me. It’s a challenging area though.

Yes, it is. It’s complex. Because how do you weight a symptom? What I’ll do. Well, all providers do it, is I’ll ask, if someone tells me they have a cough, and then they say they have a headache, I ask them, “Well how bad’s your headache?”. And if they say, “oh, not that bad’, well then I don’t even bring that into the calculation. That’s just a red herring. But, when you’re doing it on a machine, you could do a scale – how significant is the cough or the headache? – but then the complexity of the technology to do that, it gets interesting, but it gets very complex. The number of pathways that you have to QA for that is mind-boggling.

Anyhow… I would have loved to have done this earlier and I can’t wait for it to come out as it’s one of our biggest requests.

What would be your advice to  medics who are looking into taking an entrepreneurial path?

So, I think it shouldn’t be a passing fancy. Peter and I HAD to do this. Once we got started we lived and breathed it. I couldn’t wait to wake up and look at the emails. I drove people crazy with my iPhone – I was looking at my iPhone even as I went to bed. And they were never emails saying “you’ve done a really good job Wayne, have a nice sleep”! It was always a problem. But I wanted to be able to think about it, work on it at that time. So, I think, if you have a good idea, I would do some basic analysis on it – Is it marketable? How big’s the market? And then you should do it because you have to do it. And then, be flexible, because you might have to change your path. Your business plan and ability to generate revenues will probably change, as the market changes underneath you. We went from a pure fee-for-service tool to now, our whole idea about managing populations and helping people to manage populations is becoming much more significant in the market. That’s a big change in the last 3 years, because the market’s changed, but you have to move with it.

Wayne, thanks, this has been really interesting. One last question – if you were starting another digital health company – something totally different – what other areas interest you?

I would say it would have to be analytics. Someone who understands healthcare can make huge advances in that area. Also, how do you get patients to make better decisions? The long-term goal of better health just isn’t enough for many people. How do you use technology to find people in the population who for other reasons aren’t looking after their health and help them make better decisions?

Wayne spoke with Claire Novorol in March 2013

Follow iTriage on Twitter @iTriage

Follow Wayne Guerra on Twitter @WayneGuerra

Read our first interview with TouchSurgery here. 

Claire: So Jean – we last spoke a few weeks ago, soon after the Blueprint Health programme kicked off. How’s it been going?

Jean: The past 12 weeks at Blueprint have been great. It’s a well structured program with an extensive network of mentors. We’ve been having regular presentations and one-on-one meetings with a wide variety of people and building some amazing contacts. These were relentless in the first couple of weeks but more recently they have become fewer in frequency. Instead we have been getting out of the office for meetings all over NYC with people from the networks that we’ve established since arriving here. It’s been particularly exciting building links with all the hospital networks and medical institutions nearby.

Claire: When we last spoke I asked you to give me a single question I should absolutely ask you during this interview. Something you felt would be interesting as a gauge of the difference just a few weeks can make during a programme like this.  So…. (as per your suggestions) I want to know

a) “have you grown up?”

and

b) “what’s changed about the TouchSurgery concept?”

Jean: “Grown up”… definitely! I think myself and Andre agree that this programme has changed our perceptions of what a world outside of the operating room entails. However, we’ve also found that many of our skills nurtured through surgery are transferable. On top of this, we now understand a little more about what the jobs of our non-medical friends entail. The concept and idea- well, let’s just say we have a plan for execution!

Claire: Okay… so what have you learnt that you might not have learnt by this stage if you hadn’t joined the programme?

Jean: I think the most important thing we have continually been told is ‘address a problem’. Also, that to do so it’s important to understand the problem fully from the view point of all stakeholders. Once you address a problem you can develop a solution.

Andre: For me the most important thing has been learning first-hand about the need for focus and execution. Putting your idea into action. There are a lot of people out there with a lot of ideas, but having the idea is the easy part.  The only ones who succeed are those who focus, commit, and put in the hard work to achieve it.

Claire: How about from a personal perspective? What changes do you see in yourselves from just a  few weeks back?

Jean: From a personal perspective – certainly I see that we’ve developed a range of really useful skills. From sending the right kind of ‘cold email’ to “taking a business history”. By the latter I really mean consulting skills. I guess I understand the basics of business consulting, which is all about asking the right questions to understand where the pain in a customers business is.

Andre: We’ve learned that as doctors we can also bring a lot of value in other areas.  The things that we do day in and day out as a doctor – making time-critical decisions based upon the information at hand – that’s actually a skill that is transferable to so many things.  For me it has been an eye-opening experience and opened up a world of potential for our team.

Claire: That’s a great insight. So, in summary, what do you feel have been the greatest benefits to you as a team of being part of an accelerator? 

Jean: I think Blueprint really has a great model. It gives you access to an extensive network of healthcare mentors, which range from investors to super successful entrepreneurs. Being here has given us access to so many people who just want to help. Brad, Matt, Josh and Mike really push you. They ask questions you’ve not previously thought of and make comments that you sometimes don’t want to hear. However, when you eventually listen, you realize there is a point.

Andre: Access to other entrepreneurs who have ‘been there and done it’ is very valuable.  Learning from their experiences, and realizing that no matter what the business is, the startup process is very similar – that brings a lot of encouragement.

Claire: Great. So would you recommend an accelerator to others? Who can it be of value to?

 Jean: Definitely. Honestly, I’d  recommend this program to anyone who wants to be an entrepreneur. People have attended blueprint with just an idea or with a much more formalized product. From what I understand from the guys here, we were selected on the basis of the individuals involved and overall team strengths. As a startup at a seed stage that is what people invest in – ‘you and your team’. How do you get here… well that’s just about being bold and brave.

Andre: Yes… to anyone who has committed themselves to building a business.  The accelerator facilitates a lot of things. But you need to be 100% committed to get the most out of it.  At the end of the day it is your business, and nobody else is going to work hard day in and day out apart from your own team.

Claire: How have you found NYC? Will you be spending more time there once the programme ends?

Jean: We absolutely love NYC – it’s been very cold while we’ve been here, but the reception has always been warm! There is definitely a plan to have a presence out here beyond the accelerator. We’re currently looking at how best to structure this.

Claire: Okay…. so, that brings me to the most important question of course. What’s next for Touch Surgery? Are you looking to raise external capital at this stage? What are your plans for the business beyond the programme? 

Jean: We have a lot planned for 2013-2014. There are going to be a number of developments which will see Touch Surgery respond to the demands of its users. We are in the process of raising a round. Beyond the programme we will aim to continue to scale Touch Surgery and grow our user base.

Claire: Finally – when we last spoke, Andre suggested I ask you “Are you still changing the world?”… are you?!

Jean: I don’t know if “changing the world” is the right way to phrase it…. I prefer the term “making a difference”. We became surgeons because we wanted to care for patients and Touch Surgery is an extension of this sentiment.

Only the other day we read on twitter how a consultant/ attending surgeon in the US had used the programme to educate a child what happened before an appendix. The result – a less anxious child, better parent comprehension and ultimately an improves patient experience.

Another series of feedback through twitter, emails and personal conversations has been how it has helped trainees better understand operations and how even attending surgeons have used some modules to refresh knowledge.

Ultimately we wanted to improve patient care whether through better surgery or better patient education- achieving this on the scale we are does feel like we are really “making a difference- in the world”.

Next week Doctorpreneurs will be in NYC for the Blueprint Health Demo Day and part 3 of this interview will follow later this spring. You can also read Part 1 of our interview with TouchSurgery here.

For your place at the event, email doctors20@basilstrategies.com with Doctorpreneurs in the subject line

Press release Program Doctors 2.0 & You (3rd Edition: 6-7 June 2013) is based on the Best Practices for social media and mobile applications in 17 diseases. Paris, March 15, 2013 – The third edition of Doctors 2.0 ™ & You make Paris the capital world of social media and health 2.0. All interventions will be based on examples by disease. The results of several new studies will be presented in preview ( diabetes ,cardiovascular , …) 26 hours of programming are available on two days. The “Live Tweet” on the word sharp # doctors20 will be provided in several languages ​​including French course. Crowdfunding campaign until March 28, 2013 participates in travel grants for patients wishing to participate in Doctors 2.0 & You. Prizes will be awarded for the best start-up, the best poster. Demonstrations, cocktails and other events are planned. Program ( Day 1 , Day 2 ) includes, among others, cancer and cancer pain, cardiovascular disease, dermatology, diabetes, eating disorders, epilepsy, fertility, IBS and other conditions gastro tract, rare diseases, kidney disease, rheumatology and trauma, thyroid disease, and of course the drug and pharmacovigilance. According to Denise Silber, president of Basil Strategies , digital agency health and founders of Doctors 2.0 & You, “It’s time to talk digital at present. Our participants, all stakeholders of Health, looking for practical lessons. Doctors 2.0 & You present good practices, experiences, research data on social media and apps in many pathologies. And it is an international conference designed for the French to know the new French and international. “ More than 400 participants (patients and professionals, pharmaceutical industry, hospitals, government agencies and public payers) will meet on the campus of the Cité UniversitaireInternationale and meet with leaders of social media and apps in the world .. Stanford Medicine X renewed its partnership “Paris to Palo Alto”, which brings to that will fit both conferences, a reduction of $ 500 in total. According to the founder of Stanford Medicine X, associate professor Larry Chu, “Doctors 2.0 & You provides significant potential for health. We are very proud to be partners.”  Research undertaken for Doctors 2.0 ™ & You includes: ISMOR (Insulin Original Social Media Research) with partner LexisNexis BIS . 200 social media sources for diabetes and insulin in France and England are studied. CVDSM (Cardiovascular Doctors Social Media) partner with Creation Healthcare. CVDSM analysis of online conversations last year, among health professionals about cardiovascular drugs (statins, beta-blockers, anti-blocker). Research on the hashtag (hash word) of conférene # doctors20 and visualization techniques will be presented by twitter Symplur , creators of the “Healthcare Hashtag Project.” The association of patients with kidney disease, Renaloo present results contrasting the views of users and non-users. University Pierre & Marie Curie present the Health on the Internet for Generation Y. Doctors 2.0 & You present a study of “identity eHealth” performed by Denise Silber (Basil Strategies). All Francophones are invited to be involved According to Professor Franck Chauvin (Cancer Institute of the Loire) “The social networks have changed and will change the future of medicine. Revolution is on. This conference is a great initiative and provides very useful exchanges. Supporter I Doctors 2.0 & You in and I urge to participate. “ For Giovanna Marsico, CancerContribution, “two days of exchange, innovation, discovery and sharing around Web 2.0 in health and medicine. Doctors 2.0 & You was a wonderful adventure that I want to repeat instantly, and I recommends the appointment as the most important event in Europe for all those involved in Health and Medicine 2.0 and Social Media. “For Bernard Peyrical, Sanofi, “many people talk about 2.0, digital, social media health. Doctors 2.0 & You contributes to the achievement, identifying trends, and bringing together the best people. Doctors 2.0 & You, c is the “best practice” in Europe. ” The Keynotes include: Yossi Bahagon (Israel), Mark Davies (NHS, UK) Berci Mesko (Webicina, Hungary), Jacques Lucas (CNOM, France), Michael Seres (ePatient, UK), Denise Silber, (Basil Strategies) Kerry Sparling (ePatient, SixUntilMe U.S.), Jurriaan van Rijswijk (Games for Health Europe, Nl). Registration HERE About Doctors 2.0 ™ & You Doctors 2.0 ™ & You, organized by Basil Strategies, a consulting firm eHealth is the only annual conference on social media in the field of health, in Paris, the only international conference dedicated to understanding the use of new medical technologies, Web 2.0 tools and social media to communicate with other health professionals, patients, payers, pharmaceutical companies, government agencies. http://www.doctors20.fr About Basil Strategies Basil Strategies is a consulting firm eHealth eMarketing, founded by Denise Silber, to help businesses and organizations to leverage Health New Technologies, Tools and Social Media 2.0. In 2011, Basil Strategies created the conference Doctors 2.0 & You, an annual event and a permanent player in social media for health. In addition, Basil Strategies created the Twitter Directories Health, to view a dynamic health actors in France on Twitter. http://www.basilstrategies.com press@basilstrategies.com , +33 1 45 04 58 51

Places are filling up fast, with participants flying in from as far afield as Spain, Italy, Belgium and Germany. We have numerous UK and European doctors taking part, as well as students and professionals from across the business, engineering and design worlds. Our keynote speaker is Sue Siddall, head of IDEO London, and the lead facilitator, Andrea Koerselman, also worked at IDEO for 11 years. We have facilitators from a variety of backgrounds, including large and small design and innovation consultancies, meaning every team will have intensive support in navigating and getting to grips with the design thinking process and it’s application to healthcare challenges.

We have two fantastic panel discussions taking place during the day, with speakers ranging from digital health investors and seasoned health entrepreneurs through to NHS commissioners and senior clinicians. The methodologies learnt during the day can be applied in any startup or business and you will be able to draw on them again and again throughout your career, in health, entrepreneurship or otherwise!

Don’t miss out! Apply here. We’ll be reviewing all applications after March 29th and will be in touch with further details for chosen participants in early April.

During this workshop, interdisciplinary teams (designers, engineers, business minds, medics, scientists and social scientists) will work together, coached by experienced Design-Thinkers, to explore and create solutions to real healthcare challenges. Teams will work on problems identified by participating clinicians, and will use Design-Thinking methods to gain a deep understanding of the problem and develop innovative ‘human-centred’ solutions (ie. solutions that truly meet the needs of users). Methods will include user-interviews, observation, brainstorming and rapid prototyping, with the aim of creating solutions that combine human desirability and usability with business viability and technological feasibility.

To facilitate the process we will have experts from public and private healthcare organisations on hand to provide feedback as to the business viability of solutions, medics to provide insights into the human needs and design/engineering experts to help guide ideas from a technological perspective. Our Design-Thinking facilitators have worked at the renowned design and innovation consultancies IDEO and ?WHATIF! and the Keynote Talk – “How Design-Thinking can be applied to Healthcare” – will be given by the head of IDEO’s London practice.

Note – This event will be conducted according to the ’Creative Commons’ philosophy. No ownership rights will apply to any information or ideas shared amongst participants before or during the event. Therefore we advise that you do not share any information that may be sensitive (such as critical business secrets!)

Tickets are £40 and provide access to the full one-day workshop, expert coaching, refreshments, lunch and a drinks reception (5.30pm – 7pm). To apply for a place, please tell us about yourself using the form below. The deadline for applications is Friday 29th March.

Claire: Jean, great to meet you and congratulations on being accepted onto the Blueprint Health Programme in New York. Can we start with you telling us about the background to Touch Surgery and who the team is?

Jean: Sure. Well, I’m a Plastics ST3 registrar. Andre has just finished his PhD this year, in tissue engineering at Imperial College and has now gone back into training, he is currently an ST4 registrar in General Surgery. Ad Ghande is an Orthopaedic consultant and Sanjay is a lecturer and consultant Bariatric surgeon at Saint Mary’s Hospital, Imperial College London. The way it all came together was that I was working as an SHO for Ad. At the time Ad was working on the iOS platform. He had coded something which was very interesting, it was what was to become a key component technology in what we ultimately created. I had recently completed an MSc in Surgical Technology and simulation at Imperial and was looking at metrics and objective assessment. So we got together and built part of Touch Surgery. Then, having worked with Andre before as his house officer, and often being inspired by him, I called him up and said “Andre, where are you?” He replied telling me he was playing with some cells in the lab  (laughs) so I went up to Imperial College and saw him and said “look at this”. He saw it in the elevator and said “Oh my god, I can operate on my phone!”. So together we called Sanjay, who was someone both myself and Andre looked up to in surgery and academia, he’s published over 250 peer reviewed articles. He came and sat down with myself, Andre and Ad and together we further refined the product. We introduced more analytics and Andre learnt to code and developed out website and together we built a new interface. We released a minimally viable product that we subsequently redesigned based on our user feedback and metrics.

Claire: That sounds like a powerful combination – 4 practising surgeons and you can code as well?

Jean: The best coder in the team is Ad Ghande, he’s a phenomenally inspiring individual who puts hips in by day and codes by night, often until 3 in the morning. The other thing is, Ad is multi-talented. He can also animate in 3D – he did a BSc in medical imaging when he was a med student and got honours. It was all about 3-dimensional imaging and how you can interact with a CGI of human anatomy. Andre can also code, and he designed and developed our website and user experience (with help from his wife Regine who works in this field). I don’t really code but I understand what we can achieve with code and have mainly been involved in introducing functionalities and execution.

Claire: A doctor with a BSc in 3D animation – that’s great…

Jean: Ad is very passionate about art. He’s a surgeon and a passionate artist and he’s loved that throughout his life. He found through technology a way to express himself artistically.

Claire: Did any of you have previous experience of starting a company?

Jean: No.When I met Ad, he had some code and so at the time I was like “We can channel this into a product with objective assessment and metrics…. it can do so much more”. Initially it was “What do we do with this product, do we sell it to doctors?” This was something that didn’t appeal to any of the founders. Instead we believed the best thing to do would be to deliver education that’s free and accessible to the world, which would help make surgery better. I think one of the core missions of the team was based on the idea that we’re all very privileged to be in the UK and to have our experiences in surgery – however, surgical education has changed. It’s not what it used to be – there’s budget cuts, reduction of working hours… and patient safety is so important, so how can we make this better?  By not restricting this product and putting it in a locked room away from the people who need it. Instead, let’s put it out there and make it accessible to the world so we can make the world a better place.

Claire: You didn’t start out trying to build a business then?

Jean: Yes, it’s true to say that at first that we didn’t build a business – we had a vision, and based on that we built a product that we felt would make surgical performance, training and patient education better internationally. We then had to develop a strategy, and we knew it wasn’t sustainable to have just a product without the business model to allow it to grow. We also knew with our research background that we needed to validate this and make it academically viable. Having a background in simulation and how it can be used, we developed the product further to allow it to grow and also to gather data that would be useful.

Claire: So who in your team is responsible for what right now?

Jean: These are arbitrary titles for now, because when you’re in start-up you tend to cross over and do many things. I’m the CEO, and Andre is currently our COO, and Ad is our CTO and Sanjay is our Academic Director. It’s all available on our website you can see it on the ‘About us’ section. We have these titles – however it’s important that I say there is no boss. We’re a team that’s very democratic. We have weekly meetings where we go through the next steps and address different parts of the agenda and it’s a shared input from multiple members of the team. Myself and Andre work closely together on strategy, and together we take it to the other guys. With Ad we sit and design new product features.  Sanjay leads from the academic point of view, but everyone pitches in.   So ultimately the roles are arbitrary, we all have shared decision making in what we do and the fundamental vision is a shared one.

Claire: Have there been any key mentors outside of the team who’ve helped you shape the vision and get to this stage?

Jean: This has been a vision and a mission that we have generated ourselves. Of course we have met lots of interesting people in the journey. Some have been very supportive, whilst others not as much.  I think the fact that we are subject matter experts is very crucial. We’ve got registrars and consultants in our team so we know about some of the problems in education and training. I know what’s important in simulation and analytics and so really in terms of the first minimally viable product, we just developed that ourselves and we tested it.

Claire: What stage are things at now?

Jean: We released Touch Surgery not too long ago and in terms of traction we’re growing. We’ve got over 50,000 downloads in three months. The reviews and press have been great. It seems to be something that’s satisfying a need in the market. Touch Surgery is available in the app store and is free. We get lots of good feedback from twitter and other social media. People are using it and they’re using it in the way we set out for them to use it – to learn how to operate, to use it before operating, for rehearsal. And they can use it anywhere, like on the train. I’ve had people on twitter say “Oh, I was on the bus and just did an operation before I got into theatre”, or “Just using it to help understand and visualise what my boss is doing rather than standing there and being the retractor”, which is often what happens in those situations. One of our major criticisms is volume of content- every speciality wants modules – but we should be resolving that soon (laughs).

Claire: Who is using your product?

Jean: The whole world is using it. You can break it down to the major players though, the US is one of the bigger ones but we are also doing very well in emerging markets. Touch Surgery is everywhere and the world is being exposed to it. Every time I think about it, it’s very inspiring and rewarding.

Claire: So, you’re getting a lot of interest amongst surgeons?

Jean: I think in medicine what happens is someone downloads something cool and they go to their mate and say “Oh look, I can operate on my phone and it’s really great”. Then someone else downloads it and it spreads by word of mouth.  We’ve even had professors use it to teach their students, and we’ve had great support from various surgical organisations.  We think the fact that it’s free also helps, because you’re not introducing that barrier of “Should I buy this?” The problem in the app store is that people create a lot of things that are useless and there’s no way of really knowing. I’ve downloaded things that I had to pay for and they’ve turned out really useless. In addition to surgeons, we’ve had downloads from medical students, nurses and patients.

Claire: Have you taken on any external funding so far?

Jean: We’re all self-funded, so no funding!

Claire: How did you divide up the equity between you? Have you got a vesting schedule?

Jean: Ad and I were the original founders so we took the larger portion of shares. Then we brought Andre and Sanjay on board. The decisions about equity were easy and straight forward. There is no kind of vesting… look, we were naïve to all of this stuff! Vesting and the like… this is something we’ve learnt along the way.

Claire: What made you decide to apply to Blueprint Health in New York?

Jean: It was a very sporadic decision, at the time we were looking at what’s the best way to take this forward. There were a lot of options on the table for us, but I guess we looked at the US and what was happening there and the interest in this area. Blueprint Health was recommended, and I applied. I think everyone here wanted to be in New York – it’s a fantastic and exciting city to be in right now, especially regarding the Healthcare Technology scene. The guys in Blueprint are also very well-networked. Being in a space like this you really have access to the mentors and resources you need to create something that’s going to be great. Going through Blueprint we just thought was a great avenue. We do feel in some ways that the UK is further behind in this space.

Claire: You didn’t consider an accelerator in Europe?

Jean: We were approached by some of the other guys in Europe, but we made the decision to apply for Blueprint. We met with Brad Weinberg and we got on well. There’s been a lot of interest in what we do. I think in a way, what we’re doing with our vision is exciting to other people. Giving people the means to learn and educate and putting it in everyone’s pocket in such an engaging and interesting way excites a lot of people. The other thing to say is that the guys here at Blueprint are the kind of people you’d work with and then have a beer with! It is an amazing atmosphere.

Claire: It sounds as though you really felt Blueprint was the right fit for you?

Jean: I think the way Blueprint has looked at us – well, the first thing is they flew out to London to meet with us. They were making an exception to their own rule. Plus, they’ve never had a UK team, so we’re the first. When we first had our discussion with Brad, he said “I’ve done this thing for a while and you guys are definitely very exciting, and what you’re doing is very exciting”. Brad is also a doctor, so it’s a completely different conversation. It’s one of those conversations, like you said with Doctorpreneurs – you’re combining doctors with entrepreneurs – it’s just a completely different discussion with a medic compared to a non-medic, I think. So we quickly established rapport and a good relationship with Brad.

Claire: You’ve just spent your first full week in NYC… how has the whole experience been and what have you learnt so far?

Jean: It’s been pretty interesting from the learning point of view. Let’s start off with accommodation – never book anywhere without seeing it yourself! We’ve managed to move but nothing’s really working here – there’s no heating today. We’re going to have to sort that out which is what we’re doing right now – that’s the first learning point. Secondly, walking into an office space the first day and sitting down at a desk and thinking “Oh, so now we have to get to work”. It’s different to being in the hospital. We’ve very quickly had to adapt our strategy in terms of how we work. We’re very used to having to go on ward-rounds, and having a list of patients etc. so we’ve had to transfer some of our skills. We start off our meetings in the morning with a white board and make a list of what we’re going to achieve today and we prioritise, then we go away trying to tick boxes.

Claire: (laughs) well making a list and ticking off the boxes… I used to spend most of my day doing that on the wards! Doesn’t sound so different… ?!

Jean: You’re right. These are all very transferable skills. Look, in the first week we had an introductory launch day in which we introduced ourselves and people were, I think, impressed by our first sentence, we were saying “We’re 4 surgeons who can code, animate and have over 200 publications between us”. In fact, we’re the only doctors here right now. There are no other doctors here so people come to us from the other teams for medical advice. Again, we’re learning about lots of things, about how to really focus and make sure that we’re achieving our specific goals. To be honest, this is also the first time we’ve actually spent so much time together; we work and then have social-time together. We sit down together have a beer, talk and form those relationships. We’ve done that before, but doing the same thing in a house with no heating makes it feel like one of those camping trips we used to have (laughs), so it’s good I guess!

Claire: What’s the programme like? Is it structured?

Jean: It’s very structured and there are regular mentor meetings. Mentors come in and we have a 1-on-1 session. The other thing is that you get lectures on things like ‘how to write an e-mail’ (laughs)… some of those things you’ve never thought of as a medic such as how to structure the right e-mail, I’ve never had to think about that before. Other things we have kind of known, but it’s also been shared experiences from other teams and things that we’ve been learning about. There are people who have been here for a while and it’s like a family or a community. We’ll then end up being part of this family or network (or hope to be). Some of the people are still around from the first groups, and they sit down with you to give advice and share their experiences. We found it very structured and well organised, its run very well, better than any other educational programs I have attended. I think what Brad, Mat and Josh have done here is awesome.

Claire: How do you compare with the other teams in terms of what you’re doing and stage of the company?

Jean: We’re pretty far along. We have a product that’s out there with good traction.  However different people are doing very different things and it’s very difficult to try and compare different companies with each other.

Claire: So, one week into the programme… how are you feeling about everything?

Jean: I can summarise it in three words, we are learning! Every time we meet with someone, they’re like “wow, this is amazing!” then people give you lots of different opinions. It’s about mining that data and seeing what people are really trying to tell you. We have so much thrown at us we’re taking different points from different people. We’ve just spoken to some US simulation experts, and people come out with different valid points and it’s about understanding those points and bringing them together.

Right now I’d say we’re inspired by all these different ideas and mentors’ opinions and it’s about focusing and channelling our aims. Part of the first month is about getting there, getting your head around your strategy, choosing to focus on one thing. As you’re aware what we’re doing is a big mission, it’s about how you get to the end-point without falling apart.

Claire: Are you looking to raise money at the end of the programme?

Jean: Everyone here is looking to raise money in some way, right? Of course, we’re going to be open that. It’s very easy to take a cheque, but it’s harder to take one from the right person. Again, I think we’re looking for the right people to take this forward with us. I think that’s the reason we’re here, more so than raising money because we could’ve just raised money back home. It’s about finding that right fit, people say it all the time you know, when raising capital do it with someone that’s the right fit. Maybe the right fit may be in the US, or the UK, this is just an avenue towards trying to find that fit.

Claire: What have been the biggest surprises so far (apart from the accommodation (laughs)?

Jean: Yeah, the accommodation was one of the major surprises! One of the other big surprises was the view of doctors in this space. In the UK people are like “Oh doctors and entrepreneurs, that’s difficult to digest”, but in the US they’re more open-minded about it and like “Oh, you’re doctors and you’re doing this amazing start-up that’s going to help change things”. It’s a very different mentality, and that was a shock to us.

Claire: That interests me too. I think it’s fundamental that medical professionals should be involved in driving how technology reshapes healthcare over the coming decades.

Jean: I think you’re right about this Claire, and this is one of the first reasons I sought you out. I think we both share this fundamental idea that you can’t really innovate in a space without understanding it. You can’t make a solution to a problem without knowing the problem. I think, if you want to innovate you just need to understand the problem and build a solution to it. It’s not about holding an MBA or having some finance experience, it’s really about addressing problems that will make a difference, that’s why I think doctors should be in this space.

Claire: So, my final question for today… What do you want me to ask you in 6 weeks’ time when we talk again?

Jean: (talking to Andre in the background) Well, right now Andre’s question is “Are we still changing the world?”(laughs)… dude, that’s a big question! I think the best question to ask us is “have you grown up?” and also “what’s changed about your ideas or concepts?” because right now you’re talking to two guys who are saying things like “We want to change the world!”… is that naïve? I don’t know, but it’s a good ambition to have. We do want to make things better. It’s founded on some truths, but you know 6 weeks down the line will we still have that vision? Ask us about that.

You can follow the team’s regular updates on their blog

Follow Jean on Twitter @Jean_Nehme

Follow Touch Surgery: @TouchSurgery

Follow Andre: @88andre

Look out for part 2 of this interview next month!

Many thanks to Jean for the interview and to all of the Touch Surgery Team. Special thanks to Cassim Akhoon, Medical Student and Doctorpreneurs Intern, for help with the production of this article.

This time our speaker will be Dr. Thom Van Every. Thom has an incredible story and will be talking us through his journey from full time clinician through to selling two businesses in the same year!

About Thom

Thom qualified as a doctor in the UK and worked in junior posts in England, Jersey and Cape Town before specialising in obstetrics and gynaecology. He then left full time medicine to study for an MBA at London Business School following which he founded two companies – Dr.Thom and PatientChoice. Dr.Thom was purchased by the national pharmacy chain Lloyds Pharmacy in 2011 and PatientChoice was sold to Westfield Health in the same year. Thom also sits on the healthcare panel of several venture capital firms.

Further Details:

Event: Founder’s Secrets Event with Dr. Thom Van Every

When: Wednesday 27th February 2013, 6-10pm

Where: The Learning Lab, The Hub Westminster, 1st Floor New Zealand House, 80 Haymarket, London, SW1Y 4TE

Thom is a fabulous speaker and the evening promises to be one filled with both insight and inspiration. Following Thom’s talk there will be time for Q&A followed by three separate group discussions (based on the stage of your idea or startup), each led by an experienced medic entrepreneur and covering some of the topics you have told us are most pressing to you at the current time. We will follow this with networking, drinks and  nibbles.

Places are limited and we will be reviewing applications to attend on a rolling basis until we are full.

If you would like one of the (highly covetable!) spots at the event please fill out your details below and we’ll be in touch shortly:

Please note that there is no ticket price for this event. However, if you are offered a place we will ask you to consider making a modest voluntary contribution towards the running costs of the event (venue, refreshments, expenses). We have had overwhelmingly positive feedback since our November event and your contributions will enable us to continue organising great talks with fascinating speakers! We thank you for your support and interest in what we are doing.

The Doctorpreneurs and Generation Health Teams.

Martin, tell us more about the HealthXL programme

Startup Bootcamp’s HealthXL is a three-month business startup acceleration programme based in Dublin. Our aim is to help health startups across Europe prepare to gain funding, find customers and scale up in both European and global markets. We have taken the accelerator model which is starting to be very interesting in the tech world, and applied it to digital health. It’s one of the newest accelerators in Europe and is the result of a collaboration between corporates, entrepreneurs and public sector organisations.

Why have you chosen to focus the programme on health specifically?

HealthXL is specifically designed for startups disrupting healthcare with breakthrough technology and is tailored to the needs of startups in the health sector. We think that healthcare is the world’s biggest problem and digital technology in particular can really help disrupt the area. More so, this disruption should be led by entrepreneurs.

What makes HealthXL different from other accelerator programmes?

The programme is specifically run by entrepreneurs, for entrepreneurs, and offers much needed support for the startups.  Whilst it is entrepreneur-led, HealthXL Dublin also has strategic partners including well known corporates, thus offering brand credibility, in terms of global reach as well as deep scientific and commercial skills, so you get the best of both worlds! It will operate in a way that is driven by what the entrepreneur needs and at the same time adds value through the corporate partners.

Can you tell us more about those running the programme and HealthXL’s partners?

The program is run by experienced entrepreneurs and backed by leading global health investors, medical professionals and corporates including IBM, GSK, Novartis, Nesta, Enterprise Ireland, and an investment group; Personal  Health Solutions (PHS) to name a few. The guys running the programme are all entrepreneurs and include some great names from a variety of backgrounds ranging from doctors, health entrepreneurs and ex-pharma executives to technology savvy entrepreneurs.

Can you give us an idea of what the programme is like?

The focus will be on exposing and connecting startups to our expanding global community of top-level mentors and advisors.  The programme is structured to allow teams to attend certain events and classes but we really think the power of this programme is the network that it provides startups access to. We will try to help teams to understand and identify areas they may need help in and then pinpoint mentors we think can best support them. This makes it more personalised. The teams will have to physically relocate to Dublin for the 3 months in order to partake in the mentoring programme in particular and they will be provided with co-working space, a stone’s throw away from Google, Facebook and a lot of the tech companies, large pharmaceutical companies and med-tech companies as well. So proximity is key, and it’s right in downtown Dublin. Teams also receive a small amount of seed capital – €15,000 – and in exchange for the capital, as well as all the other benefits of being part of the programme, HealthXL receives 8% equity in their startup. The event will then culminate in an investor day at the end where teams will have a chance to pitch their ideas to investors.

Any tips on how to be a successful applicant?

1. Be 100% committed –  joining HealthXL requires total focus and availability. It is unrealistic to combine the accelerator programme with a day job, studies or any other distraction.
2. Be a team! Teams with a nice balance and mix of skills – with tech experts, commercial experts and industry experts would be ideal. We don’t have a bias towards age or gender, just a preference for those with an ambition to change the world and a complementary set of skills amongst the team that we believe can get there.
3. Be coachable and ready to act on the best advice.
4. Show some passion, resilience, determination and perseverance. Although money is important, building a business can talk a long time so you have to be motivated by more than money.
5. Having a track record such as a beta product, or a previous start up would be good. You should really have something you can show to customers, so it can’t just be an idea. There has to be some sort of market engagement as well.

You also have a pre-accelerator event coming up soon I believe?

We have an event starting this Friday, 30^th November, called HXL Checkup Weekend- the tag line is the doctor will see your business now. We get approached by doctors saying that they have a great idea but they don’t have the technical skill, and by tech entrepreneurs who really need help with understanding the industry and clinical part. So we are trying to bring them together, tailoring the weekend to focus around health. Our aim is that clinicians come with problems that they are interested in finding solutions for, and then instead of building a prototype and coding something which is typical over a startup weekend, we say don’t do that but instead spend the time to figure out what the business model is.

The event is open to any individuals or teams who are interested in bringing their skills or ideas to bear on one of the world’s biggest problems. We want to hear from not only individuals or teams who already have a solution to a health problem but, also individuals that have skills and ideas that could help develop IT solutions to health problems. We believe that even very mature entrepreneurs and teams will get a lot out of this and investors – both angels and VCs – will be there along with corporate partners.

On top of that we are going to have a number of our international mentors coming in or skyping in and on the Sunday teams will pitch their solutions to our Healthxl Panel of experts including Dr Johnny Walker, Jim Joyce, Martin Kelly, Eoghan Jennings and Dr Conor Hanley. There’s going to be a great group of people coming.

The weekend will conclude with The Healthies 2012, the first digital health awards hosted by HealthXL and Global Corporate Venturing. The winners will be recognized at an exclusive dinner where the keynote is Prof Ken Morse, founder of 6 companies including 3Com and someone who travels the world helping entrepreneurs to build and sell global businesses.

More details here: 

HXL Checkup – 30th Nov 2012

HXL Checkup will bring medics, engineers, designers, marketers and startup enthusiasts together to share ideas, form teams and launch startups!   It is a weekend-long, hands-on experience where entrepreneurs and aspiring entrepreneurs can find out if their digital health startup idea is viable.  Over Saturday and Sunday teams focus on customer development, validating their ideas and practicing the  LEAN Startup Methodology. The weekend culminates on Sunday evening with teams presenting in front of local entrepreneurial leaders with another opportunity for critical feedback. Book your place here: eventbrite

Great so if people are interested, how do they find out more and how do they apply?

It’s all on the website: www.healthxl.org. They can read more about upcoming events and there are videos online which showcases some of the directors and mentors. The application contains about 10-15 questions, so the application process is quite light. That’s because all we want to do is to start a conversation. We think the most interesting thing is the dialogue that happens with the teams rather than what’s written on the form.

Martin Kelly spoke to Claire Novorol. Article by Charles Badu-Boateng.

Ron’s company, Laastari Retail Clinics, is a chain of clinics (currently 12 clinics in two countries; Finland and Sweden), specialising in the treatment of common acute illnesses. The clinics are often located in pharmacies and make use of their own specialised telemedicine solutions. The goal of Laastari Retail Clinics is to provide customer-centred primary healthcare in a efficient and cost effective way.

Can you talk a little about how and why you made the transition from doctor to entrepreneur? 

I think it had a lot to do with my personality. As a medical student you tend to focus on the ‘doctoring’ aspects of the profession. As such, very few medical students think about entrepreneurship as an option. After medical school I undertook a PhD and had to do on-call shifts in the ER to fund my studies. I always had an interest in developing healthcare and during on-call shifts I began to notice certain areas that I believed could be improved in the public healthcare system; better ways to treat simple diseases for instance.

Fortunately, my brother had a background in business. After speaking with him, he introduced me to two guys that had been talking about a similar clinic concept, that’s how the founding team was created. This worked out well as we had the complementary skills needed to meet the requirements of the enterprise. The Finnish word for entrepreneur is yrittäjä, which literally means ‘to try’.  That’s what you are doing all the time really, as an entrepreneur, you are constantly trying  – trying to achieve change and trying make things happen. I guess I was interested in developing healthcare and ‘trying’ to make a difference to the system and luckily I met the right guys to do it with!

What skills do you think are most important to an entrepreneur?

I think good communication skills, sound ethical values and the ability to produce consistently high quality output are some of the important areas an entrepreneur should aim to develop. The ability to work in a fast moving environment, where extreme multitasking is needed, is also key. However, there are parallels between the work of a healthcare professional and an entrepreneur – developing hypotheses and seeking solutions to problems, the drive to do whatever it takes, a willingness to seek help from others and the stamina to work hard and put in a lot of hours!

What do you feel are the areas in which your knowledge and skills now are dramatically different to two years ago? 

• Detailed knowledge of the regulatory structures in healthcare
• Hiring (and firing) people
• General business and management skills
• Social skills; communication and building a network
• IT skills

Many entrepreneurs say that the journey of a startup is something of a rollercoaster. Have you had that experience?

Yes, definitely. We founded our business in 2010 and there have been many ups and downs along the way. A really good moment was when we treated our first patient using our own telemedical patient recording system. After all the planning, seeing it physically happen was definitely a plus. In contrast, some of the biggest challenges can include dealing with healthcare regulators who have the ability to significantly slow down and affect the running of operations and also major hiring mistakes – at such an early stage a wrong hire can be fatal to small company. In a young business one cannot afford to make mistakes that could be the downfall of the company, the difference between its survival and death. There is always the risk of failure if you go in the wrong direction for any period of time.

Some of these things you tend not to experience as a doctor and it has been a steep learning curve.

How have you financed yourselves?

From the beginning I worked as a doctor to help fund myself. Then we received a small amount of seed funding, which allowed me to be paid to do this job full time. Shortly after (4-6 months in), we secured further funding and we also have some R&D government funding.

We have to be able to show potential partners a physical space and that the clinic is up and running in order to be credible and to give them confidence to work with us. Therefore, our capital requirements are high. The financing is certainly another challenge.

What tips would you offer to doctors wanting to take the entrepreneurial route?

Healthcare in all areas needs doctors. There are many companies developing medical apps with no doctor on board or helping out on some level and this can definitely be detrimental for those companies. They would do well to find doctors to work with them. Young doctors interested in getting involved should look out for these opportunities.

I would encourage people to try it but to take it seriously if they do so. This route involves a lot of hard work and is not the safest of options as a job. However, if you are seeking unpredictability and a challenge, there is little else like it!

Colleagues will often wonder “why would you do this?” I was specialising in neurology and stroke medicine, and still have good contact with my professor there. But I suspect many in the hospital would question my choice.

Medics are frequently surrounded by other medics at work and socially, so it can be difficult to access support and encouragement to do something different from this position. I advise finding a good team to work with. Another thing – it’s best not to have overly high expectations when starting out, although at the same time, it is absolutely essential that you aim high and believe you can succeed!

Follow Ron on twitter: @RLiebkind