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Healthcare startups struggle to navigate a business world that’s set up for them to fail

Justin Barad
Contributor

Justin Barad, MD is the co-founder and CEO of Osso VR, a clinically validated and award-winning surgical training platform. Dr. Barad is also an orthopaedic surgeon with a bioengineering degree from UC Berkeley, and an MD from UCLA.

Digital health startups seem to be struggling to the point of failure. Many insights into why have addressed how technology’s traditional model of quickly putting out a minimum viable product then finding useful applications and business models isn’t working. The model might work in the general technology startup space, but it rarely goes well in the complex world of healthcare. Dr. Paul Yock, a cardiologist and founder of the Byers Center for Biodesign at Stanford University, built his brainchild program on one philosophy to help healthcare startups: need-based innovation.

Need-based innovation is a process in which problems are identified and sorted based on impact and opportunity. Once the top problem has been selected, solutions and commercialization are approached.

While I completely agree with need-based innovation, our healthcare system is set up to discourage all forms of  innovation right now. We also must tackle changing the ecosystem that healthcare startups need to navigate. As a physician-innovator, I have experienced how institutional policies, hierarchical and administrator-driven systems and pilot program dynamics are creating a stunted ecosystem that is not reaching its full potential.

When approaching any stakeholder a health startup usually works with — an advisor, a healthcare system, a pilot site — the wheel often needs to be reinvented. The entrepreneur is faced with a time-consuming and costly disadvantage that frequently forces them to enter deals that hurt them. The deals also counter-intuitively hurt the stakeholder that they are bringing on board because the technologies and companies on which they are counting are set up to fail. There needs to be a clear set of rules for everyone to play by to accelerate growth, with the philosophy that “a rising tide lifts all boats.”

These are the most crushing challenges of the current ecosystem that need a hard look and innovation themselves before healthcare startups can deliver.

Challenge 1: Institutional policies and hierarchical systems stunt innovation

Many healthcare startups are born during a founder’s time at a healthcare or educational institution. The institution promises to foster the innovation and make the nuances of the legal landscape easier. However, institutional innovation policies are not optimized to foster innovation, but rather to maximize ownership and financial returns. Most policies will require all filed patents to run through a “Tech Transfer Office,” which is assumed to provide value by performing Freedom to Operate searches and helping file for provisional patents.

Unfortunately, in today’s world of software, patents are somewhat less valuable and relevant than they once were. If any IP is filed, the institution will claim ownership and will consider licensing it to the inventor for a royalty agreement. Sometimes, if the institution does not believe in the ability of the inventor to carry the IP forward to commercialization, they will even cut them out entirely from the agreement.

An additional approach that is becoming more common within innovation policies is an equity stake in any companies started by an institutional employee, regardless of the existence of IP or whether the institution was interested in it. All of the above scenarios obviously take more from the healthcare startup than they give before an innovator even has time to blink.

Challenge 2: Healthcare doesn’t understand early-stage tech companies

Why are these policies designed this way? Part of the problem stems from stakeholders confusing medical technology with biotechnology (aka pharma). The innovation pathway within biotech is very well-defined, with established business models, established precedent and understandable risk profiles. It is quite common for drug discovery to start in the academic setting. Investors, boards and executive teams are accustomed to this model and can plan accordingly. Licensing patents and collecting a royalty on biotech sales is a market norm.

When it comes to early-stage technology companies, their challenges and early development are drastically different. The two critical resources an early-stage company has are cash and time. The goal is to unlock additional capital with product-market fit, and these companies need maximum flexibility to be able to move quickly to find it. Unfortunately, investors see the healthcare space as complex and high risk, which is true. So these startups face fundraising challenges for the space they are in, as well as unnecessary additional hurdles from the home institutions, increasing the likelihood of scaring away already skittish investors.

Challenge 3: Pilots are set up to hurt more than help

Startups are often completely dependent on partnerships or deals with larger healthcare organizations in order to grow and survive. These deals often start with a pilot. Unfortunately, the dynamic between giant healthcare institutions and tiny idealistic startups for pilots is not actually set up to be mutually beneficial.

In this scenario, healthcare systems have nothing to lose, orders of magnitude more resources and seemingly infinite amounts of time. Their incentive is to differentiate and “own” unique technologies so their competitors cannot get their hands on them. This is where startups often and understandably can make a big mistake — they believe the partner brings more value to the table than they do. For example, just having a pilot, even if it’s unpaid, with a major institution seems like it could help win over investors or additional customers. This leads to a spiral of events that frequently ends in sending startups into a trajectory toward failure (aka death by pilots).

We need innovators and administrators to come together and agree on common standards and rules to make the process more efficient, fair and effective.

Due to the lack of urgency and the intense bureaucracy, the sales cycle is long, sometimes one to two years, often lasting longer than startups have cash left to burn. Second, as mentioned, the pilot is frequently unpaid, or I have seen situations where an institution will even charge a startup for a pilot, leading to less cash and equity, which is already in short supply. Finally, onerous terms are often instituted, in which companies agree to unnecessary exclusivity or impossible goals. This doesn’t even take into consideration the challenges around deployment with HIPAA, security concerns and data sharing.

The ultimate result is that healthcare institutions that want to add value to their system by improving outcomes and decreasing costs will often doom the very technologies they believe are worthwhile. This dynamic is so well-established that many investors, even those well-versed in healthcare, will refuse to invest in institutional-oriented technology companies. My company, Osso VR, has had representatives of hospital systems approach us saying, “Don’t work with us. It will kill your company.”

Promising opportunities ahead

What if innovation policies were designed so that instead of focusing on what they can take from their spin-out companies, they focus on what value they can add? Stanford’s StartX accelerator program has a model where they commit to investing in 10% of any round a company raises after they leave the program, but it’s up to the company to choose whether or not they want StartX to participate. Unsurprisingly, almost all companies take advantage of the investment offer. These incentives help companies succeed and allow StartX to share in that success.

We need innovators and administrators to come together and agree on common standards and rules to make the process more efficient, fair and effective. One example we might follow is from Y Combinator. Raising money used to be expensive due to the amount of confusing legal documents required and corresponding legal fees. The time and expense could sometimes cause a deal to fall through, or a company would run out of money.

Its SAFE note investment document solves accounting difficulties and challenges around early-stage investment. This document has been validated by founders and investors, allowing entrepreneurs to raise money with little to no legal fees and a turnaround time of a day or two. Organizations like the American Medical Association, AdvaMed and the Consumer Technology Association have the buy-in, validation and potential to start tackling these processes. Standards could be set for protected innovation time, structured innovation positions and fellowships for organizational employees, and deal templates and best practices to shorten sales cycles and avoid onerous terms.

These problems are large, endemic and complex, but I am optimistic we can begin to work together to solve them to maximize our common interest: increasing the value of global healthcare.

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Canada’s True North conference is not your typical tech event

From the venue and the flashy event website, Waterloo, Ontario’s True North conference (in its second year) doesn’t seem all that distinct from a laundry list of other major tech events that take place each year across North America. But from the moment its main stage programming kicked off on the first day, it was clear this wasn’t your typical gathering place for the tech industry faithful.

The main stage track kicked off with Communitech CEO Iain Klugman. The event is produced by Communitech, an entrepreneurial support and resource organization founded in 1997 to foster the Waterloo region’s technology industry. Communitech sprung out of BlackBerry and the University of Waterloo and the world-class innovation community that surrounds both.

Klugman, a former communications executive and current board member at a number of Communitech-fostered startups and academic institutions, sounded a cautionary and urgent note that continued throughout the day.

Tech conferences, in general, tend to dwell on optimism and enthusiasm, with brief forays into dark alleys of negative consequences. Not this one.

Communitech CEO Iain Klugman speaking at True North 2019 in Waterloo.

Klugman’s talk touched on opportunity, but it was the opportunity to discuss among a group of peers with influence in the technology industry how they should undertake together “to set things right.” Last year’s event had a similar outcome, resulting in the “Tech for Good Declaration,” which True North describes as “the Canadian tech industry’s living document,” and includes a number of principles designed to help guide technology development with community good in mind.

Rather than changing focus for year two, True North’s organizers seem to have doubled down: Klugman’s opening talk included references to surveillance capitalism and breaches of trust, and included this cheerful analogy: “Technology is like fuel. It can warm our homes or it can burn them to the ground, so we decide which one it will do.”

As a whole, the event is about the “tough choices” faced by the collective “we” of the tech industry, according to Klugman.

True North’s official keynote perfectly took the baton from the intro, as New York Times columnist and longtime political commentator Thomas Friedman took the stage. Friedman, a somewhat controversial figure owing to some of his past political stances, launched into a talk informed by his most recent book, “Thank You for Being Late,” and talked about what we’re seeing now in human history as a moment of intersection of three different forces accelerating in a “nonlinear manner” all at once, including technological development outpacing humanity’s ability to adapt to those changes.

NYT columnist and author Thomas Friedman at True North 2019 in Waterloo.

Friedman’s talk ended with him positing that humans spend most of their time today in the essentially “god-less” realm of “cyberspace,” a realm “where we’re all connected but no one’s in charge,” while at the same time we’ve achieved better than ever ability to act with god-like power to control and manipulate our environment. He chided the essential disconnect of powerful forces that act with supreme mastery over technology but with no grounding in sociopolitical understanding (specifically naming Mark Zuckerberg) and those who have the inverse problem (the U.S. Congress, in Friedman’s view).

Overall, Friedman’s views are grounded in what he describes as a place of optimism. But the takeaway is more that humanity is currently at a state where it’s overwhelmed on a number of fronts and out of its depth in terms of having a capacity to cope.

In the afternoon, Robert Mazur (longtime undercover agent and the subject of biopic “The Infiltrator”) discussed his experience tracking down and prosecuting money launderers operating more or less with the blessing of large financial institutions, precisely because their systems were designed around incentive systems that encouraged them but didn’t have protections in place to prevent bad actors from taking advantage. Mazur further elaborated that current telecom industry structure actually makes it even easier than ever to launder large sums relatively unchecked. In essence, it was a warning to be mindful of how the products you build can be exploited by the most malicious actors.

Former Information and Privacy Commissioner for Ontario and creator of the concept of “Privacy by Design” Ann Cavoukian came next, decrying the current state of data “centralized in huge honeypots of information,” including Google (her example).

Former Ontario Information and Privacy Commissioner Ann Cavoukian.

This centralization, she noted is a huge risk in terms of presenting opportunities for tracking, misuse, leaks and more. It’s “taking away our agency as individuals,” she said, and the solution is moving to true decentralization of data.

“Privacy […] is freedom, and is about you making decisions relating to your personal information; not the state, not corporations — you,” she said. “It’s not about secrecy, it’s about control [and] privacy is a necessary condition for societal well-being.”

Cavoukian wrapped her talk by noting the sheer volume of privacy breaches that have leaked consumer information to date, and about the importance of encryption in keeping this safe. Overall, her talk was a blueprint for tech companies looking to incorporate data privacy and good stewardship into the DNA of their products from day one.

Kelsey Leonard, Tribal Co-Lead on the Mid-Atlantic Regional Planning Body of the U.S. National Ocean Council, provided a talk on the implications of digital rights and the continued digital divide as it pertains to Indigenous communities globally. Leonard pointed out that Indigenous nations in North America are the least connected in the world, something she noted continues the ongoing colonialism, and even can potentially contribute to “ongoing genocide of Indigenous peoples.”

Kelsey Leonard, advocate for Indigenous Data Governance and Sovereignty, speaks at True North 2019 in Waterloo.

Indigenous people are also systematically disenfranchised from data ownership and data control, by virtue of their being left out of advanced STEM education and formalized degrees, she said. Leonard also noted that platforms contain reinforcement of what she calls “digital colonialism,” in that Indigenous names are often flagged as fake by algorithms designed to enforce real-name policies, and Indigenous languages are often mistranslated (specifically as Estonian, she said).

This worsens existing Indigenous language and culture erasure. Leonard said a language is lost every two weeks on average, according to recent research. What’s required then is to add protection measures specific to digital platforms to help counter this institutional digital colonization and enforce Indigenous Sovereign Data.

To close day one, Recode founder and legendary Silicon Valley reporter Kara Swisher summarized a lot of her recent work as a New York Times columnist. Basically, that means she called on the industry to stop messing around and start fixing stuff.

Kara Swisher speaks at the True North 2019 conference in Waterloo, Ontario.

Swisher said we’re coming to a “reckoning” for tech in terms of media coverage, and the overwhelmingly positive coverage it’s received over the past many years. She emphasized that we’re only at the beginning of the impact technology will have on society, and laid out a number of current areas of innovation and investment that will continue to upset societal norms, including autonomous driving, artificial intelligence and more.

Regarding media specifically, Swisher noted that she marked a significant shift when BuzzFeed started A/B testing to amplify and extend the attention-capture possible around specific “news” items, citing the famous Katy Perry Left Shark incident of 2015. This, combined with our “continuous partial attention,” which is tied to our inability to totally disengage from our smartphones, is combining to have effects on how we think and work in the world, Swisher said.

She added that, today, many of her new big concerns are around AI, and that “everything that can be digitized will be digitized.” Not only that, she continued, but “almost everything can be,” which will be massively disruptive to peoples’ lives, with effects including a future where most people will have a very high number of different jobs over the course of their lives, requiring continuous education and retraining. “We have to think really hard about what good AI is and what problematic AI is,” she said.

Thompson Reuters Foundation CEO Antonio Zappulla at True North 2019 in Waterloo discussed using technology to help fight human trafficking.

Across other stages, too, the themes of technology’s dangers and how to avert it prevailed across programming. Take Some Risk founder Duane Brown gave a talk on opting out of the always-connected lifestyle and becoming “digitally exhausted.” MedStack founder and CEO Balaji Gopalan talked about the risks inherent in dealing with private patient data in healthcare. Other topics included sustainable energy for Africa, using big data to counter human trafficking and ensuring we steer away from encouraging consumerization in this generation of connected kids.

The event’s central theme was the deceptively simple (and frankly over-uttered) phrase “tech for good,” but the programming and content revealed a level of sophistication and sincerity on the topic that exceeds the low bar often found in tech industry marketing materials and staged events. Overall, it felt introspective, contrite and contemplative — a self-reflection from a community genuine about shoring up its ethical shortcomings. In other words, refreshing.

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Careteam aims to unite patients and healthcare providers with a platform approach

How best to untangle the Gordian knot that is navigating your own healthcare? It’s a tricky question, and one that seems to have become only more complicated as technology improves, in many regards — systems don’t necessarily speak to one another, and it’s still hard for an ordinary patient without specialist knowledge to make sense of everything. Careteam is a Canadian startup hoping to address that, looking to replicate the kind of advances made possible by technology in industries like e-commerce and enterprise software.

Careteam co-founder and CEO Dr. Alexandra Greenhill has experienced the frustration of being a tech-savvy person in a world of healthcare that can seem technologically inept — both as a practicing GP and as someone who depends on the healthcare system as a patient and a relative of patients with more sophisticated medical needs.

“I spent more than 15 years innovating within the healthcare system,” Greenhill told me in an interview. “I computerized hospitals, helped doctors adopt electronic medical records and other types of innovation practices. And then for the last eight years, I’ve been in tech, trying to figure out how to build the kind of technology we need in health, and especially digital health.”

All that experience led Greenhill to the realization that while there were many companies building specific solutions for real, but relatively narrow problems, that didn’t reflect how most people experienced care. Greenhill and her team of three other co-founders (Jeremy P. Smith, Robert I. Atwell and Kevin Lysyk) had all had unfortunate, but eye-opening experiences with family members in need of treatment for major diseases.

“You step in and you discover that cancer care, palliative care, post-surgical care — there’s so many things that would have gone wrong if we didn’t have the expertise ourselves,” Greenhill said. “But in the meantime, you end up being sort of pulled into multiple directions and saying ‘this makes no sense.’ You know, I can purchase stuff online in my private life; I can use all kinds of tools in the business world, and yet it’s back to paper and voice in health, which matters most.”

Careteam CEO and founder Dr. Alexandra Greenhill

What Careteam provides is collaboration for care — true collaboration, designed to span patients, their doctors and other healthcare pros, their families and anyone who matters to them in the course of pursuing their care. It provides the ability to communicate instantly, build care plans that integrate all aspects of their tailored health plans, receive custom-configurable notifications and measure progress toward specific goals set by patient and healthcare providers.

Part of the reason this process has become opaque or difficult is precisely due to innovation: Greenhill takes issue with the prevailing narrative that the healthcare industry is somehow allergic to innovation.

“There’s this sort of perception that healthcare doesn’t innovate, but it’s also almost insulting to the healthcare system, because we have innovated — we save people from cancer, where we couldn’t,” she noted. “We cure HIV, in some cases, and we prevent it from being transmitted to unborn babies of mothers with full-blown AIDS and things that in my working lifetime were impossibilities; it was science fiction to help someone with HIV. And, and we’ve managed to do all of that, and it’s a success story. We’ve created complexity, we’ve created people who live with 12 conditions for many, many years and take complicated drug regiments.”

In addition to advances in treatment, Greenhill notes that she and her team couldn’t have build Careteam five years ago, because cloud storage wasn’t secure and everything had to be done on a site-specific instance, and that would’ve been cost-prohibitive to build. In other words, technology has been applied to, and vastly improved, healthcare overall, regardless of the general perception of the industry as an innovation laggard.

That’s why Greenhill’s startup doesn’t shy away from complexity — they embrace it. Careteam is designed not to try to normalize and standardize the varied and highly specialized landscape of healthcare solutions and providers through anything like a one-size-fits-all API. Instead, the company’s tech development is cleverly designed to be flexible when it comes to integrations.

“We collectively spent $1.9 billion in Canada, to try and digitize the healthcare system, create standards and create some exchange between data,” Greenhill said. “The NHS tried the same, big U.S. hospital systems have created their own little sort of islands, including Kaiser and Mayo and others. And the conclusion of all of that is standardization in healthcare just doesn’t seem to catch on.”

Careteam’s approach has been instead to integrate specific clinics, and let practitioners and patients derive benefits and help spur the adoption of the platform to their companion organizations and clinics. It’s a sort of rhizomatic approach that starts with a node central to a patient’s care and spreads through the healthcare professionals and members of the patient’s support network that the product helps. And integration is made possible without technical demands on the part of partners thanks to the work of CTO Lysyk, according to Greenhill.

The Vancouver-based startup is working with the Centre for Aging + Brain Health in Toronto, Ontario in a validation program announced last year, and also raised an initial round of funding in January led by BCF Ventures with participation from Right Side Capital, Globalive Capital, Atrium Ventures, and angels Barney Pell and Ajay Agarwal .

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What top VCs look for in women’s fertility startups

A number of promising women’s health tech companies have popped up in the last few years, from fertility apps to ovulation bracelets — even Apple has jumped into the subject with the addition of period tracking built into the latest edition of the watch. But there hasn’t been much in the way of innovation in women’s sexual health for decades.

In-vitro fertilization (IVF) is now a 40-year-old invention and even the top pharmaceutical companies have spent a pittance on research and development. Subjects like polycystic ovarian syndrome, endometriosis and menopause have taken a backseat to other, more fatal concerns. Fertility is itself oftentimes a mysterious black box as well, though a full 10% of the female population in the United States has difficulty getting or staying pregnant.

That’s all starting to change as startups are now bringing in millions in venture capital to gather and treat women’s health. While it’s early days (no unicorns just yet) interest in the subject has been jumping steadily higher each year.

To shine a better light on the importance of tech’s role in spurring more innovation for women’s fertility, we asked five VCs passionate about the space for their investment strategies, including Sarah Cone (Social Impact Capital), Vanessa Larco (NEA), Anu Duggal (Female Founders Fund), Jess Lee (Sequoia) and Nancy Brown (Oak HC/FT).

Sarah Cone, Social Impact Capital

Sarah Cone, Social Impact Capital

We’re interested in companies that create large data sets in women’s health and fertility, enabling personalized medicine, clinical trial virtualization, better patient outcomes, and the application of modern AI/ML techniques to generate hypotheses that discover new targets and molecules.

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Diving deep into Africa’s blossoming tech scene

Jumia may be the first startup you’ve heard of from Africa. But the e-commerce venture that recently listed on the NYSE is definitely not the first or last word in African tech.

The continent has an expansive digital innovation scene, the components of which are intersecting rapidly across Africa’s 54 countries and 1.2 billion people.

When measured by monetary values, Africa’s tech ecosystem is tiny by Shenzen or Silicon Valley standards.

But when you look at volumes and year over year expansion in VC, startup formation, and tech hubs, it’s one of the fastest growing tech markets in the world. In 2017, the continent also saw the largest global increase in internet users—20 percent.

If you’re a VC or founder in London, Bangalore, or San Francisco, you’ll likely interact with some part of Africa’s tech landscape for the first time—or more—in the near future.

That’s why TechCrunch put together this Extra-Crunch deep-dive on Africa’s technology sector.

Tech Hubs

A foundation for African tech is the continent’s 442 active hubs, accelerators, and incubators (as tallied by GSMA). These spaces have become focal points for startup formation, digital skills building, events, and IT activity on the continent.

Prominent tech hubs in Africa include CcHub in Nigeria, Pan-African incubator MEST, and Kenya’s iHub, with over 200 resident members. More of these organizations are receiving funds from DFIs, such as the World Bank, and aid agencies, including France’s $76 million African tech fund.

Blue-chip companies such as Google and Microsoft are also providing money and support. In 2018 Facebook opened its own Hub_NG in Lagos with partner CcHub, to foster startups using AI and machine learning.

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DNA Script picks up $38.5 million to make DNA production faster and simpler

DNA Script has raised $38.5 million in new financing to commercialize a process that it claims is the first big leap forward in manufacturing genetic material.

The revolution in synthetic biology that’s reshaping industries from medicine to agriculture rests on three, equally important pillars.

They include: analytics — the ability to map the genome and understand the function of different genes; synthesis — the ability to manufacture DNA to achieve certain functions; and gene editing — the CRISPR-based technologies that allow for the addition or subtraction of genetic code.

New technologies have already been introduced to transform the analytics and editing of genomes, but little progress has been made over the past 50 years in the ways in which genetic material is manufactured. That’s exactly the problem that DNA Script is trying to solve.

Traditionally, making DNA involved the use of chemical compounds to synthesize (or write) DNA in chains that were limited to around 200 nucleotide bases. Those synthetic pieces of genetic code are then assembled to make a gene.

DNA Script’s technology holds the promise of making longer chains of nucleotides by mirroring the enzymatic process through which DNA is assembled within cells — with fewer errors and no chemical waste material. The enzymatic process can accelerate commercial applications in healthcare, chemical manufacturing and agriculture.

“Any technology that can make that faster is going to be very valuable,” says Christopher Voigt, a synthetic biologist at the Massachusetts Institute of Technology in Cambridge, told the journal Nature.

DNA Script isn’t the only company in the market that’s looking to make the leap forward in enzymatic DNA production. Nuclear, a startup working with Harvard University’s famed geneticist, George Church, and Ansa Bio, a startup affiliated with Jay Keasling’s Berkeley lab at the University of California, are also moving forward with the technology.

But the Paris-based company has achieved some milestones that would make its technology potentially the first to come to market with a commercially viable approach.

At least, that’s what new investors LSP and Bpifrance, through its Large Venture fund, are hoping. They’re joined by previous investors Illumina Ventures, M. Ventures, Sofinnova Partners, Kurma Partners and Idinvest Partners in backing the company’s latest funding.

The company said the money would be used to accelerate the development of its first products and establish a presence in the United States.

“As we announced earlier this year at the AGBT General Meeting, DNA Script was the first company to enzymatically synthesize a 200mer oligo de novo with an average coupling efficiency that rivals the best organic chemical processes in use today,”  said Thomas Ybert, chief executive and co-founder of DNA Script. “Our technology is now reliable enough for its first commercial applications, which we believe will deliver the promise of same-day results to researchers everywhere, with DNA synthesis that can be completed in just a few hours.”

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Dear Hollywood, here are 5 female founders to showcase instead of Elizabeth Holmes

Joseph Flaherty
Contributor

Joe Flaherty is director of Content & Community at Founder Collective.

There’s a seemingly insatiable demand for Theranos content. John Carreyrou’s best-selling book, “Bad Blood,” has already inspired an HBO documentary, The Inventor; an ABC podcast called The Dropout, a prestige limited series starring SNL’s Kate McKinnon, was just announced; and Jennifer Lawrence is reportedly going to star in the feature film version of this tawdry “true crime meets tech” tale. That’s before getting started on the various and sundry cover stories and think pieces about her fraud.

I think it’s fair to say the Theranos story has been sufficiently well-documented, and I’m worried that this negative perception may be reinforced now that uBiome founder Jessica Richman has been placed on administrative leave. While it’s hard to pass on a chance to stoke startup schadenfreude, perhaps we could focus less on these rare, unrepresentative and dispiriting examples? Instead, Hollywood could put the spotlight on women who pioneered the bleeding edge of tech and actually produced billion-dollar successes. Here are a few candidates ready for their close-ups:

Judith Faulkner, founder and chief executive officer, Epic Systems

Judith Faulkner – Founder/CEO, Epic Systems

In the late 1970s, the picture of a working woman in Wisconsin was likely Laverne or Shirley. Little did anyone know that in the basement of a Victorian manse in Madison, the future of healthcare was being coded by Judith Faulkner, the founder and CEO of what would become Epic Systems. Epic is arguably the most impactful startup in the history of health software, and Faulkner was building medical scheduling software before most people could even picture a PC. Her efforts established the Electronic Medical Records market as we know it and today. Her company manages records for more than 200 million people, employs nearly 10,000 and generates around $2.7 billion per year in revenue — not bad for a math graduate who never raised any venture capital.

One might argue that the origins of medical software are too tepid to make for exciting TV, but something tells me the kind of CEO who hires Disney alums to design her corporate campus and dresses up like a wizard to address her employees might make for a compelling subject.

SANTA BARBARA, CA – FEBRUARY 09: Lynda Weinman speaks onstage (Photo by Rebecca Sapp/Getty Images for SBIFF)

Lynda Weinman – Founder/CEO, Lynda.com

Lynda Weinman might have the most esoteric path to becoming a billion-dollar entrepreneur in history. After getting a humanities degree from Evergreen College, where she was classmates with “Simpsons” creator Matt Groenig, Lynda opened a pair of punk rock fashion boutiques on LA’s Sunset Strip.

After those folded in the early 1980s, she taught herself enough computer graphics to become a freelance animator on movies like “Bill & Ted’s Excellent Adventure,” which in turn led to her becoming a teacher at the prestigious Art Center College of Design. Her academic pedigree provided the launching pad to write an influential textbook; that, in turn, gave her the star power to strike out on her own as one of the first web celebrities.

Keep in mind; this dramatic arc only covers the time before she started the eponymous Lynda.com, and bootstrapped it to a $1.5 billion exit in edtech — an industry most VCs and entrepreneurs fear to tread. In terms of material for a memoir, Hannah Horvath has nothing on Lynda Weinman.

FRAMINGHAM, MA – MAY 30: Shira Goodman, former chief executive at Staples, poses for a portrait in Framingham, MA on May 30, 2017 (Photo by Suzanne Kreiter/The Boston Globe via Getty Images)

Shira Goodman – CEO, Staples.com

Shira Goodman has arguably done more for online shopping in the U.S. than anyone not named Bezos. She didn’t found Staples, but she did start and scale its “delivery business,” as she humbly calls it, to the point where it became the fourth largest e-commerce company in the U.S.

At a time when more nimble startups were disrupting big-box retailers, Shira did what few of her contemporaries could do — rapidly shifted a multi-billion-dollar legacy company in an ancient industry into the future, and eventually became CEO of the entire enterprise. She did this while also raising three children and supporting her husband when he decided to change careers and go to Rabbinical school. Sitcoms have been premised on less, and since two versions of “The Office” have captivated audiences, perhaps it’s time to provide the perspective from the CEO of Dunder-Mifflin HQ?

Helen Greiner, co-founder, iRobot

Helen Greiner – Co-founder, iRobot

From C. A. Rotwang in “Metropolis” to Tony Stark in the Marvel movies, there have been plenty of cinematic explorations of robot builders, but the story of iRobot co-founder Helen Greiner might be more interesting than anything yet committed to celluloid. As a recent grad from MIT, Greiner spent a substantial chunk of the 1990s applying her mechanical genius to everything from a mechatronic dinosaur for Disney to a store cleaning robot with the potential for mass destruction for SC Johnson.

Far from an ivory-tower academic, Grenier helped the government deploy search and rescue efforts at Ground Zero after 9/11 and cave-clearing ‘bots in Afghanistan, and the bomb-disposing Packbot she developed has saved the lives of thousands of service members. Grenier, at age 38, took her company public and made the Jetson’s vision of a robot housekeeper a reality in the form of the Roomba.

CAMBRIDGE, MA – MARCH 15: Kelsey Wirth, who has a grassroots organization called Mothers Out Front: Mobilizing For A Livable Climate (Photo by Essdras M Suarez/The Boston Globe via Getty Images)

Kelsey Wirth – Co-founder, Align Technologies

While the original startup bros were inflating the tech bubble in the late 1990s, Kelsey Wirth was pioneering 3D printing, which at the time was as fantastical as anything Theranos promised. Wirth’s story as the co-founder of Align Technology is especially compelling in the way it shares some surface similarities with Holmes’ narrative. Prominent skeptics of Invisalign cast doubts on the company in its early days, noting that the startup’s PR had outstripped its clinical validation. Wirth had to solve seemingly intractable technical challenges, including scanning misaligned incisors, developing algorithms to overcome underbites, pioneering new manufacturing process, convincing the FDA to clear the product and then selling it across the country — armed only with an English lit degree and an MBA. Despite the long odds of curing crossbites with software, Wirth started what has become a publicly traded business that is currently worth more than 20 billion dollars.


Most of these founders faced setbacks, including external obstacles and those of their own making. There were layoffs, bad deals and few of these stories had perfectly happy endings. Still, while a contemporary startup can earn plaudits for simply repackaging CBD and pushing it on Facebook, these entrepreneurs demonstrated a level of ambition rarely seen among modern upstarts.

The sensational focus on Elizabeth Holmes’ misdeeds steal focus from a group of landmark female entrepreneurs and waste a tremendous opportunity to inspire the next generation with heroic tales instead of fables of fabrication. None of these accounts have the black and white morality of the Theranos debacle, but these founders cleared hurdles both scientific and social. They flipped the script and made history; surely Hollywood can find some drama in that.

Thanks to Parul Singh, Elizabeth Condon and Alyssa Rosenzweig for reviewing drafts of this post.

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Mint founder Aaron Patzer launches Vital, an ER management tool that integrates with electronic health records

Aaron Patzer launched Mint to help consumers organize their finances. Now he’s raised $5.2 million from investors to launch Vital to bring that consumer-focused mindset to emergency rooms and hospitals to help them organize patient flow.

Patzer co-founded the company with his brother-in-law Justin Schrager, a doctor of emergency medicine at Emory University Hospital. The serial entrepreneur invested a million dollars and two years of peer-reviewed academic study and technical research and development to create Vital, according to a company statement.

Investors in the seed round include First Round Capital and DFJ, Bragiel Brothers, Meridian Street Capital, Refactor Capital and SV Angel. Alongside angel investors Vivek Garipalli, the chief executive of CloverHealth and Nat Turner and Zach Weinberg, the founders of Flatiron Health, these investors are hoping that Patzer can repeat in the healthcare industry the magic he brought to financial services.

“The HITECH* Act was well-intentioned, but now hospitals rely on outdated, slow, and inefficient software – and nowhere is it more painful than in the emergency room,” said Patzer, in a statement. “Doctors and nurses often put more time into paperwork and data entry than patient care. Vital uses smart, easy tech to reverse that, cutting wait times in half, reducing provider burnout and saving hospitals millions of dollars.”

Vital isn’t so much replacing the current system of electronic health records as providing a software integration layer that makes those systems easier to use, according to the company.

It’s basically a two-sided application with a survey for incoming patients. An admitting nurse begins the record and as a next step a patient receives a text to add details like height, weight, recent surgeries, medications and allergies, just as they would on a paper form. Patients can also submit a photo of themselves and their insurance card to expedite the process.

The information is then fed back into a tracking board that doctors and nurses use to prioritize care. A triage nurse then reviews the data and affirms that it is correct by taking vital signs and assessing patients.

All of that data is fed into an algorithm that analyzes the available information to predict a course of treatment and help staff in the emergency room prioritize who needs care first.

Vital’s selling the service to emergency rooms with a starting sticker price of $10,000 per month.

“Vital successfully built software with a modern, no-training-required interface, while also meeting HIPAA compliance. It’s what people expect from consumer software, but rarely see in healthcare,” says First Round investor Josh Kopelman, who’s taking a seat on the company’s board of directors. “Turning massive amounts of complex and regulated data into clean, easy products is what Mint.com did for money, and we’re proud to back a solution that’ll do the same in life and death situations.”

In some ways, Vital looks like the patient-facing admissions side of a coin that companies like Qventus have raised tens of millions of dollars to solve at the systems level.

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India’s Mfine raises $17.2M for its digital healthcare service

Mfine, an India-based startup aiming to broaden access to doctors and healthcare by using the internet, has pulled in a $17.2 million Series B funding round for growth.

The company is led by four co-founders from Myntra, the fashion commerce startup acquired by Flipkart in 2014. They include CEO Prasad Kompalli and Ashutosh Lawania who started the business in 2017 and were later joined by Ajit Narayanan and Arjun Choudhary, Myntra’s former CTO and head of growth, respectively.

The round is led by Japan’s SBI Investment with participation from sibling fund SBI Ven Capital and another Japanese investor, Beenext. Existing Mfine backers Stellaris Venture Partners and Prime Venture Partners also returned to follow-on. Mfine has now raised nearly $23 million to date.

“In India, at a macro-level, good doctors are far and few and distributed very unevenly,” Kompalli said in an interview with TechCrunch. “We asked ‘Can we build a platform that is a very large hospital on the cloud?,’ that’s the fundamental premise.”

There’s already plenty of money in Indian healthtech platforms — Practo, for one, has raised more than $180 million from investors like Tencent — but Mfine differentiates itself with a focus on partnerships with hospitals and clinics, while others have offered more daily health communities that include remote sessions with doctors and healthcare professionals who are recruited independently of their day job.

“We are entering a different phase of what is called healthtech… the problems that are going to be solved will be much deeper in nature,” Kompalli said in an interview with TechCrunch.

Mfine makes its money as a digital extension of its healthcare partners, essentially. That means it takes a cut of spending from consumers. The company claims to work with more than 500 doctors from 100 “top” hospitals, while there’s a big focus on tech. In particular, it says that an AI-powered “virtual doctor” can help in areas that include summarising diagnostic reports, narrowing down symptoms, providing care advice and helping with preventative care. There are also other services, including medicine delivery from partner pharmacies.

To date, Mfine said that its platform has helped with more than 100,000 consultations across 800 towns in India during the last 15 months. It claims it is seeing around 20,000 consultations per month. Beyond helping increase the utilization of GPs — Mfine claims it can boost their productivity 3 to 4X — the service can also help hospitals and centers increase their revenue, a precious commodity for many.

Going forward, Kompalli said the company is increasing its efforts with corporate companies, where it can help cover employee healthcare needs, and developing its insurance-style subscription service. Over the coming few years, that channel should account for around half of all revenue, he added.

A more immediate goal is to expand its offline work beyond Hyderabad and Bangalore, the two cities where it currently operates.

“This round is a real endorsement from global investors that the model is working,” he added.

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Acting as the data integrator between hospitals and digital health apps brings Redox $33 million

Investors have forked over $33 million in a new round of funding for Redox, hoping that the company can execute on its bid to serve as the link between healthcare providers and the technology companies bringing new digital services to market.

The financing comes just two months after Redox sealed a deal with Microsoft to act as the integration partner connecting Microsoft’s Teams product to electronic health records through the Fast Healthcare Interoperability Resources standard.

Redox sits at a critically important crossroads in the modern healthcare industry. Its founder, a former employee at the electronic health record software provider Epic, knows more than most about the central position that data occupies in U.S. healthcare at the moment.

What we’re doing, we’re building the platform and connector to help health systems integrate with technologies in the cloud,” says chief executive, Luke Bonney. 

Bonney served as a team lead in various divisions at Epic before launching Redox, and the Madison, Wis.-based company was crafted with the challenges other vendors faced when trying to integrate with legacy systems like the health record provider.

“The fundamental problem is helping a large health system use a third-party tool that they want to use,” says Bonney. And the biggest obstacle, he said, is finding a way to organize into a format that application developers can work with the data coming from healthcare providers. 

Investors including RRE Ventures, Intermountain Ventures and .406 Ventures joined new investor Battery Ventures in financing the $33 million round. As part of the deal, Battery Ventures general partner Chelsea Stoner will take a seat on the company’s board.

Application developers pay for the number of integrations they have with a health system, and Redox enables them to connect through a standard application programming interface, according to the company. 

Its approach allows secure messaging across any format associated with an organization’s electronic health record (EHR), the company said. 

Redox works with more than 450 healthcare providers and hundreds of application developers, the company said.

High-profile healthcare networks that work with the company include AdventHealth, Atrium Health, Brigham & Women’s, Clarify Health, Cleveland Clinic, Geisinger, HCA, Healthgrades, Intermountain Healthcare, Invitae, Fitbit, Memorial Sloan Kettering, Microsoft, Ochsner, OSF HealthCare, PointClickCare, R1, ResMed, Stryker, UCSF, University of Pennsylvania and WellStar.

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