Health IT

Google Glass entrepreneur’s brutally honest take on building an HIT startup in 2013

My 2013 year in review begins in Q4 of 2012. At the time, I was working at VersaSuite as the product manager for all clinical applications and the project manager for two grueling hospital EMR deployments. We were trying to deliver the impossible in an impossibly short period of time. I was constantly stressed and […]

My 2013 year in review begins in Q4 of 2012. At the time, I was working at VersaSuite as the product manager for all clinical applications and the project manager for two grueling hospital EMR deployments. We were trying to deliver the impossible in an impossibly short period of time. I was constantly stressed and concerned. I fell into what I retrospectively call depression, though that’s probably a bit hyperbolic.

Going into 2013, I decided that I was going to start a business in health IT. I had no clue what I was going to do, but I knew I wanted to start something in health IT. I had no savings. Or ideas. So I set a New Year’s resolution to blog 3x weekly. My hope was that potential stakeholders – investors, employees, and clients – would read my blog and come to the conclusion that I knew what I was talking about. In retrospect, I can safely say that Pristine would have probably already failed had I not blogged. Blogging has contributed to at least $200,000 in direct capital investment, Pristine’s pilot at UC Irvine, helped convince some of our early employees to join, and has opened several serious opportunities in our sales pipeline.

With a bit of hindsight, this raises an interesting question: was the most important decision I made in my life to start blogging or to start Pristine? The two are so intertwined, it’s nearly impossible to discern.

Through the first quarter of 2013, I was actively looking for opportunities. I contemplated dozens of ideas. My favorite was to build an Wikipedia-esque database of open source order sets to compete with FirstDabank, Zinx, and Provation.

Then I saw Glass.

From the moment I saw Glass in February, I knew that’s what I wanted to do. The launch of the Glass Explorer Program felt particularly timely since I’d just written three brief essays in January about human computer interaction.

Optimizing the keyboard

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Optimizing the mouse

Resurgence of the command line UI

I began frantically learning Android development. I spent almost every night in February pouring through Android material and coding late into the night; I actually built a horrendous RSS reader to learn Android development. By the end of February, I realized that I would never learn Android to the extent I would need to. So I began looking for a technical cofounder.

Thanks to my friend Mike Wilson, I scored free tickets to SXSW Interactive in early March. It was my first SXSW, and I loved it. I wondered SXSW and aimlessly talked to strangers. I met my first potential cofounder there. At the time, we were discussing Glass apps for blind people. After a month or so, we decided that we wouldn’t be the best partners for one another.

I’d known that Patrick was a technical genius since we’d first met in high school computer science class. So I floated “Glass for healthcare” by him in April. By the end of April, we were playing with the Mirror API even though we didn’t have Glass yet. At the time, we were trying to push EMR data to Glass via the Mirror API.

What a terrible idea.

I got picked up by HIStalk in May, and my first blog post on HIStalk attracted the interest of our first angel investor, who ended up investing $100,000. He is an anesthesiologist who really opened up our eyes to the opportunities around video-based communication in the OR. We would only later discover that what we were onto much broader and more profound applications.

Meanwhile, things were degrading at VersaSuite. I was getting distracted as things started picking up with Pristine. I couldn’t focus at VersaSuite. I was scared to quit. I only had a few months of cash. I had never raised money before. But I quit anyway. Quitting VersaSuite was probably the most difficult thing I’ve ever done. Both Patrick and I finished our obligations with our previous engagements on June 14th.

We received our first $100,000 by the end of June. Just 24 hours after finalizing our first $100,000 investment, I lost what was at the time our only Google Glass unit while drunk at a bar in NYC. After a huge scare, we got a few Glass units and raised our second hundred thousand by the end of July.

In early June, an anesthesiologist from UC Irvine emailed me out of the blue because he saw a blog post I’d written for HIStalk reposted on MedCityNews. At the time I didn’t think much of it as we’d already had a handful of surgeons reach out asking to pilot. I flew out to UC Irvine on July 2nd; they wrote a letter of intent that day, and we began ironing out pilot paperwork shortly afterwards.

By mid July, Patrick and I were growing sick of working out of my living room, so we began exploring incubator options. I emailed Gordon Daugherty, one of the directors of Capital Factory, out of the blue, who introduced me to Josh Baer, the Managing Director at Capital Factory. Josh made us an offer to join the incubator program during our first conversation, which I didn’t think much of at the time. I actually blew Josh off for a while, but eventually came to my senses and joined Capital Factory. I was utterly stupid for thinking that we could run a legitimate company out of my living room. Our first day at Capital Factory was August 1st.

I could have never imagined how difficult it would be to hire our first non-founding employee. No one wants to be the first non-founding employee in a startup. The first two offers we issued were rejected. In retrospect, that’s a good thing, as neither of them were as talented as Mark, who joined as VP of Engineering and has been running our development teams since. Patrick and I met Mark at the Austin Google Glass meetup, which I selfishly organized to find folks who might be willing to sell a Glass unit to us. Instead of finding Glass units for sale, I found Mark. Good compromise.

I spent most of my time through August, September, October, and November traveling around the country to attend conferences and tradeshows to network, demo our software to hospitals, and pitch investors. I learned that that conference educational material is useless, that investors have no respect for my time or capital, and that most importantly, we were onto something. I refined our messaging and investor pitch extensively. I successfully raised quite a bit more capital. And although I was frequently travelling, we were hiring. During that time, we fleshed out our engineering team as Rahul, Aaron, Arik, Derrick, and Devin joined.

Out of dumb luck, I found Buzz, who would become our VP of Sales. A woman from the Central Texas HIE reached out to me in August about developing Glass apps for the Central Texas HIE. I entertained the idea – an idea that would have derailed the entire development path of the company – long enough that she introduced me to her colleague Buzz. A couple of days later, I received an email from Buzz inquiring about the VP of Sales opportunity listed on our website. I have no clue what I would’ve done if Buzz hadn’t joined; it’s extremely difficult to find successful health IT salesman that are as talented as Buzz that are willing to join an early-stage startup.

We ran our first live surgical case on October 2nd at UC Irvine. Mark and Patrick coordinated everything to bring our product to life. I was attending the Health 2.0 conference in Santa Clara that day, and was scared beyond literal expression that we would crash and burn. But we didn’t. Somehow, the system worked. Mark and Patrick spent a few more weeks at UC Irvine where they identified an enormous number of bugs and UX challenges that we would keep us busy through the end of the year.

Two weeks after our first live surgical case, I launched the company to the public at the DEMO conference in Santa Clara, CA. I cut open a TraumaMan that was squirting a fountain of blood onto the stage in front of 1000 people. It was awesome. We won the DEMOgod award. Check out my DEMO presentation.

Buzz began working full time on November 1st, and began driving deals immediately. We have a very strong sales pipeline ahead of us going into 2014. We’re expecting first revenue in January of 2014, 8 months after founding the company. If we can successfully execute on our commitments through Q1 of 2014, the rest of 2014 is going to a story of managing rapid growth.

I could have never imagined how difficult it would be to start a business from nothing. It was an order of magnitude more difficult than I expected. Something would go wrong on a daily basis. And yet, for everything that went wrong, 1.1 things would go right.

I have learned more in the past 8 months than during any 5 year period in my life. I have been kicked around by investors and media, rejected by those whom I asked money of and offered money to, and laughed at by doctors. I have learned more about what it takes to raise money, to hire, to fire, to communicate, to market, and to lead than I could’ve possibly imagined. Running a startup is without a doubt the most dense learning experience in life. There’s nothing quite like it.

If I had to sum up everything I’ve learned into a few key themes, they would be:

Focus – I pursued augmented reality hardware, apps for blind people, EMR extensions, and more while still thinking I could pursue video-based communications. It took me at least 4 months to realize how absurd my aspirations were.

(Over) communicate – I type faster than anyone that I know. I speak faster than most. And yet I still find that I communicate less effectively and overall less than I’d like. We’ve put structures in place to shape communication, but it’s something that I continue to struggle with.

Have fun – Until November, I would have good days and bad days. I was high until I was depressed. That’s not a sustainable way to run a business. The bad days were particularly difficult. Bad news in any form would create a level of uncomfortable anxiety. I’m learning how to deal with an always-heightened level of anxiety, and how not to overreact to both good and bad news. I still have a long way to go.

Adapt – as companies grow, the most dynamic and changing role is that of the CEO. At the idea stage, the CEO does literally everything other than technology. As the company grows, the CEO must invert the business so that s/he isn’t responsible for anything. The ultimate goal is to make the CEO irrelevant.

I won’t make myself irrelevant by the end of 2014, but it’s a goal I’ll continue to strive for.

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