Building a company is hard, and building a healthcare company is the double black diamond of company building.

These past 365 days have been a whirlwind of ups and downs, of success and failure. From late night whiteboard sessions to early mornings in the OR, we’ve taken a patient-centric and provider-centric approach to digital health innovation.

By focusing on sustainable growth and obsessing over the problem, we’ve been able to avoid common pitfalls made by companies playing healthcare Tetris, awkwardly pushing their “solutions” into clinical workflows that are inherently complex and unique in their structure.

My team and I have kept relatively quiet this year and were honestly nervous about publishing this article and being so transparent in our approach. However, it’s an exciting time to work in healthcare and I hope that this will encourage you to take the first steps in building solutions that will transform how we deliver care.

Our Story.

At Symbi Medical, we help patients navigate through complicated medical care and support them between clinical visits.

If you’ve ever had surgery or helped a family member get through a procedure, you’ll understand the absolute nightmare the whole process can sometimes be. You leave your consultation not fully understanding everything your doctor said, with stacks of even harder to understand papers and instructions to “prepare” you for your procedure.

As the days get closer, you anxiously try to remember all the important details. What to bring, when to stop eating, how to do your pre-hab, what medications to stop taking, what part of the hospital to go to, etc. If you’re lucky, you might get a call from the the pre-op nurse checking in with you. On the day of your procedure, you show up and hope that you’ve done everything as recommended.

The procedure goes well and you wake up in the recovery room. A doctor or nurse comes to speak with you, and you spend the next few minutes battling grogginess as you try to decipher all of your post-op care. You get home and repeat the anxiety-ridden question period. When should I start the pain medication, is it okay to have a shower, how do I change the dressing, what signs of infection should I look for, is it normal for the site to be bleeding, what should I be eating, when can I get back to normal activity, how can I reduce swelling, etc.

There are clear gaps in the patient journey that impact hospitals, providers, and patients in a big way. Missed appointments cost healthcare providers over $150 billion per year and medication non-adherence up to another $289 billion. Beyond the financial implications, these gaps in care can be detrimental to a patient’s health and outcomes.

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As our healthcare system shifts from volume-driven to value-based, it is becoming very clear that care must expand beyond the hospital walls.

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Timeline.

I graduated from StFX University in May 2018 and thought that I’d enter directly into medical school after completing a year-long community development program through the Pathy Family Fellowship. I spent about 4 months shadowing doctors in family medicine, ER, ENT, opthalmology, plastic and general surgery.

After seeing an overwhelming number of delays and cancellations as a result of under-prepared patients, as well as a high volume of hospital readmissions and revision surgeries for patients who had difficulties following their post-op care, my path to medical school took a bit of a turn. We had to find a better way of supporting patients between clinical visits to improve outcomes and reduce the number of unnecessary cancellations and complications that place tremendous burden on our providers and healthcare systems as a whole.

My amazing co-founders Max and Devin joined me in September 2018, and together we’d spend the next few months designing a solution, talking to patients, and working with incredibly supportive clinical partners. They had both just started their final year of University, so we had to be very efficient with our evenings and weekends. Our solution had to meet two requirements:

1. SMS-based.

Our product is only valuable if patients actually use it. There’s no amount of great design and cool features that can fix building your product on the wrong medium. With most patient engagement companies building complex apps that require patients to search for, find, download and customize, we knew that we had to be different.

We decided to use automated text-messages to activate patients at every step of their journey. No apps, no confusing sign-ups, no portals. Our patients range in age from the early 20s to late 60s, so it was incredibly important that our product would work independent of a patient’s technical abilities.

Symbi is not a catch-all solution, and of course some patients will still prefer paper-based instructions and education, but by taking time to truly understand the needs of our patients we’ve built a product that will propel us towards industry-leading utilization rates.

2. Quick to implement.

Most healthcare providers spend their days caring for patients and generally do not have a huge amount of time to pilot new technologies or think about how your solution will fit in to their daily routine. Digital engagement programs can take 6 to 8 weeks to build out and implement. We designed Symbi to be launched at a practice in just 15 minutes.

Tip: The best digital health companies know how to combine engineering and product with a deep understanding of the clinical perspective. One without the other does not work. I’ve always admired Flatiron Health and Omada Health and think that they both do an excellent job of this.

As an early-stage founder, you wear all the hats. Max and Dev worked away at developing the backend platform and building out all the “magic” behind Symbi. I handled our front-end design and would meet weekly at the hospital with our clinical partners to go over user experience and quickly test our assumptions.

We finished our beta version by the end of December 2018. It wasn’t pretty, it wasn’t what we planned, but it would be enough to start collecting patient feedback. We didn’t have much money in the bank and knew that we needed to make some pretty substantial investments into data hosting and compliance.

We came across the $25,000 Innovacorp Sprint Competition. As a small company based in Antigonish, Nova Scotia, this would be transformative for our business. We poured a lot of time into our application and were fortunate to be selected as 1 of 10 companies to pitch in January.

When you look back at all the great companies it seems like everything just fell in place for them. The reality is that building a company is not a linear path. It is every part of the metaphorical roller coaster that entrepreneurs speak about. We didn’t win the $25,000 and had no idea what we were going to do to stay alive. By delaying the US expansion and focusing entirely on running a successful Canadian pilot, we bought ourselves some time.

On February 13th, 2019, we launched a pilot program with the Chief of Surgery for Eastern Nova Scotia.

His support was instrumental in getting us from an idea to a working product and he will always be one of my greatest mentors. We thought that we had all the software bugs worked out. Were we ever wrong. Patients will use your product in ways you’ve never imagined and it’s important to build a robust feedback loop from day 1. We spent the next few weeks burning the midnight oil just to keep our heads above water, and by the end of the pilot had a product that actually worked quite well.

After implementing Symbi, patient adherence jumped to about 83% and we maintained a 4.4/5 patient rating with an NPS of 100. Our sample size was too small to draw any statistically significant conclusions, but we started to feel as though we were on to something and that patients received real value from using Symbi.

From April 2019 to November 2019 we achieved a number of amazing milestones but also failed drastically a number of times. We presented our results to key decision makers across the Province, were invited to speak at Dal’s Resident Research Day, were selected out of 77 companies on our second attempt for the $25,000 Innovacorp Sprint Competition, signed our first paying customers, became fully-certified to handle Protected Health Information in both Canada and the US, and began expanding through two leading surgical conferences in New Orleans and Boston. We also failed to hit growth targets, lost a $30,000 contract, almost got shut down by a terrible error in our SMS system, and failed to get into multiple business accelerators.

The stark juxtaposition between our success and our failures, between our ups and our downs, is what keeps it exciting. If you can turn every “no” and every failure into feedback and learning, you will survive. Great companies are built through consistency, not perfection.

Working in healthcare can be challenging to even the most motivated teams. Everything takes longer, data compliance is expensive, integrating into clinical workflows can be near impossible, and there are regulatory barriers everywhere you look.

It also gives you reason to keep going. Every step forward is a step towards better patient care. We are privileged with the opportunity to make a meaningful difference in the lives of our patients every single day, and we are responsible to them to build something amazing. I’ll leave you with 3 key points that I’ve learned as a digital health entrepreneur:

• Consistency > perfection
• Hyper-focus on a niche problem faced by a small group of patients and build something truly transformative for them
• Don’t overbuild, your minimum viable product should be just that

What’s next?

In one short year of operations we’ve run a successful pilot program with a hospital in Nova Scotia, entered 4 specialties (ENT, oral surgery, plastic surgery, gastroenterology), helped facilitate thousands of patient interactions, presented our work at leading surgical conferences across North America, and expanded to the US. As we head into 2020, we have some very exciting things in our pipeline.

I can’t share all the details just yet, but it includes a game-changing clinical trial, impressive new partnerships and a complete branding overhaul. If you’ve made it this far in the article, thank you! We’ll be posting a lot more content in the new year and are grateful for your continued support.

We’re incredibly thankful for the amazing group of patients, providers, and clinical partners who’ve made all of this possible. If you’re building something awesome in the digital health space, or have an idea that you’d like to pursue but don’t know where to start, please reach out. It’s been through the support of incredible mentors that we’re able to do what we do.

Let’s change healthcare, together.

Cameron

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If you’re interested in connecting, please send me a note to cameron@symbimedical.com