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Moonlighting physicians are creating useful apps

By Dianne Daniel

In 2012, Dr. Joshua Landy, a busy intensive care specialist at Scarborough General Hospital in Toronto, was catching up with two friends over dinner. Today, the three are cofounders of Figure 1 Inc., a start-up that recently raised $2 million in seed funding to grow its healthcare photo sharing app.

Years ago, doctors Rahul Mehta and Aravind Ganesh became fast friends while first-year resident physicians at the University of Calgary, spending much of their post-call time chatting about challenges in their daily rotations. Now, they’ve partnered with software engineer Hisham Al-Shurafa to launch SnapDx, a mobile app that simplifies complex medical knowledge using infographics.

In today’s world of smartphones and tablets, there’s no shortage of ideas for developing mobile health apps. How is it that extremely busy physicians are achieving success?

Ask the founders of Figure 1 and SnapDx and they’ll tell you serendipity was on their side, but it takes more than luck to bring an idea from idle conversation to fruition. You also need a strong desire to improve the way healthcare professionals work, a willingness to put in a ton of sweat equity, and the modesty to seek help when you need it.

At Figure 1, founded by Landy, mobile developer Richard Penner and Gregory Levey, an associate professor in Ryerson University’s School of Professional Communication, in Toronto, the idea for an app was born after Landy spent a summer studying on-line approaches to medical education at Stanford University, in California. He took the age-old notion of a teaching file, essentially a file of interesting or perfectly classic cases that physicians collect over time, and applied it to the new world of digital media.

Rather than simply converting a paper-based process to an electronic one, he wanted to leverage online technology to offer improvements. “You need to invent a new process instead of just translating it into a digital one, the same way shopping for diapers on Amazon.com is different than shopping for diapers at a grocery store,” he says. “People are taking these pictures with the objective of sharing and teaching in mind … there’s no reason why anyone should keep a paper copy in a desk drawer where after a while, they don’t get used.”

Taking its name from the nomenclature used in textbook captions, Figure 1 is a secure app for sharing medical images that can be used as an interactive reference and teaching tool. A mobile, crowdsourced platform, it enables healthcare professionals to upload images from their smartphone or tablet, tag them, rate them for accuracy or search them, all in a manner that is in line with privacy and ethics requirements.

The goal is to take social behaviours – like checking a phone multiple times throughout the day – and convert those to professional behaviours, says Landy, and the concept is catching on. With tens of thousands of users in three countries, the app is currently available on iPhone and iPad with plans to expand to Android and desktop versions this year.

Reflecting back, Landy counts himself lucky that Penner and Levey had the technical and marketing know-how he was lacking. “I sort of thought I mightend up as the guy with the idea who never did anything with it,” he admits. “I didn’t have any clue how to get started with something like this.”

That’s where business incubators and technology transfer offices come into play. Many universities and colleges across Canada have them in place. The intent is to serve as an accessible infrastructure to support entrepreneurs in the early stages of launching a product or service.

Within six weeks of that initial dinner meeting in 2012, Figure 1 co-founders had a working prototype. They pitched it to gain acceptance into Ryerson University’s Digital Media Zone incubator and Ryerson Futures accelerator programs in Toronto, receiving crucial advice, support and investor backing in the early stages of their company’s growth.

“Only about 15 percent of companies that apply end up getting into the DMZ,” says Matt Saunders, president and managing director, Ryerson Futures Inc. “Of those who come in and start to gain traction, only a small percentage gain access to the accelerated futures program and potential funding.”

Both programs look for “coachable” teams, he says, people who have some expertise or edge in their sector, and are attempting to solve a realworld problem.

“Very rarely do you find someone who has the technical skills to build the app, the marketing skills, background and insight to be able to go sell and market it, and the operational background to hire a team and grow and scale,” he says. “Early on, when you can’t afford all of those pieces, we help you scale faster and accelerate the development of your business.”

From December 2012 to August 2013, DMZ provided office space to Figure 1, along with access to mentors and investors. In addition to arranging financial support from family and friends, the company has since announced $2 million in seed funding, co-led by Version One Ventures and Rho Accelerator Fund, and including a number of prominent angel investors.

Right now the company remains dependent on investor capital, but Landy remains optimistic that a revenue- generating model is within reach. It means Landy must continue to manage two jobs, working two weeks a month in the hospital’s intensive care unit, and two weeks at the Figure 1 office, now relocated down the street from DMZ, but he says he loves both.

“For the time being they expect us to focus on building a very solid, likeable, useful, enjoyable and easy product,” he says. “From our perspective we want to make sure it reaches as many healthcare providers as possible and provides the best or most educational experience as we possibly can.”

Making money is not the first priority. What’s more important is delivering a tool that makes a difference.

“We are not socialized as Canadians to be entrepreneurial in our health sector,” says Anne Snowden, professor and chair at The University of Western Ontario’s International Centre for Health Innovation, situated within the Richard Ivey School of Business. “We’re socialized to achieve the best possible outcome for the people we care for … It wouldn’t be surprising at all to me if they were to say, ‘Look. This isn’t going to make $1 million, that’s not why I’m in it. I’m in because I think it’s going to offer people some value,” she says, referring to a growing group of clinicians-turned-app-developers.

From her vantage point at the Centre, where the mandate is to be a catalyst for healthcare innovation by supporting multi-disciplinary education and research, Snowden is seeing a growing number of ideas come forth for healthcare apps. One challenge facing clinicians who want to turn those ideas into products, she says, is learning how to juggle exhausting patient care commitments with the demands of a start-up.

“We are a country that is well-known for developing and coming up with very important and innovative ideas and new knowledge,” she says. “But we are not a country that has a strong record in terms of getting those ideas or new products into our health system.”

Both Figure 1 and SnapDx are on track to buck the trend. Like Figure 1, SnapDx has its first clinical assessment product available for the iPad and iPhones with plans to offer Android and on-line versions this year. The first version of the product targets the interaction between patients and doctors at point-of-care, providing doctors with quick access to evidence-based practices and knowledge and allowing them to generate patient-specific treatment plans that can be easily explained to patients using graphics.

Inspired by infographics he routinely read in The New York Times, Mehta wanted to take the concept of simplifying complex data and adapt it to the medical community. “We started punting ideas back and forth and this model started to come together,” says Ganesh, adding that the ultimate goal is to transform the patient- doctor visit.

Knowing they needed the help of a software engineer, the two approached Al- Shurafa who was enjoying early success developing software tools for plastic surgeons as co-founder of Startup Calgary. They were simply looking for a recommendation. Instead, Al-Shurafa came onboard and the three struck a friendship.

For now, the SnapDx co-founders work out of a travelling office, meeting wherever and whenever it’s convenient. It might be Second Cup or Starbucks or somebody’s home, and they average 10-15 hours of office time per week, or roughly one hour for every three hours Mehta and Ganesh spend performing clinical duties.

In 2013, SnapDx beat out 13 other healthcare start-ups to win first place at the W21C Innovation Academy at the University of Calgary, earning a $10,000 cash prize. Beyond that, they’ve been working on “sweat equity” and have yet to look for external sources of financing. The goal is to have a strong, working beta product before they “start playing with other people’s money,” says Ganesh.

In the meantime, the team is tapping into available resources at the University of Calgary and is looking to partner with associations and groups that produce evidence-based knowledge. It also intends to join an incubator program, either in the U.S. or Canada.

“The great thing about knowledge is that facts can’t be patented,” says Ganesh. “One of the passions we share, in addition to trying to improve the quality of healthcare, is also trying to improve the equality of access to information. As we’re looking at big academic centres like university hospitals compared to the average family practice or community hospital, there’s a big gap in the knowledge that can be accessed.”

Ganesh believes one reason for the success of SnapDx to date, including its overwhelming acceptance at W21C Innovation Academy, is that it is strongly rooted in clinical experience and driven by the need to solve challenges.

“What we found is that it doesn’t really matter how knowledgeable you are about different conditions or how up to date you are on the literature, when it actually comes down to the point-of-care, your brain falls back on more simplistic models for trying to figure out how you want to manage a problem,” he explains.

SnapDx solves the problem of information overload, allowing doctors to rely on more than just their memories and giving them a visual way to present data to patients. For example, the side effect visualization tool uses a grid diagram of coloured boxes to depict possible side effects, correlating the sizes of the boxes to the likelihood of a patient developing that particular side effect.

This year, SnapDx is teaming with a group of students from University of Calgary’s Haskayne School of Business to participate in the Clinton Global Initiative’s 2014 Hult Prize President’s Challenge. Teams are being asked to build sustainable and scalable social enterprises to address non-communicable diseases in urban slums. The idea is to develop a creative solution that can change the way medicine is practiced in the developing world.

“The students were thinking of some way to incorporate telecommunications into their solution,” says Ganesh. “Our solution was born in a North American environment, but perhaps its biggest calling will be in the developing world, in places where people don’t have the hope of accessing high-end technology and everything rests on the patient-physician interaction.”

Such altruistic or selfless goals are common among physician entrepreneurs, says Snowden. Faced with increasing and significant demands for care from the populations they serve, it’s natural the number one priority is to create an app that makes their work life better or more efficient. Apps are exploding in the mainstream consumer world as useful tools to help navigate, manage and organize effectively so it’s just a matter of time before healthcare gets there too, she says.

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