Within 5 years we would expect to have significant market share in the US simulation market and have expanded internationally.

We're also planning to move into EMS, Nursing, Fire, and even police training.

By the next 5 years we would like to have penetrated the market with light therapy Foley catheter, partnered with a major manufacturer to increase production and integration. After initially establishing in the US, we will have moved to the European and Asian markets. We will then be expanding the technology into several adjacent fields.

The RHIO I work for in NY is really a kind of startup, although not-for-profit and now funded by the state. There are 8 RHIOs in NY and until recently only 2 had employed physicians. I have learned that there is a big difference between being an employee )or consultant) of a startup rather than being on the board. Every RHIO and maybe every health care startup should consider having a physician on staff to consult with tech teams and connect with customers. It has worked well for us, and it has been fun for me!

The wonderful thing about being a physician is that you can leverage your expertise in such a variety of ways. I started at Twiage as the founding Chief Medical Officer because as a resident, I couldn't work full-time on my startup. The CMO role varies from company to company, but I did all product design, all marketing, and a lot of sales. Many companies have a part-time CMO to begin. I then moved into a full-time CEO role where my responsibilities grew to management, recruiting, finances, etc.

Physicians can also work as consultants (usually for cash or part equity) or advisers (almost always for equity) in a much more part-time capacity. Consultants work on a project basis, but could be paid hourly, while advisers give a couple hours each month to be available for questions and advice. Most advisers are chosen from their expertise and their ability to make introductions to key decision-makers, so your rolodex is important!

I'd take it a step further and say there are lots of ways to help facilitate innovation, both inside AND outside of being part of a startup. For a lot of people, living the startup lifestyle doesn't make sense, but they still want to be part of building something innovative. There are lots of ways to do that.

You can be a:
- Founder of your own startup
- Part time CMO of someone else's startup
- On the board of a startup
- On the Advisory board of a startup (different, less businessy, and less time consuming roll than the one above)
- An advisor at a health accelerator to startups
- An angel investor for health related startups
- A consultant for startups
- You can be a point of contact for startups to facilitate product testing at your healthcare institution
- You can be an advisor to an angel, angel group, or venture capital firm looking to invest in health related startups
- You can invest in startups through equity crowdfunding platforms like wefunder and others
- You can be an advisor to a local business school's healthcare club

All of these and more are ways you, as a physician, can help push forward innovation. I'm not going to sugar coat it. Being a startup founder is very time consuming and is not the right fit for most people, even most people who are very interested in innovation. But if you want to be involved in innovation, there is a way to fit it into your life

The million dollar question in healthcare you need to ask is how is going to pay for your product or service and how you are going to make money. Do your innovation really have a commercial utility?

Jessica, The $64,000 dollar question (much less expensive than John's) is will the innovation or idea likely have a positive impact on the care of our patients and families. If the answer to that question is yes then the rest of the answer to your question is as follows. We would want to design a quality initiative with the frontline caregivers on board as early as possible in the design phase. They would need to stay engaged throughout the development and roll out phases and need to understand that if they feel the initiative is unlikely to work at any step throughout the process that we stop development at that point and fix what needs to be fixed before proceeding. And if during the roll out phase it hits a snag we take the initiative back to our virtual design lab and try to fix it. I have just described the quadruple aim for a Q.I. program. While certainly not a guarantee for success it does increase the chance for success and contributes to provider wellness by incorporating their input into the initiative and helping them maintain control of their care at the bedside.

In healthcare, unlike other industries, the buyer and the user are often separate groups with different goals. You need to think about both while designing your product.

You also have to understand the regulatory environment thoroughly, as it complicates certain types of products more than others.

Otherwise the advice is the same in healthcare as for anyone else. Fail early, fast, and often. Your product development and business plan development should occur in tandem. Find the most worrisome potential failure points in both your business plan and product plan and design methods to test them as early as possible.

Share your ideas freely and often with both users and purchasers to get their feedback at every stage of development. Most people have zero interest in stealing your idea, especially if you are clearly better prepared to execute on it than they are.

The risk is not that you will not be able to build what you are envisioning, the risk is that what you are envisioning is not the right thing for the market.

The regulatory environment can be lengthy and difficult to navigate. Having good counsel upfront and understanding it well can avoid costly mistakes. Talking to the FDA to early or to late can be very detrimental to the development and testing process.

Also, understanding that just because a product may benefit a patient or other user, does not necessarily mean that investors will find the venture profitable. I would like to think that everyone out there would all have the same altruistic goals, however you need to have solid evidence of financial benefit in order to get investments in a timely manner.

As always, work to find a good problem, surround yourself with a good team, and work hard to develop a solution that best answers the users needs.

Part of it was probably just right place, right time. Frankly, virtual reality was in the news at the time of the AMA innovation challenge, so I think that likely contributed a bit to the interest in our product.

It's also a product that addresses a pain point that many medical trainees have experienced. Medical simulation is nearly ubiquitous now, but it's pretty universally recognized there are significant and very visible flaws in the way it's performed. The fact that so many people in medicine have personally felt that pain probably helped add to the appeal of our product.

Finally, it's a product with public health appeal. Medical simulation improves patient safety, and our product makes medical simulation drastically cheaper and more available. It's a low cost way to help make the care that we provide safer, so it has appeal to administrators, public health professionals, and patients themselves.

Its a unique and innovative solution to a very real problem. Reducing the number of hospital acquired infections is one of the leading initiatives in medicine today. The CDC reported that an estimated 722,000 of these infections occurred in the US and approximately 75,000 patients with HAIs died during their hospitalizations.

Not only is it important from a clinical standpoint, but insurance reimbursement has now been tied to hospital performance preventing these infections from occurring. The potential impact on healthcare, infection reduction, and multifaceted value to patients and hospitals helped our product to stand out.

When assessing a problem in healthcare and your solution, its important to ask: Who are the users, What is the best optimal outcome, What value does it bring to the users, and Can it be protected? Define the problem well enough to adequately assess potential solutions, their impact, and the advantageous and disadvantages. Being able to do so will help the product speak for itself.

Twiage tackles a problem that is relatable-- emergencies can happen to any one of us. When I founded Twiage as a resident, I couldn't believe that 19 million Americans will ride an ambulance to the ER without any advanced warning beyond a radio call. So that's the second thing: a big, potential impact. Third, this is a solvable problem and it's been critically important for us to have a sustainable business model. There are millions of great ideas out there. The best ones are self-sustaining.

Getting others to see my vision/value of self-care

Funding. Always. It's a time suck for an entrepreneur. I've founded 6 companies, so I should know;)

Team is the most important element for an early startup company. I would out weight it over ideas. Assemble a great team with various complimentary skills among each other is essential in the beginning. I think the AMA Physician Innovation Network is a great place to start finding like-minded people.

Time

No matter what your funding scenario, starting a company requires a founder to put in a lot of uncompensated time, especially in the early days. The opportunity costs of this for a physician are huge. And depending on your specialty, having the schedule flexibility to make last minute sales calls or investor meetings can be extremely challenging.

For me, there is literally no amount of potential money that could convince me to leave clinical medicine entirely, so that is not an option. That means I've had to balance a clinical schedule with the rigors of starting a company and while I've eventually come to a reasonable balance, it has certainly been the most challenging part of the process.

For me a big part of the solution was finding clinical positions that welcomed my entrepreneurial activities and finding team members that were able to take on a lot of administrative responsibilities to help balance the load.

In addition to and complementing those above, I would say efficiency.
One of the most challenging aspects of starting a company is making the most out of the limited resources discussed. The funding wont be adequate, and there is never enough time. I believe that one aspect that makes startup companies successful is being efficient with time, research, and funding.
Of course everything you will be doing is beneficial, but being able to quickly assess which activity is going to be the most advantageous with the least cost makes a huge difference. A lot of time and money can be wasted accomplishing good milestones, when the same input could be invested into great ones. Also jumping too far ahead of yourself and having to repeat steps will set you behind.