Healthcare Without Walls: How Butterfly’s Tech Brings Imaging To Patients

Ayush: Hi, Joe, how are you?

Joseph: I’m doing very well, very well. How about yourself?

Ayush: I’m doing fantastic as well, especially in these times when there’s breaking news every day. It’s incredible. It’s not a dull day, I’d say. It’s all good, and we continue to innovate, I believe. Yes, all of us.

Joseph: It’s incredible times, both good and bad. There’s definitely some craziness around us. But it’s an incredible time to be alive.

Ayush: Absolutely. I agree. So why not, Joe? Let’s start with a bit of background about you. I mean, I know you’ve been in healthcare for decades. So you’ve seen it all. You’ve seen companies grow and evolve.

And so on, and I think, in fact, you know the plans we sit on today. Probably you would have seen them change from an inspiration to action in front of you. So tell us a bit of background about your work. And you know, in the last 25 years. If you were to summarize it, how would you put it?

Joseph: Well, well, I’ll first of all, thank you so much for having me. It’s definitely an honor, and I appreciate the opportunity to talk with you.

I’ve been blessed to be in healthcare. It was complete serendipity. My father came to this country an Italian blacksmith. He got a job making garbage trucks. He ultimately bought the business and, with his brother, built it. Then he made garbage containers, and I thought that’s what I would do with my life. But I would come into my father’s business, which had a big steel fabrication facility, and that would be it. But it wasn’t. We had some family challenges. And my next-door neighbor was the founder of a sensational company called U.S. Surgical.

And he gave me a chance when my family went through these difficulties to be a salesperson. And that is what brought me into healthcare in 1993 when I joined. And if for anyone who knows U.S. Surgical, it was a very innovative company. It was one of the first to invest heavily in sales training.

We were working on advanced surgical devices that were changing the behaviors of surgeons. The things they were doing, whether it was surgical stapling or laparoscopic surgery, weren’t things that these clinicians learned in their medical training. So they were learning it while in practice, and they leaned heavily on the companies for post-doctorate training.

And they leaned heavily on people like myself. And I, for my first 10 years, most doctors will say they did their residency at this place or that residency is where they trained under this particular doctor, and how they’ve developed their philosophy. Well, I did my residency at a company called U.S. Surgical, and that’s where I learned.

Innovation. There was a Maverick founder, Leon Hirsch, who I had just passed away recently, and I owe so much of my professional career to him. And that’s where I started. So minimally invasive surgery with laparoscopic cholecystectomy, laparoscopically assisted vaginal hysterectomies, fund applications. All these different procedures then bled into surgical robotics. I became infatuated with robotics.

I became very close to Dr. Yulin Wong, who, in my view, is the founder of surgical robotics. I joined Computer Motion and had a wonderful time learning there. But soon thereafter, Computer Motion and Intuitive Surgical merged. And not many people realize this, but about a third of Intuitive is owned by Computer Motion shareholders.

And that was basically the split at the time.

And probably one of my biggest regrets is I didn’t stay at Intuitive for the big run-up. I was young. I had a lot of different kinds of energy, and I chose to continue with my career. But I’ve been very blessed, and I don’t really begrudge any experience that’s been given me.

But I went on to run RITA Medical, which was an oncology device company for inoperable tumors. I went to be president of Smith & Nephew to run a $2 billion orthopedic division for reconstruction. I went to become CEO of Andrew Dynamics, which was an interventional radiology and oncology device and catheter company. Wonderful company founded by Eamon Hobbs, a great founder.

And then I got into digital. And then my life really changed because I went to California, joined Dr. Yulin Wong’s second company, which was inTouch Health. This first was surgical robots.

Ayush: Here.

Joseph: And interestingly, one of the things he did prior to his second company was an experiment. And it’s really fascinating because, you know, a surgical robot has a workstation where a doctor is working at that console.

And Yulin was fascinated with the 20 feet worth of cable that connected the doctor to the robot.

Ayush: Okay.

Joseph: And he asked himself the question, “Well, if there’s 20 feet of cable, what if we replace that 20 feet of cable with 4,000 miles of cable?”

He brought Professor Jacques Marescaux from Strasbourg, France, to New York City. He sent the surgical robots to Strasbourg, France. And in the most complex, largest, most expensive operation ever in the world, Professor Marescaux removed the gallbladder from his patient in France, sitting in New York City in 43 minutes.

And so that informed him that you know that clinical discipline and training was capable of being transmuted beyond the physical being in the physical space. And so he built a company called inTouch Health.

That helped neurologists consult with patients and consult with doctors who were at rural hospitals that didn’t have the necessary equipment to treat a stroke.

And these patients within an hour or an hour and a half, would fully stroke out. Normally, they’re put into an ambulance and sent to a hospital.

But Dr. Wong built an infrastructure to help these doctors in large cities consult with doctors in rural hospitals to make clinical decisions that were life-saving.

And that distance health, that telemedicine, so much of the telemedicine that you’ve heard of is what we’re doing now, this video type call. But what he did was bring it between hospital and hospital. So specialists can consult for complex activities. And that grew into a very big business. then today, actually, Dr. Wong is on his third company now, where he is helping other robot companies break apart the console and the robot, so they can provide distance health, actually, not as an experiment, but they can do distance surgery. So I’m very fascinated by that.

And then I’ve recently joined Butterfly. Butterfly is a fast and very unique device, semiconductor-based that allows every doctor and every nurse to have an imaging device in their pocket. Cloud-based digital, and really empowers rural health and healthcare where the patients are. So I’ve been very blessed to have a wonderful career, wonderful mentors. And it’s just been a great journey.

Ayush Jain: Thank you, Joe. I mean, you know, I could sense, of course, like hard work makes its own luck, but definitely can see you’ve been at some of the best mentors and some of the best companies that got built in your time. So yeah, I mean, can’t stop myself being jealous in a good way. Like, a lot of learnings here, great. And you know, probably in the next 30 minutes, we’d like to take some of that wisdom. So moving forward.

You know, talking more about Butterfly, you know, like what I understand and what we read about is it’s a MedTech device, which is a portable semiconductor-based ultrasound tech. So tell us more about the concept and how it works. What impact does it create? And how does it change the world?

Joseph: So, a standard ultrasound that you would see in a hospital, say, a cart. You know, you’ve ever seen? It’s like a computer that comes up to you, and then they have these probes. And there are 4 different handles, or 4 different probes with 4 wires that connect into the cart, and each probe has a different frequency and dept for the different types of imaging you would do in the body. If you’re going to do an image looking at the heart, you would use one frequency. If you’re going to look at the abdomen, you’d use another. The lung, masked peripheral vasular.

And so, each of these are pre- tuned pre, almost like a pre-focused camera lens that you pick up for the next type of image you wish to take. And that’s how imaging has been done for ultrasound for decades, and based upon the amount of power they put through the system and the type of algorithms that are generated in the power and the transducer determines how good of an image you can get.

But those devices are large, and those devices are tethered to a hospital, a hospital room.

Butterfly, and Dr. Jonathan Rothberg came up with a concept of building a semiconductor. And then putting on top of the semiconductor what’s called a MEMS wafer. An iMEMS wafer has 9,000 individual sensors that are organized in a rectangle which is very similar, like a screen that you and I are looking at now. Where there’s a pixel, and all these pixels you change the color of a pixel, and then sit back, and there you have an image with a collection of them all.

Well, our semiconductor allows us to tune to any frequency. To tune to the different wavelengths, curved linear and phased array wavelengths, and then different frequency depth. So basically, we have one device that can meet all of these different imaging requirements, and what it allows is you take your iPhone and you plug the device into an iPhone.

And now you can image a patient’s carotid. You can look for an appendectomy, and we believe now that this is entering in a new era of imaging because doctors can carry around their device. You know, supercomputers used to be huge. Now we carry one in our pocket. Everyone has one, and that’s an iPhone.

Well, imaging devices are huge. Everyone will have this imaging device, and because it’s so powerful with semiconductors, it also is on this exponential innovation curve that every several years, as the power of the chip and the power of the MEMS technology increases, we deliver more and more power into the device. And so we’ve now placed about 150,000 devices around the world.

We are in conflict areas like there we have a thousand of them in Ukraine, where every medic has one because if they’re dealing with someone who is now traumatized, they can. They don’t have to wait to go into the hospital. They don’t have to decide which probe to use. They just say, “I’m going to scan the abdomen on the phone.” They select abdomen. It then tunes the device for an abdominal scan, and they go within seconds. So it’s about two-thirds of the world doesn’t have access to imaging. And Butterfly now becomes a way to bring imaging with the doctor to the patient where they are.

Ayush: Right? Right? Yeah. And that sounds super useful, given, you know, the whole trend of moving health, say, one outside the hospital. Second, providing a continuity in care. And of course, you know, being able to bring in more health equality where people from different backgrounds or different circumstances could basically participate.

So, you know, like one of the interesting things you know, Joe, I could pick up from your experience. It was, you know, you have been, you know, in the midst of helping clinicians change behavior by introducing these new devices. And you know, what many of my friends in health tell is that’s one of the most difficult things to do because clinicians and providers and hospitals, like everybody, like to be in their own way of doing things and do not want to change. They are difficult to deal with, but from what I heard, you have successfully, you know, gone through those.

So, tell us more from your experience. If you know any lessons around selling to the hospital, selling to the clinicians, changing behavior of providers, please expand on that.

Joseph: Sure. So, there are several things that I would give as advice. The first thing I would advise on is to play the long game.Don’t expend all your resources off of a timeline that you think you control. You don’t control it. There are things you can control in your physical development, but in truth, you don’t really have control over how long it will take to get your product perfect.

And then how long it will take to change the behavior, to make the arguments, to get the right data, and to have your technology truly meet the needs of the customer.
I was a part of a startup called Surgery Quest a while back. It was a wonderful experience because the CEO is an old US Surgical colleague and dear friend of mine, and he had the instinct that when we were ready to go commercial, most people would hire a sales force, they would hire a full organization, they would go for it, national sales meeting, training, etc.

But Kurt had the wisdom to not know whether or not he was ready. He just didn’t know. So, he hired one salesperson and he put him in Connecticut. He gave him not the whole country, but a geography that would be akin to what a normal territory size was, and he studied the behavior of that one rep. He studied how that one rep did with the doctors in the territory. How quickly did they update the technology? What was their feedback? This was after they had done their work and thought they were ready.

That experience taught them how unready they were and how actually a new revision of the technology was needed because they identified some things in the learning when you get into the implementation.

So really, plan for a longer game. Don’t let the investors, or don’t let your ego get in the way to say, “This is ready. I believe it to be ready,” and then you go because many companies burn through their initial invested capital by going too fast, too quick. You really have to take your time and covet the resources you have, and be sure that you’re ready because when you’re ready, then you’ll know.

You don’t need to hire 20 salespeople who are all going to fail. If I hire one salesperson who fails, and that’s what my consequence was, right? So it’s like a test site.The second thing is, I would tell inventors is, don’t fall in love with your technology.

We have one device that can meet all of these different imaging requirements, and what it allows is you take your iPhone and plug the device into an iPhone. And now you can image a patient’s carotid. You can look for an appendectomy, and we believe now that this is entering a new era of imaging because doctors can carry around their device.

You know, supercomputers used to be huge. Now we carry one in our pocket. Everyone has one, and that’s an iPhone.Well, imaging devices are huge. Everyone will have this imaging device, and because it’s so powerful with semiconductors, it also is on this exponential innovation curve that every several years, as the power of the chip and the power of the MEMS technology increases, we deliver more and more power into the device.

And so we’ve now placed about 150,000 devices around the world. We are in conflict areas like Ukraine, where we have a thousand of them, where every medic has one because if they’re dealing with someone who is now traumatized, they can.

They don’t have to wait to go into the hospital. They don’t have to decide which probe to use. They just say, “I’m going to scan the abdomen on the phone.” They select abdomen. It then tunes the device for an abdominal scan, and they go within seconds.

So it’s about two-thirds of the world that doesn’t have access to imaging, and Butterfly now becomes a way to bring imaging with the doctor to the patient where they are.

Ayush: Right? Right? Yeah. And that sounds super useful, given, you know, the whole trend of moving health, say, one outside the hospital. Second, providing a continuity in care. And of course, you know, being able to bring in more health equality where people from different backgrounds or different circumstances could basically participate.

Joseph: Sure. So, there are several things that I would give as advice. The first thing I would advise on is to play the long game. Don’t expand all your resources off of a timeline that you think you control. You don’t control it. There are things you can control in your physical development.

But in truth, you don’t really have control over how long it will take to get your product perfect. And then how long it will take to change the behavior, to make the arguments, to get the right data, and to have your technology truly meet the needs of the customer. I was a part of a startup called Surgery Quest a while back.

It was a wonderful experience because the CEO is an old US Surgical colleague and dear friend of mine, and he had the instinct that when we were ready to go commercial, most people would hire a sales force, they would hire a full organization, and they would go for it—national sales meeting, training, etc.

But Kurt had the wisdom to not know whether or not he was ready. He just didn’t know, and so he hired one salesperson. He put him in Connecticut, and he gave him not the whole country, but a geography that would be akin to what a normal territory size was, and he studied the behavior of that one rep.

He studied how that one rep did with the doctors in the territory. How quickly did they update the technology? What was their feedback? This was after they had done their work and thought they were ready. That experience taught them how unready they were and how actually a new revision of the technology was needed because they identified some things in the learnings when you get into the implementation.

So really, plan for a longer game. Don’t let the investors, or don’t let your ego get in the way to say, “This is ready. I believe it to be ready,” and then you go because many companies burn through their initial invested capital by going too fast, too quick. You really have to take your time and covet the resources you have, and be sure that you’re ready because when you’re ready, then you’ll know. You don’t need to hire 20 salespeople who are all going to fail. If I hire one salesperson who fails, and that’s what my consequence was, right? So it’s like a test site.

The second thing I would tell inventors is, don’t fall in love with your technology. Fall in love with your customer. Your customers are what matter. And you know, I’ve learned that you gotta be careful because a lot of the doctors know what they want.

But they think they know what they want, but they don’t know what they need.And so you have to really study them. You have to really understand truthfully what problems you’re solving. And just because your technology does it a certain way doesn’t mean it’s right. So if you listen to the customer, and you’re true about the experience they have with your product, then you ultimately are going to come up with a winner.

Just to give you that example, with Surgery Quest, they made a trocar device, which is the device that you use to insert into the abdomen to maintain the pressure in the air to get the abdomen away from the internal organs so you can do these operations. The first version was pushing air in and creating an air seal. So when you push an instrument in and out of the device, you don’t have any friction.

But what he failed to realize was, as you keep pushing air into the abdomen, it has to go someplace, and that turned into some issues. So he learned, and he listened, and he tested.Ultimately, he created a way to recycle the air. The recycling of the air not only allowed the seal to work; it created a whole new product, which was smoke evacuation and automatic pressure management. Today, it’s almost a standard of care in surgery. It takes about 10 years to become an overnight success, especially in healthcare. It’s a function of staying true to the core innovation that you’re creating, but then building that bridge to exactly how a customer would interface with it. Even if it’s not logical to you, you have to listen to your customer. If you stay on that journey, and if you don’t burn through your dry powder and maintain your patience, you’re going to get there. You just keep cycling and iterating, listening and iterating, listening and iterating. Don’t just choose, “Okay, now my product is frozen, and now I’m going to hire a big salesforce.”

There are probably 8 out of 10 of those companies that fail because they run out of resources. Then they dilute down all the original shareholders, bring in all this new money, turn over management teams, and then continue to listen to customers.

If I was starting something from scratch today, I would prepare my investors for a longer haul. I would take my time to get my innovation right, and then, when it was right, I would go for it. I think patience, not falling in love with your technology, and falling in love with your customers is probably some of the best advice I can give.

Ayush: Right? Right? No, very. It’s a deep wisdom there, and of course, everybody knows in theory, but I think it becomes difficult when you apply it to yourself. But yeah, well said. I think especially, I like the aspect about not basically going all in unless you’ve proven the efficacy, or the importance, or a product-market fit, as they say now.

Joseph: Because once you have one territory that’s now successful, that one salesperson in Connecticut is now building a business in that geography. Then it’s very simple to replicate and manufacture. You take all the different training, the business process, and the customer interface. You learn from that one experience, and then you multiply it and build out a national organization, or for that matter, a global organization.

Ayush: Right, as they say, finding one customer is harder than 10, and 10 is harder than 100.

Joseph: Very much so. That’s so true.

Ayush: Yeah. So Joe, another aspect that I’d like to pick from your experiences is connecting some of the dots from the past to build the future. How do you see the current, I’d say, wave of health innovation that is happening? Do you see that it has always been there, or do you see something special about this time? Because many of the problems we are trying to solve have existed for at least a decade, if not longer, like interoperability or making life easy for a physician or freeing them from clinical work. So definitely, there’s AI, which has its own promise. But you know, with you having that experience under your belt, seeing through the ages of how health really has worked in the past, what is your understanding and your takeaways as you think about the innovations happening today?

Joseph: That’s a great question. You know, things are changing. I remember when I started off in healthcare, I was specifically taught as a sales rep to not engage with the patient. The patient is the responsibility of the doctor. Your responsibility is the training of the doctor, and then the doctor helps manage a patient.

What I think is changing and has changed with electronic health records is that hospitals now have potentially more data on your product than you do. The evolution of the electronic health record has been, in the near term, very unfavorable for doctors because it’s cumbersome and very laborious, etc. But it will change. The automations are coming.

AI and automated data capture, whether through voice note-taking, etc., are going to change that for doctors, and it’s going to change that for healthcare. Healthcare companies have to be prepared for this shift. What will happen is the day of the prospect of randomized trials, of course, for drugs and very large consequential interventions will always be in place, but the world is also evolving very quickly towards real-time data.

That’s what I love about Butterfly. What I loved about InTouch was that we had a robot, and at Butterfly, we have an ultrasound device, but every device is connected to the cloud. Every device, when it’s used, generates data. At Butterfly, we have 20 million images in our cloud, growing between 30,000 to 40,000 images a day.

So we have complete connectivity to the behavior of our customers, and we have data that suggests usage and what we can learn from it. We use that for training and for AI development. I can’t imagine today a medical company that doesn’t have some type of tie into the data and the experience that their product is having on a daily basis.

So, I believe that medical companies today, like in my past, were never about having the data from the patient. You can do a clinical trial, but then you support doctors; they support the patient, and then they work within that environment.

Today, data is so much more readily available with the emergence of the electronic health record. Yes, doctors have taken a major step back from the standpoint of the laborious nature of healthcare for them.

But that will change. There are new automation tools in the creation of the record, and there’s going to be a lot of learning from those experiences that are going to make clinicians much more productive and knowledgeable about the impact they’re having on patients.

I think when systems have more data on the interface of your device than you do, it puts you at a disadvantage. Companies need to find ways to interact with their devices and technology to manage that data; it’s essential.

Butterfly is one of those companies because we have a cloud. We have 150,000 devices connected to that cloud. We’re streaming 30,000 to 40,000 images a day. We know what presets they use, how long they’re on the device, where they are, and the different types of clinical applications.

Of course, there’s now this database of imaging that we can run all kinds of AI scripts through to help learn from the imaging and understand utilization. That gives us tremendous power to know our customers and develop more tools to make it easier for them.

Ultrasound, for anybody, is the hardest image to acquire. You have to know how to acquire it, and then you need to know what it is you’re looking at, whereas other more complex imaging has great automation. Anyone who’s developing a new device, software, or interface really has to think about how they can collect data and close the loop on the experience. They need to acquire data, learn from that data, and spiral that evolution. That’s what’s different.

If you sit back and just make a piece of plastic and sell it in a one-way fashion, you’re going to lose a lot of control. But if you think about how you can be a part of that overall experience and learn from it, you can thrive.

The largest companies now are thinking about the cloud and software interfaces to hardware. Back in the day, when I had a piece of hardware in the hospital, I had to send a rep into the hospital with a USB stick to put a software update.

Now, there are ways to communicate with your devices through the firewalls of hospitals to push software updates and pull performance data that is relevant to your technology. If you organize that well and set up the security protocols correctly, hospitals will let you do this, and it creates tremendous power.

When we sit with our customers, we have a full report that we show them about how they’re interfacing with our product. We tell them what they’re doing well, how much money we’re saving, and how many physicians are properly using it and trained, as well as how many need additional development.

We also provide a menu of recommendations on how they can have a better experience. Customers love that; they love when you bring them data because they want to get better. They see you as a partner who’s part of their journey, not just a vendor trying to extract something.

It’s that learning that I think today allows companies to create even greater value than they did 20 or 30 years ago, and they can learn faster and make their technologies easier through this advanced cycling and learning.

Ayush: Well said. I think there are definitely more possibilities achievable today compared to the past. But it also creates, I would say, more competition, which can be a disadvantage because more people can build compared to the past when monopolies could exist for a longer time. This could mean they could invest more money in innovation because they had a longer time to create that competitive advantage.

Joseph: When you think about software, for example, it’s very hard to protect with IP. It’s challenging to say, “Okay, you can’t code that way.” Of course, everyone has their proprietary code, but the way you win is through rapid iteration.

Ayush: Yeah.

Joseph: By moving quickly and responding, you can stay ahead of your customers. If you have a unique idea, you’re solving a unique problem, and you have the data to learn from, then someone starting from scratch, regardless of how good their fast-following strategy is, has to make up for all the evolution you have.

So, I wouldn’t be fearful. I’ve never really been afraid of my competition. I’ve always just tried to build the best product, learn, train, grow, and run. As long as you’re listening to your customers and continually innovating, and you have that closed-loop feedback, you can maintain your lead and your market.

When you’re executing well, you’re endearing yourself to customers, and you’re not giving them a reason to go to a competitor.

I’ve never been afraid of a competitor. I’ve always been afraid of losing the hearts and minds of my customers.

Ayush: Right. It’s well said. No, definitely, that’s the way to see it. It’s more about your customers. If they are happy, nobody can basically like

Joseph: Look, then all of a sudden, you can become successful, and then you can get content. You can stop listening to your customer, and then you can just look at your stock price or read your press, and then gaps are created between you and your customer. That’s when competitors fill those gaps, and then you’re in trouble.
Right? But as long as you keep your organization centered on your users, listening, evolving, growing, and caring about their experience and the patient, and you cycle, cycle, cycle, you know, you’ll win, no matter what.

Ayush: And especially in health, where I believe there’s still stickiness. If you are good, then there’s no reason for any of your users to look for a change. As compared to, let’s say, e-commerce, where people could be looking for the cheapest deals, healthcare is different. That’s the beauty of healthcare.

Joseph: It is

Ayush: Very sticky.

Joseph: You can create a great moat. If you’re willing to be consistent and always put them first and not get complacent, your business can thrive. Customers will tolerate a lot. It will take a while to create that fracture because they’ll give you a lot of credit for the value that you’ve created. But you just can’t take too much advantage of that.

Ayush: Right. So, let’s talk a bit more about MedTech, you know, because most of your work has been in MedTech. It is one of the most exciting sectors today. We talk about innovation, just like you said, software is just a part. But building that whole ecosystem typically would have a MedTech aspect. I imagine innovation happening by replacing the incumbents with smarter, better, efficient, accurate devices and making them more available. So, I personally am very bullish about the MedTech trend and the way the market can grow from here.

Joe, what would you see as the biggest challenges as well as opportunities for a MedTech startup today? If you were to give this wisdom to someone who’s starting out today or who’s at the early stage, what are those challenges and opportunities?

Joseph: Well, you know, I do go back to the ability to manage expectations and manage time. I would really marshal those resources before I hired a big team. Before I brought on all these people, I would keep my burn rate as low as possible.

I would iterate and keep the development tight and small. I would find ways to manage and capture my data, and I would certainly find ways to build out my intellectual property portfolio. I wouldn’t rush myself to be too commercial too quickly. I would prepare my investors for what they should expect.

The worst part of business is getting ahead of yourself, committing to something before it’s time, and setting expectations with people who are going to hold you to those expectations and then financially punish you for not meeting them.

Butterfly is an incredible company, but early on, when it went out, it set some really high expectations that I don’t think were realistic. If you look back on the journey of Butterfly, the adoption in the marketplace, and its success, it’s extraordinary. But it didn’t meet the expectations initially that were set.

So, the power of expectation is extraordinary. Don’t fall in love and get ahead; take your journey one step at a time. Keep your team small, keep your spend low, and really be tight with that core team.

Make sure that you have good data points. Personally, if I were starting a company today, I would manage my expectations. That is where I see most people fail. You don’t know how long this journey you’re about to embark on is going to take.

Joseph DeVivo: You don’t know how many additional problems you’re going to need to solve to ultimately come up with the final offering. I would start the journey, keep my team very small, and be very committed to the goal.

I’d find clinicians or users who would give you very good unsolicited feedback. I prepare my shareholders for a journey. I’d create very long schedules to create space to ensure that I’m not disappointing anybody or getting ahead of myself.

When CEOs get too excited about their technology, or inventors get too excited about their technology, and they start feeling the financial pressures, they want to hit dates and make commitments.

There is a risk that you shortchange product development. There is a risk that you don’t go all the way in your customer satisfaction. The moment you turn on the commercial engine, you’re burning capital, and you’re really now held to the delivery for your investors. The moment you turn the commercial engine on, you can’t back off. You’ve now set a time where you have to execute.

I would try to incubate as long as possible. I would iterate as long as possible. I’d preserve capital as long as possible. I would wait and get the product to a level of perfection. I would build up my intellectual property, my supply chain, and everything to allow me to scale before I hit the go button. The moment you hit that go button, you put your reputation on the line; you’ve turned over the sand clock with investors, and I would just make sure that I’m ready.

Aside from that, I would also make sure that I’m plugged into modern healthcare. I would ensure that I have the ability to get data from the electronic health record. I can get real-time data from my experiences, and I would be able to cycle on that data to get my development correct.

The other thing, if your product has to go through a regulatory process, I’d communicate with the regulatory officials early. Don’t try to pull a fast one on them. Don’t throw an application over that’s not complete. Don’t try to get some general indication that gives you the ability to go after something specific. I would sit with regulators, tell them what you’re trying to accomplish, and ask for their guidance on what type of data they’d like to see. I would get their agreement on the best ways to acquire that data.

I would slow down the process to ensure that the regulators know exactly what I’m trying to accomplish. So when that application comes, they’re expecting it. When they open the first page, they already know what they’re going to read. As they go through the construction of your trial or whatever it is that you did, there’s nothing new. You follow their feedback to a T.

What that’s going to do is not only get your clearance through quickly or at an appropriate pace, but it’s going to establish credibility between you and the regulators. This allows for the ability to go back and ask questions and build as much quality into your device as possible, maintaining the highest level of integrity. If you find something, deal with it, and go to regulators and say, “We found this, and we dealt with it.” That transparency and relationship will be foundational to your integrity.

There are so many different steps to be successful, but it’s about doing the right thing, setting the right expectations, and doing what you can to help patients. Listen to your customers, and when you’re ready, create partnerships with your regulators. They’re not police officers trying to get you; they are people empowered to protect the safety of a patient. You need to respect and communicate with them, and if you do, your product will not only be approved, but you’ll have a partner for the evolution of your product going forward.

Ayush: Right. Well said again. I think you have covered a very holistic view of the whole journey of a MedTech startup. I really appreciate the way you mentioned that clinging to the long-term plan is essential. Not making any choices that could just be an ego massage for the short term, like getting funded or published, but keeping that long-term goal in mind and being ready for the long haul. Very well said, and aptly put.

This has been a great conversation, Joe. Thank you so much; I really appreciate your insights. Thank you for sharing all these insights so vividly and in an understandable manner for anybody to consume. Thank you so much. We appreciate it.

Joseph: It’s been a pleasure to be with you. Thank you.

In this insightful podcast episode, Ayush had a conversation with Joseph DeVivo, a seasoned leader in the healthcare and MedTech industry. Joseph shares his incredible journey from starting in healthcare by chance to leading groundbreaking innovations in surgical robotics and portable imaging technology.

Learn about the evolution of healthcare technology, the role of AI in medicine, and invaluable advice for MedTech startups. Joseph emphasizes the importance of long-term planning, understanding customer needs, and building strong relationships with regulatory bodies. Whether you’re interested in healthcare, medical technology, or entrepreneurship, this episode offers a wealth of knowledge for anyone looking to make an impact in the industry.

We’ve discussed about:

✅ Joseph DeVivo’s journey through U.S. Surgical, Computer Motion, Intuitive Surgical, and Butterfly Network.
✅ The impact of surgical robotics and portable ultrasound technology.
✅ Key strategies for MedTech startups: playing the long game, managing resources, and customer-centric innovation.
✅ The evolving landscape of healthcare technology, AI, and electronic health records.
✅ Practical advice for entrepreneurs in the healthcare sector.

Don’t miss this deep dive into the world of MedTech innovation with one of the industry’s most influential leaders!