Interview with Alexis Savvy

Alexis Savvy, a fellow forward thinking health IT blogger, recently interviewed me. The interview is reproduced below.


When Google revealed Google Glass, the first question I got asked was, “How will this change healthcare?” There is no one better to answer that question than Kyle Samani, Founder and CEO of Pristine, a startup in Austin, TX that develops Google Glass apps for surgery. Kyle is also a healthcare blogger, writing for HIStalk and TechZulu. Kyle answered my most pressing questions about his journey from first seeing Glass, to creating Pristine.

When did you first try Google Glass and when did you know that it would change healthcare?

I wore Google Glass for the first time in February of this year. The light bulb went off instantly because I’d been working in the electronic health record (EHR) industry for 3 years. I spent one year as an engineering team lead, one year as technical sales lead, and one year as product manager for a wide variety of clinical applications (EHR, CPOE, Perioperative care, LIS, RIS, PACS, PAS, Patient Portal, etc), so I got to see the development, sales, and deployment cycles of health IT from a bunch of unique perspectives. With that knowledge and experience, it was immediately clear to me that Glass would drive an array of new point-of-care apps.

Since my background was in EHRs, the original vision for the company was to extend the EHR onto Glass. I gave up on that by mid-May, just as I recruited Patrick, my cofounder and CTO. We threw that vision away because we realized that it would be impossible to overcome HL7 integration challenges. Our first investor was an anesthesiologist, and he really opened our eyes to the opportunities for Glass in the OR. We’ve been actively working on what are now Pristine CheckLists and Pristine EyeSight since late May.

What is Pristine’s mission?

Pristine’s mission: We empower healthcare professionals to deliver safer, more coordinated, more cost effective care by utilizing cutting edge technologies to do what was once impossible.

Essentially, we want to pioneer new technologies in medicine to help healthcare professionals deliver care in ways that were never before possible. Our engineering team has deep technical expertise across almost ever layer of the technology stack, and substantial experience with almost every major field of human computer interaction (HCI), including audio, video, touch, gesture sensing, and more. Our business team knows the modern US healthcare environment, with years of experience working closely for or with payers, providers, and technology vendors. We hold strong views as to where things are going, and we work closely with our engineering teams and the latest technologies to shape what we believe will be the future of care delivery.

You are one of the first companies to innovate in this space. What’s it like being on the forefront?

As exciting as it is to pioneer new technologies, it’s also been quite challenging. For example, one of the greatest impediments to Pristine’s success today is, unfortunately, lack of hardware. Google is not helping enterprise-focused developers such as ourselves; they are completely consumer-focused. We have 10 Glass units today, with 12 or so inbound. Until recently, we really didn’t have enough hardware to roll out Glass widely.

We’re trying to break one of the most fundamental assumptions in care delivery: that you need to be in room X to provide value and care in room X. We need as many hardware units as possible in as many rooms as possible to prove the value. If you or anyone you know has a Glass or some spare Glass invites, can you please email me? It would really help us perform more rigorous testing across a range of care environments.

Besides lack of hardware, we’re dealing with what are pretty common technical issues when you’re on the forefront of technology: buggy hardware and software. Our technical foundation, Glass hardware and a modified version of Android, still have lots of problems, but that’s to be expected. In many ways, it provides our engineers with enticing challenges, although as CEO I wish we encountered fewer technical hurdles.

On the other hand, the business side of things has been incredible. I’m a first time entrepreneur, and I can safely say this has been the single most important, most educational, most fun thing I’ve ever done in my life. I think that rings true for every one of our employees as well. I’ve read about how hard it is to get off the ground and answer the existential startup question. We’ve been incredibly lucky that so many talented people, doctors, provider organizations, and investors have supported us so early on. Very few startups have the opportunity to raise as much capital as we have, and even fewer have the opportunity to so quickly deploy and test across over half a dozen clinical departments in live care environments, including the OR, ICU, and ER.

What’s amazing is that we’re just at the beginning of what can be done. We’re at the cusp of a major hardware renaissance powered by increasingly small yet powerful mobile systems-on-a-chip (SoCs). These SoCs are driving a quantified civilization. Pristine is incredibly excited to figure out how to support providers at the point of care using these new technologies.

Tell us what you are hoping your current Glass products will do for the healthcare system.

We’re trying to shape the next generation of telemedicine solutions. To be clear, we’re not trying to compete with Teladoc or Ringadoc and the dozens of at-home, self-service telemedicine companies that’re springing up. We’re delivering telemedicine solutions when patients are already interacting with care providers.

Mobile cameras, processors, and Wi-Fi antennas are good enough to deliver telemedicine anytime, anywhere, in 1st person. That means that we’re enabling telemedicine and video communications literally everywhere in every care environment. But our ambitions extend far beyond telemedicine. Pristine EyeSight (1st person audio and video streaming) will become the de facto training tool for most jobs that require hands-on work.

In addition to telemedicine and communications, we’re also using Glass to implement process control where it was never before ergonomically possible. Because Glass is inherently hands-free, we can implement checklists literally anywhere in the hospital, and that’s exactly what we’re doing. We believe that checklists should be implemented in any process in which the cost of being wrong is unacceptable: instrument cleaning, drug preparation, complicated tests and procedures, etc.

You are running a pilot with UC Irvine. How has that been and what have you learned?

I’ve personally worked with staff at over 2 dozen hospitals. I can safely say that the staff across every department – IT, surgeons, anesthesiologists, nurses, ICU, ER, sim lab – at UC Irvine have been the best I’ve ever worked with. They are forward thinking, open to new ideas and new ways of doing things, and understanding that this is a beta product. Despite all of the technical challenges we face, they’ve been extremely supportive and accommodating. We cannot thank them enough for their patience and for helping us refine our software. We didn’t realize how difficult the testing process would be for our solutions: there are literally dozens of opportunities for failure that are completely outside of our control. We have been extremely fortunate to work with a group of people that want to see us succeed.

We have learned a tremendous amount at UC Irvine. First and foremost, audio and video streaming is just the tip of the iceberg. We’ve developed just as much supporting technology as we have core audio/video streaming. Delivering a seamless, elegant, user experience on a new form factor requires a lot of thought, a lot of refinement, and a lot of work. The best technology is the least visible. We’ve spent an enormous amount of time working to make the entire user experience – unboxing, setup, training, charging, updating, connecting, communicating, disconnecting, etc. – look easy and seamless. We assume responsibility for everything that directly impacts the user experience across software, hardware, and training and deployment methodologies.

As an entrepreneur, what is one piece of advice you’d give to people who are thinking about starting their own company?

First, I would read all of my blog posts about entrepreneurship. I don’t mean to selfishly promote, but I’ve spent a great deal of time addressing this question and try to provide tips, tricks, and advice for others so that they don’t make the same mistakes I did. I’m certainly not the most qualified to tell aspiring entrepreneurs how to develop ideas, customer development, product / market fit, and some of the other major startup principles, but I have a knack for hacking the world to get things done.

I think the most important thing that I’ve learned is not to give up. Some days are really bad. I’ll develop short-lived doubts. Other days are spectacularly good.

I am, for the first time in my life, accountable not just to one or two other people, but dozens: employees, their families, advisors, investors, partners, and prospects. Everyone has bet on me and our team. Once we’re live with our 1.0 product, I’ll be accountable to tens of thousands of patients that I will never meet.

Whenever something goes wrong, I feel my stomach drop, and I worry that I’m going to let down all of my stakeholders. I cannot describe the feeling, but I can tell you that it’s one of the most unnerving feelings in the world. I literally live and breathe Pristine all day, everyday, and sensing that it could vanish provides for a mental roller coaster ride.

Maintaining stature during challenging times is one of the great signs of leadership. I’m still learning how to do that, but I think it’s one of the hardest and most important things entrepreneurs, particularly startup CEOs, can do.