Friday, July 19, 2024
78.4 F

    S6E2 – Peeyush Shrivastava, Genetesis


    Elio:         [00:02]        This episode is brought to you by our friends at Thomson Hine. Thompson Hine’s Quick Launch helps emerging startups get their initial team members onboarded the right way, with all the appropriate legal documentation for a fixed reasonable cost. Every dollar counts for a startup and making sure that all your team and equity compensation matters are handled appropriately, shouldn’t be dictated by costs. With the Thompson Hine Quick Launch Team and Equity Matters bundle, we ensure that you have employee offer letters, NDAs, intellectual property assignments, independent contractor agreements, and advisory board participation agreements. Visit today and get your company and your team set up right.


                    [00:45]         614Startups Nation, welcome to another episode of the 614Startups podcast. My name is Elio Harmon, your host, and I have a very special guest today. My guy Peeyush Shrivastava.


    Peeyush: [00:57]       Yes, sir.


    Elio:          [00:58]       Perfect, and you’re with Genetesis and you’re the CEO of that company. So I’m on LinkedIn. I’m checking LinkedIn all the time and I see an announcement come from Ohio Innovation Fund and I’m like, “Hold on, who is this? Let me check this name. I know this guy. I met this guy in 2018. Oh, my goodness, he’s raising all this money. He must be doing big things in the market.” And so it’s so great to have you on. We’re going to talk about all the success, but we always start the podcast with your origin story. So for people who don’t know you, give us a bit of your background.


    Peeyush:  [01:31]      Absolutely, I appreciate you giving me the opportunity. Excited to share the story. Origin story starts way back in 2006. Grandfather, personal hero of mine, visited the United States for the first time. Grew up in India during the Partition when India and Pakistan were beginning to separate – a very bloody time in the nation’s history. Dealt with a lot of emotional challenges. Grew up with major depressive disorder and ultimately just didn’t have access to proper health care facilities. So when he came to the United States, he had a little bit of an attack and struggled and was ultimately taken to Riverside hospital and was diagnosed with a number of neurological conditions and cardiovascular conditions as well. It inspired me very early on to focus my time, energy, passions, endeavors on precision health and focused on delivering personalized medicine, non-invasive medicine, to those who are most vulnerable within our health care ecosystem. That’s kind of what got us started.


    Elio:          [02:32]       Okay, so when you say early on, you’re still a fairly young guy. So how early are we talking here?


    Peeyush: [02:38]       So 2006, that’s 14 years ago. I was 10, 11. Very, very, young.


    Elio:          [02:44]       Okay. So at the age of 10, you’re making decisions about what it is that you’re going to do for the rest of your life. So what path does that then put you on, right? So how do you go from a 10-year-old with a dream, to actually starting a company? What kind of decisions did you have to make to get to where you are today?


    Peeyush: [03:03]       Yeah, no, I don’t think I could have gone a more spinny path. It certainly wasn’t a straight line. I thought the best way to do what I wanted to do, which was personalized medicine, create precision health solutions, was to go to graduate school. Do a PhD and become a professor and research one thing for the rest of my life and fell in love with this idea that the body has a natural electricity to it. Knew my grandfather was suffering from cardiovascular and neurological conditions and thought, “Okay, well, this is something special. There’s probably a lot that I could do to better understand and treat the human body by studying the electricity of the body.” So, went down this path, left high school a year early, got to Ohio State, had already been interning in various research labs, and was dead set on, “I want to pursue that PhD. I want to become an academic researcher scientist type”, and honestly just was a little baffled by the pace. Really felt the passion, the intellectual curiosity from my colleagues and some of the most inspirational role models I’ve had in the research world, but felt that I could do something a little faster, at least from a standpoint of “I want to get my hands a little dirty.” So I thought, “Why not drop out of school and start building a company instead, and take all of that great stuff that you’re doing in the lab and see if by using a startup vehicle, you can take all that great work and bring it to patients at large in a more meaningful and maybe even cost-effective way?”


    Elio:          [04:41]       All right. Now, Is granddad’s still with us?


    Peeyush: [04:44]       He is. Thankfully he is.


    Elio:          [04:46]       All right, so he must have responded well to treatment or continues to receive treatment. How’s he doing?


    Peeyush: [04:51]       He’s doing okay. He’s in a nursing home now and has been in long term care for a while. He’s been doing well, I mean, he has very late stage dementia. Not very lucid at all. Doesn’t really recognize me very much, which can be pretty challenging, of course. We started this company – my co-founders and I – in his name, and it’s very important to us that we recognize the origins of the stories, the value mission we’re trying to achieve. So the struggle to come full circle knowing that he’s in his current state, but just the fact that he’s alive and with us is really special to me.


    Elio:          [05:29]       That’s amazing, man. So the dream starter is still with us to watch the dream being realized even though there’s some difficulty around, like you said, dementia. In my other role, we work a lot with seniors and so I understand that process as people age and the effects of that. It can be pretty devastating. Well, thank you so much for sharing that. I appreciate that. So you were checking all the boxes, man. You were going to school, you were getting the grades, you were going to Ohio State. You were going to get the PhD and the “parents are proud” boxes, you were checking all of them off. Then some older people, and this is the story I have in my mind as you were telling me, are like 50, or maybe even 60 and they’re ahead of you, right? And you’re talking to them, you have this dream and like you said, you’re maybe a little bit disillusioned by the speed at which you can accomplish things in the research or academic arena. And they’re probably looking at you like, “Son, if I had to do it all over again, I would just go for it.” So they’re kind of pushing you out there. So how did the conversation go with your parents, when you told them you were dropping out of school to start a company?


    Peeyush: [06:31]       That’s the craziest part. I think the way you put it is exactly how it ended up happening. You’ve got people who have been spending their entire life, careers on mastering this really specific thing and then go back and say, “You know, I could have started”, right? It’s not about building the most successful company in the world at that time. In fact, you’re not out raising dollars or anything at this point. You’re just giving yourself the time, space, the vehicle, to work on your ideas, and to do it in a way that’s completely devoid of bias, completely devoid of any type of greed or anything. You’re just doing it to create something special and something impactful, and I think that’s what got my parents. I think my family was really receptive to the fact that, at least in the early days, I’m not talking about drop out and pursue an idea versus, stay in school, get a PhD. I said, “You know what, let’s try to do both.” Because what I want is, I want the freedom for when I need to make that call, and when I need to decide to put school on hold for a little while, it’ll be for a good reason. There will be a catalyst associated with it. Either it’s the idea is really materializing and now there’s a product or now investors are interested in the idea or most importantly, there’s viability to what you’re doing. That people actually may stand to benefit from this piece of work that we’ve invested our time and energy in. I think that’s what really convinced my family that this isn’t just a leap of faith. This is an investment in our son, in our family, and ultimately in the future. We’re excited about them. My family was really cool about it too.


    Elio:         [08:06]        I feel like there are parts of that story there, man, maybe the trembling as you’re going into the living room to explain to them what you’re going to be doing. There was none of that? Or it was just like, “Hey, man, I think this is a great idea.” There was none of that, right? You just kind of walked in…


    Peeyush: [08:18]       No.


    Elio:          [08:19]       Were you nervous about it at all?


    Peeyush: [08:21]       Well, here’s the funny thing, right? I had the conversation in a different light with my family when I told them, “Hey, I don’t want to do the four years of high school thing. I want to merge my junior and senior year into one. Hope you’re cool with that.” And it’s like, “Okay, yeah.” I mean, my family has always been very, very understanding and appreciative of the fact that I’m going to pave my own way and I’ve got a lot of confidence in that, even if it doesn’t work out to plan, that’s okay. I think that confidence means a lot to them. It’s not like if I put all my eggs into this basket, I’m going to do my junior and senior year into one and I want this singular thing and if I don’t get this singular thing my life is over, I think my family might be a little bit more resistant. Versus the way I think I handled the situation, which was, “I’m confident that this approach is the right approach. And it can result in a lot of different outcomes. I could do a startup and that startup could go on to be extremely successful or I could decide I want to go back to school, or I could decide any number of things in between.” I think knowing that I’m confident in hedging on myself, betting on myself, made it easier for them to choose to do the same.


    Elio:         [09:31]        All right, awesome, man. We have a lot of kids at Fisher College of Business that listen to the podcast, so I wanted to dig into that in case they are kind of thinking about having a similar situation. Digging into your experience a little bit might offer some assistance to somebody else who might be in your shoes. All right, so let’s talk about Genetesis. What’s the elevator pitch for the company, you know, Matrix-esque understanding of the body being a conduit for electricity, producing its own electricity. That was kind of my first introduction to that subject watching The Matrix. And so what’s the elevator pitch for your company?


    Peeyush: [10:03]       Yeah, just broadly, our vision is to get the right patients to the right place at the right time in the emergency room setting. Right now a standard of care if you’ve got chest pain, and you’re coming into the ER, every ER doc is going to treat you as if you’re having a heart attack or have the risk of developing a myocardial infarction, heart attack, while you’re there. So their entire goal with those chest pain patients is to be able to rule that out. The issue is that most patients that are coming in with chest pains don’t have cardiac origin chest pain so they’re not going to have a heart attack. And we spend so much time as an ecosystem industry, so much resource, so much investment in making sure we’re ruling out those patients that don’t have a heart attack, that we’re really creating an imprecise solution for the broader ER chest pain community. So really what you have is a continuum of care where we are not effectively leveraging resources. A lot of patients are getting unnecessarily tested, they’re staying instead of two or three hours, they’re staying for 17 hours, 20 hours, two days in the emergency room. They’re taking on a lot of that cost as patients for that inefficiency and so just long story short, from our standpoint, it’s about enabling cost-effective patient-centric care and getting to a safe, accurate disposition. Whether it’s getting a patient to therapy faster in the cath lab, or getting a patient out and back home that much faster. That’s really what our bottom line thesis comes down to.


    Elio:         [11:35]        We’re going to take a quick break and be right back after this message from our sponsor.


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                    [12:29]         All right, so if I’m hearing this from the CMS perspective, I’m raising my hand, I’m saying I’m interested. If I’m a doctor, a cardiologist, I’m saying I’m interested. If I’m a patient, family member, I’m interested. If I’m the triage person in the emergency room, great. Okay, you got me. So how does your technology actually do this?


    Peeyush: [12:47]       Absolutely. You can think about our technology as the opposite of an MRI. So instead of emitting a magnetic field to evaluate the structure or the anatomy of a tissue, like the heart, you’re actually measuring the magnetic fields that are naturally generated by the heart. So it’s completely passive. There’s no radiation associated with this. There’s no radioisotopes or ionizing radiation associated with [it]. No contrast. It’s a 90 second at rest test, where effectively you’re put into a semi-shielded chamber and for 90 seconds, there are a set of sensors hanging right above your chest wall, not even touching skin, measuring those magnetic fields, and out comes an image that shows you the magnetic activation of your heart over that period of time. That data is what an ER physician or a cardiologist would use to be able to distinguish cardiac versus non-cardiac origin chest pain versus standard of care, which would be put someone on a treadmill or inject pharmaceuticals and contrast agents, stress them and do it again 30 minutes later. It’s a very long process, a very expensive process, and very often involves injection of radioisotopes into the arms. So there’s quite a bit of staffing and external resources required, waste management, in order to properly leverage those resources. This does away with a lot of that.


    Elio:         [14:12]        Okay, so was this technology your idea that you started just on a sheet of paper and kind of built out? Was this something that was already out there in research and you guys made it a reality? Was it something that was fully developed that needed to be commercialized? How did the company itself come about?


    Peeyush: [14:27]       So this concept of measuring the magnetic field naturally generated by the heart, we certainly did not invent that. That concept had been around for quite some time. It actually started at MIT back in the late 60s when they were using magnetically shielded rooms the size of a Lunar Module and using one sensor at a time just to measure the signal. Just the time series data coming off from the heart, which was exciting, game-changing at the time. But over the course of the next several decades, there were innovations made on that technology that allowed for multiple sensors to be used at the same time, for you to create images and not just waves of data. And as the sophistication started growing, so too did the commercial interest in that technology. The MedTech industry started taking notice of what this MCG, Magnetocardiography science is really about. But it really tapered off near the early 2000s when the biggest limitation of the technology from the 1960s up until the mid-2000s really, was the fact that the sensing modality to actually measure that field was limited by liquid helium. You needed to cool the sensors with liquid helium in order for them to operate. You needed to keep refilling that liquid helium every 10 to 14 days. And over and above that you really needed quite a bit of shielding, typically a complete room and pretty sophisticated technicians and interpretation skill set in order to really make it work. So to answer your question more directly, what we really did is we took a concept that really worked on paper, really worked from an intellectual standpoint, and we repurposed it to be viable in the emergency room setting.


    Elio:         [16:14]        Okay, existing technology, it sounds like there is breakthrough in this cooling technology, right, which now makes it more efficient to do this test. So this technology is ripe for innovation, right? All the pieces are there, you guys are putting it together and you have this idea for the company that actually does this. Now, where do you start? Who do you start pitching? Do you have a co-founder? Where does it start? Do you start on the software side where you’re just building what’s going to turn the data into information for somebody reading the test? Do you start out with the hardware where you’re actually building it out? Where do you start with this company?


    Peeyush: [16:53]       For sure. I love the way you asked the question because we actually asked the question ourselves, me and my co-founders, back in 2014, 2015 when we had started really perfecting the concept here, but we actually answered the question incorrectly when we started. We said, “Okay, well, we got to build this big, new device. It’s got to be completely novel. We got to build the best version out there.” But then we said, “You know what, that’s going to cost a lot of money and that’s something we don’t have any of. So we have to find a way to demonstrate that if all of this pans out, and we can analyze the data we say we can, in the way we say we can, not only is that the core differentiator, it’s cheaper for us to be able to prove it.” So we said, “Let’s assume that the hardware is built and all of the data coming in is exactly the way it would have come in if we built the device. Then what? What do we do to make sure that we’re leveraging the newest generation of computing? Leveraging the greatest and latest technologies that are out there in cloud and AI and develop our own sophisticated framework to analyze that data.”


                     [18:01]        We spent our time, money, energy on creating that intellectual property, creating that proof of concept and it was far cheaper. We were able to prove that off of just business plan competition money and by the time we built the prototype and tested it in a pilot at the Mayo Clinic, we had enough to go to investors and say, “Now we got to put together the whole device.” That was a really, really nice, lean approach to building out the full business, but we started only by building a small subset and the most differentiated subset first.


    Elio:         [18:33]        Okay, that’s brilliant. You guys needed to start somewhere. You started, I wouldn’t say in the least difficult spot, but at least the least capital-intensive spot, right?


    Peeyush: [18:43]       There you go


    Elio:          [18:44]       And the plan all along was to ultimately build the greatest version of what would actually produce the test. So you guys are going back to do that and the financing that you’re raising now is going to help you do that. Is that correct or are you guys going to stay on the software only side?


    Peeyush: [19:01]       It’s interesting. When we first designed the software and Analytical Engine and got the initial intellectual property, got the patents, got all of the actual code written and were testing it, we’re like, “Okay, this is huge, this is exciting. We’re enhancing the value that already exists in the literature significantly and are going to be able to bring this concept of Magnetocardiography to the real world.” The issue was, even though we built the Analytical Engine, there were still enough challenges on the hardware side, and very few people who knew how to do it, that we weren’t going to be able to be the Microsoft of this business and just latch on our software onto any piece of hardware out there. We then were stuck in this conundrum of, “Ok, we now need to build a piece of equipment that actually serves as a good requisite to getting that data that we need in order for the software engine to do its job.” And so this became both a challenge but also a huge opportunity because what a meant is we could own the end to end solution and build it and be tasked with reinventing the modality so that the quality, the processing, the analysis, interpretation methods, everything we had control over which would be game-changing, especially when it comes time to support commercial users and grow the applications and build new functionality in the software and device. So it ended up being a challenge, but a worthwhile one.


    Elio:         [20:28]        Thank you for listening, we’re going to take a quick break and be right back after this message from our sponsor.


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                    [21:06]         So I know you’re just getting started on the road down to hardware. Do we have renderings already of this thing? I know you said it was Lunar Module before. Are we talking Toyota Camry now? Are we talking a mini or are we talking handheld portable? Where are we in terms of where we start with the technology we have? Are you guys at that phase right now where you’re beginning to render what this is going to look like?


    Peeyush: [21:33]       Yeah. And look, we knew one thing was more important than everything else. It has to work. Our end-users need the technology to be reliable. They need it to be robust because we’re talking about patients’ lives. So we’re not going to prioritize purely aesthetic if it’s going to compromise the quality of our product and solution. So what we realized is, there’s a reason that these things started out in magnetically shielded rooms. That’s because even if theoretically, you could do it without the shielded rooms, the susceptibility to a car driving next to that system could be enough to really compromise the quality of that data. So instead, we said, “What if we created a semi-shielded system?” So to use your analogy, instead of going from a Lunar Module, down to the mini or to the portable, we started with the Camry, let’s call it that. And that’s where we’re at right now.


                     [22:28]        We’ve got a system that we know has signal to noise ratios that are reliable, that are going to keep our end users in the ER and cardiology and most importantly, the patients satisfied knowing that they’re getting a high-quality product. Once we’ve developed that benchmark for quality, it’s a different story to now talk about miniaturization, cost reduction, feature enhancement, but the most minimum viable component here was that the product quality needs to be of the utmost and I think we were able to deliver on that promise and continue to iterate and incrementally improve that functionality and are now starting to think about things like portability and feature enhancements. But that’s where we’re at right now. That’s the approach we took.


    Elio:         [23:14]        All right, so in deploying hardware and software, where are we? Is your product now in the field being used widely? Are you in production? Where are you in that process?


    Peeyush: [23:24]       Yeah, no, we have a contract manufacturer system here in Ohio. We’re an FDA cleared product as of last March. We’ve established Medicare reimbursement on our procedure. We are an ISO 13485 certified facility as well. So quality again, coming back into the picture, into the mix. We’re certified for the design, service, install, maintenance of these systems, and we’ve got multiple systems in the field. Three systems in hospitals. We’ve got one here locally in Cincinnati as well, and we’ve got additional systems and inventory that are going out to new hospitals. We’re talking about right now Ohio, Michigan, West Virginia, Pennsylvania. So we’re starting to spread out. But we’re still remaining, at least somewhat regionally focused, knowing that it’s really important as these users are beginning to ramp up the use of our technology, both in clinical trials and now thinking in kind of the, “How do I roll this out to our ER on a real-world basis?”, it’s important that we’re dedicating resources and providing an on-premises support as the technology ramps up. It’s what we call developing the market. So we’re insistent on that and feel that it plays a lot of role in guaranteeing success for a new product in the field. And we’ve been ramping up, we’ve got several hundred cases of clinical data, exciting field performance for our product in the hospital ER setting and more to come.


    Elio:         [24:53]        So world-class software. It’s developed in Ohio, built in Ohio, so I’m just going to go out on a limb and say world-class hardware, right?


    Peeyush: [25:01]       There you go.


    Elio:          [25:01]       It’s going to be well manufactured, top of the line. But now you put yourself in a position to have the third thing that you guys can be world-class at, and that’s customer service and support. When you have machines in the field, you need technicians, you need to respond because this is mission-critical equipment. It can’t go down, right, because the value proposition is that it needs that uptime and that accuracy. So how are you guys thinking about customer service and making sure that these machines are well serviced and up and running at all times?


    Peeyush: [25:37]       That’s a great question and we used our clinical trials actually as kind of a practice run for this because when we start rolling these out for commercial use, and this is being used on patient care, I mean, we want to be sure that this system is delivering the level of reliability, robustness, accuracy, that you would expect out of any type of life or death type of management solution. You think about imaging equipment. That stuff can’t go down, especially when you’re talking about– Think about a COVID type environment where CT scanners are inundated. And now, guidelines are changing, so instead of chest pain patients getting stress tested, many might be referred over to a CT. It’s very possible that once our test, CardioFlux starts ramping up, that that volume would come into CardioFlux, and we are internally and culturally very in tune with the fact that our customer service very much dictates the growth trajectory for our business. Ultimately, start with a few sites, but give them the best. Make sure that we are developing the market by providing that world-class support on-site and providing kind of that general little bit of hand-holding, making sure people are feeling comfortable with the technology. It’s new. There’s going to be training. There’s going to be retraining. There’s going to be even more retraining, but they end of the day, that’s what differentiates power users from people who are still a little too nervous to push the button. From my standpoint, customer service translates to customer success, translates to revenue. So ultimately, for our business’s success and sustainability, customer service is top of mind and very embedded into our team culture and objectives for quality.


    Elio:         [27:21]        Let’s talk about your latest round of fundraising, right? Again, I said, I really wasn’t hearing much about your company, and then all of a sudden boom on the OIF LinkedIn page, this huge announcement about your latest funding round. So tell us a bit about that and then how are you going to use that funding? I’m sure some of it is going to go into production, obviously, but how are you using that funding to help grow your company?


    Peeyush: [27:44]       Absolutely. And kind of the biggest events for 2020, we’ve got some very exciting clinical work underway. We are already partnered with West Virginia University on a very exciting study comparing CardioFlux head to head with stress testing, which has got a lot of limitations like I mentioned earlier. But this is a great opportunity for us to demonstrate CardioFlux relative to what’s being done in the standard of care. Especially given the COVID pandemic, the importance of this study can’t be understated and will provide a very significant and transparent view on what this technology can do for hospitals around the country. And that’s just one of three. We’re launching two additional trials. The one really exciting one, our Ahmed trial is a trial that focuses on a very real-world environment, talking about all comers into the ER for chest pain. You’re not singling out low risk versus high risk versus intermediate risk. You’re looking at a very broad population, and you’re letting CardioFlux do its job which is to determine risk, which is to help the ER physician understand and distinguish risk and how patients should be dispositioned so that resources are best allocated to the patients who need that therapy that much faster. And the patients who can be sent home that much faster safely, now have the ability to do so without the need for very invasive, downstream, unnecessary tests like a stress test or even a diagnostic angiogram.


                    [29:18]         So there’s a lot of things to consider here. A lot of exciting programs underway clinically. We’ll be growing our install base, many new hospitals coming online throughout calendar year 2020. The financing is exciting. I think it represents two very, very important elements of our business. One is we are backed by very community-oriented Ohio based investors like Ohio Innovation Fund and CincyTech, which have been great long term partners for us. And Mark Cuban, who has been a long-standing seed through Series B investor for us. But we’ve attracted new strategic investors as well which represent the supply chain, strategic interest, the health care strategic interest as we disclosed in our press release. It brings the next piece of this together, which is the fact that it takes a village and now our village is getting bigger. And we’re looking at our company as a global enterprise, including strategic partners like TDK onto our cap table, which will prove to be very, very helpful for us as we scale our systems out, not just throughout the US, but throughout the globe.


    Elio:        [30:25]         Yeah. Now with the investors, with you, you need more data, right? So you got to deploy these machines. So I know that’s probably right there at the very top of objectives. Get these tests going, get these clinical trials going, put your technology up against what the conventional modes of addressing these different issues would be when somebody enters the ER. So I know that’s great. But how do you make money with this thing, right? Are they buying the machines? Are you leasing the machines to them? Are they licensing the software? How do you guys make money?


    Peeyush: [30:56]       Absolutely. If you look at our team composition, you look at our intellectual property, it’s very true to our origins. We built this company starting as a technology business. And we certainly invested a lot of time, energy, sophistication into this MedTech asset, which is CardioFlux, the device. The device is the enabler. The company and our staff and our intellectual property continue to progressively grow on the technology side and for a simple reason. It’s, we’re not in the business of selling capital equipment. We are very much focused on providing value-added service, all in the spirit of workflow optimization in the emergency room. So the way we price the product and the way we distribute the product is focused on maximizing utility and value.


                     [31:42]        So you hear kind of this term of “per click” type business models. It’s very, very similar for us. We’re not really focused on selling the capital equipment for X dollars, we’re really much more focused on, “We understand that you as a hospital aren’t going to leverage the technology two, three, four, five, whatever times a day. We understand your cost structure, your top line, your bottom line, especially in an environment where hospital margins are so important and so adversely impacted.” I think a model like ours that focuses on per click volume-based use, but in a way that’s really easy to understand, manage, doesn’t require large capital investments upfront, makes it feel more like a subscription type revenue model versus a traditional capital equipment purchase.


    Elio:         [32:29]        Yeah, and I think really, the cost savings is going to manifest itself, right? It makes sense from a “per click” standpoint if you’re getting people to the most efficient treatment, right? I know CMS is going to love that because you aren’t running all these unnecessary tests. So it’s going to drive the cost down so they can get the reimbursements. So the value is right there, right. If this software is going to help you get people to the right treatment, it’s actually going to represent a savings for the customer, not necessarily a cost, so it’s a great investment. I’m going to close the podcast with this. Over the next three to five years, where would you like your company to be? What are some of your goals for that timeframe?


    Peeyush: [33:03]       We see ourselves at 125 plus installs in that three to four to year span. It’s a very important number for us because we think it represents the growth potential of the business, certainly, but it’s only tip of the iceberg in terms of what this product can do in terms of [breadth 33:19] of ERs. Even when you look at these critical access hospitals, rural hospitals that are in a difficult position, especially a financially difficult position given the current crisis, we see our mission as being providing our solution to ERs globally with the effort of safe, accurate and cost-effective disposition, so that patients are getting to the right place at the right time. And in three to five years, we think we’re going to be a much more ubiquitous name within the ER. Which is certainly investing in optimization of our reimbursement structure, additional clinical data to provide more confidence and enable adoption, growing our Salesforce ultimately to be able to keep up as we grow over the next out years, two, three years.


                    [34:03]         But ultimately, if you go from three to five years, we see that once our technologies in the door, our job is to be able to continue living up to our mission and achieving the vision of the company. And in that spirit of enabling safe, accurate, cost-effective disposition in the ER setting, it’s very possible that this technology can be geared towards stroke. It can be geared towards heart failure, towards cardiomyopathies. There’s a lot of adjacent applications, not all of which are cardiovascular, that may be able to leverage the same footprint of the device. So I think from a technology standpoint, it’s our job to be able to scale the applications and value of the technology to the greatest possible extent. Again, just like it is with the chest pain world, I think we’re only scratching the surface right now and there’s a lot of exciting value to be had.


    Elio:         [34:52]        Peeyush, thank you so much for joining me on this episode, man. Great story, great product. Very, very bright future. I close every podcast with my one takeaway. And there [are] two sides to every person; the side that wants to stay conservative and the side that wants to go for it. Like Peeyush said, and like probably his professor advised him, “Hey, time is not always on your side. If you have an idea, you have a dream, now is the time to go for it, COVID or not.” And in these times of COVID, we chatted before we started recording, you are recording from a pink bedroom with a blue stripe, and butterflies on the wall, and probably somewhere in this podcast, people are going to hear my dog barking and some other background noise. So we’re all trying to make it work. Now in the spirit of going for it, I need you to do me a favor. Are you ready?


    Peeyush: [35:45]       Do it. I’m ready.


    Elio:          [35:47]       Tell Mark Cuban to holla at me! All right, it’s 614Startups. Thank you for listening to another episode. Peace.


                      [35:57]       That’s a wrap. You can find this and all our episodes on our website,, Apple Podcasts, Spotify, Anchor, and all your favorite podcasting platforms. Don’t forget to subscribe and write a review. If you would like updates sent to your inbox, you can sign up for our weekly newsletter on the website. To engage in the 614Startups community, follow us on LinkedIn, Twitter, Facebook, and Instagram at 614Startups to join the conversation. For sponsorship opportunities and collaborations, email us at

         [36:35]         It takes a village to do a podcast and I would like to say a special thank you to my friends at Waveform Music Group. Andy and Carlin have been working with us to enhance the production of 614Startups and we’re so happy with the results. Outside of podcast production. Andy and Carlin are experts in sonic branding, songwriting, and music production for companies and creatives. To learn more about them go to their website, that is c

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