What lessons can be learned from startups that do succeed? We spoke with founders of companies that won top awards at the Startup Showcase, part of Cleveland Clinic’s 2018 Medical Innovation Summit. The event was powered by Cleveland Clinic, HIMSS, HealthXL, Jumpstart, and Plug and Play, with more than 40 startups pitching their health tech concepts.
Sana: chronic pain relief mask
“Credibility isn’t a line you cross. It’s a ladder you build step by step.”
- Richard Hanbury, Founder & CEO, Sana
Richard Hanbury has devoted more than 25 years of his life to pursuing relief for chronic pain. It began with a near-fatal accident when he was a 19-year-old student at Durham University in the UK. He had travelled to Sana, the capital city of Yemen, to study Arabic. Driving a Jeep with a friend, he swerved to avoid an oncoming truck and plunged off a bridge. A spinal cord injury left him a paraplegic in excruciating pain – with a diagnosis of five years to live.
Hanbury found that opioids only masked the pain and he soon built up a resistance to the drugs. He tried alternatives but found no relief. Hanbury accidentally discovered that while absorbed in watching a movie, he felt no pain as his brain experienced a “flow” state. This sparked his search to reproduce this effect on the brain.
Using himself as a test subject, Hanbury eventually designed a device that used neuromodulated light and sound stimulation to achieve deep relaxation and relieve pain. Since 1993, he has been pain-free. In 1995, Hanbury founded Sana (also meaning “health” in Latin) and later earned an MBA in Healthcare Entrepreneurial Studies at the University of Pennsylvania’s Wharton School. He has focused on not only building an effective business model but undertaking more than 700 individual trials of EEG-based research and testing more than 30 prototypes.
Wisdom gained as a healthcare entrepreneur
Hanbury’s personal quest to understand and relieve chronic pain has been a driving force in the company’s success – and the fact that he’s tackling a current crisis in modern healthcare. “The sheer numbers of people dying from opioids each year is making people realize there must be a better way to address pain,” says Hanbury. “Sana has added an exceptionally good tool to the toolkit.”
Hanbury believes his focus on rigorous testing has also been a factor in the company’s success. “Lots of medical device startups skip that process of rigorous testing before going to market. But you have to show clinical efficacy in the way the provider community is used to seeing it. If you’re saying a device is better than a drug, you better have the data to back it up. It takes a lot of money for startups to do clinical trials, but we’ve been getting the support to do those trials.”
Perks of Winning in Cleveland
Hanbury says competing in the Cleveland Clinic 2018 MIS Startup Showcase gave Sana the chance to get a hearing in one of the most influential medical hubs in the country. “It was a surprise and honor to be given the award - and enabled me to talk to people at Cleveland Clinic and instantly gain credibility,” he says.
He also acknowledges that being visible in the innovation community for many years helped the company prove itself as people saw the progress made by Sana. “As a startup, credibility isn’t a line you cross. It’s a ladder you have to build step by step.”
Sana is currently involved in three large clinical trials that Hanbury believes will provide the data needed to drive FDA approval, assure product safety, and bring the pain relief mask to market in 2019. “It’s exciting but a very heavy responsibility,” says Hanbury. “Every time I talk to someone in pain, I realize I’ve got to carry on and do that extra bit of work. We’ve got to get it right. We can’t take short cuts.”
YouScript: precision medication management
“This is an epidemic. One person dies every two minutes from adverse reactions to medications.”
– Kristine Ashcraft, CEO & Founder of YouScript
After her grandmother died of cancer, Kristine Ashcraft remembers wanting to find a cure for cancer. In 1996, she graduated from the University of New Haven with a degree in molecular biology. She found genetics fascinating – but decided benchwork in a lab was not for her.
In 2000, Ashcraft discovered her mission after joining one of the first companies to offer pharmacogenetic testing. They provided data allowing physicians and pharmacists to incorporate a patient’s genetic factors into the drug prescribing process – all with a goal to help improve efficacy and reduce adverse effects.
Ashcraft remembers an “aha moment” about that same time when reading a magazine story about a young boy who died from an overdose of prescribed drugs. The boy’s foster parents were accused of causing his death until a physician and pharmacist uncovered the real culprit -- a DNA variation that caused his combined medications to become a fatal cocktail. Ashcraft describes it as “the dawn of the age of precision medicine” when drugs and dosages could be tailored to a patient’s genetics.
By 2016, Ashcraft had founded YouScript, a startup with a mission to end avoidable drug events using a precision medication management system. “YouScript is the culmination to the answers to the questions I was hearing from physicians: How do I know which patients to test? How do I act on that information in my busy clinical workflow, and where are the studies to validate this?”
Ashcraft understood physicians’ frustrations with pharmacogenetic test result data that wasn’t easily accessible. She and her team designed YouScript to deliver real-time drug and dose optimization guidance based on accessing test data anywhere that prescribing decisions are made.
Starting out as a web-based tool, YouScript allowed physicians to enter new medications and determine the best choices. But Ashcraft quickly found that physicians weren’t willing to leave their workflow to use the tool. It needed to be in the workflow at the time decisions are needed. YouScript is now integrated into the three leading Electronic Health Record (EHR) systems.
“Scaling pharmacogenetics demands a cloud-based repository of all the results and a tool that evolves as the evidence does, ideally in real-time,” Ashcraft explains. “That information needs to be taken into account every time a medication decision is made for the rest of a patient’s life – when new prescriptions are written, and as a failsafe at the pharmacy when they’re dispensed.”
Behind the YouScript success
YouScript has seen high satisfaction ratings from physicians and “super user” pharmacists. Ashcraft also cites published studies showing YouScript has caused a decrease in hospitalizations, emergency room visits, and mortality rates.
Reflecting on why her startup has prospered in the highly competitive digital health space, she attributes success to never losing sight of the YouScript primary mission to avoid adverse drug events. Her Seattle business employs about 20 people and Ashcraft is proud to report that not a single person has left since the company’s founding.
Award brings “instant credibility”
Ashcraft was impressed by the caliber of competition at the Startup Showcase and honored to win. “When you say you won the Cleveland Clinic Medical Innovation showcase, people start to listen! They know you must be doing something important.” Judges at the pitch competition indicated a strong interest in YouScript since it addresses a huge problem in healthcare, one that is often under-reported, with 50 million people in the US taking multiple prescription drugs.
Winning the top award has also meant a complementary HIMSS membership, media exposure, and demo booth space in the Innovation Live at HIMSS 2018 Global Conference. Looking to the future, YouScript is working with health system partners to gather data that will help shorten the timeline for identifying drug interactions.
“A lot of health systems are currently coming up with their precision medicine strategies, often focusing on oncology and rare diseases -- but gene-based prescribing is the lowest hanging fruit in seeing the impact on patient care,” says Ashcraft. “If it’s not part of a health system’s patient safety strategy, it needs to be.”