The last time I wrote here was May 2016. Since then, I’ve been laser focused on building my Digital Health company SeamlessMD.

The crazy thing is that without writing, SeamlessMD wouldn’t exist.

How could that possibly be the case?

In December 2012, we pitched the venture idea for what eventually became SeamlessMD at The Next 36 incubator. Just 24 hours earlier, I met my co-founders Willie and Phil for the very first time.

The selection process for The Next 36 itself was intense – you applied online, completed an asynchronous video interview, and then 72 finalists got flown to Toronto for a series of interviews by quite an esteemed group. One moment you were being interviewed by the previous CEO of Goldman Sachs Canada, and the next you were being grilled by Rotman’s top professor on entrepreneurship.

The 72 were narrowed to 36 (hence “The Next 36”), thrown into 12 teams of three (and yes, we were all strangers to each other) and given 24 hours to come up with a venture idea to pitch.

I can’t remember how many ideas Willie, Phil and I went through, but I eventually brought up the hospital readmissions problem I had done research on during medical school. From there, we decided to pitch a remote monitoring platform to prevent readmissions. The fact that SeamlessMD is still in the same overall problem space today is a pretty incredible, low probability event.

After throwing our first pitch deck together and very little sleep, we got up on stage and made that very first pitch to a crowd of entrepreneurs, executives and investors. The crowd voted on the venture most likely to succeed, and somehow we ended up on top!

While wrapping up Day 1 of being a company, one of The Next 36 co-founders shared more about the selection process:

“There was actually a huge debate about whether Josh should make the 36. What saved you was that incredible blog you created, where you not only wrote hundreds of articles, but had tons of students commenting on it. That’s what made us believe you could build something special.”

What he was referring to was another blog I started in my last year of undergrad. What was initially meant to be a personal blog to chronicle my journey into medical school, turned into a full-blown advice website for high school and undergrad students. My university went on strike for three months, so I used my free time to start write almost every other day, and it organically snowballed into a very popular resource. I have always enjoyed writing, but it was that first blog that really honed my writing skills and made me love it.

It’s humbling to realize that I very well may not be building SeamlessMD today if I hadn’t spent years writing and building that first blog. When I reflect on that, it reminds me of how beautiful the written word is, and why I love it so much.

While I’ve missed writing for five and a half years, I’ve also been lucky to learn so much while building SeamlessMD.

I have many thoughts and learnings to share, particularly on Digital Health and Entrepreneurship. I hope to be right sometimes and expect to be wrong sometimes as well. Most of all, I believe sharing these thoughts will help move the industry forward, and I look forward to thinking out loud with all of you once again.

Last week I found myself in gorgeous Banff, Alberta, meeting with an esteemed group of physician leaders and healthcare innovators from across Canada. Together, we began laying the groundwork for transforming Canadian healthcare from an ecosystem of fragmented, local Inventions to a thriving ecosystem for scalable Innovation.

This was my first meeting as the Chair of the new Joule Innovation Council for the Canadian Medical Association (CMA). It is an honour and privilege to lead this Innovation Council for our national organization of 83,000 physicians across the country!

Our Innovation Council we will be guiding the CMA and Joule Innovation on a number of new programs to help Canadian physicians achieve scalable impact with their Healthcare Innovations:

• Grant Funding to help your innovation work progress faster
• Mentorship from physicians and innovators who have successfully gone from Ideation > Invention > Innovation in our complex healthcare system.
• Access to early-adopters and beta-testers

Most importantly, we will build a thriving community of physician innovators – and together we will learn from each other, fix the barriers that stifle innovation and build an innovation ecosystem that works for patients and providers, rather than against us.

If you are a Canadian physician, I encourage you to learn about the new programs Joule Innovation has to offer. And please reach out to myself and my Council peers on how we can help!

So why am I doing this?
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Individuals thinking about applying to The Next 36 often ask me whether they should apply.

For a long time I found this question difficult to answer about any entrepreneurship program / accelerator / incubator.

Over the last few months, I’ve come to an answer that I currently give everyone, and it works for any accelerator.

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Two weeks ago, my good friend Jeff Wandzura and his company TrueVation announced they were accepted into Blueprint Health, one of the leading Digital Health accelerators in the U.S.

I am very happy for Jeff and it could not happen to a more deserving guy.

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When we were raising SeamlessMD’s seed round last year, we were asked about our competitors and how we were different.

Usually an entrepreneur will show investors how they are ahead of their competitors on important dimensions in today’s market (e.g. cost, performance, etc.). Unfortunately, the desire to appear unique can lead to a misguided view on what’s important for differentiation [1].

Image Source: FlowVentures

This is a problem created by both sides of the table. Investors may suggest that companies must be differentiated today, or they aren’t worth investing in. In response, entrepreneurs look for ways to appear unique – which, in the worst possible outcome, can lead them to focus on the wrong dimensions.

We’ve certainly experienced this, as I’m sure have many other investors and entrepreneurs. However, in retrospect, I believe this is the wrong approach.

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Last week Ontario’s Ministry of Health released a proposal for major changes to how healthcare is structured in the province. You can find the News Release here and the Full Proposal here.

Here was my reaction after reading it.

Lacks transparency

First thing I thought – it wasn’t worth reading the whole proposal. I found myself annoyed because 90% of it was fluff.

The entire proposal can be summarized in 3 sentences:

1. Put LHINs in charge of home care.
2. Put LHINs in charge of primary care.
3. Put LHINs in charge of public health.

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When I was in Grade 3, the province of Ontario implemented mandatory testing for Reading, Writing and Math.

Students were graded on a 4 point scale. I scored a 4 on Reading, a 4 on Writing and a 3 on Math. Surprised that I didn’t do better on Math, my parents asked the school if they could see my test.

The school showed my parents my test, and then a copy of the “answer key” which showed examples of “Level 4 answers”. I got most of the answers right, but I was docked a bunch of marks because my “answers were not long enough”.

There would be questions where you were given an entire blank page to use for your answer. I would write a few sentences, and then get to the answer. I looked over at the “Level 4” example answer – the entire page was filled with text. I had no clue what useful information could possibly fill the whole page.

Three years later, it was time to get tested again. But this time I was ready. I remember doing the Math section. I kept writing until the entire boxes were full. I decided it wasn’t enough, so I started writing outside the lines too. I’m sure most of it was not meaningful. But I got a 4 anyways.

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Yesterday morning, we received a question from a patient who was using SeamlessMD in her recovery after surgery.

I immediately responded to her question. A few hours later, she replied back:

“Hi Josh – I can’t believe I got a reply… and so quickly.”

I responded with:

“I’m glad the quick reply delighted you! We pride ourselves in helping hospitals provide a better experience for their patients :)”

She then said:

“Thanks Josh – I work in customer relations myself and people do appreciate timely assistance – I was actually surprised to get a reply at all.”

Of course, I’m proud of our team whenever we delight the patients we serve. It’s a wonderful feeling.

Unfortunately, what’s more striking about this story is that it shows the low expectations that patients have of our healthcare system.

Patients want better, and they deserve better. But given the challenges facing our healthcare system, you can’t blame them for not expecting much.

That said, times are changing. In some pockets of the world, patients are already expecting more. If it’s not the norm yet where you live, it soon will be.

Patient experience 1.0

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My first two years of medical school were mostly in the classroom. Although we spent half a day a week learning to interact with patients, none of that can really prepare you for 3rd year – which is your 1st real year in medicine. You spend your days, evenings and weekends in a hospital, and you start to understand what it means to be a doctor.

I had a lot of memorable “firsts” year. I delivered my first baby. I closed my first incision. I did my first (and last) thoracentesis on a patient with cancer so she could breathe more easily.

I can still remember how my first 24-hour call shift started. It was just myself and a staff physician who I had never met before. I told her I was a brand new trainee and I had never been “on call” before.

She replied: “So what? It’s not like I’m going to go easy on you.”

That’s one way to start the next 12 hours with someone.

That first year of clinical medicine really is “sink or swim”. Fortunately, most medical students figure out how to swim.

Once you can swim, you turn your attention to the bigger picture – figuring out what type of doctor you want to be, and giving yourself the best shot at getting into your preferred residency program.

With so much medical knowledge acquired in that first clinical year, you would think that one’s medical acumen would be the primary factor in getting into your residency program.

It wasn’t obvious to me at the time, but the counterintuitive truth is that one’s medical acumen is rarely the deciding factor in choosing candidates.

Fitting in

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Imagine you came across a genie who offered to play a free coin flipping game with you.

The game is simple. You flip a coin. Heads you win. Tails you lose.

Each time you must bet $100. In fact, to entice you, the genie gives you a free $100 to start.

Consider these two different outcomes.

Outcome 1

You flip the coin. It’s tails. You lose.

The genie says you can play again if you put in your own money. But you start to think maybe it was rigged from the start, that perhaps this genie was just playing with you.

You decide to never play this game again.

Outcome 2

You flip the coin. It’s heads. You win.

Now you have $200. You’re free rolling – so what’s the harm in playing again?

So you bet another $100. And you win again. And again. And again.

Occasionally you lose, but after 100 flips, you realize the coin lands on heads 90% of the time. You’d have to be really unlucky to go broke playing this game.

As it turns out, the same coin was used in both scenarios. Person 1 was just unlucky to be in the 10% of players who got the bad toss the first time around. And he will never figure out how lucrative this opportunity was.

With most things in life, there is a huge advantage to being successful the first time around.

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