Joshua Liu

As SeamlessMD, it’s important that we:

1. Focus on the right goals
2. Execute as fast as possible

This is hard for any startup. It gets even harder when you’re trying to re-design a process that’s been unchanged for decades (the patient journey) in a complex system that’s slow to change (healthcare).

Over the past few years, as we survived the growing pains of navigating multiple stakeholders and bureaucracy, we developed key processes that help us and our customers stay motivated and progress effectively.

One key process that we’ve incorporated is:

Envision success before every encounter.

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I was incredibly impressed by the announcement today that three top U.S. health systems – Dartmouth-Hitchcock Medical Center, Johns Hopkins Medicine, and the University of Michigan Health System – will be enforcing standards that prevent low-volume hospitals from performing certain surgeries.

This comes on the heels of a major U.S. News story which showed that patients who had surgeries at low-volume hospitals faced significantly higher risks of complications and death.

The data itself is not surprising. The relationship between low procedure volume and worse outcomes has been well documented since a first major publication on the topic in 1979.

It’s also common sense. The more times you perform a procedure, the better you will be at it. If you’re only performing a hip replacement surgery 3 times a year, chances are you won’t do it as well as a surgeon who performs 200 a year. Practice makes perfect.

Instead, what’s surprising is that these three major medical systems are putting their foots down, even though they don’t need to.

There’s no Obamacare incentive. In fact, this decision could cost these health systems a lot of revenue. And this will certainly upset some surgeons and staff who want to keep performing those surgeries.

They are doing it because it’s better for patients. Because it’s the right thing to do.

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A few months ago, I was catching up with Josh Landy (co-founder, Figure 1) over coffee.

If you aren’t familiar with it, Figure 1 is a free, crowdsourced photosharing platform for healthcare professionals. Doctors, nurses and other professionals can share photos of medical conditions, radiological images (X-rays, CTs, MRIs) and other clinical data streams (e.g. ECGs) for collaborative care and medical education.

If you imagine the future, Figure 1 has the opportunity to not only build the world’s largest medical imaging library, but the largest social network for healthcare professionals – pretty neat.

Getting back to the story, I was seeking Josh’s help on a few items, and was wondering if he wouldn’t mind making a few introductions to his network.

“Happy to do so,” said Josh, “But I hope you’re okay that I do a double opt-in.”

“What’s that?” I said.

He replied: “Well, I know you want the intro – but I don’t know if the other person wants it, and I want to be respectful of their time. I’ll flip them a note, and if they agree to the intro, I’ll know you’ve both opted-in and I can safely make the intro.”

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A few days ago someone asked me:

What did you do growing up to become an entrepreneur?

It’s a funny question because I certainly didn’t grow up planning to be a tech entrepreneur. But in retrospect, all I really did was build a lot of things, which eventually made me want to build a tech company.

I think that’s true for most entrepreneurs.

Being an entrepreneur is really just a never-ending cycle of building and learning.

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A few weeks ago I had the pleasure of participating in an Alumni Panel for this year’s Next 36 Selection Weekend. 

Together with fellow Next 36 / Next Founders alumni Jaclyn Ling, Michael Helander and Jessica Ching, we talked about our experiences in the program and building our companies (side note: they are all working on very interesting things, and worth checking out).

Near the end of the Q&A, one of the finalists asked:

What is the most important thing you learned from this experience?

Without hesitation, for me it was focus.

I have come to believe focus is incredibly important, not just for startups, but for pursuing anything meaningful in life.
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There is no question that the most important part of a startup is your team.

Your team determines your company culture, the market you tackle, and the product you build. Your team affects why customers choose to work with you, why investors fund you and why future employees will join you.

Put together the right team and magic will happen. Pick the wrong team, and it doesn’t matter how individually talented you are, it won’t work.

But not only is the team most important to the startup’s success, being part of a great team is the best part of working at a startup.

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People often ask who our competition is for SeamlessMD. Usually I rattle off a few companies and explain how we are different. And I do that because people are genuinely asking about other companies operating in the same space.

The truth is that our competition isn’t the other patient engagement and remote monitoring companies.

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Yesterday, the New York Time’s Editorial Board published a piece on the shortage of physicians in the United States and what’s needed for healthcare workforce redesign.

It’s a good, concise piece about the common thinking around the gap between the needs of our growing patient population and the number of doctors available to deliver the care they need. As as an example, the article refers to a recent statement by the Association of American Medical Colleges whose models predict a shortage of 90,000 doctors in the U.S. by 2020. In Canada, the story is sometimes different where physician unemployment is growing due to inadequate infrastructure and poor workforce planning.

While I do agree that ensuring access to care is important, to think that the solution is simply more doctors comes from framing the question incorrectly.

The question shouldn’t be “how many doctors do we need for a growing population?”. Rather, the question should be “how do we care for a growing population in a cost-effective way?”

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Working at Google, Facebook or Amazon today is a dream job for many. But that certainly was not the case their first year or two in existence when a startup’s future is very uncertain.

If you trace a startup’s employees in reverse timeline back to its founders, I suspect the closer you get to the startup’s origins and its early employees / founders, the more irrational those people appear to be.

In other words, the origins of a startup tend to attract people who are seemingly irrational.

What’s interesting is that being seemingly irrational is probably necessary for a startup to be massively successful.

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Last summer, I reached a fork in the road, where I had to decide between two paths. I had graduated from medical school and was accepted to a residency program. However, 6 months before that, I had co-founded a healthcare startup.

I had a few options. I could pick the startup or the residency. I could also have split my time 50/50. I ultimately decided to focus on the startup full-time.

There were a few reasons for this, but one of the most important ones was impact. Having spent the latter part of my medical training more interested in health system problems and quality improvement, the startup was an opportunity to achieve the impact I ultimately wanted in healthcare in a faster way. So I chose the startup.

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