Posts from hacking healthcare

On Digital Healthcare

At USV, we are big believers in being public about our investment thesis and the work we do to arrive at them. We are also big believers in working with like minded VCs on our investments. A few years we decided to merge the two. My partners Albert and Andy started collaborating with Boris Wertz at Version Ventures on developing investment theses in the digital healthcare sector. They roped in two analysts, Zander and Angela and off they went. When Zander’s two year stint at USV ended, Jonathan replaced him on the effort.

For several years, this group has shared investment opportunities, research, and insights with each other. They have a shared database of startup companies and a shared market map. They have collaborated on one investment, Figure1, and thought seriously about a bunch more.

Yesterday, they started to share their learnings and, more importantly, their questions and concerns. It is called OnDigitalHealthCare and as it is currently conceived, it is a six part series on what they have learned and where they are going with all of those learnings. They are two parts into it right now.

I hope they don’t limit this to six parts and would love to see them continue to update this blog from time to time with additional learnings, questions, concerns, and insights. I think most everyone realizes that a computer in everyone’s pocket (and possibly elsewhere on their bodies) is going to massively impact healthcare over time. But how, when, and why is a lot less obvious to us, and I suspect everyone else. So we are trying to figure it out and sharing that process publicly in the belief that the more eyes and ears on our process the better outcomes for us and everyone else.


Last week I wrote the Dentist Office Software Story and the top comment on that post was this from LIAD:

….along comes Sevin Kystrom, he only cares about looking at photos of teeth. he unbundles photos from by creating a standalone app called teethagram. users love it. he sells it back to for $1bn

I kind of flipped out when I saw that comment because it describes our most recent investment, Figure1, which my partner Andy blogged about at yesterday. We had closed but had not yet announced the Figure1 investment when LIAD made that comment.

Figure1 is “instagram for doctors.” It’s not for dentists, as LIAD’s fictional company teethagram is, but other than that, and the sale for $1bn, the story is pretty much the same.

We have believed that simple, easy to use, photo centric apps on mobile have the potential to become very large businesses for a host of reasons. First and foremost, as Brian Watson taught me, photos are the atomic unit of mobile. It’s easier to snap a photo and post it/send it, than it is to do anything else, including write something. And, as the old adage explains, a picture tells a thousand words.

A doctor can say “I’ve got a patient with a very rapid A-fib” or she can send this to her colleagues:


There’s a hell of a lot more info in that EKG than a doctor could type into a text message or email.

But the even better thing is the conversations that instantly develop around these images, like this one:

I think it’s rapid a-fib. I think the ischemic changes are due to the rate. Give them some #Amiodarone and see what happens when the rate sloes down.

Instagram is a powerful product. And most people know how to use it and the value of the interactions around photos that it produces. Like our portfolio company Edmodo, which took the Facebook UI and applied it to teachers and students in K-12 education, Figure1 takes a popular and effective UI and applies it to an industry in desperate need of change.

I’m super excited about the value Figure1 provides to doctors and their patients and I am really pleased that the Figure1 team agreed to work with USV as they build their business.

iOS8, Health Data, and Open Data

News is leaking out of Apple that iOS8’s primary feature will be health and fitness data. Rumors are that there will be a new app called Healthbook that will track a plethora of health and fitness data that iPhones and related devices (iWatch?) will be able to collect on the person carrying the devices.

This is interesting to me on a number of levels. We have been looking at this sector for a while and one of the things that has kept us (USV) from making investments in this space is the sense that all of this data capture is soon going to happen in the phone itself.

Once that happens, things can change pretty rapidly. The key will be APIs. And my big question is whether Apple will give its users an open API to send their health and fitness data to third parties they authorize.

I can see a button that says “auth with Healthbook” in my doctor’s office, my gym’s mobile app, my health insurers’s web app, and a host of other places.

So to my mind, the big question is not what Healthbook will look like but whether Apple will make it easy to get our data out of it. If they do, this will be a massive game changer for the quantified self, health, and wellness markets.

Large Networks, Big Data, And Healthcare

Zander posted this NY Times opinion piece to yesterday and it's been rattling around in my head since then. The author suggests that big data is coming to health care and bringing with it many issues that will have to be resolved. I am sure that is so. But I also think the intersection of big data and health care and our large networks thesis is likely to produce some interesting investment opportunities for us and some valuable health care services for consumers.

Jason Karlawish, the author of the NY Times opinion piece, writes:

This is a revolutionary shift. Once upon a time, medicine was a discipline based on the nuanced diagnosis and treatment of sick patients. Now, Big Data, networked computers and a culture obsessed with knowing its numbers have moved medicine from the bedside to the desktop (or laptop). The art of medicine is becoming the science of an insurance actuary.

The question is who will control the input of the patient data, the aggregated data sets, and the results the data science produces. If the answer is the current healthcare system; the insurance companies, the hospitals, and the doctors, then we will have missed a big opportunity to reshape healthcare. If, on the other hand, the data is entered by patients, controlled by patients, and benefits patients, then we would have something new, different, and disruptive.

Large networks of patients coming together to do this data science together and benefit together feels like its around the corner and coming fast.  Maybe some enterprising entepreneur will take this "Omnibus Risk Calculator" put it into a clean and simple web service, allow us to connect our phones and connected devices to it, and peer produce a service that we can, together, use to manage our cardiovascular health. Maybe someone has already done that.