When Sid Satish saw his first surgery he was struck by the contrast between the advanced technologies in use side by side with ancient practices such as the negotiation over how much patient blood has been lost. He saw an opportunity to apply technology to create an informed calculation of blood loss. This was in 2011, now this technology runs on iPad Pros and is in use at 30 hospitals.
Here are some highlights from this eye-opening interview:
- Siddarth Satish’s Bio
- Got Hooked on Entrepreneurship from Business Plan Competitions at UC Berkeley
- Gauss’ Device & Software Scans the Operating Room to Estimate Blood Loss – Too Cool! n[The Product Is Called Triton and Has Been Adopted at 30 Hospitals and Used on 100,000 patients Already]
- How Gauss Got Started
- “…we've had a few of our health systems study the delivery of the system and find that it has clinically impacted blood transfusions, made them more efficient, it has led to a significant increase in the recognition of hemorrhage, which is the problem we're trying to solve….by almost 400 percent.”
- “When you're trying to change an entire field and trying to change the way that medicine is ultimately practiced with a completely new perspective, it takes re-imagination both on the technical front, but also on the clinical front, on the customer-facing front.”
Transcript of Siddarth Satish on Angel Invest Boston Podcast
GUEST: Siddarth Satish, CEO & Co-Founder of Gauss Surgical
Interviewed at TEDMED 2017
SAL DAHER: Hi, this is Sal Daher of the Angel Invest Boston Podcast. If you've been listening, you might have noticed that I love being an angel investor in Boston. The reason for this is that there's so much going on in the startup space here in Boston. Practical founders working with leading inventors, venture capitalists, angel investors, patent attorneys, a really exciting scene.
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Welcome to Angel Invest Boston. Conversations with angels and founders. Usually angels and founders in the Boston area, the Boston ecosystem, but today we have the privilege to sit down with Siddarth Satish, founder and CEO of Gauss.
SIDDARTH SATISH: Thank you.
SAL DAHER: Welcome, Sid it's really great that you made time to be here.
SIDDARTH SATISH: Happy to.
SAL DAHER: You're a young CEO, very busy at this conference, here, by the way, for the audience to know is the very exciting TEDMED 2017 conference in Palm Springs California. A gorgeous place and this is an amazing conference, and Sid's company Gauss, is participating in what they call The Hive and these are a group of startups that TEDMED sort of incorporates into the conference so that the founders can have a chance to interact and so forth.
Sid has agreed to take some of this very precious time and be with us. Welcome.
SIDDARTH SATISH: Thank you.
SAL DAHER: As a service to young people who are starting out trying to find their direction in life, or to older people who are changing the direction they're going in, please tell us the story of how you go to be Sid.
Siddarth Satish’s Bio
SIDDARTH SATISH: Sure, happy to do that. I was born in India, immigrated to the US when I was seven. Ironically my father was working at a startup company in Cambridge at the time, so I guess you could say I landed at Logan and we went out to the West Coast within the year, so I grew up in California. Was raised by two very passionate engineers, both my parents. Naturally ended up gravitating towards being an engineer, and in college had the chance to study chemical engineering. What really intrigued me about engineering was the mindset, the way of thinking very analytically and critically and mathematically, and I ended up taking a lot of those mindsets into what I ultimately ended up doing, which somewhat overlapped with engineering, but certainly uses those same facets in business. And so, had a great opportunity to be mentored by a lot of amazing professors and colleagues.
SAL DAHER: Now this is where?
SIDDARTH SATISH: Attend University of California Berkeley.
SAL DAHER: Okay, UC Berkeley.
SIDDARTH SATISH: For undergrad.
SAL DAHER: Undergrad.
SIDDARTH SATISH: And then I stayed on with the UCSF, UC Berkeley joint graduate group in bioengineering, got to a Masters in bioengineering.
SAL DAHER: That's excellent.
Got Hooked on Entrepreneurship from Business Plan Competitions at UC Berkeley
SIDDARTH SATISH: And what sort of happened during college was a few buddies and I started to participate, just for fun, in these little venture capital case competitions and business plan competitions and we had had a couple of ideas that we had worked on in our classes and we ended up getting pretty far along in some of these competitions where you come out with a business concept and you start talking about where and how you can commercialize a scientific idea and that really, I would say, whetted my appetite if you will to do translational work. So the idea that you can take some truly from bench to bedside, and I guess you could say I spent a lot of time working on very technical research and undergrad, published a few papers, very sort of theoretical mathematics-heavy stuff, but what really intrigued me about these case competitions was that here a number of folks that are taking things they've come up with in a lab and very quickly thinking about the commercial pathways so that they can start impacting people and patients.
SAL DAHER: Yes.
SIDDARTH SATISH: And so that sort of framed the preconditions for what got me very interested in what I'm doing today, which is working on a medical device company, medical technology that leverages software and mobile devices to help improve patient care.
Gauss’ Device & Software Scans the Operating Room to Estimate Blood Loss – Too Cool!
[The Product Is Called Triton and Has Been Adopted at 30 Hospitals and Used on 100,000 patients Already]
SAL DAHER: Just too cool. I saw an exhibition of Gauss, the device that you have, which is just astonishing what it does is it keeps track of how much blood there is on sponges and on gauze and so forth in the operating room. It's is tablet and you show a rag that has some dye that looks like blood on it and it can tell you how much it is. This is a remarkable thing. I had a demonstration of it.
SIDDARTH SATISH: Okay.
SAL DAHER: So please tell me the founding story of Gauss.
SIDDARTH SATISH: Sure.
SAL DAHER: How did it come about?
How Gauss Got Started
SIDDARTH SATISH: Yeah, so it was part of some of my graduate work, I was working on some things around robotic surgery ultimately. I had the privilege of actually watching surgery for the first time. So here I am, I've never seen surgery before, never really done anything clinical, and I was watching everything, blood and the guts, and for the very first time, what really struck me being in an operating room for the first time was the sort of duality of what's happening there. On one hand, you have very advanced medical technologies, both therapeutic and diagnostic systems, you have surgical robotics, on the other hand, there are several things in medicine that are truly still being done the same way they were 30 years ago, 100 years ago since the dawn of modern medicine, and a lot of those things have to do with the workflow around the actual surgery.
SAL DAHER: Yeah, yes.
SIDDARTH SATISH: So, we started to ask a number of questions. We were following these two really great urologists around at Stanford in the operating rooms and we asked a lot of questions around well how do you keep track of all these instruments? How do you keep track of the sponges and the gauze? Its turns out there's a big patient safety issue around tracking sponges and counting sponges in surgery because we tend to leave sponges behind in some instances, it's what's known as a never event. Something that should never happen and it's non-reimbursable. It's a medical error that should be avoided at all costs.
SAL DAHER: Right.
SIDDARTH SATISH: But along those lines, we started to ask a number of other questions around the workflow and something that kind of was an adjacency was you have all this blood being collected on sponges, and in the canisters, and on the other hand you have surgeons and anesthesiologists kind of negotiating with each other towards the end of a procedure what the blood loss was, and they're do so to document it in the medical record, which they have to, but they're also using this gestalt or this negotiation to frame the question of whether or not, and if so, how much blood to actually transfuse the patient. And so here we have advanced medical technologies: monitors, therapeutics on one hand, and on the other hand there's complete guess work. How much blood a patient has lost and how to then treat that bleeding.
SAL DAHER: Right.
SIDDARTH SATISH: So, we dug deeper into that problem. It was started as a naive question and as the more and more physicians and blood bankers and nurses that we spoke with, it became increasingly clear this was an unmet medical need, something that a lot of folks had not realize was such a big problem. So that sort of lead to the genesis of the concept. I had my iPhone out, I was taking photos of the surgical instruments and the sponges because I was probably interested in the workflow. I started to realize that there was likely a technical way to solve this issue around bleeding.
So, we very fortunate to get a spot as EIRs in an accelerator called StartX. It's the Stanford accelerator. It was literally a couple of folks-
SAL DAHER: Which accelerator?
SIDDARTH SATISH: StartX.
SAL DAHER: StartX.
SIDDARTH SATISH: Yup. StartX, it was hosted out of a little incubator space in the AOL building in Palo Alto. I ended up partnering up with a mentor of mine from the biodesign program at Stanford, and we ended up starting this company around the idea that you could actually use mobile devices as medical devices in surgery to help solve some of these issues. The first issue we gravitated towards was what I had clinically observed, which is that blood loss is being visually estimated, it has been so since the dawn of medicine, it drives very imprecise transfusion decision making. It also can, as we've now recognized, lead to a delay in the recognition of post-partum hemorrhage, which has turned into a national patient safety issue.
SAL DAHER: That is a huge thing. That is tremendous. Now where is Gauss today? What kind of traction do you have?
SIDDARTH SATISH: So, upon founding the company, we realized that we had come up with an idea that was really an app on an iPad on one hand, but was also now a medical device, and so we really wrestled with the question of how best to develop the medical device and how best to take it through a regulatory pathway that made sense for what we were trying to do. So we ended up spending the next, I'd say four to five years developing that pathway very carefully and so we first received a couple of FDA clearances. The idea of using an iPad in an operating room as a sponge counting system, and then we developed this computer vision algorithm that basically processes the images of the sponges and can then tell you what the hemoglobin content is on the sponges simply by looking at the images, it turns out that that was a much more complex pathway. We went through what's known as the de novo pathway. It's for medical devices that aren't the highest risk levels, but at the same time, do not have a pre-existing predicate device.
SAL DAHER: Right, right, right.
“…we've had a few of our health systems study the delivery of the system and find that it has clinically impacted blood transfusions, made them more efficient, it has led to a significant increase in the recognition of hemorrhage, which is the problem we're trying to solve….by almost 400 percent.”
SIDDARTH SATISH: Where you can show substantial equivalents and so we ended up working very collaboratively with the agency over the next few years to really figure out what the special controls were around this type of a device and we ended up creating a new classification of medical device that sort of fit this external image processing system for blood loss. So as of 2016 and more recently we've done a few follow on submissions and evolved the product over time. We started to receive the strong signals from the FDA and we receive clearance on the technology. So as of today, the technology is FDA cleared, we have a device for the sponges, we have a device for the suction canisters, and what we're now doing is leading our commercial adoption phase of the company. So we've been fortunate to run a few pilots over the past year that have now evolved into 20 health systems that have adopted the system. We are performing, we just surpassed 500 cases per week on an ongoing basis, so about 25,000 patients a year, and we're seeing some very interesting outcomes data as a result of adoption of this technology, we've had a few of our health systems study the delivery of the system and find that it has clinically impacted blood transfusions, made them more efficient, it has led to a significant increase in the recognition of hemorrhage, which is the problem we're trying to solve.
SAL DAHER: Yeah.
SIDDARTH SATISH: By almost 400%, and we're finding that there are then some downstream impacts in terms of quality and safety, and we're finding that patients are able to be more efficiently triaged to the right level of care and that they're being discharged after a delivery for instance, much more quickly than they would have if we were still guesstimating their blood loss and dealing with an unrecognized hemorrhage.
SAL DAHER: Excellent. So when was that date that you were in that first surgery that you observed?
SIDDARTH SATISH: So that was early 2011.
SAL DAHER: So early 2011, so when did you have the first prototype up and running?
SIDDARTH SATISH: I'd say by late 2011 to mid-2012 is really when we had an iPad with a first app.
SAL DAHER: And GPUs were, at that time, becoming cheaper and more powerful and so forth, so it's driving the technology as well?
SIDDARTH SATISH: Well what was interesting there is so the technologies a series of computer vision and machine learning algorithms.
SAL DAHER: GPU graphic processing units.
SIDDARTH SATISH: Right, right, and what we initially did was use the iPad simply as a user interface. We ran all of the algorithms on a server, and we've actually kept that up until very recently when we've now moved to our second-generation product, it's now running on an iPad Pro, it has an infrared sensor built in. What we're now doing is processing all the images one board the iPad.
SAL DAHER: Excellent, and so how much money have you raised so far?
SIDDARTH SATISH: So, we have raised about 25 million in venture capital.
SAL DAHER: Wow. So with a series, a seed on the series A.
SIDDARTH SATISH: We've done a series B.
SAL DAHER: A series B already.
SAL DAHER: Okay, okay, excellent, excellent. Very good. So, Sid as we're wrapping up this interview, sadly a short one because of time constraints, if there's anything that I haven't touched on that you'd like to emphasize or to bring up, please do so now.
SIDDARTH SATISH: As a technical founder, what I would say to other fellow technical founders out there, whether in academia or outside of academia that are thinking about starting something new, my experience has been that the technical phase of development in the company was incredibly interesting and exciting, but I would emphasize that the process of actually now taking that technology commercial has been, I would say, even more interesting to me personally.
SAL DAHER: Interesting, very good.
SIDDARTH SATISH: And I would encourage everyone to really think about the importance of that phase their business. There are a lot of cost effectiveness concerns in the healthcare system.
SAL DAHER: Yes, yes.
“When you're trying to change an entire field and trying to change the way that medicine is ultimately practiced with a completely new perspective, it takes re-imagination both on the technical front, but also on the clinical front, on the customer-facing front.”
SIDDARTH SATISH: Naturally, and when developing the technology, you really have to think through that. You have to think forward and understand what the adoption climate is likely gonna look like when developing your solution. When you're trying to change an entire field and trying to change the way that medicine is ultimately practiced with a completely new perspective, it takes re-imagination both on the technical front, but also on the clinical front, on the customer-facing front.
SAL DAHER: Yes. Extremely valuable. I think it's consonant with, I remember Professor Ed Roberts of the Sloan school, he's a entrepreneurship specialist there and he, if likes to say, innovation equal invention times commercialization.
SIDDARTH SATISH: Right.
SAL DAHER: Tremendous.
SIDDARTH SATISH: Couldn't be better said.
SAL DAHER: Yes.
Sid Satish of Gauss, CEO and founder. I'm very grateful that you could be here with us on the Angel Invest Boston Podcast as we record at the TEDMED 2017 conference in Palm Springs California. Thanks for making time to be with us.
SIDDARTH SATISH: Likewise. Thanks so much.
SAL DAHER: This is Angel Invest Boston, I'm Sal Daher.
I'm glad you were able to join us. Our engineer is Raul Rosa, our theme was composed by John McKusick. Our graphic design is by Katherine Woodman-Maynard. Our host is coached by Grace Daher.