Medsider: Learn from Medtech and Healthtech Founders and CEOs - Bringing the ENT Clinic to the Community: Interview with Tympa Health CEO Dr. Krishan Ramdoo

Episode Date: August 30, 2023

In this episode of Medsider Radio, we sat down with Dr. Krishan Ramdoo, the CEO and creative mind behind the Tympa platform, an all-in-one ear and hearing health assessment system that has gained global recognition.Dr. Ramdoo is a celebrated international speaker, researcher, and educator with a keen focus on the intersection of medical science and technology. Some of the accolades Dr. Ramdoo and the Tympa team have received include the prestigious Royal Society of Medicine prize for innovation in ENT, the Rowena Ryan prize for research into ENT, and the Hartopp-Dixon ENT award.In this interview, he talks about his journey toward becoming a technology innovator, starting as an ENT physician to eventually developing the Tympa platform. Dr. Ramdoo shares invaluable insights on the importance of patient-centric problem-solving, balancing external feedback with personal vision, and the power of tangible products in converting stakeholders to true believers in your solution.Before we dive into the discussion, I wanted to mention a few things:If you’re into learning from proven medtech and health tech leaders and want to know when new content and interviews go live, head over to Medsider.com and sign up for our free newsletter. You’ll get access to gated articles, and lots of other interesting healthcare content.Second, if you want even more inside info from proven experts, think about a Medsider premium membership. We talk to experienced life science leaders about the nuts and bolts of running a business and bringing products to market.This is your place for valuable knowledge on specific topics like seed funding, prototyping, insurance reimbursement, and positioning a medtech startup for an exit.In addition to the entire back catalog of Medsider interviews over the past decade, premium members get a copy of every volume of Medsider Mentors at no additional cost. If you’re interested, go to medsider.com/subscribe to learn more.Lastly, here's a link to the full interview with Dr. Ramdoo if you prefer to read it.

Maybe be bold if you have that idea that you know you're getting pretty much unanimous positive feedback. You should take that jump and, you know, it's extremely, without a doubt, ups and downs, as every entrepreneur tells you. But it's definitely, you know, a rewarding journey. Welcome to Medsider, where you can learn from the brightest founders and CEOs in medical devices and health technology. Join tens of thousands of ambitious doers as we. unpack the insights, tactics, and secrets behind the most successful life science startups in the world. Now, here's your host, Scott Nelson.

Hey, everyone, it's Scott. In this MedSider interview, I sat down with Dr. Chris Ramdu, a celebrated international speaker, researcher, and educator with a keen focus on the intersection of medical science and technology. He is the CEO and creative mind behind the Tempa platform, an all-in-one ear-hearing health assessment system that has gained global recognition. Some of the accolades Dr. Ramdo and the Tampa team have received include the prestigious Royal Society of Medicine Prize for Innovation in E&T, as well as the Harttop Dixon E&T Award. Here are few of the key things that we discussed in this conversation. First, a problem-solving framework is integral to entrepreneurship.

Focus on a patient-centric issue where you can identify a clear gap with the existing technology stack. Second, seeking feedback is an important virtue across every function in a startup. However, you don't necessarily have to agree with all of the expectations. external input. Balancing feedback with your vision and understanding is vital to making better decisions. Third, your ultimate goal is to transform people into believers of your solution, whether they are investors or potential users. One of the best ways to do this is by providing them with something tangible. Showing rather than telling is a much more effective strategy for conversion. Before we jump into this episode, I wanted to let you know that we just released

the latest edition of MedSider Mentors, Volume 3, which summarizes the key learnings from the most popular Medsider interviews over the last several months with folks like Jim Persley, CEO of Hinge Health, Carol Burns, CEO of Cajent Vascular, and other leaders of some of the hottest startups of the space. Look, it's tough to listen or read every MedSider interview that comes out, even the best ones. But there are so many valuable lessons you can glean from the founders and CEOs that join our program. So that's why we decided to create Medsider mentors. It's the easiest way for you to learn from the world's best medical device and health technology entrepreneurs in one central place. If you're interested in

learning more, head over to medsiderradio.com forward slash mentors. Premium members get free access to all past and future volumes. If you're not a premium member yet, you should definitely consider signing up. In addition to every volume of Medsider mentors, you'll get full access to the entire library of interviews dating back to 2010. This includes conversations with experts like Nadine Yared, CEO of CVRX, Renee Ryan, CEO of Cala Health, and so many others. Learn more by visiting MedsiderRadio.com forward slash mentors. All right, Chris, welcome to Medsider. Really appreciate you coming on, man.

Thanks very much, Scott. Pleasures to be here. Thanks for having me. Yeah, yeah. Really looking forward to learning a little bit more about your background, sort of the origin stories of Tempa, because you guys are kind of off to the races

and doing some cool things in the E&T space. So with that said, I recorded a very kind of short bio on your background at the outset of this interview. But let's start there. If you can kind of give us a little bit more, more of an overview of your professional background before starting the company that'd be helpful. Yeah. So by training, I'm a clinical doctor. So I was an E&T surgeon, so in as a vocation surgeon, practicing in our national health service over here in the UK for about 12 and

half, 13 years. And in that time, I also did a higher degree of PhD in ear and hearing health. and it was kind of throughout that clinical journey where I guess where the origins of Timber Health came about. You know, I've seen multiple patients who were coming in to see me waiting weeks on end and using a non-digital pathway. And I use that experience to really found Temple Health. So coming really from a clinical background, so then obviously found Timber Health.

And just over three years ago, I was still a full-time doctor. and now we've kind of grown and scaled a timber health from there. Okay, cool. Awesome. Give us a sense for the technology that you're working on. And maybe you touched on this already, but a little bit of the Orton story, right? Like what was the sort of the aha moment that really kind of, you know,

where you were like, I think this is something that I should develop more time to. As I said, I had a, you know, quite a longstanding clinical career. And, you know, really, if there were probably two aha moments, I think that happened. and one I think was very early in my clinical career. I think I was a junior doctor, so been in practice for about a year, year and a half. And I had always thought at medical school that, you know, I definitely wanted to be a medic, but certainly maybe think outside the box. And my first stint was in that early stage, was in an ear-nose and throat department.

And I went from there to then actually do a stint in geriatric ward. And so I had this lady who came in and she came in and she was 79 and she was admitted to our geriatric ward for an infection. And she was treated for that infection. But what was interesting and me being the most junior member of the team, I could see she was still confused. She wasn't very engaged with her family. And so being a budding E&T surgeon, I said, well, let me go and have a look in her ears. Looked in her ears and it was actually full of wax. and so I thought, well, okay, this is impacting on a hearing.

So let me wheel her down to the department myself. So wield her down to her E&T department, remove the wax and did a hearing test. And that hearing test showed that she had age-related hearing loss. And so fitted her with a hearing aid, followed her up six months later, and she was a completely different lady. She was planning her 80th birthday. She was engaged with her family. And, you know, for me, that was that first instant that was like, okay, well, this real simple intervention has made such a big impact on that lady. But as you kind of go through your

clinical career, you got to jump through a number of hoops and you want to kind of reach the pinnacle of, you know, your training. But in that journey, I kept seeing multiple patients coming in to see me, as I said earlier, like waiting weeks on NTC a specialist. And I was looking at the equipment I was using. I was seeing the workforce that I had with me who were available to wanted to do more, could do more, and looked at this whole journey saying it wasn't very digital. And so, well, how can I solve for this? And that's kind of where the second aha moment was said, well, there isn't anything in the world that has this. And so created this hardware, software solution that takes the whole ear and hearing clinic out of the specialist environment into

community settings, upskills the workforce like allied health professionals, nurses, nurse practitioners, and makes it a digital journey. So there were lots of those factors that played into that, but that in a very condensed, maybe 12 and a half kind of percolating years, kind of came to kind of the origins of Timpa. Got it. That's cool. And I'm looking at the site and riot. It's your website now. It's Tempa Health for everyone listening. T-Y-M-P-A health, Tempa Health. And we'll link to it in the full write-up on MedSiter.

Great website, by the way. But it's in essence sort of like, think of it like, is it best to think of it. This is like almost like a kiosk a little bit, right? where if this is in a local community, I could very easily, as a patient, if I maybe suspect that I've got some hearing-related issues, I could go use the Tempa platform and get access, basically, to, you know, sort of an evaluation that much faster than sort of waiting to schedule appointment, et cetera. Got it. It makes much more accessible to patients to, you know, on average, it takes someone

about 12 to 16 weeks to kind of access care to reach the right person. But also, if someone has an ear and hearing issue, the research suggested, takes them five to seven years to do something about it. So making it much more accessible in your primary care setting, in your community pharmacy, it can allow, like you said, to have a quick, fast assessment to say, actually, Scott, you haven't got anything wrong in your hearing, or actually, Scott, we picked something up here from a diagnostic perspective, we advise you should go and see E&T, or, you know what, the hearing probably you had was just simple wax, let's go out there and then.

So much more accessible, much more efficient and equally gives a digital. record and I always liken it to your eye examination so everyone is used to going getting your eyes tested have someone your optometrists making assessments you know we should really be doing the same thing with your ears as well you know ears are just as important obviously your eyes and you know it's such a big issue like some of the things which maybe are unknown which is you know this is a great path to talk about is hearing loss by 2030 it's going to overtake diabetes and cataracts in the top 10 disease burdens because of the

aging population we all walk around with like you've got headphones in at the moment but hours on end where the ears actually built for that affects everybody and equally hearing loss is the single biggest modifiable risk factor for prevention of dementia um interesting and we all have parents, probably people simply let people that we know that have a hearing issue. So I think making it more accessible is really at the core of what we want to try and achieve. Yeah. Wow. That's amazing. I had no idea that the prevalence was accelerating that rapidly. And you bring up a good point, right? You're calling me out with the headphones in my ear. But like that is a significant change, right, versus, you know, five to ten years ago where nearly

everyone on the street is walking around with AirPods, right? In their ears or. Yeah. And the ears were they weren't naturally built for that. It's like, you know, when they talk, again, looking at that, when you were growing up, like my mum used to say, don't sit too close to the TV because it's going to stain your eyes. It's a similar analogy. You've got hours. And really, I think it's one of those things that what we really truly believe we can do at Timperis, with the assessments that we do, is that actually, if Scott, like you had normal hearing at year one,

when you had an assessment at year five, if we saw it. deterioration, is there something that we could have picked up earlier to say, actually, you should have an intervention done now to prevent some of those downstream issues? Yeah, I could see the value in having sort of that historical record sort of captured, right, over time for sure. Chris, give us a sense for kind of where the company's at in terms of, you know, development, regulatory commercialization. Because I think based on my notes, it looks like you started out, you know, commercializing in Europe, which probably makes the most sense, right? But give us a high level take on where you're out with those phases.

So we are definitely. So in the in the UK, we've been pretty successful. We've had in the last two and a half years, the solution has been used on more than 250,000 patients. We see in the UK just under 30,000 patients a month go through a timber journey. And, you know, what that's enabled us to do is, you know, in the sectors we're in, we're, you know, in multiple sectors. So three of the top five high street audiology practices users here in the UK. One sector has really accelerated is a community pharmacy where, and obviously I understand the landscape is different between the UK and the US, but more than 100 different community pharmacy chains use this product.

Walgreens in the UK probably being the biggest. We're in 300 of their stores. We're in opticians. We're in residential homes, so retirement villages. With all of that, what's happened is that we've built this validation proof points that over here we have the National Health Service, which is our biggest provider of services in the public system provider. And now because of that evidence based regenerated, they've commissioned us into areas of the

country so that people don't have to pay for the service, but actually it can be delivered as part of our public system, which is similar to your value-based care model. And, you know, really in the UK we're being seen as kind of the gold standard, I guess, of assessments in the community because of the digital platform that overlays, which allows a specialist to give advice and guidance remotely. So from that perspective, we've commercialised really well in the UK, and we've actually really only scratched the surface. From a regulatory standpoint, you know, we sit as a class one medical device. And with that in the US, we're FDA registered 510K exempt. So we still sit in that ballpark because of the assessment that it does. I think over time, because of the database of patients that we've seen

and the data that we're obviously building in machine learning record into that. So we sit on what I say pretty confidently is the world's largest bank of ear and hearing healthcare images and videos. Obviously, we don't have the identifiable patient information, but what we do have is these images and videos, but of history related to that patient as well as the hearing tests, and looking at that over time can provide some real insights. AI is an extremely hot topic,

but we already have an algorithm which will tell you is that eardrum, normal, abnormal, poor quality, or is it wax? And we'll start to go to condition analysis from a regulatory point that will then move into a medical device in its own right. We're kind of at that junction now where we know that we've got a proven model, a use case and product market fit here in the UK, we're actually launching in the US. And we already have boots on the ground in the US, and we've got two big pilots underway as well. So our next market to come and commercializing

is in the US. Got it, got it. So you'll push forward, you mentioned you're kind of just, from your perspective, just barely scratching the surface in the UK. So you'll push forward with various commercialization efforts there while also launching, you know, continuing moving forward to launch here in the U.S. Okay, cool. And for everyone listening, that's, you know, if you're, if you're kind of consuming this after the fact, we're recording this in, uh, in Q3 of 2020, just to kind of set the, give everyone a, kind of an idea of kind of, uh, the time frame here. Um, and Chris, I didn't, I didn't mention it, or I didn't, uh, we didn't talk, talk about this when you're talking about the history of

Tempa, but you started, it looks like I'm looking at your LinkedIn profile, which we're linked to in the, um, write up for meds on, on Medsider, but is it, you started working on this, the fall of 17 then? Yeah, I think it's actually, I would probably say a little bit later than that, but what you have to do, like when you have this idea, probably similar to in the US, but you have to set, you have to put up a shell entity in the company's house, we call it, where you have to shut up to shell entity that was a company. But actually, as I said, you know, I was still practicing as a doctor just over three years ago. Okay. So I was trying, I was at a moment in time when I was full-time doctor trying to finish writing my PhD. I think my second child was at born and I was like, there's so many spinning plates here.

Officially, I guess, three and a bit years ago, fully focused, probably three and a half years ago, fully focused on temper. And with anything in life, I think you can't do too many things at one point. I think when you focus your mind, that actually that has really allowed us to scale and obviously grow at the pace that we have grown. But yeah, I guess officially, yeah, the company Shell was there, but nothing was, well, things were happening. not at a scale.

Got it, got it. And you've been sort of like, you know, solely focused on, on Tempa versus practicing for about three and a half years or so, something like that. Got it, got it. Okay. I think one of those things you want to make sure you do one thing really well. Yeah. Yeah, I think at that moment it's the right thing to do.

Yeah. Cool. By the way, this is a total side note, but you mentioned company house or is that what it was I had just heard about this. Was it earlier this week or last week? I was listening to another podcast and they were talking about. it's a startup-oriented podcast kind of for general

in general business category and they referenced this private company I think that's based in Scotland but does like an incredible amount they're private but they do like it's an incredible business they just crank on revenue and it's extremely profitable

and they were like they got all this data from company house I was like I had no idea that this was even even a thing you know in England you can look up any company yeah company's house and it has

And you have to report your financials. Yeah, yeah, I had no idea. I was like, wow, that's amazing. All right, cool. Let's sort of step inside the MedSider time machine, as I like to call it, for the next maybe 20 minutes or so, and learn a little bit more about sort of the evolution of Tempa and kind of what you've learned along the way,

kind of going from, you know, clinician, academic-ish, right, with your PhD into, you know, the business world running a startup. So with that said, let's take us back to the very early days of Tempa, right? Like maybe call it 2000. 18-ish time frame. It's probably when you're working on the first iterations of your platform. When you think about that process, going kind of from pre-alpha to alpha, maybe to the early beta kind of designs, I'm sure you probably iterated quite a bit on what the product looked like, what it did, how it functioned, et cetera. Are there other couple things that, you know,

when you think back to that time that were really impactful, instrumental, things that you did right, things that you wish maybe you did differently, maybe frame that up for maybe other entrepreneurs that are kind of in that same spot with their startup. Yeah, and I think, yeah, at that early moment in time, I think what I spent a lot of time thinking about was, you know, it was the product itself. And I was like, well, what are, you know, with anything innovative, you've got to kind of change the mindset of how things are currently being done.

And so I had this, you know, in my mind, I was like, how do you, how am I going to get a procedure or part of a service, which I am doing, years of training, to actually get it to a point where I'm going to get someone else who we train up appropriately to do part of that. And then I see the things that I should be seeing, like, for example, in my scenario, patients I'm going to operate on.

And so I spent the first half kind of really understanding that as the problem, because obviously people will always talk about the problem and it can be in different facets of like, what is your total addressable market. And, you know, that you use a lot for funding. But for me, it was like, if you develop something, How is it actually going to solve a real world issue? And so from a product perspective, I said, well, can I kind of make this a bit more generic?

But I was thinking, okay, the problem is, okay, people have a problem with hearing. How do you assess someone's hearing? You need to look in the ear. How can you look in the ear properly? If there's something in the way, like wax or infection, then you can't examine the ear. And you can't do a hearing test if you haven't got a clean ear. So I was like, well, how do you, that's, that's, that's the process. So then my, I broke that down and said, well, the big issue here is like that bit in the

middle of like, how can you examine the ear properly? And I went way back in time. And obviously the, in my, when I was writing my PhD, my first chapter was like the evolution of the otoscope, which was how you, the device was you used to examine the ear. And it hadn't actually changed since the 13th century. and what I did was like well how can you do some intervention with that and then the first iteration was very simply how do you look in the ear and if there's something in the way how do you remove it and so what I went about was in my own hospital had there was like a innovation prize that you could win so I applied for that and I think

it was something like £5,000 to get a very basic so I won that but then had a very basic proof of concept which then you could talk to people and say and with any kind of pitching, if you've got something tangible to show, it just helps people understand it. And I think that continued to happen as we've developed the product, showing it live. So I really focused on the product and kept my head down to think, and just really went for feedback from colleagues of what they thought it would do. And some colleagues are about, what is this? This is, you know, like you're never going to do anything with this.

But others who've got it saying, well, okay, I understand where you're going. And I think it's trying to find those people who, because whenever you go and pitch an idea, there's always going to be people who will be like, you know, not in that same mindset of you're going to try and change the way things are delivered. But the ones that are, they can become really, really valuable to you. And I think I had a group of colleagues who really supported me in my hospital at the beginning that helped me evolve that idea and thought. And really for the first 12 to 18 months, didn't care about making any noise about where, in stealth mode, going to come out, and it was just get our heads down on product. And I think once I had that first iteration, I then went out and got some grant money,

again, small amounts to help evolve, to make it look like something a bit more tangible. And then following that, then obviously went to kind of raise the first bit of money. Got it. The point that you made about sort of not letting sort of the detractors sort of become too big of a hurdle or a stumbling block, that can be, you know, sort of a, as you probably know, kind of a careful balance, right, between using that feedback to help you gauge whether or not this is even worth working on, right? Because you're obviously a busy, successful clinician and, you know, it's going to, you're carving out time, right, to work on this project. And if it just doesn't have legs or there's nothing there, then, you know, might be a kind of a foolish endeavor,

versus this problem that you're trying to solve that you know is real, right? But you can't, you know, you've got a sort of, you've got sort of a cohort of people that are saying, yeah, this is actually a really good idea. Any, any thoughts or how to balance kind of those two worlds. Well, I think if you were in the camp where everyone said it was, and you've got to choose the right people that you want people who are going to be super honest with you. There's no point in having people who are going to, you know,

you're just going to say, yeah, yeah, it's a great idea. And I think when you, if it was in the camp where everyone was like, no, this isn't worthwhile, then obviously you have to really check yourself and think, okay, this is not, this is not where we should go. But I think for me, looking back, you know, the majority, could understand and see where this could go. And if I really broke it down, and this happens in any innovation as well,

or changing the way things are done, some of the naysayers were probably more worried about, is this going to take away business on them? If you're going to give it to someone else, what am I losing? And in the fullness of time, what has been shown is that actually the patients then end up in an EMTs department

are the ones which, in particular in the US and in the UK, ones which they can do much more fruitful surgery on that are needed to be there. Rather than the simple cases, do the cases that you're trained for the need and operation. And equally, if people were financially driven, those are the cases which you're going to build for more. If you were scratching beneath the surface,

maybe that was the naysayers saying, oh, you're going to take these patients, which are my bread and butter. But now, in the fullness of time, it's actually been better for the system. And ultimately, for me, it was always, what's better for the patient? Go and see a specialist. When you need to see a patient specialist,

you don't need to see a specialist for, you know, some of the more simple cases. Yeah. Hearing you described that, it kind of reminds me of people that are afraid of AI, right? And what it may do to, you know, either take their job away, etc. But I think most people that have a healthy view of AI at this point, almost see it as a productivity tool, right? Like, I can 5x, 10x, my production or my, you know,

and become that much more efficient. And I think you bring up a really good point around, like, if you've got a group of people that are the naysayers, right, or the detractors, and maybe even they're, otherwise, you would respect their feedback, could have understanding the why, right? Why are they giving you this type of feedback? Is it, you know, understanding kind of the incentives or the motivation?

And is it, is it feedback that is specific to your product? Or is there more, is there more something else there, right? That they're more, maybe more fearful of or, you know, there are other, you know, reasons that are, that are, you know, some of those naysetsets. And obviously they were friends and colleagues. So they weren't naysayers for the sake of it. They're trying to give use of feedback.

Yeah. Now, full circle, they're like, Chris, this was definitely the right thing. Yeah. Yeah. I think, I mean, it's, it's, this topic is so crucial, right? Because like any, almost any successful kind of venture, you're going to be up against these, you know, this type of feedback early on, you know? And in some, in some, some, some sense.

is it may be, you know, the product may not be worth working on. But in a lot of cases, if it's a, if it's, you know, if you're solving for a real need, right, that ultimately is going to help a patient, right, in a number of different, you know, factors, it's probably worth working on, right? So, um, hey there, it's Scott. And thanks for listening in so far. The rest of this conversation is only available via our private podcast for MedSider Premium members. If you're not a premium member yet, you should definitely consider signing up. You'll get full access to the entire library of interviews, dating back to 2010.

This includes conversations with experts like Renee Ryan, CEO of Cala Health, Nadine Miarid, CEO of CVRX, and so many others. As a premium member, you'll get to join live interviews with these incredible medical device and health technology entrepreneurs. In addition, you'll get a copy of every volume of MedSider mentors at no additional cost. To learn more, head over to MedsiderRadio.com forward slash premium. Again, that's MedsiderRadio.com forward slash premium. Thank you.