Maneesh Juneja

15th FEbruary 2016: Startup of the week: 11Health

For this 'Startup of the week' post, I caught up with Michael Seres, founder of UK startup, 11Health. I've known Michael for a few years and it's fantastic to hear his story of patient led innovation. I hope we have many more stories like this in years to come. 

[Disclosure: I have no commercial ties with 11Health]

1. What is 11Health?
11Health is a connected medical device company. It’s goal is to digitise medical bags and our first product is the Ostom-i Alert Sensor that is a device that sits on the outside of any ostomy bag and connects via bluetooth to a free app. It allows patients to set multiple alarms to alert them as an when their bag is filling and therefore to help prevent the spills and better self manage. In addition it automatically captures the output data in real time and allows remote monitoring which is key in trying to prevent readmissions and complications. It now uses Apple ResearchKit to do real time studies about patient use and quality of life issues and is working with three US hospitals to integrate that data within the hospital EMP. 11Health with its Ostom-i app is also one of the first apps on the Apple Watch to be used for the management of a long term condition.

2. Could you explain the essence of 11Health, i.e its core values?
At its very heart it patient led innovation.  It was from a very personal perspective that 11Health was born. Understanding the unmet user needs was key. I wanted to build technology that solved a real problem and you can only do that if you truly understand the problem. So many health tech companies build amazing technology but don’t understand the end user. That would never happen in any other industry so why in healthcare.

We adopt the Stanford Medicine X Everyone Included model where every person associated with what we do has a say at every stage. The values are simple. Improve the quality of lives of patients and assist those who care for them. If we do that well then we will build a successful business. Everyone in the team has to buy in to that. It is about the end users at every stage.

3. What's the business model you're operating under?
So we are a B2B and B2C company. Initially we are working with the major hospitals to embed the device as part of the care pathway post surgery. In that regard we are working with places like Oxford and the Intestinal Transplant programme, Stanford, Cleveland Clinic, Mayo and Weil Cornell to name just a few. We are now working with over 30 major centres in the US and expect that to grow this year. Once the patient is discharged then the model reverts to focusing on the patient and the ongoing relationship with them. This is at the very heart of what we do. Work with the patients to help them in their daily lives. We are now looking to develop more of a social movement to get patients back to work and help us with our goal of helping as many people as we can. That is really the essence of the business model. If we help one person and one healthcare professional then the money will come.

4. Is there anyone else doing the same as you?
Not that I know of but i have no doubt someone will try. We are aware of many new developments to make bags easier to fit or accessories to make them look better or easier to replace but that is very different to what we are trying to achieve. We are coming at this from the position of how do we help patients improve the quality of their lives by getting back to all the things other people take for granted. In addition it is about generating the relevant data that will assist the healthcare teams to better remote manage. No one else is doing that at the moment in our sector of the market.

5. Was there one moment which compelled you to begin the journey of working on 11Health? 
It started after I became the 11th patient in the UK to undergo a rare intestinal transplant at The Churchill Hospital in Oxford. Five of the first ten had not survived so it was a big deal and on top of transplant I was given an ileostomy. This is where part of the intestine is brought to the outside of the body and your waste is collected in a bag known as an ostomy bag. Initially I turned to social media and the patients out there to see if there were existing solutions out there to help me. I contacted around 20,000 patients on various groups and forums to find out how they were coping with the issues I was having. Was there already a solution out there that i could buy? How did they do the sorts of things my healthcare team were asking of me such as measuring my output. Was there any other way of doing it other than emptying your own bodily waste in to a jug? There weren’t so I decided to build one. This never started out as a business. It started out as solving a problem that then grew in to 11Health.

6. What have reactions to 11Health been? Do different people perceive it differently?
Overwhelmingly the reactions have been positive. I have been so humbled by how people have taken to what we are trying to do. Sure our device is not for everyone and one or two say they don’t need technology but they are the minority. Surgeons like it because it is a simply and effective way to see how the bowel is functioning post surgery in real time. Nurses find that they no long have to measure output in a jug and walk down hospital wards and then manually enter information on fluid balance charts. Our technology does the data capture. For patients is it simply about trying to improve the quality of life.

7. Given that Silicon Valley is the world's innovation hub, it's inspiring to see a startup from the UK pushing boundaries. Do you see more ground breaking innovations in Digital Health coming from outside Silicon Valley?
To be honest i had never heard of the term Silicon Valley until i started this. Now i feel like a distant cousin able to dip my toe in but i would like to do more there. It is the mindset that is inspiring. The feedback is always that you can do it and you can figure things out and how far can this go. In the UK the mentality is far more conservative and in someways grounded. But scale up of innovation in the NHS is incredibly slow and very bureaucratic. My most recent interaction with the NHS over getting technology prescribed highlighted this. There is a lack of understanding as to how to use technology by those who make the actual on the ground decisions. They require long term studies all the time without being able to use data from other countries. That might be fine for drug companies but in technology it is not. I think it is inevitable to that more companies will come to the Valley. Unless we are able to turn the wonderful rhetoric in to actual on the ground deliverables in the UK then sadly your hand is forced. The UK has some amazing digital health tech. Some truly inspiring companies that can lead the way so i hope we can all come together and fly the flag for the UK. As one recent Silicon Valley VC said to me, why waste your time convincing the UK that it should happen when it is already happening here and in a market 10 times the size.

8.   What are the weaknesses of 11Health and what are you doing to address them?
Probably the fact that we have not done this before. Everything i do is new and every day is a new challenge. On a personal level that is amazing and provides huge opportunities but it is a weakness that we are trying to address now. We need to strengthen our board and senior management team. We need to surround ourselves with people who can help. I believe that my style of leadership is one of openness. I don’t like big hierarchies so i am very open to sharing ideas and solutions but we need the people around us. 

Then there is the stereotypical start up challenge of scale up. How quickly and in what way? That requires money and strategic thinking and I am in the middle of doing both now.

9. Two years from now, in 2018, what would success for 11Health look like? What are the barriers to success?
To have totally disrupted the medical bag market and digitise the market. Barriers right now are the hours in the day. We are growing quickly and with scale up comes the usual challenges all startups face.

10.  If people feel inspired by your journey, particularly other patients, and want to do something with technology to improve Global Health, what would your words of wisdom be?
If people get inspired by my journey then that would be amazing and incredibly humbling. My advice is simple. Go do it. Patients are the greatest under utilised resourced in healthcare. We understand the end user needs like no others so just be brave and do. I would like to create this global movement around Patients as Entrepreneurs. I hope that my very small company and the small things we have achieved so far can give belief to others. Just because you are a patient does not mean you don’t have other skills or cannot be as brilliant as someone who is well. We understand the unmet needs better than anyone and we understand the solutions better than anyone. So come and join me. I want to show healthcare that we can be the ones that truly change the healthcare landscape, we are just never asked. Oh and call me because i have made so many mistakes I would be happy to share!

Michael Seres and Ostom-i  are both on Twitter and click here for the 11Health website.