Entrepreneur RX_Ayushi Patel: Audio automatically transcribed by Sonix

Entrepreneur RX_Ayushi Patel: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

John Shufeldt:
Hello everybody, and welcome to another edition of Entrepreneur Rx, where we help healthcare professionals own their future.

John Shufeldt:
Hello everybody! Welcome to another edition of Entrepreneur Rx, where we dissect and get into the how and why these entrepreneurs are so successful. Today I'm really excited to have with me Ayushi Patel. Ayushi is a very remarkable CEO and basically founder of a company called CenSyn, and it's a company that will talk a lot about. Ayushi, welcome.

Aysuhi Patel:
Well, thank you so much, John. I know before we begin, I have to say something. Last couple of months, I got a chance to check out multiple of your podcasts with guests, and I have to say, wow, so much knowledge backed between you and your guests. So what a great listen, thanks for doing this.

John Shufeldt:
Well, thanks for being on. You know, it's funny, I, clearly not the best podcaster in the world, but every time I stop, I am so enthused about what folks are doing out there because they're always bending the curve and it's pretty cool to see.

Aysuhi Patel:
Thank you, and I think there's something about healthcare, right, where we see that people pushing the paradigm, bringing access to more and more patients is just something that gets you excited about and got us excited and made us start CenSyn.

John Shufeldt:
Excellent. All right, so CenSyn, it's C E N S Y N.

Aysuhi Patel:
Yes, CenSyn.

John Shufeldt:
CenSyn, got it. Okay, that's what I thought. Okay, perfect. So you should talk to us a little about your background. Like, how did you I mean, you're obviously a significantly younger than I am, and you've done an incredible thing so far. So give us your background, how did you get where you are today?

Aysuhi Patel:
Yeah, if I were to say one line of, just one high level of what has helped me and CenSyn and grow so much is my team, and hopefully, through this whole podcast we can talk a bit more about it, but my personal background is I was born in India, raised in India, very early on, got to see the disparity in the healthcare access depending on your geographical location, your financial resources. So it was something that really stuck with me. And as I grew up, I moved to the States for my education in biomedical engineering. And in this whole vastness of human body and healthcare, one thing that really fascinated me was neurology and neuroscience. And I don't think I can pinpoint for you what was at one moment, but I think it was something about deep brain stimulation, implants, changing the life of a Parkinson's patient with a switch of an electric current, or just how fascinating EEG brain activity is when you're resting, when you're sleeping, when you're doing something else, or seizure patients, just accumulation of all of that. And as I was going through my journey both in biomedical engineering and neuroscience, I met my two amazing co-founders who are from very similar backgrounds, all in clinical neuroscience research, but a bit different in age-related disorders. And what really united us and got me thinking about this startup is what would it take for us to make neurology as accessible to as many people as possible? I think there's an incredible amount of innovation that happens in academia, a lot of it happens in healthcare institutes too, but it has to come out to as many people as possible. So we were discussing this idea multiple times, I've known my co-founders for almost a decade now, and I was actually part of a different job back then. I was doing algorithm engineering for different healthcare startups, but I just could not get rid of this idea in my head. And so I decided, okay, this is time. Maybe we go forward with this. My co-founders felt the same way and we decided to start CenSyn. And a huge part of our beginning was spent just talking to doctors, tell us what your clinical workflow is, tell us where you feel the biggest needs are. If we did this for you, how would it change how you manage a patient with this amount of brain data? And that kind of inspired that change.

John Shufeldt:
Very cool. Okay, so I'm going to back it up a little bit. So what part of India did you grow up in?

Aysuhi Patel:
So I grew up in western part of India. I don't think a lot of people have heard the city, it's called Surat. It's about four hours' drive from Mumbai and it's in the state called Gujarat.

John Shufeldt:
And then would you come over here to go to college? Because, I mean, isn't the Indian Institute of Technology considered one of the world's best schools for engineering?

Aysuhi Patel:
That is true, but then the research opportunities here are just much more extensive, especially in the fields of medicine. The cross-collaboration that exists between School of Engineering, School of Medicine, if you're part of a teaching hospital, that is unparalleled.

John Shufeldt:
Very cool. Okay, so you came over here. Did you always know you wanted to do biomedical engineering?

Aysuhi Patel:
Now that I think back, yes, because I absolutely love the multidisciplinarian aspect of biomedical engineering. You're doing a bit of engineering, you're fully understanding the scope of clinical problems, and then you engage with so many people on so many different fronts to bring a product to reality. And that's the part that excites me, is how do we get the solution out in the hospital? And my co-founders felt the same way because I asked them, what brought you to biomedical engineering and clinical neuroscience? They all said that it is working with people, making sure we deliver a solution that fits in hospital, and even outside of hospital.

John Shufeldt:
Now, you said something that was really interesting because when I talked to folks, you know, one of my mantras is, find co-founders with different skill sets that you have. It sounds like both of your co-founders have very similar skill sets as yours.

Aysuhi Patel:
It's actually very interesting. So we have a very similar focus, but entirely different technical skill sets and very different thought processes and mentality too. And I often think about it how well we complement each other. So if there's something that I would often miss, it's something they would definitely catch and we'd talk about it and discuss it over the course of time. So what brought us together was the mission to make brain health as accessible as maybe recording an ECG on your Apple Watch, but then as we built this together, we were able to put together different pieces of it based on our skill sets. And now we have even a bigger, amazing team around us that helps us take this product, bring it to more and more hospitals as we move forward and work with more sports teams.

John Shufeldt:
Very cool. Okay, so let's talk about the product, and I'm obviously interested in it for a number of reasons. One, just being in emergency medicine, two, I've done sideline work in the NFL where, as you know, this is a large problem in all the contact sports, but NFL certainly, very focused on it right now given the TBI patients they have. Give us everybody an overview of what your product, how it works, and what it does.

Aysuhi Patel:
Definitely, so I'll give you a quick thought process behind it, and then I'll describe the product for everybody who's listening in. So the three buckets we started thinking about as we spoke with more and more doctors, coaches in high school sports teams is, the first bucket is what can we do for patients inside the hospital that need access to data, patients that might be having certain kinds of seizures, which you need certain tests to be done to figure out, okay, do I give this treatment or that treatment? So that was the first bucket that had been going on in our heads from the get-go. And something else then we started thinking is, okay, all this data that has been collected, what do we do to bring that access right on the sidelines for these sports teams, sports teams that play for all the way from high school to NCAA to professional league? And the final piece is, okay, now that we have this, how do we create an education around all of our neurology and neuroscience? So the product we built is a simple platform on a high level, it has two parts to it. So the first piece is this simple device, we call it the PenEEG. For folks listening in, it's like a device, it's no bigger than the size of your iPhone. And what doctors and sports trainers can do is they can take this device and put it on the head. And once you put it on the head, the device picks up the electrical activity of your brain, and this tells you a lot about if everything is normal, if something's abnormal, and gives you an assessment for it. And then we have an app and a dashboard that tracks these metrics over the course of time, especially for sports teams that are going to be playing the entire season. So think of this like we take a baseline before the season starts and now we track that over the course of the season, and if something goes wrong, we do a before and after and we stay for the recovery of these players.

John Shufeldt:
Doesn't a normal EEG have about 18 or 20 different electrodes on someone's head?

Aysuhi Patel:
Yeah, and what makes this very fascinating is, and we've worked with so many physicians on this all the way from epileptologists to neurologists and even some sports medicine physicians is, to screen a scalp, which you can do is, and what makes the Pen very fascinating is you move it from one location to another. So you screen from the front of the head, for people listening in, then you move it to the back, you move it to the sides, and what that helps you do is you get good enough coverage, like the big machine gets too, in the hospital, but all with the ease of a handheld system.

John Shufeldt:
What do you think the sensitivity of it is compared to the traditional EEG?

Aysuhi Patel:
So we've been doing a lot of, so we're at the pre-FDA stage platform for this and we've been working with hospitals and on the critical metrics, they're very happy with the results. And now as we go through the FDA, we'll talk more publicly about it, but that's about what I can tell you at the moment.

John Shufeldt:
Fair enough. But it's sensitive enough, so, for example, let's talk about head injuries. So I'm on the sideline of the Cardinals game and someone comes off the field and they have an obvious, you know, significant head injury. Now to my benefit and certainly to theirs, there's neurologists and neurosurgeons on the sidelines as well. So these patients get a quick neuro assessment to see if they've had a significant TBI. But it sounds like with this device, not only can you do a traditional physical exam, history and physical exam, and also you get some objective data using the device. How does this pick up TBIs in real time?

Aysuhi Patel:
Maybe we can back it up a bit for folks that have just a bit of an experience with concussion. So as you know more than anybody else, the current protocol to screen any, we'll talk about concussions or mild TBI, is there's a SCAT test, which is like a sports concussion assessment tool that's available for sports teams, and in the emergency departments, it's ACE, which is acute concussion evaluation. And for physicians, that's a version of Glasgow Coma scale, but it's been adapted for sports teams or based on past questionnaires around there. What we're working on with the hospitals and our physicians is how do we combine those metrics within the SCAT plus track specific EEG metrics from different areas of the brain that have shown changes between injury, post-concussion, and ... the recovery going back to the baseline. So our focus primarily is looking at different kinds of quantitative metrics of, without getting too technical here, coherence and things of that sort, which we've known have changed over time. And we backed it, we were adding a whole neurological remote neurology front to it. That way we have physician guidance overlooking that as well.

John Shufeldt:
So let me ask you a question. Okay, so you go out to a high school football team and you say, okay, we're going to do this handheld EEG on all of you before the season starts. Is that correct?

Aysuhi Patel:
That's right.

John Shufeldt:
Okay, so then the season starts and someone comes off the game on the sidelines and they have a potential concussion. You take the pen, do it again, and now you're comparing what they had previously, their baseline to what they have now, is that correct?

Aysuhi Patel:
Yeah, and it's very similar to how the protocol exists for the SCAT test. So for any high school sports teams, the player has to, the ones that even we work with, they have to go to their primary care physician or their high school physician, get their baseline testing done, which is obviously a set of questionnaires, their response time, their balance, there's a whole slew of things there. So we fit pretty much in that workflow is on top of that, here's a quick actual EEG brain data baseline.

John Shufeldt:
Okay, and then when they come off the field and you're doing the test on them on the sidelines, is there an AI-driven protocol that says, yep, because I mean, a person I couldn't read in the EEG, and so if we don't have a neurologist by you who can read it, you're out of luck. So does a machine auto-compare the two to EEGs?

Aysuhi Patel:
That is the goal that we're striving towards. And I think one thing that is which, the physicians we work with are very excited about is now we can build a very systematic longitudinal database right on the spot, which has not existed, actually even inside the hospitals for a very long time, and see how that compares. So it is something that we're working towards. The big first step that we have to address is, okay, how do we just screen, right? And how do we screen and can we have this for infrastructure where neurologists exist? Can we start making that change first? And then use all that momentum and drive the changes for high schools, rural sports teams to bring them access as well, where right now, they don't have a neurologist or they have to meet one, they have to travel many miles to get there.

John Shufeldt:
Well, I remember, you know, just I grew up playing sports and boxing and karate, and literally, you come off the side of the field, the coaches said, how many fingers am I holding up? And you go, like two. Yep, you're back in the game. And so, you know, God knows I'd probably be a neurologist or a neurosurgeon, you know, had I not had so many concussions as a kid. So the idea behind this and, you know, there's a huge risk of sending someone back in, who is post-concussion. And, you know, we've seen some horrible outcomes in these kids with the second impact syndrome who get another significant concussion and basically die from it. So the idea behind this, if I'm getting this, is basically saying, okay, yeah, you had a head injury, but it's not significant. Your EEG looks the same or it is significant, you need to sit out the rest of the game and be cleared by your PCP or neurologist before you return, is that correct?

Aysuhi Patel:
Yes, that is correct. And just to kind of paint more context to it, the screening protocol hasn't sadly changed much since your time. And then for a while, we felt that CT scans will help us assess these concussions. But I mean, you know, these CT scans are practically useless because a concussion is a functional injury where your brain activity changes, nothing happens to the structure of your brain. And this is where the EEG technology, what we're building, can really come and help get early data and make better decisions. In terms of how you set about, okay, you sit out versus you sit in, I think this is a decision as we collect more and more data, all data has to be personalized. How your brain works versus how my brain works and how it responds to an injury is very different. So very key focus for us is as we work with these sports teams, even right now, how do we establish a very good set of healthy baseline data and we use that to make any of the injury or recovery assessments.

John Shufeldt:
Very cool, and now let's switch gears. So now everybody has, I think, a good sense of what you're, kind of the purpose of your organization, you've picked out your problem, you've come up with a very amazing solution, and now you're going out to markets. We have a sense that, but let's talk about your entrepreneurial journey. What's been the biggest surprise in that for you? Because, you know, you don't really have a business background, so you're kind of winding their way through this and I think doing an amazing job at it. So what's been the biggest surprise so far?

Aysuhi Patel:
Oh, my God. I feel like there's, every single day there's one that's on the plate, but now that you asked me, I feel like I'm at a loss of words, but yeah, but I'd say the biggest surprise many times we forget, when outside looking in, when healthcare is slow, we start blaming individuals. The biggest surprise for me when I first stepped in was just how incredibly helpful every single physician we've talked to in hospital has been because they also want to go out of their way to bring the best care for their patients. And I say it's like a very good, pleasant surprise, and that's why we work with so many physicians. We've had the fortune of having many physician investors as well who know this change has to happen, who believe in us, and our whole team could not feel more fortunate. And the other surprise has been how out of their way many of the founders will go to make an intro for you to take 30 minutes of their time, just get coffee, get you synced up to what's coming up next in the beginning of your journey. And I think all of those conversations together help you put pieces of what the business would look like step by step. When we first started out, we knew the problem we wanted to solve, we had an inkling of here's the technology that could fit, but through multiple of these conversations with doctors, hospitals, people who handle payments for hospitals, founders in healthcare, medtech, Digital MedTech, Telehealth platform, they've helped us put together the rest of the pieces of what this journey is, and that really made this a lot easier than it would have otherwise. Maybe 15 years ago, when even getting in touch with somebody was a lot more challenging.

John Shufeldt:
Is it been harder than you expected it to be?

Aysuhi Patel:
I think, yes, I mean, that's the short of it. But I do strongly feel that there's no other way to find out. I wonder sometimes if did not let go of the previous position where I was actually going to transition into a bigger role of managing more algorithms and R&D data, and if I had stayed there and not done this, what would it have been like? But while it is a lot harder, I think it's the team you work with, makes it a lot easier. You learn so much more in such a short amount of time that I feel like I surprise myself every single year of how much we've learned, not just on the medical front, but on the legal end, ..., talking to people, engaging with contractors, every single thing, and I wouldn't trade it for anything.

John Shufeldt:
Yeah, as always, the way I felt it's been, Oh my God, this was a tremendous amount of work and I wouldn't change anything about it because it's a total blast.

Aysuhi Patel:
And I'm sure people have asked you, why do you do this to yourself? And you're always at the loss of words. I love my team. I love the doctors we work with. I love, I'm passionate about what we are trying to solve. Why would I do anything else?

John Shufeldt:
I was going to say, why wouldn't you do it? How has fundraising been going? I know that's how we first met. You, unfortunately, started fundraising at a time where valuations have dropped and fundraising has become much more difficult, no matter what sort of go-to-market strategy you have. How has that been for you?

Aysuhi Patel:
You know, we chuckle about this with my founders. We actually feel very fortunate that every single partner that we've engaged with throughout our journey from the very beginning has been completely tied to our mission. And as a team, we've always had that thought process that money is critical, but can we find people who can help us take this to another level in ways we haven't even thought of yet, but they have a touch of it. So we're fortunate to do very well on cash right now, enough to fund our operations and work with multiple hospitals. As I mentioned, we work with multiple hospitals on ... fronts, we're working with high school sports teams on the sports concussion aspect, and we're also dabbling a little bit on sports performance and gaming, is how do you use brain data to optimize your flow state, understand brain fatigue, things of that sort. And our fundraising journey has helped us fuel all of that so far.

John Shufeldt:
That's really interesting about trying to optimize peak performance using EEGs.

Aysuhi Patel:
Yeah. Can I say something? What is very surprising is a lot of this data is similar or there's a lot of learnings from your clinical data that kind of segway into this. And this idea actually came from one of the physicians we work with, he comes from neurology-epilepsy, background, and we were discussing this whole aspect of longitudinal tracking and he said, guys, how far can we push this? Like, can we see other trends that change over time for gaming? And that kind of sparked our curiosity in that direction.

John Shufeldt:
Yeah, the other thing I was just thinking, so two things. So I used to do a lot with domestic violence. I started an organization about it and a lot of the women who are victims, and it's mostly women who are victims of domestic violence, a lot of times they have TBIs. And so there's a neurologist I know who does, basically battered women, TBI, So that's another area that we can talk about more offline. I can connect you with her, she's remarkable. And then the other thing is on recreational marijuana use. I have yet to partake, maybe when I'm 90, but the people that I've seen who are frequent users, they seem to be, their processing speed seems to go down. And I don't know if there's data to support that or not, but I wonder if there be an EEG way to monitor people's cognitive functions based upon their EEG, who are habitual users of different substances in alcohol and marijuana or what have you.

Aysuhi Patel:
I think there's some data very early that supports it, but to be honest, we'll only truly know when we build a good longitudinal database of how that changes over time and we test it out with a proper control group. But without getting technical there, I think what is fascinating about the domestic abuse aspect that you brought up is we had another physician that brought up the same thing that immigrants, people, refugees, military personnel, there's a lot of stuff that in the rehab and retraining their brain data can also come in and help. It's something that we're looking into. As our first three focus buckets, once we start deploying more and more in there, we want to become the infrastructure of data. We want to see if other physicians who want to do research in this, how can we help them get that data? Look at these trends, and make their practice better.

John Shufeldt:
How are you managing and integrating the AI component of this? Because I can see this that will ultimately be integral to it, because if you can have using machine learning to synthesize what's already been done and then apply it to the data it's receiving now, and that to me seems to be the core because your device picks it up, but that's not really where the magic is. The magic is, as you said, the longitudinal data that you're storing, but also the actionable information you're getting, you're gleaning from it.

Aysuhi Patel:
No, definitely, and I think part of the magic happens in the device because the simplification of collecting the data now lets us collect it in many different states on the get-go. I'd love to come down and do a demo for you too.

John Shufeldt:
Yeah, I'd love it too.

Aysuhi Patel:
To talk about that offline. But the second aspect, as you said, you're right on mark there, is how do we use the existing data and start looking into what's happening next or augment it for bigger trends. And that is something that's on top of the mind for us and it is something that we're doing from the get-go as we work on these pilots. In the next few years, our goal is to bring it out to the market and see work with more physicians and see what they have to say on this.

John Shufeldt:
Now, as you look at this today, and I have a lot of entrepreneurs, and I've been in this world myself where you have this sinking suspicion, like, okay, when you show me the device, I know it's not simple at all, but on the outward it looks pretty simple. It's basically electrodes that you put on your head and you move it around as opposed to the traditional EEG, which, you know, I walk by, patients have all these electrodes glued to their head. Why hasn't someone thought of this first? When I see it, I'm like, oh, my God, that's so obvious.

Aysuhi Patel:
We scratched our heads about it for a while when, so we did not start with this idea. We started with the problem, which is, okay, there's data that you need in EDs and ICUs and outside and it takes hours like 4 to 48 if you're lucky, right? Or if you have to be traveled, it's a whole separate story. And then we started looking into, okay, what are the solutions that exist out there? And you're probably familiar with this, but I'll quickly describe it. There's either a headband that exists, tennis headband, which has electrodes on it, there's certain types of headsets, and what intrigued us is why are most physicians not using this? So we started asking that question like, okay, have you used any of these systems? Why haven't you used it? Have you been pitched these before? And we quickly realized that all these systems are not addressing the screening need, they're addressing more of the long-term monitoring need. And where we wanted to really fit in is, how do we become the rapid test to the RT-PCR, if you will, and that changed kind of our mindset and how we talk to the physicians, how we understood their workflow. And after actually a couple designs, we landed on the pen.

John Shufeldt:
Interesting, I mean, there's a lot of patients I'm fortunate to work at some places that have more, you know, you can't spit without hitting a neurosurgeon, and in other places where there's not a neurosurgeon for 50 miles, or a neurologist or neurosurgeon, and there's patients who come in who are altered and, you know, I'll see them and I'll think, oh, I wonder if it's this or that. I'll call the neurologist, and they'll come down and say, yeah, I wonder if they're basically having a seizure. But we don't, as you mentioned, we don't have even at Saint Joe's, which is the neuro capital of the world, you can't snap your fingers and get an EEG. But with this device, even somebody like me could walk up, put it on their head, and if the thing could read it for me, like the EKGs do now, and say, yeah, John, this person is having a XYZ seizure. Oh, my God, the time to resolution and the time to be able to give them medication would be drastically different.

Aysuhi Patel:
Yeah, and you know, some of the institutes we work with and that's something that has been exciting them a lot, which is out of those two buckets of in-hospital and out-of-hospital concussions. That first bucket is also very critical because we forget that even in hospitals it's hard to get access to the EEGs, and if an altered patient comes in, the blood workup looks fine, now you know you have to get an EEG because you have to figure out what's going on.

John Shufeldt:
Like I said, I have the benefit, I mean, I can literally snap my fingers and get all the blood work I want, and, plus an MRI. But at the same time, as you alluded to before, MRIs are better, but TBIs, seizures are more functional issues than anatomic issues, and so, yeah, having this device in real-time is critical.

Aysuhi Patel:
Something like a stroke or a hemorrhage or a perfect CT scan will get you the data, MRI will get you the data, for everything else that exists, mild, moderate, and seizures, that's where we really fit in that niche. And we really see this as co-existing with the current workflow. You do your Glasgow Coma scale, your blood work, you get an EEG data as you're waiting for a neurologist, you can send this remotely, and now he has the benefit to look at this data before he comes down the remaining of the evaluation. So to give you some more context of the physicians we work with, we've tried to understand, Epileptologists are usually trained in doing all of the EEG reading, so we worked with them to figure out, okay, which are the locations that you will care about when you come down to look at these patients? How do we best collect them? How do we make sure it's up to the standard of what you're looking for? And it's in a way that will help you make confident assessments, so.

John Shufeldt:
Right. I mean, I think the real to, at least from my narrow vantage, is a machine that is able to get the data, synthesize it and come up with a, you know, basically spit out the answer for us because they said, you know, EM physicians, we're not trained to read EEGs. Now, if it's obviously grossly abnormal, I'd probably figure that one out, but anything subtle, forget it. And having that data at your fingertips, so when I call the neurologist, say, hey, look, this guy's down here, he's altered. I've done the handheld EEG and I'm the reading says X, he's having temporal lobe epilepsy. I'm making this up. I put him on this medication. What do you think? And, man, that could be 20 minutes as opposed to 20 hours.

Aysuhi Patel:
And actually, funny enough, you described a scenario which, one of our very first conversations as a team, when we were interviewing and talking to doctors, they described the same, and that's what really got us interested too. Man, Trevor, and Andy are going to be happy when I tell them this after the podcast.

John Shufeldt:
Yeah, this is very exciting. Well, actually this has been phenomenal. What have we missed? What else do you want to bring up?

Aysuhi Patel:
You've mentioned that there's a lot of physicians that are looking to start their entrepreneurial journey, and I would love to say that as daunting as it is, if you're able to find co-founders or people around you that you know will be with you throughout this journey, because the highs are highs, but the lows are very, very low. And as you know, and it's a marathon, and what really helps you through this marathon is your team, is your supporter. So if you feel that way and you know there's a problem you deeply care about, maybe like how we took a risk, you can do too, and you'll probably change the face of healthcare in your segment.

John Shufeldt:
Yeah, well, you guys are certainly changing the world, so thanks for all the hard work, and I definitely want to continue the discussions on funding and everything else we've been chatting about. Thank you very much. I really appreciated having you on the podcast. This has been incredibly exciting and again, I'm going to stop, and I'll be like so enthused. So thank you for that.

Aysuhi Patel:
No, thank you for having me, John.

John Shufeldt:
My pleasure. Well, everybody, that wraps up another great segment of Entrepreneur Rx. Stay tuned for the next one and we'll have everything and how to get ahold of Ayushi in the show notes and everything about CenSyn in the show notes, so thank you all. Have a great week.

John Shufeldt:
Thanks for listening to another great edition of Entrepreneur Rx. To find out how to start a business and help secure your future, go to JohnShufeldtMD.com. Thanks for listening.

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