RX6_Krishan Ramdoo, MD, Founder, TympaHealth Technologies: Audio automatically transcribed by Sonix

RX6_Krishan Ramdoo, MD, Founder, TympaHealth Technologies: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Narrator:
ForbesBooks presents: Entrepreneur RX, with Dr. John Shufeldt, helping health care professionals own their future.

John Shufeldt:
This week, I'm really happy to welcome Dr. Krishan Ramdoo. Chris is a CEO and founder of Tympa Health, a London-based startup that has created the world's first all-in-one hearing health assessment. Krishan, welcome to the podcast.

Krishan Ramdoo:
Hi, there! How are you doing?

John Shufeldt:
I am well, thank you! You have such a cool background. Let me ask a couple of questions to get kind of started, to get some of this background. So you were well into being an ear, nose, and throat surgeon and then you became an entrepreneur. Give me a little background of your medical, kind of your medical background.

Krishan Ramdoo:
Yeah, no, of course. Well, thanks for having me on. And from a medical perspective, so I graduated in 2009, and then, in the UK, you have the system where there's lots of hoops to jump through. And my career path, as you said, was I'm going to be an ENT surgeon and you jump through these hoops, and I think as I was becoming more involved in my clinical work, I was, you know, had this itch that I was thinking things have to be, could be done a little bit better. And at that point in time, the only way really to maybe afford myself some time away from clinical medicine was to step out to do a Ph.D. So I was very, near at the end of my training, where I stepped out to do a Ph.D. and sort of broaden my mind instead of thinking, how could digital health be brought to ENT? And I think throughout that time I was still working clinically and I was able to evolve, evolve my thoughts, and saw that there was a gap in the market and the real need for a solution which we've, we've come across. And alongside that journey, I was appointed in England. We have the NHS and they have an NHS England clinical entrepreneur program. So I was one of the first 10 in the country to be appointed to that. And that really, program has been built to help clinicians kind of evolve their clinical ideas but have some commercialization to it. And the journey has been long, but it's been evolving over a number of years. But I think it was that transition point which I realized there was something here that made me make the, dip my toes into entrepreneurial activity.

John Shufeldt:
That's awesome, okay, so let me just because in the U.S., obviously, we do it a little bit different. So you were in an ear, nose, and throat residency, how far into it were you? Sounds like you're almost done.

Krishan Ramdoo:
Yes. So if it's the equivalent to the U.S., I was probably two years away from being a ENT consultant. So not long, not long at all.

John Shufeldt:
What was your Ph.D. in or what did you start your Ph.D. in?

Krishan Ramdoo:
So my Ph.D. was, it's entitled in hearing, is hearing health. But actually it started with a slightly different variation of Tympa, it was actually a suction device, a suction probe, which has been involved, but yes, yet to be released. But it was while, whilst doing that and looking at hearing health and how you could bring a solution into the community, that Tympa Health was kind of born of saying, well, you had to not only just have a piece of hardware, but a bit of software attached to the whole system. When I mean hearing health, it was broadly looking at how you could build a community examination kit and commercialize that. And so a number of my chapters are based around that whole journey and it documents it quite well. So I kind of felt that my Ph.D. was almost like an autobiography, I guess.

John Shufeldt:
So what was your aha moment? I mean, you were two years away from finishing, I mean... Were you examining a patient and thought, oh my gosh, if they could do this, then boom! And you thought about it? Or was, did it, you know, did you get there over time? What was your, how did this come about? Because it's so interesting, ... explained it next.

Krishan Ramdoo:
Certainly evolved over time. I think I was two years into my junior doctor career, so, so residency, and I was seeing a patient on a ward, and when you do your medical training, you have two other specialties. And I remember I was doing care of the elderly at the time, and I saw a patient on the ward and she was admitted actually just for a urinary tract infection. So she was treated for that. But she was still confused, disengaged, when we went round and did our ward rounds and me being a budding ENT surgeon, I thought, well, you know what? Let me just go and have a look in her ears. And I looked in her ears. And lo and behold, there was a lot of wax there. So I thought, well, I'll tell you what I'll do. I'll wheel it down to the ENT department. I just come off my placement in ENT, so I remove the wax and got her a hearing test. And lo and behold, she had an age-related hearing loss. She got fitted with a hearing aid. I followed her up six months later and she was a different lady. She was engaging with her family, she was planning her 80th birthday. And at that point I thought, well, there's something in this here. But as with medicine, as you know, you have to go through certain number of steps to get where you want to get to. So I kind of parked it, but as I kind of evolved more into my medical career, I realized that it was becoming more of a problem, I'd see more patients coming into my clinic and saying, actually, this patient didn't need to come all this way to see me. Surely there's a way in which I could review them remotely and then provide some guidance. And then in my clinic, I would see the patients that I really needed to see. So the moment in which I decided to switch over to the entrepreneurial side was when, I think I'd evolve that thought, but I think I was only able to evolve that thought from having done many years, I mean, I've been a doctor now for 12 years of clinical practice.

John Shufeldt:
So I mean, so this is, I've had a few of those moments where I was kind of laughing while we were talking, because I've had the same moment where, like, they don't even come into the emergency department to see me, if only they could do X. And then it's led to a business. So you have kind of the same classic entrepreneur who finds a problem or identifies a problem and comes up with a solution, where you went from this frontline clinician and surgeon. And then also on wait a minute, these people don't need to drive and see me, I can basically use technology to come and see them. You thought through this process, how did you come up with the idea for the software? I mean, who did you partner with to do that?

Krishan Ramdoo:
And again, I think that, as you'll know, the journey, it's all evolution. And I think the first part was for me to identify, could we do this with hardware? Because actually the software came afterwards and it was actually what was out there already and there were smartphone otoscopes. But one of the biggest things, which was, excuse the pun, blocking good otoscopy was wax. I said, well, we have to develop a tool that can do that together. And then once I was able to define that and I partnered with a medical device specialist company called Team Consulting in Cambridge, I then thought, well, that's great, we know we can do it with the hardware, but the whole point is I need to be able to virtually see them. And then with the software, I was up till 18 months ago, just over 18 months, I was still a full-time doctor and we already had some contracts with some big retail organizations, but I partnered with some outsourced companies to start getting that work done. And then now we brought everything in-house.

John Shufeldt:
Interesting. OK, so explain to me then how does Tympa works. Yeah, I've had some ear issues in the last year or so, and so I've become much more acutely aware of hearing loss and how it affects, how it has affected me, but how it affects others as well, just for the non-physician group out there. How does the product work?

Krishan Ramdoo:
So what Tympa solution does, it allows you to really take the whole ear clinic and put it into the community, and it allows that to be done with an allied health professional so you don't need to be a ENT surgeon or a general practitioner. You can upskill the workforce to take the solution to the patient into whichever environment they're in. And the way that it works, if you take the ear clinic, let's say, what would you do if you were even pitching up to the emergency department? What would you want to do? You want to be able to look in the ear. As I mentioned, if there was wax in the way you'd want to remove that because you can't look at the eardrum, if wax was in the way and you can't do a hearing assessment. And then at the end of that, after removing the wax, if there was or debris that was there, it then enables you to do a hearing assessment as well. And it brings all of that information together, the looking in the ear, the wax removal, and the hearing assessment into one digital record that can then be shared with any clinician in any location.

John Shufeldt:
So it also helps via suction to remove the wax in real-time, correct?

Krishan Ramdoo:
Exactly. So if you're looking in the ear, as you would do with your otoscope, I mean, in my Ph.D., I was writing that the first otoscope was described in the 13th century, and it hasn't really evolved much for the last, you know, 50, 60 years. And when you're doing an otoscopy, if you were seeing there was wax, it has a special channel which allows you to perform the wax removal with micro-suction there and then, and currently in the world, there isn't a device which brings all of these elements together, and we've got some multiple global patents on the product as well.

John Shufeldt:
Ok, so speaking of patents, so you received a patent for an optical apparatus in January, tell me about that process.

Krishan Ramdoo:
Yes. I mean, patent processing is challenging. We had a great patent team working with us, but it was a stepwise approach, actually, because the first patent we had was on the spacing mechanism that we have, which is the channel that allows you to do wax removal. And it was, you know, doing all our searches, it was interesting that no one had thought that actually looking in the ear with otoscopy, if you added a spacing element that was unique and novel. So that was the first part and that enabled us with our version one to do good wax removal. The next stage was how do we get it to becoming, giving you a clear enough image to be able to make a diagnosis from it as a clinician, and that was a challenge, we had to get a lens expert in. So we harness some, kind of some of the features that you have in your mobile phone, but we've added the special and unique lens system, which is a relay system, which then allows you to get really high definition images. And it's, it is comparable to an endoscopic ridge image. And we put that in the lab and we put endoscopes up against the Tympa image quality and it shows the definition is extremely the same.

John Shufeldt:
You see a future with Tympa any, with AI because like many things that are optical, if you bleed AI into it, you can start making diagnoses and coming up with some suggested treatment paths without even having to see the provider.

Krishan Ramdoo:
Absolutely. We have actually already started doing that. So with all of the images and videos that are being captured, I mean, Tympa today is, you know, we've, it's been used on more than 25,000 patients and we're probably bringing together one of the largest banks of ear and hearing health information that there is in the world. There are databases in silos, but what Tympa has is we're bringing all of that information under one kind of roof. And so we are, have started to do our machine learning labeling, so we have a bank of ENT physicians who work with us who will sit there in their spare time and look at these images and videos anonymously and label them. And we've already started to do that, and we've got through multiple thousands of that and we're getting some really strong, robust validation from the algorithms. So we're looking to bring that into the workflow of Tympa, where the end goal is actually, you would be looking into the ear with the Tympa and it will tell you, is this normal or abnormal? And then actually in time what the diagnosis is. And alongside that, with the machine learning because we are picking up other information about the patient also looking that predictalytics, the trend analysis of someone's hearing. So because you have the hearing assessment, is there something you could have done earlier to prevent those things of forced social isolation? You know, hearing loss is the biggest modifiable risk factor for dementia. So if you can pick those things up earlier, then I think that's also an avenue where machine learning will help us and what we're looking to do at Tympa.

John Shufeldt:
Now, I have to ask this question because I got hit with this a number of times as I started these different ventures from colleagues who are, said like, dude, you're putting us out of business, you know, people won't need to see the emergency department, people won't need to go in the clinic with virtual health like you're killing us, what are you? Why are you doing this? Have you gotten any pushback from ENTs that you're taking their bread and butter?

Krishan Ramdoo:
Funny enough, I think very early in the journey I did, I mean, obviously being one of their own. I think it was an open conversation. But actually, how the conversation has evolved is the way that Tympa actually works. It's there to support that ENT surgeon, it brings the most appropriate patients in to see them. I mean, there was a body who was saying, well, I'm quite happy doing my wax removal, cerumen removal and getting paid for that. But the new breed of surgeon, and I would say, a lot of the surgeons who are adopting new technology are saying, well, we want to be seeing patients that may need an intervention and an operation. We're very happy for our allied health colleagues to assess patients for us and we have the oversight. So I think that's changing and we've had multiple case studies of working with ENT surgeons now where actually there's less pushback because what we're seeing is that we're collaborating with them and bringing the right patient to them in probably a more efficient time and ultimately better for the patient. And I think once that narrative has changed, maybe the initial reaction was what you described. But now I think everyone's seeing that actually, there's a real benefit for this. And you know, some of the wider things, which we want to do at Tympa, is not only support our local communities and in the developed world, but being able to support the developing world as well and, you know, delivering access and support to those that never would have had access to it. And I think once you start to put that message across, I think people are really keen to be involved and then, they're very supportive actually.

John Shufeldt:
And you could easily argue that they'll ultimately bring more, as you said, more patients to them who are at their right stage for treatment and it's not too far gone.

Krishan Ramdoo:
Absolutely. I mean, it's making it much more accessible. If you look at the published data out there, it takes someone five to seven years to do something about their hearing if they feel they have a problem. Here, by making it more accessible, you know you could walk into your local GP or your pharmacy to get assessed, it brings them further along to that journey and, like you said, probably funnel more patients to the ENT surgeons appropriately.

John Shufeldt:
So one of the struggles I had when I worked on software is I don't know anything about software. I mean, I was, you know, I've been in medicine and law and maybe business, but I didn't know anything about software. How did you know that you found the right software development team? Did you have a background in software?

Krishan Ramdoo:
No, I didn't have a background in software. I think the software, I think that we wanted to build at Tympa, I think I took examples from other places where it's worked really well. So radiology, you know, we've been doing remote reporting for a long time. Ophthalmology, they are used to taking pictures of the people's, the people's, patient's back of their eyes, and I think the journey evolved because what I started with was outsourcing the work and giving a brief and saying this is how I think it should be built. And I learned a lot from that process because I essentially was there signing it off and then felt like it wasn't very, although you do a piece of work and then there'd be an outcome, it wasn't very iterative, and I think that was the key to really take some time to build the right tech team around me and, you know, hiring a really great CTO. And subsequently, we've hired a really, really strong tech team who fill all the pillars that we need, from back-end development to app development to front-end. And I think the team that we built, they're funny enough at Tympa, the tech team is the biggest side of the team, which proves kind of how unique the proposition isn't that we have with our software, but how dependent we are on it as well.

John Shufeldt:
So yeah, that's, I think that's where a lot of physician entrepreneurs struggle as finding someone, you found a great CTO. And then from there, I will say, OK, I'm entrusting, here's my vision, let me articulate it for you, I want you to turn this into a software and hardware as well, like you said, to start, but then software and then maybe allow your CTO to bring the team together.

Krishan Ramdoo:
Absolutely. I think that's what our CTO, Jay, has done. He's brought together a great team. They're a great bunch. And I think probably to your point, John, one of the key things is everyone that we've hired, I think they have to be on board with the vision that we're trying to achieve. And I think if you have that big blue sky vision, I think everyone is on board with that. And, you know, almost where I found the tech team have really enjoyed it is when they're hearing patient stories of how the technology that they've developed has had a big impact on patient's lives, and I think that, that I think has motivated them and it helps them understand the journey, I mean, they all come and attend some of the training days so they can watch through the journey and people in use, I think that has helped incredibly to evolve the product as well.

John Shufeldt:
Clearly and so, now, so Tympa obviously started in the UK, is it, the U.S. patent as well and where are you in that journey?

Krishan Ramdoo:
Yes. Yeah. So we have a U.S. patent already and certainly and we're FDA approved as a product as well. So the US is definitely on our roadmap and it's something that we've already had started having discussions with. So one of the biggest hearing aid manufacturers, Sonova, we have signed a global procurement contract with them, so they are looking at providing Tympa in their US branches as well as across the whole world. But also some of the other big-box retailers have been in touch and for us, as a small company, to be having interest from them is very exciting. But what it has proven is actually the hearing, ear and hearing health journey is the same everywhere in the world, and I think we have an opportunity with our first-mover advantage, with no other products providing this all in one solution to come to the U.S. and hopefully provide a more efficient, unique service. We've spoken to a few providers and certainly, the ear and hearing health spaces is ripe for innovation, particularly with the new legislation about over-the-counter hearing aids coming in, how can we regulate that as well. So the U.S. is probably on our roadmap, I would say, you know, maybe end of the year next year.

John Shufeldt:
Excellent! Wow, that's actually coming up quickly. So one of the questions I always ask is, you know, you went from physician and now you're a physician entrepreneur, maybe entrepreneur/physician. What crossover was there between those two? How does being, how does being a physician help you become a better entrepreneur?

Krishan Ramdoo:
You know, as a physician yourself, you know that you're always faced with complex decisions. It's high-paced. You have to be quite thoughtful in your decision. And yes, you know, being an entrepreneur, you do have to sometimes go with your gut. But I guess that happens as well in medicine, where you see patients, you're like, you know what? I actually think it could be this, and sometimes your gut leads you to the diagnosis. And I think being a physician as well, you're used to working in teams. And, you know, as you get more senior, you're leading the team as well. But I probably would say one of the biggest factors, which I think has helped this entrepreneurial journey is that as a physician, you have to know how to communicate well. And I think that has made things, you know, obviously you need to be used to, you know, understanding business, knowing where the commercial elements are. But in med tech, it's also driven by what the patient wants, but the communication side. Communicating with your team, learning how to work with different people, that definitely transcends both those networks from physician to entrepreneurial. And I think if you can get that right, you can definitely communicate your vision to your team, communicate to investors as well and clients. And I think that has probably held me, I think in good stead that I've been able to communicate that well to all the different parties I needed to speak to. And I think there's certainly definitely I think that the view that if you're physician, you can't be a businessman or woman, I think there's so many synergies between the two and you've obviously proven that yourself as well.

John Shufeldt:
Yeah, and that's what I've always thought that seemed to dovetail nicely, and particularly like with your journey as you identify a problem, you have your aha moment and then you build towards the solution. One of the things that I found is, to do that you have to have a great degree of resiliency. Is that something you were born with in the sense that you were just one of those people is like, head down, I'm going to make this work come hell or high water?

Krishan Ramdoo:
Yeah, I think that's, you know, I don't know where there is a cliche, but resilience definitely is something that you need, I would say in both walks of life, because in medicine as well, there's so many exams, hurdles you have to jump through. And I think I was very focused on what I wanted to become as an, you know, finish my ENT training, but an opportunity arose and I think you have to be able to step back and do that. But by nature, I think I'm a creature of habit, but also resilience. I think, you know, those who know me that if I set my mind to something, I'll definitely want to complete it. And in this journey, although not true to my character, I think switching over what I have felt is that I am impacting on many more patients than I would have as a single clinician. And yeah, I think resilience is a very useful word when you are entering into this entrepreneurial journey.

John Shufeldt:
I mean, there's certainly, I'm sure you've had a lot of bumps in the road along your path, although when you retell it, it sounds like, oh, of course, it went from here, to here, to here, and people don't see the midnight and 3:00 a.m. ceiling fan talk that you had with yourself?

Krishan Ramdoo:
Yes, I think, I think I can definitely relate to that, and sometimes I think the other thing which you have to, I think one difference, perhaps in the entrepreneurial journey, it can be sometimes a bit of a solo journey. You do have your team that you can speak to. But in medicine, you've always got colleagues around you that you can, you can ask. But in the entrepreneurial journey, sometimes it can feel a bit solo. And yeah, it hasn't definitely been easy and you definitely have those ups and downs, but focus is probably key. And the other part, which I think is is key, is to be able to stand up and say, well, you know, actually, we didn't do that right, how can we rectify that? I think each stage of the journey you do have to be able to learn from your mistakes and be happy to accept when you're wrong as well.

John Shufeldt:
Right, and Sir Winston Churchill, you know, its success is going from failure to failure with no loss of enthusiasm.

Krishan Ramdoo:
Yes, exactly.

John Shufeldt:
How did, you know, being in the UK, I mean here, because I'm so intimately familiar and treating patients with COVID, I saw how it affected our business, and I've a telehealth business that skyrocketed, and an emergency medicine business that slowed down quite a bit with COVID. How did COVID affect Tympa?

Krishan Ramdoo:
So I think like any, any company, I think when COVID was at its peak and certainly, when there was lockdowns around, I think we all had to have a think and think, well, actually, how are we going to evolve out of this? But actually, because of the elements that we have of democratizing ear and hearing health care into the community, coming out of COVID that is what the future is, saying, well, how can we stop people from having to go into hospital? How can you make their journey a lot easier? And what we found with Tympa is that, we were talking about it beforehand, but now there seems to be much more need for a solution like Tympa. And definitely at the beginning, we were thinking, well, how are we even going to continue? But what was fortunate is that we were in that phase where we were just evolving and finalizing our version two of the product. And so actually, by the time that was finalized, we had got over the peak of COVID. I mean, we're still in, you know, uncertain times. But what has changed is that health care, the ability to see people remotely, certainly the future. And I think that's where we have benefited from, you know, we have had some really excellent support from the NHS, had case studies outs of how we are supporting the NHS with their elective recovery. So there's a huge backlog of patients waiting to be seen. And we've got case studies out there showing how we're reducing the waiting times by more than 30 percent, which is a big factor of being able to take care safely into the community. So I think COVID has been challenging for Tympa. But ultimately, if you could say in a way that it's actually proven that a technology like this can actually be supportive in the journey out of COVID, let's say.

John Shufeldt:
Krishan, what was your biggest surprise? You know, looking back, did you have anything where you said, wow, boy, I never saw that one coming. What was your kind of biggest surprise or shock during your journey?

Krishan Ramdoo:
I think, fortunate in the fact that we had one of the largest retailers, if not the largest retailer of ..., view at Tympa and said, you know what? This is the solution that we're going to use to underpin our assessment. And I think what was the thing that I didn't think was going to happen was they did a very small trial and it went from 5 to 10, to 20, to then 50. And then I think it was the point when I spoke to the managing director and he said, you know what, we're going to go and put this in every one of our stores, and I thought, wow, I didn't expect that to happen. And for us, it's an early-stage company. I thought, well, to get one of the big names already on board, and that's the Boots Walgreens team, I think that was where I thought, wow, we've really proven something here. And actually, it's no longer proof of concept is here, it's doing it in the market. And I think once that you have someone like that, I think the rest of the market starts to look at you and think, you know what, we should be using this solution. I think I, I think we've done that in a very short period of time. While I was still full-time as a doctor, we were already were supporting Boots hearing care. And I think sometimes I remember those days when I was travelling up to in my annual leave to go and help support training of their individuals to see where we've got to now. I think sometimes I think we've done that in a relatively short period of time with actually little marketing at all, I think about us as well.

John Shufeldt:
Yeah. So that was your ticket to the big leagues when they decided to put you in all their stores, did you have to raise money before that or is it purely self-funded?

Krishan Ramdoo:
No, I've gone through some fundraising. I think very supportive early investors who have, you know, followed us through. I think now we're at a stage where we are really entering into that growth phase. Where, you know, we know that it's worked, it's used on multiple thousands of patients, and I think the only way that I would have been able to have done it was to take on investment at that early stage because I think that enabled me to get in the resource to do that. And I think they've also, that transition from being a doctor to an entrepreneur businessman. I think having people on your side who have been through that business journey has been really helpful and supportive as well.

John Shufeldt:
Excellent. Well, OK. So, so to wrap this up, tell me about kind of where the future of hearing health is and how Tympa is going to lead the charge into it, because it sounds like you're set up perfectly to do so.

Krishan Ramdoo:
Well, I think the future of where things are going is, I think that patients in whether it be with ear and hearing health, but generally in health care, they want to have accessibility, they want things on their doorstep. And I think where Tympa sits in, we can enable that and where the future is going to be is how can you bring the specialist closer to home? And I think what I feel we can achieve with Tympa is not only doing that, as I mentioned earlier in the developed countries, but actually doing that across the world and linking in in communities in Africa, India. We've already done some work in Cambodia where we're able to support them from over here. And I think that's where the landscape is changing, not only in ear and hearing health care but in health care in general. And Tympa has a role to play with the over-the-counter legislation that's coming with hearing aids and that it can probably provide some support there that, you know, rather than going and just buying your over-the-counter aid from a supermarket or pharmacy let's say, Tympa can be used in that way, where actually you could have a quick assessment making sure that there's nothing unusual on the eardrum, making sure there's no wax and making sure that they haven't got a really bad hearing loss. So then if you are picking up an over-the-counter, it's an appropriate one for you. I think Tympa definitely has a role to play there as well.

John Shufeldt:
Yeah, you can just imagine all the people who they go in and they use the device and say, my hearing is not so bad, I just haven't packed its room. And once I get that out, I'm 50 percent better.

Krishan Ramdoo:
Exactly. And I think that there's, where, what we found with Tympa and I think this is what will be interesting our journey into the U.S. is that actually there's multiple markets. You know, it can work in primary, secondary care, in the hospitals, but as well as pharmacies and, you know, retirement villages as well, who have a large, you know, population with hearing loss. And you know, being able to provide the service in-house is also a solution for them, which we have done over here in the U.K. as well.

John Shufeldt:
That's awesome, Krish. Thank you so much for taking the time to educate me and our listeners on this. I really wish you all the best. I'll be following you along and we'll be very sure of your success.

Krishan Ramdoo:
All right, thank you very much. It's been a pleasure talking to you today as well.

John Shufeldt:
Thank you. To find out more about Krishan and his company, TympaHealth, you go to TympaHealth.com. You can also find Krishan on LinkedIn by searching Krishan Ramdoo. That's it for this episode of Entrepreneur RX. I will see you next time. Stay safe out there.

Narrator:
Thanks for listening to Entrepreneur RX with Dr. John Shufeldt. To find out how to start a business and help secure your future, go to JohnShufeldtMD.com. This has been a presentation of ForbesBooks.

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