Week 13 – Beginning of the End….End of the Beginning

credit:  MICHAEL HALL/GETTY IMAGES

This week we completed our last round of scheduled beneficiary interviews, effectively signaling that our coursework is in its penultimate stage. One major takeaway from this last week, however, is that the potential for our product extends beyond the Demo Day of April 18th, and we are excited to chase that.

We spoke with student developers and technology consultants, Green Beret captains and communication sergeants, and even a Telehealth nurse. While included at the end of this blog, the summation of these conversations is a validation that the work of this semester has the potential to be successful from three main directions: first and foremost, there is strong runway in the special forces community. Second, that commercial niches are worth pursuing after successful deployment in the military. Finally, that we as a team are heading down the right path from a mobile product development perspective.

As we look ahead, though, we also spent time this week reflecting on where we started. As we will show in our in-class presentation this week, the three versions of our demonstration app reflect the stages of this product development cycle centered around beneficiary discovery. Our group understanding of the military telemedicine landscape was near-zero when we first talked with Cpt. Hinnant in January, and now he is complimenting us on our “fluency with the problem lingo” and is grateful for the progress we’ve made in this relatively short time. In our presentation we will highlight some of the major stages (as well as the notable high’s and low’s) of this experience.

To summarize here, however, it’s safe to say that this project has been nothing like an ordinary “course”. It has been an experiment of our own entrepreneurial, creative, and relationship-making abilities that has doubled as an opportunity to benefit the safety and experience of highly professional men and women in the United States Military. We cannot imagine any greater reward from a short-term, real-world scholastic experience. For that, we are immensely grateful to all of those who make it possible.

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Interview Summaries:

(3) Cpt. AJ, SFC AK, LT MC — SF Communications (18E)

    • “The App must have toggle switch for low/high bandwidth”
    • “All traffic outside the version 1 app will be encrypted by the network that already exist, so you don’t need to lose time programming that into your first version”
    • “For photos, you’ll need to incorporate way to scrape any metadata in the app (like geolocating) — this will be important for the security considerations”

(2) Cpt. Drew Hinnant and Cpt. Phil Cotter — SF Team Leaders (18A)

    • “I really see applicability across the whole SOF enterprise”
    • Priority now is getting into a training program (mountain path, SOFACC, or even one of the larger SOCOM rotations). Then look to JCet trainings before full time deployment
    • Action item: schedule demo presentation for day other than 4/18 to show 4th battalion command

(1) Eileen H. — (Maine) Stroke Center Coordinator (specific to Telehealth/Tele-stroke)

    • Test: That EMS teams in rural areas would benefit from our product
    • Result: “Not really…” These types of teams already have well established procedures and channels with the hospitals they serve to do the best they can.

(1) Paul Ford — CEO of Postlight (mobile service and product studio, NY)

    • “Your version current plan is accurate. The app is completely decentralized — it doesn’t require central authority — that’s a great model. This is essentially just smarter digital paper”
    • “As you get bigger, you’ll want to engage with shops like us and we’ll be happy to keep in touch with you. You’ll also want to consider relationship managers (like Salesforce) as you go into version two.”
    • “For your business model, you will surely want to consider (for both version one and two) how you organize, and potentially sell, the injury, treatment, and outcome data.
  • (1) Rob Versaw — Product Manager at Wayfair
    • “With user experience, keep in mind the Cognitive Churn — you need continuity of actions with each interface you present”
    • “You get in trouble when you try to bite off too much too soon — its best to address your niche and grow… don’t come out saying you want to take all of it. Showing how you plan to scale is important

(2) Yash and Luke, co-leaders of Duke BlueTech

    • (This conversation was essentially a cost exploration for initial development of our product by vetted student developers)
    • “Over the summer, it may be hard to get consistent buy-in. The app would need to be developed by at least four developers on part-time schedules since everyone on our pre-vetted team has internships they’d have to work around.”
    • Total cost would be low, though, between “$2000 and $5000”

 

 

 

Shaping UI and Cost Structure: Week 12

What a busy week!

We’ve used the preponderance of our time this week to buckle down on our UI while also implementing feedback from the army (see what I did there?) of folks who have helped us along the way. We’ve also been focused on understanding potential commercial markets for a dual use role, as well as shaping and developing a more accurate cost structure. Things are really starting to come together – stay tuned for exciting news!

As always, a huge shout out to our advisors, friends, and other folks out there who have helped us reach where we are today. We are extremely grateful for your time, energy, and advice!

Team 3


Doug Powell: Former 4BN 3SFG Surgeon; current Staff Intensivist, First Health Physicians Group
– 
Pivot to explicitly focus on telemedicine consult is the right move.
– Importance of ensuring format of transcript resemble what receiving physicians are already used to hearing/ seeing.
– Demonstrated preference for segmenting “blood” and “fluids” on UI.

Roger Dail: Former 18D;  CEO & Founder – Ragged Edge Solutions
– Assessment of potential long-term opportunities and partnership between TUPAC and RES.
– Update on DHA’s (J-4) March 5th, 2019 SPEARPOINTS [Special Operations Command (SOCOM) Purposed Emergency Access Response (SPEAR) Point of Injury and Trauma Simulation (POINTS)] RFI and Statement of Objectives release, and TUPAC applicability.
– Invitation to observe future training lanes (International SOF and SOCOM) and test app and attend Special Operations Medical Association Scientific Assembly (SOMSA) in Charlotte (May 6-10).

Phil Cotter: 18A, 3SFG; SOFACC Graduate; Original problem sponsor
– Formal introduction to the team and TUPAC post deployment to Africa.
– UI needs a means of establishing next steps between user and physician, i.e. “contact at XXX time via XXX number.”
– Final pitch coordination and logistics.

TW (name withheld): 18A, SMU; SOFACC graduate
– Focusing on the telemedicine consult script is an easy, early win.
– UI is easy to understand, especially for those currently using PFC workflow.
– Demonstrated preferences for scrolling.

Jack Broaddus: CEO, Sunnyside Communities; broad PE/VC experience
– Successful strategies for pitching to investors.
– Importance of accurately assessing risk and understanding your capital structure.
– Telemedicine applications for aging in place services.

Richard Moon: MD; Medical Director,  Duke University School of Medicine, Hyperbaric Center
– Introduction to Duke Dive Medicine – Doctors for Divers and Duke University’s Center for Hyperbaric Medicine.
– Doctor for Divers 24 hrs telemedicine resources; early feasibility assessment of how an app like TUPAC might fit in.

Brian Dickens: MD; CEO & Founder, Missionary Telemedicine Organization
– Broad overview of organization, capabilities, and current efforts to create a telemedicine network for missionaries serving in areas like the Middle East, Africa, and South America.

HH (name withheld): Nurse Practitioner, Cigna Global Health Services
– Asked: “Would a tool for making telemedicine consults quicker have an impact on how you do your job as a coordinator for medical services to Americans traveling abroad looking to get connected with their American resources?”
– Summary of Answer: It wouldn’t make my specific job easier because I ensure that the patient simply gets hands-on care, whether it be in the country they’re in or back here in the US. However, for the teams who deal with initial telemedicine calls, then this will undoubtedly help. Having a script is a great thing to focus on.

TB (name withheld): Software Engineer, Lyft (Duke Alum)
– “This will be relatively easy to get off the ground- as I understand it, you’re creating a series (albeit long) of UI’s that simply collect data into a simplified format for sending on pre-existing networks. From a cost perspective, this is a great first move because you don’t require 1) any server space or 2) active platform management.”
– “Looking ahead, you have time to build out a baseline using just one smart developer, launch that prototype, and then have time to look at expansion to your Phase II (in-app messenger platform and web service) while your product markets itself in the military community”.

Joe Palermo: Corporate Pilot, Lowes Home Improvement
In case of in-flight emergency, Lowes currently contracts with MedAire (Part of International SOS group). Teleconsult was similar to military process where script is created verbally, to a nurse, and then consult was set up with doctor.
– There is a need for a more streamlined process that could leave the nurse out entirely and still get info to remote physician.

JK (name withheld): Sales Manger, Test I.O.
– Interview focused on testing procedures for different types of mobile applications, highlighting the process that we may want to consider of incorporating an iterative testing plan to the developer of our app. Later, when we have more capabilities and users, there are corporate solutions to outsource testing to experts (and this is what his company does).
– For us, we need to be careful of developer bias in testing. When we help them write a list of test cases, we need to make sure to not let their involvement in the development affect their testing decisions and outcomes. In fact, it might be good to have simple human testing done on initial prototyping before it hits customers to just “play around with the app” to make sure all of the functions are operational by the time it is ready to get in soldiers’ hands.

Extra Sleep, Bigger Pivots: Week 10/11

Andddddddd…..

We’re back. Just like that, Spring Break has come and gone. Team 3 is returning to action with renewed vigor, suboptimal tan lines, and a new iteration of TUPAC.

Chief among our work over the last two weeks was thinning out an MVP based on feedback from our marathon day with SF operators during their Mountain Path training exercise. While medics were going through unpredictable prolonged field care exercises, we watched and reaffirmed that a primary need was time-efficiency. One untrained teammate who wasn’t a medic, for example, took nearly 15 minutes to execute a teleconference that should have taken a third of that time for two reasons: they didn’t have the right information in front of them and the support physician on the other end didn’t have their patient’s information readily available either. This is the situation our app will live in, but we also learned during Mountain Path that in order to do so, we had to be more user-friendly than it had previously been.

So, before conducting any beneficiary interviews over break, we set out to create TUPAC “V3”, the latest iteration of the telemedicine app with a central focus on building a “PACket” of information that will be compressible, comprehensive, and easy to create.

After building a new App, we ran a few key A/B tests around 1) messaging, 2) scroll capabilities, and 3) home screen layouts. The results of the latter two are not as consequential as the most former, so we’ll get right to it: We learned from multiple beneficiaries that our MVP is better off to first be deployed as a file-creator, where users can send concise scripts of patient information using a method of their choice, and not as an all-in-one app messenger like our previous versions had envisioned. This does not mean that we do not see that capability in the future, but along our theme of “thinning out” and gaining adoptability, we have decided to focus the experience around creating files that will be easily sendable through already mature communication habits like email.

We look forward to sharing more of our findings and work during the presentation, but also stay tuned for a new team name out of this group on the horizon – its time to make a business!

– Team 3


Roger Dail: Former 18D;  CEO & Founder – Ragged Edge Solutions
– 
Determine a metric that demonstrates time saving between using TUPAC and “hand jamming” the information.
– “The enemy of good is perfect; anything better than what the guys use now is a win.”
– Ensure the PACket, once delivered to a physician, looks like telemedicine script they are used to using/ seeing.

Drew Hinnant: 18A; S3A, 3SFG
– Mountain Path AAR.
– Coordination for potential TUPAC demonstration for command-level leadership.
– Standardize “Medications” such that options reflect current issued drug and dosages.
– Scroll capability is nice; user preferences dictate; Build in flexibility for user.

RC (name withheld): 18D
– Add an ability to share profiles in the setting menu.
– Current debate on colloids and potential for the future; importance of ensuring app is up-to-date with current best practices in medicine.
– In Part 1 of app, merge fluids and bloods together; most medics consider them one and of the same.

Alex Wilson: Former 18D; current Fuqua student
– Importance of reflecting accurate resources available.
– Preferences for scrolling over page view.

Russell Dallas: 18D
– Relevant and up-to-date information on resources slide.
– Indicated preference for sliders and scrolling.
– Supported using other native apps (WhatsApp, Signal, etc.) as a means for sending PACket; in-app messenger not a necessity.

Sean Keenan: Former SF Battalion, Group, and Theater Surgeon;  pre-hospital care SME
– Importance of differentiating between “rank” and “position.”
– Importance of accurately recording certain vitals (i.e. blood pressure); get rid of sliders, or if kept, ensure they have a high level of sensitivity.
– Use the industry standard ADVISOR transcript as the framework for app, not the PFC workflow sheet; importance of ensuring the output mirrors what the ADVISOR docs are used to seeing.

Rich Salve: Former 18D; RN, DUHS;  Ragged Edge Solutions cadre
– PACket compression options.
– For patient history section, use S.A.M.P.L.E. format (industry standard).
– Drop-down option for medications would be easier and more efficient.

CM (name withheld): 18D
– Indicated preference for scrolling.
– Very receptive to using other native apps (WhatsApp, Signal, Wicker) to send PACket over.
– Z-out option is nice to have, not a necessity.

Beck Mitchell: TangoTango
– Discussion of PTToC options integrated w/ existing communication networks;
– Expansion of 5G LTE and high-level assessment of where TUPAC fits in.
– Potential resource for future development.

Mark Schultz: Orion Labs
– AI integration with existing PTToC, and use of bots to automate workflows like TUPAC.
– potential resource for future development.