Last January, Sachin Aggarwal, the chief executive of Think Research, was faced with a dilemma. His company had an app with a lot of promise but not a lot of support. Think Research’s VirtualCare platform helps doctors treat patients remotely, but the province’s health plan had no billing codes for virtual care.
So, he focused instead on international expansion, selling the company’s clinical treatment protocols in the Middle East, England and Mexico. But by March, he was cancelling travel plans and watching as countries closed borders and international buyers retreated. And in Canada, the demand for VirtualCare increased by 500 percent.
It’s a whiplash trajectory familiar to entrepreneurs across the country. For the first time, Canadians can talk to doctors and fill out self-assessment tools like the COVID-19 screening test at home. Aggarwal calls this revolutionary. “Healthcare — and software in particular — moved 10 years in 10 months,” he says.
The faster, cheaper, more accessible digital services created by the pandemic have also changed the way health tech startups work. Companies found themselves shrinking timelines for product delivery and navigating triple-digit sales growth while managing teams scattered across remote offices. Many entrepreneurs said it felt like a crash course in crisis management and a once-in-a-lifetime career experience. It’s also changed the way they do business forever.
Dr. Arash Zohoor, co-founder of Inkblot, a digital platform that offers a range of healthcare services, described this as the new normal. “Being comfortable with uncertainty is now a competitive advantage,” he says.
As the pandemic continues, adaptability will determine future success. Rebecca Reuber, a professor of entrepreneurship at Rotman School of Management who studies tech firm growth, says there’s an upside to surviving a crisis. “Some of our strongest companies started out in the worst of times. There could be a new generation of entrepreneurs as a result of this.”
When Aggarwal and his team started to monitor the progress of the coronavirus in January, they were told by their in-house medical researchers that it was similar to a flu or pneumonia and that treatment would be similar, too.
Then the answer changed: it was not like the flu, treatment protocols would be different and not all hospitals were prepared. By late February, his team was updating COVID safety protocols four times a week, something they only do in emergencies. And the tens of thousands of doctors and nurses in hospitals and long-term care facilities who rely on their software, including the best practices for treating COVID, were consuming it just as quickly.
“We’d been planning for a normal year. Then all of that came to screeching halt. It was panic across the industry,” says Aggarwal.
Aggarwal and his chief technology officer, Saurabh Mukhi, tracked the pandemic as it moved through communities and then through long-term care facilities. In response, they rethought each piece of technology to meet the needs of front-line workers making life and death decisions. “For each of our product lines, we had to find the most prescient aspect to the pandemic,” says Aggarwal.
Starting in March, three mental health and social work associations signed on to use ThinkResearch’s VirtualCare platform. In August, Ontario Health provided funding to put the company’s VirtualCare solution, which contains standardized checklists to help staff diagnose and treat COVID-19, into the province’s long-term care homes. Long-term care residents can also access medical resources via a new partnership with Med e-care, a cloud-based platform.
The business grew so quickly that Aggarwal and Mukhi found themselves inventing new processes just to keep up. “We had to say, ‘What do we know today? Let’s get as many people as we can to validate that and then let’s quickly iterate,’ ” says Mukhi.
They replaced a three-to-six-month roadmap with two-week turnarounds for new features and functions. Long days turned into 24-hour shifts, which meant balancing competing demands for speed and accuracy. (Double data entry, which is necessary when medical records aren’t syncing properly and information has to be entered manually by medical staff, introduces the risk of human errors.) They also mandated time off for employees who were working around the clock.
For Reuber, the pandemic reinforced the importance of a strong work culture. “Installing that kind of culture now means hopefully it will stay,” she says.
Focusing on culture also helped MindBeacon, a startup that offers digital mental and behavioural therapy services, through similar growing pains.
During the lockdown, in-person therapy sessions, which were a core part of the business, weren’t available. Yet traffic to its site in April was 15 times higher than in the previous month, an increase they attribute to the anxiety and fear caused by widespread social isolation.
They responded to those concerns by creating a free mental health program called Stronger Minds. Within three weeks, they transformed a platform designed for a single therapist and client into an open site with bilingual content, deployed a marketing campaign and created a cross-functional subcommittee to manage each step along the way.
MindBeacon’s staff did this all while learning to work remotely. The main priority for Adam Kelly, who oversees the company’s business strategy, was to recreate the engagement and spontaneity of a startup environment at home. And he was surprised to find out that more structure, not less, was helpful. On March 16, he introduced a daily virtual meeting and runs regular surveys to find out how employees are coping. “That investment of time is more important when it doesn’t happen organically,” he says.
For some startups, remote work offered an unexpected benefit: the business could expand more quickly. In the first two weeks of March, Inkblot brought on more clients, including Maple Leaf Foods and Sleep Country, than in the two years prior.
“We’d talk to three companies in the morning and they’d want to launch that afternoon,” says Zohoor. “Doing 12 Zoom meetings in a row meant we were able to manage the inbound interest. Otherwise it would have been impossible.”
Zohoor grappled with a set of changes that would have been unprecedented in a normal year. He stopped feature development to focus on the client onboarding process, hired new clinical and support staff and brought on 600 therapists in the U.S. He also managed enterprise-level clients who were concerned about their employees’ financial health while tempering the excitement of investors who hoped sales would grow unabated.
“We had to set expectations for investors and the board that this could not be seen as the business,” says Zohoor of Inkblot’s rapid growth.
But as the pandemic continues, that kind of growth doesn’t seem to be going away.
In September, Aggarwal and his team saw an increase in hospitals and long-term care homes downloading COVID protocols for admissions, infection control and treatment, an obvious sign that their frontline partners are seeing the impact of a second wave in hospitals and seniors homes. “We’re watching the health system kick into high gear again,” says Aggarwal.
But Aggarwal and Mukhi say the work is easier to do knowing they’re helping where it’s needed most.
“It’s been our mission since this pandemic started to innovate to respond to support front-line healthcare workers. We’ve never stopped, but certainly we are doubling down on that effort as the case numbers climb.”
For more information on how MaRS-supported startups are helping in response to the pandemic, visit our COVID-19 directory.