Gil Carter

Epic was the reason we got rejected from Y Combinator 👀 I still remember our YC interview in Nov 2014. Sam Altman (now founder/CEO of OpenAI) was on his phone the whole time. Gosh, were we really that boring? 😂 Hours later we figured out what happened: the previous Reddit CEO resigned unexpectedly the week before. Sam had been the temporary CEO and that day he was announcing a new interim CEO. I’m guessing he was dealing with a ton of crap behind the scenes. Later that evening, we got our rejection email: “We’re sorry to say we decided not to fund you guys. While we like the idea of helping patients prepare and recover from surgery better, it’s a very difficult business for a startup, because it’s hard to compete with incumbents who already have the doctor, hospital and patient relationships. We predict that existing EHR systems will gradually add richer patient advice, and it will get harder and harder to compete with them over time.” I thought YC would be the last folks to tell us that startups can’t beat incumbents 🤷‍♂️ It feels like a rite of passage as a Digital Health entrepreneur to be told “the EHR will build this” or “yours looks way better, but we have to try the EHR version first” For years it frustrated me to no end. But 10 years into this journey, and having been a customer of many B2B software products myself now, I have a lot more empathy for health systems who feel this way. Especially as many U.S. health systems are still in financial recovery, it’s just common sense to look to existing vendors for any new solutions. And certainly the EHR is the most expensive existing vendor, so they want to maximize that investment. I’ve been there now too. For instance I do think Zoom has a superior video call experience to Teams... BUT Teams is bundled into my Office 365 purchase. Is Zoom so much better than Teams that I just have to buy it? So how the heck do you convince a health system to invest in something outside the EHR? What I’ve found is that 3rd party solutions have to earn the right to overcome incumbents. And you don’t do that by being just 2x or 3x better. You have to be 10x better on a differentiator a health system truly cares about: 📈10x better results 📑10x more clinical evidence 👨‍👨‍👧10x better professional services and support 💨10x faster implementation Or some combination of the above that provides an aggregate 10x improvement. Otherwise, the friction for a health system to look beyond an incumbent is just too much. You gotta be 10x better so it’s a no brainer decision.

Last year, working in Ireland, having a pint in the cold outside a Dalkey pub with some new friends, a woman with purpose strode past us. Puffy parker zipped to the nape and her bowed head covered in a scarf. One of my new friends muttered an exclamation, jumped up