CEO of Digital Diagnostics (DD), John Bertrand’s foray into healthcare began in 2006, straight out of undergraduate studies. His early life was in many ways influenced by healthcare, with both parents working in medtech and exposing him to the burgeoning field of medical imaging digitization, particularly in radiology. Today, John is carrying the flag post to take digitization to the next level with artificial intelligence.
John joined Epic, a then-small Wisconsin-based company, right after graduation. Epic proved to be a front-row seat to the digitization revolution in healthcare. There he climbed the ranks, moving from initial professional services and implementation roles to more strategic positions in product and business development. Over his 13 years at Epic, John witnessed and contributed to the company’s growth from a small-cap business to a market leader.
After his decade at Epic, John had a chance encounter with Joe Lonsdale of 8VC, a technology and life sciences investing firm. A meeting with him steered John towards the nascent field of AI in medical imaging.
“I knew from growing up how medical imaging intersects with the patient and its technical arc. It was just a no-brainer to join them,” he shares. John’s experience at 8VC, with its deep insights into technology and patient care, made him an ideal candidate to lead Digital Diagnostics as CEO later.
He joined the team at Digital Diagnostics right after they received their de novo approval. John’s company aims to improve global healthcare by making medical diagnosis and treatment more accessible, affordable, equitable, and high-quality through AI. They don’t produce hardware; only software, and their business model is based on collaborating with hardware vendors to integrate DD’s AI platform onto their devices.
DD’s latest product, LumineticsCore, is an algorithm that autonomously diagnoses patients with diabetic retinopathy. It’s primarily used with the fundus camera, a century-old technology now digitized and repurposed for AI. The workflow is easy and doesn’t require a specialized healthcare provider. A trained operator captures two images per eye, which are then submitted to LumineticsCore to be analyzed and the results are out in less than a minute — no need for a physician to confirm the diagnosis!
"It’s the first and only de novo algorithm that diagnoses a patient without a physician in the loop," John shares. “It’s literally a high-school-educated operator running the test.”
The primary application of the LumineticsCore, the diabetic eye exam, is a very common and important test. Diagnosing the disease early and intervening swiftly can prevent blindness, and by enabling access to the test in more locations, Digital Diagnostics is aiming to close the care gap around the diabetic eye exam.
Today, DD stands at a significant milestone, having extended its reach to 1,000 clinics across the United States and a commercial presence in 17 countries. Their partnership with Baxter, the multinational healthcare company, is set to launch within the next 12 months and aims to automate diagnostics of various conditions on Baxter's established platform, which is already implemented by approximately 10,000 clinics. "We can see ourselves testing over one percent of the diabetics in the United States," John shares. This is an impressive milestone considering the product's relatively recent introduction and the few years it has been eligible for reimbursement.
Key Learnings From John’s Experience
- Understand and align your product with real-world customer needs to find a meaningful place for it in the healthcare system. Engage directly with end users, observe products in their natural habitats, and integrate feedback into development.
- Be intentional about working within the system rather than simply ticking off checkboxes. Also, keep your stakeholders close and strive to build a reputation as a reliable partner in the industry.
- Plan for a long sales cycle and manage your financial runway carefully. Align your product with real patient value and avoid premature investments in R&D. After some initial sales wins, shift focus to securing larger, more strategic deals rather than numerous small ones.
John Bertrand's career started at Epic Systems, where he rapidly advanced through various roles, focusing on product and business development. His expertise in digital healthcare, honed at Epic, led to his role at 8VC, a Silicon Valley venture capital firm, where he concentrated on artificial intelligence in medical imaging. Eventually joining Digital Diagnostics as CEO, John combines his extensive industry experience with a passion for innovative healthcare technology solutions.
Be at the Elbow with Your Customers
In the realm of product development and especially in healthcare technology, what seems to be right on paper isn’t always the case in a real-world hospital or clinic setting. John has consistently emphasized the importance of this connection, "You’ve got to be at the elbow with your customers, with your end users." This attitude was crucial in the commercial success of Digital Diagnostics.
Understanding real-world healthcare delivery is as vital as solving the technical challenges. John warns, "Don’t misjudge the difference between what happens in a laboratory and how real clinical care is delivered." He goes on to say you need to ground your product in practical realities such as: “How does the patient move through the clinic? What skill level do the operators have? How does the physician want to interact with the support when it's done?”
And it doesn’t end when the first development cycle is over. For example, Digital Diagnostics' engineers regularly conduct immersion trips to observe how their technology is used in real settings. These visits have led to numerous 'aha' moments, revealing small yet significant improvements. "Just little stuff that when you tweak it, tighten the screw, tighten the workflow – you produce a significant impact for people at the end of the day," John shares.
John doesn’t stop at staying close to the customers. The company has fostered a culture of engagement with a broader range of stakeholders, including regulatory bodies and healthcare professionals that John calls “working within the system, not around it”.
Work Within the System, Not Around It
The founder of the company and the platform's creator, Dr. Michael Abramoff — who is also an ophthalmologist, neuroscientist, and computer engineer — spent decades studying automated image analysis and how doctors diagnose diseases. As a result of his vision, dedication, and 300-plus academic research papers, LumineticsCore was invented.
However, creating a working system doesn’t ensure the healthcare system will adopt it overnight. One intricacy the team at Digital Diagnostics grappled with was regulations around reimbursement for such a service. When John stepped in, the company’s existing code for reimbursement did not cover the deployment costs, which was a significant hurdle.
LumineticsCore is an entirely autonomous platform that operates without the need for a provider, a concept the healthcare system hasn't fully grasped yet. John shares, “When you create a device that doesn't require a provider, as you work through deploying the product for the first time, you run into the word ‘provider’ in every rule and regulation.” But you need FDA buy-in as well as reimbursement if you want your device to be widely adopted.
John is keen on this, “You need the reimbursement to justify making the investment.” That’s why securing it was worth celebrating, particularly when the CPT code 92227 was approved by CMS, which meant reimbursement for assistive AI like LumineticsCore. This was a major inflection point in Digital Diagnostics' journey. "That's when we saw the shift," John notes. What followed was a surge in adoption, both from mainstream healthcare providers and prestigious institutions like Stanford and Hopkins.
John humorously notes the input of Dr. Abramoff, “I guess my advice would be to find yourself a world-renowned physician to build a company with, because they're going to have a lot of connections that are interested in your new technology.” To put it more seriously, when you have solid proof of validation and a network of people who are interested in your product, persuading entities for coverage and reimbursement gets easier.
John says, “Solving the technical biology problem is probably easier than getting a health system to integrate it, train people, support it, to do ongoing utilization and monitoring.” That’s what he brought to the table by actively engaging with various stakeholders, including regulatory bodies and healthcare associations, and gaining their support as they collaboratively worked through each process.
“I could have probably gotten some folks to adopt the product by just lowering our shoulders and plowing through things without paying any attention to the different stakeholders. But because we created that buy-in, that understanding, every time we want to do something new, it's just much easier because we have the reputation of working with folks rather than around them.”
While more time-consuming, this strategy built a solid foundation of trust and understanding, and that’s one of the pillars of Digital Diagnostics’ success.
Be Mindful of the Sales Cycle
It takes at least 18 months on average to generate sales within a healthcare system, even when things are going well. This is a crucial time frame for any startup's financial runway and market strategy. If you don’t plan accordingly, you run the risk of using up all the capital on the way, which ultimately leaves you in a tough spot, unable to raise more funds because you haven't proven your product's success yet.
“You really need to be thinking through cash balance, runway, how you're going to market, what's the capital efficiency of the various options that you have, and the likelihood of success,” John cautions.
One common pitfall lurking over newfound medtech companies is investing too much in R&D prematurely. If you skew too far towards innovation and away from sustainable business practices, your innovation loses its precision.
To overcome this, John advises to work closely with early adopters. Do your best to align your product with patient value, and understand the economic landscape of healthcare. Ensuring your product’s operational and commercial viability before heavily investing in R&D is a much safer road to take.
However, after getting your first sales and coming out on the other side, another crucial phase follows: expansion and building resilience in your business model. John emphasizes the critical importance of this next step.
His experience at Epic and his extensive involvement in various startups as an investor, advisor, and board member have shaped his perspective on business strategy: “don’t do small deals.”
Small, one-off deals, although tempting for immediate gains, often lead to operational inefficiencies and challenges in scaling. As a startup matures, it becomes crucial to be more selective with customer segments. Spreading yourself thin across multiple market segments has a higher operational cost. He advises focusing on fewer, larger wins, which might seem counterintuitive but are more sustainable in the long run.
Achieving this requires a unique set of skills. “It's about finding that commercial acumen, which is not easy to define, but crucial for success,” says John. He highlights the importance of confidence and resilience, especially during slow sales periods. “Don’t get rattled if you're going a quarter without a sale. Focus on securing a few significant deals per year, rather than numerous smaller ones."
CEO of Digital Diagnostics (DD), John Bertrand’s foray into healthcare began in 2006, straight out of undergraduate studies. His early life was in many ways influenced by healthcare, with both parents working in medtech and exposing him to the burgeoning field of medical imaging digitization, particularly in radiology. Today, John is carrying the flag post to take digitization to the next level with artificial intelligence.
John joined Epic, a then-small Wisconsin-based company, right after graduation. Epic proved to be a front-row seat to the digitization revolution in healthcare. There he climbed the ranks, moving from initial professional services and implementation roles to more strategic positions in product and business development. Over his 13 years at Epic, John witnessed and contributed to the company’s growth from a small-cap business to a market leader.
After his decade at Epic, John had a chance encounter with Joe Lonsdale of 8VC, a technology and life sciences investing firm. A meeting with him steered John towards the nascent field of AI in medical imaging.
“I knew from growing up how medical imaging intersects with the patient and its technical arc. It was just a no-brainer to join them,” he shares. John’s experience at 8VC, with its deep insights into technology and patient care, made him an ideal candidate to lead Digital Diagnostics as CEO later.
He joined the team at Digital Diagnostics right after they received their de novo approval. John’s company aims to improve global healthcare by making medical diagnosis and treatment more accessible, affordable, equitable, and high-quality through AI. They don’t produce hardware; only software, and their business model is based on collaborating with hardware vendors to integrate DD’s AI platform onto their devices.
DD’s latest product, LumineticsCore, is an algorithm that autonomously diagnoses patients with diabetic retinopathy. It’s primarily used with the fundus camera, a century-old technology now digitized and repurposed for AI. The workflow is easy and doesn’t require a specialized healthcare provider. A trained operator captures two images per eye, which are then submitted to LumineticsCore to be analyzed and the results are out in less than a minute — no need for a physician to confirm the diagnosis!
"It’s the first and only de novo algorithm that diagnoses a patient without a physician in the loop," John shares. “It’s literally a high-school-educated operator running the test.”
The primary application of the LumineticsCore, the diabetic eye exam, is a very common and important test. Diagnosing the disease early and intervening swiftly can prevent blindness, and by enabling access to the test in more locations, Digital Diagnostics is aiming to close the care gap around the diabetic eye exam.
Today, DD stands at a significant milestone, having extended its reach to 1,000 clinics across the United States and a commercial presence in 17 countries. Their partnership with Baxter, the multinational healthcare company, is set to launch within the next 12 months and aims to automate diagnostics of various conditions on Baxter's established platform, which is already implemented by approximately 10,000 clinics. "We can see ourselves testing over one percent of the diabetics in the United States," John shares. This is an impressive milestone considering the product's relatively recent introduction and the few years it has been eligible for reimbursement.
Key Learnings From John’s Experience
- Understand and align your product with real-world customer needs to find a meaningful place for it in the healthcare system. Engage directly with end users, observe products in their natural habitats, and integrate feedback into development.
- Be intentional about working within the system rather than simply ticking off checkboxes. Also, keep your stakeholders close and strive to build a reputation as a reliable partner in the industry.
- Plan for a long sales cycle and manage your financial runway carefully. Align your product with real patient value and avoid premature investments in R&D. After some initial sales wins, shift focus to securing larger, more strategic deals rather than numerous small ones.
John Bertrand's career started at Epic Systems, where he rapidly advanced through various roles, focusing on product and business development. His expertise in digital healthcare, honed at Epic, led to his role at 8VC, a Silicon Valley venture capital firm, where he concentrated on artificial intelligence in medical imaging. Eventually joining Digital Diagnostics as CEO, John combines his extensive industry experience with a passion for innovative healthcare technology solutions.
Be at the Elbow with Your Customers
In the realm of product development and especially in healthcare technology, what seems to be right on paper isn’t always the case in a real-world hospital or clinic setting. John has consistently emphasized the importance of this connection, "You’ve got to be at the elbow with your customers, with your end users." This attitude was crucial in the commercial success of Digital Diagnostics.
Understanding real-world healthcare delivery is as vital as solving the technical challenges. John warns, "Don’t misjudge the difference between what happens in a laboratory and how real clinical care is delivered." He goes on to say you need to ground your product in practical realities such as: “How does the patient move through the clinic? What skill level do the operators have? How does the physician want to interact with the support when it's done?”
And it doesn’t end when the first development cycle is over. For example, Digital Diagnostics' engineers regularly conduct immersion trips to observe how their technology is used in real settings. These visits have led to numerous 'aha' moments, revealing small yet significant improvements. "Just little stuff that when you tweak it, tighten the screw, tighten the workflow – you produce a significant impact for people at the end of the day," John shares.
John doesn’t stop at staying close to the customers. The company has fostered a culture of engagement with a broader range of stakeholders, including regulatory bodies and healthcare professionals that John calls “working within the system, not around it”.
Work Within the System, Not Around It
The founder of the company and the platform's creator, Dr. Michael Abramoff — who is also an ophthalmologist, neuroscientist, and computer engineer — spent decades studying automated image analysis and how doctors diagnose diseases. As a result of his vision, dedication, and 300-plus academic research papers, LumineticsCore was invented.
However, creating a working system doesn’t ensure the healthcare system will adopt it overnight. One intricacy the team at Digital Diagnostics grappled with was regulations around reimbursement for such a service. When John stepped in, the company’s existing code for reimbursement did not cover the deployment costs, which was a significant hurdle.
LumineticsCore is an entirely autonomous platform that operates without the need for a provider, a concept the healthcare system hasn't fully grasped yet. John shares, “When you create a device that doesn't require a provider, as you work through deploying the product for the first time, you run into the word ‘provider’ in every rule and regulation.” But you need FDA buy-in as well as reimbursement if you want your device to be widely adopted.
John is keen on this, “You need the reimbursement to justify making the investment.” That’s why securing it was worth celebrating, particularly when the CPT code 92227 was approved by CMS, which meant reimbursement for assistive AI like LumineticsCore. This was a major inflection point in Digital Diagnostics' journey. "That's when we saw the shift," John notes. What followed was a surge in adoption, both from mainstream healthcare providers and prestigious institutions like Stanford and Hopkins.
John humorously notes the input of Dr. Abramoff, “I guess my advice would be to find yourself a world-renowned physician to build a company with, because they're going to have a lot of connections that are interested in your new technology.” To put it more seriously, when you have solid proof of validation and a network of people who are interested in your product, persuading entities for coverage and reimbursement gets easier.
John says, “Solving the technical biology problem is probably easier than getting a health system to integrate it, train people, support it, to do ongoing utilization and monitoring.” That’s what he brought to the table by actively engaging with various stakeholders, including regulatory bodies and healthcare associations, and gaining their support as they collaboratively worked through each process.
“I could have probably gotten some folks to adopt the product by just lowering our shoulders and plowing through things without paying any attention to the different stakeholders. But because we created that buy-in, that understanding, every time we want to do something new, it's just much easier because we have the reputation of working with folks rather than around them.”
While more time-consuming, this strategy built a solid foundation of trust and understanding, and that’s one of the pillars of Digital Diagnostics’ success.
Be Mindful of the Sales Cycle
It takes at least 18 months on average to generate sales within a healthcare system, even when things are going well. This is a crucial time frame for any startup's financial runway and market strategy. If you don’t plan accordingly, you run the risk of using up all the capital on the way, which ultimately leaves you in a tough spot, unable to raise more funds because you haven't proven your product's success yet.
“You really need to be thinking through cash balance, runway, how you're going to market, what's the capital efficiency of the various options that you have, and the likelihood of success,” John cautions.
One common pitfall lurking over newfound medtech companies is investing too much in R&D prematurely. If you skew too far towards innovation and away from sustainable business practices, your innovation loses its precision.
To overcome this, John advises to work closely with early adopters. Do your best to align your product with patient value, and understand the economic landscape of healthcare. Ensuring your product’s operational and commercial viability before heavily investing in R&D is a much safer road to take.
However, after getting your first sales and coming out on the other side, another crucial phase follows: expansion and building resilience in your business model. John emphasizes the critical importance of this next step.
His experience at Epic and his extensive involvement in various startups as an investor, advisor, and board member have shaped his perspective on business strategy: “don’t do small deals.”
Small, one-off deals, although tempting for immediate gains, often lead to operational inefficiencies and challenges in scaling. As a startup matures, it becomes crucial to be more selective with customer segments. Spreading yourself thin across multiple market segments has a higher operational cost. He advises focusing on fewer, larger wins, which might seem counterintuitive but are more sustainable in the long run.
Achieving this requires a unique set of skills. “It's about finding that commercial acumen, which is not easy to define, but crucial for success,” says John. He highlights the importance of confidence and resilience, especially during slow sales periods. “Don’t get rattled if you're going a quarter without a sale. Focus on securing a few significant deals per year, rather than numerous smaller ones."
