#149 Dopl

I’m Josh Muccio, this is The Pitch, where startup founders raise millions and listeners can invest. The pitch for Dopl is coming up right after this. And if you’re not following the show already, do me a quick favor and hit that subscribe button and turn on notifications.

[clapper]

Elizabeth Yin said it best: “We all know that hardware is hard, but sometimes you also just need that in the world. Somebody’s gotta do it.”

And that’s how we felt when we met Ryan James. Despite all the reasons that hardware is so much harder to build, sometimes the best way to solve a problem, is with hardware.

And this is a big problem: Ryan wants to give everyone access to healthcare, no matter who you are or where you live.

How do we get better access, you may be wondering? Robots. $60,000 robots.

Josh: I'm gonna ask what was on your paper at the end.

Charles: Oh, just - okay. It'll be doodles. 

Josh: Hello!

Today, Ryan is pitching Cyan Banister

Cyan: Cyan. 

Ryan: Ryan.

Cyan: Nice to meet you, Ryan. 

Charles Hudson

Charles: Hey, Charles. Good to see you. 

Me!

Josh: Hey, Ryan, what's up? 

And Jesse Middleton

Jesse: Hey, man, Jesse. Nice to meet you. 

Charles: I'm getting worried about my job security now that Josh has like moved over to this side of the table.

Jesse: Right, I know. 

Ryan: Super excited to be sitting in front of you. I'm Ryan James, the CEO of Dopl Technologies, where our mission is equal access to health care. Did you know that if you live in a rural area, you're more likely to die from all top ten causes of death? Part of the problem is that specialists who diagnose and treat diseases are concentrated in urban areas, forcing rural patients to travel long distances, receive care late, and sometimes not receive care at all. It's not about what you look like. It's not about your gender or where you live. It's about the systems in place that do or do not support you, and I'm about tearing down the systems that do not work and rebuilding them to support everybody. So, after a career in tech, I pursued a PhD in health informatics, where I met my two co-founders, and we co-founded Dopl. Our vision is to democratize access to care through telerobotic and autonomous procedures. And we're starting with a telerobotic ultrasound system that enables a specialist to perform a diagnostic exam on a patient in a different location by controlling a robot over the internet. Since starting our company two years ago, we've tested our prototype in multiple hospitals we've turned four LOIs into contracts, and I'm here to raise $4 million to build a future where everyone has the same access to care regardless of where they live.

Jesse: It's a fantastic mission. I have many questions about this. 

Ryan: Love to chat about it. Can I show you a picture? 

Jesse: Yeah, that'd be awesome.

Ryan: Okay. I think this always helps. So there's, there's a, there's a patient site component -

Jesse: Okay.

Ryan: - which consists of a robot holding an ultrasound probe. And then there's an expert site component. Think, you're a sonographer. You're an ultrasound specialist. You're working from home. You hold a 3D-printed ultrasound probe that's tracked with six degrees of freedom. 

Josh: Like, like a Wii remote? 

Ryan: Like a Wii remote. Except it also has translation. 

Josh: Oh, as in space?

Ryan: In space.

Josh: In space.

Ryan: Which actually I think Wii remotes -

Cyan: Can you tell the pressure that's going down on the body? Because like sometimes it can be painful. 

Ryan: Yeah. So the most important thing for us to get right is pressure. 

Ryan: Because these are all non invasive procedures. 

Jesse: Right. 

Ryan: And so we're laser focused on safety, and the robot has pressure sensors in it. So we know when we're pushing too hard, and we've built algorithms to prevent that from happening. We can also give the remote specialists haptic feedback. 

Jesse: Yeah. 

Ryan: So they know how hard they're pressing. Cause what we really want to do at this stage is just effectively recreate the experience that they're in person.

Jesse: What would have happened when they were there. Yeah. 

Ryan: Exactly. 

Jesse: Do they do it on like on a 3D printed like dummy body in order to like feel like, there's this idea that you'd be sort of like holding your hand in the air versus pressing down on someone. Or do they need that?

Ryan: Yeah. So, we've done it on this little 3D printed surface, I'm going to take you, take you back. So I met my two co-founders during my PhD. The first system that we built was for a minimally invasive heart procedure. The electrophysiologist was in Chicago. Our system was in Seattle. And we did a heart procedure on a pig. And we did it successfully. And so at that stage we realized that telerobotic procedures are going to happen. Like this is here now. But the really important insight was that all the technology is already here. Like there are fantastic robots. There are fantastic devices. We don't need to rebuild any of that. The missing piece was a software stack that connected it all. 

Jesse: Got it. 

Ryan: And so all of our IP, all of our patents are around that and then creating a wonderful user experience for the expert. And then I can go into the other aspects of our moat, as well, if you'd like. 

Cyan: We love moats.

Josh: Tell us more. 

Cyan: Tell us more.

Ryan: Yeah. So Right now, all of the big ultrasound manufacturers have been trying to tap into the rural market, but they can't because the specialists aren't there. And so we're on track to be first to market with a telerobotic ultrasound system in the US. And that gives us the opportunity to scale up into a bunch of rural hospitals, which will build up a moat. And then we can use that data to then deliver more value in starting with semi-autonomous functionality that allows the sonographer to perform procedures faster. And then our ultimate vision is to perform these procedures autonomously. And it's not just ultrasound either. Like the big vision is to go into these minimally invasive like endovascular procedures that my cofounders perform. 

Josh: The robot itself, you're partnering with another company that builds robots for medical purposes. But it's a new version of that robot specifically meant to use your technology? Or it's like an off the shelf robot that anybody could use if they know how to write the code.

Ryan: Yeah, this is an off the shelf robot that anyone can use. It's made by Universal Robotics. So this robot is not only used in medicine, it's also used to move boxes in warehouses and things like that. It's used across all verticals. 

Jesse: You're working with the existing manufacturers, as you described. What does the process look like for you to be certified? Like, all it takes is one mistake. And so I guess I'm curious about what does that process look like? You've obviously been embedded in this world for a long time, so you should have a good, strong point of view on that. 

Ryan: Yeah. There's already been a telerobotic ultrasound system that's been FDA cleared in the US. It's a company called AdecoTech. They're a French company and they have commercial traction in Europe and Canada, but not in the US. They haven't tried to sell their device in the US yet. And so that leaves this not only this enormous market opportunity in the US for us, but it also just like rolls out the red carpet in terms of getting FDA clearance, because now all we have to do is demonstrate equivalence to their system and then we'll have Class 2, 510k clearance, mid next year is what we're projecting. 

Jesse: Got it.

Cyan: Is the reason that they haven't entered the market is because of how our healthcare system works compared to those countries? 

Ryan: That's what we suspect. So, we actually hired their former regulatory consultants. 

OOh la la, poaching lawyers from your french competiteauxs! The pitch for Dopl will be right back.

Cyan: Is the reason that they haven't entered the market is because of how our healthcare system works compared to those countries? 

Ryan: That's what we suspect. So, we actually hired their former regulatory consultants. And their regulatory consultants suspect that they got FDA clearance as part of their regulatory strategy, but never intended to enter the market because entering a new market is really challenging and focus is really important. 

Cyan: Why wouldn't you just resell their product if they're not in the United States and then lock up all of the doctors?

Cyan: And then not build the hardware? 

Ryan: We didn't do that for two reasons. One is we didn't want to give them commercial success in the US. And then number two, is there's a significant limitation to their system. So they have this big stand that holds this handle and then at the tip of the handle, there's an ultrasound probe, and it requires a medical assistant in the room to grab the handles and apply pressure and the remote sonographer can just angle the probe. And so now you have to train a medical assistant how to apply pressure and sort of where to move the probe, which is the hardest part. 

Jesse: Right. 

Ryan: And so what we've heard from sonographers is they want full control. And so we were just like, we just need to build this thing and take it to market as soon as we possibly can and then scale up. 

Charles: Yeah. How does pricing work and kind of what do your customers have to believe about efficacy or throughput in order for it to pen and pencil? 

Ryan: Yeah. So first focused on pricing. We're targeting rural hospitals. There are about 1800 rural hospitals in the US. About 1300 of those hospitals are critical access hospitals. So they're financially supported by the government. So when one of those critical access hospitals performs a procedure, Medicare will reimburse them for the cost of performing that procedure. They'll also do that when they purchase a new system. So for example, we go to a rural hospital and we say, Hey, here's our system for $60,000. Medicare is going to reimburse that for a significant portion. And so what we've heard from rural hospitals is $60,000 is totally fine. Our basic business model is it costs us about 50k to build the system. We're planning to sell the system for 60k, and then charge a 50 to $100 per procedure fee. And so, we really start to see economic success with volume of procedure. That's our game. 

Cyan: Weird idea, but have you thought about franchise opportunities with like roaming trucks? 

Ryan: Yeah. I think that's super interesting. We actually did a test from Houston to Seattle over T Mobile's 5G network. We're about to do a test in a moving ambulance.

Cyan: Oh, nice.

Ryan: Just to demonstrate that we can do this in a moving vehicle. The thing is, though, that there's a lot of volume at these rural hospitals. And so I think, ultimately, it's going to make sense to just sell a system to a rural hospital, keep it there, so that they can take care of their communities through on demand procedures. 

Jesse: We're invested in a robotic farming company in tractors and they offer sort of three modes. One is fully autonomous. One is telematic. And so you could be sitting in your home controlling the tractor out in your field. 

Cyan: That’s a thing.

Josh: That's dope. 

Jesse: And the third, though is a full stack because you have this issue of shortage of farmers, and so you can actually have somebody within their platform control the tractor when it needs human intervention for some reason. Those three models obviously have very different economics. And so it's good you're thinking about it. I'm a total fan of, like, keep it simple, do one business first, do the one that works for you. You should be able to solve for everybody in the country and make everybody healthier. But - I think you're right to start with what you know. 

Cyan: A lot of bulldozers are autonomous or remote control driven. 

Jesse: Yeah. 

Cyan: It's actually quite cool because they can just sit at home and they don't have to be out there in the field. It’s pretty neat 

Ryan: So that is what we're hearing from specialists. Like the ability for them to work from home is extraordinary. So one of our specialists, her name's Yulia, I interviewed her on her way back from Ocean Beach, and it's a three and a half hour drive. So she drives three and a half hours to get there, stays in the hotel, performs procedures, stays another night in the hotel. And then right after that long day of work, she drives three and a half hours home. So I'm interviewing her on her way home and she expresses how just taxing it is And how valuable it would be to be able to work from home and do this work, but also not have to go get the patient from the waiting room, bring them in, gel them up. And then after the procedure, clean them off and take them back out. All the non-specialty work would be handled by the medical assistant.

Charles: That was gonna be my question: who handles all the - 

Ryan: Yep.

Charles: - just the set up and tear down of each patient session?

Ryan: So there would be a medical assistant in the room who gels the patient and is just there to watch over things, while the specialist is doing their thing. And so there's just a ton of benefits from remote work that sonographers will be able to experience that they're very excited about. 

Cyan: What is your fundraising history? 

Ryan: We did Tech Stars fall 2022. That was our first 120k. and then a ton of very forward thinking angels that include physicians and technologists. To date, we've raised 870k. 

Charles: Can you tell me more about what the four gets you? 

Ryan: Yeah, it gets us to FDA clearance, and rolling out to our first four customers. 

Charles: And I guess last question: How, how big does the business get just with the ultrasound piece, if you don't move into other categories? 

Ryan: When we look at the market, it's 1.8 billion, and that's just based on our telerobotic fees in a hundred percent of the rural market and 20 percent of the urban market. If we just captured 20 percent of that, it's a great business. And that's also just in the US. I think once we have autonomous procedures, I think about what we can do in Kenya and Tanzania. We've been talking to hospitals there, and other underserved areas of the world. 

Josh: And then the critical access hospitals, the 1300, are those who you sell to first? Like, who's feeling this need? 

Ryan: Yeah, so, all four of our current customers are critical access hospitals. And when you go to these hospitals, you talk to the CEO, talk to anyone there, they'll tell you that their mission is to take care of their communities. They don't really care about making money. They just don't want to lose money. um… 

Josh: Wait, why don't they care about making more money? 

Ryan: [exhales]

The answer, when we come back.

Ryan: They don't really care about making money. They just don't want to lose money. um 

Josh: Wait, why don't they care about making more money? 

Ryan: [exhales] The way that the cost structure works is they're reimbursed at cost for the procedure. They're just set up not to lose money. And like making money isn't a huge concern of theirs, especially because they're reimbursed by the government. 

Jesse: Well, Ryan, I think, for me, personally, I don't do really like a lot of healthcare or hardware or selling into hospitals. So like, it's just not my area of focus or expertise. I'm probably not the right partner for that. So I wouldn't invest here, but I - happy to make a few intros to people that are building telematic robotics. And so I'll certainly follow up with you and make those intros. 

Ryan: Awesome. Thank you. 

Cyan: So I'd like to just dig into this more outside of this meeting. 

Ryan: Fantastic.

Cyan: And just understand more about it because this is just something I really don't understand other than having had lots of ultrasounds and knowing the pressure is important. 

Ryan: Yeah. Very. 

Cyan: Yeah the closest investment I have is in robotics like this is a - and it's a luxury sort of thing. It's not as lifesaving as what you're doing, but it's robotic eyelashes.

Ryan: Oh, interesting. 

Cyan: So they put it on and they have a tech that stands there. But it's fully automated. And so that's why I believe this future where these machines - 

Jesse: I don't want anybody going near my eye -

Cyan: I do it and it's great. A lot of times robots make less mistakes. 

Jesse: Yeah, no. That's true. The sensor in your robot can react to too much pressure way faster than the human can. So that's the -

Cyan: Exactly. 

[long pause]

Cyan: You got some deep thinking going on right now. 

[laughs]

Ryan: Don't make me start telling jokes. They're gonna be bad. 

Charles: We'll put in 25. I have a bunch of questions, but those'll come out in diligence. 

Ryan: Thank you. Fantastic. 

Charles: I have some friends who've done various things in hospital ro - incredibly, incredibly lucrative businesses. 

Ryan: Do you remember when I pitched you last year? 

Charles: Yeah, I was like, this is the craziest thing. So he pitched me, I was like, there's no way people are going to let you do robotic surgery. I was like, first of all, it's going to be very hard to build. And like, you make one mistake, you're out of business. 

Ryan: That was the minimally invasive heart procedure. 

Charles: Yeah, it was the heart procedure that he pitched me on. 

Jesse: Ultrasound feels a little safer. 

Ryan: Yeah so since then, we went out and talked to a ton of hospitals, and got feedback on what they needed the most. And it was ultrasound. And then that just changed everything. 

Josh: Hey Ryan, you already know we really like you. We wouldn't have brought you on the show if we didn't. 

Ryan: Thank you. 

Josh: I too am learning about the healthcare industry. I just know it's so broken. I think the part I like the most is the critical access piece and their need to solve this problem and it not being a budgetary issue for them. 

Ryan: Yeah. 

Josh: So I like it. We’ll invest with Charles. Our check - Well, I guess we don't know where this is gonna be priced at. It's 25k no matter what the price is? 

Charles: No, I mean, look. Depending on the price, and depending on what I learned in diligence, we would do more. We won't do less than 25. 

Josh: Yeah, it'd be probably $50,000 is our starting point. And then we'd move up just depending on valuation. 

Ryan: Fantastic. Thank you so much. 

Charles: Thanks so much. 

Cyan: Yeah. 

Charles: Good to see you. 

Ryan: Thank you. Good to see you too. Really appreciate this. 

[outside applause] 

Jesse: I think what he's doing is great.

Cyan: It's just awe inspiring. 

Jesse: Yeah.

Cyan: It's just - 

Jesse: I know I won't get there on the larger check at all. Like probably ever. It's just not our space. And then to write a small check is - it's nice to do, but it's not going to fill the round. 

Cyan: That's what I was thinking too. And that's why I was like, I want to go for the bigger swing if possible. 

Charles: Particularly with robotics or so - like we have a - we did a breast pump company where one of the cofounders had worked in surgical robotics and I did not realize what the state of the art was until I spent a bunch of time with them. But when he emailed me the first time I was like, this is a really cool idea. This like initial use case like terrifies me. 

Jesse: Yeah. 

Josh: It's kind of crazy that this doesn't exist. Why are remote ultrasounds not already a thing? 

Jesse: We have self driving cars on the road that can kill humans.

Charles: That's right. 

Jesse: It's like - and we don't have a robotic scanner.

Cyan: I think it's coming. It's just a matter of timing and when. 

Jesse: No, I think it's right. And the right person to drive it forward to find the right entry to it. 

Josh: A lot of democratization this season. 

Cyan: Right. Yeah, definitely. 

Jesse: I assume Cyan would like this one just based on his opening line. So.

Cyan: Yes, of course. 

Jesse: Tear down the system. 

Cyan: Yes. No, I loved his approach and I love that it was for everyone. By the way, I love headshot photography and he's like one of the most photogenic people I've ever seen. Like, I just wanted to like do headshots for his company. I know it sounds weird, but I was just like, he is so photogenic. 

Josh: One last thing before we go. So this is a - one of our first intros from a portfolio company. One of our very first portfolio companies.

Charles: Look at you. 

Josh: Bevz, which is a -

Charles: Oh yeah.

Cyan: Oh, Bevz.

Josh: - a listener favorite. 

Charles: That was a fun episode! San Diego? 

Josh: Yeah.

Charles: Cool. All right, we'll let you reset the room.

Thanks Jason for that intro! By the way, Bevz just closed another round of funding. A fresh $1.7M!

Ryan walked out of the Pitch Room with a 25k commitment from Charles, and interest from Cyan in leading the round. But after the show, Ryan had another lead in mind…

Ryan: So one of my big questions that makes me, makes me a little bit uncomfortable to ask, but I've got to shoot my shot. Um, okay. So if, if I'm going to call this million dollar round, our pre-seed round, um, Would you be open to leading that round?

Charles: A small million dollar round doesn't really do much for the company. the number required to get to the other side will be somewhere in the five to six range

Gotta love a founder making their move. Will Ryan’s big ask pay off? Find out on our season finale on December 11th at 7pm. You can register for the virtual watch party at pitch.show/party

No offer to invest in Dopl is being made to the listening audience on today’s show, but LPs in The Pitch Fund do have access. You can learn more and invest in our debut fund at thepitch.fund

Fund I is closing to new investors very soon. December 15th!

Next week on The Pitch … 

Gwyneth: Remynt empowers consumers to rebuild credit while resolving delinquent debt. How do we make money? We buy debt very cheaply. 

Cyan: Yeah, I was issued a credit card when I was 18 and I was very irresponsible with it. And I had to go through this. 

Gwyneth: In our country, I don't think we do a good enough job, when people fall behind. We know how to punish people. But we don't know how to provide resiliency. And that's what this product is really about. 

Ben: What's the, like the just the minimum viable proof point to be like this business works and how can we get that? 

Elizabeth: You're in that battle for that small margin with everybody else. 

Mac: I disagree with Elizabeth here. I like you a lot, and I love what you're building because what you're building is important. But I got one hang up. 

That’s next week! Subscribe to The Pitch right now, and turn on notifications so you don’t miss it. 

Founder applications for season 13 will close November 13th. So if you’ve been waiting to apply, don’t wait any longer. We’re taping January 14th-16th in Miami, FL. VCs and LPs will fly in from all over the country to attend in person. Founders can learn more at pitch.show/apply

This episode was made by me, Josh Muccio, Lisa Muccio, Anna Ladd, Enoch Kim, and Jackie Papanier. With deal sourcing by Peter Liu and John Alvarez.

Thanks to Jason Vego from Bevz (Season 10) for sharing this deal.

Music in this episode is by The Muse Maker, Breakmaster Cylinder, FYRSTYX, Joya, Phantom Sun, and the Brow.

The Pitch is made in partnership with the Vox Media Podcast Network.