From the moment Phil Martie’s twin babies drew their first breaths, they fought to stay alive. Born the size of small hamsters and severely underdeveloped, baby Nicolette and baby Bexley introduced themselves to the world 15 weeks too soon.
Their chances of survival were grim.
“They were 1.5 pounds each and had a whole list of medical conditions that needed to be addressed,” Phil, 37, tells Entrepreneur. As a new father, his first instinct was to do everything within his power to protect his newborn children, to keep them safe and alive. Yet, unable to even hold them, there was nothing he nor his wife, Jude Alcantara Martie, could do.
‘Powerless to help’
Scared, exhausted and frustrated, the new parents sat for hours, days and weeks, agonizing over their little ones’ health as they laid frail in beeping neonatal intensive care unit (NICU) incubators. Covered in medical tubing and IV lines, ventilator machines breathed for the babies’ lungs for much of the time. “We were powerless to help them,” Phil says.
His son, Bexley, pulled through. He survived despite a fraught, 110-day recovery in the NICU. Bexley’s sister, Nicolette, however, did not share the same fate. She died during surgery, just 27 days after she was born.
Nicolette’s passing is a loss that Phil and Jude will live with forever. While the void left in their daughter’s absence may never fully heal, the Los Alamitos, Calif. mother and father have taken some comfort in forging a new venture in the late newborn’s memory, and in her name.
“I wanted to participate in my children’s care, but I had no tools that enabled me to navigate the NICU journey fast enough. That's when I decided to build them,” Phil told us at a recent Startupbootcamp health tech event in Santa Monica, Calif.
The birth of a business
Still grieving and only 11 months following his daughter’s death, Phil launched Nicolette. The goal of the Santa Ana, Calif.-based startup is to give parents of babies hospitalized in NICUs an empowered voice in their children’s medical care, something he and his wife didn’t feel they had when they -- and their children -- needed it most.
“In both cases, we weren’t empowered advocates on our babies’ healthcare team, and it felt terrible,” Phil says. “If we had known then what we know now, we could have saved Nicolette’s life.”
Phil, taking on the role of CEO, co-founded Nicolette with three tech industry professionals and a medical doctor. All, apart from Phil, who began full-time with the startup last February, will continue to work at their day jobs until enough funding is raised for them to come aboard full-time, he says.
In the meantime, Dr. Michel Mikhael, a neonatologist at Children’s Hospital of Orange County, in Orange, Calif., heads up Nicolette's medical strategy. Bryan Wilson, experienced in outsourcing at Fortune 500 companies, oversees design. Seth Brickman, also hailing from a Fortune 500 background, leads business operations. Lee Martie, Phil’s brother and a computer scientist specializing in artificial intelligence, advises on technology.
Before going all-in on Nicolette, Phil held several different roles in corporate sales, analytics and operations. His most recent post was vice president of western U.S. operations for Canon, where he specialized in outsourcing.
Nicolette’s first offering is a forthcoming parent-facing, HIPAA-compliant app called NicoBoard. It shares NICU patients’ electronic health record (EHR) data in visually intuitive ways designed to allow parents to quickly grasp the information, “without being statisticians,” Phil says. “It extracts the EHR raw data and synthesizes it into a consumable format for parents. That way they can feel competent and confident in participating in their child’s journey to wellness.”
In addition to parsing out easily digestible EHR data visualizations (such as color-coded graphs of a patient’s oxygen saturation, carbon dioxide levels and apnea episode history, for example), NicoBoard will also furnish parents with curated research relevant to newborn health. The idea is for parents to use the research to make more informed healthcare decisions on behalf of their babies. The research sources, Phil says, will include accredited third-party sources, PubMed potentially included.
As for how NicoBoard will work in everyday application, Phil explains that hospitals will provide parents with a specialized tablet supplied by Nicolette that contains the app. Parents will also be able to download the app to their personal mobile devices, and to use an online version on their laptops as well.
Other similar offerings in the budding parent-facing NICU patient-focused health tech micro niche include a very limited smattering of apps. A search of options in the Apple App Store and Google Play shows that, of the very few available, most enable moms and dads to video, photograph, journal about and manually track their NICU-hospitalized babies’ overall growth and health progress, all things that NicoBoard also does. Among these loosely comparable apps are MyPreemie and NICU Parent. Unlike NicoBoard, neither directly draws off of actual patient EHR data.
Phil isn’t sweating the competition. As he sees it, there is no app currently on the market that directly competes with his. “Nothing exists in our space. With NicoBoard, we believe we are creating a category,” he says. “It could be called patient empowerment. In the future, we think all providers will subscribe to empowerment technology and services that they pass on to their patients. It will be just as normal as having phones. We are at the very beginning of that now.” (For a detailed look at another forthcoming patient empowerment app Entrepreneur recently delved into, check out this article about MyPurpleFolder.)
The future looks bright
Phil is more than likely onto something when suggesting that his app is the tip of the iceberg of what’s to come (and that it’s apparently the only NICU parent-targeted app yet to draw directly off of the electronic health records of actively hospitalized patients). More and more consumer-facing patient information dissemination and education apps continue to pop up in the digital healthcare sector. Goldman Sachs forecasts the flourishing industry will mature in the near-term into a $32.4 billion-dollar market, with an estimated 45 percent of those dollars stemming from remote patient-monitoring technology alone.
Additionally, the broader realm of consumer-targeted virtual healthcare apps, outside of patient data delivery alone, is ripe with opportunity, says Hector Rodriguez, the national director of Microsoft’s U.S. health and life sciences industry technology unit. Rodriguez also attended the Startupbootcamp event where we met Phil, after Phil pitched NicoBoard to industry advisors and potential investors.
“As [Microsoft does] our research with Gartner and other research analysts, we see virtual health growing very quickly and as an area of opportunity for traditional providers as they explore new revenue and scalable care models,” Rodriguez tells Entrepreneur. He also points out that the web- and app-fueled health tech industry is projected to experience a compound annual growth rate of 18 percent between 2015 and 2021, according to new research published earlier this month by market research firm Frost & Sullivan.
Even amid analysts’ bullish outlook for the healthcare-related app sector, and the promising greater health tech market, Rodriguez expresses mixed feelings on whether NicoBoard will be widely adopted by hospitals, mainly due to pricing. The app, slated to launch some time this summer, will be free to parents. To monetize it, Phil says he aims to charge hospitals around $10,000 a month to offer the service.
That price tag might be tough sell. “When it comes to hospitals these days, even free is too much,” Rodriguez says. “The price has to fit the need and, if the hospital is able to provide better care, a better patient and family experience, and if it helps get the baby home sooner, then yes, they will pay for it.”
Stacy Johnson, a staff nurse who works at a 26-bed, Level III NICU at a hospital in downtown Los Angeles and has 20 years of experience in the profession, does not agree. (She requested that we not name her employer, though we validated her employment there.) “From a nurse and hospital perspective, [NicoBoard] is extremely costly,” she tells Entrepreneur, “especially where we are in healthcare today and with ever-shrinking profit margins and increased regulation. Everyone is forced to do more with less. Most hospitals, especially those that are not-for-profit and/or rely on government funding, do not have the extra revenue to pay for this costly service.”
She also says many hospitals lack the manpower to oversee the use of NicoBoard, both on the NICU staff side and on the parent side. “It sounds like it might be labor-intensive for the hospitals and docs,” she says. “Having just gone through the transition to EHRs (electronic health records), I am acutely aware of all the glitches and interfacing issues that can happen. Furthermore, there are multiple EHR programs out there. No two hospitals operate them the same.”
Concerns about privacy
Johnson also voices concerns about the safety and privacy of patient data shared within NicoBoard, stating that “Maintaining patient privacy and confidentiality are huge issues in light of all the technological changes that are affecting healthcare.” Rodriguez echoes her concerns, pointing out that the NicoBoard app and the data housed within it “should be encrypted and protected across all solutions and end points.”
In response, Phil tells us the app utilizes secure sockets layer (SSL) encryption. “Patient medical data goes nowhere, ever.” That is apart from into the hands of the parents who have secure, “authenticated” login access to the app, he says. Furthermore, none of the EHR information shared via NicoBoard, nor the parent engagement data collected by Nicolette from the app, will be sold “in any way, at all,” says Phil.
It bears noting, however, that he does plan to share with NicoBoard users how they “rank against” other users in certain parent engagement benchmarks. He will also publicly publish what he calls “empowerment and engagement” and demographic user statistics, with the aim of helping to improve NICU parent engagement, particularly among low-income parents, a group he’s committed to helping. Phil stresses that all collected information will be “anonymous, agreed to and free of medical data.”
The price of engagement
To offset potential price tag panic on the part of those who hold hospital budget pursestrings -- people such as lead nurse Johnson who make cost decisions around new technology -- Rodriguez suggests having parents and insurers foot the bill for NicoBoard. Phil, however, says he’s not open to the idea. Why? He’s not concerned about rejection based on cost, at least not for now.
“We have now met with many providers and there have been many points of discussion, but pricing and affordability have not even been asked about once,” he says. “They get it.”
To further curb potential hospital adoption challenges, and to broaden his market reach, Rodriguez also recommends that Phil offer NicoBoard in multiple languages in countries where preterm birth rates are higher. This would be a wise strategy, he says, given that the premature birth rate in the U.S. is widely considered on the decline. While it may be statistically down, the March of Dimes projects that one in 10 American babies are born too soon, totalling an estimated 380,000 preemies born every year.
For his part, Phil says he has plans to add additional language support to the app during its first year on the market. He also hopes to expand internationally at the end of a five-year expansion roadmap, after prospectively developing similar apps for patients with cancer, heart and neurological conditions.
Of course, every baby born dangerously too soon is one too many, and so much more than just a statistic. Each one, like both of Phil’s twins, has a unique story to tell. This hits home for Rodriguez, who says his own nephew, born 16 weeks premature, could have benefited from an app such as NicoBoard, had it been available at the time. “He was born in 1979 when zero technology for engaging patients existed and contact with patients in the NICU was very limited,” Rodriguez says. “Information was limited and parents, particularly young, first-time parents, were uninformed, unprepared and under-educated.”
Just bystanders, left in the dark
Today, despite forward strides in doctor-patient communication, some parents of babies hospitalized in the NICU still feel left in the dark about their hospitalized babies’ care and condition. Take Michael and Tracy Glumac of Weymouth, Mass., for example. Last year, their son Alex was whisked away to the NICU moments after being born by C-section following a grueling 126-hour labor.
“Born unresponsive, rapidly breathing and not crying, they brought Alex immediately up to the NICU,” Michael, who works as a resource scheduler at Boston University School of Medicine, tells Entrepreneur. “We were not given any information. It was a fight to try to get it. The two and a half days our son was there were hellishly long, especially for my wife, who was so stressed-out and worried that it was difficult for her to recover from the C-section.”
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Michael's wife, Tracy, a property manager, was understandably beside herself, also not knowing or understanding what was wrong with Alex, left to guess what was being done with and to him in the NICU. “They put me back together after surgery and the next thing I remember was in the recovery room,” Tracy tells Entrepreneur. “That’s when I realized I had no idea what was going on with [Alex]. I wanted so badly to see my son and they kept telling me ‘later.’”
Later couldn’t come soon enough for the anxious new mother.
She was eventually allowed to visit -- and to finally hold -- her newborn baby for the first time, there, in the NICU. “When I got back to my room after and the nurses got me settled, I wanted to talk to someone about what, if anything, they found out about Alex,” she says. “I still wanted someone to tell me what was going on and no one could. I was just supposed to go to sleep and find out in the morning. Needless to say, I didn’t sleep and spent the night in tears knowing that I couldn’t hold my baby and, even worse, that I had no idea what he was doing and what the doctors knew.”
What felt like an eternity -- and an unconscionable information blackout -- to the first-time mother bled into the next day, as she describes it. “This is where it becomes a bit of a blur with the doctors, nurses and eventually the patient advocates. There weren’t consistent, reliable answers," Tracy says. "We were told that [Alex] was doing well, but it was all very vague. I wanted to know what the next steps were and no one could tell me. I wanted all of the information and was getting very little. They told us Alex had to remain in the NICU, but they wouldn't tell us why or for how much longer. Navigating the system, a system with so many people involved, was extremely frustrating. It took many conversations, and tears, for us to finally get some answers.”
Tracy and her husband, Michael, both say they wish they could have looked to a parent empowerment tool such as NicoBoard during their ordeal with Alex. “It would have been incredibly reassuring and I think would have helped us to feel connected and a part of his care,” she says. “When you have no information and no communication, you feel like an outsider in the care for your newborn baby. Being able to track progress and know what to expect would have made an enormous difference, as this was our biggest frustration. We wanted to know Alex was getting the best care, but we wanted to be a part of it and not just bystanders.”
Nurse Johnson also says she “thinks it is a great idea” to have an app such as NicoBoard available to NICU parents -- in theory. In application, she suspects it would be an entirely different story. “I just don’t see the feasibility in this, honestly, for several reasons,” she says.
The longtime NICU nurse and nursing education graduate student says that parents of babies in the NICU are generally well-informed today, basically eliminating the need for an app such as NicoBoard. “Parents are already included in their baby’s plan of care,” she says, “and should be updated daily on their baby’s progress during rounds to meet the agreed upon goals. … This is something all hospitals should do, though some are better at it than others.” An increasing number of hospitals, Johnson notes, offer bedside cameras that enable new parents to watch their babies around the clock. One such hospital is Cedars-Sinai Medical Center in Los Angeles.
While Phil recognizes that nurses and doctors are “absolutely essential to a NICU baby’s journey to wellness,” he says that they have a ways to go in more clearly and consistently communicating with parents. And he thinks NicoBoard can bridge what he characterizes as a serious and systemic communication gap.
“Verbal communication is subjective, and what is needed to convey objective truth is visual data,” he says. “For instance, I, and many NICU parents, often heard 'better!' and 'not good enough' from different healthcare team members for the same lab test. There are so many stories of powerless parents out there, even those who were at great hospitals.”
As for how adopting NicoBoard would benefit hospitals, Phil’s value proposition pitch is that the tool can increase revenue, improve compliance, reduce litigation risk and lead to better physician productivity.
Drivers behind a potential revenue increase for participating hospitals, he says, could stem from enhancing communication with NICU parents, which could then enhance the organization’s reputation and ideally result in a boost in occupancy rates. As for the possibility of reduced litigation risk, Phil says engaged patients sue hospitals less frequently in the event of unwanted outcomes. And, lastly, he foresees a bump in nurse and physician productivity when using NicoBoard as a visual aid to more efficiently and speedily explain patients’ conditions and care plans.
One baby step at a time
While Phil doesn’t have a NicoBoard deal in place with any hospitals just yet, he says he’s in contact with multiple “interested parties.” He’s working on securing a first adopter to serve as a proof of concept. By early next year, he anticipates that NicoBoard will be a fully functional product and service, generating revenue and, most important, empowering parents to play a more active role in their children’s healthcare.
Today, Phil’s nascent passion project is only five months old. Though he hasn’t officially hired any staff yet, he hopes to do so soon. He’s raising a seed round starting this week and, once the round is complete, he’ll kick off his search for talent.
He hopes the memory of his daughter, Nicolette, the baby girl his startup was christened in honor of, will live on through the many parents and newborns he hopes to help in the years to come.