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Physician Entrepreneurship & Innovation in Healthcare with Dr. Brian Rothstein

by Jen Barna MD, Leadership, Life Journey, Physician Side Gig, Podcast, Work Life Balance, Work Life Integration

In this episode, Dr. Brian Rothstein tells us about the exciting things they are doing at UH Ventures at University Hospitals Cleveland Medical Center, physician entrepreneurship and innovation in healthcare.

“Come to us, let us help you figure out what the value of your product is so that when you take it back to market you can be successful.” -Dr. Brian D. Rothstein

In this episode, Dr. Jen Barna welcomes Dr. Brian Rothstein to the podcast. Brian D Rothstein, MD is the Director of Pediatric Skull Base and Neuro-oncologic Surgery at Rainbow Babies and Children’s Hospital, and the Director of Neurosurgical Innovation for the Department of Neurosurgery at University Hospitals Cleveland Medical Center. He is an Assistant Professor of Neurosurgery at Case Western Reserve University School of Medicine and is the Chief Medical Officer for University Hospitals (UH) Ventures, where he serves as the chief clinical advisor supporting their platform. Here, Dr. Rothstein talks with Jen about UH Ventures and the work they are doing to collaborate and innovate in healthcare. You will hear about some of the success stories they’ve had as they bring clinician ideas for products into reality. Are you a physician entrepreneur? Ever have an idea about how something can be done better? UH Ventures is an excellent example of how a healthcare system can partner with clinicians to bring great ideas to improve healthcare to the forefront.

Dr. Brian D Rothstein attended the University of Miami where he received a Bachelor’s of Business Administration in Marketing and worked in the Sports Marketing and Marketing Consulting industry before attending Medical School at Case Western Reserve University School of Medicine for his MD. He also obtained a Master’s of Science in Applied Anatomy while attending Medical School. Brian completed his Neurosurgery residency at University Hospitals Cleveland Medical Center, and a fellowship in Pediatric Neurosurgery at The Ann and Robert H Lurie Children’s Hospital of Chicago. 

Brian’s clinical interests include Pediatric Neurosurgical Oncology, skull base surgery, and neuro trauma. He works closely with the University Hospitals Concussion program, and serves as an Independent Neuro Consultant for the NFL. Academically, he has research interests in neurooncology and player safety in high school contact sports. Outside of work, Brian enjoys spending his free time with his wife and three young children. 

You may also enjoy these episodes related to physician entrepreneurship: A Magic Solution with Dr. Lilit Garibyan, One Doctor’s Epic Journey of Medical Discovery with Dr. Lilit Garibyan, Four Pillars of Success for Every Physician with Dr. Lilit Garibyan

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Podcast produced by: Amanda Taran

Please enjoy the full transcript below

Dr. Brian: Come to us, let us help you figure out what the value of your product is, so that when you take it back to market, you can be successful.

 

[DocWorking theme]

 

Jen: Welcome to DocWorking: The Whole Physician Podcast. I’m Dr. Jen Barna and I want to take a moment today to thank you for being here with us on the podcast. We are so fortunate to have amazing, interesting physicians who are living their best lives and doing so much in addition to the typical work schedule. I have a fantastic example of that here with me today, Dr. Brian Rothstein, the Director of Pediatric Skull Base and Neuro-oncologic Surgery at Rainbow Babies & Children’s Hospital, and the Director of Neurosurgical Innovation for the Department of Neurosurgery at University Hospitals Cleveland Medical Center. He is an Assistant Professor of Neurosurgery at Case Western Reserve University School of Medicine and is the Chief Medical Officer for UH Ventures, where he serves as the chief clinical advisor supporting their platform. Dr. Brian Rothstein, welcome to DocWorking: The Whole Physician Podcast.

 

Dr. Brian: Thanks, Jen. Great to be here. Really excited to have the opportunity to chat with you today.

 

Jen: Well, thank you. I’m very excited to chat with you and hear about everything you’ve been doing at Case Western Reserve, especially to hear about UH Ventures, which is something that is very exciting that you guys have going on there and I think it’s really a model for other institutions. And so, I’d love to hear a little bit of a review about what that is and how you became interested in it?

 

Dr. Brian: Certainly, again, thanks very much for having me. Very exciting to be able to share our story at University Hospitals in UH Ventures. We are the innovation commercialization and venture capital or investment platform for our healthcare system. We’re really lucky, because you’re right, we are a little bit unique. I think there’s a lot of venture capital groups that are coming out of large healthcare systems and I think that there are plenty of innovation groups that are part of large healthcare systems. I think really where we’ve been able to differentiate ourselves in the marketplace and ecosystem is that, we’re blending both. Really, the way we think about who we are and how we work with our colleagues here at University Hospitals in Cleveland, Ohio is, how do we help people cultivate their great ideas? How do we empower our clinicians? When I say clinicians, I mean, everybody who works in our healthcare organization, whether you’re an EVS worker, to a nurse, to a practicing physician, or an administrator.

 

If you work at the hospital, here, you’re a clinician. And we value what you bring to the table, how we bring your great ideas into the fold that will, one either inform the way we think about creating new products and services, or help us understand where the gaps in our care delivery systems are, so that we can go out into the ecosystem and find solutions, that we can bring into university hospitals to solve those problems. All of that work then really informs our investment thesis. Where are we making smart strategic partnerships, where we could benefit both University Hospitals, as well as our strategic partners to make an investment in their platform? That’s really, in the shortest version I can give you, who we are as UH Ventures.

 

Jen: It seems as clinicians, we are super busy and engaged with the work that we have at hand every day and it seems very common for us to remark to each other like, “Oh, wouldn’t this product be better.” In the mammography world, my techs and I are always joking like, “This biopsy table must have been designed by men. [laughs] It’s not comfortable.” There are ways you could improve that and we’re always talking about that. But of course, we don’t have time in our schedules to make that happen. What you’re doing sounds especially interesting to me, because I think there are so many people who are out on the front lines with great ideas. The question is, how to help them to get involved in the process of bringing an idea to reality ultimately to improve patient care and is that who you see as the entrepreneurs that are coming in? Or do you have a way to help a busy clinician, who has an idea, to bring that idea into a product, or do you have people who already have developed products coming to you and getting further financial investment in their product?

 

Dr. Brian: Great questions and the answer is “yes” to both. Really, the role that we play in our healthcare system is that of helping inspire a culture of innovation. That culture of innovation to your point could come from mammography tech and it’s funny because I actually had this conversation literally two weeks ago around mammography and how, yes, everything about the system had to have been designed by a man. If you haven’t actually seen the mammography table in the way that the system works, it doesn’t resonate. But once you walk in and you see it, yes, that can’t be comfortable, that can’t work ergonomically, there’re so many constraints. The way that the system is designed, and certainly it works for what it’s designed for, but it could probably be better.

 

So, the answer is yes. When we have a clinician, who works as a mammography tech or someone who works on a frontline, who sees a challenge with the way that the Alaris pump is working and they have an idea for a solution to that problem, we ask them to bring those solutions to us. We ask them to bring them in the form of a question or a problem statement and say, “This is the challenge that I’m having.” Because in design thinking and design theory, it’s really easy to come up with a solution, but that solution doesn’t always necessarily really address the root of that problem. What we really try to do is educate our teams here at University Hospitals around the concept of “What is human centered design? What is design thinking, and how do we tease out? What is the problem statement or what are the ‘how might we’ questions? How might we fix this problem?”

 

It’s really fun and engaging and it really gives people a chance to come to us with a really simple, literal “back of the napkin” idea. I was sitting in the cafeteria and I’ve been having this problem with x system in the hospital, or this type of patient, or this disease process, or I’m a surgeon and the tools that I have just aren’t adequate for what I’m trying to accomplish. I drew this picture, I think it could be a game changer in orthopedic surgery, but I don’t know what to do. That’s what our team is there for. They’ll evaluate that idea. We’ll do some market diligence and understand, “What’s the real need? What’s the real opportunity?” and interview that person who came with the idea. We have something called an invention disclosure forum, where we allow our clinicians to protect their ideas. If we can find something that’s really novel, it should be protected, intellectual property and potentially patentable. So, we go from the ground level of the “back of the napkin” idea and picture all the way up to the way that you asked the second part of the question.

 

Someone, who actually was in their garage tinkering, built their own prototype. That’s happened, too. We had somebody, who was very unhappy with the mobility of children who are ventilated. It’s very hard for toddlers, who have trachs, who need to be able to move around their home, and they’re been dependent with tracheostomies. And they came up with a really cool idea of something they built in their garage and they brought it into the venture suite and said, “Hey, can we actually make this into a product that we could use?” From that, we call this the “Homegrown Inside-out Pathway.” It doesn’t matter where the idea comes from, in terms of who has the idea or what the idea is. Everybody gets that attention to be able to say, “Could this really transform the way that we deliver care or could it transform the engagement or the experience that our patients can have, if we were to use something like this?”

 

We try to put that lens on it, because our goal is to find the greatest ideas no matter where they come from. Sometimes, really small ideas turn into really incredible big things and those could be service line changes, those could be care delivery models, they could be new care pathways, they could be products and services or devices, they could be an app, or be an AI algorithm with machine learning that transforms the way that we manage our blood utilization in the hospital. Those are all examples of things that have grown out of the UH ecosystem through the venture’s platform.

 

Jen: If I’m hearing you correctly and I love the examples that you’ve given, it sounds like asking the right question at the beginning of the process is a critical step. Would you say that that’s the case?

 

Dr. Brian: Absolutely. I think that we try to create a culture around learning as well. We have great partners both locally inside of university hospitals within the ventures team, who are experts at that. We have folks who have PhDs in design thinking. We have people who are industrial designers and have engineering backgrounds who can really help us tease out those key pieces of that question. But we also dedicate a tremendous amount of time to education. We have recurring innovation days that happen where we can introduce themes and concepts. We have a program called Innovation on Tap, where we actually host a lunch and learn if you will, where we teach about design thinking, about human centered design, about IP, how to protect your IP, how to think about ideas, how to ask good questions. We host full day long events that are just devoted towards innovation in particular realms of healthcare.

 

We’re really lucky in that we have a lot of support from our healthcare system as well as donors. We have been able to recently receive a gift from Ellen and Michael Feuer. Michael Feuer was the founder of OfficeMax. He’s a Clevelander and he is a true innovator in his time. He created that big box store that didn’t exist before. He sees the value of the smallest idea. Actually, he and his wife donated a really large sum of money for us to create our own incubator. To that point around how do you ask the right question, we actually do a call for ideas four times a year, where we go out to the entire system and we say, “Hey, what’s your idea?” Bring it to us. We review it, we go through it with Mr. Feuer and our chief medical officers, and also our CEO of our system, Dr. Megerian. Dr. Megerian and Mike pick the winners and then we fund their projects. So, we try to take an idea and a question and we tried to turn it into something real. That’s really the exciting part about what we’re doing within Ventures from an innovation perspective.

 

Jen: My first question is, is it limited to Case Western Reserve, Cleveland as a metropolitan area or what are the limitations?

 

Dr. Brian: For these funding mechanisms that we have in place currently, they are local. Meaning, it’s within University Hospitals, Cleveland Medical Center and then our surrounding hospitals. University Hospitals Health System is a very large regional healthcare system. We have more than 20 hospitals. Every single one of our employees gets the message and can participate in this. It’s really nice. We have other mechanisms where we can engage with, and partner with, Case Western Reserve University, and we have a very close relationship with their tech transfer office. As one of our primary academic affiliates from a university perspective, from a biomedical engineering perspective, neurosciences perspective, all of those things, we have mechanisms to share IP, and do things together, and ensure that great ideas come to the light of day. But really these particular things that we just talked about are UH specific opportunities.

 

Jen: Say someone is in your system and they come to you with an idea, how much ownership do they retain of that idea in terms of partnering with an incubator or with other parts of the UH Ventures? For example, how does that work in terms of individual retainment of IP?

 

Dr. Brian: Great question. It’s a really common question. We are really fortunate here at UH. We have a really generous policy as it pertains to how one, we protect IP and the fact that there’s very little costs of the entrepreneur to protect that IP and number two, what they retain, which is essentially 50% ownership. We’re very different. A lot of healthcare systems don’t allow their clinicians to maintain that large of a percentage of ownership. Specifically from a royalty perspective, if we actually were to build something together, and commercialize it, and take it to market, you essentially own 50% of the royalty stream that comes from that product that you develop. We tried very hard and had been very fortunate to create an atmosphere that really values the clinician’s participation in innovation and entrepreneurialism. We’re lucky because we’re different. There’s a lot of other healthcare systems, who aren’t as generous to their clinicians. There are others who are more generous and I think that there’s always a bell curve and where you fall.

 

We at UH Ventures, we have a desire to help create alternative revenue streams that can flow back to our institution and those come from the commercialization of products and services. They come from developing things with outside companies who come to us. That’s one area we haven’t really discussed yet is the, “I found a gap in the services that we have, we can’t build it ourselves, but there’s this great company that has this app or this algorithm that we could use.” We invite them to come to present to our care providers and say, “Could this fill that gap?” If it does, is it a fully baked idea, is it an early-stage company, do they need some help in thinking about how does it actually roll into a clinical workflow? Because a lot of the startup companies don’t have clinicians on their team. They may have an advisor or a CMO, those types of things, but they may not necessarily have all of that data that they need to help make good decisions around workflow. Physician efficiency, the extra click problems, all of those pieces that make work flow and what we’re doing on a day-to-day basis from a clinical perspective really challenging. So, we’ll partner with these companies that are early stage and we’ll help them evolve their technology or evolve their product from a co-development perspective.

 

Sometimes, that means that we end up with some ownership stake in the company just because of the work that we’re doing together and it also then permissions us to consider making an investment as well. We’re really trying to find any way possible to inspire innovation and entrepreneurialism in our entire ecosystem. That second question is, although a lot of the incubators and the awards that we have are UH specific awards, the way that we work within our local environment and try to inspire people to want to participate in delivery of care, and most importantly in bettering the health and wellbeing of our community, really puts us in a unique position to be a great anchor partner.

 

Jen: It sounds like a huge opportunity for startups that could help your hospital system in addition to clinicians within your hospital system.

 

Dr. Brian: Absolutely. I think that it’s nice because we represent what most hospitals look like across this country. We have partners that are local, regional, national, and international. A lot of times, they’re just looking to get that experience in a friendly environment, where they can learn and evolve their product, and it’ll help them when it comes to the sales cycle elsewhere. We like to consider ourselves the living laboratory, and laboratory in a different sense than many clinicians think about it from the bench research side or the chemical side. But really come to us, let us help you figure out what the value of your product is, so that when you take it back to market, you can be successful. That’s what we love, seeing our partners be successful.

 

Jen: Can you tell me an example of a partner that has come through UH Ventures and has had success? Maybe give me an example or two of those?

 

Dr. Brian: I can give you two examples. One, that’s from inside and one, that’s from outside. I think it’s always nice to think about the dichotomy of perspective there. One of the companies that came from outside that we actually did a lot of work with very early on and they recently had an exit, is a company called Conversa. Conversa is a chatbot tool that really helps with facilitated conversation and healthcare. We partnered with them about three years ago, very early stage, included in an investment in the company, wanting to use their technology and help think about the evolution of their technology. For better or for worse, actually, COVID really became a pivotal moment in that company’s lifecycle. The work that we did together to create our screening tools for symptomatic screening for our employees. Really Conversa became the way that our employees did their screening every day. It was a great opportunity for us to leverage the technology, and really push it forward, and work very closely with them as a partner. I really believe, and this is a selfish belief, that the role that we played with them as a partner organization really helped them continue to grow and really informed the success that they had in terms of an exit, very early in their lifecycle.

 

Another company, that’s a local company, that’s our company. It goes back to that conversation, where I talked a little bit about blood management. We have a company that we spun out of UH Ventures called Hemaptics and their platform is called HaemaLogiX. What it is? It was an idea that actually came from an administrator that said, “Our blood utilization isn’t great. We ordered too much blood transfusion and not necessarily for the right reason. It’s a systemic problem in healthcare today. And not a lot of people have been able to solve that problem and we actually looked outside of our organization to try to find a partner, like a Conversa of the world or another company that existed that was looking into this problem, that we could bring in to either just buy their technology to use it or work together.

 

We literally could not find a single platform that was addressing the kind of root cause challenges that we were having with regard to blood utilization and blood management. One of our critical care physicians got together with one of our nurse managers, one of our folks who works as a manager of the blood bank, and one of our IT experts, and they said, “Okay, if we were going to build something, what would it look like?” And they did. It took them two and a half years to go through iteration and design developing the algorithms, but they built a product that is now available for sale in the marketplace and it is a blood utilization management tool based upon algorithms that provides both dashboards to clinicians and as well as a platform for education. So, I could go to you as a clinician, who’s ordering blood transfusions and I could show you, listen, if you look at the way that you order blood transfusions as compared to your peers, you’re actually an over-utilizer and here’s why you’re an over-utilizer.

 

It doesn’t create a punitive conversation. It creates an educational opportunity for me to educate you to say, “Listen, I get why you ordered and I can see all the reasons why, but maybe if you thought about X, Y and Z criteria, it might change your decision to order a blood transfusion for this patient.” So, it’s just an example of how a homegrown mandate, it wasn’t really an idea, it was like, we need to do better, we need to do a better job of being stewards of blood, turned into a product that’s now commercially available.

 

Jen: Fantastic. What interesting examples. I love hearing about those. I think a lot of physicians get so engrossed in the grind of every day that it’s easy to lose that feeling of purpose in what we do. When you have something like this that you’re doing in addition to your work as a physician in your specialty, I think it gives you that extra something that you’re looking forward to that you’re really enjoying every single day in your work in a different way than you enjoy the work that you do in your specialty. It gives you that extra incentive to just want to be there and want to be involved. So, I’m curious how you came to this particular interest and how that influences your work in neurosurgery?

 

Dr. Brian: Certainly, that’s a great question. It comes down to the fact that I’ve always been a tinkerer and someone who likes to ask questions. My background actually is not that of healthcare or science. I actually went to undergraduate business school. I studied marketing and advertising. That’s where I started my career actually, in sports management. After a couple of years of working in that field, I just recognized that it wasn’t where I wanted to be long term. It was a very selfish decision, but I just wanted to be doing more for other people.

 

My dad was a pediatric gastroenterologist and I was like, “Never do I ever want to be a doctor.” I know what his lifestyle is like, he’s leaving in the middle of the night, not around. But it actually turned out that he was really just an incredible role model from that perspective and it had a lot of silent influence on me. When I finally realized that medicine was the right path, I went to medical school. From the moment that I was in medical school, I started asking questions like, “Why do we do it this way?” It’s a classic business approach to things, and trying to solve problems, and trying to be evolutionary in the way that we do things not necessarily transformative, but why do we do it this way, why do we educate this way, why do we document this way in the medical record? Why do we use these products in the operating room as opposed to these ones, because these ones cost a lot less and they do the same thing? So, all throughout my education and residency, I did a lot of cost analysis work, a lot of innovation work. From a service design perspective, how do we bring new services to our patients that they don’t otherwise get? It really just sparked this kind of creative juices that I was missing from my old career in business that, not that you can’t be creative in medicine, but really in a different way.

 

It was a natural evolution. As a resident, I began working with what was the early version of UH Ventures and was called UH Innovations. I spent some time with them during my research years in residency. After I came back from fellowship, I just knocked on the door and I was like, “Hey, I don’t know what I can help with, but I love the things that you guys are doing. You’re meeting with startup companies, you’re having startup challenges, you’re an incubator.” It just all sounded, for lack of a better term, really cool. I was like, “Can I just play in the sandbox? Can I be a part of all of this?” I started off by volunteering my time. When you’re building your practice fortunately, especially in pediatric neurosurgery, it takes some time to get busier, and I had the time to dedicate, and I just got involved, and I just said, “Listen, put me on the meeting. I’ll happily show up. I’m happy to give my perspective. I like to ask hard questions.” It just organically grew into a really unique opportunity for me that evolved to the role that I have today.

 

To answer your specific question, I literally have the best job in the world. I get to do what I love clinically, which is to take care of children and their families, who have neurologic illness. Yet, I also get to work with all of my partners in our healthcare system to help them be fun, creative, and innovative thinkers about how we influence our community. Because when I made that decision to go from being in business to being in healthcare, I wanted to help people. What I think sometimes we get very tunnel vision around, is when we pick a specialty, we help one person at a time. For some people, that’s great and they love that. What I realized is that, although, I like doing that, I really liked trying to help everybody. So, I get to do both now. I get to fix problems in children who have neurologic illness, hopefully, most of the time, and help them and their families get well, and improve their quality of life, and the longevity of their life in certain situations, which is an unbelievably rewarding opportunity to have. I’m humbled every day by the opportunity to help participate in their care.

 

But then we get to think globally in the Venture suite. How do we affect the microcosm that is University Hospitals? A little bit macro perspective, the city of Cleveland and Cuyahoga County, a little bit more macro, how do we use the leverage, the power that we have within our institution to affect the region, and then hopefully we are able to participate in some form of transformative care delivery change that affects lots of people around the country and potentially the world. It’s just exciting and it’s invigorating. As much as I love my three children, and my wife, and our two dogs, and our cat at home, there’s not a single day that goes by that I’m begrudgingly walking to work, leaving my car. It’s just such an exciting time to be a part of healthcare innovation and I just feel so lucky to have the opportunity that I have.

 

Jen: That is fantastic. Well, how do you balance that? How do you balance the home life and the work life or do you find that you just, you love the work and you work all the time or what’s your take on the balance of it all?

 

Dr. Brian: I will openly say, I’m learning. That’s still pretty early in my career from a practicing perspective. And I think every day is an evolution. In general, I split my time. I’m 60% clinical, 40% administrative, but as we both know, clinical takes whatever responsibility it takes and sometimes, that’s 100% of the time and sometimes, the administrative work requires more time, energy, and effort. One thing that I learned from my dad is that, I wanted to be present and accounted for. Although, he wasn’t home all the time, when he was home, he was present and accounted for. Obviously, cell phones were very different back then when I was a kid as they are now. I have to remind myself to put it somewhere where I can’t see it, unless I’m on call and I try really hard and my wife helps me remember that piece of it, because there’s always more emails to check, and there’s always more things to be doing. But I really try hard to say, “At the end of the day, I’m going home to be with my family, and to be with my kids, and be engaged until bedtime.” After bedtime, if there’s more work to be done, then I’ll get back on the computer and do more work.

 

But a mentor of mine taught me that it is possible to not do work at home as long as you’re really diligent with your time during the day and I haven’t figured that one out yet, but I aspire to be able to do that. Then to answer the specific question, it all depends on the week. If I’m on call, I tend to be more clinical, but try to participate as much as I can in Venture’s related activities. When I’m not on call, my schedule works out that I have every other day setup, where it’s clinical day, Ventures day, clinical day, but sometimes, they overlap. What I’m fortunate to have is an unbelievable group of leaders within the Ventures team and our entire team just understands that, for me, my clinical role is my number one priority always and no one ever asks a question, no one ever blinks an eye if Brian is not there. They know that I’m there in spirit, and that I’ll get caught up, and that I’ll, you know, be able to contribute when the time comes. But if I leave a meeting or I take a pause and answer a question, it’s because we’re doing something that’s more important from a personal perspective of taking care of a child.

 

Jen: Fantastic tips. It sounds like you’re absolutely on the right track. I really appreciate all of your insights. You are such a great example and also doing such interesting things. I look forward to hearing more as time goes on of all of the different projects and ventures that you get involved with. And thank you so much for joining me today on DocWorking: The Whole Physician Podcast.

 

Dr. Brian: Thank you so much for having me, Jen. It was a pleasure to talk to you and hopefully, we can come back and continue the conversation sometime soon.

 

Jen: Absolutely. And then in the meantime, if someone is interested in reaching out to you, what is the best way for them to find you?

 

Dr. Brian: I can say that I’m not the best when it comes to social media, but I’m on LinkedIn and certainly it’s a great place to find me, just Brian Rothstein. You can find us at University Hospitals Ventures at uhventures.universityhospitals.org. And it’s a great way to learn more about our platform as well as inquire about participating in the work that we’re doing.

 

Jen: Thank you again, and thank you for listening to DocWorking: The Whole Physician Podcast.

 

[music]

 

Amanda: I’m Amanda Taran, producer of DocWorking: The Whole Physician Podcast. Thank you so much for listening. Please don’t forget to like and subscribe, and head over to docworking.com to see all we have to offer.

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