The Next Factor: Cooper and Factor 14

Factor 14 is a startup developing both hardware and software focused on helping the four million patients currently taking oral anticoagulants manage their care remotely in the hopes of reducing healthcare costs and improving outcomes.

When Cooper connected with Factor 14 during the start-up’s incubation period at Rock Health, a design mentorship was born. Co-founders Ryan Bloom and Raman Talwar worked with Cooper designers Izac Ross, Lauren Ruiz, and Cale LeRoy for six monthly design sessions. We recently caught up with Ryan and Raman to ask them about their journey from premise to prototype….

Cooper: You guys have a great story — tell us about the origins of Factor 14.

Ryan Bloom: Well like many startups, we initially got motivated to solve a problem. We saw that anticoagulants — blood thinning drugs — are presenting a huge challenge in the healthcare space and if you talk to clinicians, you hear that it’s one of their pains on a day-to-day basis. 

Raman Talwar: Yes, these drugs have a narrow therapeutic range which means that there is a delicate balance between thinning the blood too much or too little. And a lot of factors can impact the patients’ ability to stay in that range, from diet to other new medications they may start taking. 

So the problem is that often times doctors have to bring patients in to their offices once a month, for the rest of their lives, to monitor their blood’s ability to clot. They look to see if the blood is coagulating at a rate that minimizes risk to the patient, and if not, they decide if they should change the dose. 

There are 13 factors that cause your blood to coagulate. Factor 14 is going to be the next evolution — all those 13 factors manage your coagulation, but Factor 14 will do it better. 

Ryan: Raman’s mother-in-law is a nurse who worked in an anti-coag clinic and she would tell him about all of the challenges she ran into such as whether or not the patient has taken their pill, or if they’re on a new prescription that affects their anticoag medication. This process is very involved and takes a lot time. It’s also difficult to move care outside of the clinic and into the home, but we saw that as an important goal connected to reducing healthcare costs and improving outcomes for the patients as well.

Raman: To get there, we created a device similar to a glucometer that patients can use at home. They can use this device without a doctor’s visit and monitor themselves once a week instead of once a month, so they can catch problems before they escalate and keep their anticoagulation therapy more stable.  We’re also working on an algorithm that can incorporate data from the device as well as other information from the patient’s medical history, to guide the appropriate clinical interventions. 
Cooper: That’s a huge benefit. Can you tell us a bit more about the algorithm?

Raman: Developing an algorithm to guide medical practice can be challenging because at one extreme, you can have an algorithm just spit out a recommendation with no context as to where that recommendation came from. This can be unnerving to health care professionals, particularly if they disagree with the output, and it can often times lead to them not using your product. However, at the other extreme, you can spit out so much information that it completely overwhelms the physician, and again, they won’t use it. So it becomes a significant design challenge to give healthcare professionals enough information such that  they are comfortable that they’re doing what is best for the patient, but not bog them down in data and algorithms such that your product doesn’t fit into their hectic workday. We are piloting our software technology right now with the goal of finding that optimal middle ground.  We want doctors to be able to interact with the algorithm and not have it be “one size fits all.” Mathematically we can do all that, but the key will be effective interpretation and implementation of the feedback.

Cooper: We’ve had a lot of fun working with you through Rock Health. What has the design process and Cooper’s mentorship been like for Factor 14?

Raman: I have a lot of respect for the design process. A lot of what Cooper has shown me is that it’s pretty hard to do design well. They’ve done an awesome job of teaching us and showing us how to do it. The thing that’s tough — and what I like about working with Cooper — is realizing how important it is, and that I can’t do it alone.
Ryan: I totally agree. I’ve been impressed by the scope of design. It’s much broader than I thought before. It’s not just making something pretty. What really opened my eyes was the service diagram. Cooper got us to really think through our product end-to-end, exposing pain-points and areas of opportunity. 
Cooper: That’s great, we always learn a lot too. So now that you’re further underway, what is your day-to-day work like?

Ryan: Right now, at a high level, the best I can describe is we’re going out, collecting the puzzle pieces, and putting them together into a cohesive story and business.
Cooper: Do you have any advice for someone starting their own company?

Ryan and Raman (in unison): Don’t do it! (laughter) Just kidding.
Raman: Find the right partner to do it with. Founders are important. You have to be really clear on why you’re doing it. If you’re doing it to make money or because you want to be your own boss, you can make a lot of money at places like McKinsey, and you can be your own boss in a lot of other ways. You really have to find a problem you’re passionate about, and motivated about, because there will be really down days and really up days. Without that strong foundation and a good team, it’s really hard to do.

Cooper: Is one of the puzzle pieces figuring out how you take this piece of technology and integrate it into healthcare?

Ryan: Yes. We’re shooting for our first clinical study at UCSF. It will be a big milestone for us to show that the diagnostics work. We have pilots up and coming on the dashboard you guys have worked with us on. And we’ll hopefully be raising money soon. 

Raman: Right, those are three big milestones for us. And as more care moves outside of the office, we’ll also be developing new ways to recreate the context in which the clinician is used to seeing the patient, leveraging data physicians can use. 

Cooper: Which circles us back nicely to where we started — improving healthcare at the human level, something we strive for as designers as well. Thanks guys! That’s a great point to end on. 

Lauren Ruiz

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