#14 Hannah Burrow of Kiroku on Disrupting Dentistry, Pitching at the Palace and Low Tech "Pretotyping"
By Nasos Papadopoulos, EF Head of Content
Hannah Burrow is the CEO and Co-Founder of Kiroku, a company that automatically writes clinical notes for dentists.
Kiroku which is Japanese for "to document or record” uses a unique combination of speech recognition and natural language processing to produce expert level notes which has the potential to save $40 billion worldwide in the dental market alone.
Hannah met her co founder Jay on EF8 and since pitching to investors at Demo Day they’ve been developing the product further and are currently trialling it to a closed group of beta testers.
Hannah qualified as a dentist from the University of Bristol and since then, she’s worked in practice, hospitals, and public health. While in practice she optimised her workflow by developing educational software for patients and joined EF8 with the intention of solving some of the problems she’d faced in the industry.
In this episode Hannah and I discuss:
- Her experience in the dental industry and why she decided to join EF
- The early stages of customer development for Kiroku, where Hannah used low tech "pretotyping" by transcribing conversations into clinical notes for dentists herself
- How Hannah has gained the technical knowledge needed to run a deep tech company
We also dive into Hannah’s advice on pitching, her experiences on EF and how she started working with her co-founder Jai on the program so the conversation will offer you a combination of solid practical advice and insight into what it’s actually like to build a company on EF.
When To Use Data and Intuition in Decision Making
How I Used Low Tech "Pretotyping" to Get Customers
Why I Joined EF as A Non Technical Founder
Nasos: Hannah, welcome to the show.
Hannah: Thank you.
Nasos: It’s awesome to have you on. To kick us off, give me a quick intro to Kiroku and tell me how the world is going to look different when your mission plays out the way you hope it does.
Hannah: [00:03:00] At Kiroku, we're building technology that is automating the process of clinical note taking. It's able to listen to a conversation between a professional and their client and from that conversation, figure out what's relevant and generate their records in the format that they need them to be. We're focusing on health care in the short term, but in the long term it will be any industry that needs to take records.[00:03:30] As for how the world will look different with Kiroku, it's a totally different way of organizing information. If you can start being able to compile the expert language by industry and how that differs from the conversation that's being had, then it can apply to anything. You can summarize any conversation that you have. Let's say you go and see a mechanic. You come away and you've got an email saying that here’s one option, here's the other, and here's all the pros and cons - any conversation could be broken down like that.
[00:04:00] What's more, once you're able to structure that conversation and that information, you can do anything with it. It doesn't have to be record keeping. It can be reminders, information, more education for you - there's loads of things you can do with that.
Nasos: If you allow yourself to let your mind wander, which of the applications are you most excited about? Obviously you're focusing on health care at the moment, specifically dentistry. Are there any particular fields that you think “Wow, it would be amazing if we could apply our technology to this?”
Hannah: [00:04:30] It's still just health care. Being able to provide this for all doctors and dentists is important because it’s such a huge problem within health care. They have to spend a lot of time doing boring administrative tasks. If you free up all that time, they can care for and have more empathetic conversations with patients because they're able to engage with it better. So it's actually health care that makes me most excited.
Nasos: [00:05:00] You had first hand experience with the problem that you're trying to solve, right? Tell me a little bit about what your day-to-day looked like when you worked as a dentist, you were seeing lots of patients and tell me how you were starting to think about that.
Hannah: I worked as a dentist and practiced doing NHS on private work. As a dentist you're paid a proportion of what you do in a day. If you see 30 patients in a day, you're going to make a lot more money than if you only see 12 patients in a day. You cram it in, and I was seeing slightly over 25 patients a day. It’s in and out, really quick, particularly with NHS work.
[00:05:30] You're seeing a patient, you're having this conversation, you're trying to write up your records whilst they're in the chair. Quite often I would be giving them information about how to look after their health whilst I was typing. You can imagine I barely knew what I was saying, I was doing it by roads. I was doing it because I was ticking boxes in that I had to give them information, but I wasn't paying attention to it. At the end of the day I was stuck there writing up records.
[00:06:00] It was a very stressful process for me and what's more, is that as a dentist, I knew that doctors were also given constant lectures about not including enough detail in their records. They were told that they needed to include all the information that they had said. It's really stressful. You're stuck between a rock and a hard place because you don't have the time to do it, but you know that you're going to get in trouble if you don't so you're trying to make that balance. [00:06:30] I came to EF with many things that annoyed me about health care. I hadn't just worked in practice, but I'd also worked in hospitals as well, doing dentistry but within a different environment. I could see that all my colleagues were very intelligent people, and I couldn't figure out why they weren't more frustrated by how inefficient some of these processes were.
[00:07:00] I think that was probably the point that got me thinking about how you could apply technology to it.
Nasos: What made you apply to EF in the first place? Did you have any doubts in your mind about whether you were going to be a good fit for the program, and how were you thinking about it?
Hannah: [00:07:30] Yes, definitely. I think I actually applied for EF7 but towards the very end of it. I think I was a little bit more of a unique application - particularly then they weren't promoting the domain product, so I thought I probably shouldn't be applying. I did the application and they said that I got through these rounds, but they bumped me to EF8. Mine was a bit of a drawn-out process and I really didn’t think that I would be a fit for it.
[00:08:00] I didn’t see how a dentist would fit in, but I knew that I had an idea. I presented that I had this one thing that I had been working on there, and I built something and I'd tested it with my patients. I think I had something a little bit more concrete to apply with, which gave me a bit more confidence. With every round of applications I got a little bit more into it and I thought it was worth it, that it could actually happen.
Nasos: When you arrived at kickoff weekend you started having conversations with everyone, obviously all these insanely smart people in the room.
Hannah: Unbelievably so.
Nasos: [00:08:30] What was the sort of prevailing emotion for you? Did it feel a bit overwhelming?
Hannah: So overwhelming, I cannot describe it. During kickoff weekend I remember sitting down on the couch and I didn't really know what to expect. Someone turned to me and they asked what I was working on until EF kicked off. I said, well I'm a dentist so I'll probably be doing that until we get it started, and he said cool, yeah.
[00:09:00] He said he was assessing satellite images of Dafort and I was thinking, oh my God. Everyone there was so impressive and not only that, because of the situation where you're pitching yourself to people as to whether you're a good co-founder, everyone's giving their all so no one is talking about the Kardashians. Even when they're not talking about tech, they're talking about politics. Everyone is showing their intelligence. It was a very overwhelming situation, but it was so interesting and so switching on your brain. I came away exhausted but really excited to be starting at EF.
Nasos: Once you got started, how many co-founders did you have to go through before you found Jay and when or how did you know that he was going to be someone that you wanted to work with?
Hannah: [00:10:00] I didn't even know what NLP was when I started. So Natural Language Processing is an area of artificial intelligence. I'm sure everyone who's doing EF knows that, but I didn't before I started. I remember it being kickoff weekend and everyone was saying that their area of expertise was NLP and I was thinking NLP, what is that? Gradually, over the course of the weekend I figured it out and started chatting to people. I actually started working with one co-founder on this idea of whether you could diagnose diseases from exhaled breath.
[00:10:30] First we chatted at kickoff weekend, then we started working together on the first day of kickoff week and we worked together for several weeks. We were a good team, I really liked him and I think we worked well together, but we both concluded that it really wasn't my area of expertise.
[00:11:00] I'd covered biochemistry during my undergrad but it wasn't my area of expertise, so we parted ways and then I was in the lone founder pool for two or three weeks. I'd made the decision that I wasn't going to panic about it and the thing to do is just to go out and I came as a dentist, working in health care. I know where the problems are, so I just needed to go out and get some data about that. I went out and I was speaking to dentists and I was trying to do The Mom Test, which Savs really promoted then.
[00:11:30] I went and asked them those broad questions about what pisses a dentist off in their day-to-day. The answers I got were note taking and that people were spending so much time doing this. I feel like that was my ammo, I came back to EF with that and figured out that it was a problem. By that point I had a reasonable overview and understanding of what NLP was and what it was capable of, so we had figured out that there was a solution.There were several people who worked within that area. But Jay and I had been friends from the very start, not realizing that we could work together at all. We'd always wander to Abernethy station together and then I was like, oh my God, Jay! He is great and he's so good at this. He was actually in a team at the time, but they were crumbling and I was biding my time waiting for the breakup. Two minutes after they broke up I sent Jay a message.
Nasos: Straight in there.
Hannah: Straight in there - no shame. Rudy, who was his partner at the time, is also one of my good friends. Rudy eventually came to me and was like, shame Ms. Hannah. Anyway, after that Jay and I started working together. I couldn’t be luckier with a co-founder. He is so clever, so great and positive. He’s really good at balancing me out as well. I know that they say that and it seems like a trite to say, but we really balance each other out. I can think more bigger picture and Jay is really good at getting into the details and figuring out those things. Also, if I'm just feeling a bit worn out by something, Jay will always tell me, this is why it's fine. He's a great co-founder.
Nasos: [00:13:30] What were the first couple of iterations of the product then?
Hannah: We knew that we wanted to create an aid to note taking. Our idea of the product is almost exact same as what it was then. How we go about building it has obviously changed, but the overall mission has been the exact same. Jay could figure out a really easy way of putting something together, but we decided we needed to prove that people wanted it first. We'd spoken to quite a few dentists by initially calling and emailing them, and then I'd spoken at a dental conference. From that we had loads of inbound, and I think we were just very vague on the phone about what we had built so far. We said we're building this solution and it's going to automate clinical note taking for dentists, would you like to have a go?
[00:14:30] Dentists said, yeah that's great and so we did it. It was like setting up a phone call and what the phone was going to be like next to the computer. I don't know what people thought was going to happen. Anyway, I was obviously listening to the conversation - just feverishly typing at these clinical records, emailing them straight across. Obviously taking out anything patient identifiable and they were looking over the notes. They said, that's amazing that it can do that, and we were basically trying to figure out, do people want this?
[00:15:00] It's going to be really hard to build this but if we do, will we have a market? We also wanted to figure out if you could figure out this information to compile the records from one single appointment - just from the audio. You were able to figure out 95% of what you'd want in there, if not more. That was our initial low-tech way of proving things. We actually called that Hannah-bot.
Nasos: [00:15:30] Well Hannah-bot as I was saying to you before, is a part of EF folklore when people discuss things that don't scale. I've heard this story told three or four times already and I've only been here a few months.
Hannah: I've had people calling me from the EF Berlin cohort and they’re like, “Can you tell us about low tech?”
Nasos: Oh seriously?
Nasos: So people are asking you for advice now about it?
Hannah: [00:16:00] Yeah and I said this is how I did it in dentistry, I don't know how applicable that is. Interestingly, I went to a talk from the MD of Google for England in Europe. He was talking about pretotypes and its super low-tech ways of proving something before you start building it. It was really interesting because it was exactly that.
Nasos: How useful has advice been to you over the course of the journey? You get signed a VP at EF and I'm sure that you've also been seeking advice from third parties outside of EF. How useful and important has that been?
Hannah: [00:16:30] Very, very important but it's one of those things that the more advice you receive, the more you realize that it is just advice from everyone and some will be more educated advice than well intentioned. Not everyone quite knows everything you know about your business. You need to take it occasionally with a pinch of salt and I think when I started, I took all of it as fact.
[00:17:00] That isn't a bad thing, at that point I probably needed to but I think the more I've gone along the journey and the more advice I've received, the more you realize you can take bits and pieces of it but you don't have to take it all.
Nasos: How do you think about decision making in the context of running your business? Obviously we're living in a data-driven world, it's important to take the insights that you have in front of you but a large number of good business decisions also come from the gut, so how do you think about the decision-making process in the day-to-day?
Hannah: [00:17:30] I suppose in the earlier parts you don't really have that data yet, so you have to rely on your instinct and actually relying on it at that stage allows you to hone it and figure out what feels right and what doesn't. I think that when you've got the data, you should pay attention to that.
[00:18:00] There's been a situation where Jay said he felt really strongly about something and I said, okay let's go with your gut on this one. I think you have to weigh it but I think if you've got data to make decisions, you should follow that - you'd be a fool not to. But then there's situations where you don't have that.
Nasos: On that specific decision you just mentioned was it that the data was pointing in the other way and Jay was confident that the opposite direction was the one to go in? Or was it just a very strong sense that this was the proper course of action to follow?
Hannah: Yes. I think it was more that he just had a gut feeling, there wasn't really a huge amount of data. It was a weird thing to have such a strong feeling about, and we said, okay let's go with that and it's proven good.
[00:18:30] I'm glad that we did follow Jay's advice on that, but him and I have a system which is that if you really care about something, you've got to scale it out of 10. So if you say no, this is 10 out of 10 important to me. Well, it's two out of ten so let's go with your gut on this one and that is a really good way of just figuring out. Sometimes you argue for things because you feel you should, whereas occasionally you feel like this really is critical in your mind, that's a good way of communicating that I suppose.
Nasos: [00:19:00] Yeah in case of picking your battles, I guess. Over the last few months you have done a couple of really big pitches, so the EF demo day pitch and also pitch of the palace.
Nasos: How did your pitch at the palace change after the experience of the EF demo day pitch?
Hannah: I was calmer. I've done quite a few other pitches, actually not for investment or anything. Just talking about either dental conferences, Jay did one on a technology conference, just talking about what we're doing.
[00:19:30] The thing with public speaking is the more you do it, the slightly calmer you get. My pitch was actually pretty similar when I did the pitch at palace and even though a fair amount of time had passed, we just updated the things that were different. I was a lot more confident when I did the pitch at palace than when I did EF demo day.
[00:20:00] But I mean that makes sense, it was the first time I stood on stage and spoke about what we were doing.
Nasos: Sure, now you say it's a skill that definitely needs to be developed with practice. Is there anything that you say other than practice, practice, practice to the current founders on the 10th EF cohort in London, the 3rd cohort in Singapore, who are moving towards that kind of demo day and landmark? Anything that they should do in the preparation process, anything they should do on the day?
Hannah: [00:20:30] I think the advice the EF gives you is actually really good. I personally didn't like the arms. We were still a demo day that had the big arms.
Nasos: And the one, two, three.
Hannah: And the one, two, three, yeah.
Nasos: The famous EF one, two, three.
Hannah: [00:21:00] I definitely had a one, two, three. I think I had two actually. I can still see the benefit of doing it on a big stage like that, but apart from that I found the coaching and the level of detail that has gone into practicing and perfecting a pitch really useful. You feel very prepared by the time you go up, and if you forget when you're up there it doesn't matter. I mean I did, I had a moment where I was like, oh God, what is my next line? But it comes back to you and it plays on. I think that's what you live in fear of - that moment - and it's not that bad.
Nasos:[00:21:30] Did you find this clarity of message that you had to develop through refining that pitch over and over and over again helped you when you were talking to investors or potential people that you wanted to hire? Was it useful in that sense as well?
Hannah: Yes, definitely. Really, really good because the fact that you're forced into this situation where you've got to start articulating what you're doing in a really concise way is super useful. Any time that you talk about it I'm sure lines from the demo day pitch will come out of me.
Nasos:[00:22:00] You mentioned that you're bringing on three people now in the summer to start building the product. How have you been thinking about those conversations during the hiring process? What kind of character traits are you looking for? What sort of questions are you asking to see if these people are going to be the right fit for working at Kiroku?
Hannah: So that has been something that Jay and I don't have any experience of - hiring people - prior to our first hire. That was something that we really took our time with because we didn't want to get it wrong. We had many different conversations.
[00:22:30] We had technical conversations, we had separate ones that were just us chatting, just to try and break down the interviewee environment so you could see what the people were like themselves. A few things that are really important to Jay and I in that the embryo of our culture is forming which is that we have a really transparent and open relationship. If you haven't done anything, you just say it. If you found something hard, you just say it.
[00:23:00] Never trying to sugar that pill or anything like that, and that was something that was really important to us. We spoke about that, so I suppose trying to figure out that they were aligned in that respect. Equally so, Toby who was our VP during EF, also gave us the advice that you've got to be careful that you're not just selecting people who are like you.
[00:23:30] You want a variation of different types of people with different skillsets and that's something that I suppose is going to take more time and more experience for us to really hone that. We've been really lucky with Alan in that exactly like Jay and I have got slightly different skillsets, Alan's also got different areas of strength and different ways of working around problems. Can we reproduce that? Time will tell.[00:24:00] We're very aware of what is important to us and we're trying to optimize for that, so we'll just keep asking questions about things that are important to us.
Nasos: Sure, well hiring, as all entrepreneurs will say is one of the biggest challenges, so that's not a surprise. What has been one of the toughest moments that you had to deal with over the course of building Kiroku and how did you come back from the low point?
Hannah: [00:24:30] I wouldn't say it's one particular low point but with entrepreneurship you feel the highs and the lows more than any other career I've done. When things are amazing, you're just like, when can I take over the world? Then 10 minutes later you're like, why? You just feel it all. I suppose getting used to that had been pretty hard for me because particularly, coming from a career like dentistry things were pretty steady. You're never really worrying about the longevity of your career - it's all very stable. Just experiencing the uncertainty has been the hardest part for me.
Nasos: [00:25:30] To finish up with, what have you most learned about yourself over the course of the journey? We have spoken about the lessons that you've learned from a business sense - pitching, hiring, etc. but what have you learned personally?
Hannah: I suppose what I've learned is that people warn you before you start a company that it's going to be really, really hard and it's harder than anything else you'll do. What hardness has felt like for me is uncertainty and self doubt of whether you're doing the right thing.
[00:26:00] That's really hard because it's also destabilizing as not only is it a hard decision, it's should I be making this decision? I think just accepting that and the more you do it, the more you realize that self-doubt goes away a little bit. That you are doing the right thing, but the beginning stages of starting the company were the hardest for me. The thing I've learned is that if you really want to do something or be worth riding out those really hard bits, it's only going to get harder, but you know that area of difficulty.
Nasos: [00:26:30] Sure, well let's end on that note, Hannah thanks so much for coming on the show, it was awesome chatting with you.
Hannah: Thank you for having me.