In an Emergency, You’ll Want This Hi-Tech First Aid Kit

Ram Fish, founder and CEO of 19Labs, talks about developing his clinic-in-a-box


Ram Fish has seen the future of health care, and it’s in a box.

About a year and a half ago, Fish founded 19Labs, a Silicon Valley startup he sees as a platform for the next generation of digital health care. You might describe its core product, named Gale, as the first aid kit of the 21st century. But that doesn’t really do it justice. It’s more like a mini-clinic.

Gale has one drawer containing sensor-based, diagnostic tools, including electrocardiogram patches, an EKG and stroke detector, a fingertip oximeter for measuring pulse, a tool for examining inner ears and a digital thermometer. Data from those sensors can be transmitted to health care professionals. Another drawer is filled with medications and supplies.

On top is a pop-up touch screen that presents interactive treatment guides on everything from stings and bites to heart problems to child concussions. It also can be used for placing video calls to physicians or caregivers. To ensure that a person can stay connected to medical help during a call, Gale also has a built-in 4G cellular battery.

Gale’s initial market is health clinics in remote locations—pilot programs are underway in South Dakota and Canada—but Fish sees it as having the potential to become a fixture in schools, offices, stores, and eventually homes.

It’s an ambitious goal, but Fish has the credentials to back up his aspirations. Previously, he was Vice President of Digital Health at Samsung and once led the iPod team at Apple. spoke with Fish about where he thinks digital health is headed and how 19Labs could become a major player.

Where did the idea for Gale come from?

I have three young kids so dealing with a health situation is something you have to do frequently. It started when we were on a vacation in Mexico, a few days after I had done a presentation on the future of digital health and the auto-sensing and artificial intelligence (AI) technology that’s coming. We’re in this resort and one of my kids had a health problem, and none of those tools or AI technology know-how were available.

The more I thought about it, the more I realized there was an opportunity there. When we talked to investors, we actually called it “Android for health care.” It would be a device that would be in hotels, it would be in offices. The idea was to help the end user experience by providing portable health care access that is smart, that is useable and able to bring digital health care to places and people who did not have it available before. 

The goal was to bring all the different applications and experiences and services and technology together. From a business perspective, if you carry the right endpoint, you drive utilization and you control who ends up providing those services. 

Where did the name Gale come from?

That’s an easy one. Under 'Gale' on the device you see the number 19. The story here is that when you pronounce it, you’re pronouncing nineteen gale. Basically, we named it after Florence Nightingale. We really believed in the spirit of what Florence Nightingale did, but the name was too long.

What can Gale do?

I see this as a journey. The technology we have on version one is the most basic—stethoscope, an otoscope for ear exams, glucose testing, pulse oximeter, a blood pressure device. But what’s more exciting are the things that are coming up. We are working with a startup that is developing an ultrasound device. Another startup is working on a device that will be able to do basic blood lipid testing, so within a minute you’ll be able to get a whole lipid analysis done on your blood. Another startup is working on voice analytics. Not just to evaluate your mood. But they’re doing research on using those analytics to evaluate your heart. There are more and more analytics coming for different diagnostic devices.

We’re looking at this as an opportunity to help those vendors go to market in a really integrated way that provides a complete solution. If you’re developing some kind of voice analytics or some kind of blood testing, you shouldn’t have to build a whole clinic in a box for it. To really create a clinic, you need to pull together the technology from multiple partners. We see ourselves as the only real platform in health care because we bring everything together to create a compelling experience. 

This is not something that a single startup can do. XPrize got it all wrong by thinking that somebody can build a tricorder. The ultimate tricorder is a device that brings together innovation from multiple companies, not from just one. That’s what we are all about—creating the right platform to bring together all of the industry’s innovation.

In an Emergency, You'll Want This Hi-Tech First Aid Kit
Ram Fish, founder and CEO at 19Labs 19Labs

You have in the past expressed some skepticism about startups focusing too much on vertical integration. What’s your thinking on that?

The problem with health care is that we are seeing a lot of very narrow vertical solutions. But nobody is bringing those together. A narrow vertical approach is absolutely right if you develop a digital EKG or stethoscope. But to turn this into a solution that the health care industry can use, somebody needs to create a platform to bring all of these devices together. And that’s what we’re doing. 

Can you see Gale becoming a consumer product in people’s homes?

Absolutely. Like I said, it’s a journey. Like today, it’s something that can be used in schools, or by people who live in remote areas or people with special health conditions. But if you look into the future, five to seven years from now, every home, every school, every business will have a health care corner. The walls of the hospitals and clinics have broken down. Health care is moving out to the edge—the diagnostic technologies, the imaging technologies, the AI, triage—we’ll see more and more health care services moving to the edge, where people are.

How will AI be used in the product?

If you think about it, when you’re calling a nurse hotline, they’re actually walking you through a very basic, AI-driven dialogue. As we move farther into the future, we are going to see more and more of what I would call local AI analytics as well as big data analytics. That’s where machine learning can be applied.  

It can used to analyze a stethoscope audio. Or an EKG audio. Or ultrasound imaging. We’ll be seeing more and more big data analytics being applied.

I’ll give you an example, using a company we’ve been working with, that’s developing ways to recognize heart arrhythmia problems. The company with the stethoscope has a great database that can be used in analyzing your lung and heart noises, and can be much more accurate than most nurses or doctors using a traditional stethoscope. They have this database of hundreds of people they’ve listened to, and that better helps them analyze it. 

What’s the biggest challenge facing you?

It sounds boring, but it goes back to the basics of building a business. It’s execution. It’s paying attention to details, getting funding—not too much, not too little. It’s not sexy, but so much of it comes down to execution. 

Are there things you learned in your time at Apple and Samsung that you’ve applied to this company?

I’ve learned things at every company I’ve been with. Learned some amazing things at Nokia. And more amazing things at Samsung. One thing I learned at Apple—something I’ve believed all my life,  but felt more vindicated about after working at Apple—was saying, ‘Not good enough.’ But being able to do it in a culture of constructive criticism. And doing it in a friendly, positive way. That you don’t insult and humiliate people.

It means being able to go to a meeting and say, ‘You can do better and that’s not good enough.’ I think this is the core of building amazing products. Too many companies are settling for not pushing people because they don’t know how they’re going to react. And they accept that mediocrity is good enough. No, mediocrity is not good enough.

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