“I am an un­dying believer in focus”

Text: Regula Freuler | Photos: Marc Wetli | Magazine: Homo digitalis – June 2018

#pregnant  #global  #gender_equality  #digital_health

Pascal Koenig, CEO of Ava AG in Zurich, came up with the idea of a multi-sensor wristband that helps women detect the right moment for getting pregnant. His medtech start-up owes its success mainly to the capabilities of big data – which is why he’s eminently aware of how important data protection is.

With him, a typically formal German term of address is out of place. “Hi, I’m Pascal,” says the CEO of Ava AG, extending his hand to us. But just to be on the typically Swiss safe side, we shyly inquire whether proceeding on a first-name basis is okay. “We only do first names here,” Pascal Koenig chuckles. “At meetings on Paradeplatz, though, I regularly put my foot in my mouth with that type of informality.”

Koenig, outfitted in a blue sweatshirt and jeans, is obviously in jolly good spirits. He gestures towards the office: voilà, his Zurich team. Some 40 men and women are sitting at randomly arranged tables in front of computers; the sofa and a small standing table in the corridor also serve as optional workplaces – whatever floats your boat. To the left, a coffee machine and beverages; in the middle, a foosball game and mini ping-pong table; and in a corner, empty prosecco bottles suggest a recent fest. Behind a room divider, a meeting is in progress at a long table.

Here, on the first floor of an office building in Zurich’s Binz district, the Ava team tinker on a solution to an increasing problem in our society: human reproduction. Or in other words, they help women get pregnant.

Big data means big ­responsibilities

In 2013, Pascal Koenig, a native of Aargau, founded the medtech start-up Ava together with ETH graduates Peter Stein and Philipp Tholen, as well as with Lea von Bidder, who like Koenig had studied at the University of St. Gallen. Their product: a bracelet equipped with sensors that is worn at night by women who wish to have children. While they sleep, the bracelet records three million data points relating to nine physiological parameters such as skin temperature, blood circulation and heart rate. Thanks to the data obtained in this manner, ovulation – or as it were, the fertile phase – can be detected during a woman’s menstrual cycle, and this with an accuracy of 89 per cent as revealed by a one-year clinical study conducted at the University Hospital Zurich. That’s far better than the track record of classical ovulation tests, which measure body temperature or test urine samples for the luteinising hormone responsible for triggering ovulation. “Our core competencies are
data science and machine learning,” says Pascal Koenig. He leads us to the café on the ground floor, as no vacant seats are left in the Ava office. The start-up has grown rapidly; soon, the company will move to larger premises.

Pascal Koenig (born 1975), co-founder and CEO of Ava AG, has many years of experience in the field of wearables and medical technology. After studying at the University of St. Gallen and Columbia University in New York and spending one year with management consultant McKinsey, he joined Synthes as a product manager. There he learned the basics of the medtech industry. In 2008, he established the Zurich-based company Limmex, which manufactures emergency call wristwatches, and then market research company Smartwatch Group. A high-tech specialist, he has won several awards and was named one of Switzerland’s 300 most influential individuals by business magazine “Bilanz”. He lives in Zurich with his life partner and their two children.

Dealing with the data is a huge responsibility. “We have to distinguish between personal and physiological data,” explains Koenig. “Personal information is the sole property of Ava users – they can delete it or save it to their own devices – whereas the physiological datasets are anonymised and stored on our servers. We’re allowed to use them for scientific purposes only.” Data protection laws dictate that this be the case. “And the rules have become even more stringent of late,” says Koenig in reference to the new EU General Data Protection Regulation, which took effect on 25 May 2018. “Although initially, this makes things a bit more complicated and perhaps even bothersome for companies like ours, I think stricter regulation is a good thing. Anyone who turns a blind eye to personal privacy is totally naïve.”

Most people don’t take data protection seriously enough, he believes. “Including me!” Everything is so easy and practical, like storing passwords or catching up with the latest comments in social media. All too spontaneously, people post their gut reaction or give a thumbs up without thinking that they might regret it later. “We don’t have to go too far back in history to remember that only a small detail like one’s religion was enough to get you eliminated,” Koenig points out. Granted, lax data protection doesn’t always lead to such tragic consequences. But transparent as we are today, we sometimes get to experience first-hand the negative side of living in our virtual glass houses. For example, Koenig recently had trouble with a visa application because he was in Iran with friends years ago.

“Anyone who turns a blind eye to personal privacy is totally naïve.”

The CEO also has great concerns about the opacity of self-learning algorithms. “Sure, maybe they make more precise decisions than a human being; but then no one can take responsibility or be held accountable for those decisions.”

Basically, however, Pascal Koenig strongly believes in the advantages of digitalisation. Without those benefits, Ava would not exist nor would have Koenig’s previous start-up projects (e.g. a mobile monitor for heart patients and an emergency call wristwatch for the elderly). His own quality of life has also improved thanks to digitalisation – yet he’s very aware of the value of offline phases. “Of course, it’s tempting to occasionally make a quick check for emails on weekends, and I have to wrestle with myself repeatedly so as not to become captive to this kind of distraction.” And he does it at home just as undogmatically as he does in business life. Meals together with the family should remain undisturbed by technology. “It would really bend me out of shape if our children, now nine and ten years old, were chatting or gaming at the dinner table.” As digital natives, the youngsters have their own iPods and their parents’ old cell phones. “And that’s okay . . . they, too, need to be familiar with digital media,” Koenig says. “Ultimately, as with so many other things in life, it’s all about moderacy.”

Every third couple has difficulties having a child. Whether it works or not is influenced by many factors – one of them is timing. The Ava AG wristband is the first ovulation test that makes use of an array of sensors to detect in real time the beginning of the fertile days within a woman’s menstrual cycle, and this with a uniquely high accuracy rate of 89 per cent. The tracker measures pulse, respiratory rate and skin temperature, among other things. Ava AG was founded in 2013 by Pascal Koenig together with ETH engineer Peter Stein, as well as Philipp Tholen and Lea von Bidder; the latter ranks in the latest Forbes “30 under 30” list. The initial concept of the sensor wristband was successfully tested in a one-year clinical study at University Hospital Zurich. The Ava bracelet debuted in the US in July 2016; sales in Europe started in January 2017, and an office is currently being established in Hong Kong. By 2020 at the latest, Ava AG also wants to be fully engaged in the mainland Chinese market.


CEO has done away with paper

Only thanks to digitalisation has Ava been able to grow so rapidly in such a short period of time. Privately held as it is, the company discloses no financial figures. What Koenig can reveal, though: last year, Ava generated 14 times more revenues than in its 2016 launch year – “naturally from a relatively small base, but we’re growing strongly month after month; and in the USA, which accounts for roughly 70 per cent of our sales, we’re already in the black”. A year ago, the start-up had a staff of 20; meanwhile, that number has risen to almost 60. And for next year, Koenig thinks 120 is feasible as the company expands its international presence. This only works if a digital platform is in place. Ava made its official debut in the USA in 2016, followed by Europe in 2017, and an office is currently being set up in Hong Kong with the aim of conquering the Chinese mainland in one to two years’ time. “This morning, I’ve already conducted eight video interviews with applicants in Hong Kong – thanks to the digital age.”

Advertising and distribution at Ava are accomplished exclusively online. And when it comes to accounting, the CEO has abolished paper. “I had so many fights with accountants, whether it really works without folders. Of course, there are grey areas here, but as a start-up we can be more radical than any old run-of-the-mill company. Paper is going the way of the dinosaurs.”

What many start-ups are doing wrong in Koenig’s opinion is trying to handle everything from soup to nuts, both in terms of products and sales. “They get bogged down. I, on the other hand, am an undying believer in focus. As a start-up, you have to ask yourself where you can be the world’s best, and then zero in on it like a hawk.” This is also one of the reasons why Ava doesn’t sell its data and is very reluctant to allow others to conduct research based on it. Many have already come knocking in the hope that they’ll be granted access to the data – but to no avail.

How does Ava manage to win the trust of its customers by digital means alone? “Clinical studies are one of the most important things,” says Pascal Koenig. The first study was completed prior to the 2016 market launch, and there are currently seven more under way. As to the PR aspect, Ava does not promote itself aggressively but gladly responds to any outside inquiries. According to Koenig, the most important thing is the team: “Our people are intrinsically motivated, smart, they think globally, they have lofty visions and yet a healthy portion of modesty.”

The CEO is convinced that artificial intelligence is more than just hype. “Especially in the healthcare sector, there are still countless opportunities just waiting to be grasped. The human factor and personal contact with doctors will always remain important, but with the right databases we’ll be able to raise the bar substantially in terms of medical treatment and health maintenance.” Ava is also working on that.

The Ava wristband measures pulse rate, respiratory frequency and skin temperature.
Overnight, the cycle-related data are recorded.

Pascal Koenig
Short questions – short answers

Which background image do you have on your mobile phone?
My family on Ellis Island. The history of that place totally fascinates me – millions of fates were determined there. Many Swiss people also had the chance to get a new life when they set foot on Ellis – we should sometimes reflect on that when the topic of immigration comes up.

What was your dream job as a kid?
I wanted to be an entrepreneur – my dad was also self-employed. I never had any fear of this responsibility.

When did the Digital Age start for you?
The first time I experienced the power of digitalisation was as a foreign exchange student in the USA, back in something like 1992. My parents already had a computer at home in the ’80s, but my first encounter with the Internet was in the States.