Joe Rinehart’s path to UCI as a physician, researcher, entrepreneur and mentor dates back to his early days in high school, where an influential biology teacher and his father’s IBM 286 computer served as catalysts for two of his core passions–science and software. Throughout college and into medical school where Rinehart chose anesthesiology as his specialty, he was always learning software and programming concurrently. Rinehart shared, “I chose anesthesiology because [it] had intimate contact with monitors and it seemed like the [access to devices], and hands-on [approach to medicine] was a great marriage with my software background. I saw that there might be some potential to work those two things together.”
As a native of Orange County, growing up in Tustin and attending Foothill High School, Rinehart eventually found his way back to California after attending medical school at Creighton University and finishing his residency at Loyola University Medical Center. He currently serves as Associate Director of the residency program for UCI’s School of Medicine and also as Director of Clinical Operations. He is concurrently developing an active research program in new technologies and data utilization in clinical anesthesiology. As a practicing clinical anesthesiologist and software engineer with over fifteen years in application development, autonomous systems, and complex algorithms, Prof. Rinehart has published several articles on topics of technology in anesthesiology and closed-loop fluid management. Additionally, he has given talks on the subject around the country and serves as an oral board examiner for the American Board of Anesthesiology.
In addition to his growing list of responsibilities, Prof. Rinehart would eventually co-found a startup, Sironis, alongside fellow UCI colleague, Prof. Maxime Cannesson, M.D., Ph.D. Meeting originally in 2009, Rinehart had come into academic medicine due to his love of teaching. However, he considered leaving it until he met Prof. Cannesson, who had come to UCI after being recruited by UCI’s chair at the time. With an interest in potentially working together, Prof. Rinehart stayed in academics and began discussing with Prof. Canesson potential research projects they could collaborate on together. Within the first six months of meeting, the two found a common area where Prof. Canesson’s research background and Prof. Rinehart’s experience in software and understanding of human physiology complemented each other. Their common interest in understanding how to improve fluid resuscitation would serve as the foundation for their startup.
Fluid resuscitation, or the replenishment of a patient’s fluids lost from sweating, excreting, bleeding, etc., is one of the core responsibilities of anesthesiologists and critical care physicians. Prof. Rinehart shared, “You would like to think there is more science behind it. While there is some good science behind some of it, much of it is still based on what you are taught and what has traditionally happened in the past. A challenge we still face is determining whether we should use an intervention such as fluid resuscitation if a patient has low blood pressure or is in shock.” Concurrent with this challenge, the field of medicine is under enormous cost pressure. Physicians are being asked to provide better outcomes for less money. Prof. Rinehart shared that, “the US health system spends far more per patient than anywhere else in the world, and our outcomes are not better.” He stated that if the objective for providers is a consistent, predictable, delivery of health, then everyone cannot have their own individual “cookbook.” Given these challenges, Profs. Rinehart and Canesson saw an opportunity to improve the health system of standardizing fluid delivery. By using the most up-to-date, predictive measures and an algorithm that helped physicians deliver fluid to patients, they could help push medicine toward predictable outcomes.
Using multiple data points and real-time information from patients, Sironis uses a closed loop fluid delivery system to standardize the fluid resuscitation process. A common concept in engineering for automation, Prof.Rinehart describes closed loop as “any system that makes some intervention in the environment, measures the environment, and then changes its output accordingly.” Examples include an air conditioner adjusting the temperature and more complex applications such as an automatic car or an airplane’s autopilot. The pilot tells the system where to navigate, but the system handles the fine details such as speed adjustment as it adapts to the environment. Rinehart explained that “while Sironis’ system is not as sophisticated as an automatic car, it pulls data from multiple physiologic input points which include: heart rate, blood pressure, and other dynamic predictors of fluid responsiveness–some which are based on Prof. Canesson’s research in the area.” Additionally, their system uses patient responses to predict and tailor future interventions. Even if all of the data looks to be one way, but the patient is not responsive the way the system thinks they should be, then it will not give additional fluid because it may not be indicated.
Prof. Rinehart also shared the process of building Sironis through resources such as Applied Innovation. He expressed that, “UCI has been amazingly supportive at every step of the way. I started working with Alvin Viray, Associate Director of the Invention Transfer Group, very early on. Originally not intending to commercialize the innovation for ourselves or a build a company, it was during our discussions with Alvin that we realized one of the best ways to protect the future of our idea was to take it on ourselves. He was tremendously helpful in helping Maxime and I navigate what we needed to do at each step of the way. Regarding the IP process, he helped us understand what our options were for licensing the IP out, for working with it ourselves, and for further developing it. Moreover, the department and the University were very supportive of the research program. At each step of the way, and I have told Alvin this multiple times, I was surprised at how easy UCI makes the process; it seemed to me that Irvine was actively interested in their startups succeeding and understood it was an important part of building the future of healthcare.”
Noting that the OC area possesses the intersection of large medical device companies, a thriving medical device culture, and an active investor community, Prof. Rinehart shared he could not imagine trying to build a startup in a small-town setting as they would not have the same kind of access to experts and advisors. He shared his surprise at the willingness of people to donate time and energy to help, especially early on when there isn’t necessarily something in it for them. He stated that they understand, have been in the same shoes before, and are willing to lend a hand. Prof. Rinehart mentioned, “We worked for a long time to find investors and more importantly advisors. It takes a lot to build a company. Nobody can be an expert on everything, and you need to rely on other people’s help. I got lucky because I made some connections early on to help me build the company’s network. I wish there were something like the Cove back then because having been involved with the Cove now; it would have been an incredible resource to do something in that space.”
Coming full circle in his startup experience with UCI, Prof. Rinehart has recently joined the board of the Cove Share Fund and participates as an Expert In Residence. Reflecting back on his experience thus far as an entrepreneur, he shared, “this has been a rewarding experience for me on many levels. For anyone that has built a startup, it is an amazing amount of work. It is not the kind of thing you do on a weekend. You have to be your company’s biggest fanatic, or it is not going to go anywhere. It has been a rewarding experience exploring another side of medicine and what it means to be an academic, and it’s nice being able to try and help now from the other side” On the topic of his role with Applied Innovation, Prof. Rinehart stated, “Getting involved in the EiR program and the Cove fund involves a desire to work with these early startup companies and help other people to the extent that I can. It is still a huge learning process for me. It’ been a fun process and certainly something I want to continue.”
Concluding the conversation, Prof. Rinehart shared some final thoughts on Sironis. Though other people have done closed loop systems in clinical care such as sedation and vasopressors, Sironis was the first to do it with fluid management and work toward a viable bedside system that clinicians could use. Not intending for their innovation to be just a research tool, Profs. Rinehart and Canesson wanted something that could be used in operating rooms and reduce the variability and bad outcomes that were a result of unfortunate fluid management. From that perspective, they faced unique challenges and an uphill battle regarding acceptance from the physician community. Trying to protect the idea of the art of medicine, standardization of the fluid delivery process was seen as opposed to this concept. However, Prof. Rinehart sees that there is room in the future of healthcare for the art of medicine, but it cannot be the “Wild West”. With Sironis, they want to bring a level of standardization and predictability to healthcare, while leaving the physician in control. Going back to Prof. Rinehart’s analogy of the airplane autopilot system, the physician will serve as the pilot, navigating, allowing the system to take care of the fine details. In the long term, Prof. Rinehart sees this as the where the future of healthcare will go, or at least where he would like to see it end up. If there is any little thing they can do to reduce cost and bring healthcare further along, it is a good thing. Having licensed their technology to Edwards Lifesciences in 2014, they are well on their way and anticipate release of a commercial system based on their technology in the next couple of years.