“I had an invention that I felt would be great for healthcare”: HiCura’s Cailin Ng speaks about her experience building a MedTech in SG

Cailin Ng is a woman with a mission; she knows she wants to make a difference in the healthcare system, and she knows what would be required of her to do so: passion, resilience, and lots of problem solving. In this edition of Nucleate SG’s Slack interview series, we speak with HiCura Medical’s Cailin Ng about her experience building a MedTech in Singapore - how it came to be, the major bottlenecks in the process, and about good founder qualities to nurture. 

Please find transcript for the Slack interview with Cailin Ng below! We made some edits to ensure clarity and coherence. Don’t worry, they’re kept minimal so that the authenticity of the conversation is preserved. 

P.S. Some questions from the participants were also incorporated into this transcript (thank you again for sending them in). With that, enjoy!

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Qualities in a startup founder

Nucleate SG: We will begin with introductions as usual. So - if we were to Google your name, we’ll learn that you are the co-founder of HiCura, that you’ve participated in many incubator/accelerator programs, including NUS GRIP and APAC’s MedTech Actuator. Here’s a challenge for you today - can you describe your best entrepreneurial traits in 3 adjectives?

Cailin Ng: I would say 1) passionate, 2) resilient, and 3) I like problem-solving. 

Cailin Ng: And I think being passionate is really important because as a startup, you need to have passion for the things you are doing

Cailin Ng: especially in the formative stages of the company. There are so many new things that you have to learn as a new entrepreneur so you need the energy and passion to survive the initial few years

Cailin Ng: There are ups and downs in this journey so being resilient is important as well

Cailin Ng: I am in medical technology and am an engineer, so when I see problems, I feel there will always be good solutions to tackle them.

Nucleate SG: Here in the Nucleate SG community, many of us are interested in the startup business. And along this vein, a lot of us wonder how we find out if we are suitable for the founder role. Would you say that you discovered these qualities in yourself prior to going into the startup business, or were they qualities you discovered in the process overtime?

Cailin Ng: I can probably share a little bit about my background. I wasn't a founder initially and started as an engineer in Micron Semiconductor Asia and then as a Manager in Infocomm Authority of Singapore (now called IMDA).

Cailin Ng: I had some medical issues, and I realised that I would like to make a small difference to the world. This got me thinking about being an innovator and entrepreneur.

Cailin Ng: I actually started my PhD journey because I wanted to invent new things to help people.

Cailin Ng: So I act upon it. I started a company after I completed my PhD. Going back to the questions, I didn't become a founder because I think I have the right qualities to be one. I became a founder because I had an invention that I felt would be great for healthcare.

Cailin Ng: As time goes by, you start to realise what qualities you need to possess to be better in the job. And that's where I feel being resilient helps. I build up those qualities by never giving up 🙂

HiCura’s mission and how it began

Nucleate SG: I can see that you're extremely mission driven. To have a goal and then work on yourself to get to that goal - that's an inspiring story! On that note, can you tell us about HiCura, the problem that it is trying to solve, and the solution that it offers.

Cailin Ng: HiCura is a medtech startup building AI-powered ultrasound guidance software for interventional procedures. Our first product is uSINE, which guides the doctors to find the right needle insertion location and angle for a first-puncture success for spinal anaesthesia.

Cailin Ng: I had a difficult epidural during the birth of my 2nd child and hence I believe uSINE will be able to help other women like myself

Nucleate SG: I love that your mission feels so personal - that often drives the mission and passion further. We have gotten some questions from the audience - some of us are curious - what was the beginning of HiCura like? Sometimes the problem is invisible to us until someone thinks “how can we do this better?”. These have been described as the moments that have sparked innovation and birthed startups. Was there a similar moment at the beginning of HiCura/uSINE?

Cailin Ng: This idea of using AI for ultrasound procedures actually came from doctors at KK Women's and Children's hospital. KKH is a training hospital and is always thinking of new ways to improve patients' safety and clinical outcomes. Conventionally, they are using the landmark and palpation method to perform an epidural or spinal anaesthesia (meaning they use their fingers to feel the bones to know where to insert the needle). However, as they are seeing more and more high-BMI patients, this technique doesn't work very well anymore.

Cailin Ng: The doctors at KKH wanted to use ultrasound to perform this procedure but ultrasound is different to learn and very operator-dependent. Hence, they work with NUS to come up with this technology to use AI to help doctors use ultrasound to perform spinal anaesthesia.

Cailin Ng: I just happened to be in the same lab that was doing this project and hence after my PhD, I thought we should commercialise this technology. I feel there is a lot of good technology in the lab that stays in the lab. I think the universities are taking good steps to encourage research fellows to translate their technology into actual products

Nucleate SG: Good timing is always very important - right place, right time!

Hurdles to overcome when building a MedTech in terms of regulation and market adoption

Nucleate SG: MedTech/BioTech are unique in their need for clinical validation and regulatory clearance. Could you describe to us the major hoops you’ve had to jump through with HiCura, and the biggest pain points you’ve experienced along the way?

Cailin Ng: Yes, you are right! Medtech/biotech have a longer gestation period where there are lengthy clinical studies and rigorous audits for regulatory clearance.

Cailin Ng: Because of our collaboration with KKH, they were our first choice of site for a clinical study. We managed to get a grant from NHIC for the clinical studies and that formed the clinical validation we needed for regulatory approval. Having a great team in KKH and getting NHIC's help and guidance through the grant process and clinical study was instrumental in HiCura's success!

Cailin Ng: We had one clinical study paused because of Covid. It delayed our timeline and for startup, cash flow is always on the back of my mind. We had good support from our investors so we were very grateful for that too!

Cailin Ng: I think doing the clinical study and getting regulatory approval is just part of the process to prove the technology works and is safe for use, so I wouldn't consider them as hurdles. 

Cailin Ng: What I feel is that the biggest hurdle is verifying that your product is the solution that the doctors are looking for, and are willing to pay for it.

Cailin Ng: Talking to doctors (from other countries as well, as Singapore is a small market) early is important to verify that you can have the product-market fit later when your product is on the market.

Nucleate SG: HiCura is priming itself to expand into the Australia, US, and EU markets - how similar or different are the regulatory landscapes, and how can one prepare to overcome these regulatory hurdles before breaking into the markets?

Cailin Ng: There are reference agencies that regulatory authorities look towards for expedited clearance, and they are CE mark or FDA.

Cailin Ng: There is some work to harmonise regulatory standards in South-east Asia with Singapore's Health Science Authority being the reference agency so if your market is in SEA, it would be good to get HSA approval first.

Cailin Ng: To get CE and FDA approvals are challenging. We took around 1 year to get our CE mark under MDR regulations.

Cailin Ng: Getting a good regulatory consultant is essential, and they should be part of the conversation even during the early stages of product design and development.

Cailin Ng: For medical devices, our quality management system has to be ISO 13485-certified. This covers everything that we do, including customer's specifications, product design and development, prototyping and fabrication, clinical trial and documentations. So getting some regulatory advice early to help structure the whole product design journey will be good.

Cailin Ng: All in all, it is always better to go to the experts who can advise and mentor you. As a founder, I can tell you that I don't know everything and I don't pretend to know everything as well.

Cailin Ng: Being a good founder also means that you need to assemble a good team, people with different strengths.

Nucleate SG: How did you get adoption for your product? Were the doctors open to try new tech?

Cailin Ng: There are usually 2 groups of doctors. The senior doctors who are very competent in the landmark and palpation technique will probably still continue using the conventional technique. We do see another group of doctors who are more passionate about change and innovation and these doctors will be more willing to try new technology.

Cailin Ng: Just keep talking to the doctors and you will be able to get a sense which group they belong to 

Nucleate SG: Let's talk about future directions. uSINE has been implemented in KKH just past June 🎉 Do you intend to use uSINE for other applications?

Cailin Ng: We are also working with other hospitals to expand uSINE into other areas, e.g. for paediatrics and elderly, not just for obstetric anaesthesia.

Sentiments about building a startup in Singapore 

Nucleate SG: It's almost 4pm - time to bring this interview to a close. We like to do that with hard questions 😅

Nucleate SG: While there has been a great emphasis on getting overseas experience to increase professional attractiveness, the reality is that not all of us can afford this opportunity for various reasons, like family, or finances. As someone who has gone through her education and who began her startup-building process in SG, could you comment a little bit about this sentiment.

Cailin Ng: I wouldn't disagree that getting overseas experience does help, since you do get exposure to different cultures. However, I find that Singapore has built a very nurturing environment for entrepreneurs. Like what Liyana said, I studied in Singapore, did my undergrad and PhD in NUS, worked in Singapore and started my startup here as well, and I am doing well. So I think don't put yourself down just because you don't have overseas experiences, but work on your strengths and be in the Singapore market where it can be seen as a springboard into other markets.

Cailin Ng: One thing that Covid did was to push online meetings and digital technologies that facilitate connections so you don't necessarily need to be in a different country to learn and connect with people overseas.

Nucleate SG: I think this is something many people would feel reassured hearing. In this case, we also believe that we should also foster a better environment to support innovation and technology development here. In your opinion, what part of the startup ecosystem here that you hope to see develop even further?

Cailin Ng: There are several stages in the startup journey: Ideation, seed, Series A, B and beyond. I think there is sufficient help and guidance in the ideation and seed stage. We have the government promoting research and setting aside a budget for RIE2025. However, there is a gap between Seed and Series A.

Cailin Ng: I think there could be better opportunities for collaboration between the corporates and the startups. The startups could make use of the corporate's existing network and connection to further expand and the corporate could tap onto the startup's innovation for differentiation.

Cailin Ng: It would be a win-win situation.

Advice for first-time founders

Nucleate SG: Final question: What is the best piece of advice you would give to a first-time founder?

Cailin Ng: Don't do it

Cailin Ng: Haha

Cailin Ng: But seriously, if you have a great idea, a passion and endless energy, I would advise you to Just Do It.

Cailin Ng: Sometimes people tend to sit on an idea until a long time has passed and they lose the initial passion. In the end nothing gets done.

Cailin Ng: You will know in the initial few months whether it is something you can continue to pursue or whether you should pivot or give up

Cailin Ng: but until you try, you will never know

Nucleate SG: Well said

Nucleate SG: @Cailin Ng Thank you so much for your openness and honesty. I feel like I've learned a lot from this conversation, and I can really feel your passion and resilience for this purpose - your story really inspired me 😄

Nucleate SG: It has been a pleasure to learn about HiCura and your journey in this short but fulfilling hour. Cailin, do you have any last thing you want to share with the audience?

Cailin Ng: If you are pregnant and considering epidural, do ask your doctor to consider using ultrasound 🙂

Cailin Ng: And HiCura is fundraising, so if there is any VCs in this chat, and interested in medtech, please reach out to me

Nucleate SG: Thank you so much for agreeing to do this interview with Nucleate SG. We hope HiCura will continue to flourish and benefit all the women out there. Also, an early shoutout to all Mothers out there. Remember to show your appreciation in the coming month 🙂 

Cailin Ng: Thank you!