You can call it an unfathomable twist of fate, a cruel and premature end to a life lived in dedicated service to others. You can also call it a purposeful decision to take personal pain and suffering and use that horrible experience to make the world better for others.
That’s what Kermit Farmer, founder and Chief Ethos Officer of Paths, is doing in memory of his late wife, Dr. Linda Farmer, a local oncologist who passed away from the very same disease she spent helping more than 9,000 of her patients fight over her 18-year career. Dr. Farmer – wife, mother, physician, marathon runner and more – died from stomach cancer on February 15, 2022, after choosing to spend her last days in hospice care at home.
The determination to create Paths, an online educational and communications platform for healthcare providers and their patients, grew from that very personal experience.
NVA: You’ve been open about what happened to your wife and how that experience serves as the “origin story” of Paths. If it isn’t too difficult to recount, can you tell us what it was like to walk with your wife through her own excruciatingly painful medical journey and why you describe that experience as the driving force behind your mission with Paths?
Farmer: Sure. And yes, it is hard to revisit, but I do that every day. That’s what drives me.
To begin with, I have to say that I was not even remotely familiar with the end-of-life process my wife chose to go through. Linda went 18 days without food, very little water. She got down to 61 pounds. I don’t even know how her heart held up. To say I was not prepared is an understatement. I needed a path to help me through that. But there was none. I needed more timely information. It’s not lost on me that millions of caregivers and patients go through a very similar experience every single day.
The kicker here is that my wife was an oncologist, so the cancer doctor got cancer – which she even diagnosed herself. She ran her own tests based on the symptoms. She was one hell of a person and one hell of a doctor. Linda’s story needs to be told.
NVA: I understand it was a letter Linda wrote to her 700 active patients two weeks before she died – which she directed you to send to them only after she had passed – that epitomizes who she was and defines what you are creating with Paths.
Farmer: Yes, that was astonishing in one way, but so “Dr. Farmer” in another. The best way for me to explain the power of that letter would be to simply quote it here:
Dear Patients,
Cancer is fickle.
Back in May, when I first wrote a letter to you, we thought I had Stage One stomach cancer. I had 4/5 of my stomach removed with surgery. We did not know at the time I also had retroperitoneal fibrosis (RPF). This caused my organs to stick together, which was problematic for the surgeon – leading to many complications thereafter. Unfortunately, we did not remove all of the cancer. I have active cancer now with no treatment options. This letter will reach you after my passing.
I cannot thank you enough for all the cards, letters, and support. I could not respond to all the outpouring of love. My family felt your presence in every moment of the journey.
With cancer, we are all in the same storm together, but in a different boat. Please hear me when I say cancer is not a death sentence. You might be surprised to know many of my patients are still alive from 18 years ago when my medical practice began. They are doing well, healthy, and living their best life. This is what I want for you. You must navigate the seas physically, emotionally, and spiritually. This will serve you well and give you an authentic purpose day in and day out.
NVA: That’s a powerful, selfless final act.
Farmer: That’s who she was. Sometimes I hum “Who Lives, Who Dies, Who Tells Your Story”, the last song of the Broadway show Hamilton, to myself. It reminds me how thankful I am to know my role in all of this. You see, I was married to an oncologist who came home every day telling me “Hey, I’ve tried to give all of this information to my patients, but I only have limited time per appointment to actually communicate with each of them about all the things they should know about their condition, what they should expect, what they should be doing themselves to improve their prospects for a full recovery.”
It was very frustrating for her over the years, and for me as well. My background is in logistics, so seeing problems I can’t solve is hard, and it was especially hard in this case to just sit on the sidelines and watch your wife toil for years. I’ve been able to see the challenges from both sides of the fence – what doctors want to be able to impart beyond the limited time they have in front of each patient as well as what patients want and need to know. I knew that any viable solution had to be two-pronged for it to work – to create real value on a holistic level for both doctors and patients.
NVA: Can you tell us what you did first, what steps you took to get the ball rolling on the entrepreneurship front?
Farmer: It wasn’t about entrepreneurship. It was personal. I need a reason to get out of bed – a reason to live. I started with “Good is going to come from this personal and community loss.” And because my wife was such a great educator in medicine, I want to help doctors of all types become better educators in medicine in a way that will help their patients. If I’m successful in that, then I’m doing something to honor her.
On a professional level, I knew that I didn’t know what I didn’t know. But I did know a lot of people. So, I called Ryan Troll, who was Head of Experimentation at Capital One at the time and said, “put some technologists in my life, I’m going to build this thing. I think I have a pretty good idea of what it needs to do.”
One thing led to another. Jon Florin of No Stomach for Cancer invited me to speak at his conference, and we officially launched the company on-stage at an annual Stomach Cancer Symposium at Duke University, back in September 2022, with what I would call a ‘minimum viable product.’ Since then, we’ve been busy building what is essentially a relationship company that leverages technology to offer the kind of communications platform doctors need to help educate their patients and which their patients need to understand and learn about their disease, their prescribed procedure and their role in enhancing their own treatment outcome.
NVA: When did you and your team begin working with potential customers and partners to expand upon the minimal viable product you launched the company with?
Farmer: That actually started following my presentation at Duke, where I met Barb Martin at the University of North Carolina’s Lineberger Comprehensive Cancer Center in Chapel Hill. At that time, our product couldn’t be used by hospitals or other medical practices because we weren’t in compliance with the Health Insurance Portability and Accountability Act of 1996, known as HIPAA, which stipulates how personally identifiable information maintained by the healthcare and healthcare insurance industries should be protected from fraud and theft.
That first relationship was critical and helped us progress to where we are now fully HIPAA compliant. We are also SOC 2 compliant, which is actually a higher compliance standard, developed by the American Institute of CPAs, which specifies how organizations should manage customer data.
NVA: Let’s talk about the product itself – what features and functionality does it offer compared to the patient portals we all encounter that basically just speed up the check-in process from an administrative standpoint ahead of our in-person visit.
Farmer: We focus on the entire patient process, which goes well beyond the onboarding and administrative “check-in” steps you mentioned. We know patients have questions – a lot of questions. Those questions stem from concerns patients have – the more concerns, the more questions. And when those questions aren’t answered as well as they could be – or at all – the more fear, doubt, and confusion the patient has about their upcoming procedure or treatment.
Fear, doubt and confusion breeds angst about the care they will be getting, and understandably so. Patients start calling the doctor’s office, wasting valuable time the physician, surgeon or staff could be allocating to providing in-office patient care. Instead, they’re answering questions that could be handled proactively via online technology.
So, our onboarding includes a series of videos documenting the steps you’ll be going through as a patient to help make you feel more at ease, educating you on what to expect at each step along the way. We also enable healthcare providers to send important timely information and helpful reminders to patients in advance of a visit or procedure – when to start fasting if you have to, to remember to bring all the medications you are taking, who will be driving you home if you’ll going under general anesthetics, etc.
In short, we’re trying to rebuild and transform an often overlooked yet essential aspect of the healthcare delivery process – the doctor-patient relationship. That’s the longer-term vision. As it stands today, we have multiple software licensing deals on the table where our products can be integrated inside of other products such as some of the leading electronic health records (EHR) platforms as well as opportunities with other major players, including entire hospital systems.
NVA: That sounds like a lot of progress in a short period of time. How did you secure the funding to move so quickly?
Farmer: That’s an easy question – I didn’t “secure” the funding to get us started, certainly not in the typical sense of the term. I’ve personally paid for the lion’s share of what it has taken to create the product that goes a long way towards incorporating what healthcare providers need and what patients need, including things like insurance, compliance, and CMS coding alignment.
NVA: Let me stop you there for a minute – you’ve financed all the product and corporate development of Paths yourself? You haven’t tapped into what must be abundant venture funding available for the high-value, life-enhancing solutions you’re creating?
Farmer: No. I didn’t feel time was on my side for all that. I’m a bit fearless and I’m not going to sit around waiting for the day that somebody is going to fund my dream. I’m what’s called a “boat burner.” Are you familiar with how the Vikings took land? They would decide they were going to conquer a territory and they would sail off to that distant land and then light their boats on fire after getting there.
They were saying “There’s no going back. We either take this land or we die trying.”
That’s my view. It’s why I’ve spent on average almost $90,000 of my own money each month to fuel our research, product development and operations, the vast majority of it on coding the solution, refining that code to enhance the user experience and testing it. Going forward, we will be cycling down the coding effort to allocate some of that money to sales and marketing.
NVA: How long can you keep funding Paths yourself? Will you need to look for external financing to keep this dream alive?
Farmer: Yes, we will. And that time is rapidly approaching. We’re beginning to assess how much funding we will need beginning, say, six months from now and how to go about finding it.
We’re taking a measured, strategic approach to funding – perhaps that comes from being self-funded to date. One thing I know is that not all money is the same – it is what comes along with that money that matters at least as much as the amount or valuation. Industry experience, subject matter expertise, proven relationships and the willingness to provide expert counsel are top characteristics of who we want to work with from a financing perspective. I’m not a healthcare guy. It’s like I’m learning German to speak Italian. I can do it – it’s just not efficient. I need industry experts on the team that are relentless in creating a patient-centric approach.
NVA: Finally, what would you say to other aspiring entrepreneurs looking to turn their passion-driven business dream into reality?
Farmer: I’ve mentioned the concept of “I didn’t know what I didn’t know” and how a relationship I had with someone who might be able to help educate me proved to be so instrumental. That’s a lesson to be learned – reach out to those you know for guidance.
One other thing I need to emphasize here is the critical role the New Venture Accelerator has played in all of this. The NVA has given our team a home, a place to ideate and work – phenomenal facilities where our space is HIPAA compliant and secure. Ward and Jennifer are extraordinarily skilled mentors who see problems and solutions from different perspectives. That’s been key.
Bottom line is I couldn’t ask for more. Our team is lucky to call NVA home.
To learn more about the New Venture Accelerator visit our website HERE.
Or contact Lou Bifano at loubifano@auburn.edu.
