daniel kivatinos

Building on the drchrono iOS API through Deep Linking

Aug
28

What is deep linking on iOS?

Deep linking in iOS is using hyperlink URLs to launch an app with specific content. The specific content can be a particular section of an app page, or a certain tab or specific view. To test this out you can download the Twitter app, login and then close the twitter app. Next open twitter://timeline in your Safari mobile iOS browser and wallah, iOS will switch to the Twitter app and go directly to your timeline. You can even do more sophisticated app switching like this – in your, iOS Safari Browser enter this, twitter://post?message=learn%20deep%20linking and the native twitter app should open up with a draft message composed “learn deep linking”.

You can use deep linking for:

  • Moving data between the apps from launching an app from another app and passing information
  • Building a web-like URI based navigation scheme within your app
  • And of course integration with other apps like drchrono EHR by letting them launch your app directly
  • Also recording and reviewing user behavior to learn where your users launch your app from

How to use deep linking on Apple iOS iPad?

To link back into drchrono, it can now be done, you can Deep Link into the iPad iOS appointment page. This is the code to do it, it is super simple to do –

 Deep link to an appointment drchrono://appointment/<appointment_id>

You can Deep Link into the iPad iOS patient chart as well –

Deep link to a patient drchrono://patient/<patient_id>
You can Deep Link A great example of a partner show has built into drchrono is our partner Physitrack

How to Login to EHR via oAuth?

If you wanted to setup login on iOS, it can be done, the team at Eko Devices did an amazing job. They leveraged the drchrono Healthcare Doctor API which can be found here, https://www.drchrono.com/api-docs.

You can see a video here –

 

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Building on Fast Healthcare Interoperability Resources / FHIR

Aug
11

MISSION

We started drchrono leveraging technology; our mission: to build something physicians and patients want, tackling hard problems and to fix healthcare.
As part of our mission and as the healthcare revolution is also happening we want to enable an open API for developers from around the world to work together. We see a future where physicians and patients can use wearables, Internet of Things (IoT) devices, other medical software and hardware to leverage our cloud-based EHR and API. Healthcare should not be siloed where data is locked into a non-cloud-based EHR. In that future developers will come together to build jointly to create a better healthcare experience for everyone, providers, patients, caretakers, and family.

FHIR HISTORY

The Argonaut project is a way to make healthcare more interoperability, drchrono is a part of this project. The idea is to get different players in the industry on to a simple to understand easy interface. (drchrono has also committed to Sync For Science)

There is a new data standard called FHIR or Fast Healthcare Interoperability Resources.

There are some core objects or classes called “resources” that show how we represent different pieces of data in health care. Things like what is a patient look like, what does a medication look like and what does an allergy look like.

In healthcare we are always asking, how do you package data, so things like patients, they have a first name, last name, date of birth, phone number, address.

EHRs are storing patient data in different ways and it looks totally different. But if we standardize the interfaces for transferring and for receiving, the can make sure all of these different systems can communicate when sending data back and forth in an easy way. Healthcare is been transferring data for years either by hand or electronically. This is important now because we have been transferring data through on scalable standards like HL7 version 2 and X12s format. X12 and HL7 formats are delimited file formats that have embedded information with a hierarchy to that data, but it does not pass it attribute names with it. So what that means is both parties beforehand have to agree and know exactly in the format and order of the data before transfer, explicitly knowing this information before e.g. Knowing names and the delimiters in great detail. This only allows them to develop for each other using those formats.

On the other Modern formats such as JSON and XML are using a lot in web development. They are agreed on apone standards that developers can all use that tag patient information so what you call a resource you know what you are calling.

BUILDING ON FHIR

drchrono just launched a version of the FHIR API for the 10 million patients on the drchrono platform. The personal health record platform called onpatient has the FHIR API documented here – https://onpatient.com/api_fhir/api-docs/documentation/

  • Build an OAuth Login and Logout
  • Build a way to view all patient information that is available via FHIR.
  • Build a blood pressure tracker
  • Build a sleep tracker
  • Build a weight tracker
  • Build a hydrate tracker

If you are looking to join drchrono, build an app on top of onpatient’s FHIR API and impress us! The way to do this is to

  1. Create a drchrono account at drchrono.com
  2. Add test patient in drchrono at drchrono here after you signed up and logged in.
  3. Invite the patient to onpatient.com within drchrono here, use your email address so you get the patient email.
  4. Create an onpatient.com account with the email invite from drchrono, set a password.
  5. Sign in and go to the API page app page and start building.

Also post your code publically on Github as a resume builder and that the drchrono engineers can take a look at what you have built.

As you build please let daniel[@]drchrono[.com] and jian[@]drchrono.com know how things are working and if something is broken. This is a VERY new API so we are looking for real-time feedback.

This is a great project that someone built recently on the drchrono medical practice physician API and the onpatient patient API.

( This is a draft of a hackathon project to build on top of the onpatient FHIR API. I will be adding more over the next several days. )

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How to Present to Investors on Demo Day

Jun
04

Michael my cofounder at YC demo day.

Pitching at demo day can be stressful. Below are three of the best articles I have seen around on pitching, I recommend reading them all if you are going into a demo day!

A quick pitch to Anne Wojcicki

Always have your pitch ready.

This is the drchrono slide deck we used at demo day, it will give you some insight into how simple and focused a pitch has to be

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Startup Teams akin to Bands and Sports Teams

May
25

Sustaining a band like the Beatles is very similar to sustaining the momentum of a startup. You have to all be on the same page. You all have to be playing in harmony and you all have to be moving towards creating something different, unique that people actually want. I like to look to the Beatles from time to time and look at the energy that band sustained over a very long period, from 1968 to 1970.

If you look at GE or General Electric, they have been on the public markets, lasting longer than any other company on the stock market.

I see startup teams very similar to sports teams or like high energy bands.

( This blog post is a work in progress. )

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The Infinite Software Release

May
11

Software Versions

Software is living and breathing, it is something that is continually changing with “the times”, to be successful over time you must continually be iterating and updating software, working to create the best experience for your end user. Software shouldn’t be stagnant.

Many vendors in the software industry are fighting with “The Innovator’s Dilemma“, where the company has not moved to building software in fast iterative cycles. The best way to create a nimble release cycle culture in your company is to have your software created and maintained in the cloud. For vendors pre-cloud movement, it is hard for them to move to a cloud software and to Software as a Service (SaaS) models when customers are paying for older software that is working right now for them. What will justify the moved to the cloud when the customer paid large sums of money for software that is working for them. Overtime, non-cloud base software will become stagnant, it is a struggle to keep all of your users up to date.

The risk of doing large software releases in the worst case scenario; when a large software update is released, users reject it and don’t use the software at all. There is also the risk that a large software update takes to long and the software is delayed to a point where the application is “stale” altogether or never released.

The Infinite Software Release

Have you ever heard of the “infinite release cycle”? The goal is to release often allowing continuous small daily, weekly or monthly incremental changes to software. Doing large/major version releases of software every year slows down developers from moving fast and getting input. A large software release benefit’s marketing the product, the product queues up for launch and gives the marketing team something big to announce, but doing so slows down getting the product out to market for real users to take advantage of getting feedback.

For example, the drchrono iPad and Web EHR is a continual work in progress, starting January 2009 and we have been on an “infinite release cycle”, pushing code to quickly, not releasing yearly or monthly but daily or close to daily. Within a given year, we have released at least 100 to 400+ versions of drchrono, that is how we are making the drchrono platform better and better at a rapid pace.
Look at the graph below at how infinite release cycles can change the customer experience and feedback loop. The green line represents a company that is on a yearly release cycle, great for marketing and launching a product right out of the gate will tons of features, but this is sometimes bad. Customers don’t have a chance to help you refine and give input the software. The blue line represents the quarterly release cycle, it is a better then yearly releases, allowing customers a chance to give feedback and learn about software in increments. With an infinite release cycle, customers can learn the product as it comes out and as enhancements come out, the learning curve is less drastic. Fast release cycles provide quick feedback loops to be able to make changes fast for refinement. Do you think it would be easy to do this if you are building for a year in an insular environment, then realizing a customer wants a major change? It is much harder to make a major refinement if a years worth of work is complex to change, which happens often.

Software Reversibility

Version 0 of drchrono

Version “day 1”, year 2009. drchrono iPad EHR.

In a new world of cloud-based apps and services, rolling out software in the past was episodic. Now things are moving to an almost continuous release cycle, happening fast. In today’s environment aren’t products “done” like they used to be, they can’t be. Do you recall the days of software on DVD and CD? You can’t just ship a DVD with software on it and call it a day anymore. The focus has shifted to pushing code and having the capacity for reversibility. You need to build software in real-time so you can iterate fast but also build fail-safes in place so if there is an issue, the software can be fixed it before users notice it. Reversibility is very important if you’re rolling new software out that is broken. It must be tested, one great company that does testing is Rain Forest, they have an on demand Uber-like service for quality assurance (QA) testing. As part of the deployment cycle, you need to test and talk to customers, showing them the new software, react to feedback and iterate.

Move Fast and Release Often

Track Metrics

A critical metric to track is how long did a cycle take and what can you do to make the next cycle faster?

Be sure to track after a developer writes code and committed to run the unit test and then how fast the code gets into production. If you can get the code out into production in 15 minutes from a change in code base out to users allows faster iteration and feedback.

  • After developer code is written and committed track these
    • Time after code was written, track how long until a unit test is run
    • Time after code was written, how fast the code gets into production

If you don’t track that metric, release cycles will generally get slower and slower.

Many startups start moving fast and naturally slow down on release cycles, to bi-weekly, weekly, then semi-monthly, then monthly. It can get worse from there.

A great talk from Startup School 2017 from Adam D’Angelo about this. Watch from 43 minutes into the talk.

 

Y Combinator: Applying and Pitching In Person

Apr
13

All I can say is just do it; if you are thinking about it, it is worth trying to get in. Apply ASAP, don’t delay it. There are no guarantees when applying but it is worth it. Y Combinator is more open then you think if they see a great idea and team. The Y Combinator team is willing to invest early. They invest in startup ideas and people. They take risks in new markets and invest a lot of the time when other investors don’t understand the market. To apply to Y Combinator go here.

Application

Most important things to show on your application:

  • You can build stuff fast.
  • Do you have some users using something you built? If not start building!
  • Have you done something amazing in the past? (E.g. Create Django?)
  • Make sure there are two of you at least (founders). Founder dynamics is important, if you have been friends or been working together for several years, then there is a great dynamic. Friends general won’t just walk away from something that will take the time to build. Startups can be stressful, show that your team can handle the stress of it.
  • Make sure you put a video attachment in your application, it will help.
  • Y Combinator looks for good team dynamics.
  • Conviction in what you are doing.
  • Talk about something you have done amazing in the company or in your life that really stands out.
  • Talk about the passion and idea to the partners.
  • Know your market size.
  • Know your competition.
  • Talk about the vision of your product.
  • Is there something driving you do build this company, startups are the cool thing to do but generally persistence pushes companies forward and having the right motivation will keep you going. Have the right motivation if you are starting a startup.

Pitching in Person

  • The first 30 seconds are super important.
  • Have one person be the presenter during your very fast pitch in person.
  • Practice, practice, practice before meeting with the Y Combinator partners. Ask yourself’s questions the night before being interviewed, think about questions you think you won’t answer well, it helped us, my cofounder and I more than we thought it would. It is fast interview questions, rapid fire that will prep you so you are sharp for this kind of fast interviewing.
  • Find one or more founders that went through YC to talk too. We found two, one of them was the founder of Reddit, Alexis. We also found another founder who really helps us understand the process the day before our in-person interview. Insight into the fast questions you will get will help you think fast on your feet.
  • Record yourself via video and audio, and listen to it over and over. (Use Evernote to record the audio or something else.)

Alexis came to drchrono’s office talking to the early drchrono team before we pitched Y Combinator.

  • One way to think about your pitch to the Y Combinator is this way, all of these can be shuffled around, depending. If you have fast growth shuffle things around  and assume you only have 10 minutes to pitch:

  • If you have the chance to pitch in person, be sure to practice your pitch over and over.
  • Record your pitch and listen to it several times to see where you are strong and you’re not strong.
  • You need to be able to communicate, you need to convey information very fast, practice.
  • Have you done a lot with very little? No investors, bootstrapped?
  • Show the product if you have one!
  • Have a demo? Load demo data and be ready to present it!
  • The partners see a ton of pitches, so have a tee shirt on with your logo. Well worth the branding and you can wear it anytime.
  • Sometimes context – “we are the X of X” helps people understand what you are doing.
  • Highlight something impressive, featured in the App Store? Win an award? Have some funding?
  • Have you burned your boats?
  • The pitch:
    • Team: Talk about your backgrounds, the co-founders.
      • Have a good intro.
      • Why you?
      • The team is super important so introduce yourselves in 30 seconds.
      • They want to make sure the founders get along and there isn’t an internal power struggle.
      • What is something you were super proud of?
      • What is your story? (each co-founder) Did you work for Apple? Do you have a Ph.D.?
        • If it is a company that is big you worked at but people don’t know the name, just say the company is the second largest X in the world. The company I worked at made X billion per year.
      • Who is the technical co-founder? Who is the CEO?
      • Michael my co-founder of drchrono talks about the “Humble Brag
      • How long have the founders known each other? If you are friends you will tough it out when things get tough.
    • Problem: What is the problem?
    • Market: How big is the market? Is there competition? Is there a large amount of capital needed to start?
    • Product: Can you describe the company in 1 minute.
      • Is there tech risk?
    • Traction: Is this just an idea? Prototype? Have real users?
      • Do you have revenue? Do you have growth month over month?
      • Early fast growth helps.
  • We have X number of users, if you have traction, be sure to put that up!

The partners will ask questions and throw curve balls.

One tip: Be confident and walk up to others at Y Combinator and say hi! There are some really amazing founders around at YC.

Be sure to listen to this great lecture from Sam Altman from Startup School

More on pitching and demoing can be found here.

How to Interview

Mar
02

Interviewing can be hard and having the right questions to ask is extremely important. Below are some of the best questions to ask when interviewing. Always remember, interviewing is a two-way street, the candidate is looking for the right fit and you are looking for someone you can work with. Think to yourself “Can I work with this person?”, “Would I enjoy having dinner with this person?”, “Is this person a good culture fit”?
 
I look for a blend of different people to bring into my startup, people who might not have domain expertise but have the right a great foundation or attitude with some people who have some domain expertise. Diversity in your team makes it stronger, people from all different backgrounds of life and level of experience.
People generally say,
Hire slow/fire fast
I don’t necessarily agree with this, you really should be forcing yourself to interview at least 10 candidates to give you perspective. Then hire the right person fast. Make calculated and conscious hiring decisions and avoid the “fire fast” part of what people generally say scenario. Firing fast can be demoralizing. Hiring slow, with lots of  of interviewing gives a greater perspective into what you are really looking for.
 
One tip I have is asking a question in several ways, maybe three different ways, to see if a candidate is really sticking to what they initially said when you asked a question the first time. Think about people who can help the company and company plan evolve. Let’s assume that things change in a startup as they do, you need people that can adopt and change the company as the plan changes.
The best skill to look for is to learn how to learn and finding people that know are optimizing learning to learn. Innovation is happening all around us and skills from yesterday are irrelevant to what is needed for tomorrow.
 
Also, I generally keep a score of how well the candidate is doing, this is the scoring system, below is an example of it for a phone interview and an in-person interview-
  • Phone Interview Scale, Attributes [1-10]
    • Phone skills
    • Knowledge of Healthcare 8, 7 years at another EHR
    • Knowledge of Technology 6
    • People Skills/EQ 9
    • IQ 7
    • Why pick drchrono? Stagnate Growth at current job
    • Ideal salary range? 45k
    • Willing to move? Yes, Baltimore, NY, not CA
    • Willing to take any position? Yes
  • In person Interview Excellence survey, Attributes [1-10]
    • Good relationship skills?
    • Intelligence?
    • High energy?
    • Self-direction?
    • Positive attitude?
    • Curious person?
    • Going to school to better themselves?
    • Always on time?
    • Grow and learn and wanted to take on more responsibility?
    • Didn’t wine if they needed to stay late or work on the weekend?
From Warren Buffet
Things to look for, these are not questions but qualities to look for in a person!.
  • Integrity (most important)
  • Intelligence
  • Energy 

 
From Reed Hoffman
 
In every job, you create an artifact.
  • Founders create the vision statement, the org chart, the financing strategy
  • Business development creates the signed contracts with other companies
  • Engineers create code
Questions
  • What is the artifact you create as a …?

From Kim Malone Scott
Auther of the book Radical Candor.
Questions
  • Tell me your story?
  • Tell me about a time you made a big mistake?
  • What is the hardest feedback you ever got in your life?

Kim is an executive coach to CEO’s and exec’s like the CEO of Evernote Chris O’Neill.


 
From “Creating Magic” by Lee Cockerell
 
Questions
  • What do you do outside of the office?
  • When you hear the word successful who is the first person who comes to mind?
  • What would you do differently?

 
  • Ask revealing questions.
  • Use structured interviews when possible.
Questions
  • What is the best idea you ever came up with to improve your business?
  • How do you plan your day?
  • What would you do if you found out if your boss was doing something illegal or unethical?
  • What was the reason you left?
  • Explain how you plan your day?

Jen Miller of the Gallup Organization
  • Screening.
  • Profiles of people.
  • Find out what really matters to people.
  • Hire someone you would gladly report to yourself.
Questions
  • What really matters most to you?
  • Leisure activities?
  • What are your passions?
  • What do you believe in?
  • Demonstrate your expertise.

 
Questions for Leaders
  • Ask yourself how will this leader make my VP of Sales or VP of Marketing better?
  • How do you stay on top of the labor costs in your organization?

Ask for references, ask for the person’s last company performance review of them. Also get “off-sheet” references, people who know them but aren’t on the potential person’s reference sheet. Find out about the interview candidates reputation.
Some other great reading on hiring –

 

I do also recommend using Evernote as a tool to record your notes. I also recommend starting an interview scorecard template.

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Honored as Winner of the 2016 Stony Brook 40 Under 40 Award

Dec
29

Michael Nusimow and I named third year in a row by alma mater Stony Brook University as tech visionaries

stony-brook-edu-40-under-forty-2016-daniel-kivatinos-michael-nusimow-drchrono-3

Michael and I have been honored by our alma mater Stony Brook University as recipients of the 2016 40 Under 40 Award. The 2016 Stony Brook 40 Under 40 award winners are selected for accomplishments and contributions in industries such as education, technology, healthcare, law, sports, science & engineering and many others.

We are thrilled to be recognized once again by our alma mater Stony Brook University. We want to thank the staff and alumni committee for recognizing our efforts and we feel privileged that we can give back to the Stony Brook community.

stony-brook-edu-40-under-forty-2016-daniel-kivatinos-michael-nusimow-drchrono-1

 

Michael and I continue to engage with Stony Brook University’s student and alumni community. We enjoy working closely with the young entrepreneurs and students in the engineering and computer science schools and furthermore helping them learn what it takes to build a tech startup in Silicon Valley. Michael and I started drchrono in 2009 with the mission to make healthcare more innovative with the drchrono Electronic Health Record (EHR) platform for physicians and patients. drchrono’s fully integrated mobile EHR solution is transforming how providers are caring for their patients. Michael Nusimow has a B.E. in Computer Engineering & Computer Science from Stony Brook University. I hold an M.S. in Computer Science and a B.S. in Computer Science & Psychology from Stony Brook University.

More information and the entire list of the 2016 Stony Brook 40 Under 40 Award recipients are available at http://www.stonybrook.edu/40underforty/2016/.

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Creating Company Culture: Walking 1-on-1 Meetings

Nov
11
drchrono-steve-jobs-walking

Image by Akshay Parakh

If you are looking to learn a bit about drchrono’s company culture or enhance your team’s communication and culture, read on, this topic is on the walking 1-on-1 meeting and walking in general. The drchrono team goes on walks.

The Walking Meeting

Colleagues, my cofounder Michael of drchrono and I go on walks to talk about strategy, give and get updates and learn from each other.

In the early days even before we incorporated back in 2008, Michael and I would go on lengthy walks to talk about action’s we needed to take to build a company in healthcare from nothing. We both knew creating a lasting company in the healthcare space would be a long-term endeavor. Communicating rapidly every step of the way would be critical. We would stroll to local coffee shops in New York City, talk along the way, grab a coffee, talk some more and walk around the city. Walking also paid off in finding some critical team members. A great example: We hired Hong our design leader simply by going on walks with him. Hong and I knew each other as friends. I would tell Hong a bit about what Michael and I were working on and he would give me input on design, we did this a bit and those walks led to him joining us early on.

Walking made us more productive. We would go for a walk, get our legs moving, blood would be flowing and get our minds in a good headspace where we would think clearly about the company. We have been doing this since the beginning of the company.

Investor Walk Meetings

Paul Graham of Y Combinator, our first investor in drchrono would do the same thing with us, when he and the Y Combinator partners invested in drchrono in 2011, Michael, Paul and I would have “walking office hours”, wandering around nearby the Y Combinator office. Before we started any meeting with Paul, he would ask:

Is this a walking meeting or a sitting meeting? ~ Paul Graham

Most of the time it was a walking meeting. The meetings were extremely productive.

To this day, we go walking with several of our investors.

Follow in the Footsteps of Giants

Aristotle was a “peripatetic” lecturer, he walked about as he taught. The peripatetic school was a school of philosophy in Ancient Greece. Allegedly the school name came from Aristotle’s habit of walking while lecturing.

Ludwig van Beethoven was an enthusiastic wanderer, taking short breaks while working and spending his afternoons sauntering around Vienna. He would take a paper and pencil with him to write down ideas. Influence his wooded walks can be heard in his symphony’s.

steve-jobs-john-sculley-walk

A Steve Jobs & John Sculley Walk

Steve Jobs the cofounder of Apple made it a habit of having walking meetings and was know for his long walks, which he used for contemplation, exercise, problem solving, and meetings. According to CNNMoney, Steve Jobs did this particularly for first encounters. “Taking a long walk was his preferred way to have a serious conversation.”, from Jobs’ biography.

“Taking a long walk was his preferred way to have a serious conversation.” ~Jobs’ biography

Mark Zuckerberg the founder and CEO of Facebook also likes first meetings with people to be on the go. A walking conversation is natural, distraction-free and you can focus.

Jack Dorsey, cofounder of Twitter and Square, would take new hires for his ‘Gandhi walk’. This is a historic walk through the streets of San Francisco, where he talks about the companies guiding principles.

There are countless others, like Charles Darwin, Sigmund Freud, Friedrich Nietzsche, Harry S. Truman and Charles Dickens to name a few who would walk to brain storm and talk with others.

A Deeper Look

Walking meetings are great for 1-1’s or ~3 people. With larger groups, a walk sometimes gets a bit more complicated with people pairing into smaller groups to talk. But even larger group walks can be productive if you want everyone to communicate and facilitate team camaraderie.

There are health reasons and research on how walking makes you more productive. A study conducted by Marily Oppezzo and Daniel L. Schwartz published in the Journal of Experimental Psychology incorporates an experiment where participants took the Guilford’s Alternative Uses Test, a timed exercise used to measure artistic thinking: first while sitting and then while walking on a treadmill. The results? For 81% of participants, walking increased creativity, improving creative output by an average of 60%.  That is a big change in creative thinking.

We have a walking desk at the chronoplex for the team, I can attest to it, it works.

drchrono-chronoplex-walking-desk

The TED presentation from Nilofer Merchant gives some alarming statistic’s: we’re sitting, on average, for 9.3 hours per day, with 7.7 hours spent sleeping. “Sitting is so incredibly prevalent, we don’t even question how much we’re doing it,” Merchant states.

This is a great talk from TED on walking:

A Walking Culture

Some of the greatest minds used walking as a tool, it is a simple way to enhance your productivity, let the creativity flow and to allow the team to communicate. I highly recommend the next meeting you take, do it going for a walk. You will be surprised at how well a walking meeting works.

Daniel KivatinosArticle by Daniel Kivatinos, COO and cofounder, drchrono

Daniel drives direction, brand vision, and business strategy for drchrono. Daniel’s focus has been in the technology space since 2001, as a software engineer and entrepreneur. Daniel holds an M.S. in Computer Science and a B.S. in Computer Science & Psychology from Stony Brook University.

~ Life is short, build stuff that matters.

The Basics of SaaS Metrics

Oct
29
5 C’s.

1.       Committed MRR – this is the same as MRR if you don’t have an implementation phase ie. someone starts paying as soon as they commit.

2.       Churn – you can calculate unit churn as “paying users lost”/”total paying users in previous month”. If you track cumulative MRR, you can also calculate $ churn in the same way

3.       Cash (operational cash flow) – the financial statements

4.       CAC – is the total acquisition cost (sales + marketing) divided by the gross new paying users added

5.       CLTV – for this ideally you have the cohort as churn for a cohort should be going down over time. Else you can do as upfront cash + MRR*(1/annual churn) – CAC. This is pre time value of money to keep it simple

Some more great information to read.

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