# SSC x TLI, Wearable Strategy Memo

**To:** Dr., SSC / FORBventures
**From:** TTC x TLI engineering
**Date:** 2026-05-14
**Status:** For review. Companion to the integration architecture deck.

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## The reframe

Your notes describe a wearable that does ten jobs at once: continuous biosignals, lab integration, AI coaching, longitudinal record, doctor portal, cross-office sharing, medication interaction checking, research data collection.

**The wearable is one sensor. The platform is the product.**

No single device on the market does all ten jobs, and waiting for one will cost 18 to 36 months and $5 to $15M before first patient. We don't need to wait. We build the platform now and feed it from a small set of best in class sensors (one clinical, several consumer) that already exist.

This memo answers each of your six points with a specific decision we can make this quarter.

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## 1. The clinical signal SSC owns: overnight pulse ox

Your "only in the country" claim does not require custom hardware. It requires the **integrated stack**: sleep medicine, accreditation, epigenetics, GLP-1, labs, coaching, all in one longitudinal record. Nobody has that.

What we do need is one **clinical grade overnight signal** that the consumer wearable market does not deliver well. Apple Watch SpO2 is intermittent and not FDA cleared for diagnosis. Oura doesn't do continuous SpO2 at all. Garmin's Pulse Ox is consumer grade and noisy.

Recommendation: pair every SSC patient with a clinical overnight pulse ox (Wesper Lab, Withings Sleep Analyzer plus Masimo MightySat, or a white labeled Sleepiz / CMI Health unit) and stream that into the TLI platform alongside whatever consumer device the patient already wears. Details in the hardware shortlist appendix.

This is the wedge: clinical SpO2, AHI, and heart rate at night, consumer grade everything else by day, one record.

## 2. The 100 metric dashboard, AI coaching, unified record

You're describing what Evidation, Truveta, and Verily are building, minus the sleep specialization.

**Build the platform on three principles:**

1. **The patient brings their own consumer wearable.** We integrate via Apple HealthKit, Google Health Connect, Terra API, and Vital. That gives us roughly 80 of the 100 metrics on day one, at zero hardware cost.
2. **SSC supplies the clinical sensors patients don't already own.** Overnight pulse ox, optional ring (Oura or Ultrahuman) for trial enrollees, CGM for the GLP-1 cohort.
3. **Labs ingest quarterly or semi annually** via Quest, LabCorp, or Rupa Health API, pushed directly into the same record. Your "100 health driven metrics" is real and achievable once labs, wearable, and EMR are unified.

**The AI coach** sits on top of the unified record, not on the device. Guardrails are non negotiable:

- Read only on diagnosis (interpretation, not declaration)
- Advisory board reviewed prompts and refusal patterns
- Every clinical recommendation routes through the supervising physician's queue before it reaches the patient
- Full audit trail of model output, prompts, and physician edits

This is your "advisory board guardrails" line, operationalized.

**Medication interaction checking** is a solved problem at the data layer (First Databank, Lexicomp, NIH RxNorm plus DDInter). We license, we don't build. The hard part is supplement and food interactions, which we layer on top with a curated SSC formulary.

## 3. The franchise package

Your list is right. The platform supports it directly:

| Franchise need | How the platform serves it |
|---|---|
| Playbook, SOPs | Hosted, versioned, role gated in the same dashboard |
| Membership | Stripe Connect, per franchisee billing, parent revenue share |
| Wearable, products | Centralized procurement, franchise discount surfaced in admin |
| Vendor discounts | One purchasing entity, contracted pricing visible per franchise |
| Payroll, HR, EMR, billing | Integrate Gusto / Tebra / Candid Health rather than build |
| Training, certifications | LMS module (TalentLMS or Northpass), white labeled |
| CT discount (50 plus buy) | Group purchasing org structure, separate legal entity, parent owned |
| Metrics (daily, weekly, monthly) | Already a core part of the franchisee dashboard mockup in the deck |

**Build** the EMR shell, platform, and dashboards. **Buy and integrate** everything else. Building payroll or billing software is how franchise tech companies die.

## 4. EMR, work with Mahler

Two paths:

**Option A. Build a thin EMR on the platform.** Owns the record, ties directly into wearable and labs and AI. Faster to ship, lighter weight, no Meaningful Use certification headache if we stay outside Medicare and Medicaid claims for year one. Best fit for the SSC concierge model.

**Option B. Integrate Mahler's preferred EMR via FHIR.** Tebra, DrChrono, Athena, and Elation all expose FHIR APIs. We don't own the record, but we don't have to build the EMR either. Best if franchisees come in with existing EMR contracts.

Recommend a hybrid: thin EMR shell that IS the record of truth for SSC franchises, with FHIR out so any external EMR Mahler endorses can read from it. Decide after one working session with him.

## 5. The vetted network (MD VIP, med spas, longevity centers)

This is a marketplace play, not a product play. Three tiers:

1. **Free tier.** Vetted doctors in the directory, refer in and out at no cost. Lubricates the network.
2. **Platform tier.** Practices that adopt the TLI dashboard and wearable, pay per seat, get full integration.
3. **Research tier.** Practices that contribute de identified data, pay reduced fees, receive cohort level insights back.

Sleep lab to dentist pairing is a specific case of the directory. Build the directory first, the pairing logic is a filter on top.

## 6. The research arm and monetization

You named the right question and the wrong analogy. **Facebook and Instagram are not the model.** They monetize identified behavioral data without medical consent. That's the path that ends in HIPAA fines and class actions.

**The right models are Evidation, Verily, and Truveta:**

- Patients consent at enrollment to de identified data contribution
- Data is aggregated to the cohort level, never re identifiable
- Research partners (pharma, universities, government) license access to the de identified pool
- Patients get a share (small payment, premium features, free wearable upgrades) in exchange for ongoing consent

This is HIPAA compliant (de identification under the Safe Harbor or Expert Determination methods), defensible, and revenue positive. A platform with 50,000 active SSC patients contributing weekly biosignal and lab data is worth $5 to $50M per year in research licensing, depending on cohort quality.

The advisory board vetted researcher you mentioned should sit at the head of this arm, with a Data Use Committee that approves every external license.

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## Decisions to make this quarter

1. **Clinical pulse ox partner.** Wesper vs. Masimo vs. white label OEM. See appendix.
2. **Consumer wearable integration stack.** Terra plus Vital plus HealthKit (recommended) vs. build direct integrations.
3. **EMR posture.** Thin platform native EMR with FHIR out (Option A plus) vs. full integration with Mahler's preferred system.
4. **Lab integration vendor.** Rupa, Vibrant, or direct Quest / LabCorp API.
5. **Research arm governance.** Who chairs the Data Use Committee, what the consent flow looks like, what the patient revenue share is.

Everything else flows from these five.

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## What ships first

A **90 day MVP** with five real patients:

- Clinical overnight pulse ox plus Oura ring plus HealthKit pull
- Quarterly Rupa lab panel ingested into the record
- TLI dashboard, patient view and doctor view
- AI coach reading the record, draft recommendations queued to physician
- Medication interaction warnings via Lexicomp API

Everything else (franchise rollout, marketplace, research arm) sits on top of that 90 day core and ships in waves through year one.

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*Hardware shortlist follows as Appendix A.*

# Appendix A. Hardware shortlist

Three lanes. We pick one device per lane to power the 90 day MVP.

## Lane 1. Clinical overnight pulse ox (SSC-supplied)

This is the non-negotiable clinical sensor. Patient wears it during the qualifying study and on a defined cadence after that (monthly check-ins for therapy patients, weekly for trial cohorts).

| Device | Form factor | FDA status | API / data access | Approx unit cost | White label | Notes |
|---|---|---|---|---|---|---|
| **Wesper Lab** | Two adhesive patches (chest + finger) | FDA cleared (Class II, K201531) | Wesper Cloud API, JSON pull of nightly studies | $25 to $40 per night, rented kit model | No (branded) | Built for at-home longitudinal monitoring, not single night HSAT. Strong fit for SSC's cadence. Already partners with sleep practices. |
| **Masimo MightySat** | Fingertip pulse ox | FDA cleared (Class II) | Masimo Health SDK (iOS), HealthKit pass-through | $189 retail, B2B pricing on request | Limited (cobrand possible) | Best raw SpO2 accuracy on the market. Not continuous overnight on its own. Pair with a Withings or Apple sleep tracker for context. |
| **Withings Sleep Analyzer** | Under-mattress mat | FDA cleared for AHI estimation (DEN200023) | Withings Health Mate API | $130 retail, Pro program available | No | Contactless, no patient compliance cost. AHI estimation is regulatory cleared. Pulse ox is indirect. Best second-line monitoring. |
| **Sleepiz One+** | Bedside radar | FDA cleared (Class II) | Sleepiz cloud API | $400 to $600 per unit, B2B | Yes (cobrand and OEM) | Contactless overnight monitoring of HR, RR, motion, derived AHI. Higher cost per unit, lower per-night cost over time. |
| **CMI Health SleepView / NightOwl** | Fingertip recorder | FDA cleared HSAT | Direct cloud, raw data export available | $60 to $120 per study | Yes (OEM available) | Cheapest white-label path. Less rich data than Wesper. Strong for one-time qualifying studies. |

**Recommendation:** **Wesper** for the longitudinal therapy cohort, **CMI NightOwl** white labeled for HSAT-only intake studies, **Withings Sleep Analyzer** as the bedroom companion for every membership patient. Three SKUs, three jobs, all clinically defensible.

## Lane 2. Consumer wearable (patient-supplied where possible)

We do not buy these. We integrate to them. The job here is to pick the integration aggregator, not the device.

| Aggregator | Devices covered | Pricing | Notes |
|---|---|---|---|
| **Terra API** | 30+ wearables including Oura, Whoop, Garmin, Polar, Fitbit, Apple Watch (via HealthKit), Samsung | $0.04 to $0.20 per active user per day, volume tiered | Best coverage, single SDK, healthcare friendly contracts |
| **Vital** | Similar device coverage, plus stronger lab and EHR connectors | Per active user, tiered | Lab integration is a real differentiator. Combines lanes 2 and 3. |
| **Spike API** | Similar consumer coverage | Per call, cheaper at low volume | Good for prototype, less HIPAA tooling |
| **Apple HealthKit direct** | Apple ecosystem only | Free | Required regardless. Companion app must request scopes. |
| **Google Health Connect direct** | Android ecosystem only | Free | Required regardless for Android patients. |

**Recommendation:** **Vital** as the primary integration layer (covers wearables and labs in one contract), HealthKit and Health Connect direct on top of it for the iOS and Android companion apps.

## Lane 3. Optional sensors for specific cohorts

| Cohort | Sensor | Source | Notes |
|---|---|---|---|
| GLP-1 / weight loss | Continuous glucose monitor (CGM) | Dexcom Stelo, Abbott Lingo (both over the counter as of 2026) | Cohort specific, not for every patient. Insurance reimbursement is uneven. |
| Trial enrollees | Smart ring | Oura Gen 4 or Ultrahuman Ring AIR | SSC subsidizes for first 500 trial patients to seed the research dataset |
| Sleep therapy compliance | CPAP cloud | ResMed AirView, Philips Care Orchestrator, Lowenstein Prisma Cloud | Already mainstream in sleep practices. Integrate via vendor APIs. |
| Cardiac risk subset | Single lead ECG | KardiaMobile 6L | $150 retail, optional for AFib screening cohort |
| Activity, blood pressure | Withings BPM Connect plus Body Cardio scale | Patient supplied or SSC supplied | Cheap, well integrated via Withings API |

## Build vs partner verdict

We do **not** build custom hardware in year one. We do **not** white label a single "SSC wearable" in year one. The cost (NRE plus FDA pathway plus inventory plus support) is $5 to $15M for a device that delivers maybe 10 percent of the platform's value.

In year two or three, once the SSC patient base proves out a specific unmet signal (currently nothing on the market does both nocturnal SpO2 AND continuous CGM AND ECG in one wrist or ring device) we revisit. By then the platform's data tells us exactly which sensor gap to close, and we can fund the custom build from platform revenue instead of seed capital.

## What we tell the FORBventures room

> "We are not betting investors on a device. We are betting them on the longitudinal record. The wearable is rented or BYO. The moat is the integrated stack: clinical sleep signal, plus patient consumer wearable, plus labs, plus EMR, plus AI coach with physician oversight, plus de-identified research pool. Three patients in, the data flywheel starts. Five thousand patients in, no competitor can catch up."

That sentence is the wearable strategy.