NEW Innovation Intake Form

NEW Innovation Intake Form

Introduction

NL Health Services Innovation Team aims to partner with innovation enthusiasts to advance innovation in the health care system. We are a living lab, a real-world innovation test bed with a mission to improve patients' lives, the health system, and our province. We do this by helping healthcare innovators accelerate their ideas, products, and services.

The Innovation team’s robust, customizable, fee-for-service offerings can be structured to meet your needs and goals. These offerings include technology briefs, human factors testing, acceptability trials, feasibility trials, and commercialization services within the healthcare sector.

We ask that all innovators complete the following intake form to ensure a transparent intake process.

For your reference, our Research and Innovation website can be found here.

Section 1 - Company Information

Project title/Product name*

Date of submission*

Affiliation with NL Health Services*

NL Health Services Employees

NL Health Services Vendor of Record

NL company/individual not currently affiliated with NL Health Services

Company/Individual not based in NL and not currently affiliated with NL Health Services

Other

Your full name*

Your department/division*

Employee position*

Your Manager/Director*

Is your Manager/Director aware of this idea/solution?

Yes

Employee email address*

Your phone number*

Phone

Your idea*

Please briefly explain the issues you want to address within the organization and/or the innovative ideas you want to share.

Company name*

If company not established, please indicate "N/A."

Company address*

If company not established, please indicate "N/A."

Applicant's full name*

Applicant's email address*

Applicant's phone number*

Phone

Section 2 - Company and Product Description

Tell us about your company*

Please briefly provide the information in 4-5 sentences

Provide a brief description of your innovation*

Please briefly provide the information in 4-5 sentences

What is the healthcare challenge that your solution aims to solve?*

Please briefly provide the information in 4-5 sentences

How will your innovation benefit the health system?*

Please briefly provide the information in 4-5 sentences

What are your competitive advantages?*

Please indicate clearly how your solution is different from your competitors’ solutions.

Please indicate the product development phase of your innovation.*

Not sure what TRL your project is at? Check out the TRL assessment tool to help you narrow it down.

Level 1: Basic principles of concept are observed and reported (Scientific research begins to be translated into applied research and development. Activities might include paper studies of a technology's basic properties).

Level 2: Technology concept and/or application formulated (Invention begins. Once basic principles are observed, practical applications can be invented. Activities are limited to analytic studies).

Level 3: Analytical and experimental critical function and/or proof of concept (This includes analytical studies and/or laboratory studies. Activities might include components that are not yet integrated or representative).

Level 4: Component and/or validation in a laboratory environment (Basic technological components are integrated to establish that they will work together. Activities include integration of "ad hoc" hardware in the laboratory).

Level 5: Component and/or validation in a simulated environment (The basic technological components are integrated for testing in a simulated environment. Activities include laboratory integration of components).

Level 6: System/subsystem model or prototype demonstration in a simulated environment (A model or prototype that represents a near desired configuration. Activities include testing in a simulated operational environment or laboratory).

Level 7: Prototype ready for demonstration in an appropriate operational environment (Prototype at planned operational level and is ready for demonstration in an operational environment. Activities include prototype field testing).

Level 8: Actual technology completed and qualified through tests and demonstrations (Activities include developmental testing and evaluation of whether it will meet operational requirements).

Level 9: Actual technology proven through successful deployment in an operational setting (Actual application of the technology in its final form and under real-life conditions, such as those encountered in operational tests and evaluations).

Please indicate your management team’s experiences and skills*

Please indicate your team capabilities/experiences working in the health care sector*

Section 3 - Services Requested

What is the ask?*

I want to test my product/solution in a real-world healthcare setting.

I want my product/solution to be implemented within NL Health Services.

I want to scale up my business by increasing product adoption at various healthcare organizations.

Please specify why you want to test your product/service*

To get feedback from end-users for iterative product development purposes.

To get feedback from experts in the healthcare sector for product implementation purposes.

To test my product/solution in a clinic or in other targeted departments.

Other

Company eligibility*

Are you a company with headquarters in Canada, majority owned by Canadians and has a significant economic impact on Canada?

Are you a company with headquarters in Canada and a significant economic impact on Canada?

Are you a company with a majority owned by Canadian and a significant economic impact on Canada?

Are you a company with a significant economic impact on Canada?

None of the above

Has this solution been tested/validated/implemented in a healthcare setting? If so, please provide details*

Please briefly provide the information in 4-5 sentences

To your knowledge, does this solution require integration with Health Information Systems? Please provide additional details.*

Please briefly provide the information in 4-5 sentences

To the best of your knowledge, what is the scale of this problem in the broader healthcare market?*

Please briefly provide the information in 4-5 sentences

What is the incentive for healthcare organizations to solve this problem?*

Please briefly provide the information in 4-5 sentences

How will this solution bring value to the healthcare system, providers and patients?*

Please briefly provide the information in 4-5 sentences

Does your product/solution need Health Canada Approval prior to testing?*

Yes

N/A

Do you have Health Canada Approval?*

Yes

Please tick all that apply*

ITA - Investigational Testing Approval

MDL - Medical Device License

Section 4 - Champions of your innovation

Do you have a champion to support your innovation within NL Health Services?*

Yes

Please indicate the champion's name and email address*

Do you have support for your innovation from a healthcare organization/health system stakeholder or from organizations in other industries?*

Yes

Please indicate if you have support from*

Healthcare organizations/health system stakeholders

Other industries

Please indicate their names/organizations*

Please indicate their names/organizations in industries other than health care*

Have you received funding from sources such as?*

Tick all that apply and indicate the sources of funding in the comment boxes below

Business incubators - Please indicate the name(s).

Venture capitalists - Please indicate the name(s).

Grants/subsidies - Please indicate the name(s).

Other sources - Please indicate the name(s).

Section 5 - Supporting documents

File Upload*

Please attach relevant documents such as company background, pitch deck, value proposition, product presentation…

Drag and drop files here or

Is there anything else you would like to share with us?

Refer to Bounce Health Innovation, Genesis, and other business incubators

Please contact business incubators (Bounce Health Innovation, Genesis, etc.) to validate your proof of concept further and contact us when the prototype is ready. Thanks.

Fee-For-Service notice

We offer services based on Fee-For-Service model. The total project costs vary depending on the complexity and scale of the project.

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