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How a pair of 'middle school graduates' developed and sold their respiratory health tech company

The two college students built Spira, a no-code back-end tool for creating smart intake forms that was acquired by Galileo Health in April.

When Seattle natives Nikolas Ioannou and Sage Khanuja met at an early entrance program for the University of Washington after dropping out of high school after 10th grade, they quickly bonded over their interest in health and technology.

Both come from families with a background in health, and both came to UW to study computer science. Right away, the two began brainstorming ideas for a joint venture.

“So that’s how we sort of got interested in health in the first place,” Ioannou told MobiHealthNews. “But then, as we started to see, just looking over my dad’s shoulder, a lot of the existing health tech solutions out there right now are very antiquated, and can be greatly improved on. And so we really saw a good opportunity to do that ourselves.”


The two didn’t set out to build a full-blown company. They were trying to address a pain point they saw for patients with respiratory conditions: There was a lack of pre-appointment screening, causing the actual visit to be disjointed.

“We started off tackling this very narrow challenge of respiratory diseases, because there are a lot of people with respiratory diseases, and, especially in telemedicine, it’s one of the most inefficient pathways to go, because you go, and how much can your doctor do without getting actual good information?” Khanuja wondered in speaking with MobiHealthNews.

Starting there, they created the first iteration of Spira – derived from "respiratory" – that screened patients for breathing problems.

But knowing the costs, the research and development needs, and the regulatory processes involved in creating a medical device, the two college students decided to pivot Spira’s function. Now, Spira is a back-end no-code tool for creating smart forms that gather clinical information for a personalized intake and post-visit experience.

“We were like, ‘Hey we think this respiratory tool has a lot of value, but what could potentially have more value and faster value is this back-end tool which can be used by others to create these different smart forms,’” Khanuja said.

This approach suited them better because, as college students, the two didn’t necessarily have the credentials or resources at the time to take the medical-device route.

“But really, just starting an Internet business, you know, if you’re a developer or programmer, or product person, there’s a very low barrier to entry these days,” Khanuja said.

“We’re students, so we had all these different Cloud credits, and we obviously didn’t pay ourselves, so we were just grinding and hustling on the product and coding side. And then there are various small things, like we got a couple of non-dilutive grants, which just covered the small things. But it wasn’t anything substantial.”


After fully developing Spira, Ioannou and Khanuja began seeking meetings with potential customers – a challenge in and of itself for the self-proclaimed middle school graduates.

“From the outside in, it might just look impossible, but the key is just getting the meeting, and then from there it’s up to you to prove yourself,” Khanuja said. “And a lot of people are very supportive of the fact that you’re young. But then, if you can show depth, then they’re impressed, and they’re even willing to help you even more – and like brainstorming and stuff like that.”

But what surprised them even more than getting these meetings was when some potential customers expressed interest in fully integrating Spira into their own platforms.

One interested buyer was Dr. Thomas Lee, founder of Epocrates, a medical reference app, and after him appeared One Medical, a membership-based primary care provider, and then the founder and CEO of Galileo, a virtual healthcare company.

Once the two met with Lee and discussed their shared vision for the future of healthcare delivery, they knew what to do.

“Go to market in health is already very, very challenging,” Ioannou said. “And so one of the reasons we opted to get acquired in the first place is that, building out a large patient-base and agreements with large health systems, it’s a very challenging thing to do, especially at our age. And a lot of the time you need to be very connected … And so, the reason we opted to get acquired was to build off another company’s existing patient base and connections, so that our tool can have the most impact.”

Galileo acquired Spira in April for an undisclosed sum. Ioannou and Khanuja are now working full-time with Lee to integrate the Spira technology into Galileo’s on-demand telehealth platform.

“With any integration, there are always different kinds of nuances that are part of it, but … with Spira, it’s not like we’re going to integrate and just be done with it, right?” Khanuja said.

“There’s a lot of potential to actually build upon what we were building, because they have a lot of patients, they have a lot of data. So it’s never going to be a static thing, where it’s like we integrate and we’re done. It’s going to be a dynamic process, where we are continuing to innovate over time.”

For now, the two are taking a break from school as they learn real-world skills they hope they can take into their next venture.

“At heart, we’re entrepreneurs,” Khanuja said. “So it’s not a question of if, but when. But for right now, our 100% focus is just how do we make the most impact during our time at Galileo, and just going heads-down there. We’ve enjoyed every day that we’ve been there, and we’re excited for the many weeks and months – and time to come.”


  • Seattle, WA, USA
  • Sage Khanuja and Nikolas Ioannou