Last week AliveCor, which offers the FDA-cleared iPhone-enabled Heart Monitor (formerly called the iPhoneECG), appointed board member and Khosla Ventures operating partner Euan Thomson as interim CEO. Just five months ago the San Francisco-based company announced the appointment of its previous CEO Dan Sullivan, a longtime medical device industry executive and entrepreneur, who has now left the company. AliveCor’s first president and CEO, Judy Wade, helmed the company during the second half of last year when the company secured FDA clearance. She didn't last much longer than Sullivan.

Thomson started out as a physicist in the UK healthcare system, and prior to joining Khosla Ventures he spent ten years as CEO of medical device company Accuray, which he grew from $10 million in revenues in 2002 to more than $400 million in 2012 -- it also IPO'd during his tenure. Thomson describes himself as the first member of the Khosla Ventures investment team with real healthcare experience. He joined Khosla at the beginning of the year and soon after joined the AliveCor board and other mobile health companies in the Khosla Ventures portfolio.

Thomson also previously served as interim CEO at AliveCor for a matter of weeks while the company completed its recruitment of Dan Sullivan in the spring. So, why does Thomson need to step into that role yet again -- why is it so hard for AliveCor to find a CEO?

"I can definitely explain that," Thomson told MobiHealthNews. "I would lead off by saying that there was nothing untoward in [Sullivan's departure]. It's just a natural transition for the company, although I understand there [might be] a different perspective on it. I guess I'd want to answer that question by discussing some of the challenges of developing a mobile health company. As an operating partner at Khosla Ventures I am actually on the board of a lot of these companies, so the challenges I see at AliveCor are actually common to the field of mobile health." 

Thomson likes to explain the hoped for development of mobile health companies like AliveCor as "having to grow through medical practice."

"You need to use these technologies in mainstream medical practice in order to gather the experience -- the insight and the data -- that is necessary to establish the product and to establish clinical value," he said.

Unlike many others working in mobile health hardware, AliveCor has long held that its device will be made available for both medical professionals and consumers or patients. Thomson points out that commercializing a product for use in medical practices is very different from the process of driving commercialization of a consumer product.

"There are aspects of the company that relate to consumer engagement and app development, for example, that are very consumer oriented and consumer driven," Thomson said. "When you look at the leadership you need in order to build these companies and make them successful, you are never going to find -- or very rarely going to find -- one person who has already got experience in everything that is necessary to make that product successful and make that company grow."

"By definition, we are sitting in a leading edge field in medicine. The number of companies that have gone through these cycles of development from being founded, to mainstream adoption, to maybe being acquired or going public, there really aren't any major success stories in the field of mobile health that have gone through that established corporate cycle. Because of that, there really are no people with an established track record of nursing companies and nurturing companies through the complete cycle. Really what you are looking for in terms of leadership is different from what you are looking for in terms of the type of leadership in a conventional medical company."

While there may not be any executives who have precisely relevant experience, Thomson says the key will be to find someone who has a personality adaptable enough to cope with the new skills they will have to learn.

"Do they have core skills in one area that are adaptable and able to be translated into all the areas that the company needs to be overcoming in order to grow? In this field, inasmuch as we are defining new technologies, we are defining new companies -- we are defining new leaders," Thomson said.

As interim CEO, Thomson's objective this time around is much different from his last stint. His goal is to mold the organization, set priorities that get embedded "in the genes of the company". He said this is a defining period for the company and AliveCor needs to figure out exactly what its business plan is, exactly what its priorities are, and get "incredibly focused" on them.

"We need to cement that into the company and then we will have a much clearer idea, not just for ourselves, but for the person who would come in as CEO. We could give them a much clearer vision and give a much clearer remit to whoever comes in if we go through that exercise first."