Emerging Trends | Panel w/ Bryan Lord, Elliot Street MD & Berk Tas

Joe Mullings  0:00  
My LSI 2022 Dana Point. And this is going to be a fun one. I've got could be three of my favorite CEOs are here today. Gentlemen, thanks for joining me today. Good to be here. Today's session, we're going to talk about emerging trends in the marketplace. And Bryan, Berk and Elliot, thanks for joining on this, if you would take our audience just on a two minute pitch technology platform that your organization's in the middle of so we have context around our conversations today. So Brian, if you bring us in?

Bryan Lord  0:42  
Sure. So we're building a single use endoscopic visualization platform. So in layman's terms, that means a single use arthroscope for using in surgical procedures for sports medicine, ACL tear rotator cuff and the like, will be moving into laparoscopy for general surgery, and then eventually in the flexible endoscopy as well. Got it. We put all that together actually with a digital platform that will talk a little bit about sort of a unique take on single use devices with the SAS model to complement it.

Joe Mullings  1:11  
Awesome Berk,

Berk Tas  1:13  
We are SentiAR and we are focused on creating a wearable command center for the operating room. What that means is allowing the physician that's operating connect to their visualization tools and their digital tools via wearable headset is what we use today. It allows the physician to see three dimensional anatomy in real time updating in real time through the wearable system. It's an actual hologram, they can share it with other physicians, they can also manipulate it in a hands free fashion. And the objective is to improve precision, allowing physicians to have control over their tools unlike ever before, and essentially allowing them to be more effective and efficient in their procedures. Elliot

Elliot Street  2:06  
Thanks, guys. Well, nice to be here. Thanks, Joe. So Inovus medical, we design and manufacture surgical training technologies. They're based around a combination of hardware and software technology, combining paradigm shifting or bento reality approach, which allows surgeons to effectively develop their learning curve away from the patient bedside in a safe environment. And it's sort of challenging the status quo with regards to this general approach of or VR is the way to go for surgical training technology. So proud to be here and glad to be presenting it to everyone today.

Joe Mullings  2:41  
So all three of you, I realized that when I was putting together my notes for this session, all three, you have two things in common Well, three things in common one is you're disrupting a legacy model right now, very clearly, that's been entrenched in the med tech industry. And we'll, we'll come back to that in a moment. But your all three of you are incorporating visualization systems and a heavy data plane. And up until recently, visualization has been in straight sticks or flexible sticks. For a long time. We know the Olympus the Fuji, the Stuart's and on the sort of VR AR side, there really isn't anything out in the market right now that has a high end use with it. So what have you all have you learned about visualization and data and the acceptance, adoption and ongoing utilization with that? So Berk coming out of the gate with your platform?

Berk Tas  3:39  
Sure, so I think from my starting with my personal background, and then how our co founders came together and ultimately how the visualization platform is being put out in front of our customers. So I've my whole career in medical devices, the time I spent in medical devices always had some sort of a data aspect to it from early detection, early warnings, learning systems to testing transionic valves. I've always looked at everything we do as data because in a valve example, it's the most out there from a data comparison, because it's an actual physical thing, but it's only three components. You got metal, you got tissue, you got suture. What matters is the data behind how does it perform, how long does it last? What kind of treatment you do to it. So my world has been kind of enamored by data my whole career. And the visualization aspect really came from our co founders Dr. Silva and Dr. Silva professor and an electrophysiologist. Their view was I have three dimensional information. And I still have to look at it on a 50 year old technology. Yeah, it's not, you know, cathode ray tube anymore. But it's essentially the same thing. And the ability to see something in 3d has just really become a reality. Microsoft, Magic Leap, and a slew of companies now working on their own headsets, Apple was supposed to come out with it. I don't know, which had system which system you're working with Elliott, but there's lots of them out there. Right. So the way we look at this is, it's an obvious thing to do. You have 3d information, why lose that data? It's there already. Let's contextualize it. So you can see it like it's a 3d object. But I would say equally importantly, for us, especially in the procedure, you need to have control over your data that led as a physician or co founder, as a physician, when people are operating, what we hear a lot is, they don't necessarily want to ask someone to do things for them constantly. There's already enough of that. And manipulating the data today is impossible, because the only input mechanism is through a monitor or a touchscreen, or a mouse.

Joe Mullings  6:23  
But you know, one of the things I get so concerned about data, and I'll go to Elliot next on this is everybody is trying to sort of monetize data. And I'm watching them take legacy procedures, and increase efficiency on something that may not very well should exist at all. Right, so you're starting to see that on the data side. And the visualization side is we're taking a workflow that may have been appropriate, because it was best in class at that point in time, and we're trying to make it better. Maybe we should just put a bullet in the head of current workflow, and rethink how that works. So Elliot, yeah, again, you're using visualization, you're using data. But you're also reimagining training. Yeah.

Elliot Street  7:08  
Yeah, I love this. And points from you there Joe and Berk as well, which is, we actually don't use headsets. Because surgeons, so I'm clutching by background, my colleagues don't stand in theater wearing headsets. And so when we're training them, we shouldn't ask them to wear headsets in our opinion. And so actually, our approach to visualization and data collection is, let's make this as realistic as we possibly can from a in a simulated environment, so that it translates best into the clinical environment. So the approach we take, as we say is, it's a platform agnostic setup that we use, we don't require people to wear headsets. But to your point, Joe, which is, when we're talking about data collection, let's not just collect data for the sake of collecting data, it's the same as let's not just create technology for the sake of creating a cool technology and putting it on someone's headset and going, this is really fancy, we can market the hell out of this. But when we put it in a surgeon's hands, they're just gonna get frustrated by this. And so we take that exact same approach. So the data point, which I think is really, really important is when we're collecting data, we should be sucking data into the learning continuum, from our perspective, because obviously, that's what we do from a learning and training standpoint, and saying, How is this actually going to train, change your practice and improve that practice for the best interest of the patient. So the way we collect data, we use computer vision algorithms that track instruments in a 3d environment. So we're pulling off really rich data to say to a surgeon, when you are practicing this lap coli or this lap hysterectomy, this is how far you've moved your instruments. This is the amount of time you spent moving the instruments. And this is the amount of time you spent off the screen, for example. And we then lay that over a video feed. So you can not only look at the objective data, but you can look at the subjective data and say, well, actually, yeah, I've noticed that 50% of the time, my left hand isn't even on the screen. And I'm looking at that on a video now. And I'm going to use that as feedback. And now when I next go and do that procedure, I'm going to change that. And that's for us the really important part of data. And that's where it has real value because it is the thing that translates into better patient care and better performance all around.

Bryan Lord  9:11  
So Joe, kudos to you. It's an interesting compare and contrast, right in the different models visualization, 3d imaging. So though the, the evolution of the digital or if you will, at the digitization of surgery is really a fascinating frontier, certainly, you can imagine yourself driving down the freeway and having you know, your, your digital map, right, you might have 3d Kind of, you know, heads up display and all that. And lo and behold, you discover your 57 Chevy. And you say, well, all this stuff is great. And of course, we want to collect the data of what's going on with this vehicle. But at the end of the day, you've got a device that basically is the same device that you've had since the 1950s and that type of technology. So that's where we fit in this spectrum here this conversation. So what we're doing is basically developing a digital scale I'll play number of ways you can sort of look at it. On the one hand, it's single use in terms of improving the workflow and changing some of the dynamics around that. But the really exciting thing from a future technology perspective is you now have what we call a future proofed instrument, that each time you use that single use device in the OR, it's the latest and greatest state of the art. So we're able to do a lot of things with the manipulation of the image with software, similar types of technologies there that are being talked about about here. But then also have a roadmap where we can integrate those into the future, both into the software platform for the device itself. But then also, as I mentioned, do those sorts of things through cloud connections as well. So those are hard to do when you've got the chassis of a '57 Chevy, right. And so we can take a lot of that value proposition and shift it forward. And then also use that as a platform for the digital types of features that are being talked about here.

Joe Mullings  10:55  
As you're chatting about that and Elliot chats about it, so I want a couple of percentage points on this. Can we take your, your software algorithm, put it on to pristine platform, and real time in the middle of the game, not the simulation of the game, can we get lessons to the clinicians who are using his platform using your algorithm, and get the two for one there

But but more and more of this plug and play. I mean, I'm a little serious. But you know, more and more in this plug and play, when we have these open architecture systems. Why not? Why should we divide training 100%? Why should we not have it integrated into because, look, I taught combatives for a really long time to special operators, high end operators. And the way you practice, the way you perform in practice is different when you have live ammo in a gun, right and the way you practice in a fixed no consequence setting versus real time. So I think these open architectures for all three of us, and actually everybody here at the conference, more and more of those conversations will take place.

Bryan Lord  12:15  
Well, I think you put your finger right on it more and more at this conference. Right, this is the Emerging Technology Conference. And I think you would I would be shocked if we could come up with more than a handful of instances of companies whose strategy is to have a closed architecture. Right, we see certainly that that's the most logical strategic place to put, so sure, are we going to find opportunities for you know, for synergies, of course, right, which is very different than the competition that we're addressing in the marketplace, the incumbents, who for decades have been looking at how to construct and close their, their architectures for, you know, obviously, logical, different strategic purposes. So, you know, that's one of the fun things about these types of events is you can sit serendipitously or intentionally together with some provocative folks and say, Oh, wow, and it gets the the synapses firing, then the board members pull you back in and say focus, focus, focus. We all know that drill. But there is a whole world of exciting stuff. And that that notion of sort of interoperability and open architecture is what enables that it's a common view.

Elliot Street  13:22  
Can I just, I'll just pick up on that as well, because and your your point there, Bryan, which is, focus is key. So the quick answer to your question is yes, our platform could be going, you can deploy that on the pristine platform. And the important reason is because it innovates the way we build our technologies, exactly, as Bryan has said, this is an open technology. So we take a what we call a scalable modular infrastructure approach. So it's exactly what it says on the tin. It's built of different modules, and it's completely scalable. So if you want to go and deploy it on a pristine platform, but you only need 50% of the modular features, then you can go ahead and do that. And we think that's really important. And that plays back into your point there, which is I love this, which is the the elite athlete, the sporting background side. So MMA is your is your background, tennis is my background, I love those analogies, which is the training environment is not just about the simulated environment, that 80% of training is in the simulated environment. But actually on game day, it's really, really important. And if we have different platforms that are allowing us to learn and engage and gain data in in the training environment, and then we have a completely different and separate platform in the game day environment. And that's not going to help us. What we need is a platform that goes right through the vertical. So in our simulated environment on day one, we're capturing data on day two when we're doing this thing. So we go from the basic tasks, if we take tennis analogy, just forehands cross court, we're capturing data on that. Then we go to the practice match in the training environment. We're capturing data on that. And then finally we get on to game day and then we're capturing data on that. Well, you need platforms that can go all the way through there and not just be focused on one part of that. So the the Inovus platform can be used on the end of the simulators, but equally used on the on the pristine surgical.

Joe Mullings  15:03  
And one of the things that I'm watching happen, I'm got 32 years in the industry, historically med tech companies, and especially startups and boards and investors, you've got, they've thought like an I deep and vertical, and justifiably so. Because you know, ADD amongst entrepreneurs is notorious. So they're trying to keep you, you know, within your swim lane. However, we use words like open architecture, digital, right, game day and practice sessions, I make the argument that more and more, you're going to have successful companies are going to have a T. They're going to have a breadth across the top of that, that, that you're still going to have your vertical, but you need to have your expertise and but there are going to be applications where you're going to be able to take that breath, and then inject that vertical I into the category. Thoughts on that. Berk?

Berk Tas  16:00  
The whole lot, lot of thoughts, I'm trying to

Joe Mullings  16:03  
get to that point, you started to technology, and you're leveraging it into another now they do have a core base to it

Berk Tas  16:10  
That's right. So this is exactly what's rolling through my head. And I also enjoy listening to Elliot's accent. So I'm like, How do I get more?

Bryan Lord  16:21  
I thought we're trying to do is figure out how to do a mash up of tennis and MMA, that's where it's really at

Berk Tas  16:27  
on a serious note, I think. I think that the struggle, startups have the board's investors, everybody is the the business model that the payers and the Medicare pays for. hospital knows what the charge for that has not been disrupted forever. And here's what I'm saying. We sell consumables, we buy consumables, we know how to pay for consumables. So we do stupid things like I have a software, but I'll give you a token. So you can activate it for that use, because no one knows how to account for otherwise. So for that T to occur, a lot of that is in software, because designing mechanical things that plug and play many use cases, perhaps a red herring, it's tough because every user, every surgeon, every interventionalist is different. They have very different needs. But software data, there is a large potential for cross section. But we don't know how to extract value from it right now. Even though it provides value. We don't know how to account for it.

Joe Mullings  17:39  
Well, some of that is a definition though, like everybody is irresponsibly throwing around the word data, we get data, yes, we get data, I'm like, well, there's not even a common language in our industry yet around data. Correct?

Bryan Lord  17:53  
Yeah. We, we sort of look at it, that what we need to do is provide an on ramp to the data. And there may be some things that we can do with with the data in the future. But I want to go back to your question, Joe around the the T. I think that's exactly right with our experience with that. So we were founded by a couple of Orthopedic Surgeons, right. And so originally, our visualization, you know, initiative was in sports medicine, and you would have thought strategically, that if there was a next step that you would make from that, that you would go and put some other things around the scope in sports medicine. So you might look at suture anchors, or whatever else it might be. And so I think the key is sort of redefining and rethinking, and perhaps, you know, furthering the line disrupting, by thinking about differently who your customer is. So it may not be the orthopedic surgeon, it might actually be the ambulatory surgery center, you might think the same way. Right. It's, it's more about is it? Is it actually the doctor who is looking to be trained? Or is it the facility that's responsible for the training, right, and so for, for us, what we said is actually our customers, the facility, so we look for call point consistency, in a way that we can think about bringing what we're best in class, we think in doing which is single use visualization, and say, Well, okay, what verticals, can we bring that extend that so there's the verdict that the extension part of your, of your T. So that's not something that the incumbents are sort of set up to do. In fact, we know many integrated, you know, incumbents that have stayed siloed, within the same organization, it's never actually been integrated many examples of that. It also gives an opportunity from the startup side of things to rethink that, right. You're not dealing with, you know, hundreds of entrenched sales folks that are dealing with, you know, decades long relationships, but you can redefine that. So I can sort of lay out my strategic roadmap and say, well, this is where we're gonna go and you know, it's very difficult for at least the folks that we're going to meet competitively in the field to copy that because of this, the installed sort of infrastructure right so we that's, that's one of the very few I think competitive advantages you can look at sort of from a startup perspective is, you get to rewrite some of those structural types of approaches strategic as well.

Joe Mullings  20:09  
And you bring up, you bring up, I want to stay on that point for a second for all three of you. So all three of you have a technology that is dislocating by nature, you know, we know I don't like the word disruptive, because that's a speed bump, right? You can get, you can get over a speed bump. But once you dislocate from a current behavior or legacy model, you can't be caught by pushing more on the gas pedal, you can do that and disruption, you can get over the speed bump quicker. But when you this locate the behaviors and the business model, the revenue model, the sales model, change dramatically, and the strategics, who have owned that turf for decades, no longer own it. So each of you have a technology that is dislocating by nature, you're throwing away scopes to put it simply, right, you're adding 3d vision data in the hands of the clinician and their team potentially. Right. And you are looking at How's training done today? Great, each one teach one, right one to one model, and no data so to speak. So how are you going to, what are you thinking about now, changing centers of care to an opportunity for you for the big strategics don't have to sell into those private equity now, getting involved in all these and private equity is great of rubbing, rubbing the pennies out of the nickels and looking at the top 10 costs in a cost center and erasing them or attacking them all. So how are you looking at that right now as you price and design your revenue commercial model, Berk going first.

Berk Tas  21:40  
So one of the things that we think about is not every proceduralist surgeon, interventionalists, etc is going to want to wear a headset as Elliot said. For some, it's important because they need to see rich data from digital tools, imaging most of the time as interventionalists, they need to see rich information surgeons see most of the stuff they need to see, even if laparoscopy they can see through a camera perhaps. So we think about these procedures that are mostly visualization based. And there's a lot of them as we get more and more minimally invasive. And then we think about the infrastructure required to support that today. So a simple example is if you want to build an operating room for an electrophysiology suite, you need to install a gantry crane and a boom and shield all your cables that cost 300 grand if you're an ASC, if I tell you, you know what, you don't have to do that. Just roll this in wear this. That's all you have to do. We wonder how would those centers react to that? Right? But there's an interesting friction at play. And I'm not going to be able to say it with the right terminology. Because I've just learned this. To get to an ASC, you have to have a certain state wide acceptance of that procedure to be able to go into ASC so that you don't have to have some surgical backup. So for electrophysiology, for example, it's only two states, you can do that today. So that's an interesting thing I've just learned for you to be able to go to an ASC you state has to allow you to not have certain backup. I think it's a surgeon in some sort of redundancy, some sort of an unseen place. Exactly. So obviously, that's going to change. Right? Because it always does, eventually we won't have that. And I think at that point ASCs are going to have a difficult time saying no, I want a crane. Why? Right? I think to me that 3d visualization, yes, control? Yes. But you start to add, remote. Like when you talk about ASC, what have you have the chance to see everything the physician is seeing right where Elliot is sitting here, and then help them if there's a problem. So that yet earlier career physicians that operate at a higher level, continue to push that. And from an ASC private equity, someone who's looking at this without the entrenched hospital infrastructure. I see enormous potential for the things we do, because you're able to disrupt working with them. That's the way I see it.

Elliot Street  24:27  
Yeah, I think it's it's a really interesting point Joe. Again, taking our experience from the so we're, we're challenging an incumbent technology, which is virtual reality effectively, which is very expensive to develop and not necessarily headset virtual reality. But when it comes to surgical training, the virtual reality is not necessarily headsets is direct visualization on the screen, but we're using software and motors to tell us how things should feel very expensive to develop, very expensive to deploy. And going to the point of well, how do we challenge that status quo? It's saying well, actually here are values. For us our core values as a business are developed technology that's more affordable, more accessible and more functional and more realistic than the the incumbents, and then just live those values. And our view is if you just keep living those values, aggressively living those values and saying, we're not going to compromise on those, we're going to keep throwing this at you because we think that if we're developing technology that speaks to those values constantly, it will shift the paradigm. And then it comes over to well, how do you really shift the paradigm where you need to be well capitalized, there's, there's no two ways about it. And this is speaking from a guy that's built a company from a bedroom with a heat gun, a sheet of plastic, we was least capitalized as you possibly be at the start. But we understand the importance of capitalizing a business to make a real impact. And I think if you're going to attract that capital into the business, you have to have those paradigm shifting values to say, Guys, if we stick to these values, it will eventually

Joe Mullings  25:53  
How do you explain it to a board though? So right. So the board is in it, to win it. Yeah. Right. The the founders are in it first, spiritually. Yeah. 100%. Like, don't, don't talk dogma to me, as a board member. Yeah. Because what I'm putting on the table is so different than the current standard of care, or current standard of business. Just if we stay, the path we will be fine. So how do you how do you get that around the board?

Bryan Lord  26:23  
Here's theway we've done it. We've tried to point to trends in consumer behavior. And analogize that or at least suggest why would human desire for convenience efficiency and you know, lower risk be attractive trends that people buy in the consumer market? And why would that be any different in terms of the desires of the staff and an ambulatory surgery center. So my wife works in ambulatory surgery center, she's a big fan of HelloFresh, we're busy, she gets meals by subscription, right? They show up on our on our door, we plunk him in the fridge, and when you know we're running short of time you pull them out, and off you go and it's quick and easy and great. So we talked about and we're effectively taking that same model, that subscription model of groceries, you know, as a subscription, and we're doing it for scopes. And seems odd. That's a bizarre kind of analogy. But when you think about really, at the end of the day, what you're doing is you're providing the same type of service, you're really simplifying a situation where, look, you know, my wife's time is important. But if you think about the what is it, you know, $600 a minute, you know, that you put as the benchmark for time in an OR you can see the amount of leverage that you can take from a consumer environment, and translate that and say, That's why we think this actually makes a lot of sense, in a far more acute, you know, or impactful environment. So, look, boards, I mean, that's been what's what's been effective to us, at the end of the day, you know, our job as CEOs is to set a vision, and then, you know, boards to test us and challenge us. But they all know those trends as well, you know, plenty of folks have shifted from, you know, buying a car to, you know, go into a rental car to this thing, and half of the folks here, you know, put on their app and got an Uber to come here, similar type of shift, same idea, you're taking a vehicle that brings a transport that performs a transportation service, and the Clayton Christensen's, you know, sense of the word, what's the job to be done, gets you from one point to another, and you're changing the way and aligning the way in a more, you know, consumer friendly way. So that's how we've, how we've communicated that around the board table.

Elliot Street  28:47  
Can I add to that? I think I know you guys do this, I know you got to this. I like to think that we do this, which is if you take a problem first approach. So let's, let's take this problem, everything you've just said, literally, I'm just echoing what you've just said, Berk. And Bryan may say, I'm just leaning on your, your expertise. But you've got this problem. Let's go and find the technology and then fit it to that. Not this is a really cool technology, let's just find an application for it and try and sell loads of it because it's cool. And we can market it really well. And I think that's the important thing. And if you take that problem first approach, and you build a really robust technology, a great stack around it, and then a great business, you're going to end up with a profitable business, because you've got intrinsic value in what you're selling to a customer who goes, I want to buy this from you from the price that you've appended to it. And therefore you're going to make a profitable business. And then your board and your investors are going to say, well, this is this is exactly the sort of business we should be investing in. Not this vaporware over here, that sounds nice, but

Bryan Lord  29:44  
One of the things that you know, certainly we we are sort of self pejorative about in the med device industry is how the med device industry is, you know, what do you do you throw this out there 20 years behind, you know, we can turn that a little bit into a opportunity to take some of the pose problems and see how they're being solved on the places and then apply it to us as well. So you don't have to theorize to it, you can actually cite real examples and say, Well, you know, this is the way it's worked in some, some other verticals. Lo and behold, we're, you know, whatever number of years behind and we're applying those now. And yeah, we think we can be the ones to actually make that application into this.

Joe Mullings  30:21  
So you bring up an interesting point, and you beat me to the punch there is the two of you just said, and you're using magically hardware, right? If I'm not mistaken. Right. So med tech has been so inward looking, it rarely will listen to anything outside. It's, it's, it's got itself as such, and I mean, this respectfully is such an elite, you don't understand we're dealing with people's lives, type of persona. And Elliot, you mentioned, let's, let's first really define what is the real problem, not the obvious problem at hand? Right? Because it's too easy to jump on the obvious problem at hand, when it appears in front of us. Let's step back, and then let's look at analogous similar problems outside of med tech, and how did they solve them? Was it immediate delivery? Was it Uber? Was it? Was it Airbnb, was it? You know, insert above, right, Apple, right. Yeah. And Right, exactly. And so as first time CEOs, and two of you are conspicuous outsiders, you're an attorney. Thanks. Yeah. And you're, you're, you're, you're, you're you're a surgeon, right. And you're a purebred med tech guy, but you don't act like one best dressed med tech guy, they're best dressed. So is being a conspicuous outsider in our industry as a first time CEO an advantage? So take us in eventually, yeah, actually, pull on that.

Bryan Lord  32:01  
It's a disadvantage for the first terrifying, you know, a couple of years. And you hold on by your fingernails, and you know, hope the board gives you a little bit of grace, which thankfully they did. And then I think it's absolutely an advantage. So why? Well, because you look at the industry with fresh eyes, I think I came from the semiconductor industry. So yes, I practice law for four years. And then I went into a MIT startup for 10. And learned a lot about different vertical and about a very engineering, obviously, in science intensive, vertical. You know, those things have been actually useful in strange ways. That's not to the point you're trying to make, I think the point you're trying to make is around the fresh eyes view of things. So if what you're trying to do is actually grok a new industry, the process by which you grok, a new industry is actually by looking at the world around you and trying to get some reference points around it. Right. So it's not about well, it's all I've ever known, but it's actually trying to be relative in your understanding of the world around you, and figuring out the one that you happen to be and, and that's actually paid dividends for me. You know, you don't have confidence in that in the first couple of years. But I've been at this job six years now. And that's about where the break even point is. And after that, you start to kind of chat you come to conferences, you meet smarter people than yourself, and you say, Oh, well, maybe maybe you know, there's something here to thinking outside the box to terrify.

Joe Mullings  33:34  
You're a first time CEO. So you came out of Boston Sci and some of the others and so you had the app, but you've always been a very unique thinker. And that probably cost you mileage early in your career. And unfortunately, it was

Bryan Lord  33:48  
the Boston Scientific uniform.

Berk Tas  33:53  
They tase you at the door.

Joe Mullings  33:56  
But you're clearly from, you know, not just not just the obvious, but you clearly think differently than other CEOs, and a first timer. So how do you look at problems as a CEO? And do you try and battle? The med tech think?

Berk Tas  34:16  
Yeah, that's a loaded question. Um, you know, you made it sound really positive, but like, I have anxiety about it, because I don't think the way everyone perhaps or the, you know, the average med tech CEO thinks I don't look the way they do. And at some point, I'm just like, hey, I'm gonna be authentic because I think I'm good enough to be able to do that. The way I view med tech, I tried to think about the most empathetic approach I can have. And I feel like perhaps the way that it serves me, whether you're an outsider or insider, I think it probably serve everybody is that I have a, try to develop a very good, keen understanding of what's going on with whoever I'm trying to serve. Right. So. And that's not just the, the physician in this med tech world. So I think, to me, what helps is that I understand the complexity of med tech, the payers, the providers, the actual physicians, the decision making, sphere, the IT department, when you walk into an operating room, being able to go in and start pricing everything, and then wondering how that got there, and then you have an idea of how it did. And then you start to develop empathy for all those folks. And I think, to me, what I reject is becoming a med tech business, that it looks more like a bank that I give you thing you give me money. And that's a tough barrier to break. Because, you know, we talked about problems a lot. Just because I solved a clinical problem, or a physician problem or a hospital problem. That doesn't mean I didn't create one for an entrenched, massive multibillion dollar juggernaut. And, yes, they do care about the patients, but they also have to make money. And I think that's where I pull myself out. I just struggle with that mentality, I always feel like if you generate value, you will make money.

Joe Mullings  36:52  
It matters if you are a threat to that, because when the big boys are on the block, and the big girls are on the block, meaning the strategics and you were a clear and present threat to them, they will either price you out of the market, they will either block your technology from becoming a creative to their platforms as well.

Berk Tas  37:10  
It's it's an inconvenience for them. Yeah. Right. So the, what really helps with that is customers actually saying, nah, I need this. And that's where the the empathetic approach. And it's, you know, these things where you achieved one thing, it's the accumulative work you put to get there, right? How many customers have you contacted and really listened to and understood and said, I solved your problem? I heard you, I solved your problem. And how many times have you done that? And the one big difference, in addition to everything we talked about between medtech and the consumers, businesses, is consumers have power medtech consumers don't, that this, the buying center is so complicated. And forget the patients, patients don't even know what's really happening. Right? Like if they knew, we often joke, if they knew the stuff we become aware of, they would be afraid to go get a procedure done. Because it's a symmetric buying center. So it's a tough loaded question, Joe, I think I bring it back down to empathy. But it's much more complicated than having empathy for a phone user like Apple or, you know, headphones or whatever. med tech user base is very complicated. So I think it just makes our jobs harder, but more rewarding.

Joe Mullings  38:40  
Elliot, conspicuous, outsider surgeon tennis player.

Elliot Street  38:45  
Yeah, I love to play I love I love this. So there's two, there's two phrases for me. So the first is the empathetic insight. And you've nailed on that. And so, for me as a conspicuous outside, I'm actually an insider who's also a conspicuous outside. So I'm an insider with regards to I'm solving my own problems. I'm an outsider with regards to most clinicians don't make particularly good CEOs. And that was actually something that took me about eight years to learn why when I was talking to outside parties, and they were saying, Okay, that sounds really great. And then I never heard back from him again, though, it was because I was actually a conditioned founder. I applied my tennis mentality to learning how to become a CEO and using my empathetic insight to say, well, I know exactly the problem we need to solve. But actually, I don't know how we need to solve it. And this becomes the next really important bit, which is inventive execution, which for me is super, super powerful. So I'm very lucky to have a very lateral thinking co founder, and and hopefully, there's someone watching this panel, who is a really early stage of their medtech or their startup life or thinking about going into that. And they're like I, I'm a clinician, or I'm someone that's got really deep understanding of the technology. So I've got this empathetic insight, but I don't necessarily have the inventive execution element. And I will always go back to the fact that if you're going to build something really, really successful, it's not just about the CEO on their own, the CEO is right out there that one has to take all the flack, but they get all the glory. But if you can find a really, really good CTO or co founder that has that inventive execution element, which I do, I'm very lucky to have. It allows you to marry those two things together. And then you're like, well, here's this problem, we've sold in a totally different way. And then feeds right back to the point you were making, which is the customers just look at and go, Well, why didn't someone do that before? Because this makes complete sense to us. Yeah,

Bryan Lord  40:33  
it's powerful combination.

Joe Mullings  40:35  
Last question. For each of you, gents. Bryan, first, what do you think is the biggest threat over the next 24 months to the health care system?

Bryan Lord  40:48  
Was that on the pre, the pre? With that one in

Elliot Street  40:52  
the best of the best?

Bryan Lord  40:57  
Over the next 24 months,

Joe Mullings  40:59  
the biggest threat to the health care system?

Bryan Lord  41:01  
Well, look, did you say religion and politics weren't part of the discussion, you know, is that fair, fair game. So on the health front row at this great event, you know, we've had a couple, I can remember just a few, too many months ago, where everybody sort of came out of, you know, the COVID isolation, and people were just really getting to see each other. And so, you know, knock on wood, we're out through that. We This isn't timely, necessarily for topical for the med tech conversation, but man, we've been through a lot in the last couple of years, right. And now the geopolitical landscape in literally, you know, a couple of weeks, is radically different. I mean, it's hard to think that this sort of, you know, human collective can withstand that many kind of, you know, consecutive body blows here. So, it's hard to know, you know, really what's going to come out of that, I think I'm an MBA, too. So there's, there's a pretty good school, there's a macro, there's a big macro risk, right? That inflationary stuff is just crazy. And people are pointing fingers at why that's that's the case. And that's going to skew all kinds of stuff. If I had to point, you know, to most sort of topical med tech, it's probably that how does pricing and reimbursement and 7% inflation, you know, plus, maybe more, and supply chain and all that stuff is crazy. But you know, I just chat with somebody hogging the mic here, guys. Love to hear your perspective. But, you know, a couple early days in and we're, you know, only a couple of weeks in now to the you know, Ukrainian war and invasion. It was like, I've had sleepless nights, you know, around this. And I think if you're not having a sleepless night around it, you're probably missing the, you know, the impact of this, this is, you know, could be potentially potentially devastating for the whole world, let alone the poor folks, you know, in Eastern Europe. So, I don't know, that's a more philosophical and far reaching than a, but it's a good question. My best stab at it. Thank you.

Joe Mullings  43:22  
For 24 months. What do you think the biggest threat to healthcare is?

Berk Tas  43:33  
I think so. I view a couple of trends that have happened and didn't really result in the positive outcomes, or perhaps we're not patient enough. But the SPAC thing happened in medtech. Several companies went IPO earlier than what's typical in, in certainly in med tech. And the results aren't great. And then you add on top of that, hospitals are under more and more cost pressure. they've accumulated all this unperformed procedure, elective debt. And I'm just wondering how rational we're not rational anyway, when we make decisions in general, right? I'm just wondering how, how rational we're going to be and the threat I see in the next 24 months until we can kind of get through and, and we forget, right? We forget the pain of the, the perhaps some of the specs and the early, early IPOs. And, and then get back to you knowo, we need to continue to innovate. That's how we're going to bring the cost down, not by squeezing the nurses or, you know, not accepting patients, sending them to other places because they're less profitable for us. This is the kind of thing that's half running now. I'm worried about that. Because to me, there's the way to solve that is innovation. And we should really be turning to how do we innovate through this? How do we get younger practitioners to do more stuff, maybe expand to more physician extenders? Right? How do we get people involved in the practice more, but instead, we're alienating them, like all the every healthcare provider is stressed out of their mind. And there seems to be some conflict brewing as well between the C suite and everybody else. So I worry that there's gonna be some pressure on innovation, because we're gonna go back to in fun control costs. Yes.

Bryan Lord  45:47  
So you get a more volatile environment. Capital tends to constrict right time when we need to be lean. And that's

Berk Tas  45:53  
exactly because we've taken so much of tech debt, if you will. And then we said like this, let's invest. But that data and all pan out, and maybe in they're going to, but they just haven't and the public markets, expect immediacy, right. So I don't know. I don't know. We'll see how it pans out. But that's what I feel like is the threat, Elliot.

Elliot Street  46:17  
I'm just going to end up echoing my esteemed co panelists. Thank you guys for for fueling me with that. But I think that the question is, what's the biggest threat of the next 24 months to the med tech industry. And actually, I think the biggest threat is what the last 24 months is, and effectively the last 24 months, has trained the general public to have immediacy and digital access to everything. So pre COVID, actually, the general public weren't really that well trained to access things through tele platforms, or digital or digital medium mediums. And I think the threat now really leads into what both of the guys have been saying here, which is, well, actually now the general public are expecting that. And so can we, as a med tech industry, innovate at the right pace? And the right pace is not just necessarily quickly, the right pieces innovates to the right, standard and deliver things when they're finished the right level? And then can we capitalize things correctly? So can we bring the right capital at the right time and allow us to deliver the solutions? Which answer the the now current demands and expectations that have actually been driven by the last 24 months? And I think that's hopefully a summary of effectively what you guys.

Berk Tas  47:33  
It's additive. Yeah,

Bryan Lord  47:35  
I hadn't done the bar has been raised. Now you got to execute to that you actually

Berk Tas  47:38  
have to deliver more and more through those channels that we're establishing now. I mean, I got irritated the other day, because I wanted my test results on the app. Yeah. Like immediately. World? Where are my tests?

Joe Mullings  47:52  
I think is I take us out, here's what I hear is financing. We're worried about that, especially with the geopolitical issues going on right now. Second, is, are we going to have patience for these digital platforms to mature and get enough traction to add the value? Because we're so used to a mechanical device, putting the heart valve? Yeah, what's the TE look like? Right, what was good? Get her off the table. Right. And, and I think we've been over pacified on telehealth, it's still in its early days, and it's going to crash before it actually has a cruise that will be really worthwhile. And is the industry going to be calm enough to let it declare itself? Yeah. And then finally, the strategics. The strategics have a stranglehold on the industry, and they suffocate innovation, I said that they suffocate because I don't need to be bought by one of them each of these guys do. Maybe you can buy us all Joe. But when you when you won, you are the Lord of the Manor you want very little to change. And right now we are in such a state of evolution in the Health Tech med tech industry, that it is a clear and present danger to every strategic and so I'm worried about them having too much hand in the game. So we'll see what happens there. But gentlemen, it's been great. I love each of your each of your minds. really thankful for making time for this for me. Thank you.

Berk Tas  49:25  
Thank you guys. Yes, so much. My pleasure. Super.

Joe Mullings  49:28  
This is Joe Mullings from LSI 2022 Dana point, be well