Nathaniel Smith Presents nSight Surgical at LSI USA '24

Nathaniel Smith  0:00  
I want to talk to you today about the future of surgery, using artificial intelligence to produce objective data. And before we start talking about the tech and the empirical today, I'd like to build a prototype and I need your presence for it. So I'm gonna say, are you ready? And you're gonna say, let's go. So are you ready? All right. Healthcare is built on words, but words only have hold 7% of their intended meaning. I'd like you to picture I'd like you to picture a child having fun. We all picture something different related to ourselves, and we overlay the context of our lives. But if I show you my daughter, Momo, we get far more than words, even without audio, we feel her joy, we gain agreement, and we even form empathy. spoken, written and processed language will no longer remain the gold standard of healthcare communication. Words limit Healthcare Improvement simply because information transfer rate of language is limited. Visual communication will emerge as the new gold standard as it's 11 Log faster. nSight Surgical is the first artificial intelligence platform using computer vision to objectively document healthcare information. We're a Stanford Biodesign Stanford Hospital quality improvement project that has emerged as a Stanford startup startup. We're a class one device, we're now scaling our commercial go to market and we've been deployed with data in for one year, we have five patents, and we've academically published on our value proposition. We are raising money, but I'm more excited to talk to you about the possibility of how we can transform the operating room. And so that's what I'm going to focus most of my talk on today. My name is Nathaniel. I'm the CEO of insight surgical. I have a 20 year background in product design and product management. We've assembled a strong, mission driven team of incredible experts with multiple exits among us. So in 2021, my mom Kim had a surgical site infection that caused her kidneys to fail. And after supporting her through her illness, she's now mostly restored by the way reducing operative infection became a mission for me personally, and our organization. There were 6.6 million surgical site infections that happened globally. Last year, and 200,000 of those were fatalities, the quality of the care that you and I receive when we walk into an operating room and the transparency of that information is what's at stake in what we're building in Insight surgical. US healthcare cost us $4.3 trillion. Last year inside of that web, we found a $505 billion blue ocean data opportunity to reduce what's wasted in surgical care. In healthcare, we rely on subjective data, like surgeon opinion and operative notes. What we're building is a parallel video healthcare record based on truly objective data that can save the average US hospital $4 million. We've supported over 500 surgeries in the last year at the first deployed Health Center in Tulsa. The focus of our business model hypothesis was to save the hospital one case a week to pay for our system. And everybody told us that that was impossible. We found through the data that we've learned over the last year that we can find the hospital between three to five cases regardless of the service line, month over month. We have two data collection products. The value of platform one is delivering the cost of goods a surgery, waste reduction and overseeing variability. The platform two is a computer vision system that focuses on intra operative needs like infection related behaviors, and most importantly, surgical facetimes which enables us to increase efficiency and help the hospital treats more patients in a day. In a web based Reporting Suite, we provide health centers data on their efficiency, their quality and their cost. This is how the surgical count is managed in the operating room today. This is not an acceptable process for preventing retaining foreign objects, nurses are overworked. And there's too great a burden for them to document while we still need to improve how we deliver service. So we've solved this simple problem. And this interface on the wall there is our doorway to introduce a number of important objective data sources into the operating room to support how service is delivered.

Our initial work was working on tracking laparotomy sponges and needles throughout the operating room. This is our work on laparotomy. sponges were able to track them accurately in the high 90 percentile. We're tracking them as a stocks and flow problem from the back table into the surgical area. Yep, and then back to the disposal. This is what we're able to do with needles. And as far as we know, we're the only ones in the world who are able to do this. This is the entire sharp suite, including 13 millimeter needles, which we can track from over 15 feet away from their packaging state into the red disposal box.

Surgery is the aggregate discernible choices of objects used in service. The three dimensional lifecycle of each object represents a solvable and observable Choice that can be benchmarked against prior choices. Our deep tech solution is able to maintain the surgical count track of disposable items and trays opened to produce the cost of goods of surgery, we track broken and missing instrumentation, which is what SPD very much likes, and we track the longitudinal variability of procedural cost of goods on the bottom right. The reason that surgeons will have skipped one forward my apologies, this is a patient pickup area interface, our algorithms are able to detect distinct surgical events so we can accurately capture and document each phase of surgery showing the at once readiness of the operating room. The reason that surgeons love us is we've created Kanban for the operating room. So this is each phase of surgery each stakeholder in the operating room. And what this is doing is it's reducing their burden to inform the next emergent step in the case. I'm going to show you what we do on infection related behaviors. So that blue line there is a semantic edge. And each time that door on the right opens unsterile air is flowing into this room surgical protocol is that there's no more than 10 in and outs from cut into closure. And we're just now in approach. And you'll see we're already at 51. Since we've been giving this first of its kind data back to operative staff teams, we've seen significant reduction in room traffic in and outs. We've talked to hundreds of operative staff members about the right way to put cameras into the operating room. And what we've learned is two things. One, we have to focus on patient care related needs. And reducing the staff burden is the key to our adoption. So this is our data science back end. And for those who have never worked with a box and whisker frameworks, the boxes are the mean for each surgical service. And the whiskers outside are the two standard deviations for each case. And those little dots up there are are the outlier events. And this is what we study with clinicians or managers and in champion surgeons to derive interventions, and then we measure those in our platform. So I'm gonna show you some of our data. And I have just a little bit of time left, so I'm gonna try to go quickly through it. So we're working with two surgeons who do a knee, a hip in scope cases. And we found that the scope cases had doubled the turnover time of a total joint case. And if you are in a joint surgery, you'll know that that doesn't make sense because there's a lot less instrumentation and a scope. So we found that if we reduced the turnover dilation after scoped cases, for operating rooms, we could actually start to merge that into exactly the same way that they wanted to flow into three operating rooms. The upside here for the hospital was we get by adding by reducing the number of rooms reduced the cost to deliver these procedures. But we could help them by booking an entire additional operating room by adding a surgeon and getting them to more joint cases. And two additional scopes, which was a significant amount of EBITA for the hospital. We put this in front of the chairs of surgeries at prominent institutions like Cleveland Clinic Hospital for Special Surgery, Kaiser and Stanford and all of them believe that inside surgical is the future of surgery. This is our ROI six or a pilot for our customers. I've got just 30 seconds left. So I'm just going to walk you through the end here. We found that we can get our customers a total of 2.5 million in savings. And we can after our system is paid for Give them back $2 million. That's a 69% margin for year one and an 80% margin over year three. By the end of this year, we'll be at 2.2 million and exit annual creating revenue and in 128 operating rooms. We are racing around I'd love to have a conversation with you about more of the business mechanics or organization. Thank you very much