Reality Check: AR and VR in Healthcare and Medicine | LSI USA ‘23

Transcription

Scott Huennekens  0:06  

Thank you very much. And thank you all for attending. We're super excited about this, this panel, it's it's, you come in the meeting and and meet all these exciting entrepreneurs that have great visions of the future. And then you got everyone talking about how hard it is to raise money right now. And it's a depressing environment. And I'm looking at I see Allan May with gray hair, and myself with gray hair, and a few other people. Don't be disturbed that we'll get through this. You know, we live through 9091, and a recession, we live through 911 We live through financial crisis, head down, develop great technologies, and you'll get your money raised in an impact patient care, and, and we're going to talk to some people who are are doing that in the AR, VR space. So maybe to start things off just real quickly, guys, if we could go down and you could just give a quick snippet on your companies and what you're what you're doing to help patient care.

Sure. Thanks, Scott. lovely to be here. Thanks for having us on the panel. My name is Richard Vincent. I am the CEO and co founder of fundamental VR, we have a platform called fundamental surgery that uses virtual reality, and some haptic technology. So that's the sense of touch to deliver virtual surgical training.

Berk Tas  1:28  

Thank you. Thanks, Scott, for the intros. And second everything he said, Stay the course. Burke toss CEO of Cntr. We are developing a holographic guidance system for cardiac ablation surgery, the focus is to improve procedure times and accuracy during the procedure. So it's actually the first application as such with a wearable heads up display, where a physician is using during the procedure in actual cases to guide catheter procedures. And we are delighted to be here. Thanks for attending.

Tim Fitzpatrick  2:07  

Hey, everybody, Tim Fitzpatrick, co founder, CEO of Icona. Health, based in New York, we are in the patient education space. So we develop XR tools that help patients solve learning challenges. Our first commercial product uses a VR based learning platform to help patients understand and transition to home dialysis. So we think a lot about the post acute side, we think about outpatient settings, and also the future of home and education.

Murielle Thinard McLane  2:37  

Murielle Thinard McLane, so I'm the only investor on the panel. And we do invest. I represent Intuitive Ventures, we are $100 million strategic investor fund that invests in companies that help improve access to minimal invasive care.

Scott Huennekens  2:55  

Fantastic, so you can see we have a very diverse panel. And I I, when we were having our discussion to prepare for this, you know, you think about AR VR and immediately people go to gaming and, and headsets and, and the like. And we just started talking about well, what is AR what is what is VR? And I thought maybe that's where we can start because as you see across the panel, there are multiple applications preoperative or not even preoperatively. Just pre preparation for care, whether that's training or it's or it's preparation of a surgeon. There's peri operative applications, there's post operative and care pathways, there's, you know, platforms that companies can build to have apps across different things. So tons of different applications, but maybe to start just how do you guys think about what is AR and VR? What's a good way for the audience to think about that or people to think about that, from an investment standpoint? Should I take a run first jump on in?

Richard Vincent  4:00  

So I mean, there's there's a technical answer. And then there's the kind of the use case. And so I guess technically AI, you're looking through a screen at something being augmented into the real world, mixed reality, you're using a device that you're wearing to do that same thing. And in VR, we're taking control of the entire environment, and simulating everything that you see and feel within that space. It's kind of a technical answer, I guess in terms of the use case answer. They work in lots of different ways. So you know, I can see and we have examples here of great AR technology where you know, you can you can use it within a clinical space to enhance the information given to a doctor through to our use case where we're talking about teams, we're talking about nurses, we're talking about surgeons who are looking to go through repetition to build pre operative competence that they can then apply.

Berk Tas  4:59  

So I think another element to add to what you talked about is, in addition to the spectrum of AR to VR, there's also the sensor component of this, and how you can connect to a digital environment, digital tools, patient records, information about the actual procedure you're doing or preparing for. That's another revolution that's coming. And it should be layered, as you think about the space, evolving for investment or development purposes, and what you can do for patients,

Scott Huennekens  5:34  

Tim, any thoughts on the, on the kind of outpatient and anything to add to those?

Tim Fitzpatrick  5:42  

Very briefly, I do think, in terms of the media and what is new for us, so we're not innovating in hardware, we, we very much think about and where we get excited about just how much has been done in the last 510 years on the hardware side, that allows us to be able to rely on off the shelf hardware that's affordable. That solves some of the challenges, especially on the access and patient side. We have to think about that all the time. We think about budgets, think about ROI. I know, we'll get into one of those cases. But the only thing I'd add is what I get excited about is what does this medium do in a way that we don't have access to in other forms of media, especially when we think about learning and education. One of the top questions I get anytime I talk about VR, or another AR idea tool we want to commercialize with a partner is Why do you need VR for this? Why can't we show someone a YouTube video, and that always brings me back to number one, we we need to fundamentally understand good use of the term their why it is an advantage, and when to leverage the technology, the hardware and what it does differently. But we're very excited about the future. And we'll it'll continue to get better. And we can rely on that as we think about the challenges and outpatient side.

Murielle Thinard McLane  6:58  

And to the point that they're made intuitive, and I represent the venture fund, but it has started the augmented reality in the 90s. Right, so this is not new. I think that now we have access to better hardware, better software, we haven't talked about mixed reality and haptics the way Richard use it as well. So it's how do you use and harness this technology to improve access, lower cost, and really make a difference from a patient outcome? And that's where I get really excited.

Scott Huennekens  7:32  

Yeah, so you know, maybe we transition there, I mean, it's kind of like going from here, a PC could do you know, this, and then, you know, a portable computer could then do this. And now a mobile phone could do this. And I, you could say in the 1990s, we didn't have the connectivity, we didn't have the computing power, we didn't have the sensors we didn't. Now we do have all these things in 2020. You know, you guys are all excited about it. I think you're probably excited about what the possibilities could be to invest in in the space of creating these, these platforms and apps to create it. What what in your guy's perspective is holding this back from kind of running at this point. We we saw, you know, PCs did this, you know, and then mobile phones just did did that? Or can we expect that kind of rapid growth? Is this inevitable in 10 years, every AOR is going to be connected? Every telehealth is going to be you know, using AR VR, every training is going to be what what what has to happen in these next 10 years, besides her readiness checks across the industry to augment to make this happen? What's your feelings or sentiments on that?

Berk Tas  8:51  

I'll have a go at this one. It's a great question. I think. I think the very first step is the finding useful cases where we're making an impact on the very things Marielle just mentioned. So the physician population, unlike consumers who buy stuff on the cool factor, the physician population, the hospitals want to know what it means for the patients and what it means for their bottom line. Right. So I think it's going to require starting with a handful of applications that generate that published data and do it in the media. Unfortunately, the way we disseminate information and medical healthcare field is through publications. I call it unfortunate because it's so delayed. So that adds another friction to your point. But I think as there is a body of evidence being published in journals, we're going to start to see oh, well We'll be implemented that use case and the physician accuracy improved, or their training curve reduced, or the patient's pain is now lessened much faster than it was before turning all those into dollar signs. Again, unfortunately, this may be fortunately, maybe there's the right thing for the patients in the end. But I think it's going to require that dedicated, very thoughtful applications. I think if we run on the hype too fast, then we're going to reset and we're going to keep resetting until we start to build a body of evidence.

Scott Huennekens  10:36  

So like in your in your case, and specifically in and or in a interventional cardiology lab, any of these interactive periprocedural cases, how do you see things evolving? I'm, I'm Ford making cars, I don't make radios, I buy it from Sony, I decided I'm not a radio company, right? Or I'm, you know, I'm Intel, I make chips. I don't make computers. I mean, do you see it that, you know, companies that I'm involved in that I see applications like NuVasive, and orthopedics or Acuitas, and EP, all could use these heads up? Displays? Do you see them developing their own apps? Do you see that the way this markets gonna go faster is there's, you know, two or three companies like you that we go to, and we just have an open platform that you you run on, you know, a Stryker system and an Intuitive Surgical System are

Berk Tas  11:32  

another great question. So I think the field will evolve where the most effective technology providers will win. So what that means, in our world, if you're developing an application, Judas NuVasive, you have plenty of work to do just to make that work. There's plenty of challenges to solve, not just the technical side, but you also have plenty of customer challenge and patient challenges, you have to show cases where your technology core technologies working. So I think we're going to have specialties developed because developing an AR solution for the hospital or for the procedure, or pre and post, it requires a very different outlook, like we obsess about things like what's the focal distance? What's the update rate? What's the frame rate? What's the latency? What is the data package look like? What's the encryption look like? Because the experience has to be seamless, right? A doctor cannot handle in our case, a delay that occurs once every 100 times it can't happen. It just can't happen at all. So I think it's going to require this sort of special focus. And I believe the future should be I hope it goes there. We get to see this API's and SDKs like you've done with volcanoes, Scott, I think that's how we should be. So we have a system with an open API, and we give somebody an SDK to integrate with it. And you're done. Now you can use that.

Scott Huennekens  13:02  

Richard, how about in your model your business? How do you see that? I'm sitting there again, it nev as a video camera investor, we do all of this training, it seems, it just seems like it can be done so much better, faster, cheaper. And it seemed like we were on a path to do some of that during COVID. And now we're kind of off that path or trying to figure out the path right forward.

Yeah, I think that the validation is proven. It's there lots of published studies that show that acceleration that happened, the business cases are coming through and are starting to be revealed, you know, and that's important. I think the key thing, though, here is, you know, look at that, even even though the hardware has got significantly cheaper, and that's an important part, it's still an expensive, short lived piece of hardware, you know, it has a two year lifespan, and then it's replaced when it comes to VR or AR devices. So the idea that it has one function that you're innovative, I didn't,

I didn't realize that it only has a two year why, why two years, because then

there's another one that comes through that has a better focal length, it has a better visual representation. So in that scenario, you've got one use case, because of the device can only do one thing because it's your device and evasive. There isn't yet that open platform. And that's what's needed to get that acceleration, the ability to, as you said, Get API's SDKs that allow lots of content developers to publish into a device that can do multiple things. So it can be doing a perioperative use case and then can be used for training so that that investment in hardware drops can be multifaceted,

kind of like my iPhone with a gazillion apps out of the App Store and and everything else. So do you see Data is a future state. That's achievable technology wise.

Yeah, absolutely. I think it is, it's going to take a few players to make an investment in those areas. And I don't no,

those people like you No. Matter or,

you know, I don't I don't think they are. I think they're going to come from within the med tech industry, they'll

come for them. Okay. Yeah.

I mean, certainly, for our part, we're working on platform technology. We've been doing it from day one, because the idea that we have to make everything that comes on our platform is is ludicrous. You know, and, again, if you look at so I, you mentioned mobile, I worked in the mobile tech space 20 years ago, and what happened in that space for the first five years was everybody went off in their own direction. And then you start to see consolidation appstore start to appear, you start to get interoperability doesn't exist today. Really? That's going to happen in this space, too. And that's important, because that is that more to us.

Yeah. And it's on our pre call, it seems like that's going to be one of the big drivers here. Reduction of cars, versatility, open platforms.

I think so and even down to Siena, mobile. Exactly. And let learning you know, if I give you a an Apple device, so I give you a Samsung device, a smartphone, you kind of know how to use it. Yeah, if I gave you a VR device running one piece of content versus another, you'd have to learn that interface, you'd have to learn how to navigate to physically move around, that needs to standardize.

Got it. It seems like there's this huge opportunity, you know, for moving patient care out of high expensive cost of service areas into the home or other places, and augmented reality, VR monitoring, etc, would be a huge opportunity. And I know you guys are tackling some of that. What are what are the hurdles, that that get in the way of this kind of having cell phone like inflection?

Tim Fitzpatrick  16:59  

I'd say it's a couple of things. One, on the patient side, its usability feasibility, so you know, making sure this stuff actually works. Where in settings where we know, staffing is such a challenge where there's very little time on the staff side, but at the same time in an area like dialysis where we know patients are there 12 hours a week in the outpatient center. So how can we make the experience a little bit better for them? That's a great opportunity. And we also happen to have macro tailwinds regulatory reimbursement payment, an entire industry that has benefited from investment outside of VR, but where that is also having some help on our on our end where our stakeholders care about value, and they're paying attention to what are the outcomes we might get from a better learning tool. The other thing I want to make sure I mentioned is, I think the progress on the surgical training on the acute side is what will ultimately allow us to have success in the home. Now, when we think about the number of new devices that are coming to market, that have learning curves, or the shift into home based care where we know a quarter of care might be shifting in the next couple of years. That means patients really have to be competent enough to do it on their own. And I think the lessons we take from these companies will be that we can get to levels of competence that allow patients and care partners to do it confidently, that have the competence knowledge and skills of patient activation, health literacy, risk assessment, you can do that with VR, in a way you can't do it with traditional tools. So that's that's where we get excited about what we've learned, just because we've had the benefit of watching the industry evolve and seeing those early wins in the surgical setting.

Scott Huennekens  18:44  

So after our call the other day, I went online and and tried to find some market research, you know, projecting what the size of these markets would be in healthcare. And they range from anywhere from 2 billion to 20 plus billion, which is a wide range. If I went and did the same thing for percutaneous heart valves, it would be, you know, a tighter ban. And part of it is there's so many cool applications, and so many business models that have to be proven out. From your perspective, what is it that these guys there's, there's 20 More of them that aren't on the panel that are that are here. Doing these kinds of things have to prove to you from a business model and the like to make them investable and create that $20 billion versus the 240. I missed that one.

Murielle Thinard McLane  19:31  

So apparently we're about a 3 billion today in AR and VR across, you know, training, navigation post operative, but then also dx. We haven't talked about diagnosis or treatment, right to other different business models. So we see a lot of companies in the than the space and for us it's a question Is it is it a product? Is it a platform? How can it scale and is there a go back to is there a clinical utility for it? And then what's the hurdle for others to reproduce that? Does it

Scott Huennekens  20:05  

actually can you say that beginning part? Again? I think it's important for the audience and

Murielle Thinard McLane  20:10  

Yeah, and so

Scott Huennekens  20:11  

Is it a product? Or widget? Or do you have a real platform? So as we were talking earlier, I think

Murielle Thinard McLane  20:17  

it's how would you classify each of these guys business? Putting me on the spot? Yeah. Well, you know, they were gonna scorecard it. Yeah. So I think we have a platform here and training training platform, right, expandable here in the cardiac space. I know less about your business, Berk, but I would be really interested in seeing how you scale across different types of surgery and cardiac. If he

Scott Huennekens  20:42  

can't scale across multiple applicants. I know it's

Murielle Thinard McLane  20:44  

just in card. Oh, the same customer, right? Same user? Different application, right? So how can you become the best in that?

Scott Huennekens  20:54  

Okay, across all of cardiology, or just EP?

Murielle Thinard McLane  20:57  

EP. And here on this side is a How can you expand beyond because the in renal, right, you have multiple diseases that are, you know, cascading. So how do you train a core across the solution for the patient, and just not that one piece, right. So it's a product that has a potential for a platform, again, a solution for specific customer, being a surgeon, being a patient, but we thinking solution. And if you have a good solution that either improve outcome or reduce cost, then I'm interested in seeing how you can scale that, right? Scaling is really, really important. I think that's been one of the hurdle, frankly, that we've seen.

Scott Huennekens  21:42  

So fair, fair. And so in Tim's case, though, you know, I've pitched a lot of VCs, they say I want focus. And, and so you want to see that he's going to have traction and be have enough scale in his initial, but then how do I feel that that can be replicated across other applications, they're not mutually exclusive. Correct. So I will look at it until it is proven in prostate, then then expand and then expand the land and expand, right and i Exactly. So terrific. So any any advice you would you would give in this space, based upon that, because there's a number of people here, doing this, as well as other similar things like whether it's AI for imaging that has some augmented aspect to it. And, again, it can be stuck in the middle, where it's not a product, it's not a platform, they have no ability to distribute it or it can be, you know, like a heartflow, and be its own indication versus just a nice little application that could run on augmenting someone's image.

Murielle Thinard McLane  22:52  

So for, I would say, recommendation. So if you have if you're in an area where you have a customer that you think is big enough that where you have the product that helps them to do their job better, then find a way to scale through partnership, right, that's going to be really important. And think of it as Are you a hardware and software, are you just a software company, right? That's important. And I would say partnership is really, really important to get and scale. That's something that you're unless you want to spend a lot of capital you were talking about her float did that successfully, but think about how capital intensive you want to be. And be very mindful about that as you pitch to people like us.

Scott Huennekens  23:42  

So one of the things we talked about also was, you know, when you when you think about medical devices, often grown up in the industry, you think about, hey, if I got a new product or solution, it would be great if it does three things, if it can reduce costs, if it can increase access, and if it can increase clinical outcomes. And so I asked you guys, you know, how do you see your solutions? addressing those three critical aspects or, you know, or apart of access is democratizing delivery of care, equalizing it across different patient groups or physicians?

Yeah, I think from my from my perspective, some of them are really easy to think to to square in on so if we look at reducing costs, you know, there's a really, you know, well, from all of your expect there's a there's a significant known cost when it comes to the acquisition of skills around a new device, a new procedure or new drug. And tapping into that and reducing that cost is quite easy to prove. Because of the logistics, the physicality around specimens etc, we can, we can do a lot with that when it comes to virtual virtual outcomes, looking at improving the patient outcome itself, again, I think with the studies that have been going through not just from ourselves, but across the market, you're starting to see some real tangible impact there. So that's fantastic. And then democratization well, as long as you can make it seamless, the ability to collaborate across the world, to digitize expertise, so that you don't have to ask your KOL to get on a plane and go and teach in every location. But actually, just to say, look, we can do this through a through a virtual experience, whether it's an augmented virtual experience, or pure virtual reality experience, gives an enormous payback there. So I think for me, it seems pretty clear.

And I think you, Berk, you talked about it in your earlier answer, and on how you expect this to increase clinical outcomes. And you think you can prove that Is that a fair?

Berk Tas  26:01  

Yeah, I think, like, specific to our application a little quite a bit different than pre and post, what we focused on, we actually published this work, we focused on how accurate can a physician target a specific location with a catheter. And we've collected 150 points and patients. And what we've seen is they've gotten 50% better. So their error reduced from four and a half millimeters to 2.9. These are meaningful numbers, the catheter tips they work with are four millimeters wide. So we haven't translated that into a patient outcome on exactly what happened with the therapy that costs a lot of money to do that. And eventually, we will. So I certainly believe and the patients and physicians we work with believe this is going to pan out. And I think the driving reason for that in our application is we have forgotten the difficulty these physicians have in creating a 3d construct in their mind's eye, looking at 2d views. We have been working on augmenting their dexterity for 20 years and spending billions. But we have completely forgotten about all this information they have to use to create a three dimensional structure. It's not a given. And it's not easy. And 90% of them actually don't have this skill. They won't tell you that. Most of them don't know that. And that's fair. So I think democratizing and access wise, we think it's going to be a great leveler. And you're not going to need to have a special skill and just being able to see things in three dimensions in your mind anymore. I think that's huge. And then finally, from a cost perspective, we haven't proven this out yet. But what we see is the comfort level increasing rapidly. And we think that will translate in the time. And that not only has a cost benefit of having a lesser procedure time, less anesthesia, that's good for the patient along with the accuracy. So I think we're gonna see some interesting things coming up from our side at least. And I think more intraprocedural applications will follow suit once they see where the benefits come from.

Tim Fitzpatrick  28:31  

Yeah, I would highlight one use case that is a recent one for us. On the access side, we recently received a grant as part of COVID Cares Act funding from the federal government, with our partner for Sidious. And the idea being we the VR education solution is the best suited solution for helping patients understand and select home dialysis is one example, which then has all kinds of downstream benefits. But the immediate benefits are, are pretty clear, both for us for the technology. And obviously for our for our partners who we we care very much about helping them hit their goals around patient confidence, finding the right treatment option for them, be it home, dialysis, transplantation, you name it, but in Mississippi alone, where this is focused, some of the numbers around who has access to care in rural communities are pretty shocking, I think the most recent year of data from the renal surveillance system, around 1800 patients in 2018 had kidney failure and seven of them received the transplant and the rest went on dialysis. So we know that the vast majority of patients are facing these decisions. We also know that the benefits of choosing certain pathways, open up transplantation if you go home, it shows that you have a higher likelihood of receiving a transplant, your mortality rate goes down, your quality of life improves. So it's a huge win for us to know Know that the leader in this space is thinking about VR as a way to expand access to care in some of the most underserved and rural communities in the country.

Scott Huennekens  30:09  

So is your customer for Versinius? Or is your customer? Yes, your customers first Dainius customers

Tim Fitzpatrick  30:17  

Versinius is the customer

Scott Huennekens  30:20  

So then it differentiates Versinius's model they have better outcomes or better care and with with augmenting with you as part of their solution,

Tim Fitzpatrick  30:28  

right. And they've they've shown time and again that they actually outside of us, they're excited about VR and training and leveraging some of the same aspects of hands on haptics, how do we help patients use machines and who are about to be going home. And these are complex things. And we also know that more than half of the patients who are transitioning home are ending up back and center or hospitalized. In some cases, we can do better, and we can probably leverage again, ways to train remotely that's on demand to do it.

Scott Huennekens  30:58  

So back to the earlier question, what would be your your next vertical? Is there a second, the third vertical that you have in mind?

Tim Fitzpatrick  31:07  

Of course, you know, we have a few in mind, you can probably look at the data where we know, kidney care patients are more majority have comorbidities we know diabetes, we know hypertension, there are clinical settings, we're really excited about that share a lot with dialysis, where patients are spending, you know, 12, and more hours a week, where the experience matters, and it currently is very bad. We can do better. So again, why not? The platform approach I think of Hamilton, Hamilton Helmers, refresh the platforms. And there are so many companies thinking about mindfulness to pay management, as Berk points out to education and training. And increasingly, we're seeing more and more that in the past century, it's going to be huge. Why not combine all of that with great offer a true platform, you're going to have some serious results.

Scott Huennekens  31:57  

Any any thoughts about some of their answers and their invest ability improving?

Murielle Thinard McLane  32:03  

The need to write a check?

Scott Huennekens  32:07  

You got six minutes? We've got six minutes. That's right.

Murielle Thinard McLane  32:11  

No, just like, right things that they thinking about right. So I go back to what are you doing that is differentiated? How are you helping your customer? are you improving outcome? Are you lowering cost? And or are you improving access? And really, when you think through those lenses, AR VR is just a tool when you talked about AI? AI 10 years ago was just this big thing. And now everybody talks about Yeah, we have AI or machine learning behind it. It's just part of what you do. So for me, it's like how do you use it in order to make a difference in each of those verticals? And is there a business model that actually can support it that's big enough to support it?

Scott Huennekens  32:54  

So there's probably people here who aren't in AR and VR. But at the same time, are are having number of meetings this week? Any any advice for them? What frustrates you? What what do entrepreneurs get wrong? Pitching you like that? You go home and you say to your husband, I can't believe every single time like, Don't they know they should do this this in this instead?

Murielle Thinard McLane  33:19  

So advice. So don't get too enamored with your technology, really think of what the business case the problem you're trying to solve? And really think about how you're solving it? And what data do you have to back it that shows that you really solving that?

Scott Huennekens  33:40  

Can you can you say that again, because I cannot agree with you more? I mean, it's like, when you have 1015 minutes to talk to her any don't spend it explaining how the technology works. I mean, spend it on, this is how big this problem is. Right? And this is how we're going to solve the problem. And then here's our proof that the technology works and some clinical data not let me tell you 20 minutes of 15 minutes on how this technology works, because that's just something that I see is too often the issue, especially with engineering based startups, where you guys are the most brilliant minds humanoid with these these solutions. You got to market them a little bit differently, I think,

Murielle Thinard McLane  34:25  

is that a fairly myth? It's it's absolutely fair. I mean, when we look at it, once I know that there's a problem. I know the size of the problem, and I know that you have a I will believe you that you have a good solution until I do the due diligence and double check it right. I just need to know that you have data that makes me want to do that due diligence, that's when the technology will come out. But you need to show me how big the problem is and how you solve it.

Scott Huennekens  34:51  

Thank you. So we have about three and a half minutes left. What haven't I asked you about AR VR. You want to make sure you make sure this Conference takes away, that hasn't been shared each get a, you get a minute. So 3:17, you got till 2:17?

When we talked about, I think the key thing for me really as we look over the next five years and again, this is titled reality check is for this to become instilled into this industry, we've got to take away a lot of the barriers, you know, good technology disappears from view, because you standardize, you create platforms that allow people to access it simply. And I think that's the key thing that I'm certainly focused on and our business is trying to build at the moment is not just the content, you see and go, Wow, that's amazing in that particular discipline, but actually the delivery capability so that anyone can author and publish without having that overhead. I think that's the key thing really, standardization.

Berk Tas  35:56  

have extra time. No, you know,

Scott Huennekens  36:01  

you're wasting time, right? Sorry.

Berk Tas  36:02  

Yeah, with laughter. I think for me, it's all go very simple, I think we need to recognize the technology has evolved to solve some really complicated problems. Our world is intraprocedural applications. Maria was talking about, you know, scalability and adjacent applications. There's so many of them. Because a lot of physicians are struggling day to day, not just visualization, but controlling what they see, they can't reach a keyboard or a monitor. So I think the technology is here, and it's not going to go away. It's here and it's going to be a part of our life, I think, to what extent and how fast it remains to be seen.

Tim Fitzpatrick  36:51  

I would, I would say differentiation won't really touch on it. It obviously keeps us up at night patient engagement, patient education, there's all kinds of ways to do it. Our greatest obstacle and competitor is always doing nothing, which is often what is happening in the clinical settings. It's not a competitor, at least not yet. I think that's worth thinking about. And when we these days, I describe Ikona as a learning science company that uses VR to solve one particular challenge. We have a suite of products we want to develop commercially that solve different challenges. But we were at a VR company three years ago, and COVID helped us realize that the tech was the solution. And we actually had a hard time keeping the solution going in workflows that were affected by by COVID. So having to learn that lesson, and realize that differentiation is in how you leverage certain technologies to for your ultimate aim, I think is going to be key, especially in certain companies get to grow the stage and we see some of that platform competition. Hey,

Murielle Thinard McLane  37:55  

well, I continue to be exciting about where AR and VR can take patient, you know, improve patient access, you know, tele surgeries and area, for instance. And we can go beyond just how do you help them in one o r, but how can you get those wonderful surgeons to absolutely have access to to have the underserved having access to that skill set? How do we think about giving the elderly or the patient that are multi disease that are at home? How do we support them? So for me, this is another great piece of technology that can unlock so much in terms of improving access to better care in the system, where we frankly, have very different level of access, depending on where we are.

Scott Huennekens  38:44  

Yeah, very, very well said. And on that note, I mean, look, we we've known, you know, us working in the industry, there's seven and a half billion people on Earth, really only about two and a half billion people have access to surgery, high quality medical care around the world. And I think the as outlined here, the promise of this technology, this technology is other as well as other digital technologies over the next 10 to 20 years or that that number dramatically goes up and it's why we work in this industry. It's the reward of working in it is to improve clinical outcomes globally. And so that's that's exciting. And that ties into hopefully the the $40 billion market not the projected lower numbers in the AR VR space. So thank you guys all so much. Great job. Appreciate you been here.

Berk Tas  39:31  

Thank you