The Data Dilemma: How Do We Monetize Medtech's Digital Revolution | LSI USA '23

Transcription

Scott Pantel  0:07  

Welcome to our panelists here, we're gonna get right after it, we have a beautiful dinner set up for later. This is gonna be a great topic. And just a quick backstory to this, Tal, I want to thank you for pulling this panel together, Tal has been to our meetings for some time now, we had a conversation a couple of months ago, I was trying to tell him what ideas I had. And on some level, he just said, I got this from here. Let me figure it out. So I'm curious to find out what we're going to talk about today. I think it has something to do with data. We have an amazing group here. Amazing group here. And I'm so grateful to all of you for being a part of it. And what a great turnout here at the end of the session over to you Tal. Thank you.

Tal Wenderow  0:43  

No, thanks, Scott. And we don't know what we're doing here, either. So that's fine. And it's fun. Because when Scott asked me to moderate I was like, I want to be a panelist that's much more easy. Being a moderator you have to think and all that. But thanks for joining, I think what we'll do, and you start the title, I actually had a much more aggressive title initially, right is it's fake or real data. But now we they dial it down, and we dialed it down. But I'm telling you, I'm a venture partner in Genesis, what we'll do is just go around the table and Jesus each other, feel free to share about your company positions. And, and this is a freefall, right, open discussion. We're all type A personality. So let's just have fun.

Gwen Watanabe  1:18  

Okay. Hi, I'm Glenn Watanabe. I'm a managing partner with H.I.G. capital. H.I.G. is a private equity firm. We've got $55 billion of assets under management, and I'm one of the partners that run the Health Care Fund.

Tamir Wolf  1:35  

All right. I'm Tamir. I lead the Theater where we're leveraging data or data to eliminate variability and disparity in surgical care.

Manisha Shah-Bugaj  1:47  

Hello, everyone. I'm Manisha Shah-Bugaj. I'm CEO of active surgical. I became CEO in December and I joined the company about 14 months ago as COO. Activ Surgical we're leveraging science and data to improve surgical outcomes by providing surgeons with surgical intelligence in the operating room.

Ali Golshan  2:07  

Nice. I'm Ali golshan. I wear a couple hats I'm a practicing interventionalist with outpatient practice and surgery center, I focus on peripheral interventional disease. I'm the medical director for brain health and brain medical, which is an AI enabled teleradiology platform that also helps companies like Walmart with interoperability, and data management and anonymization of data. So there was less of a potential for leak. And I also have a stealth medical device company in the peripheral space, which would be five decade cleared in about a year.

Tal Wenderow  2:36  

Thanks, Alia. Thanks, everyone. I think that also unique thing about the group us everyone has a different perspective, but also changed roles in his life with to physicians, corporate startups, and we've all been in several positions. So we'll bring some different perspective. But I want to start with, you know, just the word data, right? How do you define data? What you know, is it personalized, not personalize, and we don't need to go by order. So whoever jumps first of the mic, will get to

Gwen Watanabe  3:03  

Go reverse order. 

Tal Wenderow  3:04  

See, that's what I

Ali Golshan  3:05  

was talking about. Thank you for that. I'm just running me over. But very elegantly done, I appreciate it. So I feel like there's an unlimited amount of data. And there's value sometimes in places where you think there might not be value. So I think that it's important to potentially start throwing your net very wide, when you're making your list of things that might be data. But then when you're collecting it, you might want to hone down, we were looking at a cardiac tech enabled cardiac platform. And we're talking to cardiologists, like what data points matter, right. And so if you drown someone in data, then they don't pay attention to any of it. So if you gather basic things like blood pressure, hypertension, change in body weight, that can give you a lot of information. So start broad define broadly, but then focus on what you're going to collect, so that it's actionable and not overwhelming. That's just my opinion, though.

Manisha Shah-Bugaj  3:55  

All right. So I mean, data, what is data data is really any input. I think, for Activ Surgical, we look at data, we're looking at surgical videos. And for us, when we talk about data monetization, we're actually not actually monetizing the data itself, we're really looking at what solutions can we create through that data? And what value can we bring into the or from the data that we have available to us?

Tal Wenderow  4:20  

We are going by order.

Gwen Watanabe  4:22  

Okay. So in terms of data, so data is information. And so collecting the information that has to do with behavioral, you know, buying patterns and etc. I'll give you an example. So I'm on the board of compute health, which is Omar ich racks back and we just announced the acquisition of a company called DeLorean, which is has a balloon that's inserted into the stomach. But it also has an app which registers data right so personal data and monitors things like eating weight, etc. And then there's also the analysis of the data which can be monetized by selling to what we traditionally don't think of in terms of medtech. But, you know, companies such as weightwatchers, or, you know, there's all sorts of different ways to monetize it. And I think as med tech folks, we don't necessarily think of that. But in actuality, that's a that's really the most probably the most valuable piece of that.

Tamir Wolf  5:36  

So I'll be controversial. I think the conversation is cool about about data. Our focus at theater is also around surgical intelligence and really structuring intraoperative performance. But I think the real conversation needs to be around the value that's derived from it. Number one. And I also think there's like this concept I'd like to talk about called drip. Everyone in healthcare likes acronyms. So the so D.R.I.P. is data, rich, insight, poor. I think there's tons of information we're gathering a lot of it is actually meaningless and not actionable. And, you know, I'll give you one example, there's a healthcare enterprise that we are talking to, they know that they have four times the leak rate of after colorectal procedures compared to the national average, they have no idea why they know that they have, you know, two different hospitals with their logo on them in two different states. In one of them very low complication rate after colorectal procedures, and in another like very high complication rate and bounce back rate. And they have no idea why now, are they gathering data? Oh, yeah, they're gathering tons of information. They're gathering procedure times. And they're, again, they're gathering a ton of data. But it's meaningless, because they don't have the time or manpower to like, make sense of it. And so ultimately, the conversation actually, sorry for this, but doesn't need to be around data, it needs to be around like meaningful data, it needs to be around data that is structured in that is where like, we, I think, have a real role in doing things that ultimately help whether it's a clinician, or clinical leadership or administrator make sense of, you know, the vast amounts of stuff that you know, they're gathering.

Tal Wenderow  7:34  

And I agree, but let's go one level below that is who owns the data, right? You mentioned about hospitals, physician, cardiology, the patient, meaning who actually owns when you interact with this company's hospitals and people, do you own the data? Does the hospital on the data, you have to pay for the data?

Tamir Wolf  7:52  

So I guess it depends who you ask. But then the data so so I have like, I have a few different perspectives on this at the perspective of a doc, entrepreneur, but also as a patient. So my sense is patients own the data. In the legal world today, when we interact with the hospital, and we sign, you know, an agreement, the hospital loans it, but I think, ultimately, that's, you know, that that's not really the case. In, you know, the the world that I live in, or what we're doing at theater is really for the first time shining light on what actually happens in the operating room. And I can tell you from personal experience last a year and a half ago, when I had cancer. I had to go through surgery. It was like it was a very, I don't know, am I allowed to say shitty experience here? Yes. Okay. It wasn't a good experience, to 5pm.

Tal Wenderow  8:49  

So sorry, it's after 5pm or 5pm?

Gwen Watanabe  8:51  

Yeah.

Tamir Wolf  8:53  

Right. So it was a really, it was a really traumatic experience. One of the things that I realized there was that I have as a patient, I have access to every chest X ray, MRI, CT. And then I lay on a bed for eight hours, like an exercise, I'm unconscious, someone's like, you know, moving things around, like, you know, slicing me open. And afterwards, I have no real documentation of what actually happened in surgery. What I have is like an operative report, we all know, that's BS, or let's politically correct world. It's an idealized version of what happens in surgery. But I had no real access to my own data. That was mind boggling. And that needs to change. And that's a part of like, what we're doing what we're doing at Theater trying to, you know, push that, but so long answer to a question, but ultimately, I think the patient should be the one owning the data. I think that's the entire concept around interoperability. And I think right now, there are certain loopholes within policy and legal system that give hospitals like a bit of leverage, but I think that should change.

Gwen Watanabe  10:01  

But the non so the anonymized data, the medical device companies need that to be able to improve the procedures, as well as collect information about cost savings, etc, so that we can, you know, push for technology. So, I mean, I do believe I agree with you patients, absolutely on the data. But the device companies, we, you know, I used to run with a robotics division, you know, we need the anonymized data to be able to improve, you know, fiducial markers and how our software program runs. Because if we don't have that, then we're not able to, you know, get the next generation out to improve the procedure for the next generation.

Tamir Wolf  10:44  

I don't want to hog the conversation. And that's okay. So I'll hug a hug, but just for a second. So all I'll say to that is that there's a difference between the owner of data and then whoever has license to it. And I think those are two separate discussions, I think, like the owners needs to be, you know, you know what I said before, but I think, you know, various companies can have license in order to do what you're talking about,

Gwen Watanabe  11:08  

 I guess, I don't think the patients actually knew that they were licensing the data to the robot,

Ali Golshan  11:14  

and then what happens when there's a data leak, because then it doesn't matter who owns the data. If your business associate agreement says XYZ and there's a breach, then you still have obligation to report to the patient. And then you look terrible, because they're upset with you. And so that's why the hospital is feisty, because the patient's not gonna get mad at Medtronic or Boston, they're gonna get mad at the person who's there touchpoint for the care. And so then that becomes tricky, because I mean, it's a disaster, you have to inform people, but then the Feds get involved, the state regulatory authorities can get involved. It's like nuclear waste. And so that's why I think health care providers and hospitals are alike. You can own the data, but you take the liability with it, too, you know? And that's why it gets tricky.

Tal Wenderow  11:55  

Is that your expense management?

Manisha Shah-Bugaj  11:57  

Well, I was gonna sort of piggyback on what Tamir is saying around just having access to the data versus ownership, right. So there's one aspect ownership, who owns it, who has rights to it? And then can you share access, and for companies like ours, we simply need access to the data so that we can build those enabling solutions on top of it. The next question after that, though, is if there is a monetary element to the access of the data, how do you profit share? How do you share in you know, the the, the money that comes and one of the things we've talked about as an organization is leveraging technology like blockchain? Can you use that to sort of track ownership of data and have transparency so that everyone sort of gets a piece of the pie at the end?

Ali Golshan  12:43  

And can you use it to anonymize the data so that it still has value, but that there's no personal healthcare information attached to it? Moreover, like one was saying, you know, complications with procedure is minimally invasive, or open or grossly underreported. And so you know, you'll read about a vein or arterial procedure and Gizmo. And you'll look at the MDR. And there'll be barely anything in there. But if you're a KOL, and people call you with the issues that come up, you're like, I mean, things are underreported by 10x. And so then if there isn't transparency, then you don't have a true understanding of what the risks and the complications are, et cetera, et cetera, and we fall behind, because then we don't come up with solutions to address the shortcomings.

Gwen Watanabe  13:21  

100% like, we need to understand all the failures, because if we don't, then how are we? How are we going to, you know, get the next software patch to the robot? I mean, we we can't so but you're right. I mean, it's anonymized. And I actually don't think the patients really understand that the data is coming to the medical device company.

Tal Wenderow  13:41  

So should we all start a company and going to the patient collected data? And wishing Ali's clinic and all that? Do you hear that from patients, it's like, where's my data goes, because I have the same experience of me and my son was sick, I still have MRI CDs in my house that have no clue what to do. And the only reason I have them because I asked for it. But most patient don't care. And especially when you go between physician and one two physician to another, to see that request some patients.

Ali Golshan  14:09  

So HIPAA has been used as a weapon to create data silos. And so regardless of who owns the data, it's who can get access to the data, nobody can get access to the data. Like we had a family friend who had a sad situation with an venous malformation and intracranial hemorrhage. And her daughter was 16. And she wanted to transfer care to Barrows because Lawtons like the best that, you know, whatever he was going to do in the brain. And they're like, it was COVID. And she's in the hospital and she wants to urgently transfer her daughter and like, we can't have access to the records for two weeks. That's, that's insane, right. And so the question becomes, is there really going to be a desalinization of information because hospital X will use that to be like, well, you can get all your care here, and then all of your doctors will have access to all of your information. But she go over there, and they're not going to be able to see your data. And most of it's an epic anyways. Right? But he's the primary vendor. And not that there's anything great or terrible, but I feel like I'm it's a computer software, we're not going to pretend like you know, it has a soul. I mean, it's, you know, it is what it is. It's a tool, right? Amazing interface. Fantastic user. You know, I love it when they're like, the problem is that you should become an expert in epic. Because it's a user error. Epic is the care provider and patient, it's the priority stuff, the doctor the dollars. Exactly. And they'll charge you a billion dollars for their old software, but great business model. I mean, you gotta respect it. But but the reality becomes, how does it look, in terms of a reality where there's like an interoperability a universe where everybody has access to all the data? I mean, it's a big lift, and it's probably not likely to come anytime soon. So then do we create like a gizmo a widget that helps move the data around to deal with all of the interoperability issues? Or does the patient then get their own data in a portable friendly format? It's a big question. But it's a big problem.

Tamir Wolf  16:12  

I think the the other aspect is like the power of what we as companies do is like, yes, they're like, it's important, like at an individual patient level, but technology, like the scalability is the important thing. So it's the aggregation of 10s, of 1000s, of patience, and, you know, being able to connect the dots along all of those. And so, like, it's always funny to me, like when a hospital like, you know, the hospital sees data as like, as you know, as theirs and as their you know, and so they become the product, it's very, it's very interesting, like these conversations, because the power of what we can do, because we're coming from the outside is connected between, you know, hundreds and 1000s of hospital systems where things you know, some go, well, some don't go as well. And we're able to identify, you know, for example, in what we do, I think you do as well, like best practices, and, you know, the, that's where really the power of technology comes into play and where software becomes powerful.

Manisha Shah-Bugaj  17:10  

Yeah. What's like, what's

Gwen Watanabe  17:11  

the difference between all the data that's streaming right now from all of our Apple iPhones? And if we were to have that access to information, if we were in a hospital, like, what's the difference? Really, 

Unknown Speaker  17:25  

HIPAA

Gwen Watanabe  17:26  

I understand it's HIPAA. But I mean, like, you know, we should be able to have that information

Unknown Speaker  17:32  

 100%

Gwen Watanabe  17:33  

Streaming to our phones, if we'd like it, and it's not right now

we're so far behind so far

Unknown Speaker  17:40  

so we use faxes.

Manisha Shah-Bugaj  17:43  

But I think the point you made is really critical, because we talked about the value of the patient data. One individual data point from one patient is not all that valuable, so valuable to

Gwen Watanabe  17:53  

me, if I'm in the patient, sure,

Manisha Shah-Bugaj  17:54  

 valuable to you, 

Gwen Watanabe  17:55  

but your son....

Manisha Shah-Bugaj  17:57  

but it's the volume of the data, it's the trends, you can find the insights you can get from that volume. That's really what's valuable.

Tal Wenderow  18:03  

So let me ask you a question about that. Right, we all use Google Maps, and it's okay to make mistake was using crowd sourcing about which the right path but worst case, you will be late by 10 20 minutes, right and using all this data to generalize, but as Glenn mentioned, in the end of the day, patience is in the individual? How do you go back for that macro level and the data to that individual patient to make decision in the OR, for example, right.

Manisha Shah-Bugaj  18:27  

I mean, at the end of the day, I think one of the things we talk about a lot and think about at active is we're looking to build AI models. And one of the big things with data is you have to have representative data sets, right? You have to know where the data came from, how is it collected? Similar to a clinical study, right? You're not going to get insights from data with a homogenous population, you need to ensure that your data is heterogeneous and that it is representative so that you know that the information insights you're gaining the solutions you're creating are applicable to all

Tamir Wolf  18:59  

and I'll give you like an example. It might be repetitive for those who heard me talk like a few minutes ago,

Tal Wenderow  19:06  

I was the only one in the crowds.

Gwen Watanabe  19:08  

Were you on another panel?

Tamir Wolf  19:09  

Well, you know.

Tal Wenderow  19:10  

We still love you. Go ahead.

Tamir Wolf  19:20  

So okay, so surgery is an apprenticeship model, right? It hasn't changed for like 400 years. The key component of surgery is making decisions. So if I need like to make a decision on whether or not to do you know, A or B at a specific point in time in surgery, I do it based on my very limited experiences that I have, or if I'm lucky, I have someone who's behind my back telling me all right, do that. What we can do with technology is actually you know, aid in decisions that are being made in surgery. So instead of me making a decision based on myself selective experience, which is very limited, we like the future, in our opinion, is overlaying the decision making junction in front of the surgeon. So not based on your own subjective and very limited experience, but rather on 1000s of procedures that are similar. And you can go with decision a or decision B, but based on the SAP 1000s or 10s, of 1000s of, of comparable procedures in different places around the world. This is what happens when you do A this is the complication rate, this is the bounce back rate, this is the financial implication. And similar would be you can't do that like at an individual level. And that is the power that is the power of the aggregate and scalability nature of of information data that is analyzed.

Gwen Watanabe  20:52  

So we at Smith and Nephew robotics, we actually had something called physician insights, which measured the individual physicians performance, which was so fascinating. So we had metrics in terms of you know, cut this then like and measured sort of against a pool of physicians, of course, it was all closed, right? You can, they will was not shared with anybody, but they could see their own performance against others, and then how that that patient did over time. So that was an individualized example, which was I think it's huge. I mean, they they liked it, and they learned from it, some people don't like that, but

Ali Golshan  21:27  

and the aggregate can also influence the pre surgical journey to so if you look at congestive heart failure, the probability of readmission within the first seven days can be decreased by 50%. Need number to treat is two, what's really good, by simply having a seven day follow up with your cardiologist, and medication education and reminders in the first seven days. So really cheap, really powerful intervention. But the thing is that like even the best cardiac programs, just recently started things like NP clinics where like if your private practice or your academic cardiologist didn't have time to see you seven days post op, sorry, seven days post admission, they'll see you. But how do they gather the data? I mean, they don't have Bluetooth integrated EMRs to capture this data. And so they're literally like asking people like, Oh, what did your home monitor do or if it isn't integrated, it's not automated. So if you get if you use the power of AI and ML, to train an algorithm, when to trigger and to to track, that aggregate then influences that individual's preoperative journey, so that you don't need to go under the knife

Tal Wenderow  22:32  

is there such thing as too much data, both from the data collection quality, of course, and also how you present that to the user later on, to talk more.

Tamir Wolf  22:45  

So, okay, so let's talk about quality of data and like and the world of healthcare, I have this PTSD from a company that was acquired by Medtronic, like several years ago. That called RDN, and I don't know if you guys are familiar, but renal denervation where they did like this huge study, they were acquired for like a billion dollars, like a billion dollars, that's a lot. And a lot and they were acquired before going commercial. So like, right after the the clinical study. And in the clinical study, they saw like you do denervation, like to the renal renal nerves, and you're able to, like drop hypertension, alright, cool. Medtronic, like, you know, acquired this company. The study was conducted in a way that was like flood and didn't address like a variety of like, a variety of folks, like women were underrepresented. You know, black folks were underrepresented. And then, once Medtronic, like rolled it out, it saw that the results weren't really like, what they'd seen in this study, if, if I recall correctly. And so the way that we have been using data traditionally, is flawed, like, you know, double blind randomized control studies, and the way that we've done them for like, for for hundreds of years or decades, is problematic. The value of of, of data, like as we're talking about it today, is in the fact that it's like real world. It's not in a clinical study setting, it's in the real world, and we can gather it in huge amounts. And by doing so, we can eliminate a lot of the bias that's inherent in the way that we have been doing things for a very long time and I think that is that is crucial, leveraging technology to eliminate bias so that what we do and what we assess actually has impact in the real world and not like on limited you know, clinical study setting. So I think eliminating bias is the first real important aspect of it. Obviously, the quality has to be like, you know, top notch I mean, garbage in garbage out. Like you know, with With everything, but I think elimination of bias is, you know, is an extremely component extremely important component of like what we're doing today,

Gwen Watanabe  25:09  

right. But it's also increased patient outcomes. So like remote patient monitoring, post total knee surgery. So there are devices that are collecting data on gait, etc. And just understanding, you know, if you have an infection, or if you're not walking properly, or if you're not walking at all, can really, you know, help the intervention, I think, use that example as well. So postoperatively, really intervening early to make sure that you know, that your the rest of the patient recovery journey is actually going to be very successful and positive. So I that's a very important component that I see that also the physicians do get paid for it. I mean, there are codes for remote patient monitoring, it's not a lot. But I'm, I'm glad that those codes are there. Because, you know, if you can intervene early, you can eliminate, you know, to have a revision, for instance, in the total knee scenario,

Ali Golshan  26:01  

one way to capture a lot of value is to use a value based care model, which I'm not, I mean, so far, it hasn't been well played or capitalized, but Medicare Advantage is a value based care play. And it's a big market. I mean, the federal government, we kind of do have a one payer system between the VA medical and Medicare, the super majority payer, so we're looking this law and where we pretend that we don't really have a one payer system, we kind of do, almost. And so Medicare Advantage is half of Medicare. So it's half of the biggest payer or part of the biggest pair. And if you're at risk for everything, whether you're the pro fees, or the global, or whatever your arrangement is, if you can save on a readmission for CHF or redo on a knee, you're gonna make a lot of money. And that's how you can monetize it. At least that's an entry point. I think.

Tal Wenderow  26:46  

So. So switching gears a little bit Manisha, you have a product out there limited launch, right? When you go to your customers. So first question, who is the customer who is selling to? But second, do they ask what data is it generate on? What's the background? Do they actually dig in as a consumer or healthcare providers?

Manisha Shah-Bugaj  27:05  

Can you repeat the question? I want to make sure I understand the question why?

Tal Wenderow  27:09  

Who is the customer? Who's paying for that? And then do they dig into your product? And asking, Why is the data generated? Right? Is it from Israel, India, Australia, US? And?

Manisha Shah-Bugaj  27:20  

Yeah, I mean, for us we have every hospital is different in terms of what their data sharing arrangements are. And we work with them individually on how, again, that data sharing takes place. For us, again, ownership is not as much of an issue it's really access. And then what are we going to do with that data once we have access to it? Again, we because of the way our technology is designed, we know, every surgical procedure where it takes place, when it takes place, what facility so we have the ability to go back and track all of that information on our data, if it's needed, if it helps, particularly as we think about regulatory clearance for future solutions, we'll have all of the provenance of our data, because of the way our technologies

Tal Wenderow  28:03  

You are regulated, Tamir you're not so this day, how much does he ask from a data quality design freeze? Can you update the model after more data is generated?

Manisha Shah-Bugaj  28:13  

Yeah, I mean, I think the FDA is going through this journey right now. And there's a lot of there's early guidance on what it's going to look like. I think they're also still learning with all of the technology companies. I think it again, it'll depend on what you're doing with the data, how aggressive are the solutions? Is it informational? Is it giving information? Is it actually making recommendations? Is it generating conclusions? I think all of that the level at which that data is being leveraged is going to dictate how much traceability there needs to be in the data and what you can actually show in terms of diversity of datasets.

Gwen Watanabe  28:49  

So in my experience, in terms of the customers of wanting to see the data that report, they were not shy, they were like, I want to see this, I want to see that I want you know, in almost like just a lot. They wanted to see a lot of data output, which is which is exciting. But then as a, you know, a corporation, you have to decide, can we do all that because it's a lot of expense, if you will, and there's typically you do not get reimbursed for that sort of additive feature in a robot or a program, unfortunately.

Tamir Wolf  29:25  

So in my experience, no one gives about the data. They don't care about it. They want to see value, and they want to see insights. So what they want to see is how they can do better. How can they be better? They want you to crunch it for them. You want it they want you to make it actionable for them. They want to see what the value is. So I think there are several layers, the very base layer of everything is, you know, just to surface information and to visualize it. So in the example that I gave you before about, like, you know, an enterprise that the system that has no idea like why one is doing better than the other, just like seeing, you know, initial initial data, like, that doesn't mean anything for them. What they really want to have is like insights into, alright, what are best practices here that are not being adhered to here? How can we transfer them from one place to another? I think that's where the real value is. So the conversation, I think, like, I'm trying to take it there, you're trying to pull me down to data, like the I'm trying to, like, take the conversation to write data is like the base layer of everything. Alright, cool. But how do we take that make it actionable, make it valuable. And then we can start having a conversation about like monetizing stuff, because like, you know, I've got a lot of data cool. But if I can't do anything with it, and doesn't provide value, no one's gonna pay for it. So I think that needs to be like the centerpiece of

Manisha Shah-Bugaj  30:57  

the only point I would make, though, is that I think hospitals are a little spooked right now around their data, right? And so, knowing that technology companies are collecting data from the facility, I'm not sure all hospitals have figured out what does that mean for them? Do they want to control and own all of that, are they going to give access freely, we're finding there's different tolerance at different facilities. And at the end of the day, it is the insights and the solutions that come out of the data, that's a value, the data itself is not necessarily the critical point. But hospitals are, I think, spooked about

Tal Wenderow  31:32  

On premise or can be a cloud based solution,

Gwen Watanabe  31:36  

we were not allowed to be a cloud based solution. Now, we could only have a closed system.

Tamir Wolf  31:41  

It's like 2023, dude, like, there's no on prem, 

Tal Wenderow  31:44  

you have a USB on your

Tamir Wolf  31:47  

Everything is going to the cloud, like there's like

Tal Wenderow  31:50  

this is it's the hospitals are comfortable with that

Tamir Wolf  31:53  

the hospitals are starting to get comfortable with it, because they understand that, especially with everything that's happening and all the hacking, that cloud is a lot more secure than anything that you have on prem. But then again, you have like, someone who's responsible for information security, and they have post it notes with the password to their computer. I've seen it on multiple occasions at various hospitals. It's hilarious. So you don't have to

Ali Golshan  32:17  

Sign a BAA with the hospital. Yes. And so then what does the BAA say? It says they own the data, you have access to the data, 

Tamir Wolf  32:24  

the BAA just like pushes all the responsibility to you. So I sign him happily and freely, barely negotiate on me, I've got HIPAA is like, you know, but I've got high trust, I've got sock two, type two, I've got like everything that I need in order to be able to deal with data. And most importantly, I have, like a culture in the company that deals like religiously, with all the information that we get. And so I feel very, very comfortable dealing with it. And it's like, you know, it's like data, like that aspect of it is commoditized. Today, like, you've got EMRs, like, you know, it's

Ali Golshan  32:59  

when GPIOs want to see that data when you're at a large orthopedic strategic to determine whether they're going to buy your implant or someone else's.

Gwen Watanabe  33:07  

They did not ask for that, no. But like they do want to partner with you certainly. So like HCA, for instance, you know, they're very sort of technology forward, especially as it relates to aid going into the ASCs. And our robot specifically was, you know, it was very suited for that. So they, I think they were starting to get there. But we were we were closed systems. So I don't know how somebody would hack into our system. And we, yeah, we were close, like, so it's like some representative, one of my sales folks had to go in with a special key and get download the data. Like, physical key. Well, it was like it was like, couldn't like, somebody couldn't just go and get it. So yeah. So I don't know. I don't know. Hopefully in 2023

Unknown Speaker  34:00  

Let's talk about faxes.

Gwen Watanabe  34:03  

They do have faxes 

Tal Wenderow  34:04  

I still get faxes, because someone has my fax, there's

Tamir Wolf  34:06  

a lot of data like affects you.

Tal Wenderow  34:09  

So we have six minutes, just who's o'clock here? Switching to business model a little bit without, you know, sharing any confidential information. How do you sell the product? How does hospitals looking to buy it? Is it fee per client per patient is a subscription meaning what do you see the comfortable zone from the hospital and Ali, what's your video from your physician has right? of private practice? What

Unknown Speaker  34:36  

In terms of paying for data

Tal Wenderow  34:38  

or the product that monetize the data? Right? Because software product hospitals are not unless it's epic,

Ali Golshan  34:43  

my favorite I think that you have to demonstrate how you and you have to demonstrate user friendliness. If you come to a physician with like some user interface where have to go find the data and it's not visually friendly. I pick throw it away because I could care less. I don't have time I'm busy and I got stuff to do it otherwise laser gonna get chopped off or whatever bad thing is gonna happen in your specialty, right? And the click, it either has to create value, which means money, or it has to create solve a pain, which is super annoying, either one of those, you'll pay for getting rid of pain, or you'll pay to then make more money for the money you put in. But it has to be one of those two things. Otherwise, we're saturated, so many people, we don't care.

Tal Wenderow  35:26  

So if I come to you for a solution, right? Do you need a pilot first before we start commercialized? Or you rely on hospital A, B, and C that use that?

Ali Golshan  35:37  

No, I think most hospitals are dysfunctional. And their, their deployment of anything is usually horrible. So I could care less I have a surgery center and a practice and we're very efficient and faster and lower cost, so I want to see it. For it for me. And I want to see it work on a relatively sizable, and I mean, I don't need an animal that depends on what it is, obviously, but I need to begin. So I definitely need proof of concept. I also need to make sure that not only does it do the thing you say it's going to do, but it's going to integrate with the system, people are gonna know how to use it, and I'm not gonna get phone calls from the nurses, they're pissed off, otherwise, it's gone.

Tal Wenderow  36:13  

So what is your How do you survive as a startup company that now it's death by pilots rights, that you have to do pilots and pilots then convert them?

Manisha Shah-Bugaj  36:20  

Yeah, I mean, that that is today for Yeah, that is, unfortunately, that's the challenge as a small company, right? We're bringing new technology into the world, you know, physicians want first hand experience with it, they want to see the value in their specific operating room for their procedure. And it becomes a challenge as an organization, how do you scale that 

Tamir Wolf  36:39  

The sales cycle is slow.

Manisha Shah-Bugaj  36:41  

and post COVID even slower, but but at the end of the day, I think you can leverage reference accounts, you leverage clinical data, you try to extrapolate from some experiences make that broader, so it becomes scalable, but that is always going to be sort of the challenge that you

Ali Golshan  36:58  

need a clinical champion. Exactly. Because doctors trust other doctors,

Tal Wenderow  37:02  

I just hate that because you know, he'll always support you, at the end of the day, you have to go to the CFO and meet him 65 times and then maybe you'll get that

Ali Golshan  37:10  

depends where your sales cycle is, right. So like in the outpatient vascular space or in the ASC space, often the physician is owner operator or at least decision maker, and you don't have to sell to a value committee, and you get in and you get out. And it's very, very quick and very efficient. So oh, it really depends who the end customer is. And we have to remember like the hospital market is shrinking, shrinking, shrinking, and everything outpatient is growing, growing, growing. So that might change. I mean, like your robot was complicated. It's neurovascular stuff. But if you know you're a software solution, and the doctors, outpatient are the same ones in the hospital. And while the CEO may not listen, if you've got 100 doctors on staff, and they're like, Man, this thing is really great. My office, that's sort of the Trojan horse to

Tal Wenderow  37:50  

Yeah, that makes sense. So final notes, any advice? It's a freefall write advice to a company that wants to start when you start the data. Sad story, funny story, good story of data. I don't want to go and share anything. Nothing. I have to start. 

Manisha Shah-Bugaj  38:09  

Well, so I mean, one, one point I can add. And for us specifically, as active, we have been successful in monetizing data to this point, as I mentioned earlier, we're really looking at the data, what insights we can gain and solutions create. But we've partnered with Nvidia, they've been very interested in our data sets, because their proprietary high quality, and they've actually licensed those data sets from us. So while that's not our primary focus as as an organization and our business model, that is something that we've had success doing to date because of the quality of the data.

Tal Wenderow  38:42  

So I'll ask, so when you look in company and data, how do you evaluate them? It's an investor right now.

Gwen Watanabe  38:47  

That's true. Yeah. So it's really monetization. Right? So being able to show that you can go deep and, you know, into a system and then measure the adoption. So, you know, really understanding revenue per sales rep. Right. So that's, that's key on an annual annualized basis, and then, you know, intellectual property, intellectual property, not just being patents. But you know, we all understand how quickly things technology goes. So, you know, who's going to take you over? And, you know, basically, you know, and when will that happen? Right? So, can you build a moat around what you're doing? So that's, that's really what keeps would keep me up at night as an ambassador and then the people's number one, right? Yeah. So people is is number one.

Tamir Wolf  39:40  

So I would go back to one of the things I said at the beginning. My tip for like any company or like founder is, Do not even think about that question. Like it's not about monetizing data. That is not the right question. It's about how do I monetize value? And if you focus on the value and if you focus on the patient, and if you focus on you know, What you're actually adding to this world, you'll be able to monetize it. If you focus on monetizing data, it's very short term. And it's not going to work, in my opinion,

Tal Wenderow  40:12  

Ali, anything.

Ali Golshan  40:14  

I think that at the end of the day, if you're trying to monetize data, I think a lot of companies like hims and hers, are not doing so great. You got to get dirty in medicine if you want to make money. And so if you want to monetize the data, you need to have a patient touchpoint, right. So you've got a robot or you have a clinic, you don't have to have a lot of clinics, you can have a small footprint. But you have to, if you want to make the real bucks, you've got to get dirty. And so there needs to be some patient contact. It can't be the cloud is awesome, but you can't cure anyone from the cloud.

Tal Wenderow  40:45  

Yeah, that's a good point. Because the end of the day, we're all here for the treating patient and making some money along the way to be honest to ourselves, but also to treat the patient but I want to thank you all for joining in. Hopefully, it was a fun discussion, some listen, learn and not too much challenges or problems to each one of us. But thanks for everyone. 

Speaker 2  41:01  

Thank you. Thank you. Thank you.