Medsider: Learn from Medtech and Healthtech Founders and CEOs - How Medtech Companies Can Enhance Procedural Workflow and Capture Intra-Operative Data: Interview with Jennifer Fried, CEO of ExplORer Surgical

Episode Date: May 22, 2020

In this episode of Medsider Radio, we downloaded with Jennifer Fried, the CEO and Co-Founder of ExplORer Surgical. Jennifer founded the company with Dr. Alex Langerman as an MBA student at the University of Chicago Booth School of Business, where she received her degree with honors in finance and entrepreneurship.Previously, Jennifer was a Vice President at Park Lane Ventures, a healthcare-focused venture capital fund spun out of Essex Woodlands. Jennifer began her career as a consultant at Bain & Company in Chicago after graduating from Northwestern University.With me on this episode is special guest host, Norbert Juist, who runs Sales Performance Resources, where he specializes in recruiting for medical device marketing and sales positions. Prior to this, he was a sales rep at Cordis Endovascular, a spine consultant at Synthes, and a sales rep at Ethicon. Interview Highlights with Jennifer Fried● How most medical device companies capture procedural data & workflow processes -- and why it’s completely outdated. ● The challenges medtech companies are facing when it comes to educational training & product development and why they’re considering platforms like ExplORer Surgical.● Jennifer’s favorite business book, the business leader she most admires, and the advice she’d give to herself 5-10 years ago.See more...

We really want to be that tool that creates the next generation of intraoperative data. So in order to just keep pushing the boundaries of technology and data in the space, you have to have that data set. And nobody to date has really created the standard tool for how do we capture that intraoperative data. Welcome to Medsider Radio, where you can learn from proven medtech and healthcare thought leaders through uncut and unedited interviews. Now, here's your host, Scott Nelson. On today's program, we've got Jennifer Freed, the CEO and co-founder of Explorer Surgical. Jennifer founded the company with Dr. Alex Langerman as an MBA student at the University of Chicago Booth School of Business, where she received her degree with honors and finance and entrepreneurship. Previously, Jennifer was a vice president at Park Lane Ventures, a healthcare-focused venture capital fund spun out of Essex Woodlands.

Jennifer began her career as a consultant at Bain and Company in Chicago after graduating from Northwestern University. In this interview with Jennifer, we get into the following, how most med tech companies currently capture procedural data and workflow processes and why it's completely outdated. The challenges med tech companies are facing when it comes to educational training and product development and why they're considering platforms like Explore Surgical, What does the future look like when it comes to med tech companies and their ability to capture intraoperative data? And Jennifer's favorite business book, The Business Leader She Most Admires, and the advice she'd give to herself five to ten years ago. There's a lot more we cover in this wide-ranging discussion, but I wanted to call out a few things before we get started. First, joining me on this episode as a special guest host is Norbert Juiced. Norbert and I go way back. In fact, we used to sell vascular devices into the same cath labs.

Now he runs sales performance resources and specializes in recruiting for medical device sales and marketing positions. and he's quite good at it. Norbert not only brings a ton of industry experience to the table, but he's one of the most honest, genuine, and personable people I know. So if you're looking for a new gig or need help recruiting for his open positions, Norbert is definitely your guy. In the show notes for this episode, you'll find a link to learn more about Norbert and his background, and no, he did not pay me to run this message.

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Without further ado, let's get to the interview. All right. Welcome, everyone to Medsider Radio. Got Norbert Juiced and the co-pilot chair. Again, Norbert, how are you doing today? Outstanding. Awesome. We started here with our 2020 interview.

That's right. That's right. We're recording this year in the early part of January 2020. And our first guest of the year is Jennifer Freed. And as I mentioned in the intro to this conversation, she is the chief executive officer of Explorer surgical. Jennifer, welcome to the program. Thanks for having me.

2020 is a year of hindsight. That's right. That's right. The old 2020 vision might get on a bit. But, you know, if we were to fast track, you know, another eight months into the year. But nonetheless, it's fun to kick off the new year and new conversations and new things that we're all kind of working on. But Jennifer, I mentioned. And if you edit that out or not.

That's right. That's right. All of a sudden, this is not evergreen anymore, right? Because we put a date. Oh, no. I messed up already. No. No, we're all good there.

Hopefully the stuff that we're going to be talking about. will be valuable even if someone's going to listen to this in late 2020 or maybe maybe even the next calendar year. But I mentioned your bio in the intro part of this podcast, but Jennifer, you're one of the co-founders of Explor-Surgical, you're leading the company from a role in a responsibility perspective as the CEO to help level set everyone. Can you give us a high-level pitch of what you guys do and some of the needs that you help solve at both the hospital level as well as the med tech level? So Explorer is an interactive digital playbook for the operating room.

and procedural sleep. So what it is is a step-by-step visual workflow for each step of a surgical or interventional procedure. We have a big board in the room that can display pictures, videos, high-level instructions, et cetera, for each step of the case. And then we also have customized role-specific content. So a rep in the room, for a tech in the room, for a new physician, et cetera, can have all of that information at their fingertips while they're doing a procedure. I'm going to put myself in the shoes of, I'm going to go back to maybe a big, maybe mid-cap or even a large strategic medical device company. Why would I be looking at explore surgical? People will deploy our software for a, in a couple of different instances.

So one, for new products, what's really important is getting your product to market as quickly as possible and with the best possible results. In order to do that, you need to be working with your KOL stakeholders to really develop what are the best steps of the procedure, what is every piece of data that I can capture about what's happening in the room with my products. People tend to use a lot of old-fashioned systems, pen and paper, setting clinical engineers in to build their own homegrown spreadsheets. What we can do is both display those best practices live and capture an intraoperative data set that's really never been captured before. They work with new products that are coming to market. Then we also work with products that

already in the market where field teams are able to help work with those clinical teams in order to achieve the highest level of performance, but also that data capture. The companies really come to us when they're thinking about maintaining a competitive edge on their products, but also really capturing this data around what's happening in the room in an easy way. From a stakeholder standpoint, are you typically working with R&D teams inside medical device companies? Because I know there's also like this education and training component that comes with Explorer Surgical as well. And these are some topics that we're going to get into as the conversation unfolds. But are you primarily working with one or the other or both? There's three different

groups that we work with within med tech companies. The first, as you mentioned, is R&D. So for folks that are in the early stages of their product development, we have to work very closely with education and training. And then we will work with sales teams for products that are alive. So it really depends on the life cycle of that particular product and kind of from start to finish. Those are the different groups that will work with depending on their initiatives. What we see in common is a desire to streamline processes and really think about creating the most efficient procedure as possible and also a desire to capture more procedural data. Can we take a step back? What was the brainchild of this? Yeah. Not necessarily who, but where did the idea come from? Yeah, how does this start? It's interesting.

And, you know, like every startup company, we've had our own twist and turns along the way. So six and a half years ago, I was working in venture capital as a health care investor and went back to graduate school to get my MBA at the University of Chicago. Shortly after starting, I met a surgeon named Alex Langerman who was running a research lab within the Department of Surgery at University of Chicago Hospital that was studying operating room workflow at operating room efficiency or the lack thereof, like he likes to say. So when I first met him, Alex said to me, Jen, half the time in my OR, everything runs so perfectly. I have my favorite scrub nurse, my rep is on time.

I'm doing one of my normal cases, and I can just get in the zone. And everybody is in sync. It's a perfectly coordinated symphony. But as soon as you remove one of those variables, if my rep is stuck in another room or another site, or I have a scrub that's rotated in from another specialty, or I'm working, with something that's kind of new, things become really chaotic. And I don't know if I'm allowed to swear on your podcast, but, you know, I'd say shit hits the fan. And Alex really had this vision for, hey, you know, half the time, I don't get the coordination of my team that I need

to provide the best care for the patient on the table. So at the time, you know, I was working with a lot of physician entrepreneurs who had really big ideas. And I frankly didn't believe him on the magnitude of this problem. In my mind, I said, there's no way that the OR can be this bad or that problems are this frequent in such an intensive setting for the patient where, you know, as an outsider at the time, an OR outsider, you really imagine surgery to be this purposely well-oiled machine. So Alex invited me into his OR. This is before, you know, the crazy vendor credentialing and HIPAA policies. This is 2013. So I started showing up at 545 in the morning and putting on scrubs and watching procedures. And I saw exactly what he had described, which was the

huge bifurcation in procedures where you either had the team that was well oil and worked together all the time and you were doing something familiar or just as so often the logistics of surgery demand, you didn't. But Alex had been building this research around was looking at what solutions were homegrown or built by teams to try and really streamline procedures. So the index cards, the black books, all of the notes on, you know, which surgeon likes to do things which way. Alex had this vision. Could we really bring technology into that interoperative theory? Could we have a digital workflow tool to really manage procedures? step-by-step and make things visual, bring in videos, bring in pictures, and really find a way to

get this whole team to work together and think, even if the circumstances didn't allow you to always have the same people doing the same procedures day in and day out. And so that's how we started. This started as a passion project where I did this on the side for three years, working with Alex to iterate on prototypes and get some grants through the door. And it wasn't until 2016, that I quit my at the time, you know, great day job, being an investor to raise their own money for the start building it out, start to build out a commercial solution and really bring this to market. That's really interesting.

Scott and I both come from surgical sales backgrounds in medical device. So we both. You've been in those rooms. We've been there and witnessed. I mean, the light bulb went off when you started describing that. I'm like, you know, oh, this tech is filling. in in spine coming from the general surgery team and the doctor's frustrated. You know, you've got a dozen trays. Yeah, Scott and I'm sure have both experienced that.

So that became crystal clear as you described that. Yeah, there's no doubt. And if we have time, I'd love to learn a little bit more about kind of that, that in-muching point where you felt comfortable enough to leave a pretty good gig and go all in with Explore and surgical. But the topic that I think would be really interesting to kind of transition into is it sounds like the first iteration of your platform was very much geared towards solving problems within the procedural suite at the hospital level. But now you have, I know we don't want to get into like who's using Explorer surgical, but you have a lot of med tech clients that are using your platform now. So talk to us a little bit more about that transition and maybe some of the specific challenges and pains that are happening at the

med tech level that are leading, you know, people in R&D departments or training in education departments to say, hey, we need something like an explorer surgical to help solve for this, you know, this pain point. So, you know, we raised our seed funding in 2016. We were building a commercial version of the product. And, you know, as you mentioned, we were very much geared initially toward selling a solution into hospitals. So I went out and in that first year, I think I met with over 80 surgical services or, you know, perioperative services directors at hospitals. And the question that I always asked were, you know, which service lines need this the most, right? Where is there the biggest economics, but also at the end of the day, really clinical opportunity to streamline workflow and, you know, get more data and improve both efficiency and effectiveness on these teams in his room?

And what I heard over and over again was orthone spine, as I'm sure you both can imagine, just the complexity and the dollars and volume of all those procedures. I also heard cardiovascular and really outside, I mean, still in the cardiac OR, but started getting pushed into the cath lab and AP lab a lot for some of those procedures. And then I also heard robotics. And that's where we started spending a lot of our time as a company. that the market was telling us. And it was really opportunistic. These are very vendor heavy surgical specialties, right? These are rooms where you have a vendor that is there in every room

for every procedure working with that product. One of the top three cardiovascular manufacturers kind of heard about us, and they came to us. It wasn't something that was outbound. And said, Jen, we've seen what you're doing. We see this opportunity. to really think about streamlining procedures and taking our best practices and finding a way to share that live in the room. Would there be an opportunity for us to work with you to develop a workflow for one of our implantable products and then work within our team of the company to start using this? So this was new for us. It was not something that we had specifically said, hey, I want to set, to medical device manufacturers. But I was very intrigued by it. And, you know, hospital sales cycles

are really, really tough. And the average 18 months and for a startup company with a brand new price can be even longer. So as the leader of a venture-backed company, you know, definitely on my mind is how do I get the right commercial traction in these 12 to 18-month funding increments where I have to meet these milestones. of our investors when our sales cycle is so long. So I was intrigued and spent a lot of time with this initial customer, just learning from them, what are your pain points, you know, what are you seeing, how do you view your competition, what is the value that you see in purchasing a solution like this directly from us?

And they began to pulling it with their medical education team. So using explore in the animal labs and the cadaver labs and those early procedures where they had all of their positions coming in to learn about this really new and exciting product that was generating great results. And that's where we started to just see an opportunity to scale our business much faster. So rather than having to go hospital to hospital, room to room, position to physician, we could work directly with these manufacturers that already had this scale. And then you could start to think about how much more value and power in that data when we could build a best practices workflow, you know, for, say, their total knee implant and then launch it

across, you know, a whole set of surgeons at one time. So we saw that opportunity, learned about and pursued it, and since then have really shifted our strategy to focus on marketing directly to those med device companies as opposed to purely hospitals. So the biggest need, Jennifer, that you noticed, I love the fact that this need was born out of, like, what would you say, 80 plus conversations with customers. So you were like knee deep in the trenches. It reminds me of this piece that I read. Actually just recently, I think this week, maybe it was Monday.

It was like the top learnings of the past decade growing startups. And it was from the director of brand, I believe, at Open Table. Really, it was actually a really good piece. I think I tweeted about it. But he mentioned like, you know, in several of those key learnings. It's like you can never learn like as a startup, you can never learn the things that you need to without shipping, right? without shipping product and then talking to customers and then iterating. What 100%?

Yeah, it just, it's like, it doesn't necessarily sound cliche, and that's definitely not rocket science if you're in the startup world, but like your experiences like being certainly bring true, it sounds like. But I guess just to kind of circle back around to what you mentioned, it sounds like this first started out as a very educational tool, right, going from hospitals, then even to med tech companies. And if I have a complex spine product where there's a certain amount of like intricate procedural steps,

just as a workflow tool that, you know, I could offer to my hospital clients and physicians to help them, you know, not only learn the product, but ideally resulted in more, you know, efficacious procedure. But you're also, like, how did this then evolve into the product development side, too? Because that's probably what really stands out to me is this transition then even one more twist, right, in the product development, you know, your product development life cycle and that now it's being used elsewhere. So I think that's really interesting. Can you speak to that, you know? Medical education is a great starting point for us when we are, working with new customers. And I think what we've seen over time is we've been pulled both forward

and backward in the product's life cycle. So if, you know, we're working with the medical education team, it's natural to then think about as a product is getting launched, how you continue to capture data on the product, how to continue to offer value on your previous longitudinal dataset. But we started to see as we were engaged more commercially with prospective customers and our existing customers was we kept hearing, gosh, I wish I had this two years ago or three years ago when we were first getting this started. And we started hearing about some of the pain points of candidly even just writing an IFU for a new product that we weren't aware of. And what we kept hearing was, you know, we have our steering committee of our six or eight KOL docs

and we're trying to create, you know, our next-gen implants. And we're getting eight docs in a room, but we have 12 different opinions. So there's just this incredible amount of time and money and resources that are invested in these steering committees and really thinking about how do you even get some of these guidelines built and best practices. At the same time, what we had heard from some of our hospital customers was a desire to use what's called the Delphi method. Are either of you familiar with us? I'm not. It's a method that's been around for a while and is popular in academic medicine where it's basically a way of working with

experts to reach consensus. So we just heard the scene from the market of, hey, for these complex procedures, I'm trying to find a way to map out the difference and also get all of my experts aligned, right, on what those steps should be and how complex is each one of these steps. And our DTO worked with one of the, actually, hospitals originally, to add this Delphi component to our software, where we can still build out the procedural workflow, but then you're able to remotely share that workflow with all of your K-WEL's experts, your committee members, et cetera. And then it allows everybody to interact with each other. You can start to vote. You can see where people are really aligned on, hey, this is the approach that we should be taking for, you know,

access for this particular procedure. This is, you know, the degree of approach that we should be taking. Or here are the particular steps where people are really debating with each other and what this should look like. So it was this desire for a more data-driven way to make decisions. even earlier in the product's life cycle that was all dependent on how do you map out a process, how do you collect the right data points, how do you have this in a cloud-based instant, easy-to-access way. So we started building more of these components into our bachware and it was just kind of that market feedback that started showing us that there was more and more interest in this early on in the product's life cycle. That's been really exciting for us to see. And as we're

seeing some of these, I'd say really transformational innovation happening in the tech space, you know, on the cardiovascular side, looking at how much is now transcatheter, these totally new approaches. It's really important to think about how do you get the right input from clinical folks and how you be data-driven and how do you shorten that timeline to development to really get this procedure and get these new products launched. In terms of the practical application, let's just take a transcatheter heart valve, for example. Let's say, you know, whether it's in Edwards or, you know, Amatronic, whatever the company,

I've got Explorer surgical in a hospital suite. And am I, like from a product development standpoint, am I sort of gathering data with how, based on the playbooks that, you know, these, um, in an inventory cardiologist is following with that particular implant, my gathering data and then learning a little bit more about how he or she is using that particular implant and then trying to identify, you know, pain points or challenges to either iterate on my existing heart valve or maybe there's ideas that come out of that, those sort of learnings for additional for new products altogether. Am I understanding that correctly? You are. It says that when we work with R&D teams, we're often working with them before

their product is live in hospitals. So we're engaging much earlier in that life cycle. We can absolutely do, you know, post-marketing data collection as well. But, you know, we'll often see people using Explorer to capture data in a lab setting before products even launched, or they'll use it during clinical trials to capture more data about what's happening in the room. So we see R&D teams that have a really strong desire to capture more detailed data about what's happening during procedures than the settings that it can be deployed and can be in a lab that is space that they're renting out wherever the location is all the way to, hey, my product is live and it's being used an ongoing basis and I want the field rep to capture data.

Does that make sense? It does. And, Norma, I know you wanted to chime in with a question, but is this, and I'm not sure if you're familiar with some of these tools. But like at Juve as an example, as an e-con, as a medical device company that commercializes primarily direct to consumer through an e-commerce store, we use a, you know, a decent, our tech stack is pretty deep. But we use a fair amount of tools that monitor, they do like heat mapping and scroll percentages, just to gather, like, additional data on how users are interacting with our website, right? Google Analytics being, you know, the most common. Is it more surgical almost like an offline version of that, right, where you're helping device companies really monitor that type of user data, how physicians,

whether it's in a clinical trial setting or an AMA lab, how they're using their products, sort of an offline version. Is that kind of a fair analogy to them? We support companies that want to capture a specific set of data, but often don't have the right tools to do that. So we have our own mobile app so you can interact with Explorer on a phone, on a tablet, on a desktop computer, whatever you want. But the best instances of where we did success is, you know, one of companies is, I really want to understand X, Y, and Z. And right now I'm not getting that. And we see these homegrown, you know, like the clinical worksheets are very common, you know, the pen and paper or some kind of Excel

spreadsheet or something like that, we can replace that with a really easy-to-use system in real-time. Well, to your point is that if you are capturing that data while they're intraoperative, you know, maybe it would help the company find a new iteration that is needed or some additional product or something for the future, to Scott's point. So the data capture is kind of cool and all the possibilities in them, helping them develop it and potentially developing new ones down the line. Yeah, it's a great way to diagnose what's really happening in the room. What are the real pain points? And often, where is there a variability? Right? You might see in certain types of practices, you know, if you just look at total joints,

right, you're going to have a lot of very high volume practices that may be doing this outpatient. Same teams all the time. You're always doing it in 48 minutes or whatever it is. But then you may see other settings where there's huge variability. And that's something where I think medtech companies, they want to know this. They want to understand what's happening. And they want to take that data and use it to inform their strategy, whether it's product strategy. And here's the next one of our products that we need to develop in order to the clinical teams using it or whether it's, you know, a sales or marketing strategy as well. What are the things that we can do to provide their resources to the doctors and to the teams?

that are interacting with their products every day. Hey there, it's Scott, and thanks for listening in so far. The rest of this conversation is only available via our private podcast for MedSider Premium members. If you're not a premium member yet, you should definitely consider signing up. You'll get full access to the entire library of interviews dating back to 2010. This includes conversations with experts like Renee Ryan, CEO of Cala Health, Nadine Miarid CEO of CVRX, and so many others.

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