Medsider: Learn from Medtech and Healthtech Founders and CEOs - How To Make Health Technology Fun and Accessible: Interview with Osso VR Co-Founder and CEO Justin Barad

Episode Date: June 9, 2022

In this episode of Medsider Radio, we sat down with Justin Barad, Co-Founder and CEO of Osso VR.Justin is an orthopedic surgeon with a passion for technology and a history of working in the video game industry. Using his experience and knowledge, he developed a virtual reality platform that can reform the way surgeons are trained and assessed. In this conversation, Justin explains how he avoids being pulled in multiple directions with his technology, why it’s important to let potential customers get hands-on with your platform, and why tech can and should be fun — even in healthcare.Before we jump into the discussion, I wanted to mention a few things:If you’re into learning from proven medtech and healthtech leaders, and want to know when new content and interviews go live, head over to Medsider.com and sign up for our free newsletter. You’ll get access to gated articles, and lots of other interesting healthcare content.Second, if you want even more inside info from proven experts, think about a Medsider premium membership. We talk to experienced healthcare leaders about the nuts and bolts of running a business and bringing products to market.This is your place for valuable knowledge on specific topics like seed funding, prototyping, insurance reimbursement, and positioning a medtech startup for an exit.In addition to the entire back catalog of Medsider interviews over the past decade, premium members get a copy of every volume of Medsider Mentors sent to their door at no additional cost. If you’re interested, go to medsider.com/subscribe to learn more.Lastly, here's the link to the full interview with Justin if you'd rather read it instead.

I would say probably the best advice I can give people is just, you know, be thoughtful and, you know, also be focused and kind of like move quickly, especially in today's world. And just like grit does not begin to describe what is required to do stuff like this. But I think once again, it's like you need to keep in mind that this is not the goal. This is just this is going to help you kind of get somewhere and like you really need to have a strong vision of what that is. otherwise it's probably not going to work. Welcome to MedSider Radio, where you can learn from proven med tech and healthcare thought leaders through uncut and unedited interviews.

Now, here's your host, Scott Nelson. Hey, everyone, it's Scott. In this episode of MedSider, I sat down with Justin Broad, co-founder and CEO of Oso VR. An orthopedic surgeon with a passion for technology and history of working in the video game industry, Justin developed a virtual reality platform that can reform the way surgeons are trained and assessed.

Here are few of the key learnings that we discussed in this conversation. First, keep your eye on the prize. There are a lot of great ideas out there and it can be tough to cut through the noise. Set clear goals for your product and your company and make sure to follow through. Second, find new ways to spotlight your product and get it into people's hands. Go where your potential customers are and let them try the product for themselves. Medical conferences are a great place to interact with health care professionals, but certainly not the only option.

Third, make your product fun, accessible, and easy to use. Healthcare professionals can be hesitant to try new technology. Developers and engineers need to show their products are not only safe, but also they provide benefits over legacy technology. Okay, so before we jump into the discussion, I wanted to let you know that we just released the first volume of Medsider mentors, a print-based book that summarizes the key learnings from my favorite Medsider interviews over the past six months.

Look, I fully realize it's tough to listen or read every Medsider interview that comes out. Even the best ones. But there are so many valuable lessons you can glean from the founders and CEOs that join our program. So that's why we decided to create Medsider mentors. It's a way for you to learn from the best thought leaders in our space in one central place. Here's a teaser of what you'll see in this first volume. Gar Hong Kong, founder of HealthQuest Capital, teaches you how to successfully pitch your startup. Patricia Ziliak, CEO of Ivinsens, discusses what you really need to know about clinical trials.

Jared Bauer, CEO of Ionic Sciences, shares best practices for avoiding obstacles in your startup journey. That only scratches the surface, so if you're interested in learning more, head over to medsider radio.com forward slash mentors. If you're a premium medsider member, you'll get free digital access and a print version sent straight to your door. If you're not a premium member yet, you should definitely consider signing up. In addition to every volume of Medsider mentors, you'll get full access to the entire

library of interviews dating back to 2010. This includes conversations with experts like Erica Rogers, CEO of Silk Road Medical, Dr. David Albert, founder of LiveCore, and so many others. Learn more by visiting MedsiderRadio.com forward slash mentors. Again, that's MedsiderRadio.com forward slash mentors. All right, without further ado, let's get to the interview. All right, Dr. Justin Barad, welcome to Medsider Radio. Appreciate you coming on.

Thank you so much for having me. Yeah, and for the purposes of our discussion, we'll just, we'll go with Justin, if that's, that's cool with you. Beyond cool. Sounds good. Well, let's let's start with, I always like to start these conversations off by kind of level setting the audience with the listeners, I should say, probably is the better way to describe the group that's listening to our conversation is, is what you were doing kind of leading up to starting also VR. And so can you, without getting too far on the weeds and kind of going through each and every move per se, we don't want to have that type of a conversation where this is like a job interview, but give us a, give us a kind of a high level overview of what

what you were doing before starting the company. Okay, I'll give you sort of like the, not the full bird's eye, but the medium-sized view here, sort of a small forest. I started my career wanting to be a video game developer, so very passionate about video games from a young age. I have a game credit with Activision. And then kind of got introduced to healthcare through a family member who is quite ill and doing okay now, but it was a bit of a wake-up call.

And I wondered, maybe there's a way to use software and technology, which I was so passionate about not for entertainment, but to help people. So I ended up studying biomedical engineering at Cal Gober's with this real strong desire to invent healthcare technology. But I had no idea how to get started with invention. So I was kind of asking around, going through honestly a bit of a crisis. And I was talking to one of my mentors and he told me something that really sticks to me to this day. And, you know, this would be advice for anyone listening as well, which I think is just really sage advice. If you want to invent something, thing. You need to understand the problem you're trying to solve first. And he thought a great way to

understand medical problems was to be a doctor. So I took his advice probably way too literally, and I went to med school at UCLA, and then I stayed there to do my orthopedic surgery training. And it's really there that I experienced what I think is one of the biggest problems in health care today, which is how we train and assess our healthcare professionals and procedures in surgery. And I'd be in multiple surgeries where, you know, honestly, people would ask me to kind of run to the computer and Google what to do, find a video, a technique guide. And it felt kind of off to me, but, you know, there are a variety of factors we can talk about of, you know, why this is becoming more and more of a challenge and an issue. And around this time, I got introduced to virtual reality very early in its renaissance with the Oculus DK1 because my gaming background is just still interested. And I put on this headset and I'm like, wow.

what an incredible solution to this problem. And I can do something about it. I can program, right? So, you know, built the first version myself, met my co-founder on the internet. I had some money saved from my bar mitzvah that I used to pay him and develop a prototype. And then we won an award.

We were able to incorporate, got some investor interest, and ultimately ended up dropping out of a program at Stanford to go full time in October 2016 and started OSOVR. Got it. That's a great, that's a great, classic kind of classic startup story.

That's super helpful. So when you, when you were kind of thinking about this problem, right? You were, so you were, was this during your residency? I'm just trying to like get an idea of like the time frame. Was this in residency? Yeah, I mean,

pretty much constant. Even now as I still practice, the pediatric orthopedic traumatologist, you know, hasn't completely been solved. But yeah, I mean, when it really during residency is when I first started seeing some signs of,

of this dynamic. Okay, got it. And so when you were, when you were thinking about, you know, this kind of, Not kind of. It is a massive problem, right? A huge challenge. There needs to be better solutions, right? Like what you're working on at Oso. Why did you decide to go down, you know, VR? Like how did this kind of come about this, this idea for this platform technology? Well, I think, you know, once again, it, you really need to be problem centric here. So like, you know, what was the problem in terms of like from a training challenge and then, you know, why weren't current solutions really working? So.

The problem, as I saw it, was really threefold. The first part of the problem is there's just too much to learn. So if you think about it, accelerating science and technology is constantly expanding the library of procedures. We as healthcare professionals need to know how to do on demand. I always tell a story, you know, one day I was minding my own business when we're called urgently to the zoo to operate on a gorilla, which hopefully, you know, we're clearly unprepared for. We double check with them and it's like, you know we're human doctors, right? They're like, yeah, just come over. So a lot of Googling on the way there.

And Jabari did fine. The reason why I tell that story is like more and more, we're dealing with guerrilla-like situations every day. Procedures maybe we've never done before only do very rarely. It's like we've gone from French laundry to cheesecake factory, right? We're spread very thin. You can't do everything well. The second part of the problem is modern surgery is amazing, but also amazingly complicated.

So just newer procedures are harder to learn than more traditional ones. Robotics, minimally invasive techniques, navigation, other enabling technology. The learning curves are generally around 50 to 100 cases, whereas a traditional surgery might be 10 to 20 to give you a sense of the order of magnitude. And then finally, we really lack a way to assess technical proficiency in health care. It's not that we don't want to know. We just don't really have a way to. So there's a little bit of progress in this area, but in my own career, the only time I've really been formally, objectively assessed in a repeatable way, and this is a true story, I was asked to play the board game operation and

remove some pieces without buzzing, which I did. But that's kind of like to do. But that's kind of like state of the art right now. So, you know, that's a big part of the challenge. And like you said, this is a huge problem. In 2017, pre-pandemic, there was a study that showed that 31% of graduating residents could not operate without some kind of supervision or assistance, which is a pretty big number, and I'm sure it's bigger now. And we were projected, once again, pre-pandemic, to be 130,000 healthcare professionals or physicians short. And now, you know, I believe that's much worse because of attrition and all sorts of challenges related. to the pandemic. So that's the problem. Why is VR the best solution? Well, simulation is not new,

right? And you're involved with the little bit yourself. We were just talking earlier. The idea of, like, it would be great if we didn't practice on people, right? But that's just kind of the way it works right now. We do have some alternatives. There are some simulation technologies that we can utilize, but what are the drawbacks? They're typically designed for a single procedure or a single type of procedure. So whereas we need to know how to do hundreds, traditional simulators can only simulate maybe a couple. So that's a challenge. They're very expensive. So, you know, they could be like $200,000, and they're very large. They're not portable because it's like custom technology. So that was a big issue. And also the business model behind the simulators were also a challenge that

it couldn't drive this kind of flywheel of a perpetual motion machine of a business model as well, in that they were selling to hospitals and not really providing material value in the sense of improved revenue or decrease costs or improve patient outcomes as well. So that was a major challenge there. And there's also sort of this stakeholder issue of, you know, for example, I'd be finishing up a 30-hour shift. And, you know, maybe I haven't had a weekend off in a few weeks. And they'd be like, hey, by the way, just now that you're done, once you go to the simulation lab that's, you know, kind of like six miles away, and go practice. And I'm like, are you kidding me?

Like, I want to see my family. And not only that, I might die while I'm driving over there. I haven't slept in a very long time. So it's just, it's not very practical. And I've gone to some of these simulation labs, which are incredible. They are wonders of technology and simulation and assessment. But the reality, the situation is sort of different than the intent. And I ask these simulations centers, some of which simulate like space surgery.

I mean, I can't tell you how awesome these places are. And I'm like, how often are people coming here? And they're like, the best case, once a year. And how much value is that delivering? As cool as these things are, right? That's not how we learn. We need to be practicing, ideally, every day. I play piano.

I practice piano every single day. Not once a year. That's not really going to get me very far. And then we also have the option to practice on cadavers, which is an incredible privilege. Right? people have donated their bodies for us to practice surgery on them. It's like I think we often get out of touch with like what's going on here because we do it so

frequently, but that's incredible. But the problem is we're not getting out of it what we really could because, for example, if you're trying to learn a new procedure and you're going, you know, you have 100 cases that you need to get under your belt, the yield of practicing on case one is going to be much lower than your yield of practicing on case like 80 or 90, right? the retention is going to be lower. So it's those, those, those, like, people that have donated themselves, you want to maximize that value.

And just doing one rep, one time, your first time ever, I don't think that's, like, as respectful as we could be for that kind of sacrifice. So, and then finally, there's the more and more, the procedures that we do are tied to complex medical technologies. It's a lot of where the increased complexity is coming from, I was talking about earlier. And that as like you, I'm a huge technology enthusiast. Like I'm a crazy nerd.

And you were mentioning earlier like, yeah, I wrote about medical technology for Med Gadgetter for like a decade. Like I'm obsessed with this stuff. And when I looked around, I was a little disappointed to find that it was not being adopted at the rate that I thought that it should. This technology holds incredible promise. It provides more consistent outcomes, in some cases, improved outcomes and make surgery be more repeatable and safer and better for everyone and more fun a lot of the times to do.

But it's too hard to learn. And also if we don't know how to use it, we're not going to use it, right? And so these companies like J&J, Smith, the Nephew, Stryker, Zimmer, at least in the orthopedic space and beyond, they spend a lot of time and money trying to train us up on their procedures. And like, this is an incredible opportunity for us. Like, I don't think we as health care professionals realize how much is being invested in our education with really nothing expected on the other side. But once again, we're practicing one to two times on a cadaver typically. And then months later, like maybe four to six months, we're using this technology on a patient. And it is, it's a crazy situation. And so imagine, you know, you're operating on a patient with a

device used one time six months ago, the learning curve of 100 cases. How's that going to go? probably not super great. And it's so common in the industry, there's an expression called one and done. You try these new technologies. You're like, whoa, this feels unsafe. I'm going to just stick to the older technology, which feels safer for patients because do no harm, right?

So seeing all of this and then looking at VR, it is low cost. You can theoretically get it to every single healthcare professional in the world. These headsets are $300. You can use your hands, in a really high fidelity, haptic enhanced way with cutaneous haptic feedback. You can be fully immersed in the operating room in any procedure and simulate really sort of high fidelity visuals and interactivity and basically train on any procedure you want

and carry it with you. It's lighter and cheaper than a lot of our textbooks. And so to me, this was the key. It's making it accessible, especially from an affordability standpoint and portable, so that I can take it with me. I can practice in between cases. Sometimes between surgeries, like I'm waiting for them to put a central line in,

I'm just sitting there for like an hour, an hour and a half, not doing anything. That is a great time I can be practicing, or I can do it at home. I could see my family and then practice and not have to go to a separate cadaver lab and not require someone to sort of make a tremendous sacrifice just to get those early reps in.

And to be clear, we are not replacing this sort of sacred hands-on training component of our learning journeys. We're making them much more effective and more data-driven. And in some cases, we do replace them for the right procedure and the right trainee.

But by and large, we're making those things actually work for us instead of not really getting as much out of it as we could. But there really was no other technology, at least that I'm currently aware of, that can lead to this sort of like level of,

I would say, exponential increase in skill transfer. And early on, I had this gut feeling and this belief intuitively from understanding the problem so well, understanding technology that this would work. But when we started collecting data, that's when I'm like, wow, it really did. And that was scary, by the way,

because we're doing these studies. And I see people like running through it. I'm like, oh, what if this doesn't work? I've put a lot on the line here. But, you know, the research shows that we could go into this later. This improves performance 230 to 300 percent in peer-reviewed published data. We have like, I think, five or six peer-reviewed studies now published in top journals. And we're getting some early case data back from the operating room, too, that it's like the potential impact on healthcare delivery is jaw dropping.

And I still don't think people really realize the potential impact of a technology like this that is just so rarely seen in healthcare. And that's what makes us all. Everyone always asks us, like, what are you guys so excited about all the time? And it's really that knowledge that, like, you know, we are just providing massive change and a positive change in healthcare at a time where we really need some good news. And you mentioned, you know, one of the, one of the major sort of value ads with VR is that haptic, that tactile feedback. And I, you know, we were chatting about my experience with touch surgery, you know, back in that 2015, 2016 timeframe, which was one of the first sort of digital simulation companies. And that was one of the missing components, right? That was a constant, you know, it didn't provide the ideal learning experience because it sort of, it sort of missed that, right? And touch surgery, you know, was eventually acquired. by Medtronic, but when you were, it sounds like when you were first starting out with Oso, that was like, that was pretty game-changing, right, that you could build on top of this, you know, utilizing, utilizing VR to create a much, much better sort of training experience

for, for physicians and healthcare providers. Yeah, I think some of the key differences, like, you know, the sense of presence and the full immersion is a big part of it. The cutaneous haptics are great. You know, there is a lot of research that's showing that, you know, whether or not you have haptic feedback, the impact on skill transfer is actually pretty minimal. It's not like clinically significant. So we care a lot more about haptics than the data shows that it actually impacts our learning or experience. And, you know, I give one to two hour lectures on this all

the time. We can dive into that if you like. But that's really fascinating, a fascinating area. But I think one of the key differences in addition to the immersion and kind of the one-to-one movement, you know, you feel like you're like, okay, did this in VR, I'm just going to do it again in real life. and not a lot of people talk about this is the engagement. The fact that you couldn't really jump into touch surgery with another expert surgeon and have them show you what to do and give you clinical tip, tricks, and pearls. But you can do that in VR. And you can do it from anywhere.

Like, I've done it from my car. And so you can jump in with someone in virtual reality and suddenly you're there in the same room together. You're having a conversation. You're saying to be like, oh, lower your hand a little bit this way. It's like, oh, actually look at it from this angle. It's like just like you would in the operating room. It's just like that level of peer-to-peer mentoring is like almost very hard to do through any other medium, even video streaming. You know, there's a lot of exciting like video proctoring technologies and telemetering platforms, but it requires a lot of setup and pieces to be in place in order to do that.

But here you can do it anytime anywhere, which is like these $300 headsets from anywhere in the world. And that's pretty wild. And I think one of the dynamics I didn't really touch on when we were talking about the problem is that surgery used to be. be this kind of like, you were like Batman, and you would sort of like break in from the ceiling and do like a superhero landing. It's like, everyone relax, I'm here. And you just do the surgery yourself and then you leave and go get coffee while the resident like kind of like sew the patient up, you know? And that's just not the way it works. Surgery is very much a team sport and you're part of the team. But our infrastructure is still very much around just like, hey, if we train the

surgeon, everything's going to be okay. And that's like not really playing out. And you're seeing a lot of challenges from like team members getting left behind in sort of the training experience and the learning journey. For example, when I was in training, anterior hip replacement is like, you know, at this point beyond the point of hot, it's like pretty mainstream, right? It's like theoretically more minimally informed, invasive form of hip replacement because requires a lot more coordination amongst the team than a traditional hip replacement because you need someone that's not sterile to kind of move this bed around. Typically, if you're using like a Hana table type approach. And at UCLA, there was really only one circulator nurse that knew how to do that.

And if that nurse was out sick or someone else was subbing in for them, we would just straight up cancel the case. So, right? So it's like, it doesn't matter how well trained the surgeon is in this case. And with robotics and navigation, like, you know, even more so of an issue. But so, okay, like, why don't we train the team then? Well, how many people are we working with? So at UCLA, they actually looked at this.

This was really interesting. So they followed a single spine surgeon around for about a month. On average, that surgeon was with eight people in the operating room at any given time. And over the course of a month, worked with 25 different surgical texts and 51 different anesthesiologists. So it's not feasible to fly all of those people out constantly to cadaver labs or hands-on training labs or even do inservicing. So how can we possibly, like there's just a constant sort of wheel of people coming in and out, revolving door, And I call it the team variability challenge. It's just a reality we deal with in healthcare.

We work with a lot of different people. So we need a way to train them just in time. And that's another area where this technology is incredibly effective. Because once again, $300 headset, you can just train people in a few minutes. Typically, like, for the team, it's often like a little easier and quicker to learn than what the surgeon needs to know. But it makes all the difference in the world, right? Don't have to cancel the case. You can utilize the robot.

you can utilize the navigation system and not have it sit in the corner and collect dust. So I think there are a lot of reasons why VR works, but it's also how you use it as well that can make it effective. And I think one of the biggest challenges of working with virtual reality is that it could do anything. That's actually kind of challenging, right? Because, you know, people have a lot of ideas of how it should work or what it can do. and there's so many opportunities, but focus is critical when you're developing a new technology and the new business. And so to sort of come in with a point of view and be like, hey, like, we're going to get it

to work this way and we're going to get, you know, the entire world of healthcare professionals and different professions to sort of get on board. And we can expand from there and build on top of it. But like, we need to have focus so we can scale and not just have be all over the place. And that is a huge challenge with a technology like this that feels like it. do anything. That that this particular question kind of wasn't on our on the list so to speak that that I sent over but let's talk a little bit about that because that's a problem that's a common challenge that that most entrepreneurs have especially those that are operating in kind of life

science and in the healthcare arena is is focused right um especially if they're working on an exciting idea that's you know sort of limit limitless so how what what's your general approach to staying focused and and how do you how do you do that at also with a growing a growing team Well, a lot of coffee. That's a big part of it for me. I think, you know, for the listeners out there, this is where my mentor's advice, I think, really I feel has been critical. Like, this is the only company I've worked at that I've started. So this is my first time as entrepreneur.

So please keep in mind that, you know, this is just like one point of view. But, you know, starting this, especially in the early days, one of the biggest challenges is that, you know, you're working. with customers and who are often people who are early adopters are going to be very innovative, meaning they have a lot of different ideas and often sort of strong opinions of how something should work. And then in the medical space, you're going to work with a lot of like clinicians and healthcare professionals, surgeon advisors, who also have strong opinions of how something can work. And I think back on those days, and I'm like, if I didn't have a solid foundation in surgery and deeply understand the problem, I would have been pulled in.

in a hundred different directions. Because how would I be able to determine who I should listen to, if any at all? I would have no sort of basis to go off of. So I'm like, oh, well, I better do that because this is like one of the smartest surgeons in the world. And then suddenly this person telling me something that's pretty different. I'm like, well, I better do that too. And so to me, that sounds incredibly difficult to sort of navigate without coming in

with some kind of domain expertise or point of view. And so, you know, maybe you don't have it yourself, but, you know, you really should have a partner that is kind of be like, okay, this is going to be like the key person that's kind of like going to help us decide how to navigate these waters. Because it's not just about understanding the clinical challenge. You also need to understand how to build a successful product and how to scale a technology and how to build a scalable business model. Right. And these things are, it's a Venn diagram and that the overlap of all those things is like infinitesimally small and you have to find that sweet spot. That's product market fit.

It's a big part of it. And, you know, when people's lives are on the line and health care and you're coming in without a lot of knowledge, I think that could be really scary and overwhelming and you're going to want to, like, listen to everybody. And that could just lead to this spaghetti against the wall approach that will, you know, I've been amazed. Like anyone could sort of make something work, but to kind of like really scale it and get over 100 people and start to see that kind of flywheel start to take place, it's really, really hard

for anybody. And so it's that that kind of core nugget of knowledge and domain expertise is really important. And I would pair with that the passion. Like I think it's not just enough to understand the problem, but like you have to really care about it and be excited about it. Because once again, like I think starting a company in any space is unbelievably challenging. Like everything you read is true. It's a roller coaster requires a lot of grit, daily micro failure, macro failure. There's a lot of upside too, which is like why people do it because it's like, it gets really exciting. But there's, it's really challenging. And I think in healthcare exponentially more so, innovating in healthcare is freaking hard. But boy, is it worth it, right? Like, I mean, it's very hard

to have an impact like this any other way. But if you don't wake up every day and just like, you, you, like, thrilled to be tackling a problem that you care deeply about. And I think caring about the problem is more important than really caring about the technology. But, I mean, ideally, you care about both. Then it may, at some point, you may just be like, hey, like, I don't know if I want to keep doing this. Or you may get burnt out or become detached. So I think that's incredibly important, too. And I had to get some early learnings from that.

Like, I had a lot of ideas. You know, I'm like, innovative guy. And some of those early ideas, I realized, like, if I had gone forward with them, I don't know if I would have carried it very far. Because, like, you know, one of my ideas was, like, a temporary tattoo for, like, incision alignment. 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.

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