Improving outcomes through video documentation
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: Welcome back once again to the outcomes rocket podcast where we chat with today’s most successful and inspiring health leaders. I thank you for tuning in and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today’s guest because he is an amazing collaborator in health care and a good friend. His name is Matt Schwartz. He’s the CEO and co-founder at Virgo. They’re doing some pretty cool things over there. They’re a med tech company startup that is developing a hands free cloud based video recording system for colonoscopy. Now Matt has an amazing history in product management in healthcare that includes time at Intuitive Surgical as well as NuVasive which is where he and I first met. And so now he’s doing his own thing and I just want to give Matt a warm welcome and Matt please fill in the gaps of that intro.
: Now that sounds great. Thanks so much, Saul it’s really a pleasure to chat with you had been a couple of years I think since we’re together NuVasive in it. It’s good to be on the phone with you now. We appreciate you having me on.
: Absolutely brother. So tell me Matt. We’ve had a chance to connect. But why did you decide to get into health care to begin with?
: Yes sure thing. So my dad is actually a doctor. So for as long as I can remember Medicine has just been a part of my life. I remember when I was a little kid he’d be preparing for a big surgery and we’d be in the living room he’d be watching surgical footage on the big screen. So it’s like it’s just part of my life ever since growing up I was always pretty interested in technology and just solving big problems. So the summer after my freshman year I got an internship out with NuVasive in the marketing department. And I think you know maybe my first meeting sitting in on a product building meeting and I just I fell in love instantly with medical technology and saw it as a great opportunity to solve really big problems that would have a big impact on the world and help improve people’s lives. So I really excited by that. I went back to school and changed my major biomedical engineering and the rest is really history.
: That’s awesome man. That’s awesome. And you know wow while we were there listeners, Matt was always come out with out of the box ideas to help modify certain surgical instruments or implants and it’s really no surprise to me that he ended up starting his own firm. And so right now, Matt what would you say a hot topic that needs to be on every medical leaders agenda and how are you guys addressing that?
: Yeah sure thing. So I know from our perspective there are a lot of I don’t know if you called buzz words or hot topics in healthcare that people always harp on. Me and when my cofounders were just out at HIMMS a few weeks ago and interoperability and I were to really really hot topics that everyone’s talking about. I think from our perspective we like to I don’t really feel a little bit contrarian or thinking about things from first principles so we are big fans of interoperability and AI but we try to approach it from a different angle and the thing we really like to think about is better data capture and maybe alternative styles of data capture. So it’s no secret that there’s a ton of data in the healthcare world you know a lot of it is residing in the medical records system impact systems radiological images. But we actually believe that if you if you think back to how EHR got started, how pact system got started. There’s a lot of great information about what is happening in healthcare but not necessarily. Why that stuff is happening. EHRs are kind of a thing you can say design to be building of system of records for billing. Not so much for the actual clinical experience not truly documenting what the doctors do. And so you know now it comes time where people are seeing all these great advances in AI and what can be done with massive amounts of data. So they’re trying to apply that healthcare and we don’t really think it’s any surprise that there haven’t been massive strides made in applying AI in a clinical setting and we think there’s a real reason for that is just because it comes back the data the actual data is being captured isn’t truly representative of the sort of information that doctors are using to make clinical decisions. And that’s a big part of what we’re thinking about it Virgo is how we capture different data sources that are currently going on that maybe reside outside the medical record. And how do we do that in a way that will over the longer term lead to really productive clinical applications of AI.
: That’s pretty interesting and tell us a little bit more about why colonoscopy versus any other thing that you could do?
: Yeah. So when I first had this idea for doing better video capture in healthcare in my time in NuVasive while I was with Intuitive Surgical I’d go out to surgeries around the country and you may remember from our times Nuvasive, I would often try and try to capture the video and it into like a marketing piece or sales tool
: Yes
: And found that whenever we can do it it was really impactful but it was super hard to actually capture that video footage. So when I ended up leaving intuitive, my first thought was of great I’ll call it all the doctors they used to work with, orthopedists, neurosurgeon, laparoscopic surgeons, robotic surgeons. And it turned out that getting them excited about video capture or as excited as I was at the time was like pulling teeth. Some of them like it but it was the resounding enthusiasm that I was really hoping for and sort of a little bit on a hunch. I called up one of my elementary school friends dad who is a gastroenterologist and that was the first time ever a doctor really really excited about doing this video capture and in hindsight it makes a lot of sense you gastroenterology is largely a video driven specialty when doctors are doing colonoscopies or upper endoscopy they’re looking at the video screen during the entire procedure and they nerd out on things like 40 video sensors and the latest and greatest in TV monitors. So it’s no surprise to us now that they were had this untapped need an untapped demand for video captures just hasn’t been accessible to them today. And at the same time it is an incredibly high volume specialty. So it turned out to be a pretty natural fit for what we’re working on.
: That’s pretty cool. That’s pretty cool man. So today can you give us an example of how your system or you know the things that you guys are doing at Virgo are improving outcomes?
: Yes. So you know we’re still very much a startup. So we’re we’re trying to prove how our system can improve outcomes over time but it’s definitely something that we’re trying to build into the very nature of Virgo as a company and what we’re Virgo’s all about. And so one of the things we think a lot about is that documentation today for GI endoscopy we think it’s just some are. So if you take a call an IP or an upper endoscopy it could be 20 minutes long to two hours long. And it is this video is a section of video. But at the end of the day what gets captured in the medical record is distilled down to a few blurry still images and text notes. And we just think that there’s got to be a better way that that seems crazy to us. Fundamentally we believe that doing better documentation will lead to better outcomes. And there’s actually some pretty interesting research out of the University of Oklahoma where they instituted a policy of systematic video capture for their endoscopy. And what they found is in doing so just by setting up this policy they told him we’re going to start recording. They took some of the and off that were low performers before the video recording and just sort of miraculously by doing this video capture afterward it really improved the performance and increase the frequency with which they detected precancerous polyps or added nos. And that’s really interesting to us the authors sort of hypothesize that it’s just the observer effect or the Hawthorne effect where if you give a little bit of oversight you’re going to in some way influence the performance hopefully for the better. And we think that that can be applied at a much broader scale and that’s really just a starting point you know step one is to have a little bit of oversight and do a better job documenting what’s going on. Step two is actually taking a close look at that documentation and trying to understand where there are areas for improvement. How can we use video or better research, better training, all sorts of different quality improvement initiatives and then really our long term goal in doing this is to create an unbelievable repository of Clonoscopy videos and other G.I. endoscopy videos that are incredibly high quality as well as well labeled and well-structured. And from that we think we can use various computer vision and AI principles to drive the new insights and create new technologies along the lines of automated pilot detection and classification, things that will really move the needle forward and healthier.
: That’s pretty cool man and very exciting and it’s fascinating how many companies are signed up fly machine learning or deep learning algorithms to technologies like yours to get insights.
: Yeah absolutely.
: Hey Matt tell me something. It’s not always been rainbows and sunshine for you. Maybe you could take us to a moment where you had a mistake or failure and what you learned from that.
: Yes. So I’ve learned in the startup world that basically every day is just a series of mistake and trying to pick yourself up off the floor. That’s really fine. Actually I think a good example is thinking back to when I was really knocking on doors of the physicians that I’ve worked with in the past. When I first quit my job at intuitive, I was working from the home office which was the desk next to my bed and it was pretty trying time. You know I was just calling everyone I could possibly get a hold of in my network and it was actually on a holiday. And so people are starting to go dork on me and I was getting pretty worried that if this wasn’t really going to go anywhere it wasn’t and it got to that was I think a bit of a failing and a mistake. I spent a lot of time just trying to go down the same pathway of talk to doctors and try to sell them on the idea as opposed to find an area where maybe the idea had more merit. And like I said it got pretty lucky. Just sort of coincidentally stumbling into gastroenterology and really finding a lot of room to run there and things really took off after that we went to a really popular G.I. conference and just got linked up with some of the movers and shakers in the world and things took off from there.
: That’s pretty awesome man. And it’s.
: Come a long way there.
: Yeah that’s so great man. I’m glad things are working out for you guys and it’s exciting and gut wrenching too when you’re in a position you you know you took the leap and you just didn’t know how is going to work out. But you stuck in there long enough and that’s what you have to do to be able to see the light and the other side of the tunnel.
: Yeah no doubt they had a great support system around me. My now fiance was great.
: Congratulations.
: She’s super supportive my parents as well and my friends and the guys that eventually became my co-founders do the really important part of making things up.
: That’s awesome, Matt. Hey tell us about it within Virgo a project that you’re working on that you’re excited about.
: Yeah. So something we are super excited about is incorporating voice control and voice capturer into the video product itself. So we initially identified the major need in GI endoscopy where there’s all this video and people that have a good way to capture it if they want to do it today and they need like these archaic DVD recording systems huge pain and along the way we have learned from the doctors we’re working with that there’s other challenges that they face and areas where some new technology and kind of the innovation can really improve their workflow. So today in order for doctors to use our system they basically have the also connected to an internet browser whether it’s on a desktop or a mobile phone and it requires a little bit of clicking until the system does start and stop that they’re doing a new procedure and something we’re developing right now working on it. The ability for doctors to control the video recordings just with the sound of their voice so they can basically say let’s Virgo get a new procedure going. They set up the new procedure with boys then they can say Virgo’s start to start a clip, Virgo’s stop, stop a clip. And I think the thing that we’re all most excited about is that they can and they Burgo take my note when they say Virgo take my note they can actually dictate in real time what it is that they’re seeing and doing in the procedure. And the reason that’s so impactful is when doctors are now in the middle of a procedure they’ve got gloves on their hands are full they can’t be bothered to you know turn around and operate a computer at the same time. And that’s where boys become so powerful they can just say exactly what it is that they’re seeing or doing. And in today’s workflow when GIs finish up the call on the say they take the gloves off and the first thing they go do is sit down at the computer and review all those still images and type up the notes from memory and the fact that they’re doing it from memory. Yeah I think it’s important. They’re doing it from memory because while doctors are amazing and people have great memories we all know memory is not perfect and it’s pretty challenging to try to remember every little thing that happened during the course of the procedure where certain parts were located pretty taxing and time consuming. And so we think with voice control, there’s a huge opportunity to automate that part of the doctor’s workflow so that when they take their gloves off the procedure note is just ready to go for them to review and submit to the medical record. So we think that’s going to be just incredible technology the doctors will work with are super excited about it.
: Well definitely game changing, Matt. I mean so many hours are spent in front of the computer and you know as physicians you don’t want to do that. You want to take careof patients.
: Totally.
: So I think it’s so cool that that this capability you guys are building in this capability and super exciting for physicians to be able to be more more efficient with their time.
: Yeah absolutely yeah. More efficient with their time than the other piece. It’s not just the efficiency but we think actually the accuracy of the notes will improve. I remember when I was a little kid my dad would have to dictate cases and it was so time consuming that oftentimes he would like save up a week’s worth of papers and then do it on the couch over the weekend. Yeah and I’m sure he did a great job. But it’s hard to remember all the nuance details what goes on in the clinical encounter and we think it’s just a better approach to try to capture that data and actually happening and really make sure that that is much beneficial data as captured as possible.
: Yeah. And you know to your point this is application that could go beyond the colonoscopy.
: You absolutely. Absolutely we’re starting with one of the GI. We think there’s other areas in healthcare that could really benefit from this essentially anywhere that there’s video data being generated or potentially audio data being generated in healthcare that’s not being captured today. The underlying technology is really applicable it’s just a matter of figuring out the right way to bring the technology to market. So some of the other areas we’re thinking about OBgyn it’s really popular one where not just on the surgical side with laparoscopic hysterectomy and other procedures but also prenatal sonograms or ultrasound right now is another thing kind of stuck in the target is a little bit where as patients you go in for the ultrasound you leave with like a little polaroid prints out of the picture. I talked to a lot of friends that are kind of going through the pregnancy process now and I’ve asked them video something you’d be interested in and just about unanimously they say yes they would love to have a video of the ultrasound that they could. Yeah exactly a clip they can share on Facebook on YouTube whatever they might want to do that. And then also from the clinical side the fact that that video is not being captured right now we think is just a disservice to the overall public health.
: Man that is so cool and exciting so that for sharing that and listeners, this is pretty awesome stuff. You know if you are thinking about how you can do innovative things in your facility if your provider definitely at the end of the podcast will have match share his information so that you guys could reach out. Matt, let’s pretend we’re building a medical leadership course on what it takes to be successful in medicine today. The 101 of Matt Schwartz. So we’re going to write out a syllabus and I’ve got four questions for you lining around style followed by a book and a podcast that you recommend to the listeners. You ready?
: Very cool.
: All right. What’s the best way to improve health care outcomes?
: So I think I’d be lying if I said I knew the answer to that. I’m still a fairly young guy. You know we’ve been in the industry for maybe 10 years but something that several of my mentors have preached to me and that has really resonated is the importance of clinical competency and what I mean by that is that real clinical understanding if you put in the time and work is accessible to really anyone it’s not just physicians that can understand the clinical landscape but it does take a lot of work. And I think it’s important to approach it really scientifically. So that means doing things like reading scientific journals and medical journals and not just cherry picking articles that you like or the pieces that you like but really understanding the strengths and weaknesses of different studies. It also means going to medical conferences and engaging with physicians and healthcare administrators and listening to them have engaging conversations and debate. The other big piece is to actually spend time in various health care setting. This is something you know when I was like just an intern at NuVasive they would throw me into cadaver labs with physicians and just just to be an observer and try to gather that information was really critical and then beyond that you know going into operating rooms observing surgery is always incredibly enlightening. Also you know just hanging around hospitals being in the waiting room going down to the serial processing department meeting as many folks in health care as possible and even shadowing doctors during clinic that’s something I did a few times in my career. And every time I did it I just came away with these little pearls of wisdom that wouldn’t have happened otherwise. And I think in order to contribute to improving health care it’s important to have that well-rounded background of the healthcare space.
: For sure. What’s the biggest mistake or pitfall to avoid?
: Yes so I think actually sort of tied in to the last question where if you’re going to go around and solicit all this feedback and with that opinion you will hear a lot of different things and especially in the healthcare space to find that a lot of people have really strong opinions one way or the other. And with that it can be easy to fall into this trap of sort of like feedback whiplash where someone tells you something that sounds great and then the next day someone tells you something completely different and it can be easy to lose focus through that and keep chasing just the most recent bit of feedback. And what I think is important is to try to always take a step back and be the synthesizer of that information you can’t always follow every one little anecdote but you can try to take them in aggregate and kind of parse out some overriding insights that are useful.
: A great takeaway. How do you stay relevant as an organization despite constant change?
: So I think this comes down to just constantly remaining curious. Curiosity is another thing that you know my mentors try to instill in me. And the best physicians that I’ve ever worked with industry have always been the ones that are the most curious because I think that it causes you to never settle or be complacent. And so it’s something that we’ve tried to instill in as an organization you know. We’re still pretty small there’s seven of us now on the team and I think we’re just inherently a pretty curious bunch but as we grow that curiosity is something I want to try to continue to foster. One of the things we’re going to be actually working on this quarter is rolling out a Colan class which is sort of modeled off of the spine exam that we have at NuVasive where everyone in the company was required to learn you know spinal anatomy spinal procedures. What technologies out there on the market what the surgical procedures are like. And I thought that was just incredible it created this common language and enabled everyone in the company regardless of what you’re doing to be curious about how things can be improved. And so we’re excited to get that started with Virgo and who is going to foster a lot of curiosity down the road.
: That’s awesome. Hey what’s one area of focus that should drive everything in a healthcare company?
: It may sound obvious but I think the answer has the patient outcomes. If at the end of the day everything always comes back to the patient. There’s a ton of stakeholders in healthcare. Obviously the mission the provider the payers got hospitals but at the end of the day everyone’s really reporting to the patient. And if you keep that in mind and keep that is true north I think will go a long way. That’s definitely the reason we started Virgo was to improve patient outcomes in our mission statement is to use video capture data capture and AI to ultimately improve outcomes when it comes to colorectal cancer and other G.I. disorders. So I think that that’s going to be number one.
: Love it Matt, that’s so awesome. And talk to us about a book and a podcast that you recommend to the listeners.
: All right. So my favorite book of all time is called The Elegant Universe by Brian Greene. And it’s a book about cosmology and general relativity and quantum mechanics and string theory, theoretical physics in general and it sounds like a pretty heavy topic but it was written to be just absolutely engaging and accessible to anyone. So I think I read I read the book when I was maybe 13 or 14 like eighth grade or freshman year of high school. So I couldn’t really follow along with much of the math but the examples are there just so well explained and accessible to the layperson and the part that I just love about the book is when you start to look at the world outside of our everyday scale, like things that are on our scale of speed and timing distance everything feels just intuitive at that level but when you step outside that scale things get really really counter-intuitive really quickly and that it blew my mind. And that thing is that I think it’s a great lesson to take for really everything even in the business world. You know when you’re solving small challenges or kind of normal scale challenges the answer might be intuitive. But when you try to step outside of that and do things that are really big in impact whole systems or whole population a lot of times the solution is going to be counter-intuitive. So it’s all the more important to be really rigorous and scientific in the way you approach solving it.
: It’s awesome. A good book and what podcast?
: Oh podcast so. Oh man there’s so many podcasts I love. I think the first podcast ever listened to was the Bill Simmons CBS report ESPN podcast. When I was in college. But I say right now my favorite podcast is called The Waking Up podcast by Sam Harris. He’s just the super intellectual guy I’ve been reading his books since I was young kid too. And just think he has a really really rational approach to just about everything he does need to be well thought out. Yes. Really interesting guests on the podcast covers a wide range of topics from religion and politics all the way to meditation and Buddhism. So I would highly recommend anyone check it out.
: That’s awesome. Sounds like a really good one Matt. Appreciate those recommendations and listeners. Don’t worry about jotting down. Just go to outcomesrocket.health/Virgo and you’re going to be able to find the show notes as well as a transcript of our conversation, links to the book links to the podcast as well as Mat’s company map. This has been a ton of fun. I’d love if you could just share a closing thought with the listeners and the best place where they can get ahold of you.
: Yeah absolutely. Well first of all just wanted to say thanks again for having me on. It’s been an absolute blast. Really enjoyed the conversation I guess as a closing thought. Just ask the listeners out there to stay curious and stay hungry. There is obviously an incredible amount of progress to be made in the healthier world and you never know where great ideas are going to come from. Oftentimes they’re just hiding in plain sight. So we encourage anyone that just interested in making a difference. Spend some time and reflect on care world and try to engage in deep thought and do what you can come up with. So it’s hard as the easiest way for folks to get in touch with me would love to hear from any of the listeners. There were currently looking for like minded folks that are excited about what we’re building at Virgo. So the easiest way to contact me my Twitter is @iAstrophoto. So a little bit of a strange handle on amateur astronomy enthusiast then a little bit of astrophotography though. Started my Twitter handle with a about taking photos of space through my telescope with an iPhone though @iAstrophoto on Twitter.
: I love it I love it. That’s awesome Matt listeners. There you have it. I’ve got the best place to contact Matt. Also stay curious what a great message from him today and Matt just want to say thank you again for spending time with us. Looking forward to staying in touch.
Awesome. Thanks so much Saul.
Thanks for tuning into the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don’t forget to check out the amazing Healthcare Thinkathon where we could get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is implementation is innovation. Just go to outcomesrocket.health/conference that’s outcomesrocket.health/conference be one of the 200 that will participate. Looking forward to seeing you there.
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