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With these outpatient clinics, the Augmented Patient and how patient's want to be more involved in their care pathway. There's been some recent strategic acquisitions to enable these large companies to gain traction in the data driven um environment. Also the possibility of developing new patient centric algorithms, the drive reimbursement pathways for for care for patient's and with the recent changes in the medical device regulation uh for us uh such as Smith and nephew, we've got to keep our products on the market. And the only way we can do that is to provide evidence to show safety and efficacy. And if you look at data as a product and you look at all these data centric technologies, it's very clear that we are sort of evolving into a solution and service provider and looking at different types of flexible payment options to hospitals, looking at ways to bundle payment with the implant as well as the value added services. And also looking for opportunities to connect some of these data centric products to the cloud in order to get billing for time spent using a wearable device. But the key message here is just, don't just think about the hardware. The future is providing value to customers with data. So if you look at the surgical ecosystem holistically, if we start with the primary care at the moment, when you present with new symptoms and you go and see A G P at the moment, um the technology is quite scarce. It's, it's reliant on the expertise of the G P himself to try and make a decision whether need to be made a referral to a secondary care pathway or not. Unfortunately, some of those referrals are high quality because of the available tools that are available to the GP. And you can see we're looking at the companies. Um None of the big hitters at the moment are actually trying to develop technology that is centric towards the GP or primary care. But when you get into the secondary care pathway, there are technology now that improve the preoperative planning. When you put an implant into a patient or a wearable device, there's ways that the patient and the surgeon can discuss the surgery in terms of planning the procedure. They can look at trying to refine the inventory requirements by knowing the anatomy of the patient ahead of surgery. Then you started going into the intra pretty phase. You're now seeing a planet, the technology around robotics to improve the reliability and the accuracy of the procedure. You got instrumented trials that help balance the the joint itself. You've got smart implants now that can essentially monitor the patient POSTOP for it to 20 years using a pacemaker battery. And then we've got a means of collecting data. So all these data centric tools have to go somewhere. And at the moment, all the big hitters have a cloud based platform to um securely connect patient centric data through hipper and G D P R compliance to enable the day to be sent to all different stakeholders, which includes the patient's of physiotherapists, the the surgeons and then after surgery, um we can use wearable centers and health apps to actually monitor the progression of healing of the patient. And in some instances, we're actually using intelligent implants to be able to know when the patient healing has occurred on whether they need to come in and whether it's a flag in terms of their recovery. So we're getting this much more holistic centric data, um center products, which is basically drive in healthcare towards more evidence based medicine, which is essentially the direction we're going from an industry perspective. So we start with the primary care pathway. So I said before, this is when the patient first present symptoms to a GP and at the moment, um it's not done in a data driven endeavor and unfortunately, that results in some poor quality referrals. And so as an industry, we have a ethical obligation to try and circumvent that. So what we're doing now is looking at new ways to try and uh fast track the care pathway from primary to secondary care. Because if you look at NHS England and you look at some of the statistics around musculoskeletal disorders. One in four adults in the UK have an M S K that represents about nine million patients'. And 30% of G P appointments are sent are centralized on M S K S given that there's 90 million G P appointments per year and each G P costs around about 39 lbs per for meeting that equates to run about 100 and 17 million associated with M S K referrals. But unfortunately, um as I said before, because of the technology that's available to this care pathway level, approximately 50% of the referrals, what we sought call low value. So that means there's up to 50 million lbs that NHS is wasting on referrals that probably will get bounced back to the G P for alternative therapy such as sort of home care or maybe a specialist service. But what we have to do is try and reduce the amount of burden that's being wasted on these low cost referrals. So the question is, how do we do that? Well, you know, the technology is around us today, we can start using wearable technologies and specifically trying to guide the patient to go through some specific exercises, would give some insights into the state of their disease or how, how much their disease is progress by developing some predictive algorithms. This type of technology is designed to work very well within the fabric of the GP clinic because it doesn't take much space. It's easy for the patient to use. Half the planet have access to a mobile phone in order to collect the data. So from a customer opportunity, we're able to stratify the patient's based on symptoms, we can support their um the management of their disease and much more effectively, we can also promote healthy behaviors if they're on the waiting list as well for surgery. But more importantly, we can fast track the right patient to the secondary care pathway and reduce the unnecessary M S K treatments and hopefully avoid some unnecessary x rays in the community. From a company perspective, we can have a positive influence on the primary care pathway because he saw in that, in that chart that I showed earlier, none of the big hitters are actually doing anything in this part of the continuum of care. We can also fast track patient's that just need a partial joint replacement where the disease is is constrained to one compartment. And we can also try and identify the appropriate day surgery patient's based on their risk factors. Again, trying to reduce the number of M S K treatments in the secondary care pathway. So in terms of how we connect the patient to this type of modality. So the first thing we would do is get the patient to attach the center to the to some parts of the body. Ideally, we want to connect it to the patient as close to the ground as possible because that's where the force is a more sensitive from a ground reaction perspective. So we've got these sort of like nine access I M U s which allow you to collect the acceleration, the angular velocity. And also we can measure step counts. So we can collect this data, we can determine some of the key gait parameters which will then inform the ai or the deep learning neural net in terms of how we filter or stratify patient's based on the their disease progression. This can all be done very sort of safely holistically in the cloud. Because of the limited amount of time that surgeons have with patient's, we need to find a way of filtering the data and using pop up messages to determine whether a patient needs to come in for some sort of urgent treatment or whether they can continue on their original trajectory of care. So now we thought about optimizing the primary care pathway. Now we're getting into the surgical review. So the patient now has been um uh referred onto a secondary care provider and they're now preparing their surgery. And so this is where some of these new technologies are coming into play. So, you know, from, from the company perspective, we believe this is the most important part of the surgery because it defines the expectations and the outcomes of the patient. Um It also helps execute the surgical plan and sets the tone for the operation, logistics in terms of diagnosis and treatment. And so the surgeon, the operating room staff can get together and work out exactly what equipments needed to treat the patient. The problem is, it's not fully immersive, it tends to be one way communication. Uh We're relying on antiquated information such as radiographs and and just paper exercise only because of the prohibitive cost of repeated cat scans and MRI s. And that can also have a physiological impact that psychological impact on the patient because obviously the patient does not have all the information in terms of preparing themselves for surgery. The good news is that we are looking at trying to develop tools which sort of overcomes these issues. So we're now creating an arsenal of data analytics, which has been supported by digital planning tools which helps sort of define the anatomy and how the anatomy should be uh template in terms of choosing the suitable implant sizes. So we don't have a planet of too many sizes that can overburden the inventory during surgery. We can also reduce surgery, surgery time. It's a 20% by virtue of reduce the number of implant and instrument requirements, which has a significant effect on sterilization costs. We end up having more predictable procedures. We have a much better idea of how we're going to um tactically treat the patient. But more importantly, by having these more sort of extended reality based tools, we can define new types of procedure and approaches to treating their disease. So now we've prepared their surgery, we're now getting them ready for the actual day of surgery. So we need to think about how we're going to improve the consistency and reliability of the surgical technique. And we need to prepare the patient for long term monitoring, which can be done either with a smart implants or with a wearable device. There are a number of different surgical robotics on the market. Now. Um The most common one that's been used today is the striker system. So effectively, there's something like 4000 robots that are being deployed globally for orthopedic application. And if they think there's about five million joint replacements done globally and approximately 10% of their patient's are treated with the robot. So that leaves 90% of patient's in the underserved communities that don't get access. This type of advanced technology. The first robotic procedure was done in the UK in the late nineties with the acrobat with a partial knee replacement. And since then, it sort of evolved into mainly a robotic arm approach. Um and the common commonality between all these different robotic systems that they have an external V D you. So the so the surgeon basically will navigate the procedure with a touch screen with some sterile foot paddles to actually move through the workflow. So if we look at Smith and Nephew system, it's slightly different in terms of its marketing. Instead of using a robotic arm, we've developed a more of a miniaturized handheld device to actually minimize the footprint in surgery. So we're not taking any valuable space, which is really important for outpatient type settings. It's also designed now to cover multiple procedures so we can do primary and revision knees, we can do hip procedures, we can do partial knee replacements. And we're looking to develop in the upper extremities such as the shoulder. Um we can get very accurate cuts because of the way that it's set up. So because of the handpieces tracked by an external infrared camera were able to manipulate the cut plan. And I think you can see this in the next screen. So if you think about robotics today, it's split into the following screens. So we've got the first of all, you got to register the patient's anatomy and to do that, you digitize the surface of the, of the, of the joint itself. So this you're seeing the distal femur being digitized with the point cloud and that point cloud is being used to determine a suitable implant size based on the shape model. Once you've deduced what the implant sizes, you can then go through the cut plan. And you can see that we're using these very precisely defined pixels to determine how much bone needs to be removed. And it actually protects the soft tissue around the knee joint. Because if you try and stray away from the cut plan, the birth, the actual step motor will actually retract the burr and you won't be able to cut outside of the zone, which has been demarcated by the cut plan. Once you've gone through the image free registration and the planning step, you've cut the bone, you're then in a position to do a fully balanced knee. So you can interrogate both the medial and the lateral component compartments and the knee joint. You can look at mid stance in instability, you can look at full knee flexion, look at full extension. You can see if there's any laxity in the joint. You can see if there's any stiffness in the joint as well. So you may have to go back in the workflow and remove some more bone. So you get a good range of motion with no instabilities. So all of this can be done sort of very sort of image free. So we don't need to do any preoperative planning. We don't need to introduce any cts or Mri's into the workflow. Everything is done by essentially painting the anatomy using a manual probe that digitizes the service of anatomy. So the question is, is, you know, can we make an improvement on that? Well, the answer is yes, absolutely. We can. So first of all, let's look at the workflow holistically at the moment. So I said before with modern day robotics, you're actually using the screen to navigate through the workflow. The problem is that takes the attention away from the patient, increases the time of the procedure. So is there any way that we can take the workflow, the screen and bring it closer to the patient? Well, the good news is, yeah, we can do that and we can eliminate the split focus between the patient and the display. One we can, we can do that is to use augmented reality. So augmented reality now is being used heavily in the gaming industry. Over the last three years, it's shown promise in certain procedures such as spinal surgery where you're trying to uh implant pedicle screws without damaging the soft tissue and damaging any nerves in orthopedics for joint replacement surgery. It's still in its sort of infancy at the moment. So we started to look at how we can actually use the headset and track it using the camera. So instead of getting a static image in the corner, we can actually have holographic overlay that's actually tracked by both the headset and the external camera. And if you look at the results of this, you can see that we can take the information from the display and then essentially reposition it either as a, as an overlay or as a twin model. And we can actually use this to get more of a rich point cloud collection where we're trying to determine the shape of the femur. We can also use it to actually position the implanting real time above the machine bone. So we can get a really good fit and make sure that we haven't got any rotation, external rotation in the femur. We can also see whether or not the the there's any bone spurs are remaining in the corners which might not be visible. Um Using the standard display, you can swivel the model round, we can look at different views. So the natural evolution is go from presenting to de uh overlay information using holographic guidance are using more of an X ray three D. So in that situation, instead of using the data from the screen during surgery, you can bring three D preoctive model data and directly um seat that on the limb and look at some of the missing anatomy like blood vessels, which potentially could get damaged during surgery. So we've looked at how we can address the problem of a heads up, heads down situation and having a split focus on the patient and the uh and on the screen itself. The other thing that which is uh seems to be a parental problem with robotics is using an external camera. So the moment the camera normally sits to the side of the patient, and what happens is if somebody stands between the camera and the patient, you lose registration because essentially it's GPS and it's using sensors to basically bounce off reflected light from the reflective markers to the camera and back to the controller. And if you get between those two, then you end up causing um conflicts in the workflow. So to do that, one way we've done it is to try and miniaturize the cameras. So actually attach the cameras to the bones itself. So essentially, you can measure the range of motion you can look at um cutting the bone by mounting these little what we call Zepp to track devices, which are miniature reciprocating reciprocating cameras, which is an integrated tracker and fiducial array. And it makes everything very small. Instead of having a 40 kg robot, you end up having something that it's about 40 g in size and it's about the size of an inch by an inch by half an inch. So it's very, very small, very portable, very low cost. And potentially when I said before, 90% of orthopedic surgery today are not done by a robot or done by navigation, essentially developing a different type of solution for the underserved community that don't have access to this advanced technology. But what I'd like to see is, you know, Smith and nephew has a technological VISIONAIRE that's around about 10 years old. And we essentially use VISIONAIRE to understand patient anatomy before they actually go into surgery. So we look at the MRI data, we segment it. So we know exactly the shape of the femur and the tibia, we create a three D specific patient model and that is used to in for a set of cutting guides. So we can cut the bone in a very patient specific way. The problem is you can't balance the knee. So this is the difference between using um P S I and using a surgical robot is with a robot, you can balance the knee and you can cut the bone. So you get everything in one. But obviously, there's an added added cost of that capital cost. This is a much more low cost solution, which you're able to shake the bone, but you're not able to balance the knee. What we'd like to do though is take the three D model that we've already created and then essentially combine that with a modern day augmented reality headsets. And to do that, that would allow you to basically create a 1 to 1 correspondence between the three D model that you've created of the patient anatomy before surgery. And when you're actually executing surgery. So by putting these little skin markers on there and essentially doing a point cloud with one of these structured like projectors, you can essentially a line of two models together. And then you have this situation where you can actually see three D information rather than A two D overlay, which will help you align broken bones more effectively if you've got a very small incision site, or if you want to reattach damage blood vessels. So I think this is the value of being able to go from two D to three D with extended reality and bring in the preoperative model into the surgical seen. So we talked about two problems footprint. We've talked about looking at screens. The next thing is, is, well, you know, we're still putting markers onto patient, which means it can cause bone fractures, it can cause potential infection. It's obviously has um it increases the the burden on sterilization cost because obviously, you've got to bring tracking arrays into the into the field and it can make the workflow a little bit chaotic sometimes. So the question is, can you use video based registration? So can what we call flash registration instead of painting the bones with the probe and creating a point cloud, you create a point cloud using a video based registration. Now there is a technology that's been approved on the market for spine and it's called 70 surgical and it's used for craniotomy knees and it's used for spinal surgery. At the moment. There's nothing approved in orthopedics. But what we're doing with it, Smith and nephew, we're looking to develop this type of technology, so we can bring this into orthopedic joint reconstruction. So we've got a new camera system that essentially has an infrared sensor. So you can do marker based registration with an infrared camera, but it also has a video and it has an RGB and depth sensor all on the same referential. So you're able to with the support of augmented reality, start to bring um you know, segmentation real time dynamic registration into the field without the use of markers. So it's less evasive to the patient, it improve the workflow efficiency. And it also gives you specific landmarks which will help you prevent any external rotation of the femur, things like Whitesides line that can be projected. So you can see the value now of um enhance visualization um and extended reality and preoperative planning as well. You can bring preoctive planning into the workflow as well and this will hopefully reduce any iatrogenic complications. So before, because it is very evasive to try and register the patient using bone markers today. So we've looked at how do we um execute the plan? How do we register the patient to a robot? How do we bring the preoctive data into the workflow? The only thing that's missing in the jigsaw puzzle is we're still cutting bone with antiquated tools such as Bors oscillating saw blades, anything causes significant damage to the bone. If you look at bone after it's been cut with a sore, there's a lot of thumb on the crosis because if you go above 44 degrees C for 30 seconds, the bone starts to die. So the cutting zone, you'll get a lot of dead bone there there, which means you're going to have a lot of remodeling taken place. And the way to get around that is you grout the implant with bone cement. So essentially, you're depriving a lot of patient. Certainly the younger population who would benefit more from a cement this fixation if you were able to maintain a biological type fixation between the implant, a cement lis implant and the surrounding bone. Well, the good news is this technology starting to take off. So not only can we sculpture the bone, we can also change the way that the bone interfaces with the implant. So we can start to think about developing lower profile implants which not haven't got such a thick femoral distal femoral condo to overcome the promise stress transfer. Because essentially preserving the biological structure of bone, you make you keeping the porosity, you're allowing the bone to grow into the implant more effectively without having any dead bone to be removed by osteo class. And so you're getting a better stress transfer, which means we can start to look at the way we design are implants, just buy able to remove the bone with a laser and sculpture in a second step. So we've now treated our patient with all the latest generation tools. The question is is how do we look after them after surgery? And the problem is in most situation, it's fairly greenfield's as we call it. So it's very subjective qualitative face to face consultations, maybe three or four in the first sort of 3 to 6 months. And we're relying on patient testimony, we may have an X ray to help us follow the trajectory of healing. But ultimately, it's still a little bit sort of qualitative subjective. We're using survey scores such as Oxford knee score, um and pain scores to actually give us an indication with how the patient's feeling on a day by day basis. And if we look at the secondary care pathway today, you know, some of these um waiting rooms are extremely busy, especially with the backlog of um elective care after the pandemic. And we think about what a follow up appointment cost. The NHS, you're talking about 100 and 50 30 lbs per visit. And there is an NHS mission. If you look at the, the database, they want to reduce the number of out patient follow ups by 25% which if you think of the cost saving that could equate to around about 60 million over 292 trusts in the UK. So we think about the amount of primary cost savings we talked about early because of poor quality referrals and also the number of unnecessary secondary care uh appointments follow ups. That's over 100 year that we're wasting because we're not fully utilizing digital technology. So, as I said before, you know, the most patient's today are really want to take interest in their recovery and there's ways to do that using avatars using online PT tools and using sensors to basically acquired data real time to generate actual insights. There are implants that actually have sensors. And many years ago, I actually developed a telemetric implant for trauma to actually monitor fracture healing, which is much more objective, uh more uh objective, more quantitative it required less follow up x rays. It was more real time in terms of what was going on the progression of healing. We could look at the data and we could determine whether the patient was actually trending towards bone union or not trending towards bone union within three or four weeks. Just because of the data and the real time nature of the data collection. If you look at the guidelines in nice for diagnosis of union, a non union, it takes 6 to 9 months. So the patient has to wait nine months before he gets official diagnosis. In the meantime, if you're using smart technology, you can get a diagnosis quicker, you can prepare the patient for surgery. And this technology extends to wearable devices such as Taylor spatial frames and the max frame by J and J where essentially you can on a on a daily basis, you can interrogate the loading through the struts and whether the adjustments are going according to the prescription and all this is done in a very autonomous way. So the patient doesn't have to adjust the struts using a spanner. It's done with a geared motor you can actually change the frequency adjustment. So at the moment, the standard of care is for quarter turns today, which constitutes one millimeter of distraction. But we know that's painful for the patient. And we know that it can have a negative impact on soft tissue and it can slow down bone healing. With this type of technology, you can actually adjust every 70 microns uh using a sensor and using a mobile phone. So all of a sudden you can actually create semi continuous actuation which makes the bone will heal a lot more effectively and it's less pain for the patient. And you can also work out exactly when the frame needs to be removed by the amount of load that shared between the spirit and the surrounding bone just by looking at percentile data and compared to general population. So there is a smart device that's actually on the market for joint reconstruction application. It is called the Sanctura Center technology and it's a new platform developed by Zimmer Biomet and essentially it uses a center developed by Canary medical. So you can measure things like salary meter, you can measure the step count, you can measure range of motion, you can look at gate in terms of gait quality, you can look at the speed a gate and the stride length. The problem is um to able to deliver those that technology you needed an extended tibial tray to house the pacemaker battery, which means you have to remove but more bone to get the tray into the patient. So the trade off is if you want to be monitored with a smart implant, you have to remove more bone, which could have a negative impact on a secondary procedure. If you look at spinal application again, there is some devices that used to determine the amount of tension required on the rods just prevent the screws from breaking out. And then there is another company in that's based in Southern Island, which is actually using intelligent implants to navigate the amount of bone that's grown around a spinal fusion device. So one thing you don't want to happen with spinal fusion is for the bones to grow around the nerves because obviously that concurs um disastrous effects in terms of nerve palsy. So what you can do is got this on board DC stimulation and depending on the polarity of the D C, you can actually remove bone or grow bone in either direction. So not only does it measure the electrical properties of the bone around the implant, it can also control the amount of bone growth around the implant. So in terms of wearable sensors, it's a lot safer to measure patient progress than putting sensors into implants and wearable sensors tend to be arranged into two buckets there either worn as a garment. So there's an interface between the center and the skin which could be a sock, it could be sleeve, it could be some sort of rigid box or it can be a skin adhesive where the sensor is attached directly to the skin. In both situations, it requires patient compliance. And also because of the nature between the sensor and the skin, there's no, not a natural interface. And so it's quite rigid and obviously that can create noise which needs to be calibrated out with the filter. If you look at what the sensors can deliver today, it's very similar to an E K G, you get these readings that I'm almost 24 7. It's implants agnostic. So it's not attached to the implant. It's as worn as a center on the skin, it gives you real time kinematics data and has said before, the quality of the data can be just as good as one of these smart implants without having to uh expose the patient to a battery. The question is, is who is working on this at the moment? Well, Zimmer Biomet have launched their Mind mobility app which is a collaboration with Apple. The problem with is it doesn't give you any gait data. It's purely step counts, heart rate and engagement data and patient reported outcome measure survey scores. They have developed an AI algorithm which protect basically looking at your your gait speak and determine whether or not you're trending towards normalcy at 90 days compared to general population data. It's smart watch compatible and it's been used in both hip and knee patient's and you can see it on clinical trials doc of some of the data strike has a very similar platform which measures step counts and range of motion because it's still in its infancy. There's not much data out there. It has the same sort of workflow. You put the center onto the skin, you connected to your phone. The data is then sent from the phone to the cloud is then filtered and sent back to the surgeon. And then there are, it's basically filtered and then you get pepper pop up messages sent to the patient to tell them whether need to come in or whether they can continue with their normal PT. So I said before, so why are we driving towards sensor reported outcome measures? The problem is when you look at patient reported outcome measure like offered knee scores, there's a ceiling effect. So if you look, your surgeon is able to improve your score by maybe 20 points, but then it reaches a ceiling effect, the difference with sensors is there's no ceiling effect. And because it's objective, quantitative and real time, it doesn't rely on the patient to tell you how you're feeling. It's much more sensitive to surgical technique. And it's also more certain sensitive to different types of implants were from a clinical study perspective. And we're not trying to burden surgeons with more data. Because if you look in the cardiology community, if you look at the the US database on uh arrhythmias. I think there's something like 11,000 different pathological heart rhythms that have been detected from collecting E K G rhythm data from patients'. And the same train of thought can apply to orthopedics where you basically stratify patient's between healthy, normal and recovering abnormal and, and to do that, you look at specific um events within the gait cycle and then you translate that into known clinical outcomes such as whether joint is stiff where they're undergoing any short steps, whether limping or more importantly, there's any micromotion which suggests there's a problem with the implant. And using pattern recognition software, we can start to link specific events on a trace to specific events in the patient. So with the CGs, you can confirm um my cardio infarction by, by an inverted T wave. Uh and the same train of thought with orthopedics, you can look at some of their um the gate cycle data and you can basically stratify the patient seen someone who's training to normalcy or someone who's not training to normalcy and determine whether or not they need any immediate intervention where they've suffered any iatrogenic injuries or there is something about their physical therapy that's not promoting recovery. And the good news is we started to look at this now. So we're looking at patient's 12 and three. If you look at their cadence, their walking speed, you look at their step counts, how active they are and look at their gait quality. If you have to look at the cadence in on its own, you would think that patient one is really motivated. Look at their cadence, their speed, their speed is good. They're motivated at step count is good. It's within sort of the average between the normal percentiles for the general population. But you look at patient three, you're thinking, why is patient three not moving much? And they're walking speed is poor. If you look at them, you think, well, we need to bring them in because there's a problem with their, with their surgery. But if you look at their gay quality, they're gay quality is exceptional. It's at the upper 95 percentile. But then if you look at the patient's one and two, uh specifically patient one, they're gay quality is very, very poor. So it means although patient one is motivated, there is something wrong with their surgery and they need to be brought in. And this type of database and this dashboard can be sort of like simplified to traffic lights. So patient one is likely to be limp or stiff that needs to come in maybe for a soft tissue lease where patient two and three just need to be more motivated with physical therapy. And the same thing applies to just looking at range of motion data here. This patient undergoing a oxygen knee replacement surgery, you're able to follow their flex and extension angles longitudinally. And if you see that their extension is not training to zero, you know, in the first few weeks, it means they may have a contracture which needs to be addressed. And obviously that will send alert to the the database to bring them back in. Unless this trend is going, going toward zero over time, then this would flag up a problem in the first three weeks and then hopefully it would resolve on its own accord. So again, patient stratification to can apply to other types of monitoring events such as impact load. So we can start to differentiate uh a a symmetry between the operating on operated limb. So if there's more load going through this stance phase on the operated limb over time, that's great, which is high impact low. But if there's a low impact low, which is read, that suggests that the the most of the load is going in the contractual limb, so that obviously the continue to limp over a period of time and obviously that needs some sort of intervention. So I like sense reported outcomes because you know, when you think about um robotic surgery, mechanically assisted TKR, the debate is on whether it's actually showing value because these, these capital equipment costs between half a million and 1.5 million. And it's a lot of money for a hospital to buy into a robot. If there's no evidence level, one evidence suggests that patient's are recovering better and at the moment with these survey scores, they, they seem to be insensitive to how patient's are recovering between with, with the robot and out without the robot. But the good news is when we look at center reported outcomes in this sort of case level four case study, we can see that patient reported outcome measures, there's almost like a plateau effect from week to two weeks, six after surgery. But when we look at center reported outcome measures, you can see it's a lot more sensitive to the recovery of the patient after surgery, which we're not seen between conventional and robotic assisted procedures. So the good thing is that we can start to use center reported outcome measures as a tool to determine whether or not, you know, um hospitals are benefiting, benefiting from putting the patient's through this type of procedure, which is obviously going to add costs to the procedure. And also it's going to um we got to think about how we're going to expand this out to the 90% of patient's not receive a nice the technology at the moment, maybe since reported outcome measures are probably more sensitive to actually show an improvement in functional score after that type of procedure. So we think about the data flow then, so we put a center onto the patient. It collects a multitude of different signals. We use some sort of deep learning model to try and do some feature extraction to try and reduce the burden of data, overload, two surgeons because they're very, very busy and they don't have a lot of time to actually look at this type of information. We take this filter data and we try and classify the patient's based on their gait patterns and we try and stratify them in terms of ones that need to be brought in for some sort of urgent treatment or patient's that are doing well based on the particular analytics and where they just continue on their physical therapy on, they're looking at their longitudinal data. And this can be handled very, very succinctly using a mobile phone, a cloud based database and some sort of pop up message to send to them on a sort of like, you know, a frequent basis. So if you look at the summary of the digital technology evolution at the moment, we're seeing a huge impact on the orthopedic industry in terms of improved productivity efficiency. I've already pointed out that potentially there's 100 year cost savings in the NHS by improving the efficiency of primary care referrals and the reduced number of follow up after surgery. It's changing. Our evidence is gathered and utilized. You can see that sense reported outcome measures much more sensitive than blunt antiquated prom's for determine whether patient's are actually seeing benefit from the robot itself. These external internal sensors that are the pen and paper of the next wave. The data acquisition they already going to stay with us. Big data will feel Oscillo Tate new algorithms which will allow us to carry out some sort of early detection of changed in patient health. A lot more timely than what's carrying on at the moment. Using subjective qualitative face to face visits. And this is gonna have a direct impact on our industry. We're gonna have to do business very differently. Um We're going to have to partner with new customers to assist us in caring for patient's in a more holistic way. And then uh just in the final slide here, we've got, this is how skin sensors are going to evolve. They're gonna evolve from something that's fairly rigid, that's quite difficult to use by the patient. There's something that almost is like wearing a skin center that flexes with the skin that uses this type of architecture where you got a serpentine structure that flexes and moves and you can actually places underneath the wound dressing. And the final thing I've got here is, and I think that should play, hopefully, should hear the sound. Just let me know if you can't hear the sound. Uh darn we can't hear this signed, but you may need to turn the signed up on the computer perhaps. So it's on at the moment. Unfortunately, probably didn't look the sound when we shared the screen. I think there's any way to do. And this is a because I can hear on my end on my my speakers. You're not share in the sound, unfortunately. Okay. Well, sure how we're going to solve this problem. I think the point, what I pointed want to the point I was the effect of using avatars to try and um improve this sort of holistic care from the patient's home setting in terms of managing prescriptions, managing expectations and being a direct link between secondary care pathway and on the home setting. So, thanks very much. My presentation is finished. Thank you very much, Doctor Wilson. Um We had one question uh earlier on in the chat, which I will bring back in. But if anyone wants to ask any questions about the talk we've just received, please type them in the chat and I will bring them um uh to Doctor Wilson. So the first question is from Ravine J Syria and he asked, um do s rooms are s rooms anymore valid then prompts? So the answer to that question is absolutely yes, from what we've seen from level four case studies. So I said before the the problems is, is obviously a survey score that's filled in by the patient. So it basically is how the patient's feeling on that day where the serums is independent of what the patient feels. It looks at what's actually happening from an anatomical perspective because it's taking precise measurements from the gait cycle. So I believe that we will start moving away from problems and going more towards serums. Okay. Um I have a question obviously, at the moment in the NHS, there has been um uh some focus on inequality, inequality and healthcare and you did mention something to talk, which I thought was really interesting, which was kind of the inequality in health tech across the country. For example, we know robotic um hips and knees, not every center does that. And the way the NHS is set out if you are lucky and you live in a region which is served by a hospital that has a robotic, a robot, you might be able to get a robotic in your hip. Do you think there's anything that you can do as a company? Uh And I'm thinking, for example, when you were talking about your wearable technologies, is there a way for example of having a patient who you might see on the data will probably benefit from a, a row but assisted knee or hip. And then can you link that patient up to a center that may have a robot if that makes sense? So I think that's, that's a great question because I think 90% of joint replacements are not receiving advanced technology, which I think is horrific when you think about that at the moment, I just said the metropolis hospitals, you know, forgetting it's all about case volume. If they're getting 100 joint replacements per hospital, then they can justify to the payers to bring in a robot. But as you said before, if there's a patient that would really benefit from because they've got a deformity that's going to be difficult to correct with mechanical antiquated um, tooling, then they should be promoted to joint replacement surgery because they will, the, the benefit will be more obvious with this type of patient and you'll pick that up with the serums. Certainly, if the soft tissue balancing and the good news is that we are trying to address that deficit by looking at a lower cost robotic platforms. And we're very fortunate because of electronic miniaturization that we can create these sort of disposable tracking arrays, which is gonna be, you know, less than 50,000 for the kit, which will be the arrays, the markers, the tablet, the smart glasses. So you're still getting the benefits of a 1 million lb Robo robot, but it's gonna be repackaging something that's more affordable to the community hospitals. Okay. Thank you very much. Um Ravine who asked the previous question, which was regarding our S Rome's any more valid than problems has had a follow up question which he basically says um uh what your description was was about precision. And he's questioning whether it's relevant to patient if at some point there isn't. Um there isn't a match I think between the prom and Esther. Um I think that's what he's trying to say. Um It's in the chat. I don't know whether you have any response to that follow up. Let's see if I get into the chat here. Let's have a look. But the point is that, yeah, that is. So what we're saying here is precision relates to patient outcomes. So what we're not sure about is we know that a robot will reduce an aura of bed stay in hospitals from maybe four or five to maybe one day with an outpatient. Well, we're not sure about is the benefit having a balanced knee on long term performance. That's sort of 10, 15 years out from surgery. And whether that whether the sense reported outcome measures is able to pick up those sensitive differences between a mechanical and robotic assisted procedure. And we're not seeing that with survey scores. That's the point. You know, there's 2 to 5 year data with, with problems. There's not really showing any benefit team mechanical and, and robot assisted surgery, but that might not be because there isn't a difference. It may be because it can't pick up that difference because it's survey score. So you really need to know exactly what is happening too, the limb from a loading perspective to understand whether they're soft tissue balancing or whether there's been any excessive rotation. And the only way you can pick that up is with a sensor, there's no way you can pick it up with a survey score. So will that answer the question? I hope, hope so. Anyway. Okay, we have one final question. I'll take one final question and that's from Archie Alan. Um And so he basically says, uh he worked on the holo lens project a couple of years ago, which explored using three D holograms of CT and MRI scans. However, unfortunately, at the time, the three D models of blood vessels were not accurate enough to be used in assume clinical practice. For example, it missed some of the arteries in the actual three D hologram. He asked, how far are we from Freedy holograms that are actually an accurate representation of the scans that they are based on? That's a great question. So a lot of the work that we're seeing in these presentation slides is based on Microsoft Hollande's technology and that was never designed for surgery. It was designed for gaming. And if you look at the optics, it's it's a single optical plane. So there's a disparity between the real and the virtual. We call it focal rivalry. Now, fortunately, if you're to look on the internet as a company called Light Space, and they have a multifocal optic display, which means there's no disparity between the real and the virtual, which causes what you're seeing here. The issues with the accuracy from a tracking perspective. Their headset is accurate around about half to one millimeter where Microsoft Hololens is around about two millimeters from a registration accuracy. So you've got a sort of a four fold increase in registration accuracy by having a multifocal optic display. So I'd say it's still in its infancy, this next generation optical display system, you know, we've moved from virtual reality to augmented reality to an optical optical reality where you don't get the disparity between the real and virtual. That's probably going to be in the marketplace in about two years' time. So it's saying two years, we should have sufficient accuracy to be able to reconnect, damage blood vessels because of the this type of technology. But you can't do with Hollande's. I carry it's just really something where you put uh an image in the corner and it gives you a rough representation of the anatomy and the field. And I think another question in the field of you horizontal is about 65 degrees with the light space technology. So it's higher than the Holland's. Thank you very much question. Uh Also fantastic talk, fantastic start to the innovation session. Um So we will lead on to our next speaker who will be Rahul Senen and he is from the Med Tech Foundation as Oliver um described previously, they are national engagement initiative and mainly for kind of university students and any career professionals, essentially, what they are trying to do is support healthcare technology innovation by connecting the different aspects that make that work. So from the medical engineering, scientific product design business, um kind of industries all into one to try and deliver on that. Um They do this via various initiatives such as um educational innovation programs, uh and also organizing research and industry internships that members can obviously go and get enhanced training to help uh improve on these opportunities. And so we've out further do I would like to introduce Rahul um to deliver his talk um as part of the Med Tech Foundation. Thank you. Hi. Hi there. Thanks a lot, Frank for that introduction. Um You've done most of my work for me already by giving a really concise good history of, of what Med Tech Foundation does. But yeah, so I'll just put up my presentation. Uh Can everybody see my presentation? Yep. Looks good. Awesome. Um So, yeah, so my name is Rahul and finance director for Med Tech Foundation. Um Today, I'm gonna give a talk on um how MedTech Foundation is approach the issue of innovation and we'll talk a little bit about the issue of innovation just in general. Um But what we'll go through today is um innovation of the NHS, what we feel about it uh collectively or, or what my thoughts are at least. Um And then talk about how the Med Tech Foundation tackle some of these issues and we'll go through what Med Tech Foundation does. But as our events, medex workshops, internships, placements, innovation program and our hack up on all things that even as trainees you guys can get involved in. Um and the integrated innovation training program which has garnered a lot of interest recently and something that all of us specifically asked me to speak about today. So um my first question, so first, before we talk about innovation any further, we need to really drill down on what we mean by innovation. And it's quite a broad topic. Um but it can include things like devices, medical devices of products, like um what was talked about in the previous talk, it could also just be services and not something tangible and even just new methods of ways in which we do things. Um But fundamentally, innovation simply comes down to new ideas. Um And it's how we use these new ideas to put them in the clinical practice that creates an innovation. And that's where the ball of neck is. I don't think there's a very uh there's a shortage of great ideas and that would be great, lots of great ideas. It's just we need people to put them into practice. Um And that's the tricky part of innovation and that's the definition that I'm going to be using, going forward. So the first thing I want to ask you guys is, is your healthcare system innovating. I'm gonna try and use the pole thing that I just discovered. Um I don't know if it's gonna work if people can see the pole. Um um To, to get a sense of what the audience thinks. How well is the NHS innovating? Is there an issue? Is there not an issue do we do it well, do we not do it well? Okay. Um So some of you said somewhat, well, some of most of you have said somewhat poorly and a few 23% said very poorly. Um I think that's very reflective of the current understanding of how innovation is in the NHS is that the NHS is a great system, but there's something preventing us from really using innovation. Um So, um and this is not a new thing, this is something that we've known for a while back in 2012, we had the Innovation Health and Wealth Report. Um And in that one, they sort of suggested that innovation needs to be incorporated, that perhaps we might need to start thinking about making innovation a bit more structured in the NHS. Um And despite years of funding and neglect, it's, it's, it's something that HS could do well and there is a, is a large niche for, but then in 2016, they accelerate access review um really hammered home the point that NHS is not doing well with innovation compared to its counterparts in Europe and elsewhere. Um And there's more to be done. Um They specifically said that um they need to um incorporate innovation training within the NHS to make the workforce more amenable to incorporating new innovations. Um Then you had the Toprol review, which is a really large review. And again, they reiterated essentially the same thing they're asking for more innovation, training for um medical professionals and healthcare professionals in general to be involved with medical technologies, innovation. Um And they're, they say the future doctors will be unprepared if they do not have a good understanding of how innovation is brought in or medical technologies just in general. Again, 2019, long term plan, same thing um and same with the future doctor program which again um re trade at the same point. The, the point I'm trying to make here is simply that we know the NHS is not doing well, it's just known, but for so many years having understood the issue, why is it that we're not able to come across and, and fix that? So I'm gonna ask you guys again, what is preventing your healthcare system from innovating? I think we can use the, the chat um function. I think it's the best way to do it. What do you guys think are the main barriers that prevents new innovations, new products from entering the healthcare system and, and making them work? Yes, Frank says finance funding. I'm going to give it a minute. See who else. I've got some ideas. Attitude to change. Yes, I think that's a big one and I think I'll touch on that a little bit status quo bias. Yes. Again, attitude to change. Yeah. And the current healthcare delivery model. Yeah. Then it hasn't founded in 1948 I think, and we're still running with essentially the same system, the bigger the organization gets, the harder it is to get anything moved through in an organized faction culture. Yeah, I agree. Age and the vision of decision makers, truth of those in power aren't the ones that maybe know what it's like um focused on specialty applications for, for quantity of research as opposed to quality of research. And that's a really good point. Um And a lack of knowledge of enabling technology. Yeah, true. Um I think, I think we're all somewhat on the same page and, and, and I agree. Um so some of the things that were highlighted um and we'll probably touch on all of those things that you guys have said thanks for your engagement. Um And some of the things that were highlighted in those reports were specific and again, something that we know is that NHS is supply driven or a top down approach where a um a product or, or, or producer of a product will first have to design a research and make their product and then they have to see whether or not the NHS or the C C G which wants to take it up, which makes the risky environment for, for a, for a company or a startup, say that one that sees an issue or problem um and wants to solve it, but cut really because they have no guarantee whether or not it's gonna be adequately, it's gonna work within the NHS. System so often what you get is the NHS buying products and systems that are not designed for the NHS because they were made in markets that were more amenable to entrepreneurship and innovation. So we get stuff that's not particularly useful for the NHS or is um not cost effective. Um We also have a lack of specialist or expert workforce. I think um a really good way to say this one of the reports was that it's nobody's day job to innovate. That's a really powerful statement is that no one is, is charged with that. Let's innovate, let's find new solutions. Um And that's a big part of, of, of white things not working. And that comes back to some of your comments about culture. NHS as we know, is really siloed and separated institution. It's really old and it was established in the 1919 48 I think. And since then, the, the ultimate that the structure hasn't changed and everybody operates independently sometimes. Um One of the things that reports have highlighted is that you've got procurement departments that would choose a cheaper option that inevitably caused costs in another department, but they aren't able to see that. So overall, you get this these inefficiency stacking up. Um And then you've got this short term focus or short term benefits, you've got a funding constraint that asks you to reduce costs in the next year. But then you're not able to say, for example, by the product that would reduce costs 10 or 15 years down the line. And yeah, it, it comes down to funding again, you don't have a specific revenue um push towards innovating within the NHS. So what the, what metric foundation does or tries to do is, is a really simple but very effective thing is to challenge this lack of specialized workforce. And we'll speak a little bit about how we do that later. But I want to hear from you guys again, how do you increase the adoption of innovation? What solutions do you guys see? Or that are easy, low hanging fruit that we might want to implement within the next five or 10 years. It's one thing, I'll give it a second. I'll see what you guys have to say. Francis, the medical school curriculum. Yes, absolutely. So, starting really early innovation with that benefits multiple stakeholders. Yeah, and put people at its center. Absolutely. Um root and branch change. Yes. So um taking things from the bottom up. Yeah, absolutely. Um So what I'm going to focus on again on this time is how to create innovators rather than developing the products themselves. Because we believe that if you can create the innovators, give them the tools and, and the, and the skills necessary that that innovation will, will come about because we've got billion people working within the NHS or who are going to work in the NHS. So some of the barriers that we face in higher education and this is probably um applicable to postgraduate education as well is that there's just a lack of awareness or unclear pathway. I mean from medical student onwards, the only thing that were beaten into us is is higher specialty training or research and things like that. Why is there nothing about innovation or how to bring new solutions into the? NHS? Um There are a few programs that worked really well for this like the clinical entrepreneurship program. Um but the spaces are limited, they're competitive and it doesn't really increase the access of that education to everyone who needs it. And then there's limited productive time. Again, it comes back to the same thing. It's nobody's day job to innovate. We're not giving people the time to, to do what they need to do. Um And we're siloed and separated. There's no interdisciplinary work here. This is a quote from Sir John Bell and accelerate access review. Um Just want to point out that he says that we need to work together specifically with digital Metchek and diagnostic innovations. Um And this is like a really key point that Metchek Foundation tries to address. So what we do or what we aim to do is try to give some semblance of structure training and we make sure all of our stuff is open access so that anybody who wants to get the education can get the education we're also working on trying to integrate this into the curriculum, both at the undergraduate and postgraduate level as well as making sure that we keep a strong interdisciplinary approach and everything that we do. So the solution then um after seeing all of this, the, the NIH are set up the med tech and in vitro Diagnostic Cooperative's. Um and you may have heard of them, there's about 11, um there's about 11 in the country and each one is hosted by a separate NHS Trust and each one has a specific focus. Um So I suppose the ones that are of interest to you guys would be the N H R or Trauma management in Birmingham as well as the one in Leeds, which is medical technologies, which has a big folk which has big applications in, in orthopedics. Unfortunately, again, they're difficult to, to engage in the fairly small. So how do we increase that engagement from the ground up, really from the undergraduate level all the way up um to hire specialty training? That's where Metric foundation comes in. So we're engagement initiative essentially for students in early career professionals. Um And in the past few years, we've grown quite a lot. Um As of now, we have 11 spokes with which and we've got one new spoke as of yesterday or day before in London. Um So we're growing exponentially. Um and what we try to do is connect people where they need to be connected. Um So we want to do is create this interdisciplinary community um of talented individuals and again, open access um and access to training and opportunities. Um We believe that people can learn from each other and collaborate and if you can prevent those barriers and that siloed thinking that ideas will sprout by themselves. And we've seen this in the past with quite a few successes in our, in our events. We'll speak a little bit about that later. So how do we do what we do? Um The first thing is this Medex programs will speak about this a bit later, but they're essentially like these kind of talks, lectures or inspirational talks with the focus on trying to inspire students as opposed to an academic focus. We've got workshops which are more didactic where we and, and interactive, where we try and teach people basic skills. Um We sort out internships and industry placement so that people can get more specific um expertise in wherever it is they want to go. We run our flagship event, which is the Innovation Program and the hackathon, which are structured training programs that we've developed over the course of a few years to try and give people an experience of innovation. So in terms of our medics events, we really are focusing on non academic or even if they are academics, we're trying to focus on how they're academia or their products have improved cation pair care while integrating it into the NHS and are real, a real focus here is to try and inspire people to then go on and create their own ideas or build a network. Um We've also got workshops which sort of encourage this interdisciplinary working. Um Things like coding for absolute beginners, which has started to roll out this year where we're teaching medical students and anybody who wants to join basics of coding, linking that back to health care and how you can apply that into healthcare. Um We also do some workshops and entrepreneurship, some of the basic skills that are commonplace in other courses, but not so much in the medical curriculum or higher specialty training. Um Again, it's just a really large gap that is easy to fill, but no one's filling it. So that's why the Metric Foundation exists. Um And then things more niche as well as people progress, intellectual property, how to bring something to market. Um And some of those practical skills that you might need, if you want to create a startup, if you want to um do things with your ideas to actually make change. So our innovation program, which is our flagship event is this um is this this educational structured program? And we, and we do that to introduce the basic principles of medical device development. Um So again, as we said, as I said before, um business marketing, um intellectual property concept generation, how to create an idea of find a niche. Um And it takes you from all the way from zero to hero, essentially from know past experience and no ideas. At the end of eight weeks, you have, have an idea, you'll have a pitch and you presented to possible investors. And that's our goal with innovation program, we make sure that it's interdisciplinary. So every team um um we design is that every team has a different background. So if you were to join as an orthopedic surgeon or a trainee, you would never be paired up with another orthopedic surgeon or trainee. You, we would make sure that you had somebody else that could give you a different perspective because that's how innovation is done. We also do our interactive workshops which are, which focus on specifics um to try and increase the capacity. Um All of our workshops are in small mentors uh in small groups to make sure you've got a great 1 to 1 contact and you can really build on it. And then there's our final pitch event where all the teams will present their work to an expert panel of judges. And in the past, some of these, some of these works have actually gone on to secure seed funding through their panel. Um And I'll speak about one that, that got particularly successful and they're still on their journey in entrepreneurship. Um This was the Cambridge um Innovation Program in 2021. Um It was done virtually. Um But um we run I think last year, there was about seven innovation programs every year. So I would encourage you guys to have a look and find out um where the closest Innovation program is to where you are because chances are they'll probably be 12 hours drive from wherever you are. And we really encourage you to join. Um It's not close to anybody. Yes, we were initially designed for early career professionals and student. But um our, as our content has grown, we're beginning to starting to introduce this higher specialty trainees and people who aren't from medicine. So whatever your background, we would really encourage you to get involved and we've had really good feedback. So we'd love for you to join the Innovation program will get as much out of it as possible. So here's the basic structure in terms of its timeline is first we introduce um the session, give them information about how the innovation program is going to work and then we introduce the clinical problem. What we do is that we get experts in the field, who no, the no the field really well to find niches that teams can then challenge. So they may say that there's a large issue and heart failure or specific medical issue and they'll, they'll, they'll give them specifics as to where the issues lie. But, but they won't tell them how to solve them because obviously that's their, that's their, their, their job. We then give them the tools to design and develop their ideas, things like concept generation and development prototyping so that they can then flesh out those ideas a little bit more. Then we give them some of the basics of business and modeling because innovation can't really succeed if you can't make it sustainable and then we get them to pitch so that they have these presentation skills and what people want to know when you're trying to pitch an idea. Um In a similar vein, we also run national hackathons, which is essentially the Innovation Program, but squish down into a two day intensive accelerator program. So all the same things as innovation program um with the unmet clinical needs workshops, seminars, and mentors and elevated pitches. But all of this in a very, very short period of time, um even though it's really short, we still get great ideas and that in person merging really helps to consolidate people's ideas and a lot of great things come out of national hackathons. The other attraction for the national hackathons is that we partner with Bio Nabu, which is a um online platform that connects you with other mentors and national hackathon and Innovation Program winners will automatically get a free mentorship spot on the Bio Nabu platform. And um we have another team now who's actually gone through the entire, by an ob a mentorship program and pitch their idea last week to a couple, a couple of investors. Um So we're also working on modifying the hackathon with the virtual consensus hackathon, where again, you take that same framework of an unmet clinical need, get them to figure out solutions with guided training and then pitch those ideas. But this time we get them all working on the same idea and they all end up having slightly different ideas or solutions. Um And then we can then use those um kernels of ideas and bring them forward and flush them out. The third support and training. Um So I spoke about some of our internships. Um And in the past, we've had partners that we've done. So obviously with the NIH on the Surgical MedTech Cooperative in leeds with by now, but which is one of our major partners are other major partners, BSI British standards and industry. Um And we've got some university ones you need of leads um Bela culture medicine and, and other industry placements. Um We try and tailor them to what our people, what are students want. Um And we try to use our network to, to the best benefit of our membership. So, um the last thing that I want to talk about, think I've got about 5, 10 minutes maybe left. Um is the Integrated Innovation Training scheme. And this is something that's garnered a lot of interest in the past few years. Um As um as it's seen that we need curriculum integration within um post graduate training to get people to innovate and it's the, it's one of the few ways that we can improve the workforce and then start breaking that cycle of culture um and creating people that can innovate. Um So it addresses this key gap in innovation education. Um I, I don't know about you guys, but first, um but there doesn't, there isn't any structured innovation training or anything that um that's available to us now, perhaps except for the Clinical Entrepreneur program that really gives you um the resources and the mentorship that you need if you want to develop yourself as an innovator. Um So are the potential is to give people protected time to pursue innovation training and expand their digital capacities? Again, this is another key aspect that was touched on by the earlier reports and the Toprol review in the future doctor report that really stress on the fact that that um doctors, surgeons um and healthcare professionals really need to focus on digital capabilities. And unless there are structured training programs to allowed to do that, um I don't think we're going to progress very far. Um So here's the proposed plan. So this is not up and running yet, but it's in the works. Um And as you can see, it takes the groundwork laid by the academic uh integrated pathway and modifies that to better suit innovation. Um And in the same, in the same way, um we have the S F P or the specialized foundation program, we can adapt that include innovation training. If if people choose and then further up, you can have NIH are academic clinical fellowships that focus on innovation training. Um This then leads very well on two out of program experiences phds mbs, leaderships, industry placements like we've spoken up before. Maybe the brave can do a startup in that time or join the Clinical Entrepreneur program. Um And then the future path forward to be a collector ship and final posts might include clinical Director of Innovation or become an industry expert. Um So the groundwork has been laid already thanks to people who, who created the integrated academic um kind of populations that we need to adapt it and create solutions to address this market. Um And something that we've seen with the Med Tech Foundation is that our events are always oversubscribed. We were never struggling to find people who want to innovate. It's whether or not we have the capacity to teach them. Um And so that's where we are at the moment. We need to have a specific training program to try and um try and solve that. I can answer, answer your questions about the integrated Innovation dream scheme afterwards if need be. Um So what can you do? Um I assume we've got medical students, uh surgical trainees, orthopedic trainees, um consultants on here. Um Innovation Program. Please join hackathon and our internships and mentorships would be really fruitful as I've touched on before the clinical entrepreneur program is actually really good um really good program for people with ideas on how they want to solve it. You can get um clos mentorship and training um in entrepreneurship and how you can implement that into the NHS. Um And from people who have spoken to done in the past, I've said it was really useful on their journey. Um And I would highly recommend it. The only issue is that it's a bit competitive. Um Then you can get involved with the NIH our surgical mix, either the trauma one in Birmingham or the leads one um for the Med Tech Cooperative. Um uh Again, you can work on your innovation or your met medical technologies research there. Um But obviously, you know, I'm gonna advocate for the Innovation program, the hackathon and the internships. Um We are currently working on with the botha on creating an innovation program that's tailored specifically to hire specialty, organize um or higher specialty trainees and probably eventually roll that out to other trainee associations. So it's not just orthopedics. Um And um if you follow us, we'll let you know how, how we progress, we're in the beginning stages of planning that and hopefully, we'll have something running maybe by the end of next year or mid next year. Um We'll have an innovation program specifically target, targeted for uh specialty trainees. So lastly join us um use a Q R code or follow us on Twitter um or you can simply Google MedTech Foundation and you'll find our website um wherever you are in training, I'd highly recommend that you join because um it's never too late to start. Um And all of our, all of our materials and education is open access. We don't discriminate. Um So find out where your local spoke is, see what events they're running, join them, see if you like them and then join us for national hackathon and Innovation Programs as well. That's my time and that's my talk. Thank you very much. Yeah. Uh Thank you very much, Rahul. That was a excellent talk. Does anyone have any questions that they would like to ask Rahu at this time? I have one question Rahul. Um Obviously, you know, I'm, I'm definitely a believer that we need to innovate um particularly in the situation that we're in uh in this country of our healthcare system. However, sometimes I get a big cynical and I get a big cynical because sometimes innovation to me plays out as just trying to paper over the cracks of methods or pathways of ways of working that are, are clearly outdated. And so my question to you is how do you avoid that? How do you avoid using innovation uh to cover over poor practices when actually uh potentially, sometimes it's not innovations that needed. It's to address the poor practice of which after that, innovation can actually then something useful. Yeah, I think you've highlighted a really good point actually. Um I think innovation is it needs to be done correctly for it to be useful. Um And part of the things that we teach with the Med Tech Foundation is um not just finding an issue, but rather finding a niche or market space and then developing a concept or idea that can be integrated into the NHS long term and something that we preach in our, in our programs of sustainability. So when um so something like a root cause analysis would help us find out what the root problem is and whether or not your innovation can nip it in the bud there rather than going on fixing a symptom, patching something up and creating essentially just a more bulky worst version of the NHS instead of a better one that's more streamlined. Um I think part of the challenge is there are also because of just how the NHS is structured and unless you've got um stakeholder by and higher up um to incorporate innovation training um ground up, teach people how to do it. Well, you won't have innovation that really fundamentally changed the NHS, which is what we need. Thank you. Uh We have a question from Shahir and he basically asked, is there any training that you do as an organization around procurement cycles or NHS procurement systems? Um not specifically, but we do teach about procurement and NHS procurement systems during our um innovation program where we have a bit more time to delve into some of the specifics. So what we do is that towards the end of the Innovation Program, while we're teaching them about business and entrepreneur and, and profit models, we also explain to them how to approach innovation within the NHS. Um And we, we get speakers or experts. Um So this is never delivered by us specifically, we have experts deliver those workshops. Um And we always have one or two sessions about um innovation within the NHS and integrating it. Um So yes, in terms of it's there within our innovation program, but no, we don't have a specific workshop standalone. Um Maybe that's something if there's demand for that, we can work on. Okay. Um I think there's no more questions. So Rahul, thank you very much for your time and your talking exceptionally interesting. Um And with that, we will move on to the next part of the schedule, which will be a, I think a video from a company called Off Oracle and it will be delivered by Mark Herron, who's the founder of North Oracle. For those of you who um don't know what Oracle is. It's an online e learning orthopedic platform. It's something that I personally use quite often and what it really does is it the main thing that it does is it, it goes through different procedures that you may come across as an orthopedic training or consultant and it breaks them into component parts. It provides really nice kind of high quality pictures and explanations to help you understand what you might be doing in the procedure. Because uh one of the reasons why I really like it is because you, you read a book, see what the illustrations like, but it never really quite looks the same in real life. And what I like about all for records, they use real time pictures. So what you see on their platform is generally what you see when you're actually by the patient with the scalpel in your hand. Um So without further do we will hopefully get uh Mark Herron's talk to begin. Good afternoon, Botha, I'm Mark Herron, uh an orthopedic surgeon and also managing editors of authority. All uh my thanks to Frank and Oliver, the voter committee for giving me giving us this opportunity to talk and to present my apologies. I'm having to pre record this. There has been a classroom uh diaries, I'm afraid um my authority email is at the end of the presentation and if any of you have questions arising from the talk or just more general questions or points about authority, all, then it would be my pleasure to receive your email. So please email me directly about about that. Um I hope most of you will have heard of authority. Maybe some of you even will be using authority. All what we are is an online platform, a collaboration of the UK based in the main UK based orthopedic surgeons um publishing on a regular basis uh instructional operative technique in particular in orthopedics. The platform is now 500 techniques strong and our USP is detailing a step by step every single step of an operation that you need to know and understand. Uh an objective is to provide one location where as much information is required to understand learning operation is provided. Um What started us off on this journey? Well, I could say it's this article from The Guardian, which is still available online and definitely worth looking up from June 2017. Um That was something which detailed really the nature of scientific, technical and medical publishing and just what a a what a very profitable industry it was. But be also really how that business model was affecting innovation. Um the main scientific medical publishers as you know, haven't innovated in the educational space in an awful long time. Um You could ask why um difficult to know for sure, but probably they have a very nice business model with a talent isn't paid. The talent is you. It's me, it's research scientists, it's people in academia. Um they've got a very tight control over the route to market and really they have no particular incentive to alter their pricing structure. So they get very high prices with very tight control, with just a few publishers producing this material. Um anyway, that's given us an opportunity. And it's also made a difference to a lot of clinicians worldwide who started file share ng, who started producing their own educational materials. And that was something which was recognized by an article uh short presentation actually by CNBC. Back in 2019, they made the point that there's uh with the far showing, there's really no quality control in terms of what's being produced. And I suppose you, you pay your money and you take your choice. There are certain presentations that are good in the certain presentations that that aren't anyway. The short version is there's been some move away from the traditional publishers in terms of how people get their information to support there, ongoing career wide uh learning. So we were already on this path and we're aware um that nobody was producing sort of materials that really were needed to demonstrate how to perform operative techniques. That was material that we as established consultants wanted to see for ourselves, for those less frequently performed operations for, for understanding new techniques that we wanted to take on board. And that was also very similar need that we saw for our trainees. Um the key to what we saw and what we do is both quality and also detail and to produce the sort of materials that we wanted to see. We knew it was going to take uh surgeons, generally with significant experience, it was going to take time to produce the materials and it was also going to take money. So that's what we set out to do. The first thing we thought about was what actually is an operation. It's um essentially just a manual tasks like any other manual task. However, um it does need to be thought about investigated histories, taken, examination made um in quite some detail. And then the operation itself. Once that phase has been completed, the operation itself is a series of carefully executed steps with a clear appreciation and understanding of the nuances of human and asked me and also in orthopedics, in particular, the nuances and variations in terms of implants. The good news for you who are trainees and also for us who are established surgeons is that there are lots of new uh tools coming out immersive interactive tools, uh simulation solutions which I think without a doubt are the way forward and a key part in surgical training, they're engaging, they are fun. My own experience with them is they also significantly assist with retention of some key facts, key parts of the operation. However, the bad news is that they are expensive to produce their time consuming to produce and a solution for any one particular speciality. An end to end solution covering the techniques of specialty needs is going to be an awful long time coming. And I think my opinion and the opinion of the team at authority is even then even when these new interactive and immersive solutions are available. At some point, you are going to need to sit down and learn didactic lee step by step and reflect on the stages of the intervention that you are going to be um taking on with your simulation solution. So the materials that were producing, I think have longevity even with the new frontiers and the new innovations that are clearly happening but not happening. Perhaps at a pace that we would, ideally, all of us would ideally like to see. So what is needed um immediately is in fact deliverable. Uh And that's what we set out to do. Um We are unique in terms of what we produce and were innovative and we are all ways involving um technology though, enables what we do. It's not really basically what we're about, we are about learning procedures and learning procedures in detail. So before we set about producing the platform, um we thought how we're going to do it. And if you go to a designer, ask them to make you a bridge, they won't, they'll still expect to be paid, but they won't necessarily make your bridge. What they'll do is they'll design you a way to cross a with a river. And that's the principle that we took, we decided, first of all, what needed to be understood, what needed to be demonstrated in shown. And then we designed a platform to support that process, but I'll come onto what we've done how we've done it. But as well as designing the front end to deliver exactly what is needed to learn operative technique and also too easily maintain and support, maintaining that knowledge. What is also as key is actually being able to produce it, produce it consistently, produce it regularly and for that to happen, it's not just about the platform itself. It's the model if you like the business model. Um it takes the right surgeons, it takes the right specialists in I T. Um It takes the support both of the hospitals we work in and also to an extent the profession and it also takes money. Um One of the key things we realized early on is that to get surgeons to produce the content that we want to produce uh would take money that we're not able to pay because it takes time. There is a little bit in terms of how long each of the techniques we demonstrate takes to produce. Uh We have a lot of uh innovative ways of using our platform to accelerate the process, using digital transcription, automatic blinding images, those sorts of things. But nevertheless, it's, it's a, it's something which will take even some of his experience probably at least several days. And most of our editors are either producing eight or 16 operations. So what we realized early on is that for people to produce their best and produce it consistently, they need to own part of the company and that's the deal we have for our editors. So the orthopedic surgeons who produce content of which we have a limited number, own a percentage of the company. Um The other thing as I alluded to was it was as important that the back end of the platform was as user friendly as possible. Uh Though I've had to learn about uh I T and I've had to learn about platform design and use your experience and all those sorts of things. That's nothing that I would have expected any of the surgeons that work with us to uh to take on board and to and to want to know. So the back end really is a very straightforward way of producing content and essentially, if you can use Power Point, you can use the back end of the of the platform. Um Every step of the way is supported by the team at authority. All. Um there are online tutorials, there are live tutorials, there is cover 24 7 for surgeons producing the content if they get into any sort of problems and all of the tools that are required to produce the content are supplied. So we have professional medical photographers subcontracted to a large NHS from a large NH Trust in, in Birmingham, we send those out to the surgeons to photograph and produce the content and we have our own uh photographic protocols that we've produced and refined over the years. So we do have content also being produced remotely. We produce in South America, we're producing in Germany at the moment about to produce in the US. And that's with third party photographers but using our protocols. Um and, and that's also supported by our photographic services. So this is the base unit of what we produce in terms of the uh sorry, I'm playing around here a bit with the uh that was annoying me. So let me just get back to uh slider apologies so that this is the the basic uh page that you'll get in authority all. Um And what you see is a higher isn't photograph here, high rise photograph. This is actually burning hip reserve seeing. This is Roman Tracy. All of our techniques are by named uh surgeons who are experienced in the techniques. And the way the pages are set up is you can jump to any particular part at any point. We start with an overview section which is not what this is, which gives the USPS very succinctly of the operation and the implants, we have an indication section which runs through Didactic Lee the sort of patient's you're going to perform the operation in the examination findings. You're looking for the investigations that you're going to rely on how to interpret them. The set up ready is a checklist of kit that you need. Uh We are detailed in the post operative protocol that we suggest people use. We provide um specific implant insights from our own editors throughout. We're very careful to distance ourselves from the official versions of the uh implant techniques, we display them or we link to them and we say that users should defer and rely on them. But what we are showing is how one particular surgeon does a particular operation and this is what works in their hands, but don't try it at home sort of thing. Um We'll come onto the other sections that we actually that we actually um provide as well. Um You can jump through each of the operations are subdivided into three, sometimes four different sections which allows you to jump through, you can toggle through front and back. Um And once you're logged into the platform, you can add your own notes to any particular step of the operation. So that when you come back, maybe you've assisted Boston doing it and when it's your turn or maybe you've assisted a few times, you'll have your own insights that you can add your own version of the platform. And those are all downloadable from the uh from the dashboard. Um The operations, all the operations are made up of multiple images here. We're obviously getting down onto the through the capsule onto the femoral head. This is a relatively short operation with only 40 steps. I would say probably one of the shorter ones. We have mostly the optics. We've got our anywhere between 70 to 100 steps. Some of them are some of the spinal operation, some of the larger shoulder and revision cases up to 200 as I say, you can just jump through these as you need. They say they don't have to be gone through one at a time. Um And at every step, what we are instructing are authors to do is not just to say what they're doing, it's absolutely key for them to describe exactly how they're doing what they're doing. So uh and that's with reference to the anatomy at risk to the anatomy that the users are going to see uh there nuances, their experience, their tricks, they're tips. Um And uh that is how we started back in 2017 with 50 techniques. And now the, the scope of what we had have is 500 orthopedic operative techniques throughout all the different subspecialties. The only one was slightly lighter light on I think is pediatric orthopedics, but they are scattered through the other uh core specialties that we, that we cover. Um what we've done. What we continue to do since we started is to add new functionality. So we publish on a regular basis. I would like to say it's monthly. It's at the moment actually, alternate monthly uh new techniques. Normally four of those come out every single month, but we also add new functionality as well. Um And that's how we see the platform developing going forward, doing both of those. So once you've read an operative technique, if you want to and you don't have to, you can do a CME module, which once you get 75% will produce a digital certificate that's accredited by the B O A, accredited by the Surgical College in England, London College and also the, the Edinburgh College as well. I meant to say that the, in terms of what we have produced or how we've produced it, what we've used is a commercially available and commonly used uh platform for building and that's called wordpress. A number of you will probably have used wordpress for building your own sites. We've, we've heavily modified it a lot of time and efforts been spent in that. But by using something that is readily available and used by other parties, number one, it's uh cost saving for us. But number two, it's also allowed us to add very straightforwardly additional bits that we've needed with readily available plug in's. Um And thirdly a big advantage of doing that has been interfacing with other platforms of which more of shortly. But um it's a common used platform, other people use it, it makes it very easy for us to collaborate and integrate content with other um providers, other publishers who are producing slightly different things than, than we're actually uh producing. Um This is quite a nice feature of the platform. So we have within our team, uh an expert in A I we're developing various different AI based solutions at the moment. But one of the early things we did was to integrate IBM Watson into the back end of the platform. So now when you've read an operative technique, if you go to the results section, one of the things that you can do is drill straight down into full text academic papers, we don't hold those on the platform. All we do is root users immediately to the relevant publishers uh where they can read the papers. And that's the only things that we're sending uh readers to look at. So there's no um proceed versions and buy a paper for $30. If you see a paper listed on our results section, then you know, it's going to take you to a full text paper. Um This summer, we've gone live with a the anatomy module with a collaboration with Bio Digital in New York. Um Just a couple of static images of their, of their platform. The um it's, it's, it's a nice solution. It's helpful. Um We are modifying it um at the moment, but what it allows you to do is to rotate the regional anatomy 3 62 to click on structures, identify those structures to remove those structures. Um And again, all a way of assisting in preparing for an operation and also reflecting after an operation, the anatomy that you've seen a nice feature in particular, the bio digital version is that once you are, once you've produced your own particular version of the image, then you can actually very straightforwardly download that for your own personal use onto your, onto your laptop. Um And that's something I think, which does add a significant strand too. Um to what uh we have available for our readers. We're continuing to develop new offerings and all of those uh will just be part of the standards of subscription price. Our objective is not to increase our cost. If anything, it's a prices, any anything is to bring it down. Um but we are hedging on the fact that our user base continues to increase and increase. And so that allows us to do that. Um As of the first of December, we're launching our first E book which will be sat behind the platform and within a foot and ankle surgery. It's a collaboration with the UK based implant company. A number of you will have heard of, I think called Auto Solutions. My experience, my personal experience of them is they've always been a very ethical company in terms of their uh the support they've given specifically to surgeons and that's been established surgeons and that's also trainees. Um They've produced over the last decade, a unique portfolio of very interesting um academic content uh from an annual meeting called the Round Table Meeting, which is um which is languished on their website on their platform. You can go see the go down there the PDF that cover a lot of different areas in foot and ankle. And what we've done with them is is um collaborated to integrate their academic content with some of our academic content. And also a lot of our images, we have almost 90,000 images uh in our database and we use only a fraction of those uh to demonstrate the operation. So we have a significant capacity to be able to add to third party content. And that's what we've done with the, with the Ortho Solutions book. Um It really is an assimilation of their content into our platform. Um It's very much a symbiotic relationship and what we've produced, I'd like to think is, is, is a chimera of us and them. If you're thinking chimera analogy wise, I think think Mermaid which is slick and alluring rather than mine, it'll badly behaved, noisy and poorly dressed also. What other things we've got coming in 2023 with luck, we are collaborating with H E and we've produced again from our core content um an interface to support the J C H S T process both in terms of procedure based assessment and cased based assessments. And this is an interface that has been designed participle, the process that you'll go through with your trainers at the moment. So an interface where you would sit down and can go through step by step stages of an operation, different fields that you are being questioned on already the approach, the anatomy complications because those sorts of things and the this interface supports all of that. This is a part of a flat foot correction. This is a Calcaneal osteotomy. And again, you can see perhaps how this is going to assist the detailed questions that you are expected to answer during these assessment processes. Um What the way the platform set up? In fact, the way our platform now is set up is that you can toggle through different versions of the screen. And if you or if the trainer wants some uh detail is unsure, unsure of the detail, then what the platform does is by just clicking the screen version, you are able to display the text that goes with any particular image. Also coming in 2023 we have a collaboration with our friends at the B J J and what that will lead to is on our, on our from our results section, be able to get directly to their free downloads. Um There are very uh forward thinking company and we've got other ways we're going to be working collaborating with them. But from 2023 possibly in the end of this year, you'll be able to see and download directly from our platform there, open source papers. Um We also in the US have a collaboration with weirdness. We've been working with them over uh an 18 month period. We're about to go live with that and that sees some of our content improving. Uh the Wheelis content with this is obviously something everybody's aware of and has been online forever. Very much is a list of things that you need to know and the format of it needs some updating, some improving. They have a very, very high footfall, it's used by a lot of people. Um And it's a pleasure for us to work. Then they're also a great company to work with. Um uh propose that we do actually have discussions ongoing at the moment about um producing some unique content for, well, this and there is absolutely a possibility for botha members post CC S T to produce uh some content to support and add to the wheels content. This would be uh an opportunity I think to have your name and potentially a trainer's name associated on one of the most used platforms internationally. Um That's likely to have legs in um first quarter, I think of 2023. So if there are any of you for whom that might be of interest, perhaps those of you coming uh to need to build your cvs coming close to uh consultant, interviews, that sort of stuff, then that is very much alive topic. We're negotiating, negotiating at the moment. And in the back of my mind when we started these conversations was that this might be something that UK trainees would be interested in participating in. So please, if that is the case then do use my amount at the end of this presentation and getting contact, we continue to be accredited by a lot of international bodies and partner with more associations than uh I've actually put on this not comprehensive list. Um I think I'm almost at time here. The final thing I wanted to say was that our platform, whether you know it or not has always been discounted too. Boater members. It's a long term discount to be, oh, a the discounts the same which is 50% from the whatever the published price is. Uh the way for any of you to access that if you would like to uh subscribe on that on that basis is to email our queries uh mailbox and just identify yourself as a Boater member and then the discount will be applied to your, to your account. Um Thank you very much for your attention. I hope that's sparked some interest and explained a little bit about what we do and why we do it. Um And I hope you will have a great uh annual general meeting. Thanks. Um So moving on from uh that video of Oracle, um we will move forward to PS Mohapatra. He is um part of the team. He's a one of the directors of innovation at Path Point Open medical uh kind of e trauma platform. And essentially, I'm sure many of you would have recognized this. You're, you're, you're doing a trauma on call at your hospital and you're struggling just to piece together the patient who's at home that you need to bring in for an operation, the patient you've just seen in any that might need to go for an MRI start to hand over and what, what each trauma has tried to do and it is doing is they're trying to digitalize that and make our lives easier. And it's a platform that has been made by orthopedic surgeons for orthopedic surgeons. Um I've used it, it's really good and we fortunately have someone here who can talk to us more about that. So about further A GPS. Thank you very much for attending. Uh and, and being able to give this talk today. Um No worries. Thank you very much Frank. So I'll just start my screen chair, right? Is that projecting through? Okay? Yeah, looks good. Fantastic. So, good afternoon everyone. And thank you very much for inviting me to talk. So as Frank, very kindly introduced me. I'm Piyush. I'm director of Innovation here at Open Medical. I'm also a consultant, lower limb arthroplasty surgeon at West Hearts. Within my role there, I have some sort of digital and sustainability kind of leadership roles as well. Um And they all kind of tie in together. So I thought I'd, you know, I'm not going to be able to kind of teach you how to build an app within 20 minutes. So it was more around my story. And innovation and perhaps to give you some ideas and frameworks of how you might be able to take some ideas forward that you have. So this was sort of our journey. It's probably a site you some of, you know, quite well. So trauma whiteboards. Ours kind of started one weekend, we came in after an on call and slightly enthusiastic cleaner had robbed the whole whiteboard away. So there's a bit of a mad scramble kind of looking for old word documents and lists and things like that trying to see how many broken ankles are waiting at home for an operation. So after that kind of e trauma version, one was born, it was a very simple database. Um you know, beyond a kind of bog standard Microsoft access database, but not much beyond that. And it was, you know, very much a Q I grassroots project since then, it kind of has changed and adapted. We've now moved into what we call path point. So this is really a enterprise wide solution um that's now competing with some fairly big heavy hitters. But ultimately, we do more than just the trauma pathway now and it covers a full end to end journey. And it's really about trying to capture meaningful clinical data and deliver data driven care. So this was our footprint back in kind of 2017. And as you can probably see it sort of ties into where we rotated through people kind of spoke to us, heard about the platform and we sort of quickly realized that we were addressing a market need that people were asking for it. And again, I think I'm sure locally you guys probably seen it. Some of you may well use it. So since then, we're now across about 100 NHS sites, we've got a couple of million patient pathways. We moved internationally um into the Republic of Ireland have a huge number of use cases. So we've really brought watched outside orthopedic. We're doing a lot in the kind of dermatology space at the moment, which has been a bit of a learning curve for us. Quite interesting. I know a lot more about dermatology than I thought I ever would um during my training and we do a bunch of other stuff like proms and National Hip Fracture Database, etcetera, etcetera. So it's really now a multi specialty multi functionality platform. So what was the journey like? And I think, you know, the one thing I get asked for advice quite a lot for people who are wanting to embark on an innovation journey. So, uh you know, I'd always suggest have a think, you know, is this something that you really want to pursue or are you just frustrated with the status quo? Because if you are, then my sort of challenge back is if you're trying to get away from long hours, always, always being on call, having a high degree of responsibility and heavily regulated environment and having being put in high stress situations, then innovation isn't really going to get you away from that. So, you know, at the moment, we as you move up and particularly as you start running and owning a company, a lot of those responsibilities get magnified and amplified. Um But ultimately, you have a much greater impact. So I think the one thing I'd always advise is, is this something that you really want to commit to? Um or as I said, is it just something that you feel frustrated with the status quo? So you have an idea and how do you go about then putting that into practice? So uh unique strengths again, as Frank kind of alluded to is we were orthopedic surgeons. So we understood what we needed. So I still use our platform every day at work. So if things are annoying or they don't quite work well, we can change them. And I think that's really important to keep hold of when you're innovating. It's not about designing a fancy sort of technical solution or coming out with something that targets a small issue that might have from time to time. This is about, can you make a meaningful difference every day? Um And at scale, because ultimately, those are the innovations that are gonna get scaled and adopted. And as you sort of seen from our footprint, we are able to do that even when we move into different specialties. We sort of understand where the real pressures are. And ultimately, it's about solving problems. And again, I think that is said quite a lot and it has become a bit cliche aid, but it really does stand true and that you, you need to listen to what your users and customers are saying and innovate in that direction. And the advantage that we have been clinical is that we understand the clinical user group better than anyone. See, you've kind of got your idea and the innovation journey. So this, there's, you know, lots of fancy diagrams, lots of sort of maps about how you can go through a process and my again experience and I think speaking to a lot of other people in this space is it very rarely looks like that and quite often it ends up a bit like this. Um And this is certainly how we started. So as we mentioned, the trauma version one was written in 2013. So going back close to 10 years now, first four or five years of that was very much a sort of local project and that was a real time of refinement. So when we look back on it, now, we learned so much that really then has propelled us forward. Um And there is an adage in technology and an innovation in general that sort of overnight successes take about 10 years. So the bit there's often unseen is this messy bit early on. So, which is again, it, it boils back down to if this is something that you want to pursue, you have to be sure because it's generally not an easy path, but it can be very report rewarding if you do make it out the other side. So these are some examples of, of programs and help. So, you know, if you've decided that you want to go ahead and you're going to pursue your innovation, um I'd highly recommend having a strong team with you. Again, a lot of innovations in the digital space. Um I'd strongly recommend the technical founder if you don't have technical expertise yourself. Um The way the current world is going and the landscape is going, development costs can be extremely high and often kill early stage innovation. Um Again, we had a sort of unfair advantage in that uh original founder is technical as well. So again, there's a few unfair kind of advantages that you can try and utilize as much as possible. So, so that would be um one bit of advice I'd really give to anyone thinking about entering that space. Um The other help that out is out there. So I've been involved in quite a number of these are the academic health science networks, really sit at the interface of the NHS as well as academia. And they can often serve to either signpost you to information or broker connections and help you evaluate and understand your innovations in practice. When you get to that stage, there are some training programs for the NHS Clinical Entrepreneur Program uh led by Professor Tony Young. Again, I'd highly recommend people to sign up to that. If they are interested, it gives you uh a significant amount of resources in to help you understand innovation, running a business and they hold regular workshop. So particularly for new to that area, it's certainly something I recommend and then um slightly more advanced ends, you have the Innovation accelerator innovate UK, um S P R I. So the last two are essentially funding mechanisms. Um they are available in order to fund innovation. And again, being in healthcare, it's an area that is currently being is fairly favorable in terms of the funding landscape. And there's a lot of interest in funding innovation in healthcare. So it's if funding becomes a barrier to scale or deployment, it's an avenue again that I would strongly encourage you to look at. Um it's an area that certainly has benefited does quite well. And we're now involved particularly with the S P R I healthcare sort of initiative, some some large national projects looking at skin cancer and various other platforms. So um there are way to help scale and adopt. Uh and in terms of what do you actually need to do the nuts and bolts of developing a digital innovation, whether that be an application or whether that be something else is the fundamental principles is you need to be agile. And that's a word used a lot in software development, less in healthcare and clinical environment where the risk is much more of a concern. So there's an inertia and a a barrier to change, but that has moved or shifted quite significantly post COVID. And there is a move to understanding, you can do small scale experiments, learn from that, adapt your solution and then run another, run another experiment. So it's about keeping that agility. And as I mentioned, the first few years of what we did was really that learning process before this was a commercial exercise. Uh And we turned it commercial because at some point, you need to scale and the best way to do that is through a commercial entity and I'll come onto that a bit later. So the other sort of critical factor really in um application development is security. So the regulatory barrier for any application is high and quite rightly. So um there's both information governance and cybersecurity, which are slightly different things, although they do go quite closely together. Um There's been some fairly high profile data breaches um recently. So again, it's just really important you have the security element lockdown as tight as you can. And you know, we take that the most seriously out of anything. Um It's certainly our the single biggest risk that keeps me up at night in order if there's a if there's a breach or an issue, um that's gonna be a thing that hurts us the most. So, and that was, again, speaks to having in house an ongoing technical expertise that you can call upon to make sure your security, everything is always up to date. All the security credentials are applied, etcetera. So clinical insight. So this is again, we have a lot of, you know, this is where an unfair advantage can be had. So leverage that we have a lot of clinicians in our company. So three of the four kind of directors, orthopedic surgeons, uh we have a few trainees who have either left or on ups. And again, there are opportunities that are available. There's talks with the Royal College of Surgeons around integrated innovation training. And I think the direction of travel, at least nationally, certainly to have greater focus on innovation throughout people's clinical careers and the clinical insights that you can bring to any innovation. So whether that be your starting your own or even joining an established organization, there's clinical insight can be highly valuable. Um So that's that kind of domain expertise that again, you should sort of think about leveraging or utilizing versatility. Ethics generally do very well in terms of versatility, they, we often are get do get thrown in the deep end. So again, it's about retaining that uh and keeping that skill set up uh knowledge. You again, people, you'll have different baselines and my advice about knowledge is stick to your strengths. There's, you will very quickly need a team, particularly you're successful and hire people to cover some of your weakness is I think there are different strategies. Do you try and increase your knowledge to make sure you don't have any weaknesses or do you try and recruit people? So again, it will depend on your innovation, depend on specifics. But I guess my personal take is try and hire a team or get a team that will complement your weaknesses. Um And really double down on your strengths and your knowledge and finally scalability. So if you're making it that far, think for scale because you don't, a lot of innovations do get stuck in that early phase. Um You know, one or two clients often where clinicians are practicing or where, you know, people. Um It's about how do you build that for a long lasting uh scalable innovation because ultimately, I'm sure that's what you're looking to try and achieve. So, uh please feel free to drop me a line. So that's my email address. You should open medical. I'm on Twitter, linkedin and various other things as well. So I'd be very happy to sort of have a conversation or discuss anything, but I thought I'd leave a bit of time this afternoon for questions. If there are anything specific to cover, I'll just share my screen. Thank you much Piers. Uh Excellent talk. Um We do have two questions at the moment. The first question is from Michael Akin fella. His question is, do you have any recommended organizations that assist or advise on data security or technical expertise to prevent breaches and ensure data compliance? I do. Um So they are various sort of consultancy firms. Again, I'll give you my own our own experience. Our own experience is we were very fortunate. We have our senior engineer has a sort of significant interest in data security. Um So we had that expertise in house. So that meant a lot of that early cost was absorbed. But there are so I think there's organizations like eightfold governance and hardy and health that have very specific NHS focused consultancy. Uh If you're looking for external expertise, ultimately, a lot of content is now available and out there through the through various channels. So NHS Digital do have developer guidelines and information governance guidelines. So NHS X had a fairly comprehensive library of sort of standards to a credit against. Um but their, their website keeps moving with the constant flux. Um And the other thing you can think about is going on in NHS Digital. They have some e learning modules including things like clinical safety, clinical risk assessments. And they'll give you a bit of a framework about uh you know how to approach clinical risk, how to approach data security, where, where the real challenges lie. But it depends on what level of technical requirement you're you're looking to get into because ultimately eventually going to end up in an engineering or a developer type sort of question and said that that's where you may need external consultancy. Um So that would sort of be my advice around data security and technical expertise. Thank you. We have the next question from Shahir and he um first thank you for your talk. And then he says, how did you manage to build validity for your platform when you were at an early stage? Especially when you didn't yet have much funding. Um And hadn't built your full kind of fledged platform. And did that involve any formal compliance work with an NHS Trust or could you follow operative route? Uh Yep. So that is a great question. And I think the, I mean, what just to give you a bit of frame of reference, this was 10 years ago. So, so that the healthcare landscape was quite different. We um did go through a sort of compliance process but the that was much lighter and it was not as formalized as it is now. And we're actually working with say the clinical Entrepreneur program on a initiative called insights to be able to give innovators a defined pipeline of requirements that you need to make, to get your innovation piloted and then adopted. So to really address that early stage challenge of what do you actually need to do to get your platform used and piloted etcetera. So I think the fortunate thing that we had was we were solving a real world problem. There was a large element of clinical risk based on, you know, the fact that the trauma board been rubbed away, et cetera. So we were able to implement a pilot of a basic data base with our information governance, documentation and security in place. Um And that fulfilled the use case. So that was effectively our pilot project and that did kind of go through a process and then you can then go through and scale. So that's the approach that we took. So that is the pilot sort of route. There is the collaborative route where you work in hand in hand with the NHS partner saying will co design a solution for you or with you. And that can be challenging because you often get into complexities around um who's going to fund that? Where is the I P gonna lie, etcetera, etcetera. So, so that can be some of the I guess logistical challenges around the collaborative route. Um The other sort of entry point is through various accelerators and innovation hubs. So I know of a few trust like Chelsea and West and others that run quite advanced innovation programs. And again, those are sometimes a route of access because you absolutely need to do through go through formal compliance work. I think, you know, that's a prerequisite. Uh And you should have that in place before you deploy. But ultimately, you're looking for someone who's going to pilot your solution and see how that performs. Thank you. I have a question. How do you ensure that you are adhering to the highest kind of usability standards for your platform? Because one of the biggest groups I have of a lot of uh kind of health technology that we use in NHS is they're just not usable, they're not user friendly, they're very difficult to get around, particularly when um you're presented with something like you say, we get friends the deep end. How do I quickly get up to scratch of using your platform without a user guide or someone telling me how to use it? Yeah. So I mean, the short answer to that question is be the end user. So I mean, obviously that can't be, you know, it's not a scalable thing to be in every case. But ultimately, we knew what annoyed as we designed the system exactly like we wanted it with everything as an orthopedic surgeon would want it. So it took a few of us. Uh and it's gone through 10 years of kind of ongoing change and we still get disagreement. So, you know, user experience is a subjective phenomenon. Some people would like things one way of people would like things another way. But ultimately, you have to settle on a happy medium. So our sort of key message is listen to the users. So listen to feedback. We do something fairly unique in our platform as well. We do level one user support. So we have a direct line to users. We speak to them regularly, people report problems and issues and, and really like having your ears open and continuously improving and delivering value will eventually get you to your sort of end result around usability because it's about where your focuses and and and our focus has always been to deliver maximum value to the clinicians. And what we're confident that if you provide a platform that clinicians love and can use well, that, that will have massive benefits to hospitals and patient's both on operational and a sort of patient benefits perspective. So that's always been our emphasis. I think where a lot of health tech falls down is they are often targeted at different aspects of they, a lot of targeted at say the financial elements or the operational elements. And they don't think about, well, how does the actual end user is going to be using this every day? Really get maximum value out of this system and, and, and there's no sort of ongoing development and change and improvement. Thank you very much. Um Oh, we've got uh I think we've got another question. So we've got a question from Ravine and he says that this will be our last question. How do you integrate your platform with existing NHS systems? Uh There's already 10 programs at a single site um kind of at your day to day job does path point linked to existing NHS path platforms? And how does, how did you make this happen? Or is it just a standalone platform to solve the solu? Uh great question. So integration is a or interoperability is the holy grail in healthcare? Um There are again, we're very fortunate, we have quite a lot of in house technical expertise and have done pretty advanced in this. So we're integrated at national level with things like the national spine. So you can put in anyone's NHS number in the whole country and you will know who that patient is about. So which patient that is? So that is, you know, something that is fairly advanced. Now, there are other applications that have that, but we've integrated with the spine, we've integrate with the electronic referral system. So now any elective referral in theory can end up on path point. So there are that those National level integrations and then you have local integrations which require direct work with the hospital departments. And this is sort of getting patient's hospital numbers, sending documentation back into the specific E P R or patient record. And again, we kind of currently have a sort of five man integration team and that is all they do is really build interfaces and embed the solution into existing NHS applications. But ultimately, we're a fully cloud hosted solution and we want to provide maximum value to users. However, that may be and often that we find is actually if you can look at your trauma list incredibly fast on your phone at home, do you really want to be logging going through a VPN? Putting your smart card in logging into a VP VPN and then your E P R to get to that same end result? Or do you want to be able to look at your trauma list? Uh I G secure way on your phone and we find that users will automatically navigate to the way that is the most efficient. Uh you know, most clinicians sort of see that they'll, they'll, they'll do, how can I get my job done the fastest way? So it's a bit of a long winded answer to say yes, but we're integrated with lots of things including all the big GPRS like Cerner, etcetera. Thank you very much. That was an excellent talk. Really. Appreciate the time. Pierce. No problem. Pleasure. Thank you very much for me. Yes. So we'll move on to our next speaker who is Fill McElhinney Fill is the CEO um of medal, which is the platform that's currently hosting uh this innovation session. Uh He's a previous uh NHS doctor, I think he was in Cardio for Essex. Uh And essentially what medal does is it, it tries to make healthcare education more accessible. Um three technology and so without further due, I'd love, I'm very kind of honored to uh introduce Fill, who's done excellent work for Botha so far. Thanks Frank. Just to say it's, it's a real honor to be here. And I, I really love kind of seeing all of the amazing innovation that's happening around uh the NHS around healthcare more generally. Thanks for the opportunity to share a little bit about metal. Why we do what we do perhaps more than what we do. Um And I'm really happy to, to kind of take questions at the end of there's time, my background is as uh an NHS doctor, I was an academic in cardiothoracic surgery. And I actually transitioned then into med tech, really to try to solve some problems that I have felt as uh as a registrar, uh accessing teaching and training, making it accessible in a uh in the most appropriate way, but also some problems that I've seen in kind of global health and uh really tried, tried to solve healthcare training at a kind of global scale. Why does that matter? Well, this is the number that the world health organization has described as a workforce crisis in healthcare. We need to train 18 million more healthcare professionals by 2030. That's one third more healthcare professionals than we currently have on planet Earth. But it takes 15 years and $700,000 to fully trained doctors in some parts of the world. And when you couple that, with what the lancet describe as severe institutional shortages in our healthcare training capacity. We have a bit of a toxic combination. So we need to train a third more healthcare professionals than we currently have on planet Earth. But the lancets say that we face severe institutional shortages even in training, the doctors that we already have. And here's the thing where the problem is at its greatest resources are at their at least. So there are 11 countries on the continent of Africa which do not have a single medical school for the entire nation. There are over 20 which only have one medical school for the entire nation and as a healthcare community, um this is something that we really need to lean into for us as a team that was intolerable when we started to look at some of these problems, but it's not a problem that's confined to somewhere else in inverted commas. These are headlines from high income countries around the world from the last 12 months in the UK. Uh the use headline well that the NHS faces it's worth staffing crisis in history. And when you look at the cost of surgical training, uh speaking to a room of budding or current orthopedic surgeons, you can begin to see why that is a bit of a problem. This paper from the Association for Surgeons and training, talks about the cost of surgical training to the individual surgical training and this is only as a postgraduate. So it doesn't include the 200,000 lbs of student loan that many um uh surgical trainees have already accumulated. It talks about the cost of surgical training being between 20 and 26,000 lbs to the individual surgeon up to 71,000 lbs. You were training in oral and maxillofacial surgery and the top. Right. You actually see the cost um of course is and conferences to individual trainees in every single year of their postgraduate training. So surgical trainees are on average spending 1300 lbs in courses, conferences, travel and tickets per year out of their own money. And that's in 41% of cases where uh they absolutely received absolutely nothing from their regional study budget. What does that mean? Well, when you combine it with the reduced buying power, medical salaries of about 10% in the last 12 years or up to 20% in the last 16 years compared to retail price index according to the British Medical Association. You can see why that's a bit of a problem here too. It means that it can turn healthcare training into who can most afford it, who has the best connections or who lives in the right place. This is a quote from Maria Prial who is on an event being run by Botha today on another event. In fact, on metal and she said um as a widening participation, doctor money is and always has been tight. Study budget covers one big course or maybe 2 to 3 small ones. And to meet course surgical training needs, the wealthy can easily treat the tick box, treat the application as a paid tick box exercise with little actual development. And again, as a healthcare community, we should find this intolerable. We want the best trained doctors for our patient's not those who can most afford it. And that's where we kind of landed at metal. How do we make healthcare training more accessible, not just for people in some far off place in inverted commas, but how do we do this in our our own country for the people who don't live in our own city? Who can't travel to courses, conferences, events. But also how do we welcome colleagues from around the world at our courses, conferences, teaching and training sessions, but not only, not only kind of one or two events, but how do we, how do we do this at a scale that allows us to begin to solve that really big problem. We need to train 18 million more healthcare professionals. And when you actually dive into high, those events are being run, particularly since COVID, we saw a really recurring pattern. We saw healthcare organizations, wonderful healthcare organizations being stuck with technology which was not fit for purpose. And it's really interesting to hear what piece was saying about us just having technology thrown at us that it really isn't usable. And when we looked at how healthcare organizations were running their training courses, conferences, events, teaching sessions. We saw a really consistent pattern happening. We saw them setting up an Eventbrite or a Google form to take registrations. We saw them binding people to a zoom or teams call. We then saw another Google form or a a surveymonkey being pasted into the chat box. In that Zuma teams called to collect feedback ubiquitously across the country. That was some per soul in an office somewhere who was copying names from a Google sheet into a Microsoft word certificate template, saving them as PDFs and E mailing them out to all of the attendees. We saw people downloading a video from Zuma teams because they only had a gigabyte of storage. They were editing it in um movie, they were then re uploading it into youtube or Vimeo and then adding in the same Google former Surveymonkey for feedback on the on demand content. Then Steve in the office was having to do all of that certificate uh creation once again. And we thought my goodness, we need to train 18 million more healthcare professionals one third more than we currently have on planet Earth. And this is the system that we expect our healthcare professionals and healthcare organizations to work with. We ain't gonna do it in this way. And so we started to think how can we solve some real problems for these healthcare organizations? The big problem is grand. It's bold, it's visionary, but how do we do that. We need to solve some really small real life problems on the ground and there's a really good one to start with. So what we did was we just lined all of those things up. We lined up registration right through to on demand content. We automated it to the healthcare professionals who are super busy can with about three clicks, set up an event and automate absolutely everything. And not only did we do that, but we really considered how does this technology impact the person in the world and to reduce inequalities? Why? Well, this is a quote from Dr Tedros that really inspired me, inspired us as a team, a tech conference in 2020. He said, ask yourself every day if your technology works to help the poorest in the world and to reduce in equalities. If we use it correctly, technology can have a leveling experience for our community. If we use it incorrectly, it can create more barriers. And so we really considered how do we make healthcare training more accessible, not just for the people in our own country, but people in some of the most challenging circumstances around the world. And when we looked at how healthcare organizations we're beginning to run their events. So many of them were happy and well welcoming to colleagues who maybe weren't able to ever join before during COVID. So they were they were welcoming people from beyond their own country from beyond their own city to what was previously a national or regional event. We saw people from around the world join, joining those teaching sessions. But we saw some anxiety, we saw anxiety around zoom license limits. So if they had an institutionally zoom license for 300 people, there was an anxiety about making it more accessible to more people because uh they had a remit to actually teach and train the people in front of them, not the thousands of people around the world. And so it metal we just lifted the limit on that to the an organization kind of stuck to 10,000 people on an event without any anxiety about making it more accessible. We looked at how organizations were running events, some were running, paid for events, we can help them facilitate those events, but so many of them were also running free and open access events and we're really passionate. We have to be about more than just the bottom line as a team if we really want to effect change at a global level. And I really love that um that, that conversation we've already had today about how do we um uh not just to stick a sticking plaster plaster on with our innovations, but how do we really be bold and innovative in how we approach innovation to solve a really big problem? Then then we can't be another barrier. If our goal is to make healthcare training more accessible, then we cannot ourselves be another barrier. So those organizations who are running free and open access events, there was almost no point in us charging them to use our platform. So we made it free and open access for them to run free and open access events. They can host up to 10,000 people and fill their boots with, with the platform is the right thing to do. And it makes healthcare training more accessible, not less for those organizations that do you have to charge for their events? They've maybe got team members, they've got offices, they've got resources they need to pay for. That's okay. We all need to put food on the table. We all need to feed our families and um and the economy is how is how that happens and, and wonderful organizations do need to charge for people to attend their events. But we saw so many of them want to make them available to colleagues in lower middle income countries, but they didn't want the PFAFF that went with it. So what we did at Metal was we actually added a special ticket type called Fair Medical Education. And what it allows organizations to do is add a special ticket type to their events. We're happy to process all of the tickets for their paid for ticketing, but we add these special tickets on for colleagues in lower middle income countries which allows them to offer their event for free or a significantly reduced cost and our technology will do all of the verification and automation for them to check that they're actually joining from a lower middle income country. And the organizations you see on the screen have all signed an open letter to the healthcare community to say just how important this is organizations want to do. And our technology was, was there ready and able to help them. How do we work to the art? Technology helps the poorest in the world and reduce in equalities. And taking that step further, we actually looked at accessibility from a uh an internet perspective. Then we know that live is great, but it's not always a magic bullet. If the internet drops out, if there's a connection issue, actually being able to watch on demand is really, really important. And it's something that has become a thing in the last couple of years. And it is particularly important for colleagues joining in low resource settings. Being able to join a live virtual event is not always ideal because they need to join at a time under an internet connection that suits them. Actually, if you're joining a high income setting, but you just live in Auroral part of it like I do. And uh namely Northern Ireland, then you need to be able to join on an internet connection that suits you as well. So actually being able to watch on demand is really important. And so we added uh feature for organizations to, to simply click one button and make their event available on demand with feedback, forums, automated certificates uh for colleagues who weren't able to join for the live event as well. Just thinking about how do we continue to make healthcare training more accessible? What is that resulted in? Well, the numbers you see on your screen are the collective impact of a community using metal. In the last 18 months, it shows the power of collaboration. It shows the power of working together in this space. 1600 healthcare organizations have helped to deliver almost 5.5 1000 events to colleagues in 171 countries. They're only are 100 and 95 countries on planet Earth. What's really exciting is that those organizations come from 20 countries. So we've got 20 countries worth of organizations, teaching and training colleagues in 171 together. We are stronger and we can, we can leverage technology to really make an impact on global health. Does it work? That's the question. Well, I come from a surgical background. If you told me that you could teach surgical skills online a few years ago, I'd have laughed you out of the room. But this is a really interesting paper from Mathias for of I where they did just that. Um uh my test for a very, is a researcher at Imperial College, London. He's also General surgery registrar and one of the senior authors is David, not from the David not foundation who helped to deliver surgical training and some of the most challenging war torn settings around the world. And what they did was they compared uh face to face basic surgical skills course with an online basic surgical skills course and they compared the outcomes of both groups afterwards. And this was their result, there was no significant difference in the competency ratings of delegates receiving online teaching or face to face teaching. And in their discussion, they actually talk about how online teaching of surgical skills for early years training is an appropriate alternative to face, to face teaching and breaking down geographical barriers. That's particularly important in some of those low resource war torn or challenging settings. Not only that, but they actually taught 553 surgeons in 20 countries on a single day. They used metal uh to, to do it. The first time we heard about it was when the paper was published. So we didn't have any editorial impact on their paper whatsoever. Um uh And for me actually was a, it was a really interesting uh finding really innovative work and they're actually moving on to do that in a laproscopic or minimally invasive study as well. We can use technology uh to, to, to scale up the amount of surgeons that we train as planet earth. And I think the last two years have given us the fire in our bellies and the confidence that actually this is possible, but it's not just an imperialistic high income country takes low income country thing. If we want to make this work, we've got to do as a global community. And what you see in in front of you. The moment is uh some screenshots from an event that was run in Kenya. Um in November, it made Kenya news on the news. There is the Vice President's of the College of Surgeons of Eastern Central Africa. You're using metal to actually deliver anatomy course to colleagues in auroral selling around the country. And interestingly, they also welcomed colleagues from around the world at that event as well. So this has to be a community effort. It cannot be some sort of imperialistic thing. I got to skip to, to last stories. The the screenshot you see on your screen at the moment is of uh an empty podium at the global anesthesia surgery obstetrics collaborative meeting. And this was a wonderful group who made their event accessible and they added online tickets using fair medical education uh technology and they doubled their attendance numbers and they had the kind of same number of people attending online, but they also had colleagues from around the world attending online and it was a two day event that was hybrid. And uh in that two day event, there was one comment or question in question times that got a round of applause and it was from a colleague in Kenya who said that the only way that he was actually able to join was as a result of those fair medical education tickets. He paused, the audience paused for kind of 10, 15 seconds where there was silence and then they erupted in a round of applause. And I think collectively as a healthcare community, we do care about this. I think as, as doctors, we go into the profession wanting to make a humanitarian impact. And that round of applause for me actually spoke volumes. It wasn't the cleverest research or the brightest question that got a response from the audience, but it was the widening access that technology and the right mindset was able to bring and it really does begin to make an impact. This final story is just a story about how this works about the impact that this can make when we work together. Um We actually verify colleagues when, when they're joining medal, it means that organizations can make their events more accessible whilst keeping the events safe. But one or two times per week, we get questions to say, I haven't been able to verify myself for whatever reason, I would usually get one or two of them and we have a manual process to help those people. But in a single day in the spring of this year, we had kind of high tens into the hundreds of people reaching out in a kind of 60 minute period to say they couldn't verify themselves. And when sue heads up, our support team reached out to those people to ask, why can't you verify yourself? The same consistent response came back. I didn't think it was important for me to get a letter from my dean to say that I could access metal and I haven't got access to my institutionally mail addresses since I fled the country. And what we found was happening were was these were all Ukrainian medical students who had had to up sticks and leave in a matter of moments and they had their entire curriculum flipped online. Um It was delivered by an NGO in London in, in partnership with the Ukrainian Medical Schools Council. What the NGO did was they recruited 250 doctors from around the UK to deliver education to Ukrainian medical students and to keep medical education afloat during the war. And what they did was was incredible. They taught 2000 Ukrainian medical students seven times a day every single day for two months and they weren't doing it as again, some sort of imperialistic UK teach Ukraine thing. They were doing it because the colleagues on the ground where all trained clinicians and instead of them having to deliver face to face medical education, they were freeing them up to provide face to face patient care, to bolster the medical resources of war torn country at a critical moment. And it made it made the news, which was cool. It was a wonderful organization called the Crisis Rescue Foundation. This is what one of the professors from Nip you had to say, thank you for everything you're doing for nipper and for all the people who are trapped in this situation. And I love the fact that they use the word people there because I think that has to be the focus of any innovation that we're doing. We need to train 18 million more healthcare professionals by 2030. We believe that Metal, that the only way that we're going to be able to do that is by radical collaboration by using technology in its smartest possible sense and by making our education more globally accessible. If you want to get involved, you'd be most welcome. If you wanted to host a training event, metal door slash host, if it's free and open access, fill your boots or technology is free and open access. If you want to find an event to attend metal dot org slash events. And if you just want to watch on demand because you live in neural Northern Ireland like me then metal dot org slash on demand. Just want to leave you with this one last quote. It comes from someone who backed us from day one. She's a wonderful person called Sarah Frier. Um She is the CEO at next door, which is a social network in the US. She's on the board of Slack she was Jack Dorsey's uh CFO and she's on the board of Wal Mart and her brother is an atheist in Scotland. And so she felt the pain of medical training. Uh but she said this, the metal platform has enabled and impaired. Uh And I'm not reading the side to bang our own drum. But it's because I love these two words. And if we can get this right, not only as medal but as a medical community, we've got the opportunity to make some sizeable change in healthcare education. The metal platform has enabled and in part, I love those two words, enabled and impart the medical community to deliver medical education at a scale. Never before imaginable. And we believe that's the right place for us as technology for us as a platform to enable and empower. This cannot be all about us. It has to be about the wonderful healthcare organizations who are already delivering amazing education and if we can empower them to do that in a more scalable way and a more accessible that way, then then we've got it right. Thank you. Thank you very much, Phil has a really excellent talk. Um Does anyone have any questions for Phil? You've got one question I wanna, it's just a, it's just someone who's uh thank you for, for the talk and another. Thank you. I think I want to echo the sentiments to say thank you. Fill the work that you've done. Absolutely. Fantastic. And uh and uh and you know, I want to reach out and say, thank you on behalf of BOTHA for supporting our conference um uh over the last few months and being our partner in all the list this year. So honestly, from a lot of my heart, thank you for everything. I have a question fill. Um Say you are an organization that wants to provide some medical healthcare related teaching and you want it to go to a part of the world where you think there is need but you have no idea. You have no context, contacts or any sort. Can medal. Can that organization come to medal and say, look, we have this teaching program. We'd really be keen for it to be screened to people in Ukraine or wherever it is. Um Can you help us to find those people and, and link us? Yeah. Yeah. Really good question. And I think that's the part of connectivity, community and network effects in some ways. So what we've seen is some really interesting stuff happened. We can't, we can't magically force people to come and attend teaching. But what we can do is um uh we can, we can leverage the fact that we are a community, we can leverage the fact that people here attending an orthopedic event run by botha are probably interested in orthopedics. And on our kind of suggested events, we can actually begin to suggest more orthopedic events to them as well. Um And we've seen the real power of that. So we've seen uh colleagues from uh kind of 50 countries joining events where there was previously only one country worth of attendees uh joining. And um that's really powerful because we don't, we don't necessarily limit it to just one country. But actually that teaching and training, if you're targeting colleagues in Ukraine, probably is also going to be relevant to colleagues in France or colleagues in Uganda or colleagues in the US or Uruguay or wherever, probably gonna be interested in that as well. So we try not to put limitations on where um where those people attend from. But also in that is one of the greatest strength. So we can really leverage that network in fact. And we've now got kind of hundreds of thousands of uh medics viewing metal events um kind of every, every single month. So um uh real power comes from when we work together as a as a as a community. Um So yeah, doing teaching journey, we can help it kind of reach multiple countries where you might not have connections, we can't force people into them, but we can certainly increase the visibility of the teaching and training sessions. Perfect. There's another comment in the comment section from to here. He essentially just says, thank you for your helpful and for how much you've helped the six PM series uh for supporting us to provide teaching to over 30,000 people. That's really impressive. Um What is the six PM series? Yeah, I could probably fill you in but uh here to here my might do a better job in the tab books, but just, just to come back on that. I mean, the people who are saying thank you to you guys who are saying thank you. We echo that right back at you. Um And I think we've got, we've got to be in that position where this is, this is teamwork, this is us working together. It's about, I don't know a thing about orthopedics, right? Like I absolutely no, nothing. Don't ask me about whether it's inter capture or extra capture any of that stuff because I don't know, but you guys do and uh what we have is is uh some technology that can enable and empower people. And I think that has got to be your posture. Um Is this is total teamwork and the thanks goes two ways. So it has to be um has to be that kind of collaborative effort to thank thank you for you guys for kind of believing in our mission and, and, and we hope to be able to repay that with, with all of our support. Perfect. She has come back and, and he uh the 6 p.m. series, the junior doctor led teaching program or platform aimed at medical students. Um and they collected over 15,000 feedback form. So obviously, if there are any medical students here. Uh definitely look out for the 6 p.m. series. So moving on to our final talk of the schedule. Uh we have K Z A dragon who is from B braun and she'll be hopefully talking to us soon about innovations that B braun have um that can make our job and life easier. Mhm. While we're waiting for uh a little technical problem, um I just want to say thank you to all of you for attending the course today. Um We appreciate uh you joining us for the First Boat innovation course. We hope that you've enjoyed all the speakers uh and the topics today and uh I hope you've taken away something from it. Um We hope to have a few more webinars about the year, like I mentioned earlier on, hopefully in partnership with our, with the Med Med Tech Foundation, which will hopefully give us a deeper dive into the innovation pathway and some of the things which we can achieve with the foundation. Um And um this, this is the last speaker of the day. So hopefully, once, once we're done with this, we can let you let you go free. I know it's just past five o'clock and people are keen to kind of get off, but we hope you can stay with us. It's a short talk just just over seven minutes. So um if you can bear with us, that would be fantastic. Again, if you have any questions, feel free to put it in the chat box and uh continue to interact with boto across the congress. For those of you who are joining us face to face. Uh Please, please do come and say hi. And if you're joining us virtually continue to interact on the metal platform throughout. Hopefully, I think we're good to go. Hi, everyone. It's a great pleasure to take part in this innovation course session. I want to thank Oliver for inviting me. I look forward to join you in person on Thursday and Friday and I look forward to meet many of them. Uh Today, I'm gonna focus on explaining what is the escalate way when it comes to the principal's in design of our power systems portfolio. Hope you're gonna enjoy this presentation. Our company has over 100 years of experience in power tools industry and as one of the global market leaders, we work very closely with different customer types from all over the world. These years of experience help to gather a lot of information how to high speed drug system and orthopedic drug system should look like let's have a closer look at a coupon for typical orthopedic battery driven range to address the needs of orthopedic hip surgeons. We have developed a strength oscillating. So handpiece which is brilliant for a vision hip surgery allowing you to reach far when you have obese, large patient on the table. And also allows you to, to use a shorter plates to avoid the public of those long ones. There's two handpieces on the screen share exactly the same attachments portfolio. You can find them in orthopedic trauma as well as orthopedic spine surgery. There are various of attachments for leaving drilling Kershner wire, so attachments, but this one on the slide is extremely interesting. We are offering a screw attachment which is combining electric and manual mode in one which means you can drive your screw um electronically but finish tightening to avoid over tightening with the ratcheting manual function. If I try to gather all the design principles that apply to the actual um for orthopedic drill range, I would like to tell you about the three core values. Number one hour drills are made out of titanium material. This is very unusual. Titanium is very lightweight and resistance to alkaline detergents which I used in CSSD Department and might cause discoloration or corruption. Secondly, we use sensor less motor technology which means we take all the sensitive electronics away from the sterilize a bill hunt pieces and we place them into nonsterile battery just to protect them from getting damaged. You will also note on this image that the battery housing is incorporated into the handle. So there is no bulky battery housing sitting at the bottom of the drill. The last key design principle applies to the Washington structures for the argument for where every handpiece, every attachment is cannulated allowing for flushing through them, making sure that our drill is perfectly clean every single time after use. I would like to tell you a few words about the Ellen for high spectral system because you can find this betrayal in orthopedic spinal procedures, of course, neurosurgery and T max packs, plastics, but also in a hand and food trauma. This is probably the most exciting slide of the whole presentation today. I'm gonna tell you about the fundamental revolutionary changes to how power is delivered to the drill. Let's talk about direct drive technology. The angled gear mechanism that you see on the slide disappears in design of Ellen fall when power is generated, runs straight onto the cutting too. So Ellen is extremely precise and has a very smooth transition. The economics of the drill improved as well. The design is combining the angled handpiece with the straight handpiece. The second in credible and very unique development. It's introducing a validated clinic method for the high speed drug system. Even four introduces uh the raising device which is used by CSSD department in the water doesn't factor and meets the high standards. Now expected from even more stringent NDR requirement for not only external but also internal turmoil disinfection. This process reduces the risk of infection but also contamination and readmissions. When you think about high speed drill systems, the decontamination process varies from manufacturer to manufacturer and we strongly advise our customers to always review the instructions prior to purchase some of the models ran up to 90,000 rotations per minute. So using this kind of greasing devices help to make sure that the validated clinic method is followed. We are very proud to say that escalate received the red dot prestigious award for design of the enough. Okay. We feel very lucky at the Brown SQ lab that we can work with number of experts from different backgrounds. And our power systems team is really large. But at the same time, we always like to work closely with the customer and we encourage this inclusive look at design of our products. We have made significant improvements in design, our console food pedal, uh battery charges, we have different technology batteries today, then we have a few years ago. So just a few words about diversity in design. When it comes to the nonsterile outside of the 12 wireless foot pedal, this is the most popular option today and this this one for uh L info can be immersed into the water, which is absolutely amazing, which is very unusual feature for clinic has a number of functions allowing you to control the sterile handpiece from underneath the table. The console is a very classic, very simplistic escort of design. However, the number of functions and the software upgrades uh are quite amazing. Uh The battery that we work with today is the same that we have in our mobile phones and to the grasses. I strongly encourage you to have a go and give it a triumph. This is one of my last slides and I would like to dedicate it to the details of our portfolio, the accessories and this one slide applies really well to the female group of surgeons, those surgeons who have quite small hands, uh use two hands technique for example. But at the same time, the design of the successories is so universal that can also prevent theater manager buying additional dedicated countries by using this holding sleeves, we can reduce the length of the high speed bearing countries or create a meaning the invasive environment and improve the site of view, eliminating the need to buy a dedicated meaning the invasive ilam for countries. I will try to summarize my presentation today on diversity in design and try to give you some take home messages. So even for an a coupon for on the to streamline universal power systems lines serve all of those clinical specialties and diversity in design, the success that made us one of the global market leaders in power tools industry, I believe comes from the fact that our design team is very diverse. You our customers are members of this design team and together we produce a really big impact when building designing our products. And I believe that this way we are able to design for more inclusive experiences that reach global audience and better self, all of you. So I want to thank you so much for your attention. I hope you're gonna pop into our stand and have a look at our products, have a go play students for yourselves. There is also a very interesting range of SQ orthopedic uh line of instruments that my colleagues will be more than happy to present uh with you the evidence data. So enjoy the rest of the meeting. It's been absolute pleasure taking part in this session. See you also so much for your attention and I look forward to meet up in press and soon. Thank you. All right. So that was our final talk. And so we uh come to close of the session. Thank you very much uh to everyone for attending. Uh I think we have some really interesting talks from a variety of different um kind of uh people and innovators uh within orthopedics as well as the surgical space. Um If you have any feedback for us, uh a feedback form will, will shortly come up on your screen, please, please please fill it in. Um And if there's any sort of final remarks, please put it in the chat. Uh Otherwise, yeah. Well, we'll leave it there. Thank you for attending. I just remind those who may not have had the chance to get a virtual ticket for the both congress that they're still available. So feel free to tune in virtually Violent metal platform. Uh And hopefully, we'll see you soon.