Ep. 16: Richard Vincent, CEO & Co-founder of FundamentalVR. Topic: Virtual Reality in Healthcare
Kathy: Welcome to Episode 16 of the Smarter Healthcare Podcast. Our guest today is Richard Vincent, CEO and co-founder of FundamentalVR. Richard is here to talk to us about his company’s new virtual reality solution for surgery, which combines VR, haptics – which is the sense of touch and motion, deep data, AI, and multi-modal learning. We also talk about other applications of virtual reality and what changes are on the horizon for healthcare technology.
I hope you enjoy our conversation.
Kathy: Richard, thank you so much for joining the podcast today. Could you start by telling me a bit about FundamentalVR and why you decided to start the company?
Richard: Hi, Kathy. Thanks for having me. It’s a real pleasure to be here. Yeah, I’d be delighted to. I founded the company with a partner of mine about six years ago. I’m a technologist by background, and I was really interested in the application of virtual reality to a big problem that’s been around a long time, which is how do you teach surgery in a safe way, that doesn’t cause damage for either the surgeon or the patient? It’s a very precise capability and science, it’s a very imprecise learning curve. So finding ways to accelerate that was really what I was interested in. And that was the impetus to really move this amazing technology into this very needful space.
Kathy: Now surgeons have typically trained for procedures either using cadavers or live patients. How does your solution complement that, and is it your goal to fundamentally change surgical training?
Richard: I wouldn’t say it’s to change it. But rather to augment it. And really accelerate it. I think if there’s one thing we exist for it’s really to accelerate the adoption of surgical techniques, products, procedures through the technology that we’ve got. So, absolutely, we sit alongside very well-established and reliable skills transfer modalities. But what we’re able to do through the technology that we use, and particularly with the haptics that we have within our system, which is that sense of touch, we’re able to give vastly improved ranges of repetition. We can bring that experience to somebody at the point that they need it in their location, particularly important in the world of COVID, and we can give them really, really precise feedback on the way that they’re performing, how they’re improving, where they have skills or knowledge or movement issues, and really to precisely develop their skills in a way that is difficult to do in traditional training techniques.
Kathy: Now talk to me a little bit more about this notion of haptics. What exactly is it, what’s so important about it, what are some of the benefits?
Richard: Yeah, haptics is one of those words that a lot of people haven’t come across. And then when they hear about it, they hear lots of different definitions. So I’ll try to keep it simple: Haptics at its simplest is the sense of touch. But it’s so much more than that. Haptics can range from what we call cutaneous haptics, which is a sense of interaction on your skin, so kind of on your fingertips, through to kinesthetic haptics, and that’s where you get into weight, pressure, resistance, force feedback, and being able to cover the full range is important but actually when it comes to skills transfer, to try and build up, in effect, muscle memory, what you need is to be able to feel what it’s like to do it. And that’s where we can really come in with kinesthetic haptics. So we spent five years of technology investment and clinical input to build a library of what we call haptic VR capability. Which means that we can simulate the precise interaction with a subcutaneous tissue or a bone resection or an injection into a subretinal area. All of it goes through that one haptic capability. And what it does is it allows you to really understand again not just what it looks like to do it, but what it feels like so you can get that sense of how it feels when it’s wrong and how it feels when it’s right. And it’s through that process that you build up that muscle memory and it’s that that then allows you as a surgeon to really start to build that new skills level.
Kathy: Now have you received any resistance to your technology? Have people come to you and said, “This isn’t like you’re doing real surgery?” It sounds really interesting to me, being able to feel the pressure and feel what you’re doing is right and wrong, but I think there’s some people out there who will probably say, “You’re not practicing on a real person.”
Richard: Yeah, everybody has their view on what’s right and wrong when it comes to the ways that you should learn. And again, I emphasize that our system fits into a matrix of different skills transfer approaches. Some people have that view, that actually this is not necessarily the ideal way of learning. And I counter that one with the benefits that you get from not having a live patient interaction and therefore no impact on anybody. The ability to repeat, the lower cost at scale that systems such as ours can deliver, and the precision. So what I mean by that is often in a scenario where you’re learning to do a new procedure or activity or use a new drug or medical device, the assessment of good performance is fairly subjective: It’s normally another person who’s making an assessment of what you’ve done. And that’s fine to a point. But when you’re dealing with very precise, very minute interactions, often you need a little bit more than just an observation. And that’s where systems such as ours that can say down to a sub-millimeter level how precise you were in your interaction is really, really important. Particularly in a world as we move into some value-based care, where actually the patient, the surgeon, the institution, and the life sciences business all want to know that actual performance will be as effective as possible at the point of delivery. We can just give a much better torch light towards that capability.
Kathy: Now how does your solution differ from other types of simulation for surgeons?
Richard: I think the haptic capability is probably our biggest single differentiator. The, as I said, there are a number of different versions of haptics, but to achieve that skills transfer you really need that kinesthetic haptic capability, particularly when you’re in very, very precise areas. So that’s probably our single biggest differentiator. But then the other area is having a scale platform. There are a lot of great organizations out there who are able to make a simulation. And there’s a lot of people using VR today. But actually, to be able to scale that globally, to get it into the right places at the right time in the right way seamlessly and frictionlessly is difficult, and that’s a key point that we’ve got. I think the other one is about future-proofing. We’re in a world of virtual reality and haptic feedback and technology and it’s all moving really, really fast and it’s all really exciting and the danger with that for a lot of people is, “What if I buy or invest into the wrong area?” Well, our platform future-proofs that. So we’re able to say, “Look, just come on the journey with us because we know that whatever investment you make, it will carry forward within our system.” And I think the final area for us is one that we worked really hard on which is about being hardware agnostic. Because again there’s lots of technology out there and what you don’t want to do is pin yourself to one particular flavor. So we’re able to say to our customers and clients, “Whatever the best is, our platform will support it.” So it’s future-proofed and it’s agnostic to headsets, haptic devices, computers, Macs, et cetera. So it’s kind of in those areas.
Kathy: Now your platform collects a lot of different data. What type of data do you collect and what can your customers do with that?
Richard: Yeah, it does. Enormous amounts of data, from the really simple - how many instances, what sort of repetition have you achieved, how far through procedures have you successfully navigated? We record all of that but then we go into another whole level of measurement when we start to look at approaches, the angles of approaches, the trajectory and the pressure that’s applied. Because of our haptic system we can take it down to this minute level of understanding whether something’s been pushed too far, too hard, and then we take another whole area of data assessment in as well as knowledge, we also take in telemetry. So there’s a number of long-established, validated measures of medical and surgical capability. Things like eye movement. Where and how you look at your patient in the surgical site is a good predictor of your confidence and your skill level. So we measure your eye movement and we feed back on that. We can see as the validated studies have shown, if you’re experienced and confident and competent, then your eye movement is very small. And if you’re less so, then your eyes tend to be moving around a lot. Another example is telemetry. So your hand movements, so the efficiency of your hand movement and how your hands, whatever they happen to be holding at the time, whether it’s a scalpel or a drill or something else, how those move in and out of the field of surgery. Again we can measure, predict, and map those pathways and use them as ways of assessing and feeding back on how your skills are developing, or not. If they’re slipping back in certain areas we can identify that through the data that we build up. And we think this whole area – we’re just scratching the surface at the moment in terms of providing real-time feedback to our users on exactly what they’re doing within each procedure. But over time as we start to really apply our machine learning to that, we can really start to give a clear indication of where risk lies within systems, which is really exciting, and again, back to that whole trend towards value-based care, when you need to know that the outcome is a positive one, we can start to be part of that journey of giving a predictor to positive outcomes for patients.
Kathy: That’s really interesting. It seems as though some of the things that you’re measuring, like the eye movement and the hand movement, are probably things that haven’t been measured in traditional settings. So I imagine that as a result, medical schools will probably have to even change how they’re evaluating students.
Richard: I think it gives them a whole new set of tools to understand, and we’ve seen some examples of this, where some of the institutions we work with have used our system to see at the very early stage whether or not a training surgeon can triangulate and work out the trajectory of a particular device or a technique within the body. They can use our system to understand that sort of area. But actually, at the other end of the extreme, so for qualified surgeons, experienced surgeons, learning new techniques, these can be really useful, fast ways for them to understand how their particular approach needs to be adapted or changed based on different patient scenarios. And again, that’s where ours and others like us have a great advantage because we can, I can present to you 20 different patient presentations straight, one after the other, which you would never be able to achieve within a real-life situation in any sort of speed that we do with the virtual reality.
Kathy: Now have you seen an increased interest in your solution due to the pandemic, and if so, do you expect that to continue as we start to come out of this?
Richard: Oh, yes, we’ve seen a big increase. The, I guess the key things that we saw emerging this time last year when COVID really started to take hold was a need to find a new way to have remote collaboration. Whether that’s training or whether that’s with live cases or just through discussion, and obviously technologies like Zoom and What’s App video kind of took off, but actually in the area of surgical training what our customers and the life science companies we were working with were looking for was a way to remote in and we have a whole platform of multi-user capabilities. So you can I can pop on a headset, meet each other inside a virtual operating room, and collaborate around a particular case or learning scenario. So that’s been a real driver for us in terms of the adoption of the platform going forward. And I think as we look at this last year the trend has been really from an inevitable innovation that most of the industry thought would be adopted over time, to actually seeing virtual reality, and particularly virtual reality with haptics as mission critical, because in the absence of all other training modalities, you need something and that’s really where we can come in.
Kathy: Now healthcare has been really notorious at being slow to adopt new technologies over the years. Do you think that the pandemic has provided some type of a tipping point in terms of digital technology and innovation?
Richard: Absolutely. Absolutely. Whether it’s just basic patient consultation using mobile devices, through to haptic-based education such as ours, I think it’s been a tipping point across the board. As I was saying, it’s gone from interesting things that we should probably adopt in the future through to mission critical, we need to do it today, because we need that capability. And I think that trend is going to continue. As I talk to surgeons around the world, what they’re telling me is, “We don’t really want to return to the way it was. We don’t want to take a day out, travel somewhere, spend another day in a session that will only give us three or four opportunities to get hands-on and then return. We’d much rather be able to do that at speed at the place of our choice.” Which is why again we’ve launched things like at-home VR so that we can literally ship the headset to them where they are, at their place of work or at their home or anywhere around the world, and allow them to train and refine their capability in their own time, in their own space, when they’re ready to do it. And when you combine that with multi-user, so they can then join each other in those spaces, suddenly it becomes incredibly powerful. So I think we’ve started, we’ve accelerated something that was happening already, and I think that will continue as we come out of this period.
Kathy: Looking to other areas of medicine and science, what are some ways that you think virtual reality could also have an impact?
Richard: So across the board I think, again, we’re at the beginning. If it’s a ten-step process, I think we’re probably on step one. We talk, again, with - our clients are generally life science, pharma, med device companies, obviously our end users are the health care systems and their surgeons, and as we talk to them we’re seeing increasing applications in the early stage of R & D, in drop discovery, checking efficacy there. We’re seeing applications in treatment, whether that’s in some of the companies that are starting to use virtual reality as a pain relief or a distraction technique or a training technique, aversion therapy, all of those sort of areas, really exciting applications, and again I think all of those areas are probably in the first couple of steps of the journey that they can go on. When I started Fundamental, I started it, and we called it Fundamental because we believed that virtual reality will have a fundamental impact on the human computing interface, and I think if you think of it that way and then turn back to the medical industry again and think about all of those different areas of engagement, there is an enormous opportunity that is really starting to show itself now. We’ve just chosen to start, really, in the area of medical training and surgical training.
Kathy: So if we were to look ahead five years, where do you envision that we are both with surgical training and with adoption of VR technology in healthcare as a whole?
Richard: Well, I’m always a little bit concerned about future-gazing, but I’ll take a run at it. I think in terms of surgical training, I think we will have seen then that the leaders in the life sciences marketplace will have had adopted virtual reality and haptic virtual reality as a standard in most of their skills transfer activity. I think that we’ll see that leading healthcare institutions, certainly in developed countries, again will have adopted this at scale, and be reaping the benefits of that activity. Again, across a number of different areas. It’s great for first-time learning, but actually it’s really good for on-going competency and capability-checking, and I think that’s going to be a key one. I think more and more we’ll see that move towards people saying, this is actually a stand that we should adopt on an on-going basis. Because just as we saw in the aviation industry in the ‘80s and ‘90s, the adoption of simulation at scale dramatically changed the impact of error. It reduced it incredibly and I think the same thing will be true. I don’t think in a five-year period, but I think over the next 20 years I think we’ll go in that same trajectory within medicine. So I think that’s where it will go. When it comes to the adoption of virtual reality more generally, I think what’s happening in that space when it comes to the technology is it’s getting smaller, it’s getting cheaper, and it’s getting faster. And things I hear people ask me, what about mixed reality versus augmented reality versus virtual reality? My view – they’re all combining into one. And we’ll get smaller headsets that will be easier to use, start to look more like the glasses that I often wear, maybe even move into that space of contact lenses. Again, probably not five years, but beyond that, and I think it just becomes more and more part of our everyday life.
Kathy: Well, Richard, this was fascinating. Thank you so much for your time today.
Richard: Kathy, great to chat to you. Thank you for inviting me in.
Kathy: Thank you for joining me for this episode of the Smarter Healthcare Podcast.
To learn more about Richard’s work at FundamentalVR, you can follow him on Twitter @ravincent. Follow the company on Twitter @FundamentalVR.
You can also follow me on Twitter @ksucich or @smarthcpodcast. Feel free to get in touch with comments or guest suggestions.
To listen to more episodes, visit our website at www.smarthcpodcast.com or find us on your favorite podcast app. I’d appreciate if you would subscribe, rate, and review.
Thanks for listening!
