How a New Autonomous Robot May Help Solve a Patient Access Problem
Johannes Schaeferhoff is CEO of ROPCA, a company focused on an autonomous robotic solution to aid in the diagnosis and monitoring of Rheumatoid Arthritis. In this episode, Johannes shares some of the cultural differences in the countries he has lived in and what he learned, trends in medicine that led their team to develop their innovative solution, how efficiency in medicine can be as important as efficacy, and how the ROPCA system may help solve issues with patient access and the timely and accurate diagnosis and monitoring of patients with Rheumatoid Arthritis.
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ROPCA https://ropca.com/
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Episode Transcript
This transcript was generated using an automated transcription service and is minimally edited. Please forgive the mistakes contained within it.
Patrick Kothe 00:31
Welcome! When I say robots and medicine, what comes to mind? Well, I bet for most of you, it's robotic surgery or robot assisted surgery, which has been around since the 1980s. And these robots are controlled by an operator most like a surgeon during during the surgical procedure. And our function is to deliver more precise and consistent movements, which lead to better clinical outcomes. And again, as I said, they're not operating by themselves. There's somebody behind the curtain, at least at least, that's the way it is today. There are other uses of robotics in medicine. And we're going to discuss one of those today. Our guest is Johannes Schaeferhoff, CEO of ROPCA, a company focused on an autonomous robotic solution to aid in the diagnosis and monitoring of rheumatoid arthritis. Now, this application is not surgery. But it's an automated way to perform an ultrasound exam autonomously without a human. Johan has began his career as a consultant at AT Kearney then spent 12 years at Arthrex, with various responsibilities in Europe, Middle East and Africa, before taking over as CEO at ROPCA. We discussed some of the cultural differences in the countries he's lived in and what he learned trends and medicine that led their team to develop their innovation, innovative solution, how efficiency in medicine can be as important as efficacy, and how the rope cost system may help solve issues with patient access, and the timely and accurate diagnosis and monitoring of patients with rheumatoid arthritis. Here's our conversation. So Johannes, tell us a little bit about yourself, you know, where's home? Where have you lived before, and a little bit about what your professional journey has been so far.
Johannes Schaeferhoff 02:56
Home today is Denmark, living north of Copenhagen, about 20 minutes outside of the city. I'm a German, so I'm living abroad. Previously, you know, I grew up in various places. I grew up in Germany for the first 16 years and lived in the UK for five, and then moved around between quickstop in the United States, and stops in Spain and France. And then I settled in my first job, which was in Berlin, Germany, my professional career has been spinning, essentially two industries, one as a management consulting, where I started a company parney in Berlin. And then I joined Arthrex and spent 12 years with Arthrex. And obviously, in sports medicine, and for about a year now, I've been working at both ground and robotics and AI, where we provided diagnostic essentially,
Patrick Kothe 04:02
so many of us don't have the opportunity to live and live in different countries you lived in several of them speak five languages Tell me a little bit about about moving around and different cultures and embedding yourself within different different countries and cultures.
Johannes Schaeferhoff 04:19
Yeah, I mean, I was super, it was like you say I was very, very lucky that, that I could could could go abroad initially. In Germany, we tend to learn or at least when I grew up, we were not often not that great at speaking English. So I was very fortunate that agenda and English school and learned learned better English over two years. And then it seemed like a natural next step to continue the education in the UK. So I stayed at a place called King's College in London. And that greatly I mean, I really greatly enjoyed being a foreigner because I found that in Interesting, it was not always pleasant. I think being a foreigner gives you a unique perspective into your own culture and into the culture of the place that you live in. I learned a lot about the UK, the historical relationship between the UK and Germany while living there, you learn a lot about what what changed, or what, what is different between different countries. So I think, you know, I took took away some positives from sort of Anglo Saxon culture in the UK, where I think they are generally much more open, they approach people a lot more than we typically do in Germany, they're a lot more positive and believes that the future or the best possible, the optimistic version of the future will come come into being like to, you know, to practice that, I think having a positive outlook and approaching people as a really good trait, or good to good traits. Whereas I think in Germany, we, we tend to focus more on people that we know or know from somebody. So there, for example, I learned something, and I think that has that has only, you know, that has followed me. So I liked several aspects of of my time in the US, again, they are probably in the United States, even more outgoing, and even even more positive, and maybe in the UK. So I think, you know, that's really good. Or when I moved to Denmark, I really liked about the first team that I got a chance to read that they were really practical and very focused on finding ideas that worked, instead of focusing on some sort of policy or bigger strategy that, you know, sometimes it cannot be implemented. So I think they always found practical solutions to getting, getting things on track. And while my home culture in Germany is one that is maybe a little more control focused in the Nordics, the people are much more autonomous. And they expect that also, so I learned that, you know, employees in Denmark, question you, as a manager a lot more than maybe most employees in Germany would typically do, and they do it really openly and directly and in front of others. And that takes a bit to get used to, because when I was quite young, at the time, I was 26, when I had my first team, it felt tough, you know, to be in a group of experienced people, and then, you know, get also bombarded with, with questions and with also with some criticisms. So I think, you know, that's, that's in I think that's an important lesson. And I really like this today. I have, you know, grown with it, I would say, but it's probably not for everybody. And it can probably be a bit daunting when you maybe are used to a more controlled culture or controlled environment, like we have, for example, in Germany, in Germany, you would probably still sometimes be able to get away with an argument that you just say it's because the management wants this, or it's because the x y and Zed policy says that anything in Denmark, you know, most people would just question that it doesn't make sense.
Patrick Kothe 08:10
That concept of challenging everyone is interesting. The old, old school, old school management and some countries management is still very hierarchical, as you said, I mean, it's you know, the, the boss knows best and don't question the boss. But if we all challenge each other, and we're all open, what we're ended ended up doing is we're ending up making each other better. Because we know as a manager, you don't know everything, you have the ultimate responsibility for setting tone and doing things. But you're not the expert in everything. You know, the people that you're managing are experts in certain areas. And they will also need different things. And if you're if if they don't believe that you as a manager are getting what they need, giving you what, what they need. They're doing themselves a disservice by not saying you're not giving me what I need. So the challenging of management is something that is important for the benefit of everyone else for the benefit of the whole team. Because if if a manager doesn't know what you need, or where they're doing something wrong, it's just forcing the situation to get worse and worse.
Johannes Schaeferhoff 09:25
Yeah, exactly. And I think you're absolutely right, I think you can get in Denmark, it's not going to be difficult for you. With very little encouragement, you will get a meritocracy of ideas. And I think that it's also important to leave the people the space to actually be those those experts or to have that expert knowledge and to utilize that expert knowledge. The best teams are teams where everybody has the room to you know, to play their best game. And in Denmark, people will will also request that and demand that and I think that's positive thing, because you might sometimes, especially when you have people that are maybe not so outgoing, you might have have people that that just, you know, take a step back and might might might be too quiet to get that space. So I like the overall culture here that people will go out and actively asked for it. And most people that I've come to know on here can do that. So I think that's really good.
Patrick Kothe 10:26
That's a, that's a great management philosophy, with one caveat, being having disagreements is fantastic. Opening people up to ideas is fantastic. Challenging is fantastic. But at some point in time, you make a decision, and then everyone has to agree to that decision. So you, you can challenge, but then there has to be alignment. And that alignment needs to be universal. You can't say, Okay, I I don't agree with with the decision that's made. And I'm still disagreeing with it after the decision is made, you have to get in get in alignment on those decisions, even though initially, you may not have agreed on it, there has to be true alignment, you can't hold it in the back of your mind. And, and just, you know, wait to say, Hey, I told yourself that that's, that's not alignment.
Johannes Schaeferhoff 11:23
No, no, I totally agree with you. I also think that one aspect that I always liked in Germany is that I think in Germany, there's a few more decisions that are not necessarily always taken, you know, following sort of consensus mode, because consensus can also sometimes lead to bad decision. So there's pros and cons to it all. But I think, you know, at least in the very early steps of decision making, it tends to be a really good idea to listen to different viewpoints and, and also have a team that is not shy of expressing them.
Patrick Kothe 12:03
So, Johanna, tell me a little bit about your initial time in medicine, and what what was going on at Arthrex? What, what were you focused on? And how things have evolved over the past 15 years? Since, you know, since you began your career at Arthrex?
Johannes Schaeferhoff 12:25
Yeah, so when when I joined Arthrex, it was obviously a smaller company, they've had phenomenal growth over the years, and has been a huge success. For me, when I joined, it was a huge step, because you know, I have a have a business education. So I did not, you know, join there. And, you know, I had no knowledge or hardly any knowledge of anatomy and, and you need to pick that up. But I think the the company was very good and teaching that we had extensive extensive training, and then also extensive time in operating rooms, where we would scrub in. So I scrubbed in for several weeks in Germany, and learned a lot about the different different techniques and what to do the do's and don'ts of the operating room, essentially. So I think that was really very helpful, I think the best education you can get is to just spend time with clinicians think to immerse yourself in any topic is just generally the fastest path to good knowledge base. So the immersion there was, was very, very helpful for me.
Patrick Kothe 13:36
So throughout your your time, at Arthrex, many things changed things, things do not, do not stay the same. And there's a lot of trends that have happened in medicine. So let's talk a little bit about some of the trends that that you've seen in your time, and how they're changing the way medicine is delivered today.
Johannes Schaeferhoff 14:04
Yeah, I think there are, there is going to be or there is already profound change in in medicine. I think we are seeing essentially, at least here in Europe, I don't know about the United States, but we see increased demand for all medical services, it says I think only been a bit exacerbated by by COVID. But I think there's just a demand for for for medical services that greatly outstrips the supply. And I think a lot of a lot of clinics are suffering from big weights in Europe. The patients obviously also suffer from that. And I don't really see that changing I think if anything that's that's probably going to increase and take us further in that direction with like the like, for example, until the darkest kept getting older while I was working at Arthrex. And the clinicians here in Denmark, that I that I met regularly, they seem to be getting older and older and older and several of them kept working well, after the typical pension age, that's only a matter of time until some of these people will stop working. And it seemed that the the number of doctors that were newly coming up was was greatly outstripped by those going into retirement. While the the episodes of care are that the demand that I just mentioned, seem to grow fairly relentlessly. So I think that's, that's, that's really one of the the major trends that I'm experiencing, I think, we have older and older, and older and older workforce, and we have a falling falling workforce, while the demand just just keeps going higher. And I think, like at Arthrex, at the end, we were already looking a bit into automation, and what we could offer in order to make people's lives easier. Clinicians lives easier. And I think, you know, increasing productivity and helping clinicians in whatever they do, but like to help them with, with repetitive tasks to help them maybe also with decisions or documenting since there's so many, so many tools, I think that they're going to be required to run with a smaller workforce with a bigger demand for care.
Patrick Kothe 16:39
As you said, I mean, we've got technologies, and sometimes the technology can be a double edged sword. If that technology makes things more complex for the fewer clinicians that are there, it just makes the problem worse. Technology has to has to make them more efficient. In order to be adopted, you know, there's one thing about making the result of a surgery or procedure patient care if the efficacy of your of your technology makes things better, that's fantastic. But it can't do it at the cost of time. Because that that will that will lead to less efficiency and fewer people being treated.
Johannes Schaeferhoff 17:31
Yeah, exactly. I think that's a that's a good point, I think that generally technology probably has to has to has to increase productivity. And it probably over time, it has to drive down cost per episode of care. Because if we have, you know, today in Europe, at least most health systems are already really strained. Actually, I don't know a single one that isn't the number of episodes of care in any department seems to be on the rise. So if if we have, you know, more care than every, every unit of care has to be cheaper. And I think in the past, this has been slightly maybe maybe I don't know if the word ignored is fair, but it has not been like maybe the primary concern, the primary concern was to provide better care. And better care is also really important. But at some point, I think the cost component is actually is going to be very, very crucial. Because if things keep getting more expensive, eventually this is this is not going to be possible anymore. At least here in Europe, I hope that we find means and ways that we can reduce costs, and that we can make people more productive. And that the standard of care for everybody can remain high. Because that's that's also going to be a challenge. So so we need probably a lot more automation and maybe also some simplification.
Patrick Kothe 19:00
It's a global issue. Every every country has got their own health care system, some are private, some are public, some are mixed. Some are you know government paid some aren't. So ever every country is a little bit different. But the issue is is global. We've got a lot of people who need care. And we've got got a relative few number of of clinicians who are doing that and costs keep going up, somebody's got to pay for it, whether it's the government or the people, depending on you know, where you live, there's a payment that needs needs to be made there too. So as we talked about, efficacy is one thing, efficiency is something else. We all want better care, but it has to be delivered efficiently. So one of the things I want to get into into your company Roca B because I think that it's got a very interesting take on On a couple of things that we're we're hearing in the marketplace constantly, and that's robotics, and AI. You know, we hear a lot about those, those two things. It's important to understand what you're getting with robotics and what you're getting with AI and how that fits. So I want to kind of start off with the customer that you're dealing with with Roca. And then we'll talk about the technology and how it's different than what a lot of robotics plays are out there out there right now. So tell me about about what what customers you're serving with your with your company,
Johannes Schaeferhoff 20:38
we are solving the essentially right now we're solving the problem of the big weight, and the problem of having an inadequate workforce, essentially, for offline ufologists that are dealing with, with a patient population that is suspected of rheumatoid arthritis, or that has rheumatoid arthritis and needs to be monitored. Currently, in in Europe, the average waiting times really quite long is six months on average and wait, and the disease's aggressive disease, and it should be found significantly earlier, ideally, according to the German mythology Association, after six weeks after the onset of symptoms. So we are currently missing that target by quite a bit. And in terms of monitoring, most in most systems, it's it's tough to monitor the patients, if the patient for example, feels that that they have an increase in inflammation, they're just tough for them get the appointment time, there's there's a big need that we were hoping to solve. And the first probably most obvious application that everybody agrees on that HopCat can be a part of or should be a part of, is to use our arthritis ultrasound robot offer for triage of patients suspected of rheumatoid arthritis.
Patrick Kothe 22:18
Yohannes what is rheumatoid arthritis?
Johannes Schaeferhoff 22:21
Rheumatoid arthritis is a chronic autoimmune condition is your immune system attacking your anatomy for amongst other things in your joints. And that's why you suffer from swelling from inflammation in the joints and also have massive pain in the joints. We have drugs that that treat this condition with good results. The only issue is that oftentimes these drugs are delivered later than ideal. Mostly it's it's a problem that we diagnose these late and of course, because it's a chronic condition that yeah, it is a it's something where the patient requires care all their all their life.
Patrick Kothe 23:09
What what age does it typically manifest,
Johannes Schaeferhoff 23:12
it normally starts in the 30s and 40s. Therefore it affects people also in their best working age. And that's of course, why the disease has such a heavy burden.
Patrick Kothe 23:25
So it's it's painful, it's extremely painful, and you'll extremely painful. And you may you may lose dexterity lose the ability to kind of move move the joints as well, is primarily hands up. Where do you where do you see,
Johannes Schaeferhoff 23:41
the disease manifests itself in several parts of the body, but hands are normally included. So in recent study in the Netherlands, I think it was like 98% that had it in the hands and then maybe also somewhere else. But that's why we had what we decided to focus on on diagnosing it in the hands because that's where it manifests itself the most. And because hands obviously a part of the body that in all cultures that we know of, can be easily shown and the public is fast to quickly scan a hand it is it's not difficult for a patient to expose the hand. And therefore we initially focus on the hand
Patrick Kothe 24:29
in many diseases. Early diagnosis leads to better care. Is it the same way with RA or is it different?
Johannes Schaeferhoff 24:37
No, I think that's the same. I think if you diagnose early in ra you there are several studies that indicate you get significantly better results. There are several studies that indicate that you can treat disease with cheaper drugs. There are several studies that indicate that people can work and keep their dexterity like you mentioned a lot longer. So there's really Make a very, very strong case on on all parameters, why early diagnosis is what contribute a lot.
Patrick Kothe 25:08
And as far as treatment, you said, pharmaceuticals are one way of treating, I'm assuming this is a systemic thing. So you don't have one drug for your hands and other drug for another part of your, your body wants, once you're treating you're treating ra throughout interrupt your system.
Johannes Schaeferhoff 25:24
Yeah, exactly. So the drugs are drugs that affect your overall immune system and your your overall body. It's not only drugs, there are also several other things. Studies indicate helpful there are some some things you can do in terms of your food intake. There are various exercises you can do. But the medical consensus is that you also use these diseases modifying anti rheumatic drugs.
Patrick Kothe 25:58
Let's look at it from a patient's perspective, patients noticing that their hands are becoming fragile, so to speak, or more pain in the joints and they suspect something something may be wrong, where do they go? And every country may be a little bit different. But where do they typically seek answers to this, this pain in the joints?
Johannes Schaeferhoff 26:18
Typically, they would go to general practitioner in most European markets, from the general practitioner, they would then be if they are suspected of having rheumatoid arthritis, there'll be sent to a specialist. And then the specialist has Yeah, has to deal with referrals. And that's typically what is definitely a contributor to the big weights, because the specialists oftentimes have already a busy schedule. And some I think, in some markets, they see, or in some countries, they see a lot of patients suspected of rheumatoid arthritis when actually very few have the disease. So in Denmark, and in Germany, we talked to some clinicians, that they they only found one in 18 patients referred to them had rheumatoid arthritis. So there's 17 patients that don't have the disease. But that's still, you know, required to seen and it's still require resources. Of course,
Patrick Kothe 27:21
those 17 Other patients, what do they have?
Johannes Schaeferhoff 27:24
Oh, it could be different different things. I mean, I think it's not uncommon that they have maybe osteoarthritis, I would imagine is the most common cause of pain for them. But there's also, of course, other conditions that they could have, they could have some something wrong with attendance, to synovitis there are numerous things they could have. But the important thing about I think about reading further Freitas is that because it is an aggressive disease, it's important that you find it early. So if you don't have that you should probably be very happy as a patient. And then it would probably while in Denmark, at least, it makes sense that you go back to the general practitioner and find out which you have to join instead,
Patrick Kothe 28:10
prior to your technology. How do people diagnose Ra,
Johannes Schaeferhoff 28:16
our technology is also not standalone. So you would use our technology in conjunction with bloodwork you have palpation is a very common way to diagnose disease. Manual ultrasound is another very common way to diagnose the disease always in conjunction with bloodwork. And the difference I would say that we provide is that we greatly increase the availability of ultrasound scanning of the hands. So the technology we provide performs and ultrasound documents, the ultrasound annotates the ultrasound with what the artificial intelligence component of our technology saw. So anatomical structures, and then based on that it provides a diagnosis per joint. So we do not provide a diagnosis for the entire patient. We had a decision support tool for the clinician,
Patrick Kothe 29:15
when people hear ultrasound, have got a mental image and their mental images. There's a cinematographer and they're holding a probe, and they're probing across an area, put some gel on it and probe across an area and that's an ographers looking at a screen, and they're performing the test that way. Now, tell me about your technology. We actually
Johannes Schaeferhoff 29:39
pretty similar to that image in the sense that instead of a scenographer, we have a robotic arm, holding the probe, and instead of sonography and knowing where to place the probe, we use three dimensional images Um, that we take with a 3d camera and then apply AI to determine where they're landing sites for the probe need to be. And while the probe is scanning it, it is there's a there's artificial intelligence, that quality controls the images that being taken. And lastly, there's there's AI that grades the images as well. So our technology is essentially different from the current image in that it Well, currently it would be the patient arriving being met by a cinematographer, and then you know, scanned, in our case, the patient would potentially even arrive directly at the robot would then scan in Denmark a social security card, and would then be prompted to apply gel and perform the scan essentially, together with the robot, then, and then the the images are captured and clinician would review the reports. But that's, of course, markedly different from for what for what is happening today. So in our case, potentially, the patient could even self initiate a scan, and could then go there and conduct the scan and get a result. So the level of automation is really high with this autonomous robot. And this autonomy for the robot is generated through the eyes. So yeah, I think it is a big change from from what we've been doing in the past.
Patrick Kothe 31:36
Well, I want the listeners to take that in for a second. Because when we think in medicine, we think of robotics in surgery, it's robotic assisted surgery, where the clinician a surgeon is manipulating something and using the robot as an extension of their hands of their arms, etc. What we're talking about with robotics in this setting is an autonomous robot, something that's performing the test by itself without the aid of the synagogue refer. So someone has, as you said, could walk in, perform the test themselves without the aid of that person. And that kind of goes back to the conversation we're having earlier, does an enabling technology enable it to be more effective and efficient? Let's talk about effectiveness first, and then we'll go further into the the efficiency. But let's let's talk a little bit about this technology and using the hardware and also the software and how it compares to the effectiveness of systems that are being employed. Right now for identification of Ra.
Johannes Schaeferhoff 32:51
terms of effectiveness, the big lever that we at work provide is that we make so nog Rafi more widespread and more available, there are many studies that indicate that our sounds actually really good fidelity to identify the disease, providing more of more objective and consistent assessments is something that is that is quite powerful. And that's actually generally something that we we are interested in. So I think ultrasound is is a really benign modality. It's typically it's cost effective, it often is small bile, it is also relatively inexpensive. It's obviously not invasive. So ultrasound has a lot of potential. And we as a company, want to make Agusan are available. And arrays is essentially the first application of that. But if you you know, if you think that further, there's there's probably quite a few different applications.
Patrick Kothe 33:55
So let's talk about efficiency for a second. Walk through that procedure, and what's done and how long it takes. Typically, the
Johannes Schaeferhoff 34:05
patient would come in, and then if it is a first time user, they would be greeted and bent helped along by maybe a medical student or receptionist, they would be shown to the robot. And then like I mentioned, they would scan their social security card or input a unique identifier in some markets, that's their insurance number. And then they are prompted to interact with a robot and one of the first brands is that they are supposed to put out some jello on their hands themselves. Now we we know that that putting that Joe on this challenge for for some of the people that encounter are for for the first time. So it's been helpful if somebody who's guided them to the robot quickly helps them put ultrasonic gel on there first And then they, they are prompted to place their hand on the screen. And that's very intuitive, there's essentially just the hand drawn on the screen and you place your there. And then we have this overhead camera that maps the hand determines the landing sides, the robot is then prompted to move in. And why while it once it moves in and lands, the probe, it does a sweep, just like a human would do, you know, going side to side with the ultrasonic probe, while we're doing that the quality control the the image that have been the images that have been taken, and if the robot is not satisfied with with an image, it will come back for a second try. Lastly, we grade the images and we send the generated report to the electronic patient journal, that's then when when the doctor really you know plays again, a big role because you know, alpha provides information on inflammation per joint. But of course, you know, we aren't cars and it's not like, you look at okay, this screws, loosen that screw is loose, but you're looking, you know, in a person, you're looking at all the other information, information, they provided, the blood work, and then the doctor is is of course, the person who does the overall assessment and decides what to do and how to proceed. So when we talk about triaging our hope and idea is that in the future, if a patient is VSD, not in the right view for RA, and therefore should revisit the GP that, you know, the whole procedure can be can be a lot quicker, so the patient doesn't wait as long for an appointment, the patient can then instead of visiting doctor, they visit alpha and get the bloodwork done, and then they get a much faster answer. And if they need to be seen, we are talking about much or significantly short. Q. So that's, that's, that's really something that can provide great value for all people involved.
Patrick Kothe 37:12
And when Johanna said Arthur Arthur is the is the hardware platform. That's that's, that's the robot. So, Johanna, how long does the scan take a full scan?
Johannes Schaeferhoff 37:22
It takes between 12 and 15 minutes for 22 joints?
Patrick Kothe 37:27
And is that is that about the same as it would take? Experience and ographers?
Johannes Schaeferhoff 37:33
Yeah, I think it's quite similar. Although one has one has to say that most experienced and ographers in Europe are really time pressured. And they will only scan the joints where they see either pain or inflammation. So they would typically not scan all 22 joints, even though when you talk to them, they pretty much all agree that it is not a bad idea to get a comprehensive or view.
Patrick Kothe 38:01
So this is an automated imaging system that provides a report to a clinician for a clinician to make their their treatment decisions, a diagnosis, diagnosis and treatment decisions.
Johannes Schaeferhoff 38:13
Yes, it's it's a novel way to work in this field.
Patrick Kothe 38:19
Let's talk about you know where it should be deployed. So you you said you know, the patient journey looks like it goes into the into the general practitioner and then goes to the specialist. Is it best deployed at the GP level? Or is it best deployed at the specialist level?
Johannes Schaeferhoff 38:38
I think you know, there are several things that we are currently still finding out right now probably say it's it's the specialist, but it could overtime also be the GP. So we are working on extending the therapeutic domain for offer. Because there are other other conditions like I said, you know, many patients might have OAE ot some patients might have to synovitis or other patients might have carpets, carpal tunnel syndrome. So we are looking to extend what we can diagnose with alpha in the hand. And once we have a broader a broader therapeutic domain, then it might make more sense for author to be either at a radiologist or potentially at a GP or at a larger GP, maybe I think single GP is probably a bit too small.
Patrick Kothe 39:33
So as as far as somebody that wants to get involved with the technology, what would their cost structure look like?
Johannes Schaeferhoff 39:40
Yeah, so their cost track structure will be an initial upfront cost where they purchased the device. And then there are so there is a subscription costs for 4000 scans, after which we have a very Very low fee per scan. And the idea here is that the costs drop as you use the machine more. And therefore, you know, we would align with the customers interests. So we would like customers that want to use the machine extensively. And the customers also get the added benefit of a falling cost curve as they use the machine more.
Patrick Kothe 40:26
Many of us go to a physician or go to medical care, and we get benefit of personal interaction. Tell me a little bit about how patients have interacted with the technology, and whether there's a benefit of having a technology only or if there's some trepidation on the part of patients.
Johannes Schaeferhoff 40:50
So far, the acceptance of the technology has been very good and very high. We ran a patient acceptance study, and most of the patients wanted alpha to be part of the routine. So I think that was really good. But of course you have, you're absolutely right, there's a human element. And there's always a social element. And it is, I think, for many patients, it is also nice to meet their you know, to see their doctor again. And therefore that is something important. And that's something that you cannot just replace the with a robot. And I've also had that feedback from some doctors who say, Well, when they ultrasound scan, they talk to the patient. And that's, you know, part of the the overall package the patient would like to have. So absolutely, we can provide that. But what we can provide, though, is that, I mean, there's I think there's also a big need for the patients to get timely visits. And most of the patients that have the disease and unknown patients, they they understand this, they like the idea of being able to self initiate a visit, they like to come in at their leisure. And I think also, doctors, maybe not all but quite a few doctors also like the idea that you could then have a bit of an asynchronous type of work. So you could have scan patients, and review patients at a later point in time. So for example, here where I live in Denmark, it's quite often the case that young parents would pick up their kids, drive home, cook dinner, bring the kids to bed, and then afterwards, maybe have another hour of work. And of course, if offer in the meantime, has been scanning patients to a doctor who's qualified, could, you know, review offer cases in the evening, and could probably get through quite a few cases. I think that's really attractive. There's also many patients include myself here that are happy if it is possible to get a late appointment. And also maybe sometimes an early appointment. And that sort of flexibility is just not there if the patient and doctor have to be at all times in the same space. So decoupling these things. This is another very interesting feature about technology. It's also actually what makes me very confident that it could be a fantastic remote monitoring monitoring tool in underserved areas as well. So there are really quite a few applications where the technology could do a lot for for clinicians and patients.
Patrick Kothe 43:33
You honest we focus a little bit about the diagnosis. Is there a monitoring component of this as well?
Johannes Schaeferhoff 43:42
Yeah, so because the the disease is chronic, and the drugs that you take have also significant side effects, the clinicians try to treat to target so they try to think keep the dosage of the medicine at smallest possible level. And therefore it is important that you that you monitor the patient's if there is more inflammation you to increase the dosage again, I think if you gave people a choice to come in at their own leisure or when they feel they needed verses and predefined times I think many people would be very happy if they could come in at their own leisure.
Patrick Kothe 44:20
And that will kind of mitigate some of that patient trepidation. They've done it once they've done it two times it's under five times now they kind of know know the drill and they're able to utilize it without an issue so so the physician may say hey, let's go get blood work done. And we'll we'll do your your scan with Arthur and I'll get the data and then we'll we'll monitor or we'll we may change your medication level.
Johannes Schaeferhoff 44:51
Yeah, I think you're absolutely right. I think the complexity of using alpha is on par with using using a photo booth. I mean, I haven't used the photo booth in a little while, but they're still around. And I remember having to rush to the embassy and not having my passport picture taken in advance and rushing into this photo booth. And you know, at first, it's like, you need to find your way around in the in the thing. And if you haven't been there in a decade, it probably requires a moment, or two. But if you come and go to a photo booth on a recurring basis, you'll become a very good photographer using a photo booth. So that's how we see the world. So we think first time patients will maybe require a little bit of help. But recurring patients that come and visit us regularly will probably become very proficient.
Patrick Kothe 45:46
Yohannes, where's the system available? Where are you in regards to CE mark? Are you selling? Tell me a little bit but your early market adoption,
Johannes Schaeferhoff 45:56
we have a CE mark since late last year, according to the MDR. We have currently three systems out in Denmark, and we are looking to also start a system in Germany soon. And then we will also want to enter Austria and Switzerland. I expect the first the first sales to happen in the next few weeks. One of the things that is holding us back is the robots are expensive to manufacture. And therefore it's really you know, it's a limiting factor, we can go out to all the customers that would like to test the robot, there's a lot of interest, there's a huge pipeline of customers that are interested in testing the robot. But I only have so many robots so so we we as a company just have to be really focused on where we test.
Patrick Kothe 46:52
How's the company been funded so far?
Johannes Schaeferhoff 46:55
So far, we've been funded through soft funding and to angel investments. And we're currently also raising a small round of funding, because we expect to succeed in some of our soft funding applications towards that we'll know more about by the end of the year.
Patrick Kothe 47:15
Sounds like you've been very careful, capital efficient a robotics company with those types of those types of numbers. Sounds sounds very, very capital efficient.
Johannes Schaeferhoff 47:25
Yeah, I think we have been very capital efficient. I think the two founders who started the company have been been very good at conserving cow capital and have been very fast in the certification process. So I think they can be really, really proud of where the company is, with the amount of money that has been raised.
Patrick Kothe 47:48
Well, it's a really an interesting story, thank you so much honest for you're kind of walking us through here. It's a different robotics and AI stories. And then we've we've heard of in the past, and this autonomous system is really quite interesting. So we'll be definitely keeping an eye on it. Robotics and AIS, as we said, have gotten so much attention over the past several years. But in many instances, it's kind of like a mousetrap looking for a mouse I've got I've got this, I've got this robot now let me find something, something that it can do. So how do you view the way these these types of technologies and these enabling technologies should be deployed, in order to provide the best clinical use and the best medical use as possible?
Johannes Schaeferhoff 48:47
They should be deployed with a very open mindset, I think the the product that we have, like you mentioned earlier, is a bit unique in the sense that it is not a tournament up relation type of robot, but an autonomous robot. So when you when you take that into account, I think you just have to adapt the pathways and the processes that surround the robot a little bit to also fit the technology and to then still maximize elements that the technology also cannot provide. Like I mean, you mentioned that human aspect and having a conversation etc, is really important. And that should remain important. And the thing is, is that it is that we approach these technologies with an open mind that we find the best possible pathway for the patient, and that we can also that we create the value for the patient. So for example, most health systems today are not self initiated. The patient cannot just book himself an appointment with somebody. It's typically always either it's initiated by the healthcare system in many state systems, or you you know, call a receptionist or secretary and make an appointment. But it's not possible that you just book an appointment like in a Calendly. I mean, Alpha has a calendar Alpha couldn't be booked by Calendly calendar, these types of things, you know, might be medically rather trivial, but I think they will make it will have a tremendous impact in the lives of people if they can determine when they want to have that test being done, and that they have more availability, and that it can be done quickly. And on short notice. I think those those things make a big difference. I think one should never underestimate some of the other side effects of the current system. So these big weights, accompanied by anxiety, and so on. So when people counter or say that, well, you know, maybe the human element is coming short with a robot, I can, of course, understand that. But I think there are also several, several side effects of requiring currently always the human element, which you know, then maybe a bit overlooked, like anxiety while waiting, and so on, so forth. So I think we need to approach these technologies with an open mind and find the best use case for patients and and for clinicians, because clinicians are also under strain. And I think they'll be happy if we can use technology in a way that takes some weight off their shoulders.
Patrick Kothe 51:28
Robots are here to stay. Finding the right applications and developing systems that interact with us comfortably, will be our challenge and opportunity. I enjoyed hearing from Yohannes, about another innate enabling technology that may drive better access and better patient care, a few of my takeaways, first differences and work cultures, I find that to be really interesting. He's spent time in Germany and Denmark and other countries, and found that the way people behave in those countries is completely different. And can lead to different types of culture. And a Germany he talked about, you know, being more top down and a Denmark, it's more collaborative, more challenging for the people. I liked that that style fits with the US style as well, where you're able to question authority, and you're able to make suggestions and be part of the discussion. And that challenging leads to more engaged team members, and then also leads to better, better overall decisions. The second thing that was interesting to me was the way he described the problem. It wasn't faster ultrasound, better ultrasound, cheaper ultrasound, it was the big weight. It was something that was going on with the patient. It wasn't about the technology, it was about the problem. And the problem is too much weight, too much weight for for access to care. So these market forces of fewer physicians and more patients is something that's going on in their local area. But it's a universal topic. So I just encourage you to think about the problem from the customer standpoint, and not from yours. The final thing was keep an eye on what your technology can and can't do. So we discussed the human touch in this procedure, and whether people patients were going to accept computer only or robotic only, or they needed that human touch. That's something to really keep an eye on and they've done an initial initial study on that, but they're going to continue to keep an eye on it because maybe that initial visit is going to be important to have some human touch, but maybe some patients, they're going to need it for more and more. And they're going to have to find ways to to have a little bit of human touch, but still use the robots, the robots for the majority of the procedure. Thank you for listening. Make sure you get episodes downloaded to your device automatically by liking or subscribing to the mastering medical device podcast wherever you get your podcasts. Also, please spread the word and tell a friend or two to listen to the mastering medical device podcast as interviews like today's can help you become a more effective medical device leader. Work hard. Be kind
