Virtual orthopedic training is booming amid Covid and the Orthopedics 3.0 movement. One major player leading the way in the VR training space in orthopedics is Osso VR.
I virtually sat down with Justin Barad to learn more about the technology and business.
#1 – How did Osso VR get started? Take us back to the lightbulb moment. We would love to hear the backstory.
The Osso VR origin story really dates back to high school for me. Back then my goal in life was to be a video game developer. I started coding at a young age which led to the opportunity to work at Activision during high school and even earn a game credit. I was well on my way when I had a bit of a wake up call when a family member became ill. I started wondering, and to some point became fixated, on if software and technology, which I was so passionate about, could be used not just for entertainment but to help people with medical challenges.
This led me to pivot and pursue Biomedical Engineering at UC Berkeley with the goal to invent a new healthcare technology. Although my goal was clear to me, as I neared graduation I realized I didn’t really know how to get started with innovation. I sought advice from a mentor of mine and he told me, “If you want to invent something, you need to understand the problem you’re trying to solve first.” He felt the best way to understand medical problems was to be a doctor.
Taking his advice quite literally, I subsequently attended medical school at UCLA’s David Geffen School of Medicine and stayed there to do my orthopaedic residency. It was during my training I began experiencing first hand what I believe to be one of the most critical challenges we face in healthcare today: how we train and assess our healthcare professionals with their technical skills.
The problem to me was really 3 core dynamics:
There is too much to learn: In a way we are victims of our own success. Accelerating science and technology has massively expanded the library of procedures healthcare professionals are expected to know how to do with a moment’s notice. I always tell the story when the team I was on during residency was urgently called on to operate on a gorilla, which we all had no experience with.
Procedures are getting more complicated: Newer, higher value technologies like robotics and navigation tend to have longer learning curves, sometimes nearing 100 cases to reach basic proficiency. This makes it much more challenging to leverage traditional learning modalities like cadaver labs where you typically get 1-2 repetitions.
A general lack of technical skill assessment in healthcare: In my own surgical career I’ve only been objectively assessed one time when I was asked to play the board game operation. It’s not that there isn’t a desire to assess technical ability, it’s more that we don’t have a way to repeatedly and easily do so.
With my background in gaming I was able to get involved in VR very early with the Oculus DK1. I immediately recognized virtual reality’s ability to address this problem. You can:
- Use it anytime, anywhere
- Train on any procedure
- Use your hands in a realistic way
- Get objective assessment
- And train as a team and train remotely
This is ultimately how the idea for Osso VR was formed.
#2 – How was Osso VR initially created, funded and staffed?
I co-founded Osso VR with a professional game developer, Matt Newport (now our CTO), who was also passionate about serious VR. We got started in October 2016 and were initially backed by a small venture capital fund which we used to hire our initial employees. We identified at that time a very strong value proposition within the medical device industry where they could leverage Osso’s unique platform to make their training strategies more efficient, effective and trackable often by supplementing in person training. This led to rapid and early traction ultimately leading to Kaiser Permanente Ventures taking notice and leading our $14M Series A earlier this year.
#3 – Please describe the benefits of the technology and how Osso VR is different from other VR training companies in Orthopedics.
Osso VR’s platform is unique in a number of different ways including our visual fidelity, clinical validation, simulation methodology and scale.
Visual Fidelity: Osso VR’s team consists of the world’s largest medical illustration team and veterans of top studios such as Industrial Light & Magic, Apple, Microsoft and more. Our team has worked on a number of leading games and Oscar and Emmy award winning VR experiences. When showing video clips of our platform I, and this is not a joke, have to remind the surgeons I’m speaking with that this is a simulation and not a real video.
Clinical Validation: Osso VR has two published peer-reviewed level one randomized clinical trials, and four additional studies currently being submitted. The first study, “Randomized Trial of a Virtual Reality Tool to Teach Surgical Technique for Tibial Shaft Fracture Intramedullary Nailing,” published in the Journal of Surgical Education in early 2020 by Blumstein et al. looked at 20 subjects and showed that when compared with traditional training Osso VR led to a 10 point (230%) improvement in overall surgical performance as measured by OSATS (Objective Structured Assessment of Technical Skill).
The next study, “Does Virtual Reality Improve Procedural Completion and Accuracy in an Intramedullary Tibial Nail Procedure? A Randomized Control Trial,” published in Clinical Orthopaedics and Related Research from Orland et al, looked at the ability for a trainee to perform a procedure without supervision. They found that with traditional training, 25% were able to complete a procedure independently. When trained and assessed with Osso VR that went up to 78%.
Simulation Methodology: We have a unique way we implement technical training and assessment in healthcare. We focus on three elements related to mastering clinical scenarios: knowledge of steps, ability to perform critical steps well, and efficiency. As a surgeon who trains future surgeons the most critical element to any procedure is understanding all of the steps. This is a way of turning something incredibly complex into something more simple to manage which I think is described incredibly well in Atul Gawande’s “Checklist Manifesto.” Osso is unique on the market in that we simulate comprehensive, full procedures with steps that are critical and steps that maybe are not as exciting but still very important to understand. When it comes to performing critical steps it is important to allow people to fail, but also to maintain the user in the “optimal zone of learning.” This means ensuring individuals are obtaining the desired learning outcome and are not becoming frustrated to the point of losing their engagement. Finally we focus on efficiency and “flow,” so that by the time a user is fully trained they are almost automatic when it comes to performing the procedure in a real world setting. While most VR platforms on the market have no published research, those that do have not shown statistically significant overall skill transfer in OSATS/GRS scores, whereas Osso VR once again showed improvement from 7.5 to 17.5 (a 230 percent improvement) when using the same evaluation methodology.
Scale: Osso VR has the world’s largest VR surgical training library currently available with over 70 different training modules utilized by over 1000 surgeons/month in over 20 countries. We have achieved this scale thanks to a variety of factors including our unique platform, capital raised and team size and quality. We have raised approximately $17M in venture capital financing in addition to grants from the Department of Education, NIH, NSF and US Air Force, the most capital raised in this space to date. We have invested years and millions of dollars into creating a scalable platform that allows us to rapidly create a large number of high fidelity, fully interactive and validated VR surgical training modules simultaneously. Finally our team is truly Osso VR’s not-so-secret sauce with the world’s largest medical illustration team (over 20).
#4 – What is your business model?
Osso VR has a relatively standard model consisting of a platform license and the option to create customized content.
#5 – This is a very nascent space. Share your thoughts about future applications of your technology as it relates to COVID, AI/ML, avatars, haptics, remote collaboration, 5G, and other coming tech.
I don’t think one technology or platform will solve every problem related to procedural care delivery in medicine. There are many technologies that will need to interact and work together in this ecosystem in order for us to drive value for patients. COVID has driven a wave of digital transformations as stakeholders rush to be able to deliver healthcare services remotely. Likely many of these changes are here to stay in the long run although we don’t entirely know what the new normal will look like. Technology that is beginning to bloom outside of what we do in VR includes remote proctoring and telementoring like what you see from ExplORer Surgical, Avail and Proximie. There is a lot of discussion around Augmented Reality and its utility in the operating room. Navigation like Augmedics seems to be getting early steam and excitement. Visualization solutions like Medivis also seem to be seeing a fair bit of use and growth. I think intra-operative assessment is also a critical piece of the puzzle, with technology like that of Johnson & Johnson owned C-SATs able to leverage machine learning to objectively assess real world surgical skill. 5G will of course help streamline many of these technologies although I have to imagine that there will be implications related to privacy and security that I don’t believe have been fully fleshed out yet. Finally I think robotics is an absolutely critical piece of this puzzle. It ultimately will allow for surgical care to be more repeatable and trackable and I think is still incredibly exciting to me as a surgeon.
#6 – Where do you see Osso VR, the company, going in the future?
I became a pediatric orthopaedist because I was attracted to the mission driven nature of helping children. I wanted to bring that same philosophy to Osso VR, so I’d love to share our mission with you: Our mission is to improve patient outcomes, increase the adoption of high value medical technology and democratize access to surgical education all around the world. Estimates show that there are roughly 20-30 million healthcare professionals around the world who perform technical tasks with patients, anything from putting in a central line to doing complex robotic procedures. I see no reason why every single one of them shouldn’t be training and assessing themselves using Osso VR’s platform on something like the Oculus Quest 2. Our mission and the scale of our work is why we get up in the morning here at Osso. It takes a village and we never could have gotten this far without our incredible team, partners and users. We still have a ways to go but it’s been an incredible journey so far!
Bio of Justin Barad
Co-founder and CEO of Osso VR, Dr. Justin Barad, is a board-eligible orthopaedic surgeon with a Bioengineering degree from UC Berkeley, and an MD from UCLA, where he graduated first in his class. He completed his residency at UCLA and his fellowship in pediatric orthopaedics at Harvard and Boston Children’s Hospital. Justin is currently practicing at the Orthopaedic Institute for Children.
Justin, who has been a lifelong coder and has a game credit with Activision, originally wanted to be a game developer. When a personal family health incident introduced him to the world of healthcare, he decided to find a way to combine his passions and use his technology background to solve medical problems. During his residency, he identified what could be one of the most pressing medical challenges of this century: how we are training our surgeons. With a strong interest in gaming and a first-hand understanding of the challenges facing residents and experienced doctors, he co-founded Osso VR with a mission to improve patient safety and democratize access to modern surgical techniques.