Ep 304 - J&J MedTech's Polyphonic Lead Explains Why Surgical Intelligence Is the Next Big Shift in the OR

0:01Chris Newmarker: Hey everyone, Thompson Lemmer here. Welcome back to the Device Talks weekly podcast. Great show coming your way. It's going to be very Chris Newmarker heavy. Chris Newmarker and I kick things off with our talk of the Newmarkers, Newsmakers, Top 5 Stories from MassDevice. We'll also delve a little bit into our experiences, more Chris' experience in D.C. on the morning of 9-11 in 2001. Of course, coming up on the 25th, we're here at the 25th anniversary as we recorded this episode's newsmakers on the Friday morning of September 11th. So as I said in our conversation to those folks who had a more direct impact from 9-11 than we did, I hope you found some peace and fond memories on this day.

0:53Chris Newmarker: So later on, though, Chris Neutmacher will talk with our main guest. He's leading our keynote conversation as well. Chris spoke with Shan Jigathaswaran. He is the global president of Polyphonic at Johnson & Johnson MedTech. Johnson & Johnson MedTech of course enjoying the approval of Otava a little earlier this year in this conversation Chris and Shan will talk about how surgical intelligence is really the next evolution in digital surgery I mean the tech is here but there's a lot of data that needs to be accessed so there's a lot of complicated next steps for everyone in the surgical robotic space and Johnson & Johnson MedTech has an interesting story with Polyphonic that Chris and Shan will explore.

1:36Chris Newmarker: Before I begin this episode, I want to give a shout out to my great friend and colleague, Kayleen Brown, Managing Editor of MassDevice. Kayleen will be leading the executive interview at MedTech Vision, one of the great shows in MedTech. It's happening on Tuesday, September 15th. Kayleen will be interviewing Martha Ronson, who is the CEO and president of Merit Medical. So that promises to be a fantastic conversation. And I'm just so happy that Kayleen could be part of MedTech Vision. It's truly a great show. I've gone the last three or four years. I'm not able to make it this year, unfortunately, but Kayleen and Skylar Rivera, associate editor of MassDevice, will be representing as well.

2:23Chris Newmarker: So make sure if you are one of the lucky ones attending and the show is sold out. So if you don't have your tickets, don't know what to tell you. But if you are one of the folks who were able to get tickets, please say hello to Kayleen and Skyler and make sure you sit down and sit in for Kayleen's interview with Martha Ronson. So once again, congratulations to Kayleen. Congratulations to MedTech Women for putting on such a great event. And I'm sure it'll be a fantastic time for folks at MedTech. And I am I'm sorry. I'm missing it. So without any further delay. Oh, actually, no, I did want to just talk about one other little thing.

3:00Chris Newmarker: Our own conference, Device Talks West, is taking place on November 30th and December 1st. We've got an early agenda up there with some speakers. I'll continue to add that, but it's always a great time. We have a new venue. We'll be at the Signia Hotel in San Jose. New time of year. Excited to be sort of wrapping up the year with Device Talks West. So go to west.devicetalks.com for more information. All right. Now with that, let us get this podcast started. All right. You ready for this? Ready.

3:53Chris Newmarker: Chris Neumarker, how are you, sir?

3:55Shan Jegatheeswaran: Doing all right, Tom. We're recording this on Friday morning. So, man, 25 years ago, huh?

4:04Chris Newmarker: Yeah, just a full transparency. Chris and I were just trying to discuss how much we want to delve into 9-11. I mean, clearly it was my singular day in my lifetime that sort of has the before and after feel. Like there was, it's one of those moments that just everything pivoted. So I don't think I need to go into my where was I story. It was pretty mundane in an office, you know, trying to refresh my CNN browser on 2001 technology and it didn't go well. So I ended up going to the Radio Shack under my office and watching everything on TV. But Chris, you were actually on a scene on that day.

4:43Shan Jegatheeswaran: Yeah, I'd started my journalism internship right after college a week before 9-11 in D.C. So I was on the metro coming into the city. I think I boarded the train just a few minutes after the first tower hit. So I'd been walking over. And back then, we didn't have iPhones and stuff. So I just heard people talking on the train about, oh, there was some weird accident. And then a few stops later, somebody came on. I was like, oh, a plane hit the second tower. And everybody cleared out of the train pretty much. Did they stop the train prematurely? It went into the city. I stayed on because I had a news bureau I was interning at.

5:26Shan Jegatheeswaran: So I thought I could be of help. But it's definitely a weird feeling when you're walking out of a metro station. And you're one of the few people leaving the station. and there were like hundreds of people running into the station to get the heck out of the city. So had the plane hit the Pentagon yet at that point or was that still to come? It had just, I kind of remember getting over to the Bureau and I could see like smoke over the city all of a sudden. Like something had been hit. And when I got in the Bureau, found out the Pentagon had been hit as well. And one of the top editors at the Bureau had actually seen it happen.

6:02Shan Jegatheeswaran: Wow, really? driving on the interstate with his wife into town for their jobs and like uh was like wow that plane's flying low and then whoa saw saw the explosion so yeah it's uh it's something else um but um yeah and uh i remember yeah such weird things as like rumors that other stuff around the city had been held hit like the the bureau chief like was like oh we've heard something might have happened at the white house could you run over there and look at the White House?

6:34Chris Newmarker: What did they have you do that day? Do you have anything, any memory of, or do they basically have you just kind of run coffee and keep everybody fed as an intern? I did run out.

6:44Shan Jegatheeswaran: I was like the intern in the Bureau. I ran out and got sandwiches. I, you know, I, yeah, I made sure the White House still existed. So you actually did that?

6:54Chris Newmarker: You did that? You ran over to the White House?

6:56Shan Jegatheeswaran: Yes, I ran over to the White House to make sure it still, it was, it still is. I mean, at least part of it. And, you know, oh, yes. And like near the end of the day, I actually headed out to Dulles Airport, you know, because they wanted to see if we could, you know, talk to any relatives of, you know, people had been killed in the plane that had taken off from Dulles that day. But they kind of cordoned off the reporters from everybody. But that was pretty grim. So it was, yeah, and things totally changed. And I still don't forget, you know, like the weeks afterwards seeing, you know, like National Guard troops guarding, you know, like, I mean, you'd go to cross a street in D.C.

7:40Shan Jegatheeswaran: and there'd be somebody in full camo with an assault rifle standing there. That's a very weird sight.

7:48Chris Newmarker: That was a different. Before 9-11 was a different world than this. We were ignorant, and blissfully so, I think, of a lot of the dangers and tensions that a lot of the world already lived under. We just thought we were automatically immune from everything, and that was—

8:05Shan Jegatheeswaran: It's so weird that, you know, a week before, I had flown to D.C. from a little regional airport in Ohio. And, you know, like, I think it was the airport in Dayton, Ohio, like, you know, because I found a deal on an airplane ticket. And I still remember my dad drove me there. and uh you know like i mean he could walk right to the gate with me you know gave me a hug you know said said you know good good luck in dc and everything you know like that that was all gone

8:29Chris Newmarker: after that uh you know so i had to go down to a private equity conference we were hosting a few weeks later end of september so it wasn't that close but taking the train from boston into new york not really expecting what to see i did walk down to uh to um to ground zero um to take a look around and it was it folks we're at a point now where there are people listening to this who who don't remember to have no memory of it maybe weren't alive during it but uh it was a distinct before and after feeling and we you and i you were more touched than i was uh of course you know we don't need to delve too long into our our sort of secondary experiences but of course we want to wish those who were who lost loved ones either in the attacks or in the rescue attempts after or were impacted anyway uh i hope i hope today doesn't bring back too many painful memories and perhaps give some peace because uh it was uh it was just probably one of the more important days of my life for sure so i can't imagine how someone who was directly impacted feels about this day i

9:35Shan Jegatheeswaran: can't even imagine yeah so i mean yeah well 25 years man time goes by fast yeah like uh like i I think we're, we become an older, older, older guys, Tom, like 25 years.

9:49Chris Newmarker: Despite my best efforts, yeah, yeah. There we go, right? All right. Well, again, our thoughts and our hearts go out to folks who have had direct experiences on 9-11. Yes, absolutely. And we're directly impacted. And to the rest of us, we're here and we're moving forward and we're going to talk medtech because it's important. Yeah.

10:14Shan Jegatheeswaran: Exactly.

10:15Chris Newmarker: All right, Chris Newmark. Let's hit the Newmarkers Newsmakers.

10:17Shan Jegatheeswaran: What's number five? Hey, number five on the list. This is from managing editor Jim Hammerand. He had a really nice exclusive interview with Petal Surgical, the incisionless surgery company. And we have a good little update on the site about where they're going with the technology, about how they're planning. They're moving toward human trials. They said they're moving out of the lab. They gave us a little teaser image of their robotic system that delivers histotripsy. And yeah, along with a Minneapolis-based company, Histosonics, I think this is one of the most exciting areas of medtech, actually, right now.

11:00Shan Jegatheeswaran: It hasn't been talked a lot. I think it's going to be huge. Well, do I really want to stake my reputation on it? Yeah, I think this is a big deal. I think it'll be really, really exciting to watch where this goes over the next 10 years. This, you know, that we're seeing technologies rolling out now that use ultrasound and increasingly sophisticated ways to accomplish things that in the past, you know, were only, you know, done with, you know, radiation or surgery. So it'll be, yeah, it'll be great. But, you know, if you want a little idea more of, you know, where Pedal Surgical is going, you know, Jim has a really solid story on a mass device, you know, about Pedal Surgical saying it's first in human incisionless surgery is coming soon and offering a first glimpse of its system.

11:51Chris Newmarker: yeah they say they're using a millisecond pulse histotripsy and yeah you mentioned um histosonics and insight tech is another company in florida that's working in this space so we've got three which makes it a makes it a trend and i think you're right i think i mean the potential to to to remove harmful tissue from the body without having first cut into it i mean i hope in 25 years that we're going to look back at some of the things that we're doing now and say, oh my gosh, can you imagine they used to have to cut people open to reduce a tumor?

12:31Chris Newmarker: I'm hopeful that someday we're going to look back at a lot of the procedures we're doing and saying, thank God we don't have to do those anymore. So I agree with you. It's one of the more exciting spaces of MedTech. All right, Chris, what's number four?

12:42Shan Jegatheeswaran: Well, number four on the list is from yours truly. There was an SEC filing earlier this week from Boston Scientific that this cybersecurity incident that they went through is going to cause them to miss their guidance for the year. So it seems that, you know, that sales growth and EPS could be even lower. I mean, they already, you know, cut back their guidance, you know, during their most recent earnings call on July 29th. It could be even lower now after this global communications outage that hit them in late August. So, you know, we're talking on Friday and we just noted that there's a, you know, post out from the company about, you know, how, you know, their processing and shipping is, you know, backed.

13:32Shan Jegatheeswaran: you know, to, you know, normal operating levels. So they're coming back online, but, you know, they're, you know, they're still, you know, working with, you know, you know, cybersecurity experts to kind of investigate how this happens. You know, so far, they've just said that this was like, this involved unauthorized activity that affected access to certain operating systems and business applications. So, yeah, there's just been a real uptick in these types of reports. I mean, and I've been kind of wondering in MedTech, and probably in corporations in general. I mean, maybe some of this could be, you know, the SEC requiring, you know, more disclosure of this type of stuff, you know.

14:13Shan Jegatheeswaran: So, I mean, that could be one thing, but, you know, it certainly doesn't help that we have a huge war going on in the Middle East or, you know, other things of that nature.

14:23Chris Newmarker: Yeah, and also just, I made a point on LinkedIn earlier this week. I mean, one of the promises of MedTech is connected health, connecting devices, connecting devices to, for patients to interact with, connecting devices to obviously clinicians to track data and with every time you add a layer of connectivity, I think you add a layer of exposure so the very thing that is creating great opportunity for medtech is creating great risk as well. That's like, that happens sometimes but I think we're going to be hearing more and more of these as medtech devices, as medical devices get smarter and get connected.

14:59Chris Newmarker: Exactly.

14:59Shan Jegatheeswaran: Yeah, totally. So this probably isn't the last time we've reported on it.

15:04Chris Newmarker: I don't think so. I don't think so. And certainly not isolated to Boston Scientific or Striker. I mean, everyone's been reporting. I think Boston Scientific and Striker are the first that recorded a business impact. I think Intuitive and others have sort of reported that data has been compromised. And I think most of the big device companies have reported some sort of cybersecurity incident. so it's not isolated to one company

15:31Shan Jegatheeswaran: absolutely we had stuff from Medtronic from Striker all kinds of companies alright what's number three

15:39Chris Newmarker: Chris Neumarker?

15:40Shan Jegatheeswaran: number three on the list this is from freelancer Sophie Corita who's been helping us out this week I think we'll have an announcement soon about a new editor joining our team but you know thanks again to Sophie she wrote up an article for us about how So, you know, Teleflex just earlier this summer had Medtronic executive Jason Weidman join them. You know, Jason, you know, run, you know, coronary and renal denervation over at Medtronic. And, you know, and now Teleflex is adding, you know, Sean Salmon to their board who, you know, stepped down from Medtronic in September of 2025. I mean, he was, he actually was Jason's boss.

16:24Shan Jegatheeswaran: He was president of the career manager portfolio. So, you know, that's, you know, I guess, you know, hopefully they can appreciate the humor, but, you know, like, you know, you're a really good boss when your, you know, former employee gives you a board seat. So that's a good deal, right? That's a really great, but a lot of positive comments on LinkedIn, you know, from this news that we posted as well. So, you know, obviously you could tell, like, Sean was a very well-respected executive over at Medtron. and it's kind of cool. It looks like Teleflex is kind of like starting to gather kind of some like Medtronic know-how over there.

17:03Shan Jegatheeswaran: So it's going to be fun to see, you know, see where they go next. Absolutely. Medtronic is Medtech's

17:11Chris Newmarker: tree of life from what's the big movie? Avatar. Medtronic's branches and roots are touching a lot of companies in medtech.

17:26Shan Jegatheeswaran: It's definitely true in the Twin Cities where I'm based. It's hard not to go into any company that doesn't have somebody who was at Medtronic at some point. It's almost like the grad, the super duper extra grad school for people in medtech around here. So yeah, it's cool that Teleflex is getting a little more of that Medtronic mojo over there. So it'll be fun to watch.

17:49Chris Newmarker: Absolutely. All right, let's roll on to number two, Chris.

17:51Shan Jegatheeswaran: Number two, talking about like kind of like rejiggering and getting new things going on um you know it looks like zimmer biomed i mean they've got a like a leadership restructuring going on um they you know they mentioned you know that this is coming at the same time they're planning to get a next gen orthorobot out next year um you know they're calling it the monogram you know system so that'll be really really fun to watch you know to see where that that's going but um And, you know, Bradley Kessler, who's been, you know, already in charge of their robotics, you know, program over there, is now getting promoted to president of the Americas for Robotics Technology and Data.

18:33Shan Jegatheeswaran: And, you know, there are two other executives at Zimmer Biomet that are getting promoted up to president's rules. The flip side is they're letting go of Kevin Thornell, the former Nevro CEO who just joined them last year as their group president, global business and the Americas. So it kind of looks like, well, it's kind of interesting. It's like, you know, you had, you know, Kevin reporting to the, you know, the CEO, even Tordos, and now like Kevin's, Kevin's leaving, they're bringing up three executives who are all going to, you know, report to, to even. So, you know, it's kind of maybe getting rid of a layer of management.

19:21Shan Jegatheeswaran: And, you know, you got like a next-gen robot rolling on next year. You know, maybe just getting the CEO more involved in, you know, what's going on down there, you know, as they're getting ready.

19:32Chris Newmarker: Yep, for sure. These things certainly happen. Kevin Thurnall, of course, has had great success in the past. and as I like to note every time he's brought up on the podcast he was our first interview with someone from one of the larger OEMs Wow We talked to him early on when he was at The Logic about the diagnostics they were creating My goodness During the pandemic Alright Well we'll be excited

19:58Shan Jegatheeswaran: to see where Kevin goes next and you know Absolutely Absolutely Get him back on the podcast Yeah you can't can't can't keep a good man down we'll see where he is next So we could.

20:10Chris Newmarker: What's number one, Chris Neumarker?

20:12Shan Jegatheeswaran: Hey, number one on the list, we've got Abbott earning FDA approval for a new dual energy ablation catheter, the Tectiflex Duo. So, I mean, these systems are really, you know, have really been gaining in popularity, kind of this idea that you can, you know, toggle between, you know, kind of this new pulse field ablation technology and RF ablation, like giving electrophysiologists this flexibility. So, I mean, we've had, you know, Medtronic, you know, has been seeing a lot of success with its Sphere 9, you know, Aferra system. Now we've got J &J MedTech with their ThermoCool Smart Touch SF. And now we've got Abbott here on the U.S.

20:55Shan Jegatheeswaran: market with Taktiflexa Duo. So, the competition is just, you know, growing even more. So, just really cool news. Absolutely.

21:05Chris Newmarker: And it's an interesting space is all these companies. I mean, it's amazing to me how quickly the atrial fibrillation and cardiac ablation area is moving with the introduction of PFA. I mean, just two or three years ago. I mean, that's when the FDA approvals first came in. I think it was 2003, 2023, 2024. And now it seems like several of the big players have their dual systems. and now everyone's integrating mapping and other sort of technologies that can read not only what tissue needs to be ablated, but how it is after it's been ablated. And then of course, the ability to toggle between the RF and PFA.

21:46Chris Newmarker: It's just amazing how quickly this space has moved. But I just think as this area gets smarter and smarter, it's going to be an interesting space for automation, for AI, for surgical robotics, maybe to play a bigger role in this area. Maybe this is a space where Boston Scientific finally gets involved in robotics or Abbott, perhaps. So we'll see. Not that you have to apply robotics to everything, but why not? It seems like it's getting smarter and smarter and could be a nice fit for a robotics platform in a few years.

22:17Shan Jegatheeswaran: Yeah, I've heard a lot, especially with PFA, there's kind of like this trying to find the secret sauce of exactly how to deliver it. And, you know, maybe these systems that toggle between RF and PFA are like kind of just allowing the, you know, electrophysiologist to kind of experiment even more with it right now. So it almost feels a bit right now like an art, kind of this art over science thing going on with it a bit right now. But yeah, you're kind of right. As they figure out more how to do this well based on different cases and they get the data, yeah, why not have something like where you have some kind of robotics play in the EP lab that could make accessibility of these technologies even wider, perhaps?

23:05Chris Newmarker: Kind of right. Why'd you have to qualify my rightness? Why can't I just be right? I have to be kind of right. You want me to say, sure, Todd, you're right. I'll just delete that. I'm going to edit that out anyway. You took them right. Yeah. You are so smart, Tom. You are smart, Tom. Tom. All right, Chris Newmark. So this is the point of the podcast where I generally record my intro for the keynote interview because I usually do the keynote interviews, but you are handling this one, Molly, my old friend. So do you want to tell folks who you talked to and what you talked about? Yeah.

23:42Shan Jegatheeswaran: I mean, like, you know, we recorded an interview earlier this week with Shan Jagathis we're on. He's the president of Johnson & Johnson MedTech's Polyphonic Digital Surgery Ecosystem Initiative. But they just recently had a really extensive report come out about surgical intelligence. This is kind of, you know, we've had like, you know, the rise of robotic surgery. We've had, you know, digital surgery. But now, like, especially with AI, we're moving into this kind of era of surgical intelligence. And, you know, Johnson Johnson really sees itself as like kind of a leader in this. And it was a really, really, you know, there's some really fun, insightful things that we got out of that, you know, discussion, including like, you know, even like, you know, you know, kind of try to compare what's going on with surgical intelligence right now to, you know, how does it compare?

24:32Shan Jegatheeswaran: How does it not compare with, you know, the rise of surgical robotics a few decades ago? So, yeah, versus me just talking about this interview, like, yeah, everybody can just check this out now.

24:44Chris Newmarker: Absolutely. No, it's much more fun now that JJ has a TAVA approved and is an active player in surgical robotics. So, all right, I will stop talking and let's get this interview started.

24:56Shan Jegatheeswaran: Oh, hi there. This is Chris Newmarker. I'm editor-in-chief of MassDevice, and we're on Device Talks Weekly today. Some really big terms that have like dominated med tech in recent decades, surgical robotics, digital surgery. But, you know, we have a new term that's really on the rise of like kind of the next generation of all the surgical intelligence. and luckily like Johnson & Johnson MedTech just recently produced a large, extensively researched report on the subject and I'm lucky enough today to have Shan Jagathiswaran, the president of Johnson & Johnson MedTech's Polyphonic Digital Surgery Ecosystem Initiative just announced last year includes partnerships with such big names as NVIDIA and Amazon Web Services.

25:45Shan Jegatheeswaran: Shan, welcome to Device Talks Weekly. It's a pleasure. Thank you for having me, Chris. I always like to start out by talking about how people got into medtech and just looking at your LinkedIn profile. You have an interesting story. You spent a lot of your career in the energy sector, just joining Johnson & Johnson a few years ago. What drew you to our space?

26:11Chris Newmarker: I had an atypical path, as you alluded to. I started my career in capital markets, worked in a bunch of industries, and most recently, as you mentioned, in the energy space. I like to say it prepared me for surgery because it is multidisciplinary. The things I learned along the way are incredibly applicable. But net-net, if I look at the common themes, it's a regulated industry. It's global. Software in this space needs to work. There's implications when it does on both human and environmental. So it's important stuff. Excited to be here and working with J &J on it.

26:49Shan Jegatheeswaran: Yeah, that's very true as well. I mean, like MedTech, energy is a space where if something goes wrong, it can go very wrong. And if it goes right, it can go really right for a lot of people as well. So tell me the story about this report. I mean, I saw there was a report last year, but I mean, how did you get involved in really deciding, like, we really need to dig into what surgical intelligence is? what its potential is, what the future of it is.

27:18Chris Newmarker: Yeah, it feels like, you know, we started the report because it feels like a special time, especially now in surgery. There's a lot of sort of converging themes when you think about devices being more connected, robotics, et cetera, the prevalence of AI and the ubiquity of AI, and then also the needs. Hospitals, surgeons, and patients, they're looking for how digital can alleviate some of the things that they're experiencing. So it just felt like a special time. it felt like there was a lot of amazing work happening in pockets through strategic startups some of our technology partners in hospitals governments but for me what was what was lacking is like how do we talk about this in with common language common frameworks common mental models that yeah enable and accelerate our conversations with each other and that starts to build out a category right when we can align on simple language and terms it makes doing business and doing building innovation much more simply and easier.

28:12Chris Newmarker: And that's why we started this second version of the report is how exactly the people that are doing this every day working in surgical intelligence, so to speak, how are they talking about it? How are they thinking about it? And how can we coalesce so that we can partner up?

28:25Shan Jegatheeswaran: So just to back up, I mean, what is surgical intelligence?

28:29Chris Newmarker: So we define surgical intelligence as the clinical knowledge generated when multimodal data is connected across the perioperative surgical pathway and then analyzed to support clinical decision-making and operating performance. So that's sort of the definition in the report. If I were explaining it to someone outside of the industry, it's essentially the combination of digital, physical, and human coming together for the purposes of safer, better surgery.

28:59Shan Jegatheeswaran: So it really sounds like getting AI involved in the data analysis and the insights that we could potentially gain from all the data we're increasingly collecting from the operating theater.

29:16Chris Newmarker: Yeah, exactly. I mean, you're seeing data start to get generated. Outside of the OR, it's pretty prevalent, right? like EMRs, imaging, they've sort of had their maturity curves. Within surgery, devices are getting smarter, and there's also more data coming into a clinician's sort of purview as well as a patient's purview. And what's the infrastructure and the mechanisms around bringing all of this together and adding value or creating value out of it for the purpose of either a clinical or an operating outcome, right?

29:44Shan Jegatheeswaran: I just got to think the challenges around creating those mechanisms have to be huge. I mean, just because of, you know, different health providers using different, you know, electronic record systems, all these different devices producing different types of data, you know, areas you'd like to get data from, but they're still totally analog on it. And, you know, like, it's just not going to happen. And then, you know, I could also just see, you know, the health providers themselves are just busy doing health care. So, you know, why, you know, take time when they could be treating people, like bringing in revenue to their systems to like, you know, grapple with all this data?

30:28I mean, am I kind of like, what am I missing here?

30:31Shan Jegatheeswaran: I mean, am I right thinking that there's just a lot of challenges to kind of make this a reality?

30:38Chris Newmarker: I mean, you're right when you say it's hard, right? It's hard. It's complex, especially in our industry, as you know, there's regulatory elements to it. But then there's also, it has to be right, it has to work and add value almost on day one to your point. Having said that, a lot of things in healthcare are hard. And yet innovation is pretty prevalent. And so our approach here, at least through the work that we've done with the surgical intelligence report, it shouldn't be all borne by the hospitals anyway. And so when this thing works and scales, there's a leaning in from med tech players like ourselves.

31:15Chris Newmarker: There's a leaning in on the government side. There's a leaning in on startups and big tech. And I think it's twofold. One is the mission is important. This has patient impact. And so there's an altruistic rationale for spending time here. But it's also highly valuable when it's right. As you know, surgery is a key driver of revenue as well as complications and cost for hospitals. And so if you can fix that, it has direct impact on throughput. Other areas that are important for the hospital and patients as well.

31:49Shan Jegatheeswaran: Yeah, I mean, it sounds like bringing in data on what, not just like the immediate outcome of the surgery, but, you know, how the recovery goes. I mean, that's kind of why you're using the phrase perioperative. It's everything from getting ready for the surgery to doing the surgery to what's the outcome going to be for this patient down the road. And we all kind of have a stake in that, too, because if you have more surgical complications, that's more money being spent in the system and more people having more health problems that could have been avoided if there were more insights. So, I mean, it sounds like there's a tremendous amount of promise if we do it right.

32:27Shan Jegatheeswaran: Agreed.

32:28Chris Newmarker: And I think you've got to believe in a few things, right? The North Star for us is, as the report suggests, is collective intelligence. At some point, if you squint into the future, what is that future? It's the convergence of these themes that we talked about, right? Compute power, AI, the unmet needs clinically and operationally from hospitals. and then devices themselves in medtech are getting smarter and more connected so if you if you just extrapolate what that looks like 5 10 15 20 years from now you're going to end up in a space where data does exist data is being used at scale and it's finding its way back into clinical workflow the problem is or the opportunity for us is from today to that north star what is the pathway and you know what i'd like to say is that there's no map for this so you sort of have to direct this with the concuss.

33:16Chris Newmarker: So you get direction of travel and then you do a few smart things along the way. Some of them are bets, some of them are not. And you move in that direction. And what we found was and what you probably see around in the industry is we tend to focus and index on sort of the technology element and the technology story. And that's what you see in the headlines, right? But the foundational, I would say the tougher stuff is the mindset part. That's the governance, that's the policies, that's the economic incentives, all of the regulatory bodies that now have to be involved? And how do you even move data around compliedly, let alone in your hospital system, but across state lines, across countries?

33:56Chris Newmarker: Those are things that we have to tackle when this thing is going to scale and become real.

34:01Shan Jegatheeswaran: I mean, is there any kind of changes in, I mean, does Congress have a role to play in this? I mean, could there be like changes in regulations that could help out? I mean, obviously, I mean, HIPAA, I mean, I was a young man when HIPAA was, you know, passed. So, I mean, it's been a long, I mean, well, it's not been that long ago. Yeah, I'm still a bit young. But, I mean, it's been a while. So, I mean, you know, if you had a wish list for, I mean, I saw you were, you know, you've done work with Avomet. I mean, what, you know, how could, you know, the government help, you know, facilitate this? I mean, because there seems there could be a lot of positive things that come out of this.

34:41Chris Newmarker: yeah i mean i think overwhelmingly the feedback from from the work that we did was uh and we fully believe in this is um no one entity is going to figure this out on our on on our own on its own it's multi-disciplinary at its heart so that's the one key thing the second is um most respondents i think just over 70 percent of them eliminated technology as the as the main barrier and the four that that sort of bubbled to the top consistently were economic incentives interoperability of the data and the devices themselves capabilities of those deploying the technology but also using the technology so let's call that change management and then the governance of that whole thing and across these four areas you see a role for government to play you see a role for hospitals to play and you see a role for med tech slash tech players to play along with your institutions like your academic institutions, your societies, etc.

35:36Chris Newmarker: And so that's really what the report has laid out, but that's also the journey that we've been on as Polyphonic, but also as J &J.

35:43Shan Jegatheeswaran: Yeah, no, absolutely. And like a huge, huge role to play because, you know, you're one of the largest surgical tool makers in the world. You're, you know, heavily involved in, you know, surgical robotics and digital surgery and, you know, and other med tech. Like, you know, the report, I mean, my gosh, 44 interviews with senior leaders. I mean, reviewing more than 100 publications, you know, and, you know, prior research involved like hundreds of clinicians, administrators, 15 countries, you know, 1 ,566 surgeons. All that research to kind of be like, how, you know, how could, you know, how could we kind of move this forward?

36:18Shan Jegatheeswaran: I mean, what was the most surprising thing to you out of this, out of all this research?

36:26Chris Newmarker: I'll go across both reports, right? Because they were both important for different reasons. Last year, we went broad, close to 700, as you said. Between that 700, by the way, we were intentional. About half were clinicians and about half were non-clinicians, so administration roles, which are also equally important, I'd say, in this space. And 15 countries, as you mentioned, across multiple procedures, multiple also care settings, ASCs, hospitals, academics, et cetera. For me, the key takeaway on that report was, despite country procedure and, let's call it, respondent flavor, the feedback was homogeneous.

37:04Chris Newmarker: There weren't topics that were prevalent in the U.S. for a particular type of entity, versus Abu Dhabi for something else. Across the world, there were common issues in surgery that needed to be solved for. And that's a good thing, because when you solve it somewhere, you can solve it almost everywhere. And that for us was a hypothesis and a learning. The second thing that came out of that report was the prevalence of technology already in the OR. I mean, on average, there are seven software solutions operating in any given procedure, four hardware devices, and five unique data streams. That's a great starting point.

37:41Chris Newmarker: It's not like the tech doesn't exist. then almost 100 % of clinicians interviewed said that data and that value that juice was inaccessible. So that's really the problem for us to solve, right? And that was last year. This year we went deep and I'm really proud of the makeup of the 40 plus people that we talked to because it wasn't just med tech players. It was CIOs, it was government officials. It was also in many cases all of our competitors because we truly wanted to get sort of a holistic view here. and here I think the key takeaway is number one, that the input cost is improving and reducing at the same time.

38:21Chris Newmarker: So that's sort of a check mark for technology, right? Compute performance doubles every nine-ish months these days and the cost reduces quarter over quarter. The prevalence and the acceptance of AI in surgery for me was also a learning. hospitals clinicians understand the value of it not only that they want they want to participate in the scaling of it as well it isn't something that is a science project that people sort of shiny shiny object that they see and right they want to keep up themselves their first question is how do i use this safely compliantly and consistently in practice because they understand what it's done for them in their personal life one can only imagine what can this can do at scale in in surgery.

39:07Chris Newmarker: And then the third thing for me, which wasn't an aha, but it was nice to break it down into practical steps was take away the tech challenge for a second. Not that it's simple, but it's simpler. It's the mindset stuff, right? It's like I mentioned, the mechanisms and incentives that how data standards now need to evolve so we can share data in a compliant way, norms and governance. That helps me internally speak the language within J &J with my counterparts of my functional leaders but frankly it also helps me speak with customers and some of our partners as you mentioned with aws and video because they've done this and so have i have done this exact play in other industries right we went through this journey in energy the automotive industry has gone through it itself capital markets as well so how do we leverage some of those lessons learned and and um jump ahead so to speak now surgery is unique it has its own nuances for sure.

39:58Chris Newmarker: That's where the talents and the capability of J &J come in. But there's definitely things that we can learn. So for me, those are the takeaways that will follow up with some of these respondents.

40:09Shan Jegatheeswaran: A lot of times when I look at health providers, I mean, surgeons are kind of like the rock stars of the medical profession. I mean, how do you ensure the fact that in the end, even though you're getting all this insights and suggestions, I'm sure, from like an AI, like, oh, you could try this, you could do this, how do you ensure that, you know, the surgeons are still, you know, in the driver's seat and responsible? I mean, I think the, there's a couple of things that we hear.

40:37Chris Newmarker: One is we're not jumping to the most exotic AI use case, right? Like you can go interoperative and apply AI interoperatively. It comes with its regulatory checks and balances. It also comes with the need for large training data sets. And both of those are long cycle and hard to do. And it doesn't mean we shouldn't do them. We should start. But the immediate impact and the use, and I would say the habit-forming behavior where AI can be used in a safe, consistent, scalable way will happen on the outskirts first. And we felt that in our personal lives, right? You're not going to be comfortable having AI manage your bank balance tomorrow, but it helps you write up an email or plan travel.

41:21Chris Newmarker: and lower written stuff. And that's sort of the themes we heard when we were speaking to folks and also how we're approaching our product strategy.

41:29Shan Jegatheeswaran: It told me how to swap out my garbage disposal two weeks ago. I mean, that's good. I mean, it worked out. It worked.

41:36Chris Newmarker: But it saves you time. And you're like, okay, that'll work. And you'll expand your sort of usage as time goes. And that's the adoption curve that we're on. And so we heard that from the interviews themselves. and that also of course influences our strategy in the sense is can we save time what's the highest feasibility highest impact thing we can do immediately uh and we build a muscle yeah and that muscles to grow and you go from there i think um i think we have to recognize this is a long journey right it's not a tomorrow thing you got to start though and i think everyone's making progress

42:12Shan Jegatheeswaran: including ourselves i thought when you say friend you know kind of like it's starting on the fringes I mean, you know, where on the fringes do you think it could, you know, the adoption could gather steam, you know, fast? Is it where the cases are like more high risk, like oncology or, you know, where it's like, hey, we need to throw everything at this, you know, to try to save someone's life or extend it? Or, you know, is it more like things that are more like low risk and, you know, routine or is it mixed? I mean, where do you see the opportunities for like adoption, like starting?

42:46Chris Newmarker: I think there's two sort of themes. One is if you're a device manufacturer, you're usually dropping some level of algorithmic value in your device because it's a controlled environment. You have sort of the practices in place to deliver that safely. and so teams that we work with within Johnson & Johnson do that today, right? Monarch just released an update to their AI algorithms for their devices and you see that across the industry and that's where they tend to focus because that's a competitive advantage, right? You own the device, you own the data within that device or have access to the data within that device.

43:20Chris Newmarker: So that's one theme that has emerged and I would say is, you know, take me at scale-ish across surgery. Because it can just be deployed across the robot,

43:28Shan Jegatheeswaran: So as like robotic surgery continues to grow, you're just going to see that deployment of AI tools and data tools going with it.

43:37Chris Newmarker: Exactly. And that's the box of, you know, when you go back to the report, that's the box of institutional intelligence, right? It's within an OEM, so to speak, ecosystem. And that entire fleet of devices are going to get smarter over time. And we expect that to happen. That's a natural tendency, both in med tech, but also other industries. Then there's another theme, which is if you're not a device maker, we see areas like scheduling, patient engagement, patient risk profiling, 3D visualization, so for preoperative planning. These are, I would say, logical areas to begin in terms of access to data sets and also value to the surgeon.

44:14Chris Newmarker: Now, the question is, and that's what I would imagine is connected intelligence, right? Which is, it's always fragmented. Like, it's one-off solutions. Some surgeons use it, some don't. Sometimes it works for a procedure, sometimes it doesn't. When you put both together, the question becomes, how does it move to the top right, which is collective intelligence? And hospitals need to, you know, as simple as, not simple, but they need to understand what's the contract that's going to underpin all of this. Like, am I going to sign 25 different agreements with suppliers who are giving me digital solutions?

44:46Chris Newmarker: How do I manage that? How do I manage single sign-out? How do I manage data generated between all of these apps and shared? Those are the real problems, I think, that the report elevates. And that, practically speaking, how do we solve for that? Because that is the next sort of innovation arc after robotics for us.

45:04Shan Jegatheeswaran: It almost comes down to the question I hear a lot with any kind of, like, new medtech. Like, who, I mean, who pays for it? I mean, I know there isn't an answer right now, but I mean, like what kind of questions do you grapple through to get to that answer? Like who pays for this in the end? I mean, it sounds like there's a lot of agreement. There's value, but who's willing to fund it?

45:28Chris Newmarker: And that's the chief inhibitor today, right? when you talk to the folks who are interviewed, economic incentives is a big deal and it's real to solve for. And that's why I think a lot of the time that I spend with my team is on contract innovation. How do we measure value in this new world where raw data is value-add, and then the outcome is also value-add, and how do you adjudicate that value and get a sense of ownership on that value? That's, for me, quote-unquote, a ledger that hasn't been realized yet in surgery. And that's the type of work that we are doing right now. I'm lucky. I can bring my previous experiences to this space, but I have access to some of the best world-class talent in government affairs, regulatory compliance, cyber, whatever, that are functionally important.

46:19Chris Newmarker: You need all of these things, all of these humans to weigh in. And that's why I said that you started this conversation. It's hard. Yeah, you're right.

46:27Shan Jegatheeswaran: I mean, it's hard.

46:29Chris Newmarker: And you've got to have conviction. and sort of the appetite to take this on, I think fundamentally as a company, we believe that this is happening and will continue to happen. And not only do we want to participate, we want to lead in the space. Humbly though, we don't know already, right? And so that's why the report that we sort of commissioned was one of the things that we're doing to educate ourselves as we're on this journey. Yeah.

46:54Shan Jegatheeswaran: You know, one like, you know, insight i read in the report that struck out to me was like kind of the comparison to what's going on with surgical intelligence right now to kind of like the early you know years of um of you know surgical robotics um yeah i mean i mean it's kind of wild to think that i mean intuitive was getting started with soft tissue surgical robotics like in the 90s i mean this is a long ramp up to get to where we are now or all of a sudden like you know you know And Jane Jay's really getting in the space. You know, Medtronic's really getting in the space. We have like a whole host of companies like doing different things.

47:30Shan Jegatheeswaran: And, you know, Intuitive keeps innovating as well. But I mean, this was like a 30-year journey. I mean, is it at least like, I mean, kind of like reading the report, it kind of sounded like heartening. Like, hey, you know, this takes time. But, I mean, how did you see that analogy? And what kind of hope does that give you that, you know, like it might, it'll take effort and time. But we'll, you know, we'll get there. We'll get to a new level with surgery.

47:57Chris Newmarker: Yeah, I mean, similar patterns, right? The diffusion of innovation is really the problem that we're talking about, the challenge. Robotics was one, as you mentioned, in the early 90s. I think, and I'm sure you'll agree, that the window and the cycle time of that change management has accelerated greatly. So I don't think it's the same sort of 30-year journey that we're going to be on, on surgical intelligence.

48:18Shan Jegatheeswaran: Definitely software iteration is much faster than hardware like that.

48:24Chris Newmarker: And in the early 90s, affinity with the robot was still pretty foreign in your personal life, right? But affinity with software, digital AI today, people kind of get what it can do. People also understand when it's uncontrolled and ungoverned how dangerous it can be. So there's a mental model that our surgeons and folks that we work with are already coming in. So they know what this thing can be and should be. now we've got to figure out how it's applied to surgery so it's a bit of a different journey in that regard but the similarities for me are we've passed now the point of the technical challenge we need to now start talking about trust common standards, shared workflows sustainable business models that's the work to be done the cool part in all of this is there's predicates that we can lean on again if you look in the early 90s there weren't too many predicates on how you can build a business model around surgical robotics To date, I would say there's a menu of options in terms of how we can approach surgical intelligence.

49:23Chris Newmarker: So it's on us to go figure that out and make it useful not only for us, but also for our customers.

49:28Shan Jegatheeswaran: Is there anything, you know, that in the report that we didn't cover that would be really, really great for people to know about?

49:35Chris Newmarker: Listen, I think, you know, there's two adages that come to mind. one is uh we typically tend to and i think this is like a bill viet's thing but one is we we overestimate what we can do in a year and underestimate what we can do in 10 and i think that that fits here there's a lot of amazing work being done um but it's a it is a journey and i think we people folks in this space need to have the appetite to join up and do this right and it's not going to be done by j &j alone it's not going to be done by a competitor alone It's not going to be that way, anyone alone. And so the mentality of how we work together as an industry is going to have to change.

50:12Chris Newmarker: And the work that you guys do, Chris and Tom, and the device talk sort of brand is important to that. Like bringing us together so that we can start talking common language and community, that's important. Because it's not going to get software on its own. The other one, which we have to go through every day, is on one hand, the healthcare model is... Thanks, Sean. I appreciate it. It's true. It's true. Like, you know, bringing folks together, especially in this case, is important. But in healthcare, we always say, you know, do no harm. And then in software, it's like move fast and break things.

50:47Chris Newmarker: And both those things are different. In surgery, when they come together, we have to be very careful that we're being responsible by the thing. And so, yes, speed matters, but so does truck and quality and all those other things that, you know, for the last century, we've been around with the company. So for me, the one thing I'll leave your audience with is this is an important space for us to solve for. A lot of smart people are in this space already, which is great. I think the sense of community and cooperation is what I would say is something that we need to really push on by working together.

51:20Chris Newmarker: And that's a new muscle. Like I would say we're very good working as individual organizations. What can we do together for the benefit of a patient or the industry at large? That's going to be exciting to see within one to two years.

51:33Shan Jegatheeswaran: Yeah, I'm excited to be able to, you know, continue to cover this and watch this incredible journey. Shian, this was a real pleasure. It was great to have you on here.

51:42Chris Newmarker: Yeah, excited to be here and I'm happy to come back. And that is a wrap. Thanks so much for joining us in this episode of the Device Talks Weekly Podcast. Once again, I hope you're one of the lucky ones attending MedTech Vision on September 15th. You'll hear Kayleen Brown's interview with Martha Ronson of Merit. Please do us a few favors about this podcast. please subscribe to the Device Talks podcast network so you don't miss a future episode of this episode, I'm sorry, of this podcast or our other podcasts. Or you can subscribe directly to Device Talks weekly podcast so you don't miss this particular show.

52:17Chris Newmarker: But why not get them all for the same low price of nothing? Please make sure you join us at Device Talks West. That's happening on November 30th and December 1st. Go to west.devicetalks.com to check out that agenda. and of course, please do connect with us on LinkedIn. Connect with me, connect with Kayleen Brown, connect with Chris Neumarker. Make sure you follow MassDevice and DeviceTalks on LinkedIn as well so you don't miss our future MedTech conversation. So that once again is a wrap, folks. Thanks again for joining us on this episode of the DeviceTalks Weekly Podcast.