Full presentation video. Slides below.
nSight Surgical is the first, artificial intelligence platform using computer vision to objectively document healthcare information.
• US Healthcare cost 4.3 Trillion dollars today
• Inside this web we found a $505B blue ocean data opportunity to reduce what is wasted in surgical care.
• Today in healthcare we rely on subjective data like surgeon opinions and operative notes
We are building a parallel video health care record based on truly objective data that saves the average US hospital $4m.
Oklahoma Surgical Hospital
• We have supported over 300 surgeries in the last six months at the first deployed operating room in Tulsa, at the Oklahoma Surgical Hospital.
• We have active sales relationships with one of the largest med device companies in the US, term sheet signed, under NDA that will deliver 55 ORs this year.
• My name is Nathaniel Smith, CEO of nSight Surgical. I am a serial entrepreneur I have 20 years in product design and management
• Our CTO JD is a senior AI platform engineer, former YC Founder who exited to Google
• Our CMO Derek is a prominent orthopaedic surgeon and scientist at Stanford
& Chief CV Scientist Mohammad has a wealth of experience developing commercial CV products
Full Simulation OR Space Fully Built & Complete
• Last year, we cloned my co-founders operating room to test prior to our first install
• During presentations to investors, and customers.
• We discovered a smaller system, with less friction, with a shorter sales cycle,
• We have that ready to scale right now.
The ASC of the future
• This is our intra operative cost analytics system
• The core value of this system is surgical case cost or COGS of surgery.
• We are able to collect all the inventory used in a procedure and cost of personnel in the room
IOCA Intra Operative Cost Analytics
• We provide administrators a way to monitor cost, efficiency, and surgical quality data.
• Our deep tech solution maintains the surgical count and shows case variability.
What is the Surgery Center ROI?
• Hospitals and surgery centers don’t have an activities based cost methodology. This is not a small problem.
• Surgery centers only get 48% reimbursement of a hospital, so they need to consistently mitigate the reimbursement adequacy.
• The Avg Net Revenue of a surgery center is $9.5M
• If we get back the low hanging fruit of 10% on inventory waste and personnel waste, we can save an ASC around $400k per OR
What is the Surgery Center ROI?
• This is a massive window for savings for the ASC that produces $38k of ARR for nSight per OR
• Our SaaS fee is 1/10th of the savings opportunity.
• We have tested this with hundreds of centers and we are sure this is the right price.
Whiteboard Deployment Path
In three weeks we can onboard a digital whiteboard and execute a sale Integration, set-up, and deployment are straightforward since there are relatively few parts.
The OR of the Future
• nSight Surgical is an artificial intelligence platform with a software as a service pricing framework.
• We can retrofit our system into an operating room in a weekend with a zero-footprint design.
• We install an interactive digital whiteboard that delivers data to staff when and where they need it.
CV System Capabilities
We use computer vision to collaborate with data on patient care related needs like:
• infection related behaviors
• tracking needles the smallest instruments in the OR (which as far as we know no one else in the world can do),
• surgical phase times
• and distributing surgical operational information
• Our proprietary metrics allow administrators to incentivize team performance and focus on revenue generating efficiency.
Existing Reality Problem Ecology
• This is my cofounder Dr. Amanatullah’s typical day in surgery - 3 cases at Stanford Hospital.
• The red indicates when a surgical team member was obstructing the progress of surgery.
• This resulted in over 3 hours of wasted time costing Stanford over $7,000 that day.
• Without objective data applied to surgery, Stanford wastes $1.8M a year in my operating room alone.
• If we applied nSight Surgical metrics and incentives to optimize surgical team performance, we can save 1.3 hours of overtime
• and recapture 1 case a week, which at Stanford is worth $1.6M per year.
• Our research indicates that each OR in the US wastes approximately 147k. We believe we can help with 25% percent of that problem and bring $36,750 to each OR our system is in.
Sterile Field & Room In/Out Violations
• The green shows the 36 sterile field violations made by my team in one case.
• nSight Surgical also tracks room traffic shown in blue.
• Staff should not go in and out of the room more than 10 times or the risk of infection increases.
• Clearly there is room to improve care and open up the discussion about operative time as a performance and revenue generating metric.
• We have sped up surgery and are monitoring the staff go in and out of the room in the upper left hand corner
• We use a semantic edge on the right (the thin blue line), which is our counter for how many people go in and out of the room
• Administrators were extremely happy to see this, they are now use this as their training video to reduce room traffic
• We provide clear metrics and feedback that can be used to incentivize behavior in the OR.
What is Reducing Infection by 50% Worth?
• With our first partner in Tulsa, modulating behaviors related to infection opens up a clear pathway to $2M in savings for hospitals by reducing readmissions related to infection.
• If I said to anyone in this audience, I am going to put a camera in your office to watch you to make sure your doing your job efficiently, you’d probably say no.
• What we learned from speaking to over 100 surgical team members is focusing on patient care-related needs paramount to adopting a computer vision system in the operating room.
For a Quick Look At the Data We are Studying Presently
• We are building a non discoverable data platform through the quality improvement pathway laws in every state
• We are extracting de-identified case information and studying thresholds to increase efficiencies.
• The chairs of surgery at prominent institutions like Cleveland Clinic, Hospital For Special Surgery, Kaiser, and Stanford all believe nSight Surgical is the future of surgery.
• The landscape can be broken down into three large groups.
• Medical record conglomerates, Outcome conglomerates Other computer vision players
• All of these players are taking a surgeon centric point of view and don’t consistently provide objective data to feedback on
• We are helping hospitals improve their entire staff efficiency footprint, not inventing a faster surgeon.
• We expect gradual revenue growth, with 2023 ending at at $2.5M in exit annual recurring revenue with a projected 29 operating rooms.
• We are scaling Oklahoma Surgical Hospital right now from 2 operating rooms to 6 operating rooms. As a result we should be able to have direct efficiency outcomes on revenue increase from that data. Those bookings result in $390k year to date ARR.
• Sales are exceed expectations, Greg was present this year for Derek’s talk at DOC SF and he can attest to the reception of nSight Surgical.
• Traditional Capital includes Mammoth Ventures, who helped us build a 33 physician champion network, Sand Hill Angels, and InnoVision Ventures.
• We have a host notable silicon valley independent angels that have invested as much of their time as they have their capital.
We use privacy forward design taking into consideration local, state, adn federal regulations surrounding camera and algorithm use in the operating room to maintain an FDA class I exempt distinction. Additionally, we are about the information we can obtain from the items used in surgery and the impact of those items will have on defining quality, safety, and efficiency. We do not blame people! We ensure anonymity by blurring faces and name badges in real time. We move data over a HIPAA secure pipeline. We only save data that makes our algorithms better. We access the quality improvement pipeline to facilitate feedback and reduce the hospital’s liability footprint.
We can use metrics to incentivize teams in novel ways to improve and outcome even time.
Here is a star based structure to accomplish this with both personal- and system-based goals that lead to lower infection rates and drive toward a revenue generating extra case.
Example of a Time out early in the case
This the current technology in almost all operating rooms to maintain the surgical count to prevent items being left insight patients. It's clear we can do better.
This is a quick example after a recent cases timeout when they reconciled and stacked the count.
The point of the whiteboard is so all operative staff have glanceable data on the current count, but that remains challenging with this.
• Our system consists of 2 software platforms priced per operation room per month.
• Platform 1 is a digital whiteboard with an inventory tracking system that shows hospital savings while creating market traction.
• Product 2 is a computer vision system that focuses on intra-operative needs, like infection control, facilitating staff adoption, eliminating the need for hospital pilots, and allowing computer vision to generate revenue.
• Pricing is negotiated under NDA. We have a discount to encourage ASC growth, accounting for the 48% reimbursement discrepancies between hospitals and ambulatory surgery centers.
• Together, both platforms drive a month recurring revenue of $23K per operating room.
Our competitors are limited only to the service obtainable market, which we calculate at $78.3B. This is driven by the antiquated electronic medical record, but nSight Surgical is a data platform that is able to surpass all of those who are leveraging different types of inferior technology.We alone can expand to the total addressable market $505B through our proprietary data platform and reporting.
• Over 50% of the market of EMR is controlled by Epic and Cerner
• Cerner was acquired by Oracle for a 5X multiple of revenue at $28.3B
• All Script pieced off portions of its business to exit at over $2B.
• This demonstrates the value of the subjective verbal healthcare record.
• However, we are creating an objective video based health care record.
• This is like Fit Bit who drove equal value with objective data in half the time to All Scripts with subjective data. All Scripts founded 1986, Fit Bit Founded in 1997
https://techcrunch.com/2021/12/20/oracle-snags-cerner-in-28b-mega-deal-to-make-a-big-move-into-healthcare/ Sold large physician practices business segment
https://www.healthcaredive.com/news/allscripts-hospital-ehr-sale-harris-veradigm/619762/ CarePort Health
Projected Use of Funds
• This slide breaks down the usage of investor funds from our Seed Round
• In order to fund the development of the product, nSight Surgical requires $4M in funding
• Cash raised will be largely directed toward development and technical staff
• We have kept general operating costs to an absolute minimum
• We have 64 institutions in our pipeline with champions that account for over 600 operating rooms, with each CV system accounting for approximately a quarter million in ARR.
• We have three customers. Oklahoma Surgical Hospital, Stanford Health Care Valley Care, and a large medical device manufacturer who we have a signed distribution term sheet with . We deploy our first customers next month.
• We have 5 patents and a wealth of data that is first of its kind.