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It was 2014 and I was sitting in my OR and I was frustrated. I was frustrated that we still have a high amount of variability in patient care. You see this in the US and we see this everywhere in the world really. I was frustrated that 5 billion people in the world still lack access to safe surgery. And I was frustrated that this environment that I was standing in then and there on that day in 2014 was such an analog and undigitized environment in a world where we're in this information revolution where everything is on your mobile device and on your phone. And everything's digital. Why is it that an operating room is still so analog and so opaque in terms of how we derive information and how we share information.

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Thanks for joining us on This Week Health Keynote. My name is Bill Russell. I'm a former CIO for a 16 hospital system 📍 and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to our Keynote show sponsors Sirius Healthcare, VMware, Transcarent, Press Ganey, Semperis and Veritas for choosing to invest in our mission to develop the next generation of health 📍 leaders.

All right. Today, we are joined by Dr. Nadine Hachach-Haram, CEO of Proximie, and a lot of other things, faculty of singularity university, Ted speaker, surgeon. And today we're going to talk about one of the greatest challenges facing healthcare today, which is a staffing or access challenge, a staffing shortage, or an access problem. And the shortage is not only in the US it's really a global problem. And we're going to explore ways of expanding the availability of surgeons at a time when it's needed most. Nadine, welcome to the show.

Thanks for having me. It's great to be here.

I'm really looking forward to this conversation mostly because I just geeked out for the last two hours, watching videos, your TEDx talks and your TEDtalks, and a bunch of other things. This is really exciting technology. So why don't you start by talking about the genesis of Proximie. Where did this idea come from. And what gave you the passion to get it off the ground?

Sure. No it's, it's great to be able to share my story with you. And just in terms of background my clinical practice, I'm a reconstructive plastic surgeon.

And even choosing that as a career, probably stems from my upbringing to some extent. I was very lucky to be born in sunny San Diego, an amazing city in Southern California. Had an incredible upbringing as a young child, but my family's origins are from Lebanon. From the middle east. And so in my early kind of, I was nine or 10 years old and my parents decided it was time to move back and spend a bit of time with the family in the middle east to really learn about my extended family, the culture and see life in a different lens. And you can imagine what it was like leaving beautiful sunny San Diego and landing in sort of postwar, Lebanon. Very different.

No I can't imagine what that was like.

Yeah. Yeah. Probably you can't and it's really a culture shock. I mean, it was just even the most basic things. Water, electricity. The things that I've taken for granted as a young kid who is spending her weekends at San Diego zoo and just enjoying life and the simple things, but you move into this environment and it's very, very different.

And I think that influenced my perspective on life in general. Both from a sense of the gratitude you have to have for any opportunity to have access to these things that we take for granted, but ultimately also the fragility of life in some cases. And it wasn't the safest time to be growing up in Beirut.

And so without a whole history lesson, it exposed me to things that probably most teenagers aren't exposed to. And that made me think about what do I want to do with my life? What meaning or purpose do I have by being by being on this earth. And it was very much around this idea of helping people have a better quality of life.

And hence I chose reconstructive plastic surgery which is very much focused on restoring form and function for people. And moved back to the States, did undergrad, pre-med and then eventually met my husband and moved to London and trained in the NHS or our national health service, which is a centralized healthcare system here.

But that drive and passion for trying to always help as many people as possible or deliver care to more people was something that was always in the back of my mind. And I got involved in different activities to help with that, whether it was global health or helping device companies, launch products and train people faster.

And more effectively, but at some point it was sort of 2014 and I was sitting in my OR and I was frustrated. I was frustrated that we still have a high amount of variability in patient care. You see this in the US and we see this everywhere in the world really. I was frustrated that 5 billion people in the world still lack access to safe surgery and the Lancet commission, which was an incredible piece of research published that. And a lot of it was coming out of Harvard, around variability in surgical care. And I was frustrated that this environment that I was standing in then and there on that day in 2014 was such an analog and undigitized environment in a world where we're in this information revolution where everything is on your mobile device and on your phone.

And everything's digital. Why is it that an operating room is still so analog and so opaque in terms of how we derive information and how we share information. And why is it that a patient who is in a town that is 50 miles away from another hospital is having a very different experience. And so I started to imagine this world when you can almost imagine it sort of digitally connected a world where a pipeline was connecting, operating rooms and turning these once analog and undigitized environments to connected collaborative, intelligent environments. And perhaps that by creating this pipeline that connects all these rooms and this expertise together, we could find better ways to connect, collaborate, and activate knowledge and information in a meaningful way. So it was really the thinking behind Proximie is how do we utilize the best of expertise and distribut it to everywhere that it's needed in a much more data-driven and immersive and digital way.

Actually what, as you're talking, I'm picturing you see those old photos where the surgery is going on down the bottom. And then there's the amphitheater of physicians who are learning up top. And that's part of what you do. You bring. You bring people who are learning into the environment so they can see maybe a surgery that's being done for the first time, at least for them to see that surgery being done and the experts sort of explaining what's going on. But it's more than that too. Isn't it?

Absolutely. It's the funny bit is in the UK, they still call operating rooms, operating theater, because it's still has this conceptual concept of what that looked like. I'm like an amphitheater, you've got an audience watching a key surgeon doing something and that Genesis of communication, collaboration and co-presence is at the core of surgery.

It's how we drive and push each other to do more, to continue to evolve and innovate the way we deliver care to patients. But that is analog in every sense of the word. And it's about a moment in time. We don't capture that information in any meaningful way. So imagine that experience that you've very eloquently described, but digital, but not only for people to observe, but for the reciprocity of that as well.

So I could be a doctor in my operating room and I'm doing a difficult case, and I know that. Dr. So-and-so who's a couple of states away or a country away could dial in and join me for that case. And we could work through that case together and optimize the delivery of care to that patient, but also up-skill and support the sharing of knowledge in a much more meaningful way.

And so you start to create almost an ability to crowdsource expertise anywhere where it's located in the world and distributed to the point of care where it's needed in the moment that it's. And that's a beautiful way to sort of think about, we have a limited supply and demand of expertise. That's not going to change, but how do we utilize it in the most effective way for the patient who needs it?

Yeah. I'm also going to take you down the road of underserved areas and those kinds of things. But before we get there, you're truly a global company. I mean, you're in London today. I'm in Florida. Give us some stats. How big is Proximie? This isn't a new thing. You've been doing this for for a little bit.

Yeah, no. So we are, as you said, a global company, we are a team of over 140 people now, mostly based between the us Europe and the middle east, but we serve over 90 countries. We have deployed our solution and supported thousands and thousands of cases around the world. We work with over 40 device manufacturers, helping them to support scale of new techniques and technologies. But most importantly is that we are a vendor neutral application. We work with everyone. The key for us is that we are supporting as many people as possible. We are in about, I would say 500 plus hospitals at the moment of which close to 50% of those are in the U S and the other 50% are, are spread between Europe, APAC and then of course we do do a bit of work in the global south as well, supporting capacity building and sustainability and searchable care.

Wow. All right. So I do want to talk use cases right upfront because there's, there's probably so many use cases and I'm not even sure you imagined all the use cases when you put the technology out there, it's sorta keeps growing. I want to specifically talk about the hand replacement that was shared in one of the videos. We'll get to that in a minute, but talk about some of the use cases, maybe some of the use cases you imagined, and then some of the use cases that surprised you as the technology took off.

Sure. It's really interesting. And we'll get to some specific cases. When I started to imagine this digitized environment, I'm a surgeon and I know the experiences firsthand as well. It's a, it's a complex environment. There's lots of different stakeholders. What I recognized very early on as I needed to find a really immediate use case that would provide an unlock immediate value for clinical teams.

So not just surgeons, of course, nurses and trainees and all of the above. And so we really took that approach of telementoring or teleprompter proctoring, or that kind of tele support as a first key use case that would help us seed the pipeline that would create the digital environment and the operating room, because we need this as doctors, as clinical teams, patients need this as well. And so even for example in the last couple of months, there was cases where we did a, an endoscopic sleeve gastroplasty in Jakarta prompted from Brazil and France. With people dialing in to provide support from the US, UK and Italy. A couple of weeks ago supported the first robotics case in Jordan with the top surgeon, actually out of the United Kingdom.

We do cases across the US coast to coast, pretty much on a daily basis. And we have American doctors who are doing a lot of overseas work as well. So we have doctors in Chicago supporting work in Ethiopia. We have we work with Japan go and Arianne day labs with Johns Hopkins and Harvard supporting a safe maternal obstetric care in Kenya.

And we also support between countries like France and England, where the. Cardiac ablation courses or the delivery of specific new urology techniques or interventional techniques. So all of this is happening pretty routinely because the engine is in the operating room now. And so people are starting to unlock lots of new use cases and how they harness it. And that's the bit that really excites me. I mean, we started off with telementoring as the key use case, which I described now we've got medical schools using it to dial in and train students and give them more access to surgery. We've got hospitals looking at this saying, well, if we've got eyes and ears in this operating room, how can we optimize our efficiency?

How can we start to understand better how effective we are in terms of working in the OR and driving as much efficiency in the system as possible to hopefully try and deal with the surgical backlog that is obviously a consequence of COVID. Surgical coaching, which is something I took one day and could prescreen Berg have published and spoken about quite a bit, which is how to peer support each other in difficult cases.

And all of this is happening because the application exists. Now, the OS is there. It's an enabler. And it's unlocking lots of value points from multiple stakeholders around the surgical environment. 📍

📍 We'll get to our show in just a minute. As you've probably heard, we've launched a new show TownHall on our Community channel. This Week Health community. And it airs on Tuesdays and Thursdays. I'll be taking a back seat to some of these people who are on the front lines. TownHall is hosted by an array of talented healthcare leaders who are facing today's challenges head-on. We're going to hear from professionals and their networks on hot button issues, technical deep dives, and the tactical challenges that healthcare faces. We have some great hosts on this. We have Charles Boicey and Angelique Russell, Data Scientist, Craig richard v ille, Lee Milligan, Reid, Stephan, who are all CIOs. We have Jake Lancaster and Brett Oliver who are CMIOs and Matt Sickles, a Cybersecurity first responder. I'd love to have you listen to these episodes. You can subscribe on our Community channel. This Week Health Community, wherever you find and listen to podcasts. Now let's get to the show. 📍 📍

So talk a little bit about the training of a clinicians. I've talked to Dr. Klasko on the show, I've talked to others and they talked about how the training of clinicians is broken and we need to rethink it and those kinds of things. And it sounds like some academic centers are actually rethinking how education happens one time, like in their process, but also ongoing. You're, I mean, it's almost like I decided to go to this school for medical school and they keep training me for the rest of my career. Seems to be a potential that, that happens. So I want to talk about it from that perspective, but I also want to talk about it from the the integrated delivery network that is trying to drive out variation. So first talk about the training aspect of it, of I don't know, printing new doctors of minting, new doctors out. How is that changing?

What's really interesting is understanding the genesis of surgical training was very much designed around see one, do one, teach one. An apprenticeship that is, conceptually seems fun, but if you actually think about what those words mean, You realize that there's a lot of flaws in that system. It's very much.

I don't want to be the first one.

Yeah andyou're like see one, do one, teach one. What does that mean? And that, that method, and we've all got our stories of, of the training and that experience naturally has a learning curve and ultimately there are challenges with that as well. It's very hard to track. It's very hard to, assess a lot of elements of that around competency and others. And a lot of evolution has happened to try to improve the way we assess competency and validation and accreditation, but there's still a lot to do in the digital environment. It's still very analog.

My mantra has always been that we need to just eradicate that concept, have to change, that that shouldn't exist anymore. What it really should be is a continuum called prepare, perform perfect, because it doesn't really matter if you're a medical student, an intern or resident, or even a surgeon at the top of your game.

You are going to go through that journey because surgery evolves, new techniques come out, new devices, come out on a weekly, daily, monthly basis. We're seeing new launches. And so this learning cycle, as long as life lasting, especially if you choose medicine as a career. And so how do we create an environment where you're able to prepare.

Therefore, you can either join live cases in real time and see how these techniques are being delivered. Look at equipments and how they're being used, or go onto the video library and actually watch the cases that have happened. So the point at which you've done that, and you've done some SIM training, you're now ready to perform.

And with performing your cases, why should it be a moment in time? Why wouldn't you want a video log book of that? So that you can then go back and review your performance after the case in the perfect phase. And either you can give yourself feedback by watching that video or get your peers to give you feedback.

And it's very similar to the game tape concept in sports. Like no athlete today at the top of their game, isn't being filmed all the time and getting feedback. No athlete doesn't have being coached on all the little details of that to try and eliminate whatever variable they think needs eliminating to give the best performance.

So why wouldn't we do that in healthcare as well. And th this kind of digital continuum enables you then to identify elements that are introducing variation and hopefully reduce those to reduce the variation in the outcomes for patients.

So are there libraries being created? Are their academic medical centers creating libraries that are available to the industry?

Correct. And when you think about, for example, a, an IDN or big hub-and-spoke health system, You're going to have different expertise positioned at different sites. You might have some expertise in an, an ASC or in a community hospital or some in a big central academic center. How do you find an engine that enables you to crowdsource all that knowledge? And share it with the trainees or the doctors that are going through that learning journey in a more meaningful way and bringing that expertise so that we can all be upskilled. It shouldn't be that only the people at the academic center are getting the best access to training. It should be everywhere.

Let's talk stories cause I think this brings, brings it home. The person who lost their thumb from from a blast in Lebanon and then the surgery. Can you tell us a little bit about that story?

Yeah. So I used to work in a, in an ER here where I did rotations with a doctor who was very much involved in doctors without borders and other initiatives overseas. And he was out in Gaza doing some filming and doing some pro bono work. And he called me up and he said, Hey, do you remember this technology you were talking to me about over coffee? This work that you're doing, I think it could be really helpful here. We've got a young guy, who's got a blast injury to his dominant hand.

He's the only breadwinner for his family. This is a devastating injury for them and it's going to affect not only him, but his whole family. And we really want to try and find a way to get a specialist 10 surgeon to support the local team to reconstruct his hand. And your technology seems like the perfect conduit to deliver that.

And so the beautiful thing about Proximie is that it is hardware neutral. You don't have to send any special equipment. You can just pick up your own laptop or tablet and use it. And so he had a tablet, they stuck it to the side of the bed on the hand table and they started to do this case and we had an expert overseas dialing in with them.

And we sat with them through that case and works through the case for a couple of hours as they reconstructed the hand, the skin, the vessels, the nerves, all of it. And it was incredible. And the beautiful ending for me, always, I always bring it back to human stories is what was great of course, is that we were able to deliver this and we were able to support the local team to up-skill, but what's even more beautiful is that guy went on to train to be a nurse. And now works as a nurse in his community, helping many, many other people. Someone who didn't even have a shot now is a nurse helping tens and thousands of other people.

That's a phenomenal story. And it sort of highlights a lot of different things. It highlights training, access underserved areas. I mean, because that hand surgeon is such a specialist. That you don't have one in every community, let alone every city for that matter across, I mean, when you're talking global company you're talking use cases around the world. I'd love to hear more stories of how people are utilizing this for for outreach, for going to places that that are underserved.

I mean, I'm, because I'm so focused on the US I'm picturing rural America that doesn't have access and people sometimes would have to drive an hour and a half to two hours to the city to see a doctor. And sometimes that's not, not even possible.

I couldn't agree more. I mean, it's, it's interesting sometimes when we think about access, our immediate thinking is, okay, it's going to be outreach in the global south. It's going to be in Africa. It's going to be, but actually, like you said, even in our own countries and communities, there are areas that don't have access and patients are having to travel quite long distances to get basic care that that should happen.

And so we can play a role in like democratizing and globalizing. This expertise to anywhere that it's needed. And I'll talk just a little bit about the global south works. I think it's really meaningful, but you can extrapolate similar examples really anywhere. But for example we worked with Dr. Marian Redleaf who's a professor of autology and urology at the university of Illinois and for her, she really wanted to support the upskilling of ear assessment and evaluation for patients in Ethiopia, where they had like a handful of specialists only. And she was able to up-skill, I think triple their workforce through her training remotely. Now the immediate impact is just the number of patients you can treat more locally, closer to family, closer to their own support network is hugely valuable and it's unprecedented. So that's the kind of impact we're able to have. One story that really sits with me because in our hospital in the UK was one of the most effected by COVID.

It's a very big central teaching hospital with a huge amount of diversity around the area that we treat. And it was completely just packed with patients who sadly were suffering with COVID. But during that time we had a patient who had a really complicated metastatic testicular cancer that was wrapped around the vessels in his, in his abdomen.

So we had his chemo radiotherapy, and he was ready for surgery. But it was going to be a difficult case that normally they would have tried to do through open surgery. But the big concern was it was COVID no one wants to be in hospital for any longer than they need to be. And this patient was immuno-suppressed so already was going to be a high risk for complications from that perspective, if he was in hospital for a long time.

So what they did is the surgeon who was an amazing robotic surgeon in our hospital realized that actually the, one of the world's experts is out in Seattle, I think works part Swedish. And so she reached out to him and said would you mind dialing in and we can do this case together.

You can just support me remotely. I'm a great surgeon, but I want to have that extra eyes and extra expertise with me through this difficult case. So he dialed in, they worked through the case together over a number of hours and were able to take all the cancer out. And that patient went home three days later.

And was on TV doing an interview like at day seven, and he's now in remission. And that ability to access expertise where, you know, Without having to ask people to travel or to step away from their own practice or step away from their patients and ultimately deliver patient care to the patient where they live is, is just a game changer. And that story for me was so essential to demonstrate the benefit of globalization and bringing care to patients.

So give me the components of the operating system as you refer to it or the platform that you're rolling out.

So Proximie is a browser-based solution, but it exists in iOS and Android as well. So anyone who can access Google Chrome will just need to go to my.proximie.com and they'll have a username and a login and they can get going in an operating room. What we tend to do first is evaluate what is the equipment that exists there? Some operating rooms are integrated already. Some aren't. Some have camera stacks and other bits that they've invested in, in the lights and other things. So we ultimately try to leverage existing capital equipment first and where it doesn't exist. We supplement with off the shelf equipment camera and tablets. So it's very straightforward to sort of deliver.

And for someone like me to be able to plug it in and get it set up for someone who's never done it before, probably takes you 15 minutes to get a setup. And after that, it's pretty smooth sailing for anyone remote who wants to dial in and join the case. Just need your laptop, your phone, your tablet, you go to my.proximie.com or you download the app and you join the case on your dashboard with three clicks. Very straightforward.

And it's been designed that way because we don't want people to have to download desktop-based applications and make it very complicated to implement. One of the key pillars for me in the early design of Promixie was how easy is implementation because as a doctor in those environments, anything that's going to be too complicated or too cumbersome is largely going to be harder to adopt, and it's gonna have a much higher threshold to adoption. And it's all wireless cloud-based HIPAA and GDPR compliance.

My next question and this is the CIO in me talking, which is, can I do this with Cisco WebEx? Can I do this with Zoom? Why wouldn't I do it with zoom? And I think you just hit on some of those things, but why wouldn't that work in that situation?

Sure. Proximie is so much more than just the telecommunications engine. At the core? Absolutely. There's a highly proprietary video communication layer that has been designed to optimize for video, audio performance in these environments that can take direct and ingest direct video feeds from any device in that room. Be it an imaging system, a laparoscopic stack, a robot, even an open case you can bring in multiple views that give you that holistic experience of the. But we also layer into that experience, augmented reality. So I could be sitting at my desk and I can actually reach in with my hand and the people in the operating room can actually see my hand, can see the movements and see my interaction a much more immersive way.

I can take x-rays scans or imaging and overlay it onto the video stream so that you can start to correlate images. With the operation and I can ingest lots of those inputs into a single place. The second bit is it's designed to be HIPAA and GDPR compliant, but very robust and assess that even the UK military is one of our customers.

And finally is that we've built the whole user journey based around a surgical instance. It's not designed for video conferencing. It's designed for the operating room for surgery, and it's because of the way the system is designed. We can integrate into any hardware in the operating room, pretty seamlessly.

If it's an integrated OR that you've invested in, or a video streaming system that you've invested in, we can plug into that and become part of that environment. And one other bit I would say is that because of that approach, which is much more of a platform approach, as opposed to we are just a point solution, we now have the capability to become a partner to a lot of other third party softwares that are trying to impact surgery, but don't have a root in. So you might be an application that is really good at creating 3D reconstructions of a scan that could be useful in surgery. We can plug those in and bring them into that environment to enrich the operating room environment in a meaningful way.

And these are just a few examples. We could talk for quite a bit about the vary, the differences, but it's so much more than just a video conferencing type solution.

Yeah. I wanted to get that out there because some people might be listening to this saying, well, I just set up Zoom here and here. That's a general purpose platform that you're trying to adapt to this situation. And this was designed by surgeons for use in the OR. And so it has a lot of specialty applications. I'm going to give you a use case. UC Davis. UC Davis is a Northern California. Large academic medical center. They serve though a very rural population just outside of Sacramento. And just outside of that area, Northern California. Yes, it does have beautiful vineyards and those kinds of things, but it's very rural as you go out there. So they serve an area that's, that's pretty rural and that's not uncommon in the US. You could have the same. I could describe the same thing in Texas and some other locations.

As UC Davis starts to partner with the providers and the remote locations, what's the cost to the remote providers who are trying to, as you say, upskill their surgeons in those locations to provide better care to those communities?

I mean, the way we look at it, and I hope I'm answering your question correctly is our approach in the market is often a partnership or licensing with health systems or with hospitals. And it's, we don't really charge on a per minute or per usage. It's ultimately just a per year per room because we want to encourage and invite as many people who see value in it to use it as many times as possible. And from a health system perspective, when we think about the economics around that, and the benefit is if you're able to deliver high quality care to patients close to home, And at a lower cost space, that's meaningful.

That's meaningful for the provider. It's meaningful for the patient. There's a, a long-term, there's a value chain that you're unlocking and providing across that from an immediate perspective. It's about. Reducing needs to travel, reducing carbon footprint, but ultimately delivering care to patients, but from a longer-term value, you're unlocking the ability not to deliver great quality care at lower cost based centers around a particular partnership or IDN or health system, or however, the relationship is between those. We don't get involved in the transaction between the different institutions. Ultimately we license that solution to them and they can use it as many times as they want.

That's fantastic. Let me ask you this from a scale standpoint, you're the CEO. You're a female entrepreneur, which is not, not all that common in our industry. And I'd love to just ask you about that, but I also want to ask you about, about scale because you're at that point where you have a proven technology, it's being used by a lot of health systems around the world. And I'm sure you have a board or whatever that's saying. Okay. It's time to ramp this up because it has so much value. What does scaling this up look like?

Absolutely. I mean, one of the things that I'm excited about is just the sheer potential of this, but also I love surrounding myself with teams and people and skillsets that really compliment my expertise and how together as a team, we're on a mission to change this.

And we've been very lucky and that's demonstrated not least of course, with the investor groups that have joined us. People like F Prime or Maverick or Questa who are well-regarded in the industry, but also the incredible team we've been able to attract and hire into proximity that want to be part of this journey.

And you may have seen just recently in the last couple of weeks our announcement of a new GM for Americas which is Charlie Wilhelm, who was the president and COO of Carl Storts for many years. And for someone like Charlie to be stepping away from that incredible role and joining Proximie says a lot about the excitement of the potential of where we're going.

We recently hired Dave Herman as well, who led a lot of the digital solutions at Johnson and Johnson and a few other organizations as well. And so when we think about Going global and being global. It's about making sure that we're also bringing in great caliber, great talent and those who are all mission-driven as well to where we want to go. Cause this is not it's not for the faint hearted this is a real mission drive to sort of change and disrupt surgery.

How does healthcare change? So give me, I love talking to somebody who saw the potential of this many years ago. If everything goes according to plan, what, what do you imagine healthcare might look like in I hate to do 10 years to you cause it's so far out, but what could it look like in five years?

It's great that you asked that. Actually a couple of years ago, I was asked to be one of the commissioners on the future of surgery white paper, which we wrote for the government here and for our college of surgeons. And we were really looking at the next five, 10 and 15 years. And we recognize that surgery is going to continue adapting and evolving before our eyes. And we were going to move to an environment where things were very analog and, and digitized to a world where solutions and technologies would compliment surgical care, such as immersive experiences and communication, connectivity, layers like proximity an environment where, you know, things like robotics, we're going to accelerate computer vision, artificial intelligence and machine learning, coming together to give us better insights into what's happening in an operating room and how can we drive towards better outcomes. And ultimately I'm less interested in the technology stack itself. What code is used or what bit of technology.

What I'm most interested in is how are we re-imagining the digital operating room or these digitized environments to really accelerate the adoption of best practices. And to democratize access to care. And I can say as someone who was working on the front line during COVID never, has there been a more poignant time that has really highlighted the need to change and the fact that we can no longer keep delivering care in a bricks and mortar approach.

In a building type approach. We have to start to evolve healthcare that is decentralized. That is at the point of care. That is patient centered in a sense with all these solutions that can help us deliver that. That is less opaque. That is more digitally connected and more global because we can learn a lot from each other as well.

And so I I'm, I'm excited that Proximie will play a role in that. We're not gonna solve all of it on our own, but we shared them well, want to make sure that we play a significant role in that change. And I can tell you, 6, 6, 7, 8 years ago, when I thought about this, I was definitely thinking, gosh, how am I going to get this surgical community onboard with this. And spent a lot of time, as you highlighted in the beginning, putting thought leadership out there doing the TED talks, going to every conference, even it was, if it was just a five minute slot, I would still stand up then I would talk about the digital operating room. And it's incredible now to see how this has shifted. And we were winning hearts and minds in terms of what this future should look like.

I have two closing questions. The first one is, if I were to walk into an operating room today that even has Proximie in it, what aspect of it is still analog that you're looking at going that will be digital in the next five to 10 years?

I'm very interested in kind of when you think about solutions. It should just turn on with the lights. They should just be part of the lights. There's still an element of you have to click the machine on to use it. This should just become routine. Proximie or other, we are heading into a world, that's not a question of if, but when every operating room will and every surgery will be recorded. Every surgery and OR will be digital. And that we are heading into that world rapidly and the more seamless and the smaller the footprint can be of those solutions, the more part of day-to-day practice that becomes.

And so we're working a lot on continuing to think about the user experience and the journey and how we continue to put the building blocks around this, not only for the operating room, but the preop environment and the post-doc environment as well. How do we start to connect the dots? So that whole user journey is a singular digital experience that is meaningful and powerful for optimizing quality of care.

You're driven by a purpose, but I do want to close this out by just asking you. Female entrepreneur. Has that created some challenges or has that created opportunities as well?

I'm always one that likes a challenge, as you can see from the problem I'm trying to solve in surgery. Naturally the entrepreneur world is still very heavily weighted towards male CEOs and male leadership, but it's a challenge I've taken on with excitement, for the opportunity.

I, I have a role to play here. I have a role. So hopefully be a role model to show that we we can be successful in trying to make these changes with female leadership. I have a 13, 14 year old daughter myself. And I want to be a role model for her and all of her friends that you can change the world. You can follow a path that has ups and downs, and it's not always a straight path, but one where you can truly make a difference and be proud of what you've achieved. So I'm excited about hopefully continuing to see more women in these roles and being an advocate for more diversity in hiring and in the work that we do.

And one final point I would say about diversity is I often think about diversity, of course from a gender perspective and a race perspective, but I also believe in diversity of thinking, and I'm always a big proponent as well as bringing different thought you know, ways of thinking to the table and being open to being challenged about the way you think about things and where you look at things. And so I think there's a lot of opportunity to continue to evolve that and, and hopefully I can play a role in changing and being more of a statistic towards more diversity in those roles.

Nadine I'm, I'm excited to bring this to my community. Aand I'm glad that your vision is bigger than just your little world and that you've decided to impact the entire world. Thank you again for coming on the show and sharing your story, your experience with us and this solution. And I'm excited to be a part of sharing that story.

Thank you so much Bill. I really enjoyed this conversation and I want to commend you on this incredible podcasts and set up that you have, and I'm excited about hopefully doing more with you.

How can people find out more about pro I assume proximie.com, but any other ways they can find out more information?

Yeah, proximie.com. We're super active on LinkedIn. So if they want to look us up on LinkedIn or myself or Proximie we'd love to respond. Do reach out. We'd love to share more of what we're doing and help collaborate and support as many people as possible.

Fantastic. Hey, thank you again. Appreciate your 📍 time.

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