Virtual, socially distant sales representatives in surgery
CEO: Daniel Hawkins
Based: Palo Alto, California
The scoop: Patients, surgeons and staff aren’t the only people in the operating room when it comes to procedures involving medical devices. A sales representative from the company that made the product typically needs to be there.
“Procedural healthcare has an obligation to the presence of outside people in operating rooms, and that is for everything from medical education and training to new product launches, all the way through to product support on an ongoing basis after a product is launched,” Avail Medsystems CEO Daniel Hawkins said.
The problem is, requiring their physical presence means that a patient’s surgery can be derailed by any number of reasons—from limits in a device maker's travel budget, flight delays and cancellations, or even a worldwide pandemic.
And it’s not an issue that just affects individual patients. This requirement can hold up procedures needed to complete clinical trials that are required for FDA approval, increasing the time it takes for new or improved devices to be adopted into patient care.
Avail offers a solution: make this presence virtual. It has built a portable console that connects physicians in the procedure room to industry experts anywhere they might be. With multiple remote-controlled, high-resolution cameras, the outside experts can see and hear the procedure as if they were present themselves and can advise doctors in real-time.
What makes Avail fierce: An orthopedic surgeon may do the same kinds of surgeries over and over, but the equipment needed for each procedure can vary dramatically from patient to patient.
In the case of knee replacement surgery, three different people would each need a different knee, and because of differences in their anatomy, the surgeon might need three different sets of instruments to implant that knee, Hawkins said.
Despite the amount of training and experience a surgeon might amass, there are just too many combinations of devices and instruments for them to keep straight.
“There are probably 20 or 30 knees available, which explodes out to hundreds and hundreds of trays with thousands of instruments in them. A surgeon is going to look to a technical support specialist to help them through that,” Hawkins said.
On the expert’s side, they’re connected to hospital operating suites and surgical centers via an app, which allows them to control the console’s cameras for a better view.
“If you’re in the operating room, you’re standing 10 to 15 feet back from the table, which means you really can’t see squat,” Hawkins said. Instead, a sales rep in the room may typically observe video from a mounted camera or surgical scope.
They can also freeze, magnify and annotate images for the surgeon during the procedure, or use a split-screen to see two views simultaneously—while all staff in the operating room can see exactly what the remote user sees, thanks to the console.
"We envision ourselves with consoles across the country in what we estimate to be 70,000 potential locations,” Hawkins said. The hope is that physicians and device makers will use the system for procedures in clinical trials all the way through the launch of a product and beyond.
In addition to speeding up procedures for patients and the device development cycle, the console could level the playing field for doctors and hospitals in economically challenged areas or help doctors who may perform certain procedures infrequently.
“There is a challenge that is unspoken in the medical device business where those who see the most of a particular type of procedure get the most attention from industry,” Hawkins said. A device maker may take more care to send experts to a hospital that does a certain procedure three times a week than one that does it three times a year. Avail’s system could democratize that access to expertise, he added.
Avail provides the consoles to hospitals and surgical centers for free, charging them instead for the time spent using the device.
“We’re making a bet that enough users are going to end up using enough time to make it worth our while, eventually,” Hawkins said. And those users don’t necessarily need to be sales reps—they could be a specialist across the country or the surgeon’s colleague who is working out of town.
The company started in 2020 with just under 30 staffers and grew to about 100 over the course of the year. With plans to place its consoles in hundreds of sites by the end of 2021, Avail plans to double its workforce, Hawkins said.
“We’re already under contract with a dozen and a half, going onto two dozen medical device companies of varying sizes, with new ones added regularly. And those are across clinical specialties from vascular to neurology, orthopedics and spine... really every specialty you can think of,” he said. “What’s coming next for us is continued growth in the platform and continued growth in installations in new clinical areas. We’re building a field support team to support all of these units.”
Investors: Avail raised $100 million in an October 2020 series B round, joined by 8VC, Baidu Ventures, Coatue, D1 Capital Partners, Lux Capital, Playground Global, Refractor Capital and Sonder Capital.