Dr. Justin Barad, is a board-eligible orthopaedic surgeon with a Bioengineering degree from UC Berkeley, and an MD from UCLA, where he graduated first in his class. He completed his residency at UCLA and his fellowship in paediatric orthopaedics at Harvard and Boston Children’s Hospital. Justin is currently practicing at UC Davis Medical Center in Sacramento, USA.
Justin, who has been a lifelong coder and has a game credit with Activision, originally wanted to be a game developer. When a personal family health incident introduced him to the world of healthcare, he decided to find a way to combine his passions and use his technology background to solve medical problems. Justin now serves as the co-founder and CEO of Osso VR, an award-winning, clinically validated surgical training platform designed for medical device companies, practicing surgeons, residents and medical students of all skill levels. Using immersive VR technology, the scalable platform offers a realistic, hands-on training environment that leads to real world performance gains and ultimately improved patient outcomes.
Q: As a specialist in orthopaedic surgery, could you tell us more about your experience and training background in this field?
After completing medical school at UCLA I chose to enter the specialty of orthopaedic surgery. As an engineer I loved being able to apply mechanical engineering and biomaterials concepts in order to provide immediate benefit to patients. For example you can take a patient who has a broken femur, fix the bone with a titanium rod with interlocking screws in a mechanically sound construct and have them walking that same day. You also can apply concepts like viscoelasticity and creep to do incredible things like lengthening bones, which feels like magic or science fiction. Orthopaedics also incorporates quite a bit of technology which I’ve always been very passionate about.
As I progressed through my training I noticed a few dynamics around the ever increasing complexity of surgical care. These core dynamics were:
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There is too much to learn: In a way we are victims of our own success. Accelerating scientific turnover and technological breakthroughs are massively expanding the library of procedures providers are expected to perform on a moment’s notice. For example, one day during training my team was called to the zoo to operate on a gorilla, something we were all clearly underprepared for (but went great!). It also wasn’t unusual for me to be asked to google before or during procedures to find instruction manuals and videos for the procedure in question.
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Modern surgery is more complex: Learning curves for most modern surgeries are longer than their traditional counterparts. For example, a minimally invasive anterior hip replacement takes 50-100 patients in order to reach proficiency (almost a 10x increase from traditional approaches). Robotics, navigation, patient specific guides/implants in particular often have these longer learning curves.
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There is little to no assessment for technical skills in healthcare: Most people don’t realise this but most surgeons are almost never evaluated for their technical skills. This is important because we know based on studies published in the New England Journal of Medicine and JAMA that surgical skill is directly correlated with patient outcomes. In my entire surgical career I’ve only been evaluated once in an objective manner for my technical skills where I was asked to play the board game Operation, and asked to remove a plastic piece without buzzing (which I did!). It’s not that we don’t want to assess technical skills, it’s just that previously there has not been a reliable, scalable way to do so.
Since I had a background in Video Game development I was involved in Virtual Reality very early, and co-founded Osso VR in 2016 with a mission to improve patient outcomes, increase the adoption of higher value medical technology and democratise access to surgical education. That being said, these problems are highly complex and I feel require a number of changes in order to adequately address the risks facing our supply of sufficiently trained healthcare providers who perform procedures.
Q: As we head in 2021, it is clear that the healthcare industry has been greatly impacted by this year’s events, what has been the greatest impact within the orthopaedic industry?
We’re still really in the thick of things so it’s hard to say definitively where we’ll end up as we navigate the COVID era and prepare for the post-COVID new normal. What is clear is that COVID is driving rapid and urgent digital transformation both in the orthopaedic device industry and for healthcare institutions.
Given the concern that some COVID restrictions may remain indefinitely, the device industry’s focus is how can we function as a business without needing to physically interact with our hospitals and customers. Our company has seen an explosion of interest since we allow for training without needing to interact face to face and without needing access to capital equipment or an operating room. You’re also seeing an explosion of interest in remote proctoring/telementoring technology like Avail, which recently closed a $100M fundraising round, or ScopeAR, which provides an augmented reality solution.
For healthcare institutions, one of the most immediate changes has been a sudden and massive shift towards telemedicine in order to minimise the need for patients to physically be present in a healthcare facility. This massive expansion (and I’m not exaggerating here), has led to some interesting dynamics such as the $18.5B merger of Teladoc and Livongo. What we don’t know is how permanent the telemedicine shift has been as anecdotally I’m already seeing and hearing that patients are preferring once again to come into the office. But certainly there has been some level of permanent shift towards remote medicine being a focus of care long term.
A huge issue during COVID has been it’s impact on the training of our future healthcare providers, especially surgical residents. Pre-COVID data showed that 31 percent of graduating residents cannot operate independently. COVID has without a doubt had a negative impact on this already concerning dynamic. During the shutdown, residents lost a significant amount of hands on time and even now volumes continue to be somewhat lower in general and residents are often being “staggered” to build more redundancy into the system in case someone gets sick. This is going to have downstream ramifications which could potentially result in years of undertrained providers. This challenge has led to a massive interest in how to get residents hands-on training time, which is a great application of VR training and assessment. Given that dynamic there has been a massive explosion of interest in our technology for teaching hospitals and academic centres.
Q: Do you think Covid-19 will have a long-term impact on surgeries and the delivery of care?
Without a doubt. Many of the changes taking place, whether in the surgical care delivery supply chain, have been needed with greater urgency for a number of years. In some ways COVID has been a forcing function that finally is catalysing a lot of this digital transformation. Ultimately care will be more efficient, measurable and effective once these new models are implemented which will likely lead them to remain in place for the foreseeable future.
Q: How do you think the future looks within the field of orthopaedics and what are your predictions for 2021?
While digital transformation takes time, COVID-19 has brought this issue to the forefront of orthopaedics with an accelerated need. A few predictions that I see coming to light in 2021 include:
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Technology solutions are becoming undeniably effective in orthopaedics, sometimes 10x better than traditional care. Adoption to technology will be crucial moving forward. Key technologies:
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Include VR simulation and assessment like Osso VR
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Remote proctoring like Avail or ScopeAR
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Team coordination with ExplORer Surgical
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Robotics
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Telemedicine
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Remote Rehab
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Ambulatory surgical center models
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