Have You Seen The Microsoft Hololens?

By:  David Kashmer (@DavidKashmer)

Dr. Kashmer receives no reimbursement from Microsoft for reviewing their product or for anything else for that matter (!)


It’s rare that a new piece of technology falls in my lap that makes me say wow.  Maybe it’s the professional detachment from years of physician training…who knows!  But, write it down:  the Microsoft Hololens is amazing…and it’s useful right now.


Recently, as a Microsoft Developer, I received the Hololens I bought several months ago.  I had fairly low expectations.  I mean, yes, I’d read great things from CES and other events.  But I mean, come on, we’ve all seen way over-hyped tech products that promise great things and do very little.


I’d been a Google Glass Explorer, and I loved the idea.  The heads up display, the fact that the device took up very little real estate, and the ability to connect to useful data in a rapid way seemed to hold great potential for healthcare applications.  Once upon a time, I was even part of a company that was developing a system for the device for healthcare applications.  However, once I reviewed the device (see that review here) I began to realize that Glass held great potential, and could be more useful with time, but that it really wasn’t ready for primetime.


Now, fast forward a year or so, and my expectations were (maybe understandably) low.  I mean, after all, I’d experienced the Glass, and the “Glass-hole” (term coined for how people came off while wearing Glass) phenomenon.  I was still a little jaded from the whole thing.  My expectations were low.


So, when I received the developer version of the Hololens, I figured much of the experience would be the same.  I was wrong.  So very, very wrong.


First, the developer version of Hololens that I received has smooth, incredible functionality.  It does MUCH more than the comparatively bare bones developer version of Glass that I’d received previously.  But that’s not all.


This thing is stunning, its voice, hand gesture, gaze, & click recognition are all excellent.  Cortana (the Microsoft voice-activated assistant) is also very useful.  Battery life is good.  And, of course, there’s the holographic interface.


I mean, jeez, I would’ve bought it just for that.  A three dimensional anatomic model, a virtual trip to Rome, and a Holo Studio for creating your own 3D (and 3D printable) models were easy to install from the Microsoft store via Wifi.


The form factor?  Well, this device isn’t super cool or incredibly sleek.  Lucky, with its amazing creation of a three dimensional interface environment, I didn’t (and still don’t) care.  After all, a lot of the accessories we wear in healthcare don’t look cool.


What did I do with the device first?  Well, after setting it up, I did what any good user would do and immediately tested this new, incredible piece of technology by opening a panel with Netflix and streaming a Game of Thrones episode followed by an episode of Stranger Things.  I laughed at myself for how silly it was to use such awesome technology as a fancy Netflix streaming device…but, hey, it could easily handle it and the whole situation was (although funny) truly awesome.  (Not long after, it was on to Family Guy.)


So what now?  Now, it’s easy to take this incredible device into the different fluid, fast-paced venues of the hospital.  It’s a simple matter to use the device as eye protection in the trauma bay or the OR.  It’s straightforward to setup some holographic projections over the patient’s bed and to display their real time info from the electronic medical record.  It’s no big deal to setup a panel with their CT scan displayed while I teach or perform a procedure.  The photo above highlights just a bit of how easy it is to show website information in the Hololens environment.


In conclusion, it’s rare that I’m amazed by a tech product–especially in these days of fast-paced innovation.  However, when it comes to this one, I have one thing to say:


Thank you, Microsoft, for building Hololens.  This thing is amazing and will allow us in healthcare to do a lot of good.  Thank you so much.


…and that’s coming from an Apple guy!


3 Reasons Why Great IP Doesn’t Get Developed – It’s NOT Always About The Money


By: James Kashmer (LinkedIn Profile here.)


For a product person like me, walking through a research institution is like a kid going through a candy store. Visiting with brilliant people and listening to them talk (while they show their life’s work) is an uplifting and motivating experience for me. So how do people like me choose with whom to work?


Personalities And Assembling A Team – What Is The Personality Of The IP Generator?


Personalities play more of a role than they should (and I do admit it). I, for example, do not waste time trying to get someone who has been working his or her entire life in pure research to sit down and prepare a detailed 100-page business plan. It’s NOT that they can’t do it–it’s that they choose not to. I also recognize it is not usually the best use of their time.


The same can be said about getting “researchers” to help get their “product out the door”. Recognize that implementation is not usually what interests (motivates) these people, and the person who created the IP (basis of your company) might not be the best person to do this.


In a startup situation, everyone needs to wear many hats and minimizing time to complete tasks is of the important for success. Some people can “flex” to do tasks they do NOT enjoy. It has been my experience a person who actually does (is able to) “flex” is a rare bird.


Greed – Drinking Your Own “Kool Aid” – Rewarding Those Who Actually Contribute To The Company Moving Forward


I have written previously “your IP is not worth much until you start eliminating unknowns” .  Another way of putting it is that your IP becomes more valuable when you are able to answer questions, and replace assumptions, with facts.


So how much do you compensate (with salary and equity) the IP Generator on day one of your NewCo? What’s the idea premium really worth? Usually going through this exercise on (or before) day one of your NewCo tells you everything you need to know about the people who you are choosing to start working with. Even though it is true that you would not even be talking about NewCo without the IP Generator, the IP IS NOT WORTH VERY MUCH until things start to get accomplished and the unknowns have answers. Shouldn’t the people making the contributions and enhancing the value of NewCo be as generously rewarded as the IP Generator? I think so.


Getting The Message Out:  Be Pro-Active


Just because you think you have a better “mouse trap” does not necessarily mean people will be “beating a path to your door”. Often the answer to fulfilling your funding needs is getting your succinct and targeted message out to where the people that can help frequent. Kudos to the present generation for creating and using powerful networking tools to help get the message out.


Getting the message out also implies people will respond. Critically analyze responses to see that the message that you thought you sent is being heard and / or understood by your targeted market (people). If your targeted market is responding and engaged to your message it is an excellent opportunity to choose “early adopters” willing to work with you to refine your initial product offering.  This, in part, is the basis of that well-described strategy of “getting out of the office” to create the Minimum Viable Product (or MVP).  For more on the MVP, look here.


Questions, comments, or feedback?  Let me know.  And keep the ideas coming!

3 Things To Know About Licensing Your Intellectual Property (IP)

By:  James Kashmer (LinkedIn profile here.)


Going the license route is a “no brainer” right? You get lots of money up front and still get to sit back and collect all those future royalty checks over the life of the patent!!!! You do not need to worry about raising money, hiring employees etc etc…….not a bad way to go right?


I wrote previously “there is NOT a shortage of new ideas or inventions that warrant licensing and development”. Visit any web site where you can find available IP from Government and Universities to see and understand this. Try Googling “tech transfer” sometime…..(or just click here–I did the work for you).


The truth is Government and Universities do a great job of licensing technology with revenues in the billions of dollars each year. Unfortunately, only a relatively small percentage of available IP is ever licensed despite their best efforts.


What Are The Potential Markets And Who Are The Leaders In Those Segments?


Chances are you did not create your idea or invention in a vacuum. It’s likely you already knew something about the subject; who the players are in the field; something about their strengths and weaknesses; something about the current offerings that you could make better. Chances are that, as you talk to people, you will learn about additional markets or potential applications. Spending some of your time researching potential markets (including their size and competing companies) is a good idea even if you have no intention of licensing your IP. By doing so you likely will come up with alternative paths on how to proceed.


In the Medical Device Industry as an example, it is not uncommon to enter a market that has fewer FDA regulatory requirements then an initial targeted market. On the other hand if your intention is to develop your IP ONLY for a specific market or industry, the background work will be very useful for you or your “tech transfer office” to target potential licensees outside your interest.


How Do I Get People To Understand What I Have?


Newer “cutting edge” or technically advanced IP is often hard for people to understand (and therefore value). Do not underestimate how big a problem this is and how important it is to find ways to make people “understand” what you have AND how to apply it. It is my strong belief this is a major key to success and the earlier in the process it is done the better even when resources are tight.


What Is My “End Game” Or “Exit Strategy”?


Thinking of an “end game” or “exit strategy” early in the process does not sound like a useful exercise, but I would argue that in fact it is. Managing expectations and measuring results helps to keep the head “screwed on” and focused on the important objective(s). Without thinking about these early on, designing for “manufacturability” can be challenging later on.  If you are strictly planning to only license your IP, you may be able to make your idea more or less attractive by considering what’s coming downstream.


Questions?  Comments?  Thoughts?  Let me know.  Until then, keep the ideas coming.

3 Things To Ask Yourself Before You Start Developing Your Intellectual Property (IP)

By:  James Kashmer (Visit James’ LinkedIn Profile here.)


Why Would Anyone Invest In My Idea Or Me?

If you already have a track record of commercial success you can do pretty much anything you want and command terms that will make you happy that you were born (or live) in the good ole USA!!!!

Short of proven commercial success, if you are a surgeon and are considered a leader among your peers, most likely you also can do pretty much anything you want under very favorable terms.

The point I am making is that investors look to minimize risk, and the lower your credentials are on the “food chain” the harder it will be for you to get them to invest in your idea. So, unless you have significant credible endorsements that are also early investors, recognize that raising money will be difficult.


How Comfortable Am I With The Information That I Have?

Everyone makes assumptions in their plans. It is important to remember these “assumptions” at some point need to be replaced by “facts”. The sooner that this can be done the better so that you (and investors) can attempt to quantify and minimize risk going forward. Even though it is well known that some startup companies have successfully “pivoted” to avoid extinction, I think they all would agree that firming up your business plan “assumptions” sooner rather than later is the way to go.  This idea of rapidly and progressively eliminating unknowns is part of the modern technique of the lean startup.


What Are My Options?

I am in the business of developing “options” and have been for the last 20 plus years. Sad to say:  it’s tough to do anything of consequence out there, and it’s getting tougher all the time.

For those of you who do not already have a track record of commercial success, if you have an idea or patent that is applicable to many markets consider licensing your IP to a company that already dominates a particular segment and don’t be a “hog” about it!!! (Borrowed from the expression “Pigs get fat, hogs get slaughtered”.)

Another option is to try to go as far as you can on the “cheap”. By this I mean do your homework to eliminate as many unknowns (and risk) as you can BEFORE approaching potential investors (or licensees). With the ability today to produce mockups and even working models (prototypes) using 3D Printing, never has it been so easy to go so far on so little.

Until next time: keep on developing your ideas, and get in touch with any questions or comments!

3 Reasons To Add This New Specialty To Medicine

by:  David Kashmer, MD MBA (@DavidKashmer)


By now you’ve probably heard of 3D printing.  Sometimes, 3D printing enthusiasts are referred to, collectively, as “makers”.  Well, let this maker tell you:  3D printing has wide applications in Medicine–so much so that it could do very well as its own specialty.  Here are three reasons we should create a new specialty in Medicine that focuses on 3D printing:


(1) Truly Personalized Medicine


The push to serve patients with a focus on their unique needs is on in full force.  Whether it be genetic testing to predict response to anti-coagulation, recognition of the necessary Prograf dose as adjusted for metabolic variation, or a focus on specific social factors, personalization of the practice of Medicine is becoming a buzzword that’s hotter and hotter all the time.


3D printing is a way to truly personalize that medical experience.  The vascular surgeon can size your aortic graft preoperatively from a model created from your own CT scan…or surgeons can even replace / stent your trachea with a new one generated from images of your old one.


This can already be done and is getting easier with time.  So, much like the rise of Radiology focused on imaging studies, let’s consider getting really good at creating personal models, devices, and anatomic replacements by creating a field devoted to just that.


(2) One-off, Specialized Medical Devices


Having a hard time fitting an ostomy appliance near an open wound?  Is the effluent from the ostomy leaking into the wound bed?  Why bother with all that?  Create a custom printed ostomy appliance from a 3D scan of the patient’s abdomen.  (We can already do that.)


Want to get really fancy?  Upload your custom-tweaked design as an .STL file to the “app store” of compassionate-use approved, one-off medical devices.  (Here’s something that’s an early version of what I describe.) No manufacturer could justify a large batch run of the perfect device you’ve created for a small (but important!) patient population…but those of use with printers (and those same patient issues you have) could go to the “app store”, download the .stl file, and create that medical device to solve their patient’s issue.


A field devoted to creation of these models, knowledge of filament types, and understanding of model usage would go a long way toward spreading this technology.


(3) …In Hard To Reach Places and Beyond


A 3D printer and system could allow creation of useful devices and models at even hard-to-reach, remote locations.  Consider rural centers, international areas, and even forward military venues.  Need a prosthesis fit to your patient’s stump?  Make it from a white light 3D scan and printer.  Viola.


A team of Makers could easily be responsible for creating the prosthesis from imaging.  It could ensure both fit and tensile strength.


Soon, Grasshopper, The Future Is Coming


Just imagine a day where a patient has a CT scan and, immediately, necessary equipment and devices are created according to their own personal requirements.  As physicians, we could create everything from special use medical devices (eg ostomy appliances that fit near difficult wounds) to highly personalized cervical spine immobilization collars.


Want to take your gallstones home with you?  (We can’t give them out anymore right?) Well now we can give you an awesome copy for your morbid fascination or other interest.


Who Would Pay?


Hospitals currently have add-on services such as baby photos and other fee-for-service add-ons.  Perhaps 3D modeling could be another.  Filaments like PLA and ABS are inexpensive, after all, and the initial costs would come, mostly, from a one-time hardware expense of less than twenty thousand dollars.


…and if the hospital couldn’t make a business model out of the direct revenue, it could definitely justify the expenditure in terms of patient satisfaction and niche marketing.  After all, I would be much more content, as a patient, if a physician could show me how my spleen was injured using a model of my very own spleen.  I’d like to take that home with me, and would give even higher Press-Ganey scores to hospitals that could create that model of my particular injury and send me home with it.  Will that hold for most patients?  I don’t know…maybe a study is in order.


Let’s consider creating a subspecialty of Makerology, where we develop a system of creating special use medical devices (we could even have an app store for the .stl files) for rural, international, or under-served areas.

4 Things Doctors Should Report When There’s An Equipment Problem

By:  Jaime Ennis (visit Jaime on LinkedIn here.)


For all you physicians, surgeons, and healthcare providers out there:  I’m the guy who works to make sure your equipment does all it’s supposed to for the care you give to patients.  Stapler misfire?  Broken laparoscope with lines on the screen?  I’m the guy for that stuff.  Let’s talk about how equipment problems are reported so that we can work together to make sure that we don’t have equipment issues that hinder your ability to do the best you can for us–the patients!


The Quality of Medical Device Reporting

Data is everything to a Quality Engineer, and when a Medical Device Report (MDR) is received we must follow a strict procedural approach to reveal the root cause. Often the information received is ambiguous and actually hinders a proper investigation! The Failure Modes Effects Analysis (FMEA) are updated,  Statistical Process Control (SPC) is analyzed, and Control Plans are reviewed…but the true value of the report is diminished when a reactive approach is taken and the preventative opportunity lost.  Let’s talk about some of the ideas that may diminish the best reporting possible.

Medical device manufacturers are doing it for the money!

True, but remember at the same time device engineers strive to deliver perfect products that meet the customer’s requirements and provide a positive, memorable experience. It’s for the docs, the manufacturers, and the patients. (Don’t worry, I know there’s a patient at the end of the stapler!) In manufacturing medical devices we choose to follow a difficult and costly path riddled with risk. We imagine being the patient who requires perfect quality the first time, every time, but our best efforts are only as good as the data collected from the field. I often wonder what percentage of mandatory reporting is misrepresented or the adverse event occurred during misuse and ultimately a misunderstanding of the devices design capabilities. Please help us understand the problem and we will fix it at any cost!

One MDR can take a year to resolve and is worth every second!

Without being specific, I have worked an entire year to improve a product without a single change to the design. The cost has yet to be realized, but $1,000,000 is a conservative estimate and will absolutely be captured in our cost of quality metric. In this example, different tissue thicknesses were evaluated and countless tests were completed to improve the device’s performance envelope. To validate the smallest process change, several thousand devices were assembled and tested in the predefined manner outlined with the devices approval. Imperceptible to the user, this device will now function in applications never imagined or planned for. This duration could have been reduced, but one MDR with very little information is all it takes to spend a year putting the pieces together. The next time a surgeon reaches for this device the last thing I want is the distraction of failure in their mind. 

Surgeons, help us help you!

Here are some simple rules to follow when faced with an MDR:

  1. Capture every detail: There is no technical detail we can’t unravel, and we will consult your peers to understand any situation. The more relevant detail the better we will serve you and this information may be passed down several times before it reaches the appropriate subject matter experts. Don’t be afraid to use that extra page provided to describe what happened.
  2. Include technique: When we set out to recreate the failure, your experience must be clear. We want to test devices in an accurate manner and this information is paramount. If a surgeon describes their experience firsthand, we won’t assume anything.
  3. Query your peers: Before committing to the content, consider every perspective of your surgical team. Perhaps they will add value and reveal something unperceived.
  4. Pictures speak a thousand MORE words: The most successful investigations I have participated in included reports that were accompanied by pictures. You may be contacted by the device manufacturer and pictures will always be valuable.

So, to all you healthcare providers, I want to say hello and let you know about what we do to make sure all those devices out there do the right thing for the first time they’re used and every time they’re used.

Thoughts, questions, or comments?  Let me know beneath!