 Hello. So surgery is possibly one of the most tactile, kind of close-up parts of medicine still remaining. And so if we're talking about a remote surgery start-up, that almost seems like a paradox and oxymoron. So Nadine, can you sort of explain to us, for those in the audience who maybe aren't familiar with Proxima, how it works and what it seeks to achieve? Sure. Well, first of all, thanks all for joining us. It's great to be here at Slush again. My name is Nadine Hashash Haram. I'm a reconstructive plastic surgeon. And my clinical practice is mainly in the areas of breast and pelvic cancer. I designed Proxima and I'll tell you a bit about it, but truly from a front-end experience of the frustrations of surgery. Today in the world, we know that five billion people lack access to safe surgery. We also know that there's still a high amount of variation in surgery. And the operating room where the surgery takes place is incredibly analog. Often, operating rooms are the most expensive assets in a hospital when you think about the workforce, the equipment, and of course, the stakes involved. And they're also a part that is least understood. Everything that happens in that OR is lost apart from a piece of paper at the end of an operation that says, this is the surgery that happened. And as a surgeon in that environment, I started to think to myself, how do we change the paradigm? How do we turn these analog environments into smart, intelligent, connected, data-driven environments? And what's missing is regardless of what operating room you're looking at, no matter where you are in the world, what procedure type it is, what instrument they're using, there is no true operating system, no platform that is connecting devices, people, and processes together. We don't really have any ways or historically had ways to connect, collect, and activate surgical data, knowledge, and expertise, and make sure that it's available all around the world. So that's why Proximi was born. Proximi is a digital platform. It is a software. We leverage the best of cloud computing and AI and video technology to enable us to turn these environments into smart, data-driven environments, data-rich environments. By using Proximi software, no matter what procedure you're doing in whatever country, you can have people virtually scrub in and operate with you, share best practices, share expertise. Every single case in that environment is collected, recorded for analysis, for playback, for sharing, for codifying and understanding what's happening in an operating room. And all of that data that's sitting in a secure location in the cloud is now available for analysis from simply looking at turnover time between cases to phase segmentation of steps of a procedure, to how many people are in the room working together, and how do we build better workflow and better processes. And this is fundamentally making an impact in three key areas that affect healthcare. The workforce. Today we train twice as many doctors in half the time. To media management and how do we capture and store knowledge and information in a meaningful way so that we can lean into the horizons around data and AI and all these great technologies that are being built. And ultimately quality and safety. How do we ensure every patient in the world gets the best care the first time, every time? Nadine, you mentioned training there, but what in terms of kind of live use does Proximi look like? I've read about kind of the possibility of patching surgeons in and getting them to kind of consult on things like as an operation is happening. Correct. And for us, what was really important about the technology is that it offered both real time and post case analysis. So in real time today, if I had my phone on me today, I could dial in to any case that I'm invited to anywhere in the world where Proximi is available. I can virtually scrub in. I can look at the case from different angles. I can speak to the team in the operating room. I can draw my phone or my computer and they can see my illustrations on their side and we can collectively work together through procedures. And if you really think about surgery, surgery is an apprenticeship. The old adage of see one do one teach one, that's how we learned how to operate. But it was very analog. It was very focused on in person. People would travel miles and miles to get to different operating rooms to see how people operate and to learn. Now you can digitize that whole experience. So moving from see one do one teach one, we move to prepare, perform, perfect. And so we've got trainees dialing in to cases all around the world to learn from best surgeons. We have proctors or teachers dialing in to cases with their juniors or with their colleagues to give a second opinion, to share best practices. And it's global. We have people working together all around the world and we've deployed this in over 60 countries so far. Thinking about kind of where things go next, you know, when we've talked about this with Wired, you kind of flagged an instance of a keyhole surgery that was done with consultation from overseas in the United States. That was done with that person kind of sitting in, but that's a robotic surgery. Someone else is doing the actual sort of manual control, but is it possible that we'll move on to a point where actually the person who is doing the surgery could actually be somewhere else in the world and not actually in theater? Yes, and I think the, you know, remote surgery or tele-surgery, as they describe it, has happened in the past, although the technology was not sophisticated enough, you had a lot of issues around latency and others. But ultimately, when you think about those future states, you talk about tele-surgery and there are many others. The surgical co-pilot, the, you know, automated shared decision-making, all of those toolings fundamentally require a shared pipeline, a shared language, a shared operating system. And as I had observed for 10 years, operating rooms were completely disparate and different. It's still the case today. But now what we have is a common language and a common platform, proximity being deployed in thousands of operating rooms around the world. Once you've laid that piping and you're able to share and collect data in a very meaningful way, you're able to do a lot more with that now and you're able to both in real-time and post-case do all the things that you describe. How do we learn from this data? How do we do automation where possible? How do we alleviate even administrative tasks, like, you know, after an operation, do I really have to go and physically write the up-note or does the system learn from what I'm saying during the case and how I'm working to automate operation nodes? And so there are many toolings and I think applications of the pipeline that we've built that are going to unlock, I think, pretty rapidly given the advancements we've seen in GenAI and other technologies and computer vision, et cetera. So we're very excited because we've had to create the category. We've had to lay the piping ourselves and now both individually and through strategic partnerships with, you know, data companies, algorithm companies and others, we're going to be able to create one of the richest engines that aligns with surgeons and healthcare workers to deliver best care to patients. I feel like it's mandatory for me to ask about AI right now, but do you have kind of specific kind of applications when thinking about where GenAI may go with Proximate? It's always interesting. I feel like it's the common, you know, everyone, you can't do a panel today without using the word AI. So I completely agree. What I want to take a step back is say fundamentally, we focus on two things. One, building exceptional products. So the experience on our platform is exceptional and we are very obsessed about that. And the second is making sure there's a value exchange. Because what I can tell you as still a practicing surgeon is it is very hard on the front line. You know, there's challenges around backlog, challenges around workforce, challenges around delivery of care. Healthcare is complex. What we need to make sure is whatever that underlying technology under the hood is, it is one that is truly creating a value exchange between the providers and the patients and the systems and the devices that we use. And absolutely AI plays a role and has played a role in our technology today. Even looking at things like how our system adapts to bandwidth, there's an algorithm in there that's letting us do that. How do we build on the data sets that we have? I mean, we're sitting on over 30,000, 40,000 videos of surgical cases. There's so much we can be doing with those videos. Simply by looking at, you know, how do we change Nadine's turnover time from 45 minutes between cases to 20 minutes so we can do more cases and more patients get surgery to more sophisticated applications like fake segmentation of a procedure to, you know, video-based assessment of skill sets to relieving administrative tasks like I talked about, operation notes, instrument counting, et cetera, et cetera. And so we see that there's a whole range of applications of AI and Gen AI. And if you think about it, surgery is reliant on communication. You know, we do a lot of talking in the OR and its movements and what's happening in that space. So if you're able to bring the strength of video, the strength of Gen AI, the strength of cloud computing together, then I think the possibilities are limitless. And we've got a number of prototypes today that we're working on. We just announced an hour or two ago the release of our SDK, our developer kit, which means not only are we benefiting as proxmy from the great technology stack that we've built, but other manufacturers of medical devices will now be able to take our SDK and integrate it into the devices as they go out into market. And so these are ways in which we're enabling many providers in the market to join that common language, join that common pipeline, and leverage the power of all these great technologies like AI in the future. Thinking about that consistency of kind of what's at the base here, can you see kind of proxmy going beyond surgery? Like can we expect remote consultations or other medical services being provided using the platform? Absolutely. And I mean, ultimately, there's a general consensus that, you know, healthcare is also moving beyond the four walls of a hospital, right? This idea of virtual care, remote care, you know, care closer to home. And we see that happening from an infrastructure perspective. You see, you know, we're not seeing a lot of big teaching hospitals being built. We're seeing a lot more ambulatory day case centers being built, smaller hospitals, boutique hospitals that are closer to patients' communities. Proxmy plays a role in connecting those networks of bigger teaching hospitals and smaller hospitals and centers together. At the same time, when we think about procedural medicine, it's getting closer and closer to home. So even simple things like wound care dressings where patients just have to travel into hospital to have those things done. We are now creating air traffic control hubs where you've got an expert sitting in a hub remotely helping more junior nurses or specialist staff in the community to help that. So Proxmy will continue to be the enabler of that sort of move from big teaching hospitals to care closer to home. And I think equally, Proxmy will continue to be an enabler and grow as an enabler, which is purely demand-driven around supporting device manufacturers to bring those technologies to those communities and use Proxmy's technology to power it to be digital more rapidly. And where is Proxmy being used right now? Do you have rough figures of how many hospitals, how many countries are using it? And whether it's also being used in any kind of perhaps less well-established settings, so maybe disaster zones or war zones, where there's obviously a high burden of care and where expertise perhaps isn't always readily available? Absolutely. I mean, what's great about Proxmy is it's a platform that people will use throughout their life journey or career as a healthcare worker or surgical healthcare worker, whether you're a nurse or a doctor. So we have it being used from medical schools and medical students to very sophisticated, complex, quaternary centers of care, and all of those are using it. And today we've been deployed in over 800 facilities around the world. A facility can have anywhere from 10 ORs to 300, 400, 500 ORs, so it can range. We've been deployed across multiple geographies, pretty much every continent. And we have been deployed from the most austere of environments, as you describe, war zones and difficult-to-reach environments to the most sophisticated cutting-edge Western hospitals in some cases as well. And the reason that we've been able to do that is, again, goes back to the two fundamentals I talked about. Building great products and making sure that there's value exchange. What was very, very clear to us early on was that we couldn't build our software relying on other technologies that we wrapped up into our platform. We really had to own our whole infrastructure down to the bare metal because that would enable us to adjust for all kinds of environments. We talked about austere environments, we talked about emerging economies, we talked about the Western world. But ultimately, you want to be able to adapt to variable bandwidth, variable hardware devices, iOS versus Android, the constant debate, web browser versus sort of a non-web browser. And so those decisions had to sort of be embedded into how we built the technology. And because of that, we have been deployed in war zones. We have been deployed with certain military. We have been deployed in the latest cutting-edge teaching hospitals in the US or in Europe. And we're used every single day. We've done thousands and thousands and thousands of cases around the world. But what really is important to me, I think still as a practicing surgeon, is that all those numbers are great. But at the heart of it, the DNA of our company is that we are impacting human lives. So there's stories behind all of these cases. When we do our monthly company call or town hall, we always start with a mission and vision story. How has Proximi changed someone's life? And we share those stories because that's why we do what we do. It's not just technology looking for a problem. We truly are solving some challenges and we want to bring it back to the human impact. And those stories really get us through the good days and the bad days. And I think that's the same for any tech company that's being disruptive, that's got a mission and a purpose, and that's pushing through. You mentioned development, that's something I'd like to get into. How when you have an idea that feels very good, do you actually go about kind of putting that into practice? Particularly when you are first and foremost a surgeon and this is a different kind of technological challenge? Like, is it about finding the right people? Or do you have to kind of get stuck in and actually learn a new set of techniques to kind of make things work? What I can say is I would probably call myself an accidental entrepreneur. I didn't sort of wake up one day and say, I really want to build a company. It was sort of 2014. I was in my operating room. I'd spent 10 years in global health. I used to travel to many parts of the world to deliver sustainable, scalable surgical care. And I worked with a lot of device companies training doctors and nurses on new equipment. And what I realized in the face of the numbers of 5 billion people lacking access to safe surgeries that no amount of organic human growth was going to address this problem. We needed to think laterally. We need to think differently. And so I started to think about the role technology could play. My father was a computer engineer. I kind of had a love for video games as a child. So perhaps that kind of played into it. But even till this day, I'm not going to claim that I know how to code anything. But I sort of had an affinity to this space and decided to ask some engineers to build a prototype for me that we could test out so I could publish some academic papers on a digital approach to surgery. And it was two years later when the technology was being used in a war zone that CNN covered the story. And the article heading was, could this technology be the future of surgery? And a week later, VCs were reaching out saying, are you fundraising? Send us your pitch deck. We'd love to give you money. I'm like, I don't even know what a pitch deck is. I'm a surgeon. That's what I've been trained to do. I've not done a day of a business degree anywhere. But you end up learning on the job, but you also know what you do not know. You become, you know what you know well. You know what you do well and also know what you're not good at. And so very, very early on, it gives you a sense of humility and a drive to go and ask questions and be curious and not be afraid to ask. So I think very early on it was clear to me that I needed to build this technology. The impact was so tangible, but I also knew that I couldn't do it on my own. So I surrounded myself with incredibly bright individuals that complimented my gaps and my blind spots. And I like how did everyone I could on LinkedIn, can I get 10 minutes with you? Can I get five minutes? I would turn up to conferences like these, like Slush, and just wait for people after their talks and say, can I just get five or 10 minutes? And many people were generous. Not everyone was, but a lot of people were. And you realize that quite quickly, you can pick up a lot of the, you know, you can ask your questions, you get the answers, and you iterate and evolve through that. And, you know, I sit here, of course, representing Proximy, but Proximy's success to date is purely due down to sort of the great team that we have and the willingness for all of us to pile in and bring our expertise to address this challenge. And talking about kind of scaling up and getting kind of interest, you know, was that serendipitous with like the media coverage and then the VCs coming? Was it all down to kind of like the shoe leather and kind of like tapping people on the shoulder? Like how do you, how do you get from idea to prototype to, you know, to 800 facilities? I mean, it's a great, good approach because I think, you know, early on as that article came out, it was quite disruptive. I mean, in 2014 and 2015 to be talking about remote surgery, I mean, this is pre-COVID, pre-all of that, seemed quite out there. So even the medical community and the surgeons were like, this is crazy. This is never going to happen. Like why would our ORs be digital? Why would we want to know what's happening? You know, why would we want to share what's happening in the room? And so early on, you know, we raised money, but it wasn't as easy, you know, as perhaps, you know, other companies that were tapping into a particular area or a particular, you know, hype phase in that time. We were seen as sort of an outlier, but we were very persevere. I mean, we knew that this was, this had to be built and we had to find a way to get this technology out there. And so we spent a lot of time early on building proof points, human impact stories, showing the value of the technology. And over time, you know, it's a combination of great product, solving a real tangible problem and, you know, funding being made available that we were able to then scale and grow rapidly. I cannot tell you how many rejections we had early on or how many times I'd get on stage and people told me I was absolutely nuts and this was just a voodoo idea. But in my heart of hearts, I knew that this had to happen and it's so amazing to see how much the industry has moved along. You can't see a single big MetTech company not have in their quarterly investor updates something about digital OR, digital operating rooms. Now it's become the standard and the expectation. And so I see a world in the future where every room will be digitized, hopefully powered by Proximy and it's a credit to the perseverance of the team. Do you have to do any work to convince people within the medical community that this is something you should be doing? You know, I mean, we can see what the benefits are of having more eyes on practice but perhaps not every surgeon wants or feels they need someone there, they're kind of on their shoulder looking in. It's a great question and for me it goes back to, you know, how do you frame it in a way so the question doesn't become why would I do it? The question then becomes why wouldn't I do it? And so we, I mean, I still practice one because I absolutely love, you know, I love operating but also because I believe that as a champion and an evangelist for this new way of doing things I have to, you know, be in the field with them. I'm one of them, I am a surgeon. We are in this together. The second is there has to be very clear value creation. If I'm just going into ORs and saying I'm just going to record you and kind of let you know how you're doing afterwards you'll get some adoption but you're not going to get the kind of adoption where everyone benefits. And there's this often misconception that the operating room is purely about surgeon and patient and it is just not, I mean, that's just not the reality. The operating room as a construct is about the surgeon, the patient, the administrators, the medical device companies, the accrediting bodies and so it was really important that the system that we built was a system that unlocked value for every single stakeholder. So surgeons and nurses love it because they can dial in a friend. They can record their cases. They can go back and review their cases. I don't have to leave my clinic to go up to change into scrubs to go into the operating room to give a five minute opinion. I can be sitting in my clinic. I can dial in for five minutes. I'm in there. It's an instantaneous opinion. Everyone wins. From a media management perspective, now hospitals have all the content they can leverage and understanding of what's happening in their business and ultimately you drive efficiency and productivity and I think that approach of winning hearts and minds is what's got us so far. Can I ask a quick question? And it's maybe a predictable one because we're surrounded by VCs and I was asked it last night but how does the sale of the platform work? Like, is it subscription-based? Is it a one-time fee? Yeah, we are a B2B SaaS platform. So we sell to hospitals, medical device manufacturers, licensing to our technology so they can leverage it for those use cases and as of announcement today, we also now have a... I mean, this was demand-driven. We've been doing this for a while but we've now sort of officially launched it, our SDK so that manufacturers can now take our technology sort of stack and sort of integrate it into their devices as well. So we have a diversified revenue pool but it's ultimately a B2B SaaS platform. Brilliant. Thank you so much, Nadine. We're at time but I just want to say I hope it comes full circle and maybe someone who's working on something that feels like it could be just as revolutionary in the health space, you know, comes and taps you on the shoulder at the end and asks you for advice because I think that would be wonderful and kind of feels like what Slush is all about. No, thank you and I'll leave by saying, you know, we've used this technology on many thousands of patients but even my own mother has benefited from this technology so we truly believe in it and if anyone's interested, visit our website or reach out, we're more than happy to collaborate. Brilliant. Thank you so much. And enjoy the rest of your Slush, everyone. Thank you.