- This is Scott Becker with the Becker's Healthcare Podcast.
We're thrilled today to visit with Dr. Brian Miller.
Doctor's a a PhD.
He's Executive Vice President
and Chief Digital Officer of Intuitive.
Intuitive is the world's leader in robotic surgery.
It's got this incredible both footprint, foresight, and,
and, and way of working with surgeons
and systems to really provide
advanced minimally invasive surgery.
Uh, Dr. Miller, Brian's gonna talk to us today about sort
of the role of Chief Digital Officer, the things
that he's watching,
what he's most excited about, and a lot more.
Brian, could you take a moment and and,
and introduce yourself
and tell us a little bit about your background and, and,
and sort of what, what are you most focused on?
- Yeah. And, and Scott, thank you for having me.
And it's, uh, it's great to, great to be here today.
And so, uh, yeah, so just a little bit about my background.
I was, uh, trained as an engineer, so a electrical
and computer engineer.
Uh, but early on in school, uh, was introduced
to this concept of human machine interface or human
and robot interface, which, um, at
that time had nothing to do with surgery.
It had nothing to do with healthcare.
Uh, but it was fascinating to understand,
and I was a controls engineer, understand how do you program
and develop robots so that they could interact with, uh,
with people, uh, to do things that were,
uh, that were interesting.
And so, um, so went, went through school and, and, uh, and,
and that was the focus of, of my PhD,
which was actually humans interacting
with virtual environments across networks.
So you had to deal with delay, you had to deal with a,
a range of, of challenges.
Um, and then I was really fortunate, got lucky,
right when I was finishing my degree, uh,
to meet an individual, uh, Dr.
Yuan Wong, who had started Computer motion, um, uh,
which was a company doing similar things
to Intuitive at the time
and developing, you know, surgical robots.
And first time I heard about it, but, uh, but I jumped in
and, and my first task was to, uh, program the robot and,
and help us get FDA clearance so
that it could be used on, on patients.
And so, um, and so that was, that was the beginning.
And, and for me, uh, what's so fascinating, uh,
I've been now at Intuitive for 24 years.
And, uh, and when people ask me,
well, why do you keep doing it?
It's, it's because of this intersection between technology,
uh, and helping patients, and it's just fascinating.
And I continue to learn things, um, every day.
- So that, that's fascinating.
So 24 years in Intuitive, that's amazing.
And the, and the amount of growth that's been seen in
that period of time is remarkable.
Talk a little bit about, as you look at the sort of
this intersection of digital technology, robotics,
other issues, what are the big issues that,
that you think about at night
that might keep you up at night if you were worried about
things or just excited about things?
What keeps you up at night when you think about Yeah.
Sort of robotics and digital and so forth.
- Yeah, so what, what, what keeps me up at night, uh, uh,
both, uh, as an excitement,
but also as, uh, uh, you know, is, is is really trying
to get things moving, is that it, it is clear, um,
that the power of, of analytics and, uh,
and the data that drives it, um,
to really deeply understand, um, not only what's going on,
um, but guide you to, uh,
what you can do about it, uh, to improve.
And so, uh, so what keeps me up at night is,
is it's staring us in the face.
It's, it's right in front of us
that we can have a, a big impact.
Um, but there are challenges in quality of data, uh,
standards around being able to connect various data sets.
Um, and once you have unique data like, uh, uh,
things coming from the robotic platform, um,
and these are signals that, uh, that,
that don't exist anywhere else, we can measure, uh,
how a surgeon is interacting, uh, with the instruments.
And, and once you use those unique data sets
and you start connecting those to, uh, clinical
or operational outcomes, that can be really powerful.
And, uh, and, and I just wanna go faster
because of, of, of the value it can bring.
- Thank you. And, and in the digital world,
when you define digital health, it's one of these kinds
of things today where there's, there's thousands
of different definitions or different unique definitions.
Talk a little bit about in, in the digital space, uh, about
how you're sort of working with digital health
to use data responsibly and, and try
and improve patient outcomes.
How do these things tie together with digital health?
- Yeah, yeah. And so our, our,
the way we view it in our approach is like everything
that we do at Intuitive, you know, we start off by really,
um, being clear about articulating what is the opportunity
or the question you're trying to answer,
or the problem that you're trying to solve.
And, and, and the reason that that is so important, um, is
because that will then lead, uh, to identifying
what data is necessary, um, and,
and drive the responsible use, uh, of that,
uh, of that information.
And so, um, when you go through and,
and our approach is to really engage with customers, um, so
that collaboratively we can identify, uh, what is the value
of, uh, of, of using data
and analyzing it and, and improving.
Um, and so when you get there,
and then when you start having to tackle the things
that are really important around privacy and security, uh,
and the measures that, that we take as a company
and in collaboration with our customers,
so we can address those concerns.
If we've got the why we're doing it and,
and the value that it will bring,
then people get into problem solving modes and,
and you can work through, uh, some of those challenges.
And that's the approach that we've taken.
And, and while you have to be really thoughtful
and really careful about those types of things,
if you get the why and you get the value, then we found
that we, uh, we can move
forward together with our customers.
- Tell us a little bit about, you serve
as Chief Digital Officer at the most advanced robotic
company in the world.
Talk a little bit about, at least the advanced,
most advanced robotic surgery company,
the World Digital Health Robotic Surgery.
How do you work on supporting hospitals and health systems?
What approaches, particularly at a time where hospitals,
health systems are facing so many financial
and staffing headwinds, uh, how do you go about trying
to make sure you're supporting your
hospitals and health systems?
- Yeah, so our, our view, so we view the efforts that,
that we decide to invest in, um, in, in the same way
that customers look at their hospital, which is, uh,
captured in, in what's called a quadruple aim, uh,
which involves, uh, improving patient outcomes.
That's, that's why we are all in this.
Um, but also patient experience care, team experience, uh,
and then ultimately, uh, you know, bringing that together
to, uh, to reduce the, uh, the total cost to treat.
And so, um, and so our approach in, in viewing, uh,
the types of things that we do through that lens, you know,
allows us to connect, uh,
with our customers in areas that matter to them.
Um, and, uh, and,
and we're able to, uh, uh,
to start putting an action plan together and,
and moving down the path.
Um, we have this concept that, uh,
that we call the virtuous loop.
And, uh, and, and it's, and it's powerful
because what it allows you to do is once you have, uh, data
that is, is high quality and it's the right data, um,
and you go in and you start to extract
what are those important insights
that you can get from that data?
Um, um, and,
and then the next step that you take is you go, okay,
well, what can we do about it?
And so, um, so by providing an ability to go from data
to insights and then ultimately action, um,
but being able to see where, uh, uh, hospitals currently at
so that they can measure and say, okay,
how are we doing in this space?
But then as they apply those actions, being able to track
and monitor to make sure that they're improving, um,
that has been an approach that has been, uh, uh, you know,
very, uh, very important
and very powerful, uh, as we engage with our customers,
because then they can see how the various digital solutions
that we offer are actually impacting, uh, their business,
whether it's better clinical outcomes, um,
or improving their operational efficiencies.
- Thank you very much. And, and,
and right now it's tremendous discussions around ai,
generative ai, machine learning in so many terms
that are newer to a lot of us, probably not newer to you,
but newer to the rest of us.
Why should people invest now in these concepts
and these tools to help surgeries?
Why is now the time?
What are some of your thoughts around that, Brian? Yeah,
- It's, it's a, it is a great question.
Now, I'll, I'll start off, I'll go back to the, uh,
the virtuous loop for a moment.
'cause it will help, uh, it will help highlight that.
And so that concept of, of the virtuous loop,
we actually see three areas, um, that,
uh, that we're focusing on.
And, and we have heard from our customers that matter
to them, and that's around improving outcomes.
Um, and so using that data, finding insights and,
and then those actions
and closing that loop around, uh,
improving patient outcomes.
The second is, uh, um, uh, enabling personalized learning.
And so this is, uh, leveraging those data
and insights to be able to say, Hey, uh, if we want
to engage in a continuous improvement program, um,
where do we need to spend our time and energy?
You know, surgeons and care teams, they are busy, uh,
as you said, there is, uh, challenges in, in, uh, shortage
of healthcare, uh, workers.
Um, and so having very purposeful ways
that they spend their time
to improve is really, really important.
And so that's the second. And the third one is,
as you back up and look at just the overall, what it takes
to deliver care, uh, is a range of, of things.
It's not just what happens in the operating room,
but it's what happens before and after.
And so closing that loop around optimizing efficiency
and the insights
and the information that we can
provide to help them do that.
And so, so that's kind of the framing
and the framework with which we think now,
when you get into things like artificial intelligence
and machine learning, I think for me, I view it as overall,
I think it's really important for inve executives
to invest in, in data-driven, uh,
uh, continuous improvement.
And, uh, and, and we've been able to see, uh,
that when you look at it in that construct,
you got high quality data,
and it's the right data combined together that the insights
that it can generate are truly meaningful,
and they can start to see those improvements, uh, which help
with some of the headwinds
and some of the stresses that, uh, uh, that they have.
Um, and ai and ml, uh, it's a tool, but,
but it, it has helped us advance and,
and, uh, tackle some of the more complex problems
that have large data sets.
And, and it's hard for humans or,
and sometimes impossible for humans to be able
to see the patterns or, or understand the, uh, the trends.
And so, so that's why, in my opinion, they ought to invest,
not because of AI and ml, uh, but it's
because of this data driven continuous improvement
that can, uh, that can be had.
And so, just a quick example of, uh, of, of what we've seen.
So, uh, we worked with Adventist Health, uh, in,
in Simi Valley, uh, in, in Ventura,
California, so Southern California.
And, uh, what they were looking at is they were new
to their program, it was, uh, about three years ago.
And so, um, uh, they had three DA Vincis and,
and 20 surgeons that were, uh, uh, becoming,
uh, da Vinci surgeons.
And, and they were noticing that they were, you know,
losing patients to, uh, to other hospitals in the area.
And so, uh, they wanted to understand
how can they build their program
and really start to show, uh,
that they were doing it responsibly and,
and that there was an IROI for,
uh, for their healthcare system.
And so, um, uh, in working with them, we started to apply,
uh, some of our digital solutions from,
from our digital portfolio to different areas, uh,
that are required to build a healthy robotics program.
And, um, and just to highlight a few, uh,
we have Intuitive Hub, which is our edge compute device at
the point of care inside of the operating room that allows
for capturing of this rich data that that can be analyzed.
It's also the conduit for bringing in, uh, information
for clinical decisions.
So we have telepresence
where you can connect in an expert if you need a consult
or you need, uh, a second opinion.
Um, so they started to, they adopted that, uh,
they also started using my Intuitive, which is a, uh, uh,
an app with which surgeons can come on
and they can understand.
We give their data back to them, they can understand
how they've done, where they're performing.
They've got a timeline that shows them every step of the way
during the procedure, when did I use this instrument?
When did I do that? And they're able to use that
and sit down with their care teams
and go, okay, there's a point in time in the,
in the procedure where we had, uh, there was no activity.
What, what was going on? Did
we not have the right instrument?
Was somebody running down the hall?
So they were able to break it down
and start to understand
where they had opportunities to improve.
And then they started seeing
that improvement in subsequent procedures.
Um, they also started to activate, uh, learning,
so giving the surgeons, uh, uh, access to tools
where they could continuously do self-improvement.
Uh, with our sim now, which is a virtual reality simulator
where a surgeon can sit down and practice skills, drills
and, and, uh, and techniques, um,
and then access to remote proctoring where, uh, where
as I mentioned before, they could bring in expertise into,
uh, into the operating room.
And finally they said, okay, let's look at our whole program
and do analytics.
We have, uh, um, uh,
what we call our custom hospital analytics,
where they could look across their entire surgery service
line and understand how robotics was comparing to open
and lap, uh, both clinically
and operationally, uh, to see how things were improving and,
and to see that the robotics program was, uh, uh, was,
was improving quick, quickly.
Um, and so when they looked at it
and said, all right, now let's just see
what are the, what are the outcomes?
What, what are we seeing in our business impact?
Um, they started to see
that they were getting increased market share.
Um, and so they were solving their initial problem
that they wanted to, to, to solve.
They were also lowering costs,
so they were getting quicker in the operating room
'cause they were taking out some of that, uh, idle time.
And they also were looking saying, Hey,
can I use this set of instruments?
And they were able to control the cost of, of that.
So they were getting that total cost to treat,
that's part of the quad aim.
And then finally, uh, they were a better, uh, uh, surgeon
and, and care team experience by giving them access
to those tools, uh, for self-improvement.
- Thank you. Take a moment on this question.
And, and bear with me for a second.
So you did 25, 30 years ago, a master's in science
and a PhD in mechanical engineering
and robotics and haptics.
And 25 years later, I mean, you did
that at Northwestern brilliant academic institution.
You've been in robotics for 25 plus years.
I, I'll ask you two questions.
First is, what are you most excited about
for the future in terms of robotics and digital health?
And the second question is, did you ever envision,
because you got into robotics early when,
when it was just in the evolving field,
did you ever think the advances that have come
to this point would come?
I mean, how did you look at 25 years
ago versus what you see today?
And then what are you excited about for the future?
- Yeah, so I'll, I'll start off yeah, with, with your,
uh, your second question.
I would love to be able to say 25 years ago
that I could predict that we would be where we're at today
and, and the future would look like this.
Um, but, but I would say that, uh, uh, I, I,
I did not predict it.
And, uh, now it was, you know, a lot of people, uh,
and a lot of hard work and, uh, and dedication
and focus on doing it.
Um, and so when I look back going, Hey, I,
I can see why this much progress has been made
and the impact on patients is, uh, has, has been seen.
Um, but, but it is some, uh,
un unbelievably remarkable things that, uh,
that the teams have been doing over the years.
And so I, I definitely did not, uh, think 25 years, uh, uh,
ago that we would be sitting here where we're sitting now,
um, which, which makes me, then as I look to the future, go,
man, um, I think it's gonna be very different than
what I can envision today.
Um, now I've got 25 years of experience and,
and a little bit more, uh, uh, a little bit more, uh, uh,
knowledge about the space.
Um, but, uh,
but I, I think, you know, next 25 years
are gonna be unbelievable.
There's, there's two areas where I am, uh,
really excited about and, uh, and excited to see the impact.
Uh, 'cause teams are working on these things today.
And, and, and the first one is what I alluded to, uh,
with regard to that personalized learning.
And when you think about, you know,
we've done over 12 million million procedures, uh, uh,
to date with, uh, with Da Vinci
and capturing
that rich data over those 12 million procedures.
And that continues to grow every single day, uh,
as we do procedures, um, uh, that knowledge of here is
what was done, here's the technique,
here is the outcome for the patient.
And, and the learning over that, being able to harness that
and then deliver that back to surgeons
that are early in their career going, look here is,
here are best practices, here is the way to do things,
um, is just powerful.
And, and in the age of compute, uh,
and things that are always online, uh, the ability to spread
that throughout the world very quickly
is, is extremely exciting.
And so that will continue to grow.
The second, um, is, uh, uh, you know, moving into a,
a realm of being able to give surgeons information
in real time, why they're doing the procedure
that they've never had before.
So this is the ability to go in and see beneath tissue.
So advanced imaging technologies where you can, uh,
where you can see the beneath tissue,
you can identify structures that you can't see.
Um, and these are things
that will not only reduce complications in surgery,
but have the potential to eliminate 'em,
because you can see 'em, you can avoid 'em.
And so that is a, a, an area that will continue to grow.
Um, but I, I'm really excited about what we can do
and in, in kind of this next, uh, this next phase
of being able to really drive better patient outcomes.
- Brian, Dr. Miller, thank you so much.
What a, what a fascinating field you ended up being in the
leadership of at, at the leading robotics company,
surgical robotics company in the world.
Intuitive. Thank you so much for sharing some
of your thoughts with us today.
What a pleasure. I always learn something when I talk to
yourself and people from intuitive fastening,
what you're doing, 12,000,
12 million procedures so far. Is that what I heard?
- Yeah, 12 million and counting.
- That's an amazing number. Who would've thunk it?
Thank you so much for joining us today.
- Thank you for having me.