Dr Nadine Hachach-Haram FRCS (Plast), BEM, is Consultant Plastic Surgeon and Head of Clinical Innovation at Guy’s and St. Thomas’ NHS Foundation Trust. In 2015, the NHS clinical entrepreneur drew on her surgical experiences and her passion for innovation and education, to create Proximie; a technology platform on a mission to save lives by sharing the world’s best clinical practice.
Dr. Nadine received the British Empire Medal in the 2018 Queen’s Birthday Honours for her innovative work within the fields of surgery and medicine. She also undertakes a number of roles to help advance surgery, including council member of the Royal College of Surgeons Future of Surgery Commission, council member of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), Innovation UK and council member of the Royal Society of Medicine plastic surgery section.
Tell us about Proximie . How did you first come up with the idea?
Imagine a world where every surgeon has all the expertise and information available in real-time so they can deliver the best surgical care, for every patient, every single time? As a training surgeon I grew increasingly frustrated with the widening inequity in care. I wanted to see if we could create a solution, using technology, that could empower surgeons to virtually and practically interact with each other from anywhere in the world, and share expertise at scale that could help to save lives. I wanted to create a platform that could extend the reach of a surgeon’s expertise, but also make that skill timeless.
I wanted to create a platform that could extend the reach of a surgeon’s expertise, but also make that skill timeless.
Proximie was built to allow experts to virtually scrub-in to operating rooms and cath labs around the world, to support, coach and mentor each other, and to really look at the continuum of expertise throughout a surgeon’s career.
I had been exposed to early-stage telecommunications platforms, but all of them are anchored to one moment in time. One meeting, one call, one conference, but then it’s gone. The options available did not enable a continuum of sharing knowledge and expertise, and they were too passive. You can’t do remote surgery in 2D. It has to be more immersive than that. What we wanted to do with Proxmie was to create a multi-sensory experience that was a catalyst for collaboration and could digitise a surgeon’s footprint. We wanted to extend the geographical reach of a surgeon and create the effect of a borderless operating room that could empower surgeons to remotely share knowledge that could ultimately reduce variation in care.
We wanted to extend the geographical reach of a surgeon and create the effect of a borderless operating room that could empower surgeons to remotely share knowledge that could ultimately reduce variation in care.
Once you knew what you wanted to build, how did you go about creating your technology and scaling your company?
Disruption in healthcare has many challenges and anyone who says it’s easy or straightforward, has probably never experienced it. But if it’s really solving a problem, then adoption can be swift and decisive. Proximie was born out of a need, and my ambition as a surgeon was to find a solution and scale it using technology. I think when we first set out there was understandably some scepticism about whether or not we could match our ambition to change the paradigm of surgery! There was also concern about whether or not we could build something that was intuitive yet capable of supporting the type of precision that is required in an operating room. Would Proximie end up being too otherworldly or cumbersome from an integration perspective? We knew we had to build something for the here and now, as well as for the future. It had to answer an urgent need and have the potential to both decrease costs and increase the efficiency and quality of care. That was the dichotomy we had to overcome.
I think when we first set out there was understandably some scepticism about whether or not we could match our ambition to change the paradigm of surgery!
I think we managed to build a platform that combines the very best human expertise with advanced technologies, to empower any surgeon to virtually transport themselves into any clinical setting to interact in a live situation, regardless of geographical location. The evidence for that is tangible – Proximie is already deployed in more than 50 hospitals around the globe, completing more than 300 surgeries each month, in 30 countries.
What have been the greatest challenges?
Without doubt the greatest challenge was making the decision to start Proximie in the first place. A great idea does not necessarily lead to a great business.
Without doubt the greatest challenge was making the decision to start Proximie in the first place.
Taking those first tentative steps to try and turn the idea of changing the paradigm of surgery into a scalable business, was definitely the hardest challenge I had to overcome! It was also one I took while I had young children and was still in surgical training, neither of which afforded me a great deal of time!
How does Proximie continue to reach surgeons in developing countries?
We work with a number of global charities and organisations to provide a variety of services – from training and mentoring, to remote clinical assistance – so that patients all over the world can have access to the best care possible, regardless of location. We have initiatives running in Ecuador, Costa Rica, Brazil, Peru, El Salvador, in the Middle East and Europe.
How do you balance being a Surgeon and a CEO?
I think they compliment each other incredibly well. Being a healthcare worker has been instrumental in the Proximie journey. I’m a frontline surgeon that has been exposed to the complexities of healthcare systems, so I understand the challenges around behavioural change, and how sometimes the adoption of new technologies can be slow. I also understand what may or may not work within the healthcare environment because I have experienced it first hand. That has been an invaluable experience and something I’m incredibly grateful for.
I’m a frontline surgeon that has been exposed to the complexities of healthcare systems, so I understand the challenges around behavioural change, and how sometimes the adoption of new technologies can be slow.
Secondly, like all healthcare workers, I’m very mission driven. It’s about trying to create a solution or work on a solution, that is solving a genuine problem. The platform we built is testament to that. Using augmented reality, healthcare practitioners can remotely interact in a procedure or assessment from start to finish, and mentor a local clinician through a live operation, in a visually and intuitive way. An internet-connected device allows them to view a live camera feed of the assessment or operation, provide verbal instructions, draw or overlay important patient scans or X-rays, and virtually reach into the clinical field to provide precise guidance.
We have been used to using digital technology to communicate and share information through voice, through text and through video. But our integrated technologies of machine learning, artificial intelligence and augmented reality do something deeper than that. It allows two people in remote locations to interact virtually in a way which mimics what they would experience if they were collaborating in the same room. It means one can physically show the other where to make an incision, in real-time, or use gestures to illustrate a technique, rather than just talking about it.
From a commercial perspective, where have you seen the greatest uptake of your technology?
Covid-19 is accelerating the adoption of telehealth technologies across the board and we’re no different. A recent paper in The Journal of Urology concluded that Proximie “allowed more flexibility in patient scheduling and reduced travel costs with similar outcomes” compared to face-to-face. We’re increasingly seeing the platform used to enable surgeons to stay connected and collaborate from a distance. This is obviously critical as we continue to try and stop the pandemic. It’s a matter of limiting physical numbers in operating rooms and Cath Labs but, increasing clinical expertise.
Proximie was recently employed intra-operatively during a complex transcatheter aortic valve implantation (TAVI) procedure to virtually connect an expert surgeon in Copenhagen and a medical device representative in the US with a consultant cardiologist on the frontline in Beirut. Given current travel restrictions, physically connecting this team of experts to perform the life-saving operation would have been impossible, and we’re seeing our technology used as a means to bypass the restrictions imposed on us by COVID-19, in order to ensure critical procedures can go ahead. For example, Proximie was also recently used to enable two very skilled surgeons to collaborate virtually, from London to Seattle, during a complex robotic procedure, in order to help save an NHS patient’s life.
The challenges posed by Covid-19 are going to endure for a long time following its conclusion. In the immediate phase, all resources have been channelled into stopping the pandemic, which has resulted in elective and semi-elective surgeries being cancelled. Health systems are going to need to adapt in order to manage the increased capacity which is imminent. We are already seeing how tools like Proximie can be used to support clinicians in cath labs and operating rooms.
With travel and access to operating theatres restricted, our augmented reality platform can be used to transcend geography and time to ensure skills that are normally siloed can be shared in real-time. Clinicians are going to need to embrace these new technologies to find ways to get surgeries done under very difficult conditions, and demand for Proximie is increasing every day. The early adopters are stealing a march.
Clinicians are going to need to embrace these new technologies to find ways to get surgeries done under very difficult conditions, and demand for Proximie is increasing every day.
We also know that many clinicians are going to require support to re-engage with performing routine procedures after a period of deskilling, and we are already working with a number of societies and national bodies to plan for the re-engagement of clinicians into training. We have recently been facilitating virtual masterclasses for different organisations — from anatomy sessions with Keele Anatomy and Surgical Training Centre to immersive webinars with The British Association of Aesthetic Plastic Surgeons, and also the International Hip Preservation Society (ISHA) — in order to maintain their respective education remotely. In addition, to provide virtual training programmes in plastic surgery and urology at Guy’s and St Thomas’ NHS Foundation Trust, we recently announced a new partnership with The Association of Surgeons in Training (ASiT).
Whilst educational programmes and training have inevitably been disrupted due to the pandemic, we are already seeing the resilience, adaptability and collaborative spirit of the surgical community shine through. I’m proud that we can contribute to supporting the education of trainee surgeons during these difficult times.
Whilst educational programmes and training have inevitably been disrupted due to the pandemic, we are already seeing the resilience, adaptability and collaborative spirit of the surgical community shine through.
As a clinician, how has Covid-19 impacted you personally and professionally?
Covid-19 has tested the capabilities of healthcare systems all over the world, which has compelled pragmatism, collaboration and innovation in order to try and meet the varied challenges presented by this viral pandemic. Necessity is the mother of invention and we have seen how Covid-19 has forced innovation at a pace that was previously unthinkable.
Necessity is the mother of invention and we have seen how Covid-19 has forced innovation at a pace that was previously unthinkable.
The urgency that was needed to try and combat Covid-19 has been a catalyst for incredible collaboration. We have seen the blurring of lines between the private and public sectors for the greater good. This has certainly been the case at Proximie, where we have been deployed across a host of NHS sites to remotely connect surgeons and healthcare workers in the battle against Covid-19.
As a frontline NHS surgeon myself, I’m immensely proud that we have been able to help in the acute phase of the pandemic.
From my personal perspective, all healthcare practitioners have that adaptability and innate appetite to want to support and find solutions. This is why many of us became surgeons in the first place, and everyone is trying to muck-in and support where they can. During the early phase of the pandemic, I was doing things like portering and training as a respiratory clinician. That was the reality for many of my colleagues.
We must all look at this moment in time as one to embrace change. We must harness the collaborative ethos of the Covid-19 response, in order to drive long term change. And return to a new, better normal. Things like reimbursement, legislation and affordability need to be addressed.
What advice would you give to medics who want to pursue their entrepreneurial aspirations alongside their clinical career?
I would urge them to do it and to be courageous. Anyone who has ever endeavoured to create a disruptive business, in healthcare in particular, will know that it is hard. You will encounter knocks along the way, but have the courage of your convictions, have faith in your team, and don’t lose heart.
You will encounter knocks along the way, but have the courage of your convictions, have faith in your team, and don’t lose heart.
Most importantly, always remember your purpose. What are you trying to achieve and what problem are you solving? Make sure that everyone within your business is aligned to your mission and your purpose and that it is front and centre of everything you do. Finally, there will be bumps in the road. It will be hard, but enjoy the highs, learn from lows, and make sure you enjoy the ride.
What’s another health startup you’re excited about?
Rather than focus on one startup in particular, I think the collaborative and innovative spirit that has characterised the response to Covid-19 has been incredible. Seeing the collective will and proactive endeavours to find a vaccine, create suitable and effective testing, develop protective equipment and produce short and long term solutions to the outbreak has been inspiring. Covid-19 has forced innovation at a pace that was previously unthinkable, and the need for speed is bringing out the best in so many people.
Finally, why do you think there are so few female doctorpreneurs? And how can we fix this!
Although you will still find a gender imbalance in terms of female representation in healthcare technology – only four women made this list of the top 50 Healthcare Technology CEOs – and far fewer female leaders are responsible for helping to address health challenges. I’m very hopeful things are slowly changing. Inclusivity is the way forward for healthcare technology but it must be promoted and championed. The industry needs it and the world would benefit from more female doctorpreneurs.