Sandeep Akkaraju, founder and CEO of Exo, on VatorNews podcast

Exo developed a handheld medical device, and software, for making ultrasounds cheaper and easier

Steven Loeb and Bambi Francisco Roizen speak with Sandeep Akkaraju, founder and CEO of Exo, a company that has developed a handheld medical device, and software, for making ultrasounds cheaper, easier, and ubiquitous.

The idea behind Exo was to make the ultrasound machine as easy to use as a smartphone camera; that meant getting rid of all of the extraneous things like the knobs and sliders and track pads and trackballs, on that equipment. In addition to its hardware device, Exo has also developed a software platform called Exo Works, which is designed to solve workflow issues around imaging. That means it combines exam review, documentation and billing into a single platform, and it works with nearly all point-of-care ultrasound devices.

Last year, the company, which is pre-product, raised a $220 million round of funding, bringing its total capital to $320 million.

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Highlights from the interview:

• The idea for Exo came when Akkaraju sold his startup and then went traveling to Africa, where saw how inequitable the distribution of healthcare is. That made him want to build something that would impact people around the world in indelible ways, rather than just  monetizing or sell something.
• Imaging technology was originally World War II technology that was developed for sonar and has not been fundamentally innovated on since. This is a failure of imagination and a failure of driving to new physics and new ways of doing things. 
• Exo's idea was to drive down the price, performance, size, and weight down so that the ultrasound ultimately becomes a wearable device.
• Current ultrasound machines have all kinds of knobs and sliders and buttons, making them difficult to use. The company wanted to make it simple, reducing the skill level that's needed to be able to use medical imaging, and massively increasing the number of people who can use it. 
• When there is really no innovation in an industry, they try to differentiate themselves on trivial things, which is where ultrasounds are today. They focus on adding more shiny things, as opposed to giving access to billions of people who don't have it and solving that problem. That is what Exo wants to solve for.
• Exo is not just device company, it thinks of itself as a health and information company. Ultimately, this is about tools that fit into the daily lives of doctors and nurses and other care providers, so it's important to know how the hospital works. The company wanted its technology to disappear into the background, which meant making it as simple as using an app on your phone.
• A real problem in point of care were clinicians doing exams but being simply unable to bill for it or do quality assurance on their tests or figure out who is credentialed to do what. Exo wanted to build a system that was open to everybody, so that it doesn't matter if you brought in an ultrasound system from another vendor, it wanted to make sure it delivered these experiences.
• When everybody thinks about ultrasound, they think about baby pictures. What Exo is focused on is the  point of care applications where you really need to get a quick answer. For instance, somebody who's shown up at the emergency room may have internal bleeding, or they may need to go into surgery. The clinician needs to see if their heart function is okay or of their lung is punctured. With COVID, ultrasounds and point of care have seen record usage because you may have an intubated patient and you want to look at their lungs and see the disease progression. All of those things can be picked up in matter of seconds with an ultrasound. 
• Exo is targeting physicians, but the company wants nurses to be able to use it as well. One of the things that's happening is over the next five years about 20% of acute care is moving towards the home, with decentralization happening because of COVID. That's accelerated significantly in terms of not just telehealth visits, and you're starting to see what companies are doing in terms of deploying care at your own bedside. Exo sees use cases in the home as it moves forward as well.

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