#20-Anatomy of a startup - 1st conversation with Erik Paul, CEO of Exiom who is bringing 3D printed casts to the US for better early fracture immobilization (17 mins)

Brought to you by Tiger Buford.

Hello, Orthopedic Tribe. Welcome to Inside Orthopedics. My name is Tiger. I'm an orthopedic industry insider and retained recruiter for early-stage orthopedic companies. Thank you for listening. This is episode number twenty, titled Anatomy of a Startup Interview with Eric Paul from Exiom. This is one for those who want to look inside an early startup with a better solution that is right on the cusp of commercialization in the U.S. Eric Paul is the CEO of Exiom. That is E.

Xiom.

Eric and I were in different locations after Academy in 2019, and we've never met. Xiom is the solution for casting or bracing in our world of orthopedics. Software wins again for this breakthrough. An iPad app makes a 3D image, and an on-site 3D printer prints A 2-piece cast or brace while the patient is waiting. This cast is cool, it's colorful, it's waterproof, and more. You will start to see these casts pop up all over the country. This is just a better solution. Enjoy the conversation. As always, don't forget to subscribe. Thank Tiger Buford for your next key hire, and keep innovating, my friends.

Thank you.

Thanks. Hello, I think we, we've got it.

All right, sounds good.

Okay, we're live. This is Eric Paul with Exxion. Is that how you pronounce it?

Yes, sir, Exxion. We, uh, we started the company last year, mid, mid-year around June, and, um, took us about 6 months to get through the FDA regulatory process and, and put together all of our quality systems and all that stuff. But yeah, we are Commercializing a new 3D-printed brace.

Cool. Yeah, so I saw some information about you guys at Academy, and it's— what a brilliant solution. I mean, you know, casts are a nightmare, and even 3D casts are— takes— it takes too long, you know. And so I love— so you got to tell me We've never met, but I looked you up on LinkedIn and saw that you've got some history in 3D printing. So tell me, kind of tell me how you got into this and the backstory. Sure.

Yeah, a little bit. So, um, we've got, we've got experience in business building and, um, we're with another big network marketing company in the health and wellness field. And my wife and I have been with this company for 5 years and we've just kind of become experts in and networking and promoting products and finding, you know, innovative new ways to do things. And so we have, uh, we have 7 children. We live on a farm in North Florida.

Wow.

And 2 of our children broke their arm pretty much at the same time. And, you know, minor fractures, typical kid stuff. So we went in and got a cast put on the first one. And, you know, it was your, it was your, your typical cast process. It was itchy and stinky and they got it wet and we had to go back and get a new one put on. So when the second kid broke his arm, I looked into, you know, other alternatives. I'd seen, you know, pictures of these 3D-printed, you know, mesh casts online over the years, and I wasn't sure if they'd commercialized yet. So I contacted one company and talked to them a bit about theirs, and, you know, just the whole process of, you know, getting the arm scanned and the wait time and and everything just, it just didn't make sense. It was too arduous and it wasn't, it didn't really seem like it was worth the hassle. So we just went ahead and got a regular brace put on him. So, you know, it kind of piqued my interest and I started looking into other companies that were producing these 3D printed brace models. And I found a company in Spain called Excalib. And Excalib developed this super awesome proprietary software algorithm Where you can basically load an app on an iPad and a physician, a medical professional, can perform a 3D scan of a patient limb, and then the app automatically models the brace and produces a print-ready file. So that was light-years ahead of anything currently on the market, right?

And that's just a photograph image?

It incorporates a special 3D scanning tool that mounts to the front of the iPad.

Okay.

And so that 3D scanner captures submillimeter measurements of the surface of the limb.

Got it.

And then the app uses those measurements to model a brace that's print-ready. So, you know, it cuts out— cuts down the time as opposed to using a traditional 3D scanner and scanning a limb and then manually building a brace. It just makes it way easier and automates the whole process. Um, I, I talked to the company and he told me about how their material they're printed out of is biocompatible. You know, it's PETG plastic, the same stuff you'll find in water bottles.

Okay.

Super thin, really cool helical union system to attach it. So we, uh, yeah, we chatted for a while, we made friends, and Worked out a contract and we became the US distributor for Excalid. And now we're commercializing and scaling nationwide and enabling orthopedic professionals to rapidly produce 3D printable braces for their patients.

Wow. So what's— so tell me, what hardware would a clinical setting have to have to do this?

Well, it's super simple. Right now all they need is an iPad with the scanner attached. So when we sign up a new clinic, we We go in there and bring as many iPads as they need. If it's a large group, 20 surgeons, they might need 5 or 6 iPads. So we'll assemble the iPads and the 3D scanners. We'll install the software and configure their user accounts. And then we'll go in for a day or 2 and perform training with the staff that's going to be using it. Yeah, it's been an incredibly easy process to onboard. Because really all they need is an iPad and everything is really easy to understand and follow along with.

And there's a printer, right? How large is the printer and does it stay in the clinical setting all the time or does it move around?

There's a couple different options. I'm glad you asked that. Right now what we do is we 3D print the braces at our North Florida production facility, and then we overnight them back to the clinic within 48 hours for application to the patient.

Okay.

So, you know, that's not really ideal, but that's, um, that's as good as the technology is right now. But we've got new technology that's coming on board in the middle of 2019, which will be a standalone printer, brand spanking new technology that's not on the market yet. And that'll enable us to provide the clinics with a printer where they can produce braces on-site while the patient waits.

Wow.

Within 30 to 40 minutes, the print will be done, ready to go. You can pull the brace out of the machine, do some minor cleanup, and apply it to the patient before they leave the office. So it'll eliminate the office visit and really make our provider partners, you know, real technology leaders in this field.

Yeah, that's brilliant because then you're taking out— you're turning 2 visits into 1 and there's an immediate treatment. That's brilliant. So what's the business model, Eric? Is it— are you selling the cast or are you just— and will you sell the capital equipment and the material and stuff in the future? How does that work?

Yes, well, it's a flexible and scalable business model. You know, each clinic's different. Um, in the way that they want to approach it. But typically, um, right now, we, we retain a percentage of the collected amount per brace that's printed, and the software keeps track of each brace that's printed, um, and each patient. When the new printer becomes available, then the clinic will have the option to either purchase the printer or lease the printer from us, and then we'll also be the sole source for all consumables.

Okay.

So yeah, we'll provide the hardware, the equipment, the consumables, the software. And so we'll, uh, we'll collect on each brace printed. And in addition, we'll make profit on the equipment.

Got it. Got it. Wow. So where are you in the US today? Are you across the whole country, big cities, or scattered?

Well, we're pretty much a new company, right? So we're a startup. We're through seed phase. We commercialized early this year. So we've been super busy integrating into new provider clinics. So we have clinics in North Florida, South Florida, South Alabama. We've got some other new practices opening up in the Midwest. And New England. So yeah, within a month or two, I'm sure that we'll have at least a dozen locations across the country where patients can go to get the new brace. And then of course the idea is to scale nationwide over the next 2 to 3 years.

Yeah, yeah. So it's really early. So what's your biggest challenge right now?

I think the biggest challenge is Probably the same challenge that most startups face, especially startups in the medical or medical device field, and that is process. So figuring out the most efficient way to get the equipment and the software into the hands of providers. And, you know, it really hasn't been a difficult process as far as marketing is concerned because I'm sure you saw what the brace looks like.

Oh yeah, yeah. It sells itself.

Yeah, it sells itself. So, um, I guess really one of the main challenges has just been implementing the appropriate processes, um, anywhere from, anywhere from billing to onboarding, um, to scalability. So those are all things that, that we're getting worked out and, uh, found some really effective, uh, team members that have been helping us with that. So it's, it's going great. We're excited. Uh, it's almost moving too fast to keep up with, but We're getting there.

Good problem to have. So will you be at some of the upcoming orthopedic shows like the OTA trauma show? Are you— how— so I guess how are you getting the word out?

Yeah, we've mainly been getting the word out through social media as well as attending trade shows. So AAOS 2019, that was a huge show for us. It was incredibly productive. So we've been— we've spent every day since we've gotten back following up with huge orthopedic groups and providers who are interested in the braces. And then, you know, they'll tell all of their friends. You know, another cool, I guess, side benefit that came out of the show is there was a media consultant there that saw us and chatted with us for a little while. And he called a contact who's a producer for a major television network. And so there's a major television, educational television series that's going to start filming here in, you know, the coming months. And so we just finalized a deal with them to be featured as one of their new innovative providers in the medical device field. So that'll be— That'll be incredible press, um, you know, nationwide coverage. And so we've just been trying to capitalize on each individual opportunity that makes sense to, um, you know, to get the word out and let people know about us.

Sure, sure. Wow, that's, that's exciting. Um, so what's the, what's the end game for you, Eric? Are you— you want to build a business for 10 or 20 years? Do you want to sell? Do you want to Bring in new 3-dimensional printing products? What's your ultimate goal?

Yeah, well, it's pretty fluid at this point, of course. I mean, there's so many different directions that we can take, but yeah, we want to scale this business up to its max potential. You know, the software developer is incredibly talented, and they're releasing new brace models this year to, you know, It'll be suitable for foot, ankle, and leg braces and other models as well. So yeah, the idea is to scale this business as big and as fast as we can over the next several years. And then if the opportunity presents itself for an acquisition and it makes sense, then that's great. We also have several other venues in mind for other products that can be produced with the same technology and the same type of, same type of process. So we'll be developing those other potential businesses and income streams as well to try to capitalize on, on different markets.

Got it. So I'm sure you have patents that are either pending or issued. So what is the secret sauce? Is the secret sauce in the software or in the business process?

It really is. It's in, it's really in both. You know, you're You'll have to develop your own business process for any, any new business that you start in any new industry that you begin a business in. But yeah, there are European patents and US patents, and those are well, those are well organized and protected. So, you know, the secret sauce, I think, really is the software. I mean, that's the short answer. Because right now, the only way to make one of these braces is manually, you know, you have to manually construct it in a program. Whereas this program automates the entire process and just makes it a really simple, easy-to-onboard process for professionals.

Wow, that's brilliant. And the neat thing about software is it's easy to scale, easy to change, easy to upgrade. That's fascinating. So, well, this is great. I mean, I love innovative Startups that have taken a problem and solved it, and you guys are early. You're going to have a great future. Is there anything I can do to help? I'm just a well-connected orthopedic medical device guy.

Yeah, well, I think there is. You know, I mean, as an orthopedic medical device guy with 30 years in the industry, you know the key to getting in front of decision-makers at practices and hospitals is utilizing connections and having, you know, a handshake intro. Um, so yeah, I'm sure we can chat more about that. I read up a little bit about, uh, your, your history and your experience and, um, yeah, I look forward to chatting with you more about, you know, potentially working together on that.

Yeah, we'll, we'll do that, Eric. Uh, so here in closing, um, I'm trying to be careful with your time. What's the best way for, uh, a doctor or hospital to find out more about your product and where to get it?

Yeah, the best way is just to visit our website, exiom.com. It's exiom.com. We have a phone number on there where they can email or call me directly, as well as our national sales director, and we can walk them through the process. We'll come do demo scans and demo braces and provide any information they need to get started.

Sounds terrific. Well, thanks. Hey, thanks for your time.

Absolutely. Yeah, yeah, Tiger.

Yeah, great work, great work. And, uh, be looking for you in the future at shows. I'm sure we'll talk again.

Yeah, we'll be at a bunch of them, so look forward to meeting you.

All right, thanks, Eric. I appreciate it.

Take care.

Take care.