The Frank & Lizzie Show, Episode 20: Making the Invisible Visible with MIMOSA Diagnostics

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Frank and Lizzie interview Dr. Karen Cross, who elaborates on the capabilities of MIMOSA Pro, a pocket-sized imaging device that can capture tissue oximetry, temperature, and a digital image in less than one second. This device along with an accompanying HIPAA-compliant web portal can empower clinicians to assess tissue health noninvasively at the point of care. Discover how the MIMOSA Pro solution transforms wound care across the continuum and be inspired by the journey of a plastic, reconstructive, and aesthetic surgeon-scientist in creating this innovative product.

Visit https://www.mimosadiagnostics.com/ for more information!

Transcript:

Frank Aviles Jr., PT, CWS, FACCWS, CLT-LANA, ALM, AWCC:
Live from SAWC Spring, The Frank & Lizzie Show. 

Today we have a product, a company, that is changing the way we're looking at wounds and skin conditions. With me today we have Dr. Karen Cross from MIMOSA. Now, I want to give a highlight to what Karen and her team did last year to the Save a Leg, Save a Life Foundation screening event. She and her whole team brought this device to help us screen for PAD and other conditions. 

Without hesitation, I do want to not only thank my co-host, Lizzie, but also, I want to tell you a little bit more about Dr. Cross. She is a plastic surgeon and also a scientist researcher that developed a product to change the way we look at things. She is the CEO, she's passionate, and maybe we'll have time for her to tell us a story, but also she's changing the way we look at things. And so now, Dr. Cross, thank you for what you brought to us. 

Elizabeth Faust, MSN, CRNP, CWS, CWOCN-AP:
Thank you. And I think we also owe you a congratulations, because you just won an award for being Canada's top 14 entrepreneur of the year. I love it. I love it. I love it. Congratulations. 

Karen Cross, MD, PhD: 
Thank you so much.

Aviles:
Tell our viewers what it is that we're talking about. Yeah. What is MIMOSA? 

Dr. Cross:
Well, let me just take it out of my pocket and show it to you. So, for everyone to see it's clearly pocket-sized. It's a medical device, it’s a skin imaging platform. We measure 3 things, so it's tissue oximetry, temperature, and your digital image. All of those images, those 3-in-1 insights in 1 little hand pocket sized device. 

Faust:
It's so small, I love that. We've seen very bulky machines, so that is genius to have it like the size of an iPhone 15.

Dr. Cross:
Yeah, and exactly, so in my clinical practice, one of the problems that we faced is that when I started off with this technology, it was 14 feet tall and 200 pounds. So when we decided to scale it down, I said it has to fit in my scrub's pocket. So the little side pocket that you have on the side, or your lab coat, and I said if it's not that size, we need to be able to bring these technologies to the patient, we need to be able to have multimodal technology, 1 capture, less than a second, 3 insights, and that's what the product is. 

Faust:
That's great, that's great. And does your, how does it communicate with our records or where does that data go to?

Dr. Cross:
Yeah, absolutely. So the other piece is we didn't want to be a traditional device where you leave it in the clinic or on the inpatient unit. Healthcare happens after hours, right? So, the images don't live on the product. They actually go in through a web portal through cloud-based services so you can remote monitor patients. And so, for example, as a Canadian surgeon during COVID in a big urban center, I was able to monitor 366 patients in rural New Brunswick. So, it's about a 5 hour flight, and I had never seen a single one of those patients. We were able to save every single person's limb who was at risk during the pandemic.
And I think that's really how we can bridge a gap with portable handheld technology that we're actually bringing to the patient, helping that patient age well in their own communities. 

Faust:
Yeah, that had to be such like an aha moment for like, this is where we need to go to. 

Aviles:
Right, so let's go back a little bit because I love technology. But as people are looking at technology, tell us the importance of it. You mentioned a lot of different aspects of it, but as a clinician, why is that product important? 

Dr. Cross:
Yeah, and so, you know, we've relied on what we'll call our naked-eye vision. So our experience, we look at the moon and say, I think this is what is going on, and you know, why don't we do this, and let's come back next week and see if it worked or not. So, it's what I call a wait-and-see approach. What MIMOSA brings to the table is really those insights at point of care to say, what are those next steps to treatment? You know, does that, do we need more oxygen? Is it a need of vascular assessment? Is it safe to debride? Can it accept that skin sub? Or is it going to respond to hyperbaric therapy? So it's giving those real-time insights. It's giving us the data to really understand the physiology of these wins. 

And the analogy I've given in the past, it's like, what we've done so far is we say, here's the car. So when you look at a car, we're going to measure it. And measuring is very important. And I'm not being discouraging, that we have to measure the wounds, it's how we measure progress, but what technology like MIMOSA enables us to say is there enough gas in the tank for that wound to heal right or for that car to get off the lot? Is If it has a steering wheel and tires, so it's giving you more information to say what is really happening within this wound on the physiology side of things; it's really complimenting what we've done already but it's the next evolution that in assessing tissue physiology. 

Faust:
Well, and something I want to mention is like in my clinical practice, we would see what I call the “let's wait a day.” So, in acute care, we would say, okay, well, I'm concerned about this. Let me order a test, and then I'll come back in a day. And then I'll maybe make my decision about what I'm going to do with it. But now there's a point of care testing, and that allows you to capture that in real time so that you can have the conversation with your patient and not this back and forth and even we had a hard time finding really good like text to do our vascular studies as well if it was just something as simple as that. 

Aviles:
Right and so what I hear is that you have something that can right away guide in the right direction, but she also mentioned it can validate whether hyperbaric is working or other devices. I like that.

Faust:
Or even the skin sub, obviously, that's going to be a huge thing. Like, are we ready for that skin sub and what is the activity around it? 

Dr. Cross:
And, you know, in some of the early data that we've gotten back from even applying a skin sub, we can see changes within a few seconds, in some cases. In a few minutes. Because the product, in certain cases, can image right through into the wound bed. And I think that's really exciting as a clinician to be able to say, wow, we can actually see this product working. 

The other piece to that, too, is that it's also showing the patient. And if we talk to the patient, the patient doesn't understand. We're trying to explain very advanced technology to the patient. Being able to show them and say, the reason you were in that chamber and you came out of the chamber, look at the pre and look of the post, and those images are so valuable to the clinician, but also to the patient. And they can say, wow, I did respond to that therapy. You can't see this with the naked eye. We are really truly making, and our tagline is making the invisible visible, but making it visible not just to the clinician but to the patient. 

In a study actually that we're presenting here at SAWC, we were able to show that patients were more likely to come back for their therapy because they felt engaged with their care.
They saw the changes that were being made and then more likely to return. In that case, it was for hyperbaric oxygen therapy. 

Aviles:
Wow, and Lizzie, and what I like about this is that I can also communicate this to the physician if I need a sense of urgency. So this is great. 

Faust:
Yeah, in sense of referrals. Well, and I think the other big one that we missed out is the payers. Like, how do we communicate this like medical necessity and showing them having those images or even that data to support what you're doing is super helpful, because it seems more and more so it's harder to get things covered or there's hesitation or resistance to that.

Aviles:
Dr. Cross I do have a question; we're at a big conference, and there's a lot of vendors out there as we go through the vendor booths, we have all these technologies but can you explain a little bit how you're different?

Dr. Cross:
Yeah, so the first is just 3-in-1. So it is the trifecta technology where the only one that offers those 3 insights in less than a second. I think the size, it's half a pound. You know, I had back problems as a plastic and reconstructive surgeon was like, please, I just need something light. I'm carrying a lot of things around with me. 

The other piece that I think it's really important to highlight about MIMOSA is something called standard image capture. Standard image capture is taking that same image each time over and over again. We know that in skin photography, there's hundreds of articles being written about, we cannot do machine learning. We cannot learn from these images, because on day 1, we take it in one orientation, and on day 2, we take it in a different orientation. By really standardizing the data that's going into the algorithms, we can learn a lot. And I don't mean that just as a company. I mean, the clinician can learn a lot. You can see that evolution and progression of the patient. And when you put it amassed for a large organization or a clinical network, they can compile all of their data and say, this is what's happening to the patient. 

Not only that, with our tag managers, so as you get into the software, we know what happened to the patient. Did they have a hyperbaric treatment? Were they debrided? And then that means we have annotated data. We've amassed the largest data set anywhere in the world in skin imaging. So that means we're learning, the device is getting smarter, our clinicians are getting smarter, and they're using that data then to also educate their networks, which I think is really a differentiator in the space. 

Faust:
We love education. We love that. It is kind of the trifecta of technologies, but also you're educating clinicians, payers, patients. You've got all of these people that you can use that information for as well 

Dr. Cross:
Yeah, and I think when you look to you know, how we've driven the customer success piece or how we really surround the clinicians, I think it's with a unique approach that we call the MIMOSA way, right? This is the MIMOSA community. We say hey, let's meet for a MIMOSA. It's really a MIMOSA image. So we're not having a cocktail. It is virtual. They are delicious. And it really brings that community together to say, bring the MIMOSA images, let's talk about that. 

And I think the greatest part for me as a clinician and also the founder and inventor of this technology is to see me kind of fade into the background. They're starting to talk about the images, share knowledge about how to treat patients. And that's a real pay it forward. And so I also think it is a differentiator for us as a company because people are using the image to connect with each other. And I think it's like one of the greatest gifts you can give back to the wound care community is just to bring us all together and help each other. 

Faust:
Yeah. Well, and I think it's super helpful that like, I hate going to value analysis for anything. And so to not have to do it for 3 different devices, but actually only have to do it for 1 device is a big savings for me. And that just the size of it, I think it's a huge win. 

In terms of adopting the technology, how have you seen clinicians that are utilizing your device? What has been the success of bringing it in? And in what capacity, would I have one as a clinician? Would my clinic have one? How does that work? 

Dr. Cross:
Yeah, so we've just been so fortunate. We launched our product into the United States last year to great success. So we overwhelmingly just want to thank everyone, those early adopters and everyone who's taking the technology right away. Lots of good traction in outpatient wound care, people have hyperbaric, people using a lot of skin substitutes, again documenting the medical necessity, figuring out if you're putting your product on the right patient at the right time, and this is where this technology is very valuable. Mobile wound care, again, we have 4 of the 5 largest mobile wound care groups adopting the technology. Again, putting a lot of data into that back end. Really anywhere where outpatient with mobile wound care, hospitals, so big hospitals have taken it as well. And inpatient, pressure injury documentation. Outside of wound care, it's also being used in intensive care, looking and saving limbs in children at the Cleveland Clinic.  

So there's a lot of this type of technology, you know, when you put it in the hands of the clinicians or doctors or nurses, PTs, podiatry, everybody who's using the tech, they come back and say, "Hey, I think this could be used in this scenario. What do you think about that?" And we are really open. We want to hear that feedback and work with you to say, "Yeah, I actually think that's possible." But we're also very honest when we think, you know, it's probably not the best use case for that technology. 

Aviles:
And so we want to know more about how you're using the technology, but do you have posters at this conference? Can you tell us about how they're using it? 

Dr. Cross:
Yeah, so the posters, and again, there's so much gratitude this year to all of our clinicians.
It was really their initiative to say we want to present at SAWC. We have 11 posters here, so happy, come to the booth and get the list. We're going to celebrate everyone tonight. With respect to, for example, some of the hyperbaric, so we're showing responders versus non-responders, flap surgery, so looking at pre, post, where is the appropriate area to debride,
levels of amputation, as well as some other skin subs and therapies that would provide energy to an area safe for treating pressure injuries such as ultramists. So lots of  multimodality. We did have one poster as well around some of the mobile wound care, so how to deliver care with portable multispectral technologies. 

So lots of lots of very different but very synergistic and how the MIMOSA images can really help those clinicians make those decisions. So, yeah we're excited.

Faust:
It's probably going to make a path that you can't even think about yet, right? I'd have to imagine once it's in the hand of more people, I mean I know it's already use so much, but the more it's widespread we're going to see it probably take off in a whole another direction too.

Dr. Cross:
Yeah, and we really tried to look at you know how would a clinician adopt it, how easy it is to use, and it’s fairly seamless, and most of our customers have said this is really easy to integrate, it's been very easy to teach, and we have a great company that surrounds all of our clinicians in supporting them in utilizing the technology.

Aviles:
So let's recap this. MIMOSA, Dr. Karen Cross, not just the founder, the inventor, but the scientist and the clinician. It delivers real time data so we can make decisions. We can talk to payers, patients, and other providers. And so we can make decisions. But I do have a question, you know. I saw the picture of that 200-pound beast that you developed. What made you decide back then to develop this? I mean, it looked like a robot. What made you decide to build this elaborate contracption and why? 

Dr. Cross:
Yeah, so as I started as a young plastic surgeon, it's something called the Surgeon Scientist Program. So, we get a PhD and a residency at the same time. And so my master's project was in burn injury, so we were looking at burn patients. And I realized, wow, this is a wait-and-see approach. We're waiting days, sometimes weeks, to make decisions about when to excise a burn injury. So, working with the National Research Council, which is like the NIH of the US, I was able to partner with some scientists. We built the first one, and at 12 hours, we could predict what would happen 5 to 7 days downstream. We did that with a 92% and 94% sensitivity, specificity for outcome, and experienced clinicians got a rate 70% of the time and someone inexperienced 30 % of the time. We were really changing the lives of adult burn patients, and as I became a trauma plastic surgeon and really fell in love with chronic wound care, I realized this technology that we were using in the burn unit could be translated into chronic wounds and even acute wounds. 

And then I'll just finish the story, if I could. I think what really transformed and gave me the passion to really change the space was my own personal experience with the health care system. I lost a loved one who had an undetected skin injury. He had a diabetic foot wound in a rural part of Canada. And it was in that moment that I had that 14 foot tall, 200 pound device, and I said, my gosh, what if I could put this in the mail to someone in a rural part of Canada, they could take an image, a clinician could look at it and say, "This is what's wrong. You need to come drive that 5 hours to see me in the urban center." 

I think it was in that moment it changed how I practiced as a clinician. It changed my scientific approach, and I realized everything I was doing wasn't going to change things for patients. It wasn't changing for the clinicians. And I said, well, who's better to stand up? Who better to stand up and solve the problem than someone who has a background in this technology? I'm experienced in the clinical space, till they partnered with a great team. And so we decided to step up and say, instead of saying, where does this widget going to fit? We said, we know what the problem is, let's build a solution. So the rationale really was how do we bring tech out of like the basement of a hospital and put it in the hands of the clinicians at the bedside? So that was a long-winded story, but that's my story. 

Faust:
Well, first off, we're sorry that the experience, but you know from some of the worst experiences comes huge growth, and I think that's what you're talking about.

Dr. Cross:
Yeah and not everyone had someone that could be in the emergency department fighting to save the leg right, so I thought all these patients who are coming to see us they don't this technology could be an advocate for them. It can help them….

Faust:
With the discrepancies and access or is this clinician trained in this technology or not? It's to standardize what is expected of our community for wound care patients.

Dr. Cross:
I think one of the most exciting things that happened, when we first deployed it into those rural parts of Canada was the nurses, they were like, wow, this is helping us educate each other. They said, we feel smarter. We feel more comfortable. We feel more confident. And within 3 months, they didn't really need me anymore.

Faust: 
And that's the goal; that's the goal to teach them. You have to talk and then they'll teach more and then they pay it forward.

Dr. Cross:
And I think that's really the MIMOSA philosophy. How do we pay it forward using technology?

Faust:
That's great.

Aviles:
Which I know the name is great for you, but I want to tell you something. If you haven't met their team, the passion that she has carries over to the whole team, because I've seen them all. We didn't have 3 or 4 helpers at the Save a Leg Save a Life Foundation event. She had her whole team. The whole team was there. 

Dr. Cross:
And even 1 person from our technical team, and when he came back, he was so moved by it that he's sharing that with our very smart technical people. We celebrate a win. So, for example, if someone emails and said we got a pressure injury before it came to the surface where we saw it, we have the high five on our slack channels, and everyone's celebrating, like look what happened today. We made sure that person didn't get a pressure injury. And so it's really a team win. We win when the clinicians winning right 

Aviles:
And I do have a question since we got a little more time. You mentioned pressure injury; Lizzie loves pressure injuries, but what you said is we prevent them. But tell us how the technology prevents pressure injuries, because people may not know how it works. 

Dr. Cross:
Yeah, so, pressure injuries are ischemic reperfusion injuries, but they're caused by pressure. So, we can actually see those changes before you can see them with a surface. It's kind of like the apple, right? You have a red shiny apple and a red shiny apple. You don't know if the core is good on 1 apple or the other until you open it up. So, with MIMOSA, we can really see through the core and see what's happening below the surface. So, by being able to say, oh, okay, wait, this person's not recovering once we're turning, you can get that surface in place. You can turn them more frequently, get the prevention products in place. Maybe it's a dietician. But it's actually triggering a pathway for that patient who's at risk. And it's early days for us with that data, but we do have a lot of funding around the pressure injury piece for the product. 

Faust:
I love that. Well, prevention's near and dear to my heart, so I would love to hear more about that in the future. And certainly, if we need to learn more about MIMOSA, where can we go to? Do you have a website? 

Dr. Cross:
Yeah, so just come to our website. It's at www.mimosadiagnostics.com. You can email me directly; it's drkaren@mimosadiagnostics.com. If you meet anybody on the team, it's their first name, usually, at mimosadiagnostics.com. Come to our booth, you know, happy to reach out, LinkedIn, so yeah, there's multiple ways to reach us. 

Faust:
Well, thank you so much for coming and talking to us about your amazing technology. I know when Frank said at the Save a Leg, Save a Life screening event, he was super impressed. And I look forward to seeing what more can happen with this technology in the future. 

Aviles:
Yeah, and so we want to thank you for sharing your story with us but also the device. If you want to get more information, please stop by, see Dr. Karen Cross, look at the technology; it's phenomenal. Don't be scared of it, because I've seen it, and it really helps save lives.