How Virtual Reality Is Changing the Healthcare Industry | Ryan Ribeira

How Virtual Reality Is Changing the Healthcare Industry

with Ryan Ribeira


About today’s guest:

Ryan Ribeira is an Emergency Physician, Assistant Professor at Stanford School of Medicine, CEO at SimX VR. SimX makes professional grade VR and AR medical simulation software.

As always, May I Have Your Attention is brought to you by, which turns your podcast into three months of social media content, you can find out more at

Time Stamps:

Juggling 3 careers [0:42]

VR medical simulation [1:43]

High quality product with a low cost [6:45]

The demand is there [12:39]

Capturing market’s attention [16:34]

Selected Resources:


Justin Nassiri  00:04

Welcome back to May I have your attention, a show about slicing through the noise online. I’m Justin Assyria. And each week I chat with industry leaders about how to get keep and monetize attention online. May I have your attention is brought to you by, which turns your webinar or podcast in the three months of social media content? Find out [email protected] Let’s get started with today’s episode. Well, joining me today in Los Altos, California, my guest is Ryan Ribera. Ryan, welcome to you. May I have your attention?


Ryan Ribeira  00:40

Thanks for having me.


Justin Nassiri  00:42

I want to give listeners a quick abbreviated bio. Ryan is an emergency physician, assistant professor at Stanford School of Medicine, CEO at Cimex VR as well. Cimex VR makes professional grade VR and AR medical simulation software. So maybe to start things off, Brian, how on earth do you juggle those three? Very, very meaty careers?


Ryan Ribeira  01:08

Yeah, no, I mean, it definitely keeps me busy. But it’s all fun stuff. So that helps. And I mean, I think in many ways, it’s very complimentary, right? It would be, I think, very hard for me to successfully lead a software company designed to train physicians and nurses if I didn’t really know the content of what they were supposed to be trained on. And similarly, I mean, I think, frankly, my involvement in the kind of the educational space, from a technology perspective helps me in my personal skills as an emergency medicine physician. So it all ends up working together pretty well. It’s a busy life, but I enjoy it.


Justin Nassiri  01:45

Well, I want to hear a little bit more about the genesis of Cimex VR, but let’s set the stage if you ran into a lay person on the street, and they said, Hey, Ryan, what is the next VR do? How would you explain that in a simple way?


Ryan Ribeira  01:59

Yeah. So you know, whether you’re trained to be a doctor or a nurse, or an EMT, there’s generally like three phases to your training. There’s the didactic phase, there’s the skills building, where you’re learning how to put in IVs, use a stethoscope, and then there’s simulation where you’re like bringing it all together, practicing your skills in simulated encounters. And generally speaking, in medical training, now, that’s done with either a mannequin, or a standardized patient, which is a trained actor. And you’ve probably seen this on TV, where they bring a trained actor in and they say, oh, Doc, my stomach’s hurting, and you kind of try to practice your skills and your diagnostic abilities. So what Cimex does is instead of using that mannequin, or a trained actor, you put on a headset, and you’ve got a virtual patient in front of you, and you’re in a fake o r Ed, or, you know, out on the streets. And but otherwise, it’s the same principle. I mean, you you say, Hey, I’m Dr. Rivera, what’s going on, and you talk to your virtual patient, you stethoscope on the ultrasound of your practice your skills. So it’s really a way for you to kind of get reps in, especially for those medical conditions that, you know, are really important to know how to treat but what you’re not going to see very often in real life, so it just helps doctors, nurses, EMTs be prepared for those kind of circumstances when they come.


Justin Nassiri  03:09

That’s great. I imagine it’s, it’s, you know, much more immersive that way. And it’s also much more cost efficient for whoever’s putting this on.


Ryan Ribeira  03:18

Yeah, I mean, that’s exactly the idea. If you’re using a mannequin, for example, I mean, they can’t have a missing limb, they can’t even have rashes, they can’t have neurologic symptoms. And really, even a trained actor can’t really do that very well either. But you can do all of that in VR, your patient can be a baby or grandmother, they can be vomiting, big enough for them at once. And then you know, the environmental complexity that you can contribute, I think adds a ton of value, because it doesn’t have to just be an ED or an O R, we have cases, in moving transport helicopters, we have cases where you’re pulling someone out of a burning car and resuscitating them on the ground. And then even beyond that, the ability to add psychosocial elements is really, really powerful. So we have cases where you’re, you know, resuscitating a child and their parents are there and they’re crying, and you have to explain to them what’s happening while you resuscitate the baby. And like that kind of stuff is what makes real medicine hard. It’s not just knowing what to do. It’s being able to manage some of that psychosocial complexity while you’re doing what you need to do for the patient. And that’s really hard to incorporate into traditional simulation methods, but really easy to do in VR.


Justin Nassiri  04:25

I imagine. Yeah, you know, those unique situations, if you think about using an actor, it becomes cost prohibitive to cover all of those, but with what you’re doing, it’s so much more scalable. Yeah. Is that what was the genesis for you of starting Cimex? Er,


Ryan Ribeira  04:41

well, so, you know, my background prior to founding cymax, I had a background in entrepreneurship. I’d worked for an angel investor for a while it when I was preparing to go to med school, and I’d been part of a few different startups, but my academic background was in quality improvement and patient safety. So I worked for a CMS Center for Medicare and Medicaid Services and HR You building like packages of metrics for regulatory programs to try to make care safer. I think as I was going through that process, you know, I realized these are great programs, important programs for improving safety by like 5%, or 10%. But not 80%, right, which is kind of where I think we need to get to eventually. And I think to do that, we have to look at examples like the airline industry, where they’ve successfully made flying across the country safer than driving down the street. And the way that they did that is through simulation through just a high volume of really high quality simulation. And I think both of those elements are important, they do it a lot. And that, but also that the simulators that they are in are like perfect one to one matchups with the environment in which they’re actually going to work. And so it was pretty clear to me as I was going through my training that we did not have that in healthcare. And we have a similar problem to solve all these like, low frequency high consequence events that we need to prepare for, just like pilots do. But you know, we have such limited tools in regards to simulation that are unrealistic for the reasons we talked about. And then logistically really hard to use. Because you know, a mannequin is a is 150 pound robot that you have to keep in a specialized room. And so it seemed to me that with current sim Tech, we were never going to get to the realism or the volume that we needed to get to, if we were going to make care like 75 80% safer. So that that was the ultimate Genesis is you know, at that time, I was very familiar with upcoming VR tech. Now this was actually in 2012. So you couldn’t you couldn’t get development kit for any VR headsets yet, but we knew it was coming, we knew it was going to be a good use case. And we knew it was something that was going to make sim a lot more accessible and a lot more realistic.


Justin Nassiri  06:45

That’s, that’s incredible. I’m guessing, I’m guessing, you know, I always like to learn about how how, as an early stage company, you’re getting deals in the door, and I’m guessing you go after med schools, and then any sort of hospital or teaching environment? Can you talk a little bit more about like the type of customer you go after? And whether it was when you first started, or now different ways that you found getting their attention and slicing through the noise to have them see this incredible technology?


Ryan Ribeira  07:20

Yeah, well, so you know, we were a little bit fortunate because we’re not introducing the idea of VR sim to people really, I mean, people in medical education circles have been writing about virtual reality simulation as the future of healthcare training since the 90s. And so, and I myself was very influenced by that literature. I mean, I was training and hearing about how this was going to be the future. And so we knew building this and we were the first ones to our knowledge to build VR products for this use case, that there was a group out there of kind of the cutting edge academicians who, for whom this was going to be a familiar topic, and that our task was not really to convince them that VR is useful, but that the technology is mature enough that it’s actually it can actually be used, right. So a lot of that is done through hands on experience. I mean, I think we found a great early success by just going to educational conferences and trade shows and putting it on people’s heads. And very often it was the first time they put on a VR headset, or they’d say, you know, last time I did this, I got super sick. And we’re like, Don’t worry, like this, this is much better than the cell phone in a cardboard box that you used before. And you know, they’d come out of the headset, all smiles and you know, right, realizing that it finally was technology that was ready for primetime. So that was very helpful. You know, and I will say that, frankly, we didn’t really do any early marketing. And some of that was just the limitations of a kind of scrappy, bootstrap startup that we just didn’t really have the resources to do it. But we still had a lot of big name institutions reach out, you know, just to find us on the internet. And it was kind of as expected, the Mayo Clinic, University of Pennsylvania, Northwestern, it was like the very academic centers who were the early movers in this space. And so we built our business model around the assumption that that, that’s how it would be. And so what we did is we kind of marketed this as a platform, and we would make custom cases for people. And we would work with the education experts at these institutions to build the actual scenario content. But they signed contract saying that we would then be able to take those cases and resell them to other to other institutions. And so it’s kind of a win win. Because, you know, some of these early customers, were able to kind of attach their names to some of the first big VR curricula out there. And some of the are then follow on customers who are maybe from smaller and less resourced institutions, were able to get access to really high quality scenarios built by simulation experts at these big name institutions for a really low cost. So that’s kind of how we went about things and how we still go about things just kind of slowly building up the curriculum, we’ve got about 140 cases now in the system.


Justin Nassiri  10:05

Well in and one thing I’m curious about, especially for listeners who are in a similar stage of company is, it sounds like you have a very experiential product where if someone is using it, they immediately get the value. And it seems like you’re also dealing with the product where like an Account Based Marketing approach is going to be more influential, there’s probably, let’s say, 100 institutions that you’re going after. So you really want to go after them. I’m curious, how do you stay deliberately focused on the one or two things that move the needle? Like, for instance, I’m guessing social media doesn’t play that big of a role in your space? So would you recommend to people in similar situations Look, just don’t do it? Like, I know, everyone says, you need to do social media, but focus on this? Or is it something that you deploy some Reese’s resources towards? How do you manage that balance of myopic focus, but also knowing that there’s other things you may need to do?


Ryan Ribeira  11:07

Yeah, well, so I mean, we definitely have to balance that because I mean, I should say are our early focuses in health care, but our platform is designed intentionally in a way that it’s easily adaptable to other spaces. So we’re already moving into like veterinary medicine, and we’re already moving into, like chiropractic care, and we want to partner with some fire departments, and that sort of thing. And so we had to be cognizant of the fact that, like, our initial market is pretty niche, and pretty small. And we can go to a medical simulation conference, and like, 70% of the people that we want to sell to are physically present at that conference, right. And so yeah, in those early days, a social media presence, frankly, it’s not that valuable, you know, you want to have a good website, because that’s your digital front door, you want to have good SEO, because even if people see you at a conference, they’ve got to be able to find you on Google and that sort of thing. And so that was what we focused on early on, we’ve, as we’ve started to grow, we have started to, you know, build a social media presence and focus on more traditional advertising and marketing, but really only just now. And you know, as far as how we go about kind of thinking about it, I think it was, I think it was just in our early stages, who we knew very well how to contact the niche market. And then as we’re expanding to other markets, but when we’re going after, like two or three different kind of disparate markets at once. That’s when those broader tools like social media, and like broader advertising and PR efforts, I think, start to become valuable.


Justin Nassiri  12:39

How do you I hadn’t thought of the of the expansion opportunities there? How do you as the the CEO? How do you make that decision of, you know, let’s stay extremely niche focused. And the advantage there as we build up simulations specific, we have a bigger archive, versus I’m guessing there’s also the fear of like, well, we need to expand as well or someone else is going to address these these other ones, like, how do you balance that decision between staying in a very niche swim lane? Versus Okay, let’s let’s expand and serve these fire departments and veterinarians and these other people?


Ryan Ribeira  13:17

Yeah, well, so I would say, you know, we built from the start with the assumption that we were going to move into other spaces. And so that helps quite a bit. Because the decision for whether or not we want to move, say, like, into, into fire departments simulation, we don’t have to say, All right, well, you know, we’re basically going to have to double our development efforts. So you know, and we’re going to lose money for, you know, yours up front. And, you know, when do we think we can get enough market share in the fire department to make up for our huge initial r&d efforts, like we design the software such that our additional r&d for moving into fire department training is minimal? Actually, I mean, it’s these would be a little, the first few cases that we would create for the fire department market would be slightly more complicated than our average medical cases, but not by a lot. So really, it’s more a question of, is it worth the kind of marketing investment and you know, a little bit of building up our internal teams capabilities around? Like, what the educational goals are a firefighter training, you know, and that’s, it’s a relatively minimal investment. And so for us, it’s mostly about, like, where are we going to get the most bang for our buck in terms? And that’s a pretty traditional calculation of how many fire departments are there versus how many police departments out there versus how many wilderness rescue departments are there out there? And how much are they spending in training right now? And you know, how much of that do you think they’re willing to convert over to VR? And so, you know, we’ve done a little bit of like, preliminary market research there and talking to some of the potential customers in each of those spaces to get a sense for what like, what their willingness to adopt this kind of technology would be, and then it’s just, you know, what’s, what’s the biggest market to move into next? And so, those are the calculations that we’re kind of doing right now. I mean, in the meantime, because the because the The marginal r&d for us is so minimal. You know, we’ve always said that we’re open to those contracts and fire department comes to us and wants to make cases. And we’ll probably say yes to that contract. If the police department does and wants to make cases we’ll say yes to that contract, it more becomes a question. When we say, you know, what we think upfront, we want to put in the effort to make a five or 10 ks curriculum, and then do a focus marketing campaign into those spaces. And then then we have to do the calculations, you know, but right now, and we’re also content to just let it be a very customer driven experience, right? If we get a great partner in fire, and they want to build a curriculum with us, then that might be where we go next.


Justin Nassiri  15:40

I love that because it removes all the speculation. It’s just, you know, the demand is there.


Ryan Ribeira  15:45

Yeah, in general, I mean, that was our explicit business strategy at the start was to say, we won’t build, we’re not going to build a curriculum and then market that around, especially when you’re talking about a new technology like, VR, and you’re talking about the early movers are going to be hyper academic departments that have very specific requirements. And from educational perspective, we knew that that would give people an opportunity to reject us, not just based on the technology, but by the content of our educational curriculum. And so we chose to present it as a platform and let the content be driven by the early customers. And then you know, when we build a ventilator, we know we’re building that because there’s demand for it. And we know there’s demand for it, because they already paid us for it. And so we tried to make it a very customer driven, kind of like lean methodology, product development strategy.


Justin Nassiri  16:34

That’s great. One, one last question I had was you talked about those marketing campaigns, when you’re entering a new market, any tips that you’d have for listeners about anything in particular, that’s worked really well at capturing attention, anything that you’ve learned along the way through mistakes, I’m just trying to leave people with any sort of tactical thoughts of how to effectively get in front of someone they’re wanting to get in front of?


Ryan Ribeira  17:01

Yeah, I mean, I will say I don’t, I can tell you what works for us, I don’t know how transferable this is going to be from market to market. But for us, we find trade shows to be super helpful for the spaces that we’re most interested in. Because our our experience is so like hands on, like putting on a headset is just so different from watching our videos online, that we tend to get loads and loads of value out of that. And it also tends to be a great first stop to just make a bunch of inroads into a new market real quick. And because we’re in the education space, I mean, almost every industry has a very education focused conference for their industry, right, we just came back from EMS world, which is like the paramedic EMT, version of that. And you know, it’s just a great place to rapidly have your team become familiar with all the major players and how they’re structured and have hundreds of conversations about how they think about buying a product like ours. So you know, it’s, it’s often 10s of 1000s of dollars to get a sizable booth and to get your team out there for something like that. But we find it to be a really great investment.


Justin Nassiri  18:11

The two things I love about that is it really underscores the advantage of being niche focused, because you can find these conferences, like where you said before, 70% of your target market is there, which is an extremely efficient use of $10,000. But second of all, I feel like in this age where we’re always looking for the next cutting edge marketing tool, we sometimes overlook the traditional time tested one like events that in trade shows that continue to add value. They’re less sexy than you know, the latest LinkedIn ad but it’s a you know, depending on a market, it could still add value.


Ryan Ribeira  18:47

Yeah, yeah, I agree. It definitely depends on the market. But yeah, for products like ours ends up being really beneficial.


Justin Nassiri  18:54

Well, thank you for your time today. Ryan, if people are interested in learning more, where can they find more out about you and some ex VR?


Ryan Ribeira  19:02

Yeah, well, Cimex VR comm is the place to start. So we’ve got a bunch of information on there about the markets that we serve in the product and the cost and all that sort of thing. And then if they want to reach out to me, I’m feel free to drop me a line on LinkedIn or through the website, and I’m happy to have conversations. No one’s interested in talking more.


Justin Nassiri  19:20

Awesome. Thank you so much, Ryan. Yeah,


Ryan Ribeira  19:22

thanks for having me.


Justin Nassiri  19:28

Thank you for listening to me, I have your attention. Each episode, I meet with top marketers thought leaders and experts to find out how individuals and brands can get keep and make money with attention. You can subscribe to me I have your attention on Apple podcasts or wherever you get your podcasts, show notes are provided for each episode.

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