Aleksandra Zuraw: Today, my guest is Dr. Martin Weihrauch, a hematologist-oncologist with over 20 years of medical experience. And the co-founder of Smart in Media. Smart in Media is a virtual microscopy platform and the digital pathology solution provider from Germany.
[00:01:22] Good morning, Dr. Weihrauch. How are you today?
[00:01:26] Martin Weihrauch: Hi, I’m great. How are you?
[00:01:28] Aleksandra: Great. Thank you so much for joining me on the podcast. And let’s start with you, with your story. What’s your background? Tell me about your company and what’s your role in the company?
[00:01:42] Martin: Yep. So, I’m a physician. I’m actually a hematologist-oncologist, and have been working at the University Hospital of Cologne for roughly 22 years with a brief interruption, approximately 15 years ago, where I worked for two years at the Dana-Farber Cancer Institute in Boston as a research associate. I love to say that I studied medicine by accident. Actually, I’m more of an IT nerd and I just love developing software. And I, well, got into medicine. I also like that a lot, but always pursued my dream to found a medical software company, which then became reality in 2012 when I founded Smart In Media together with a pathologist.
[00:02:32] Aleksandra: So, you are the co-founder of Smart In Media, your partner is a pathologist and you’re an oncologist-hematologist.
[00:02:39] Martin: Yeah, hemato-oncologist. And this partner of mine with whom I founded company in the very beginning is a pathologist.
[00:02:49] Aleksandra: So, tell me about Smart In Media. You say you are located in Cologne. Is Cologne Germany, also the headquarters of Smart In Media?
[00:02:58] Martin: Yes, it is. And so Smart In Media is a company which I would now or not really describe as a sole software company. We are more of a solution partner for pathologists, and we have the philosophy, by physicians for physicians. So, a lot of our staff on the… Well, or a lot of people on our advisory board and also a lot of people who are closely related or working with or for the company are in fact pathologists. And so we have an extremely close connection to pathologists, also working with our software. So, this is where we pride ourselves in that we really know what’s going on in the pathology lab and that we make it happen that the pathologist can really become faster in diagnosing diseases with our software compared to the regular microscope.
[00:04:00] Aleksandra: You said you started Smart In Media in 2012. So, you’ve been on the market for quite some time already. How did it start? How did you start the company? What’s the story behind it? You said it was your dream. How did it become reality?
[00:04:18] Martin: So, in fact it was that a pharmaceutical company had asked me if I had any good idea for a medical congress for their exhibition booths, because usually the only thing that they handed out to physicians was coffee during break time in between the lectures. And I thought of something that I thought it would be really great to have something like a large screen, a large iPad, where it would be possible to microscope with your fingers. And I thought that probably there is something like that. I Googled and simultaneously I met Dr. Perez-Bouzo Alberto, and he is a pathologist and I talked to him about it and he said, “Oh yeah, there’s something like that at that time called virtual microscopy. But all the systems that I know, they really suck. They’re not user friendly. And I think that can be done better.”
[00:05:12] And in fact I saw that as a challenge. And so we created this first working prototype there, for the congress. And actually it took off quite well, and a lot of doctors were very enthusiastic during their coffee break too. We post some riddles, some hematological riddles. What kind of disease is that? And so forth. And then Alberto and I thought, how can we further use this technology? And in fact, we thought about that we wanted to give our medical students and also our colleagues, the opportunity to be able to micro-digital slides on every device at any time. And at that time during 2012, that was not quite a thing. During that time, most of the viewers that were out there, the few viewers that were out there on the market, only worked with flash technology, not supported of course by any Apple product.
[00:06:05] And so, using digital microscopy was not really something that worked well, and we just created our own viewer, which worked on any device. And in fact, for university hospitals teaching their medical students. So, we really started the whole company on education and teaching. And this was for four or five years. The only products that we had revolving around that teaching, and that is something where we are still extremely strong in, and also our market leader worldwide with our smart zoom teaching system. And only for the last four or five years, actually we entered diagnostics.
[00:06:49] Aleksandra: You say the system you have is done by physicians for physicians. What is your mission with Smart In Media? And why is this mission important?
[00:07:01] Martin: So our mission is to, first of all, to bring digital pathology to every pathologist, and to improve the workflow and to speed up the workflow, to ultimately be able to diagnose better, faster and with a higher quality. And this is, I think, this is very important for a couple of reasons. First of all, what I see is that the load, the workload for pathologists, worldwide, is rapidly increasing because so many more biomarkers are being known by now, and are important for making a personalized therapy, especially in oncology. That’s where I’m from, my field. So, a lot of new drugs have evolved. Just one example are all the PDL1 antibodies that are now on the market against cancer. For them, it’s important that a pathologist makes the diagnosis on the PDL1 status, and how much PDL1 expression is present in a tumor.
[00:08:12] And this can be quite overwhelming as a workload in the already very busy day of a pathologist. And also there’s a problem, especially in Europe, I don’t know about the rest of the world. But in Europe, not too many pathologists have been trained in the recent two decades, so now as some pathologists retire, there’s a lack of pathologists. So, you have an increase of cases and you have a decrease in pathology workforce. So, that clearly shows that we need some to speed up the diagnostic process and also to help also remote pathologists or pathologists who may have already retired and would like to work on a few cases per day, to stay active, to integrate them into, well, the pathology workforce.
[00:09:08] Aleksandra: The problem of not enough pathologists is indeed a worldwide problem, not only in Europe. So, how do you want to make this technology accessible for every pathologist? What products and services do you have that can help with that?
[00:09:28] Martin: So, we already have that running. Again, we discriminate between our education teaching products and the diagnostic products. For diagnostics, we have a platform, an on-premise platform which is called Digital Lab. A Digital Lab is a platform that is in between the scanners, the LIS, the AI providers. So, for artificial intelligence, the QM and in between, of course, all of that, is also still the team of pathology. So, Digital Lab integrates all these parts as an open technology platform or an open architecture platform. And we have a growing number, hospitals, institutes, practices using Digital Lab on a daily basis.
[00:10:17] And this is in fact, something where we as a solution partner are really strong because not only can we provide our own software, but actually we help the pathologist also to purchase this or lease the scanners. So, we can also co-sell scanners from the known scanner vendors. We have contracts with them, as well as talk to their LIS providers because in the end, the pathologist doesn’t want to stand in the middle and between three different vendors who then cannot collaborate. We see ourselves as a solution provider who string together all these different players so that in the end, the pathologists has a running solution that integrates in his workflow.
[00:11:03] Aleksandra: This is indeed crucial, the interoperability of systems. Was this like that with Digital Lab from the get go? Did it evolve, somehow? What’s the story behind that?
[00:11:15] Martin: Because we started so early in that education and teaching fields, one of the requirements was that all of the different teaching hospitals had very different scanners. And thus, we were confronted with all these different scanner formats. So, we were able to step-by-step integrate all these different formats. And this is also one of our strengths, that we can work with all these different scanner formats. Plus a new goal which we have already accomplished, and that is to be able to read and also to write into DICOM. I personally believe that all these proprietary scanner formats should have an end in the next coming, well, few years hopefully, and that everything will be replaced by an open standard, which I strongly believe will be DICOM. So that then the interoperability between different hospitals, practices and especially between all these digital pathology vendors, will be easier as they are in radiology already for a long time.
[00:12:24] Aleksandra: So, this is a goal for you. When do you think you’re going to have it ready?
[00:12:29] Martin: Well, we already are capable of reading DICOM and also writing DICOM. That was a requirement by one of our customers as actually the University Hospital in Bonn. They had the requirement that they want to long-term archive all the digital slides in the future in an open format. And this was why we implemented the DICOM format. We also have a specialist for DICOM, who also releases an open DICOM open source DICOM software in his spare time. So, we are really experts in also the field of end. Yeah. I think this is really important that the scanner vendors also now open up more and more to the DICOM format. It’s not rocket science. It’s also not really difficult. I mean, we as a relatively small company were able to implement that within a month or so. I would really also think that.
[00:13:24] Aleksandra: Really?
[00:13:24] Martin: Yeah, absolutely. Yeah. I really think that the scanner vendors should also be capable to do that in a brief time.
[00:13:32] Aleksandra: This is great news. And I heard it from another guest of mine that this is not rocket science, like you say. And then I’m really wondering why it’s not a standard yet. I assume maybe it comes from the previous mentality where you wanted to make everything proprietary and protected. But now with so many systems and so many areas of medicine going digital, radiology obviously being the pioneer there, it needs to be interoperable. So, great to hear that. Great to hear that you can do DICOM. This is great. So, who is your platform for? Who are your customers? You mentioned the education version and the Digital Lab. Who are the different recipients of your system?
[00:14:21] Martin: Yeah. So first of all, I would say that 80, 90% of our customers are pathologists, and the rest of 10, 20% are hematologist-oncologists, pharmaceutical companies. So, we have six of the big pharma companies as customers and few others like biologists, veterinary pathologists, and so forth. And so, we really focus on pathology. Well, and for teaching education it’s university and teaching hospitals, as well as the large pathologies associations and pharmaceutical companies. So, we are very happy that the European Society of Pathology selected Smart In Media as their digital pathology provider for the next years, and chose our teaching platform to do all of their webinars and seminars and congresses in the future. We also have the International Academy of Pathology in Germany as customers now for years, and they do all the continuous medical education for physicians, pathologists, especially in Germany. And also, we have a couple of pharmaceutical companies like Novartis, MSD, Bristol-Myers Squibb.
[00:15:40] They actually started with information platforms, for instance, training portals. For instance, for PDL1 or for specific diseases where they have drugs for mastocytosis, where they can showcase different pathology cases in full digital microscopy, two pathologists in our teaching platforms. When it comes to diagnostics, we have all the customers from small labs with, for instance, three pathologists, up to large university hospitals, as well as large labs with sometimes 30 pathologists. We are market leader in Germany, and we are now slowly but very clearly expanding within Europe. So, we have a couple of customers in the UK, in the Czech Republic, in Switzerland, Austria, Italy, Spain. And now we just recently started to roll out our products also in the US and I’m very excited about that.
[00:16:45] Aleksandra: This is great. So, your system obviously is not the only digital pathology system on the market. But before I ask you about what is different in your system, let’s go back a step to the workflow. When somebody opens Smart In Media on their work computer, what can they do there? What’s there? What functionalities are there? What do you do with it as a pathologist or as a med student?
[00:17:13] Martin: In diagnostics, the Digital Lab platform enables you to work completely without a microscope. You have, on the one screen, your laboratory information system. When you open a case there, magically in the same split second, the same case opens a Digital Lab. On another screen, it can and be the iPad that lies right beside you, you don’t even have to be on the same computer. And you can immediately microscope the entire case on that other screen. And you can do this faster than with your real microscope. So, switching between slides is an extremely fast experience with our system, as well as the whole penning and zooming experience. And a lot of other things become easier. For instance, reviewing cases from junior pathologists. So, signing out their cases because the junior pathologists can pre-diagnose the cases and leave certain annotations at areas. For instance, here, I found a tumor or here I found an H pylori bacteria where the senior pathologist can then way fast review than before with a microscope.
[00:18:32] Also, we were able to integrate AI from other companies into Digital Lab, because this is one of the big strengths. We are an open platform so that the pathologist can even use AI in the regular workflow. And this has led to a large improvement in speed performance, and also quality and as well as the possibility to integrate pathologists from other places who are not physically present in your lab. I’m talking about for instance, COVID situation or where you have a retired pathologist who wants to join the working in the lab, but not being present in the lab and can work from home. So, this is all now possible with our digital platform.
[00:19:23] Aleksandra: So the features or the differentiators of your system that you would like to showcase, so, that you are most proud out of which one are…?
[00:19:32] Martin: I would really say that we are an open platform. This, in fact, means a lot. It means that we can communicate with any LIMS system or any LIS system, that we can read every slide format on the market and on the planet. It’s the ease of use. That means that you can chaotically scan your cases and your slides, and Digital Lab groups them into cases and makes them presentable to you. The ease to share cases just with an internet link. The great thing about Digital Lab is also that it separates itself from patient data. So, we only carry the case numbers, which makes it easier to share something without having a conflict with any data privacy. And also the ease to integrate other modules, for instance, AI, from other companies. So, with our open API, it is possible that for instance, in a university hospital that runs Digital Lab, their software developer, who also co-develops AI or wants to read slides or from the database, can do so through our very strong API.
[00:20:49] Aleksandra: Do you have something already integrated or is it case by case basis for the AI solutions?
[00:20:56] Martin: No. We have actually already integrated the breast cancer AI from the company Mindpeak in Germany. It is CE certified, so it’s a medical product. We have already successfully integrated that, so pathologists can just book this option to their work. Also, we are currently developing another AI with Aiforia from Finland, in a very large project that will also be deployed on Digital Lab. And again, we happily invite every AI vendor to also deploy the AI in our app store, so to speak. And so, the AI companies can completely also steer our viewer for their purposes, so that the pathologist in the end, or I would say the pathologist in the future has the opportunity to choose from whatever, 50, maybe hundreds different AIs. And can for instance say today, I want to use the Ki-67 AI from Mindpeak or the PDL1 AI from Roche. In the end, it’s a little bit like with the IHC antibodies. They’re also are just in fact, really choose the different vendors and we are just open to everything and the pathologist uses our platform to deploy it and diagnose.
[00:22:15] Aleksandra: That’s a great analogy with IHC. I mean, all of these antibodies have to work well enough, but every lab has their own preference. So, that’s exactly like you could use AI. Definitely.
[00:22:31] taking another large step back to the beginning of Smart In Media, why digital pathology? Why pathology in the first place and not other medical disciplines?
[00:22:45] Martin: That came somewhat because I am a hemato-oncologist. And in hematology, we also use the microscope to diagnose cancer, especially in leukemia lymphoma. And this was always an interest of mine. And then this one project that we had through a pharmaceutical company, plus meeting with Alberto Perez-Bouza, the pathologist who was the co-founder, this all came together and that sparked the interest in digital microscopy, or at that time it was called virtual microscopy. And I saw the potential of it not only for teaching, but also for a diagnostics, which was almost 10 years away. And so we were very, very early. A lot of times I would’ve said too early because it was always financially, also a huge struggle in the beginning. But now we are there, and now the wave of digitalization in pathology is coming and we are absolutely ready to serve all the customers.
[00:23:51] Aleksandra: So your co-founder is still on board? You work with a pathologist on a daily basis.
[00:23:57] Martin: Yeah. He’s still on board although he has his own lab. There are five pathologists and he works there full-time. So, he’s still in our board of shareholders. We’re now a small privately traded stock company. But he is a pathologist who works in his lab full-time and day-to-day, which is great because everything that we deploy or everything that we want to try out, we are testing a lot of scanners from vendors, we always do it in his lab because there it’s really hardcore routine work. He diagnoses around, I would say, 50 to 80 cases per day himself and all his colleagues do the same. So, if it works in his lab, it usually works in all the other labs.
[00:24:44] Aleksandra: This is great. This is a reality check and normal workflow check from the get go, which I think in many solutions is lacking. I also heard people working in the labs say that not only in digital pathology, but just in the lab, informational systems and LIMS, LIS, the software is totally not adjusted to the task or to the workflow of the people that are using it. So, this is a real differentiator, I think. Especially for pathology, because the workflow here is unique, is different than other branches of medicine.
[00:25:23] Martin: Yeah. And as a physician myself, I worked 20 years clinically in oncology. I have suffered a lot under bad coded software and as I can develop and code myself, it even hurt twice as much as any other person because I always knew that these things can be better. And I always set out to really make the best products. And what I really enjoy about my work is that because physicians are usually used to bad software, they extremely marvel at our software because it not only mimics their workflow and eases their workflow, it also looks great.
[00:26:03] So, we have accomplished a couple of these goals, and customer care and customer satisfaction is also our highest goal, which we have also achieved by setting up, for instance, WhatsApp user groups with pathologists who are using our platforms. So, whenever they encounter a bug, a problem, something they would like to have improved, they can just make a photo of their screen, send it in the WhatsApp user group where also the software developers are connected to, and then they will immediately receive an answer. For instance, yeah I found the bug. We’ll fix it in one hour and then everything runs again. So this is a huge advantage that we have.
[00:26:47] Aleksandra: Oh wow. This is so user-friendly. I find that all the digital pathology software, every time there is… So I worked with a couple of systems and I’m also hyper alert to things that could be done better, but there is never an easy channel to communicate that. And I missed that because I worked in a digital pathology company where I could actually go to the developer and say, ” Listen, this is not working. Here’s the screenshots exactly like you said.” And I totally lost that connection when I left the company. So, providing this to your customer, I think it’s a fantastic feature because it’s so new.
[00:27:28] Martin: I mean there are different pathologists. You have the tech savvy pathologists and they can also always partake or participate in meetings that we have, where we even go through the backlog of our features to help prioritize them. And then of course we have the not so tech interested pathologists. They don’t have to get involved. They voluntarily, but a lot of them are to share their thoughts and also love to see it once their ideas become deployed. Recently, we had the requirement for showing high power fields correctly and also to have accounting feature. And usually our software developers come up with a couple of cool features, how that really looks very neat and is very efficient to use.
[00:28:14] So now for instance, we have with these high power fields grid. And when you, for counting click somewhere, in the square of the grid, you see a small counter going up or down, you can make classes for the cells you wanted to count. So, we always add something on top that in the end, the pathologist says, “Hey, this is cooler than I expected it to be.” So, that’s where we actually have our nerdy, or where we put our nerdy energy to.
[00:28:41] Aleksandra: To hear something like that from a pathologist, I think is a really great compliment.
[00:28:47] Martin: Yeah, absolutely.
[00:28:48] Aleksandra: So, I want to learn how come you know how to code and how did this got into your life? And then you became a medical doctor and then now you combine. But I want to know about the coding and the techy part of your interesting career.
[00:29:04] Martin: All right. Yeah. So, I got enthusiastic about programming when I first saw a programmable calculator that had some kind of a basic in, I think, that must have been 1981 or so. And then I backed my parents for a home computer and I think it was 1982. So I was… 1983. In fact, I was 12 that I had my first Commodore 64 and I started to code. Actually at that time, games were not such a thing. They came one, two years later so I had quite some time where I taught myself this basic coding and this small world ended with this one manual that was enclosed in that Commodore 64. So, of course there was no internet, no source for more information but I did a couple of small programs that I wrote. Also, for instance, my biology class.
[00:30:06] So, I even did something that is similar to what I do today. And as I was always interested in natural sciences and I didn’t really know what to do after high school and my parents are both doctors, I just said, “Yeah, what the hell. I’ll just study medicine.” Because informatics was not such a big thing, at least I didn’t have it on my radar at that time. So I started studying medicine, and to be quite honest with you, I really hated it because it was mostly learning things by heart and there was nothing where you had to really set your mind to. It’s not very creative, the medical school, but I always, I pull through. And during that medical school time, I also always coded on the sideline. For instance, with C++ I wrote some small encryption program and so forth, and also did something for my doctoral thesis, which I coded.
[00:31:00] And so I stuck with that love for informatics. I tried to do something in medical informatics after my medical school time, at the end of the ’90s. But again, there was not really much going on, so I started at working in oncology. I immediately liked it. I also did a lot of things there. Clinical work, research. Again, on the sideline, I always developed software and it actually really, really took me a long time until I was really ready to start a company. So again, I was then yeah, roughly 40 years old when I then finally was able to found my own company.
[00:31:43] Aleksandra: Basically, you incorporate in one person what I want to achieve with this blog and podcast, to build a bridge between computer scientists and pathologists. Obviously there’s going to be only very few people who, like you, are able to code and are medical doctors. But the bridge needs to be there. So, you having a company that provides the best of both worlds to the medical community, to the pathology community, I think it’s definitely building this bridge. So, is there anything you wish you had known when you started out that now it’s obvious to you, but it took you some time to figure out?
[00:32:22] Martin: Oh yeah. The biggest mistake I did in the whole time, because in the first four years, Smart In Media was always very close to being closed because we were running out of money. What I really should have started earlier, is getting someone for sales. So, I always believe that software would, more or less when the software is great, it would sell itself off the internet. I would just have to have a great website where everything is explained and people would just come to my website, buy the software from us and make us happy, but this never happened. So, one of the very, very, or the biggest lecture during that whole endeavor, was really for me to understand that sales is as important as the development part, the product development. And fortunately, my long-term management partner from the University Hospital of Cologne, joined the company in 2017. He’s a real management and sales genius, Dr. Finkler. And since then, Smart In Media really took off like a rocket.
[00:33:31] Aleksandra: This is a great lesson because I think, still many people think, you build a great thing and everybody’s going to come. More and more of these tools are on the market, so the chances that somebody’s going to come to your tool, even though it’s better than others, gets smaller and smaller. So, that’s a good lesson for all of us, I guess. Once I have a product, I will need to learn this skill as well.
[00:33:58] Martin: The thing is, if you have or if you create a product that hasn’t been on the market yet, and I would say digital pathology was a product like that, it just did not exist. And people who are working with a microscope aren’t unhappy people, they don’t have a pain every day, then they won’t find your product. So, if you open up the next bakery, everyone knows what to expect. Bread or any other pastries or whatever. But with that digital pathology, it was really new and you had to do a lot of explaining, and you also had to explain how and why and where digital pathology would really bring an advantage to the regular workflow or over the regular workflow. And that was really a hard thing also because a lot of money is involved, especially when it comes to purchasing scanners. People don’t just buy stuff off the internet when it’s priced like the scanners are, at 150,000 euros a piece. So, you have to go there personally. You have to explain that. And for that, you really need good sales people.
[00:35:09] Aleksandra: Yeah, definitely the price. That’s what I heard as well. That every product that is above a certain price point needs a dedicated sales force because of the trust issues with people spending money on something in the internet. Exactly, like you say.
[00:35:29] Martin: Yep.
[00:35:29] Aleksandra: So, thank you so much for taking your time and telling us about Smart In Media. Before we go though, tell listeners, where can they find you on the internet? Where should they go? And I will link it in the description in the show notes.
[00:35:44] Martin: Okay. Very simple. www.smartinmedia.com.
[00:35:46] Aleksandra: And do you have a demo of your platform or how can they have a look, how to navigate in your platform? What would be the next thing for them to do to see it a bit more?
[00:36:02] Martin: Yeah, so it is very simple. If you just contact us and tell us about your requirements. So, if you want to go to the education teaching side, for instance your university hospital, then we can provide you with a demo platform that you can use and try out. If it is about digital apps or diagnostics, because there are so many different things involved, like which scanners do you have, which LIS, we would just take the time to have a brief zoom call with you, for instance for one hour, where we understand your requirements. We can give you demo and then we can move on from there. And you can also of course test drive it. The great thing about our products is we usually have software as a service as a business model, so people don’t have investment costs. They don’t really have a risk purchasing our platforms and products. It’s really that you can book us or cancel us like Netflix. The great thing about us, since 2013, we have never, ever lost a customer.
[00:37:06] Aleksandra: Great.
[00:37:07] So, one thing that I thought of that I wanted to ask. Because I am of veterinary pathologist and you said you served some veterinary pathology laboratories, did you discover any differences in workflow or what were the main differences that you discovered between veterinary pathology and the human pathology when you were setting up the system for the veterinary pathology?
[00:37:30] Martin: The great advantage of veterinary of pathology is that you don’t have to abide by any FDA or other regulatory instances. So, we don’t have to be a medical product for you to use it on a daily basis. Here, with of course the rest of medicine, it has to be a medical product and actually almost there to being finalized in having the approval. And then by the end of next year, we will also be FDA approved.
[00:38:00] Aleksandra: Fantastic. Great. Congratulations on that and thank you so much, again, for joining me on the podcast. Have a great day.
[00:38:09] Martin: Thank you, you too.
[00:38:13] Aleksandra: Bye-bye.
[00:38:13] Bye-bye.
