FITM Extended Interview: XRS Medical (Marie-Isabelle Batthyány)

A patient had already signed every document — but no one had told her she would lose her stomach. That moment early in her anesthesia training convinced Marie-Isabelle Batthyány that informed consent was fundamentally broken. Years later, she built XRS Medical, a VR platform that replaces paper consent forms with immersive, avatar-delivered patient education and tracks attention in real time using a patented eye-tracking algorithm.

Batthyány walks through exactly what happens from the moment a patient puts on the headset to the moment an attention evaluation report is generated for the surgeon's file. The numbers back it up: 84 percent recall accuracy and 87.5 percent patient satisfaction versus paper forms that almost nobody reads. The platform creates photorealistic digital twins of the operating surgeon, delivers the explanation in the patient's native language, and produces a legal record that the information was delivered and attended to. With over 4,000 patient uses across Austria, Switzerland, Poland, and France, XRS Medical has moved well past proof of concept.

The business story is equally sharp. Batthyány designed the company for acquisition from day one — lean team, phantom shares program, three distinct revenue streams across healthcare providers, pharma, and medical device manufacturers. A surprise pivot into clinical trial consent with Boehringer Ingelheim turned out to be one of the strongest product-market fit moments of the journey. For clinician-founders navigating the European fundraising landscape with a disruptive technology, her playbook on investor fit, due diligence readiness, and the "three threes" rule is essential listening.

https://www.xrs-medical.com/

⏱️ Chapters:
00:00 Meet Marie-Isabelle Batthyány — anesthesiologist turned founder
03:00 The patient who didn't know she would lose her stomach
06:04 From clinical frustration to founding XRS Medical
07:23 Why paper forms and traditional videos fail patients
09:28 How the VR informed consent workflow actually works
14:40 The eye tracking algorithm and US patent
19:40 Early prototypes — from real VR film to digital avatars
26:04 Designing a company for acquisition from day one
28:24 Ideal acquirers: pharma, hospital groups, and three revenue streams
34:41 Advantages of being a physician-led European startup
37:04 How the core team came together
39:41 What medical school never taught about business
46:02 Where XRS Medical is heading: US, Japan, AI avatars
48:08 Advice for future clinician-founders
49:05 What "from idea to market" means: blood, sweat, tears

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This podcast is intended for educational and informational purposes only.

The content discussed does not constitute medical advice and should not be used as a substitute for professional judgment. Clinicians should rely on their own training, experience, and clinical decision-making when applying information from this discussion.

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Transcript

Marie-Isabelle Batthyány 0:26

My name is Marie-Isabelle Batthyány. I'm an board certified anesthesiologist specializing in orthopedic anesthesia at the orthopedic hospital. Surprising in Vienna. And I'm also the founder and CEO of XRSynergies, uh, which is an Austrian company where we build vr, virtual reality patient education tools designed for maximum legal, security and efficiency for our fellow doctor colleagues.

Joseph M. Schwab 0:57

So Marie, thank you for joining me today. I what I wanna ask, first of all. Is you saw some sort of gap in informed consent with patients and in patient education. Was there a personal or clinical moment that kind of first made you aware of these gaps? How did it start?

Marie-Isabelle Batthyány 1:19

Mm. I guess by spending endless days in pre-clinicals already during my early training and just trying to get some information on impending surgery through to the general patient population, so which actually means weary patients with lots of questions I couldn't really answer proper. Back then anyway as a junior. So medicine since then has evolved with so much innovation. I mean, look around you, orthopedics is, uh, really leading in this field, but somehow the whole informed consent situation just didn't evolve. I worked all over the world, including South Korea and countries like Belgium and the uk. But it's just really the same everywhere. And any doc you spoke to shouted you that endless lamentation when having to do the consent talk. I hear a rumor that most docs who can afford it don't do the consenting themselves at all because they really don't find the time and, and have the the patience and will to do it. So we had to use paper forms, um, uh, as, as I nowadays see as one of those gaps. Uh, we had to use paper forms, which is still the most commonly used medium in consenting today, but actually no one ever reads them. So you find yourself explaining the same all day all over again, knowing deep down that your patient only understood half of what you were saying. Chances you would be in trouble if you didn't do it properly where and are fairly high.

Joseph M. Schwab 2:59

You mentioned a few gaps there, and I wanna know what was the most pressing problem of those that you identified? Was it the time pressure, uh, the pressure of the surgeons? Was it the lack of standardization or the medium used? Was it the patient understanding or was it the legal vulnerability?

Marie-Isabelle Batthyány 3:20

I mean, we've all been there. I will be 48 next week, and I collected so many issues in patient communication and actually medical communication during my medical career. But what stuck with me was the situation really early on in my anesthesia training. I was still a resident back then. A lady who was scheduled, she was around 60 for very extensive gastric surgery, and I visited her in her room at the hospital the day before to tell her what we would be doing to her during anesthesia. And she was sitting there, all her documents were already signed, and when I got to the part of telling her that she would need a gastric tube after her surgery, she looked at me and she said, why would I need that? And I told her, because you won't have a stomach lift after surgery. And she was so utterly shocked because she was still wasn't aware that of the fact that she was going to spend the rest of her life being fed through a tube. And that was the, the initial situation where, where I thought. That the issues in patient communication are so evident in practice and in literature that I'm still amazed how little has changed since the Helsinki declaration in 64. Um, and I wrote my MBA thesis on the topic of eligibility of virtual reality in patient education and informed consent. And that's where I found my scientific confirmation that the whole consent sector really is in trouble.

Joseph M. Schwab 4:59

Yeah.

Marie-Isabelle Batthyány 4:59

So. I think when you ask me about which problem is most prominent, I have to answer pretty much all of them. But for me personally, the strongest is legal and anesthesiologists are not the greatest talkers. According to many videos on YouTube, we prefer Sodoku in the chair to rest of weary heads on. Uh, but on a serious note, uh, whenever I check out the program at a conference and I want to attend, uh, the lecture about the legal implications of improper informed consent, I can get a, can't get a seat because the room is so packed. So docs aren't worried about legal implications and we all work so hard. And what do we want? We don't want to think about possible lawsuits or unhappy patients.

Joseph M. Schwab 5:49

And so what was it about either that story or the way you thought about it afterwards? That took you from thinking somebody needs to fix this problem to Maybe that's somebody is me.

Marie-Isabelle Batthyány 6:03

Mm-hmm. Um. It, that situation with, uh, this, uh, lady patient, it, it came back, um, many times to me. And, uh, it resulted in the end, uh, during my MBA, which I did in 2018, I came to a point where I had talked to so many different people from different fields, um, providing me with information what else is out there in the world. And, um. Actually taking a first peak into, into the tech world. So I, um. I thought, how could I combine this? Um, with solving problems we are facing every day in our clinical lives. And I actually did think, yes, this could be me because there was no one else around doing it. We are up to this day, uh, with our solution pretty much singled out. Um, and, and rather unique, uh, because it's such a neglected field and. This is also based on, on, on the clinical experience. The biggest misconception lies in, in neglect of informed consent. I.

Joseph M. Schwab 7:24

So from your perspective in your clinical experience is neglect, uh, of the patient education and informed consent, what most healthcare systems get wrong or is it something else?

Marie-Isabelle Batthyány 7:38

Mm. I do think neglect is one of the main issues because nobody really pays attention. Informed consent is, is not a niche in truth. It's huge. There's so much money, time, and responsibility involved when things go sideways in consent, uh, which makes it clear. Uh. That is just not a niche. Uh, not for hospital management, not for pharma, not for private clinics. And, uh, numbers are rising in litigation cases. They range from$800,000 upwards, but to most of us doctors, it is a niche nobody really wants to think about much so. Somehow we are always on the legally questionable side. No matter how diligently we document, we usually don't have time. Um, healthcare systems get that wrong, that we actually have the time to speak to patients, but in truth we don't and or somebody else does it for us. There's no control of which patient sees or hears what. There's no quality, quality management or standardization behind and. There's always these questions we, we have to ask ourselves. I think, um, do, do our patients even remotely understand what we will, um, what we will be doing to them and how they can actively participate in improving their outcome. So. It, it, it, it again reflects on our surgeons and, and physicians, um, that many patients report negative experience with medical education,

Joseph M. Schwab 9:28

So why do traditional materials, paper and traditional videos, why do they fail to achieve comprehension in patients? Hmm.

Marie-Isabelle Batthyány 9:39

but the main medium is still paper forms. So, uh, which are not read. I think that answers the question in very short, but currently we do live in times with very short attention spans. So if you take a ten second video and some, and you get somebody to watch this video for 10 seconds, you're already doing great. So people are used to fast content, have difficulties in concentration, and they're young and they're old. Same thing. So when you make a decision about having surgery, the fear and uncertainty add to even less concentration. So when you present patients with a paper form in bold point size nine and seven pages long, they just won't read it. And if you ask someone to watch a video, they're easily distracted. So now paying attention to what expect from surgery can influence outcome, compliance satisfaction with a procedure. We, we know this and we have so much evidence. That, uh, it just doesn't work. Uh, the material we give to patients, it doesn't reach them anymore.

Joseph M. Schwab 10:53

So XRS medical tries to, uh, handle this situation with a virtual reality workflow. I want you to walk me through what exactly happens from the moment a patient puts on this headset to the moment the report is generated.

Marie-Isabelle Batthyány 11:14

I think, uh, let's use, um, uh, a practical example for this, if I may, uh, use you for this. Joe. Uh, imagine this, you're scheduled for hip replacement on a busy clinic day, so there's much going on around you.

Joseph M. Schwab 11:30

I hope it's an anterior approach, hip replacement. Okay.

Marie-Isabelle Batthyány 11:34

of

Joseph M. Schwab 11:35

Whew. Good.

Marie-Isabelle Batthyány 11:37

there is so much going on around you, and a nurse walks up to you and puts a light headset on your head. She adjust a headset band in the back and makes sure you sit comfortably. And the video starts automatically as you, as soon as, uh, the headset cameras recognize the viewer, so the patient, you has to do nothing about it. Everything is automatized and kept simple. You are transported into a calm, very pretty room and where, and now it gets weird. I'm sorry. The orthopedic surgeon explains to you in your mother tongue, which by now I'm sure is fluent Swiss German. And in any case, uh, easy to understand terminology. How to the procedure works, what the risks are and what to expect from surgery. So the more complicated parts are visualized in very simple animations without, as we say in German, um, you have forgotten the puzzling sound around you, and you focus on what you digital twin is actually saying. So when the info experience is finished, you're asked to take the headset off and return it to admin where you got it from. And during your viewing the eye tracking data. Which is an algorithm we, uh, developed, uh, within our company, um, is to to track attention that I hope you paid to your digital twin, uh, is then computed by our software into a yes. Joe was attentive, no, Joe was not attentive and in real time. Actually only takes a few seconds. It's available in our web platform for, um, download. And this comes in an attention evaluation report, which is customizable to any legal system, so country independent, um, and, uh, accessible on the web platform. And you can, the admin staff can hand it to the doctor so you can discuss your remaining questions. Or with the study nurse, depending on, on the system we're in. So, um, your, your, your digital twin Actually, what, what, uh, our colleagues appreciate most about those videos is that it can be them talking to the patients. So we generate photo realistic avatars, even voice clear on them and can let them talk in every language. So the avatar takes over the explanation part in a very. Personal audiovisual way, and this is especially interesting for surgeons who don't see their patients much or not at all. Um, and it creates kind of a cool link between patient and surgeon where they explain personally, uh, how they perform, uh, in their or, and it simply bows the patient, what their doc can do.

Joseph M. Schwab 14:41

Wow. So there's a lot to unpack there. And the question, the first question I really have about this is you described a number of things that to me sound very technical. Challenging to have built, and I'm interested to know from your perspective, which part was the most technically challenging and, and, and why. Mm-hmm.

Marie-Isabelle Batthyány 15:43

Well, we, we spent a great deal on the eye tracking algorithm. I think that was the most challenging part. Uh, on one hand you have, uh, you depend on, on hardware development, where does it stand? And when we started in 2020, uh, VR hardware available wasn't as good as it is today. So we had to ask our ques, the question was, uh, how do we measure attention so we can use it to verify user engagement and thus provide a solid base for higher legal safety in information transfer in general. Um, and evidence from feasibility studies out of the gaming sector helped us a lot in product development. So after all, we want our patients to focus on important parts of the videos we create and watch. So where do we place things? How do we place them in the videos so we can align it with the tracking algorithm that actually makes sense. So, so we first looked into video content generation. And, uh, back then I, in the beginnings, I took part in a German study, which later became one of the most European, most cited European guidelines in how to transfer health information to, to the general population and the German network of evidence-based medicine published that very successfully. Uh, it was very good to see that something was happening on the informed consent sector. So the two major challenges were eye tracking and a usable, useful, understandable algorithm, easy for doctors, as well as judges to interpret. And secondly, how to create the technical side of the 3D videos that they are engaging and understandable. To the non-gaming population because of course, all big gaming companies have been very successful and, and, uh, in, in Croatian. But, uh, when you, when you have to speak to everybody in your clinic, uh, language design, color placement, icons, inserts, everything becomes important. And the, the XRS team at that time worked very closely with a highly specialized company, COER from Zurich, Switzerland. That's why we have Swiss made software. And also my CTO Christophe is employed there, uh, still. So he has a double role, uh, which comes in very handy because we have a great, uh, communication between, uh, the, the two manufacturing companies and. The guys came up with a patentable idea on their eye tracking, so we were granted the US patent this year for attention tracking in medical education and informed consent, which I'm very proud of.

Joseph M. Schwab 18:44

Um, and your clinical results, at least what I can find online. Seem pretty impressive. I've got an 84% recall accuracy and a published 87.5% patient satisfaction. My question is this, how does that compare to traditional materials?

Marie-Isabelle Batthyány 19:05

Yes. Um, orthopedic surgeon, whom many of our listeners know, I'm sure, and Peter Maho, a friend of mine in pediatric anesthesiologist, they, uh, looked into that early on in product development. So they compared patient satisfaction with 3D videos and vr, uh, consenting them on, on, uh, actually hip replacement. And knee replacement and, uh, general anesthesia. So against patients that had to read paper forms and the results were nearly embarrassingly high in favors to vr. So, in VR we work with immersion and, uh, Brennan Beagle of the Cina Sinai Hospital. He calls VR the Empathy Machine, and being in a nice comfy room, you search and taking the time. In that brain trick of course, but to explain everything to you, uh, and you're not distracted. It works wonders on concentration and recall. Uh, that's why we get so high numbers and uh, it's very convincing numbers too.

Joseph M. Schwab 20:19

I'm interested to know. So you described what sounds like a very pleasant experience. Um, is that how I, with the very first early prototypes, is that how it would've looked or did it look different?

Marie-Isabelle Batthyány 20:33

No, that was fun. Uh, well, we practically forced our prototype creation on an orthopedic colleague of mine. He flew down to Vienna for during the first year of COVID where travel restrictions were heavily in place from the north of Norway out of the snow. Uh, and. Had to learn the entire tiki a uh, uh, content by heart using pleasant language and appearing nicely and pretty in front of a 360 degree, uh, VR camera. Um, we left. At that stage at some point. But we did prototype and we were able to test, um, in, uh, Viennese also practice, uh, of a very benevolent surgeon who helped us getting started in these early tests. So the first prototype really was real VR films, and it just turned out very quickly that that was not a scalable solution at all because we had. You made one mistake or had one content adaptation and you had to get the whole filming team together to, um, redo it all again. So very quickly switched from prototyping to, um, meta humans from, uh, which were digitally animated avatars, uh, where we could, uh, change content more easily and also adapt, uh, mimic and body language. And gender and all this much easier.

Joseph M. Schwab 22:07

So with those initial trials, was there some early feedback or pilot data? That convinced you after what seemed like maybe a, a little bit of a difficult time getting started, that you were on track towards a solution that might have some real world viability. Hmm.

Marie-Isabelle Batthyány 22:26

Mm-hmm. Patient feedback. They found it really cool. So a sim, even with the older headsets, we, which we used in the beginning, um, people were just totally bowed by the experience. So that feedback was good. Our users, the end users, which were not the customers, but the end users liked our solution. Uh. Very early in the beginning. The second part was, uh, that the, the eye tracking development, uh, looked very promising. And, um, I think what also showed us, uh, that what also was kind of a different kind of, uh, pilot data was that. We have so many, uh, desperate orthopedic surgeon tangled in lawsuits that, uh, really very frequently asked us, how far are you with your product? We really need to, uh, to, to explore this and want to be, uh, safer on the legal side than we feel now. And another pilot data, which turned out to be. Very good for us was that we got, uh, attorney's opinions from various countries attesting that we are among the first solution where the clinicians can outsource repetitive and documentational tasks into tech saving time and expensive doctor's time actually, and, and, and, and really dumb, rather dumb tasks. Um, who to. Actually, yeah, improve their everyday work life and having this legal backup also propelled the product forward, um, that we're doing something useful for here.

Joseph M. Schwab 24:17

So speaking of multiple countries, you now have, I think, over 4,000 sort of real patient uses across Austria, Switzerland, Poland, and France. Um, what have those early deployments taught you about product market fit?

Marie-Isabelle Batthyány 24:38

Hmm. I think I can answer that with the three T, with the three threes. That's difficult for a German speaking person to say that it takes three times longer than you think It costs three times as much, and you have to change your product at least three times all over again. Uh. It's in fast paced tech, you have to be constantly on the forefront of development. Um, you have to redo so many things. And my stepfather and mentor, who is a professor in statistics, he always told me that, and he told me that from the beginning. And he said, also, you will start with something entirely different than with what you started out. And. My ideal from, from looking at a product market fit, ideal example actually, was that I'm honest here. Um. Farmer came as a surprise in early development phase. We had just gotten funding and had focused much on informed consent in presurgical consent until Boehringer Ingelheim expressed interest in using it for study participation, informed consent, and the team at BI is very supportive and great to work with and for them. It was a very good fit. So they wanted a solution that actually supports the study center staff to increase recruitment success, um, and to, to, uh, support study adherence, give caregiver involvement, and produce dropout rates so participants can now revisit content they might have forgotten in the meantime, and find comfort and better recall of what's going to happen during a treatment cycle. So. That I think was the nicest for me, the nicest product market fit example, and it taught me many things.

Joseph M. Schwab 26:41

So let's talk a little bit about your business strategy, because you've been, I would say, fairly intentional that XRS Medical is a company designed. With acquisition in mind, um, what does that change about how you make company decisions?

Marie-Isabelle Batthyány 27:04

I never wanted to build a family business. I think it, it's a good, good thing to be clear about this beforehand, before you get started. And my three daughters will take off into the world soon. And although they're very interested in what I do, uh, they have different things on their mind. So it was very clear from the beginning. Um, I will. I have to do something very different to many startups because I was already 42 when I started the company and um, I'm very much an anesthesiologist, so I certainly had very stubborn ideas on how I would. Like to do things and I decided, uh, on the decision making part, uh, not to build a huge team right at the start, but trying to keep the company agile and fast. Pretty much what I was used to and am I am still active practicing anesthesia. Um. That you have fast, agile, small teams where you can make quick decisions and you can respond to your customer's need to protection, changes, whatever comes up in a very, very quick way. And to be acquire for, for somebody, uh, to, to bring in a huge team. Um, if you only might want to have the CEO to build a new team inside their firm. Um, I structured XRS, uh, in a way that it's, it's fairly easy to take over and I also never made a secret out of that and, and implemented a Phantom Shares program for employees incorporating funds at a very early stage. So an exit is a very great incentive for a hardworking team, and they need to be okay with changing to corporate or to look for new adventures at some point.

Joseph M. Schwab 29:02

Yeah. And when you're thinking about acquiring partners or partners that could acquire your company, what are you thinking? Are you thinking a med tech company, a company in digital health, or maybe a large hospital group? What would be your ideal partner?

Marie-Isabelle Batthyány 29:19

Um, XRS has customers in several segments. Um, so I think we're interesting for. Various partners. Um, the most likely is pharma or large Hollywood Hospital Group. I nearly said Hollywood Group. Uh, a large hospital group for deployment, scaling within their own sites. Um, one thing that, uh, that might be interesting for an acquiring firm is that I was. In the beginning, told to, to focus on one stream, on one project, on one thing. And I met a down in Harvard, uh, right at the beginning in 2020, just before lockdown. And, uh, she's a professor for, for, uh, economics, um, and, and all kinds of other great things in Germany right now. And she told me, Marie, you need to think big. So we. XRS very early on developed three streams. We, our customers are, uh, healthcare providers, the pharmaceutical industry as well as medical product manufacturers. So an acquirer acquires, um, several revenue streams in different branches and thus reducing risk for whom. That is interesting. I think we'll see.

Joseph M. Schwab 30:48

From your perspective, what should innovators understand about building something that a larger enterprise one day might want to acquire? What would, what do you wish you would've known a few years ago?

Marie-Isabelle Batthyány 31:08

I think, uh, um, it's largely underestimated by startups, young startups, uh, the big role. Revenues play, revenues and traction, and you actually have to show to a larger enterprise that somebody else besides them is willing to pay for your product. Um, so. I think this innovators should understand. Don't be so much focused on investment or grant financing. You always need this in the beginning, but you need to find the, the jumping point where you go from research, from gather data, from from data gathering from. To actually into the business world and, and getting your product out into the market. And if that's a pilot or prototyping or whatever it is, it's great if somebody gives you a dollar for it. Um. Uh, you're already showing that somebody's interested. That and, um, a clean due diligence. This is also something, um, I think it comes with age that one considers structure a big different than somebody in their mid twenties. It has a different, um, experience packing the whole thing, so. What I see regularly in, in my, in, in, in the startup environment is that the startups don't have their due diligence ready and acquiring firms. Uh, they expect them to have it ready. So this is a recommendation. Do it from the beginning and be thorough about it.

Joseph M. Schwab 32:57

So you brought up funding and I'm curious, since your product crosses virtual reality, artificial intelligence, legal compliance, clinical workflows. There had to have been some challenging part of fundraising for a product that crosses so many of those, uh, uh, so many of those areas. What was the most challenging part?

Marie-Isabelle Batthyány 33:24

Uh, I think, uh, the fundraising landscape in Europe is, um, very different to the one in us. Uh, there are different attitudes shared, um, but looking at, at it from the European perspective, um, the challenging part is to find a good investor fit. I was lucky that I had a family office from the beginning, a Swiss family office investing, uh, in the first round that gave me the ability to, to come from, to pro, proceed from the idea to product. But, um, immersive technology was stuck for a long time in the nineties and it kind of didn't evolve much until, um, meta and Google and Samsung started investing. So one of the biggest challenges in fundraising was, uh, to raise for, uh, disruptive technology. Everybody kind of knew and felt, okay, this is going to be tricky to bring it into hospitals because change management is not something the healthcare sector is famous for. Um, so, so convincing investors that, uh, you have a plan. And that this disruptive technology is actually necessary as a step from dumb phone to smartphone when I was in my mid twenties. Um, that it will come, but it will take patience and a bit of time because we are not quite there yet. Yes, I would sum it up as, as that being the trickiest part.

Joseph M. Schwab 35:09

You, so you mentioned some of the difference between the European market and the US market. How has been a physician led European startup, how has that influenced your strategy both on the the regulatory side and maybe on the commercialization side?

Marie-Isabelle Batthyány 35:29

This is such a great Quest question. Really it is, uh, because us, us Europeans physicians, we practically grow up in regulation, that makes thinking in these terms a bit easier. I think, um, docs. Our great entrepreneurs. Why? Because we're used to taking risks and we are used to making fast decisions. We have great clinical insight from our everyday work, um, and it certainly influences how we approach the regulatory sector. We know how to, what to anticipate because we are subjects to regulatory, um, confinement to some extent. Let me call it that. Of course rules are written necessary, but sometimes really it can be overdone. The physician knows. Very well, I think what will work in clinical life, so how to build a product that is actually used and to commercialize it further, uh, deploy the network, which in Europe it's, uh, very close network, uh, because. Many countries in, um, in a, a certain space, so everybody at some point knows each other. And that nece, that network is very necessary, uh, if you want to get started with a, uh, an allegedly complicated MedTech or tech product. Um, and, and I think it gives us an advantage when you are a clinician, uh, entrepreneur.

Joseph M. Schwab 37:18

So speaking of your role as a clinician entrepreneur, you've created this core team, uh, which spans anesthesiology, orthopedic surgery, software engineering. How did you, did you choose your co-founders or did they choose you and what makes your sort of core team function so well?

Marie-Isabelle Batthyány 37:43

Um. XRS is software, doctors, content creation, and legal. So that's pretty much the core. And the team grew actually. So we started up out as a group of three. Um, some of them dropped out again and new ones came. Uh, the content guys prefer not to be in the website. They love the screens more than the photo studios, so, uh, they brought in extensive experience on 30 years of filmmaking, first analog, and then VR in the nineties. And now they are, those guys are on the latest hot stuff on the market whenever it comes to AI avatars, immersive design, custom products. Um. The doctors understand clinical life. So in the core team, that's Johan and me, um, uh, Johan acting as a medical advisor. Uh, but we have an extensive, uh, network around us on medical experts in different fields supporting us. Uh, the Swiss engineers. We picked them because they were, uh, uniquely qualified to combine medical software and immersive tech, which is a very rare combination. And they are also very active in surgical navigation for big, um, big, uh, medical product manufacturers. Uh, so this combination. And being able to talk to each other on a very professional level. We are about all the same age, and each of us brings in a lot of life experience and also, um, some entrepreneurial background. That made, I think that the team growth and the productivity very unique and very beneficial to, to both of us. So the doctors advise both arms of XRS on, on the clinical feasibility and software, as well as the patient usability and video design. And of course, legal takes care of all of us.

Joseph M. Schwab 39:56

And so you're, you function, I mean, you're the clinician founder. Is there something you've learned about leading an an innovation focused company that you didn't learn in medical school?

Marie-Isabelle Batthyány 40:13

Yeah, everything concerning business. I think it really is. Uh, I think. Again, this, this is very different to US clinicians, but in Europe, uh, educating physicians and surgeons in economics is just not done from the healthcare provider standpoint. That's understandable. They want doctors to to, to be in the system, to stay in the system and keep it up and running and not go out there and innovate things. So I, um. I didn't think much about the, the toughness of being an entrepreneur and I had to learn the business language because I only knew the medical language and I didn't know anything about accounting. Oh God, it's still my nemesis. Um, so it's all these business aspects which we are not taught. The MBA did help. To some extent, uh, but does it really make a difference in the real world for a 40-year-old doctor? I am not so sure you really, I had to go out there and learn the hard way. Um, I didn't know much about financial structures, term sheets, um, marketing strategies, all this. Uh, I spoke to a lot of people, so if you ask me what I have learned every day. Sorry to have extended that answer. Uh, but you really, everything, literally everything I had to earn from scratch.

Joseph M. Schwab 41:50

You mentioned your MBA, which you actually got during COVID, if I'm not mistaken, during the, starting in the spring of 2020. Was there anything about that experience? I, I recognize that you just sort of answered that you have learned a lot sort of on the job. Is there anything about that experience of getting your MBA during such a unique time that influenced your thinking or ultimately helped shape the idea of how you wanted to found XRS medical?

Marie-Isabelle Batthyány 42:23

Yeah, I think yes, of course it did, because it was the time where, where the, the idea came up. It was, um, it's always about people. It's always the people. And an MBA tends to bring people together, value lies in conversation and networking and. Training ideas in a structured way. So again, does it prepare you for out there? I think it's maybe not so much, but was it in the best case, it pushes you out of your comfort zone. And I think that's what it did. You got together with other people, they told you things, you pondered that in your mind, and then you said, okay, uh, I'm doing only anesthesia. I don't mean it in a demeaning way, but after some time you do, uh, it, it, a change can be valuable. So I remained in anesthesia, but added to that, um. Talking and getting fresh ideas, uh, really did push me out of the comfort zone, and I just went out and founded this company and it's been a wild ride since then.

Joseph M. Schwab 43:36

Is there a particularly personal, a personally meaningful moment that you've experienced on this journey so far?

Marie-Isabelle Batthyány 43:48

May I be really honest?

Joseph M. Schwab 43:50

Please.

Marie-Isabelle Batthyány 43:51

Yes. When I first got, when I got the first cash to bring the idea to life, that was a moment. Really looking back, I'm so in awe that, uh, that this was, this family office gave us the money to go into prototyping with a wild idea. Nobody really knew if it would work. There was nothing like it on the market you could compare it to. So it, it really was a thrill to, to look at your account statement and see, okay, this is what I'm going to do the next years. And now when I sit with my investor five years later and, uh, we talk about the beginnings, um. We, we tried to laugh about it, but I think we were both very, very afraid that this would go sideways. And, uh, they believed in the team they gave us, gave me the money and, um, the thrill of, of, of being able to move something that I think was a very, very meaningful moment. Yes. Mm.

Joseph M. Schwab 45:00

so you've made it past five years. Where is XRS medical in five years from now? Both geographically, let's say clinically and technologically. Where's it going?

Marie-Isabelle Batthyány 45:13

We have, um. Very strong expansion tendencies, meaning that, uh, we want to enter the US market in the beginning of 26. There are first negotiations with, uh, key opinion leaders, um, about, uh, getting started. So this is exciting. Uh, the other markets include Japan because I have a very good network, uh, into Japan and also. Uh, there are tech affinity, uh, for vr. Um, among the population is very high. So, uh, the next steps are the US and Japan. But in the end, in five years, um, we would like to expand worldwide, uh, which is most likely within the pharmaceutical sector. Um. And technologically, I would really love to see avatars answering patient's questions in VR in real time, out of, um, uh, well-trained AI database. Um. And, and enabling hands-free communication, voice controlled. I think it will make our lives, mostly our necks better not to stare at our phones all the time, but actually look into the other one's face, even if you're wearing a device. But anything's better than this.

Joseph M. Schwab 46:43

Hopefully you're not going to design it, so the avatars do the surgery too. We still like doing the surgery. Okay.

Marie-Isabelle Batthyány 46:50

Yes, and I like the orthopedic surgeons also very much. They are my very esteemed colleagues at the hospital, and I want them in person there too. I totally agree with you.

Joseph M. Schwab 47:04

So if you could look at a group of future founders, um, who hope to turn an idea into a real scalable solution similar to what you're doing with XRS medical, what advice would you give to them?

Marie-Isabelle Batthyány 47:19

I may answer this in, uh, bullet points, uh, because it's pretty straightforward. Leadership needs to be clear from the beginning. Who is the boss? Um. Hire only when you really, really, really, really need it. Check your, if you have buyers as early as possible to build a feasible market fit. And on the danger of repeating myself, um, have a good quality and risk management from the beginning, uh, to, to not be surprised when somebody actually walks up to you and says, Hey, I would like to buy you.

Joseph M. Schwab 48:01

Um, so this series is called From Idea to Market. And if you could just give me in, in one sentence, what does that phrase mean to you with the journey you've been on, um, at, at this stage?

Marie-Isabelle Batthyány 48:18

I will use, uh, full words, uh, five words as a one sentence, blood, sweat, tears, highs and lows. One can also say, uh, from idea to market means, um, leading with clarity and actually purpose, it makes you stick to things and turning a real need, not an imagined need, but a real need into a validated from the beginning, clinically validated solutions, building with users not. Not for them and driving it forward until it creates really an impact in the real world.