A little more than two years ago, when the Endo Orthopedics team identified an emerging need to assist its pivotal audience of hand specialists, Chris Randell had an idea that was, in his words, “a little out there.”

One of the company’s breakthrough products – Xiaflex, the sole FDA-approved nonsurgical treatment for a particular type of Dupuytren’s contracture – is administered via injection in a sensitive and specific area of the hand. The Endo team sensed an imminent chicken-or-the-egg dilemma: Without experience in administering the injection, hand specialists would lack the needed confidence and comfort to do it well. But that confidence and comfort could only come after multiple administrations of the injection.

“The disease can present in so many different ways,” explains Randell, director of marketing for Endo Orthopedics. “We needed to focus on getting [physicians] the familiarity they needed with the injection.”

In the past, marketers and educators in similar circumstances filmed the procedures in question for use as a training tool. Endo, for its part, had previously produced videos and created a rudimentary injection simulator but, Randell says, “It all felt very underutilized.” While physicians might see a procedure video or engage with a simulator at an industry meeting, neither provided enough in the way of coaching or guidance.

Randell relished the opportunity to fill this void. A self-proclaimed “massive tech nerd,” he knew the Apple Vision Pro mixed-reality headset was due to arrive in the U.S. in early 2024. He proposed a project that ultimately became Endo’s Spatial Computing Injection Simulator, which was officially rolled out last week. The life science industry’s first external spatial computing program, it allows hand specialists to simultaneously engage with both physical objects (a model of a hand) and digital content (through the Apple Vision Pro).

“The goal was to do it all: Give [hand specialists] the advocacy and safety information, but also what they need to know about angles to take with the injection and other techniques,” Randell says. “It wasn’t innovation for innovation’s sake. It was about providing a very deep experience.”

Of course, such experiences, especially ones tapping technologies that haven’t been widely deployed in and around life sciences, tend to face internal resistance. That’s why Randell’s first move was to familiarize Endo teams with the technology itself: He coordinated a half-day session for stakeholders to engage with the headset and existing health apps.

While a majority of team members understood and immediately embraced the approach, skeptics remained. Most of the legal considerations around consent were addressed early in the developmental process, but some of the medical ones proved a trickier fix.

“We needed to make sure everything was 100 percent medically accurate,” Randell stresses. By way of example, he describes how the digital syringe “floated” just enough over the physical model of the hand to make Endo’s medical team uncomfortable. To address that concern, the project team created a digital version of the physical hand model that layers on top of the actual one.

“When [physicians] are practicing their technique, the digital hand moves out of the way. It’s a pretty creative solution,” Randell adds.

The Injection Simulator received internal approval a week before the American Society For Surgery of the Hand’s annual meeting last September and was soft-launched in Endo’s booth at the event. Some 330 attendees visited the booth, spending more than 20 minutes on average engaging with the Injection Simulator. “That’s essentially the full experience. We thought they’d stay just a few minutes, given everything else going on,” Randell says.

Equally important was the type of attendee that expressed interest. “We got a lot of fellowship directors, which is important because many doctors don’t get hands-on training until they get into practice – and that’s often too late,” Randell continues. “It’s one of the first times we’re getting requests from large institutions to come to them, rather than us knocking on the door.” As of late March, nearly 700 hand specialists had trained on the Injection Simulator

Over the course of his career, Randell has heard plenty about the chronic risk-averseness of life science organizations. He believes, however, that each successful implementation – whether in the digital realm or elsewhere – converts a few non-believers.

Looking back at the development of the Injection Simulator, Randell believes his team’s early engagement with Endo’s medical, legal and regulatory affairs leaders made a huge difference in their receptivity to the new approach. Alison Tapia, who has led a host of gaming and immersive executions over the course of her career, believes it’s long past time to stop viewing these stakeholders as human red lights.

“There’s this idea out there that PRC [promotional review committee] teams are the enemy; they’re not,” Tapia, the former senior director, performance marketing and digital innovation at Dermavant, explains. “They want safety and compliance just like you do. They want to help you swim, not keep you out of the pool.”

Another takeaway from the successful development of the Injection Simulator is not to overshoot a project’s initial core goals. Randell and his team toyed with the idea of adding a gamification component to the project – say, by assigning users a score or grade at the end of their sessions – but ultimately decided that doing so would diminish the impact of the peer-level feedback that’s part of the simulation experience.

Randell acknowledges that the development of the Injection Simulator came with some professional risk – “some part of me was like, ‘Is this going to flop and I’m going to lose my job?’” he recalls with a laugh – but says that such risks can be managed and mitigated.

They’re richly worth taking, he thinks. “We don’t get a lot of shots in our careers to take chances we truly believe in. We had a unique opportunity to solve a business problem in a creative way, and we ran with it.”

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