Good morning, and welcome to our Fisher & Paykel Healthcare Investor Day. I'm Fiona Cresswell, and I'm in the marketing team here at Fisher & Paykel Healthcare, and I've been in the business for just over 20 years.
I'm Harris Ang. Not as long as you, Fiona, just under a decade. I started as a grad, and now I'm a process development engineer working with the 950 production line, which produces neonatal circuits for hospitals.
Oh, Harris, look at you saving the baby.
We try our best.
Today, we are showcasing our relentless innovation at Fisher & Paykel Healthcare. To do that, we have an incredible lineup of live presentations, video footage, and interviews for you. Harris and I are here to facilitate your day. We're gonna let you know what's coming up next and also when you can take a break.
Since you're joining us from behind the screens today, we're gonna do our best to recreate the experience that our on-site audience are having as much as possible. That means you'll be fed through to the live presentations when they're happening. When the on-site audience is having a walk around or a show and tell, we too have also created that experience through pre-recorded content.
We're gonna give you a 45-minute break around midday just for your lunch, and at that time, our live audience here are gonna do a site tour through our new Daniell Building. Don't worry, because we didn't want you guys to miss out. We got hold of Jonti, our VP of Supply Chain Facilities and Sustainability, yesterday, and we had him give us the tour just for you guys. We recorded that, and throughout the day, while there's segments of the live activity which we need to fill as they're walking around, we're gonna play some of that footage for you, and then you'll get to see the truly magnificent campus that we have here.
Now, we are here to communicate today, not to answer any questions, but there will be a Q&A time which we will prepare you later in the program. It looks like they're about ready for us in the live room, so let's cut over to them, and we'll see you guys in a bit.
Morning, everyone. Welcome to Fisher & Paykel Healthcare's Investor Day for 2022. My name's Andy Niccol. I'm the General Manager in charge of Respiratory Humidification. With me today is Vandna Patel. She's one of our very talented product development engineers, and we're gonna be your MCs for today.
Cool. Hey, everyone. It's great to have the investors community back on site for our first in-person Investors Day since 2018. Also, hello to all the online investors joining us remotely. I hope you're wearing your comfiest sweats 'cause we've got a packed day focusing on relentless healthcare innovations.
Yeah. It's a really interesting concept there, actually. You know, it makes up a huge part of our culture. We're never satisfied with what we've already got. You know, you can see that coming through with our products and the innovations over the years. You can see that with even the way we do our Investor Days, you know, Hayden, Marcus and Chris, how they've evolved those over the years, hopefully you've experienced that as well.
Cool. Yeah, I know what drew me to this company as a young engineer was its strive for Care by Design. As engineers in the medical device industry, we are focused on innovation led by empathy, and the products that we make, sorry, are used by people like us, and as the world constantly evolves and change, we do too.
Yeah, absolutely. You would have even seen that relentless drive for innovation coming through with our buildings. You know, this is our newest building. It's called the Daniell Building. It opened actually. Well, we moved in in sort of the middle of the first lockdown, opened officially about July. You get an opportunity to have a bit of a site tour during lunch, and I'd definitely recommend taking up that opportunity. We'll be able to point out some of the things that are different about this building, some of the things that really make us very unique and encompass our culture for sure.
Yeah. When you probably arrived on site this morning, you probably noticed that you can access the building via the main gate, and that's due to the construction of our next building, Building 5, like, right over there.
Yeah, sorry about that. It's a bit hard to find. Makes things a little bit tricky. Okay, maybe before we talk about the agenda, we should probably cover off some of the obligatory health housekeeping things. In the unlikely event of an emergency, the nearest exit is actually in that back corner over there. Gonna go out those stairs, down the driveway, and our assembly point is in the far car park just behind us.
Cool, if you need to use the bathrooms at any time, they are located right outside the foyer directly on the left.
Yep. The entire site is smoke-free, so that's not just the buildings. That's actually anywhere on the tour. In your cars, on the site, the whole thing's smoke-free, so please refrain from smoking.
Cool, if you have any general questions or queries, there's a help desk right over there that says, "Here to help," that can help you with all your problems.
Yeah. You'll probably see us running around as well. Feel free to ask any questions as we go. Okay, the agenda for today, we're gonna start by hearing from Lewis Gradon, our CEO and Managing Director, and Lyndal York, our CFO. They're gonna talk about the aspirations for the company. We're then gonna hear from Andrew Somervell, our VP of Products and Technology. He's gonna give some insights into how we do R&D. Then we're gonna get a brief introduction from Winston Fong, our VP of Surgical Technologies, and Chris Crone, our General Manager of Airvo/ Optiflow, and they're gonna be talking about some of the breakout sessions that are coming up after the presentations.
Yeah, cool, then we'll be heading off into our first rotations. You'll either be exploring Airvo 3 or anesthesia and surgical. Don't worry, you'll get to do both. There's plenty of opportunity to ask questions and stuff.
Yeah. There'll be an opportunity to swap over as well. Once we've done that first rotation, we'll come back here. There'll be a bit of lunch. We'll start some of the site tours about 12:15 P.M. They'll be leaving. There's four tours in total, leaving about every five minutes thereafter. Don't worry, one of us will probably be on the mic telling you when they're leaving. Yeah.
Cool, and then after that, we'll be back here around 2:00 P.M. for our second round. Sorry, we finish our second rotation, we'll be back here around 2:00 P.M. with a fun Q&A panel with all the speakers from today.
Yeah, perfect. Without further ado, Lewis Gradon and Lyndal York.
Before I came up here, I did tell them that their primary task was not to make me look bad, so could they, you know, screw it up a little bit, and I think I'm in trouble, mate. Thank you very much and welcome everyone. I thought I might just start by talking a little bit about what we think the purpose of today is. I think over the last few years we've talked a lot about COVID, and the impact of COVID on us and on our business, and the 10 years' worth of hospital hardware in two, and what that means, and what we need to do with it, and what the goals and aspirations are with that. We've talked about, you know, the likely impact of COVID having ongoing variability over maybe the next year or two.
We feel like we've covered that pretty well, and what we'd like to talk about today is really what are the flow on effects of that, big bolus of 10 years worth of hardware delivered in years. What else does that do for us over a bit of a longer term? Now, we've got a diverse audience here, and we've got a diverse audience there online as well. I thought I might just take a little bit of time to talk about how we thought about the business before COVID, and that's the slide in front of you now. Now, our business started with humidification in intensive care with intubated patients. That's what we did for a couple of decades. The next sort of incremental growth driver was obstructive sleep apnea.
For us, that was around about late 1990s. Humidification in intensive care keeps growing. That's what we're trying to illustrate there. It still keeps growing at a decent clip, but the primary driver becomes OSA. Over the last decade or so, the primary driver's been respiratory support in hospitals. We actually started that journey 15 years ago, probably more visible to you 10 years ago. Our thinking was that home respiratory support, so that's myAirvo treating COPD in the home. That's the next likely incremental growth driver. If you think long-term enough, that's got global distribution into respiratory support in hospitals. That's got global distribution into home care, and if you think long-term enough, you're gonna need something else in terms of a distribution channel, and that was the surgical opportunity. Again, I mean, I just mentioned Optiflow.
We're maybe 10% into that journey, and we're 15 years into it. It was looking material maybe 10 years ago. When you think like that, this opportunity for surgical, we need to start it, well, not now. We've been on that journey for a good 15 years as well. These need to start now or start much sooner. On the graph there, we've also labeled short-term, medium-term, and longer-term. I'd say, roughly speaking, in this context for us, short-term is kind of less than 10-15 years, medium-term is 10-year-plus, long-term is 20-year-plus. I'm gonna totally disconnect that language from quarters and halves and years. The aspiration was to double the business in constant currency terms every five or six years, and do that in a sustainable way so we can keep doing it for a very long time.
Now, COVID came along, and that's what we're trying to illustrate here, and we're illustrating COVID with that bump in hospital respiratory support. That's the hospital hardware, largely 10 years' worth going out in two years, and that's been primarily used for COVID, is what all the signals are telling us. If we can convert that into something less than 10 years, we're ahead of where we would have been. That has another implication. That means we need to pull forward home respiratory support. For home respiratory support, historically, its growth and its usage has followed penetration in hospitals of Optiflow. That should be like a natural benefit from increasing penetration in hospitals with Optiflow.
Then the other thing that we've talked about that we really would like to see for that opportunity is more clinical data. One of the things we can bring forward, and we're bringing forward, is supporting more clinical studies, bigger studies sooner. I'd put that in a medium timeframe bucket. Finally, for everything we talk about continually evolving the product, there's always something we can do to improve uptake on that therapy. The next thing we look at in the longer term is surgical technologies. Now, when we look at surgical technologies over the last few years, that's been about improving and expanding the product range that we offer there and building the global sales force. Shortly this morning, Winston's gonna talk about one of the expanded product opportunities in that category.
Now, that brings me to anesthesia. Anesthesia's a little bit confusing, the way we talk about it. When we think about the therapy of anesthesia, it's in the Optiflow bucket, it's in hospital respiratory support. When we think about the call point where the salespeople go, it's in anesthesia, so then we're thinking of it in the surgical bucket. Timeframe-wise, we're most definitely thinking about it in the respiratory support bucket. What we can do with anesthesia, I mean, we've been trialing this over the last five years. We've been trialing a specialist sales force calling on anesthesiologists. We're pretty confident now that that's a good idea and it gets a better result.
It's an even better idea now when you look at the job that our hospital respiratory therapists have to do and you look at the opportunity they're trying to realize, we think it's an even better idea to have a specialist sales force. We've been building out that specialist sales force globally over the last two years and the plan is to continue growing it strongly, certainly during FY 2023. In the sense of bringing things forwards, adding salespeople is something we can do relatively quickly. We think this is a, you know, this is an important opportunity for our business. This is a total addressable market of size pretty similar to the hospital respiratory support business. You know, it's important, and it's something we can bring forward relatively quickly with more salespeople.
The final thing is those new products that we talked about yesterday, and we're gonna do a whole session on them today, Optiflow Switch, Optiflow Trace. They make using Optiflow in anesthesia applications even more compelling. I guess the summary of all that is when you look at COVID-19, what it's really done for us, it's accelerated placement of hospital hardware due to COVID, and it's given us the opportunity to advance these long-term plans. Now I'll hand over to Lyndal to talk about some of the other implications of that.
Perfect. Thanks, Lewis. Okay. As Lewis mentioned, our long-term aspirations haven't changed, and that holds true for our margin targets as well. I'll talk through each of them individually and give a bit of a context around where we currently are and what our thoughts are going forward. In gross margin, we're currently around about 240 basis points below our target of 65%. As we've experienced significant supply chain challenges as well as COVID demand over the last couple of years, we have been and continue to use more air freight to bring in raw materials and to deliver our product to customers quickly. The cost of freight has been elevated since the beginning of the pandemic, with restricted capacity, and then more recently with the shipping disruptions and delays.
The increased proportion of air freight and the higher rates compared to pre-COVID-19 is currently impacting our constant currency gross margin by about 240 basis points. We don't see that the rates of freight will abate materially through FY 2023, and we still anticipate needing to use a higher level of air freight during FY 2023 whilst the supply chains and the shipping delays and disruptions settle themselves down. If the freight impacts continue at the rate they are today, we would expect FY 2023 constant currency gross margin to be similar to what it was in FY 2022. We do remain confident of a return to our target of 65% over time, and we believe that that is achievable, realistic, and sustainable on average over the long term. Remains our target.
Our operating margin for FY 2022 was in line with our target of 30%. As the freight impact of the gross margin was offset by the COVID demand-driven hospital hardware sales in FY 2022. To achieve our aspirations, we would be aiming for operating expenses to have a compound annual growth rate of around 11%-12%. Over the past five years, that CAGR is around 9%. A bit below, we're tracking a bit below where our aspirations would want to be. For FY 2023, we are targeting to return to about an 11% CAGR from FY 2020. That would result in a year-on-year growth in operating expenses of 13%.
Two percentage points of that growth comes from travel and sale events returning to more normalized levels compared to where they have been in FY 2022, which is less than half of what we would have liked to have done. On a like-for-like basis, if travel, sale events, et cetera, have been at normal expected levels in all years, we would be targeting an 11% growth in FY 2022. That target of growth of 13% in FY 2023 is contingent on us adding people. I'm sure you all know, in this environment, that is challenging. In terms of the split of where that targeted 13% OpEx growth for 2023 is coming from, we're targeting 20% in R&D and 10% in SG&A.
As Lewis mentioned, we're really accelerating a lot of our R&D work, particularly the clinical trials in our home respiratory support, the myAirvo side of the business, and new product development, especially in the surgical space. In the sales area, we're continuing to invest people on the ground where we've placed all that hardware over the last two years to make sure we set ourselves up to take the best advantage of all of that hardware that our customers now have, as well as to maximize that anesthesia opportunity. During FY 2022, a lot of our sales teams were actually starting to travel more, and so that travel impact that I spoke about before is more pronounced in the R&D line than it is in the SG&A line on a year-to-year basis.
As well as investing in our R&D and our sales teams, we plan to invest significantly in our facilities over about a five-year timeframe. Earthworks for our fifth building here on our Auckland campus are well underway. For those of you in the room, you'll be able to see that once that building is complete, we are at maximum capacity here in Auckland. This is a 40-hectare site and has well supported our growth for the last 20 years. To set ourselves up and support ourselves for the next 20 years of growth, we need an even bigger site. Work is really progressing well in identifying and acquiring an additional site within New Zealand, and we'll announce that as soon as we can and give you more information about that.
Our third building in Mexico will be complete next month, and on that site, we have enough room for another two buildings beyond that. Our manufacturing strategy has adapted a little bit over the last couple of years to a more distributed manufacturing footprint. That is so that we can have more manufacturing sites closer to our customers and our supply chains. Again, work is progressing really well on a third manufacturing location outside New Zealand and Mexico, and we will announce that as soon as we can. We're in the fortunate position that we've got a very strong balance sheet. We've got net cash of about NZD 200 million and a gearing ratio of -16% at the end of March.
This allows us to be in a brilliant position to be able to invest for the future and invest in the business for the next 20 years' worth of growth. With that, I'll pass it back to Andy and Vandna. Thank you.
Yeah. Thanks, Lewis and Lyndal. It's great to sort of hear about our expansion and the addition of more manufacturing sites somewhere else in New Zealand to go and visit. What did you think about that presentation?
I thought it was really cool. It's nice to hear about the aspirations of our company, especially someone who's just started under a year ago, and as well as kind of learn about the expansion of where we're going as well and the direction that we're taking moving forward.
Yeah, absolutely. Who we hear from next?
Oh, I'm excited to introduce Andrew Somervell, VP of Products & Technology, who'll be giving us an insight on how we do R&D here.
Okay. Thanks, guys. As Lewis just mentioned, my name's Andrew Somervell. I am VP of Products and Technology here. A big part of today is about introducing you to some of the new products that we're putting out into the market at the moment. I'm talking about what the benefits of those products are for patients and caregivers, and some of the technologies that enable that. Before we get into that, I already just wanna give you an overview of how we think about product development, how we think about R&D, and how we end up by coming up with those really good products. To start off with, I'm gonna play a really short video. It's gonna touch on a few themes that I'll expand on a little bit later on in this presentation.
We care passionately about improving lives. Care focuses and inspires our people to put patients first, to purposefully keep innovating and simplifying until we create an original solution that answers a human need. Design enables our researchers, scientists, engineers, and designers to apply their inherent curiosity and desire to do meaningful work. Importantly, it also helps us build close relationships with clinicians around the world. Through clinical collaboration, we are able to gather insights and create innovative solutions to deliver meaningful improvements in patient care, comfort, and to even change therapy practices for the better.
Okay, I'll touch on a few of those themes in a bit more detail as I go through the talk. Before I do, I really wanna talk about what we're trying to do with our products at a higher level. Ultimately, that's about enabling growth by changing clinical practice. Obviously, our products are the key to doing it. They're actually what provide the benefits for the patients that are using them. It's not enough by itself, though. We need the better products. We also need to develop that evidence that supports why those products are better. We then need to go out hospital by hospital, educate people on why those products are better to affect that change. It's a long and difficult process, but the products are the ultimate enabler of that.
When you think about what our products are trying to do, there's really two things. The first thing is to improve care and outcomes, and the second thing for us, it's about driving sustainable, profitable growth. If you think about that first, that first bit, improving care and outcomes, we wanna develop products that have direct benefits for the patients that are gonna be treated with them. This is helping them to recover from their illnesses more quickly. It's about reducing the chances of complications, ultimately improving the quality of life of the patients that are gonna be treated with our products. It's also about improving the way care is delivered. Care is really, really complicated, and we wanna make sure that caregivers can get the benefits of our products on their patients as easily as possible.
It's also about lowering the overall cost of treating patients. Not about selling them products at a cheaper price, but enabling the whole healthcare system to be more efficient as a result of the products we're putting out there. That's the improving care and outcome side of things. The sustainable, profitable growth side of things really is about developing products that's gonna enable us to treat more and more patients over time. That's how we grow. It's really important we do that in a way that is sustainably profitable. From a product perspective, that really means developing unique technologies. These are technologies that are really difficult for our competitors to replicate. Maybe they're protected by some form of IP.
Those technologies are delivering benefits for our customers that are really, truly valued, so they're gonna wanna purchase our products. Now, doing both of those things simultaneously is actually really, really hard. It requires a lot of innovation. For us, innovation is really about coming up with new insights all the time, new thoughts, and really about finding new problems that are unarticulated, and solving those. Many people think innovation's sort of about the technology side of things, but actually it happens often before that. It's about finding an unrecognized problem. We're in a really good position here. We have so many different ideas of things that we could be working on, and often the challenge for us is not really coming up with the new ideas. It's actually picking which of those are the best for us to be working on.
I think one of the reasons we are really good at innovating, why we are really good at coming up with new products is the culture that we've got here at Fisher & Paykel. I think of this as a patient-focused culture. We are always striving to do the absolute best thing that we can for the patients that are gonna use our products. If you think about it, the patients aren't usually the ones that are picking our products. It's the doctors, it's the nurses, it's the respiratory therapists that are actually putting the products onto the patients and choosing which products they want to use. Ultimately, though, all of those people have the same job, but that is to provide the best possible care for patients.
If we just concentrate on that, then we're gonna do the right thing by everybody in that care delivery chain. You can kind of think about doing what's best for the patient is true north for us. Whenever we're trying to figure out which direction to go, do I go this way? Does that way? If we boil it down to what's gonna be best for the patient, we're gonna do the right thing in the long term. Now, patient care is really, really complicated. The patients are complex. They, they're really varied, and the way that care is delivered to those patients is really complicated and varied as well. That's a good thing from our perspective, though. That complexity provides us a lot of opportunity, and it provides us an opportunity to simplify the way the care is delivered.
In order to take advantage of that, though, you really need to understand every aspect of patient care really, really deeply. We do that. We have that really good understanding. It's that understanding and then talking among ourselves, coming up with, identifying new problems and, of ways that we can, solve them that leads to the innovation. One of the ways we set ourselves up to gain that understanding is to set up our teams into what we think of as patient-focused product groups. These are teams which have got a really diverse range of different skill sets in them, different engineering disciplines, marketing, clinical, scientists, et cetera. Their job basically is to develop the best products for a particular set of patients.
We think that that approach enables that understanding, enables those discussions to happen between those individuals and come up with the best or recognize new problems and come up with really innovative ways of solving them. I'll talk about that in a little bit more detail here. I've kind of around the outside of the slide, I've got some examples of some of the things that we need to understand really, really deeply. Now, if we do understand these things really, really deeply, and we understand how they interact with one another, that sets us up to innovate, sets us up for original thought, sets us up to find those unarticulated needs, ultimately leads to better products and what we're after, the growth that we're after.
I'll talk through a few of those in a bit more example. I can't talk about all of them. I will talk about a few of them. I'll start with physiology. The physiology, the pathophysiology of patients is really complex, and it's really varied from patient to patient. The mechanisms of action of the products that we are developing are also complex. To start off with, they're often not particularly well understood, and what's important for different patients is very different often. Because we're at the forefront of developing these technologies, we understand these things better than anybody else in the world, and it sets us up to continue to innovate. I've got clinical workflows up there in this example. Clinical workflows, the way that care is delivered to patients is complex and it's varied.
It's varied from country to country, from hospital to hospital. We need to develop products that work seamlessly with with all of those different stakeholders and all of the different ways they provide care to patients. We also have to realize that what we are doing is often quite a small component of what a clinician is doing. When we're developing our products, we need to make sure that that is fitting in with everything else that they're doing. In order to do that, we have to understand that really, really deeply. Users in the use environment. Our products are used in all sorts of different settings by all sorts of different clinicians.
The way that care is delivered in the environment in an ICU is very different than an ED department, than a ward or perhaps a home. The clinicians in those areas have a completely different set of problems and different sets of skills. If we understand that better, if we understand how patients are moving between those environments better, sets us up to really solve a lot of the problems in those different areas of the hospital. Developing all of that understanding is really difficult. It takes a really long time, like years and years and years to develop that deep understanding. We think that ultimately, that's really a big part of what sets us apart, is the depth of understanding that we've got in our teams here.
I wanna move on to talk a little bit more about some of the more specific things that we do to enable our teams. The first one of these, and perhaps the most important one, is to make sure that we have the absolute best people working for us. We're in a really good position here. Being located in New Zealand is a good thing. It's an attractive place that people wanna come to. Our reputation and size within New Zealand plays into our advantage as well. We've got a great reputation in New Zealand for innovation. People want to come and work for us because of that.
If you look at their different engineering departments from universities, all of the relevant students pretty much are applying for jobs here when they've been coming out from graduating from their studies. That sets us up in a really good place to actually get the best talent in here. I wanna talk about the importance of access to user environment, in particular, getting our product development teams that are actually involved in developing products firsthand access to those environments. That's the best way of learning, rather than hearing secondhand through clinicians or through sales through our sales teams, perhaps. Actually getting our people developing products into those environments, seeing the problems firsthand, we think sets ourselves up so that we can learn and develop the best possible products.
A good example from that, I think, is our relationship with Middlemore Hospital here in Auckland. We have. At any given time, if you go out into Middlemore Hospital, you're gonna see many of our engineers out there in the intensive care environments in the wards, observing how care is delivered, seeing our products in use, and learning from that, bringing that knowledge back into New Zealand, into the team here. The next bit I wanna talk about is the importance of dealing with the absolute best in the world. I'm kind of thinking of this in two categories. The first is the clinicians that we deal with. When we do product development, we're not doing it in isolation here on this site. We're doing it with clinicians around the world.
We wanna make sure that we are working with the absolute best when we're doing that. Our reputation helps get out to those people. I think more importantly, the culture that we've got, that patient-focused culture, that wanting to do the absolute best thing by the patient comes across. As a result of that, those clinicians are always wanting to work with us. That's very helpful when we're going out there testing, getting ideas and testing our products. I also think about this from a technology perspective as well. We're not just sitting here talking among ourselves.
We're going out to the best technology experts around the world, and our approach to that really is to try and work with them, not just get them to do a task, but to work alongside them, learn from their expertise and bring that expertise back into Fisher & Paykel. It's one of the ways that we grow our expertise over time here. Another aspect I think that's really, really important for us is making sure our teams here have always got access to and really easy access to the best prototyping equipment, the best testing equipment. If you do walk around here a bit later on, you're gonna see that we have labs and model shops scattered all throughout the campus here.
It's really easy for an engineer to get up from their desk, walk a few meters, go into a room so that where they can prototype something, where they can test something, and we think that's a really, really important part of the way that we do product development. If we have an idea, we want people to be able to build it and test it really, really quickly, learn from it, iterate that. It's an important part of the way we do product development. Last point I wanna touch on is the importance of having manufacturing and R&D on the same site. When you go on your tours today, you're gonna see that the only thing that separates our product team to our R&D teams from the manufacturing environment is a glass wall.
At any given time, our R&D teams can go out into the manufacturing environment and have a look at what's going on out there, and that's really important for us. A lot of the time, the challenge for us is not just what should the product be, but how are you gonna make it in hundreds of thousands, millions per year, and that challenge is really, really difficult. We think the best way of enabling our teams to do that is to make sure that they can go out into that environment really, really quick, really easily. That's a big part of why we have manufacturing co-located with R&D on this site. Look, I've given you guys a few insights, I think, into the way that we approach development, a few things that we do to enable some of our teams to do that.
You're gonna see the results of some of these when we talk about some of this process, when you go out and look at some of the products, and I hope that some of what I've talked about comes across from those teams. I'm gonna stop there, and I'll hand back over to the team.
Yeah. Thanks, Andrew. It's always inspiring to hear that, talks and similar talks. One of the things you did touch on was, you know, in the Daniell Building, as you take the tour, I definitely encourage you to take the tour. No matter where you are in the office building, you're always able to see our manufacturing facility, and that's really key to getting that, you know, that, R&D and manufacturing working really, really closely together. The other really cool thing, we touched on, which is another core part of our culture, is Care by Design. V, what does Care by Design mean to you? Not to put you on the spot, but as a young engineer.
I guess, it kinda means having empathy for the patient, but not only the patient, also the nurses, the doctors, anyone that's actually interacting with the product.
Yeah. I mean, it's a really key part, right? You know, we can all be patients, you know. It could be us. It could be a colleague, friends, loved ones, investors, it could be anyone. By holding that sorta really central to who we are and keeping it in mind when you design, it really leads to better outcomes, we believe. Yeah, definitely.
Yeah.
Yeah. Cool. Okay, moving on to the next bit. We're gonna invite Winston Fong, our VP of Surgical Technologies and Chris Crone, our GM of the Airvo Optiflow group, to give brief introductions into what we're gonna cover off next, which is our breakout sessions. Thanks. Should we? Do you wanna grab a seat?
Morning, all. As Andy said, I'm Winston, the Vice President of Surgical Technologies. You know, following on from what Andrew talked about, you know, I've got the great opportunity to talk about the outcomes of that. I'll be covering. Myself and the team, we'll be having these breakout sessions, and I'll be talking about three new products, which is a result of this, you know, the way we go about working things and developing these better products. I'll be covering one in surgical humidification, and the two we announced yesterday with Optiflow Switch and Optiflow Trace, which is a, you know, brand-new area of the hospital where we can treat patients with Optiflow. It'll be the first time we actually talk about it out to the public, like yourselves.
Thanks, Winston. My name is Chris Crone. I'm the General Manager of the Airvo group here at F&P, and my colleague Sam and I will be introducing some of the great new features of the Airvo 3 device. We're gonna be covering some of those features and how they enable us to treat more patients in more parts of the hospital by more clinicians. We've got an expo session. We've got 30 minutes of expo session with some of the engineers from our team, and we're looking forward to giving you some hands-on experience of those features of the device.
Thank you so much. I hope you all are excited for the upcoming rotations. I know I am. I might have to sneak into one of them later. Just a little bit of, I guess like info, we will be entering laboratory spaces, and often these are used as cumulative environments, so hazards are present, and that can include high-pressure gases, high-voltage equipment, hazardous chemicals and no food or drink, obviously. Don't take any pictures. I know we're pretty, but please refrain.
I'll be available for selfies a bit later. Look, I think the key message in the labs is just don't touch anything. There's lots of hazards there.
Just stay away from everything. We've got a bit of logistics going on. When you came in, you might have noticed on your badges that there were two colors. There was blue and orange. If you're in the blue group, you're gonna be seeing anesthesia and surgical rotation first. Dan is gonna be your guide, so you're gonna follow Dan. Dan, put your hand up. He's just over here. If you have an orange name tag, you're gonna be going and seeing the Airvo 3 rotation first. Raylene, who's over here, is going to be your guide for the day. The key thing is Dan and Raylene will be your guides for the day. They won't swap, but we will give you an opportunity to swap the breakout experience.
Have fun, everyone. See you guys here back at 12:00 P.M.
Yep. Great. Enjoy yourselves.
Welcome back. That was a summary from our executive team about what relentless innovation looks like here at Fisher & Paykel Healthcare. I guess the takeout for me is innovation's pretty difficult, and it's all about that unarticulated problem, Harris.
Yeah. Speaking of that problem, as a engineer myself, we had to deal with that kind of problem. For example, the nurse would like a flexible circuit, and we asked ourselves, "What does flexible actually mean? Is it a flexible metal chain, or is it a flexible wire that you can bend but it will bend back? Stuff like that we had to really dive deep to figure out what they want.
Yeah. That's awesome. Of course, you did, and you came up with incredible circuits like you guys have. I think the other thing is that clearly there is a focus on the patient, and that's a driving force for our innovation. You must see that in your engineering too.
Yeah. That example there, definitely the patient is our number one focus, and we wanna do exactly what they want and when they need it.
Awesome. What's coming up next is a first showcase of our surgical products. As you heard the guys in the live room saying, our audience is now walking down there. What we're gonna be showing you is our new Optiflow Trace and Optiflow Switch, which are those new interfaces fresh off the press from that announcement yesterday.
While they're making their way down to the lab, we thought we'd showcase a new product from the NIV business.
We are in the studio with Laurence Gulliver, who is our GM of Non-invasive Ventilation. Laurence, you've brought for us today a mask called Visairo. Welcome. We'd love to hear more about this.
Welcome, Laurence. Yeah, could you tell us more on how the product was made, designed?
Yeah, absolutely. The Visairo mask is an NIV mask made for hospital, and we saw really an opportunity to improve the comfort for the patient and the usability for the caregiver. Of course, that's very on theme for what we do at Fisher & Paykel Healthcare, an opportunity to improve patient care. We then collaborated with an in-house team, the home care interface team, and created a seal which we think is really clever and does some great things for the patient.
That's cool. I love hearing about the collaboration between teams. That's definitely something we do well here. I've read some of the materials, some of the promotional materials. It talks about bridge-free NIV. Can you explain what that is?
Yeah, sure. Bridge-free NIV probably sounds abstract, but when we talk about bridge, that's the nasal bridge. That's the part of the facial anatomy that with conventional NIV masks is probably most susceptible to discomfort for the patient. The whole idea behind the seal and this design was to totally avoid that part of the face and to seal over the nose and mouth without being on the nasal bridge. I'll show you how that works.
Nice. Yep. Nice and away from the eyes.
That's right, and we call it the under-the-nose seal. It was done with a particular, I guess, attention in mind around making it most comfortable for the patient, including taking things out of their field of vision. Unlike some other masks, where we see a rigid material in the field of vision of the patient, we've been able to achieve a stable, comfortable mask with nothing in that field of vision. For someone who wears spectacles, y ou'll appreciate that really helps for a patient who wants to take off, put on their glasses. The other thing that moving the seal down away from the nasal bridge does is helps with leak discomfort. A really common place for an NIV mask, non-invasive mask to leak is around the eyes. When it leaks into your eyes, it's really uncomfortable. It can blow on your eyelashes, which a patient feels.
Over a longer period of time, it can dry out the patient's eyes. A patient can end up actually shutting their eyes to avoid that discomfort. I'm sure you can understand that, you know, a patient who's in a hospital environment, potentially under respiratory distress, they already have a degree of anxiety. Them having to close their eyes to avoid discomfort is just another layer of stress discomfort that we think that we can take away with a design that avoids that.
Yeah. That's awesome. Just the general claustrophobia, right? Just hopefully gone.
Exactly.
Nice.
Another point, on the material is TubeFit. Do you mind explaining what that is?
TubeFit, it's a feature of our mask. It's actually not a new feature to this mask. We've had it in previous [audio distortion]
You know, haven't really talked about before. I'm gonna give you a bit of an overview of these products. There'll be a number of team members supporting me as well. I'm looking out for them. We've got Matthew back there. We've got Samantha, Ali, and Chris. After I talk, you're gonna have a bit of a breakout session, and we've got four kind of booths around the place. We'll just break you up, and you'll rotate around the booths. Obviously we'll have one here around surgery, another surgery one back there, and then Optiflow Switch and Optiflow Trace. To kick things off, I'll cover the surgical humidification one first.
What we've got here to announce today is that we have developed our very first surgical humidification open abdominal diffuser. We've talked about it a little bit in the past, but what we've been doing in the past was learning about this environment with an off-the-shelf diffuser. The lessons learned with this was that, you know, the surgeons, they certainly value the therapy. They value the benefits it provides. However, this off-the-shelf diffuser is just simply difficult to use. A challenge was set to the team here, not too long ago. It was actually Ali and his team back there, so you'll hear from him directly. You know, to develop a product which is gonna deliver the right level of therapy.
Two, it was to make it easy to use, and three, make sure it doesn't get in the way of all the complex surgery activities. Open abdominal surgery. You know, it's obviously in the abdominal space, they do a large incision, and they retract that back. They use tools like this to go into there, and it retracts that surgical space throughout the whole surgery. In the operating room, they're actually quite you know, cold and dry environments. There's this constant laminar flow through positive pressure ventilation in the operating room that happens, and that can contribute towards the patient getting cold. It can cause the surgical site to also get cold and dry, the organs and tissue to dry up. What that means is the patient can get hypothermic, which is, you know, certainly not a really good thing. That can then relate to surgical site infections.
During surgery it can cause more bleeding, which then patients could require more blood transfusion. Post-operatively, there could be shivering, and that energy is going towards shivering rather than recovering. Surgical site infections and the likes can also mean increased recovery time, increased length of stay. The team developed this device. It looks quite simple, and that was part of the challenge they put. You simply peel this off, put it onto the retractor, and that simply stays. It's connected to the humidifier, and that simply stays and provides that surgical humidification throughout the entire, you know, the surgery time.
That could be easily three hours or six-plus hours for some of these procedures. This, you know, helps address some of those complications which I mentioned. It helps maintain the patient's temperature so they maintain normothermia. It can decrease surgical site infection among the other complications. These complications today are a huge cost to the healthcare system. By providing this, you know, it provides those benefits and those better outcomes for the patient. Now we've released our first one. We're really confident in changing that clinical practice and improving the care and outcomes of the millions of patients that undergo a laparotomy, which is open abdominal surgery. Now I'm gonna, you know, talk about Optiflow. That's what I was gonna cover, and you get to hear more details.
Chris is actually gonna be presenting here, giving you more details about the surgery, the therapy, the benefits of the product, those complications. Ali will be behind you on that booth there. He'll be talking about some of the technology and innovation that goes towards what might look like a simple product. There's, you know, some amazing innovation behind that. Now we're gonna talk about the anesthesia products which we introduced. You know, these patients, you know, undergoing a wide range of surgeries, including the likes of laparotomy, they get an anesthesia, and this anesthesia actually causes a respiratory compromise. About, you know, 10 years ago, we started exploring how can or if.
Before that, if you think about the mechanisms of action of Optiflow, I think you're quite familiar with Optiflow now, but you're talking about the humidification, the positive pressure, the oxygenation. We were trying to determine how Optiflow can help these patients which go under anesthesia and have this respiratory compromise. Working closely with anesthesiologists, being in that environment, we developed products, and we obviously released the two, which we announced yesterday. What this helps with is it helps facilitate the use of Optiflow in the anesthesia practice, and it basically extends where Optiflow is today to a new area of the hospital, which we haven't been doing in the past. Now I'm gonna walk over to this model here to talk about Optiflow Switch. Straight. Switch. Gotta get the products by myself. Got everything here?
We can imagine the patient, which I kind of spoke about, they come into hospital. Pretend to be an anesthesiologist, but trust me, you don't wanna be looked after by me. What happens is the patient comes in, and the anesthesiologist will pre-oxygenate that patient. This is in the operating room. They put this traditional anesthesia mask on top, and what that does is, you know, builds up their oxygen reservoir in their lungs. Soon after that process, they use an anesthesia. They put that into the patient. They use the likes of a neuromuscular blockade, and very soon after this, the patient's gonna stop breathing. That's part of the practice.
Because they stop breathing, they're gonna have to, sorry, use one of these things called a laryngoscope and put a tube down their throat to be ventilated by one of these machines. I made that process sound, you know, pretty simple, but it is actually can be very difficult. One other step. Before they do that intubation, though, they traditionally can also use this face mask to check that the patient is ready to be intubated. They might give them some extra breaths just beforehand. This process, as I said, can, you know, appear to be quite simple, but it can actually be very difficult.
Some patients, they are very difficult, some patients are very easy, and then some patients are, you know, can also be very unpredictable. Basically from that time when the patient stops breathing, you've got a limited amount of time to obviously intubate that patient and get them ventilated. That time, if you don't get that done in time, the oxygen levels in your blood drops down to critical levels. I think we all know the importance of us breathing and getting that oxygen. As well as that, because of that restricted time, it can be quite stressful. You can cause a bit of airway damage, or you could actually cause some broken teeth.
That time criticality, you know, it could be quite a bit under pressure and is very difficult. What Optiflow Switch does, it helps with that entire process. If we can replay that process, the patient comes in, you put the cannula on, and that pre-oxygenation starts happening immediately. You give the anesthesia, the neuromuscular blockade, and then very soon after, when you wanna make sure. When the patient stops breathing, you wanna make sure to do those checks still. What you can do is use a traditional anesthesia face mask and put it directly on top. You do those checks, are they ready to be intubated, do give them the extra breaths. In this step, you can, you know, we wanna make it seamless for the anesthesiologist to use the products.
You can't do this with any other cannula. After that, obviously the patient's stopped breathing and you're ready to start intubating. That oxygenation, when you take the mask, it continues immediately. In terms of that time I talked about from when they stop breathing to intubate, it's already continually providing the oxygenation. You can, you know, it gives you a more calm environment, enabling you do that intubation safely. Benefits of Optiflow Switch, it helps with the pre-oxygenation, it's compatible with your traditional anesthesia face mask, so it works seamlessly through that process. Lastly, when the patient's stopped breathing, it provides that additional oxygenation, giving you the extra time to safely intubate that patient. There's a whole range of other procedures. Oh, sorry. Matthew, as I mentioned, is gonna be here.
He's gonna be providing more details around Optiflow Switch around the procedure, and you'll see the product in action as well. There's a whole range of other procedures, which what they do is they do them under what they call sedation. There's a large portion of those, and sedation means you put the patient asleep, so they're not aware of the procedure, but the patient is spontaneously breathing. They're still breathing themselves, so they don't need to be intubated and ventilated by this machine. However, that sedation that you get can certainly impact your breathing. It can repress your breathing, so there's still an increased chance that you'll have a desaturation. Again, the oxygen in your blood dropping down to really critical levels. This is Optiflow Trace. You can imagine again, the patient comes in.
I think someone else has been practicing and muddling things around. Patient comes in, and you put the cannula on, and it provides that oxygenation. If you think about the humidification, that positive pressure, it helps decrease the chance of a desaturation. The other key thing is we've also integrated a side-stream CO2 sampling line. Obviously, when you're exhaling and inhaling, when you're exhaling, CO2's coming out. This helps measure, you know, to take a sample and enables the anesthesiologist to see that the patient is still breathing. This is happening whilst we're providing the Nasal High Flow. Why that's important, obviously, you see the patient's still breathing. If you recognize they've stopped, enables the anesthesiologist to immediately intervene and get them breathing again.
The benefits here, Optiflow Trace provides that oxygenation, decreases the chance of that desaturation, and it enables and supports the anesthesiologist to see if the patient is still breathing, enabling them to take action if they require. In terms of Optiflow Trace, Samantha back there is gonna be talking through that product. And again, you can see obviously the trace element that in action as well. You know, we've been doing this, you know, kind of investigating this over the last 10 years. We're building that deep knowledge around anesthesia. We've been learning, and what we've been learning about the anesthesia practice, the environment, the complications, the patients. We've been learning all about this, and that's kind of resulted in the release of these two new products.
As well as that, we've been building the clinical evidence. The clinical evidence, I know you're all aware, is very critical to support the change of clinical practice. If you can imagine the hierarchy of clinical evidence, right from down the bottom, you know, kind of cohort, you know, basic opinions, case studies. The lower quality, lower mature evidence right up to the top of your meta-analysis and systematic reviews. About that 2014, kind of 2015 timeframe, you know, we started seeing and the publication of these case studies, these opinions of Optiflow in use in the anesthesia setting. It's starting to show, you know, there's interest and there's possibility.
Couple of years on, we started getting observational studies, investigations of Optiflow in use and starting to show real promise that it's actually, you know, very, very beneficial for the anesthesia setting. In 2018, these are just thereabout numbers, you're starting to see large, high-quality, randomized controlled trials in the space. They're comparing Optiflow in terms of an intervention against the standard of care. We're starting to see large volumes of that and continuing as well. Because of those high-quality randomized controlled trials more recently, last year, we started already seeing meta-analysis and systematic reviews for the use of Optiflow in the anesthesia practice. This reflects the strong clinical evidence that supports the use in the space already. I'll give you one example of a clinical study.
This was published in 2019. It was done by Lin et al. It was comparing Optiflow against the standard of care, which is a low flow oxygen cannula, in gastroendoscopy procedures. There was 1,994 patients for the study, which is, you know, really large study. The results of that study was there was a significant decrease in desaturations. From 8.4% down to 0% with Optiflow. As well as that, there was, in terms of number of interventions to open up the upper airways, make sure the patient's airways are open for their breathing, that dropped from 23% down to less than 1% with Optiflow.
There's a lot of other clinical evidence supporting similar things where there's significant decrease in desaturations, significant decrease in the number of interventions or disruptions to surgery, extending that apnea time, which I talked about, to enable the safe intubations. What the clinical data tells me, you know, shows me, is that there's certainly a long runway here with a lot of wide range of patients that can be treated by Optiflow. It also shows that we've made strong progress towards creating the evidence to change clinical practice already. I guess in summary, I've talked about three new products. We've got strong and growing clinical evidence. We've got ongoing innovation. That gives me great confidence that we can change clinical practice and establish that sustainable profitable growth both in surgery and anesthesia.
That's my quick, you know, overview. Hopefully, that provides a great introduction of what we're, well, you know, we're certainly excited about. Now what we're gonna do is do the little breakout, mini breakout sessions. I think the easy way to do this is somehow split yourselves into four equal groups. Perhaps the groups, you know, The bunch there could go towards Chris. The bunch kind of here go towards Ali, that way there. The middle group [audio distortion]
Thank you, Winston, for a great overview of our surgical and anesthesia products. Products that facilitate the use of Optiflow in the anesthesia practice and basically extend the use of Optiflow into these other areas of the hospital.
Yeah, for sure, Fi. It's great to know that the anesthetist's time to complete the intubation. You know, if I was put under, I would like my nurse to be able to, you know, not hurt me in the process.
Of course.
What else did you find interesting?
I think that model with the CO2 sensor, that is awesome. I mean, how great to know that not only am I gonna remain oxygenated with that Optiflow Trace. Also, my anesthetist is gonna recognize if I stop breathing and do something about it.
Right now, as you heard from Winston in that presentation, the on-site audience is gonna be shown around some show and tell stations. As promised, we would like to show you as well. Enjoy.
I've introduced our new release of our Open Abdominal Surgery Diffuser, and now we're gonna have a chat with Chris to get a better understanding of that. Hey, Chris, I see you have a patient, a model here on the table. Obviously not a real patient. Can you tell me a little bit more about what's going on here with this patient?
Let's imagine this patient's been diagnosed with a colon cancer. He's come in, been anesthetized, laid out on the table, and we're about to conduct an open surgery on them. A long incision's created, and that wound is retracted by, typically using another retractor. That patient's on the table for a long time, and during that time, the cold, dry environment can really cool down that wound and create a lot of risks for that patient.
You mentioned the cold, dry environment. What the patient?
That operative air is really moving quite quickly. It's changed over in theater about every three minutes, and that can desiccate and cool the wound right down, which impacts the core temperature of the patient as well. That can create the risk of, you know, obviously desiccation of that wound, but also by cooling the patient down, it increases the risk they'll bleed more and will require blood transfusions.
Yeah, right. Other things, you know, post-operatively?
As the patient recovers or, you know, successful operation. They move into the recovery room, they're more likely to wake up cold and shivering, increased risk of getting a surgical site infection as they recover, and that will take them meaning they'll stay in hospital longer and take them longer to get home to their families.
Yeah, right. Obviously, we've introduced our first, you know, Open Abdominal Surgery Diffuser. How does that really help with that? Can you demonstrate that to us?
Of course. This is the diffuser here, and we've designed it to make it really easy to implement into that surgical field simply by sticking and adhering to the retractors that are already in place. That creates a steady flow of warm, humidified gas to that patient to fill up the wound and really stop that desiccation effect and keep that patient warmer, so they get into that recovery room in a much healthier state.
Well, cool. Thanks for explaining that, Chris. I think that's gonna really help the patient, so I'm really excited with the release of this new diffuser. Thanks, Chris.
Cool.
We've talked about the patient and therapy, and now we're gonna talk to Ali about the product and some of the innovation behind this. Good day, Ali.
Hi, Winston.
To kick things off, can you talk me through the rest of the surgical humidification system?
Yep, absolutely. What we've got here is a traditional humidifier and a chamber. It's just been specifically tuned for the surgical environment in order to combat the cold environment when we add heat and humidity to the gas that we deliver. We run it through this insulation tube. Now, this insulation tube has got gel tubes inside it to create an air pocket of insulation around the flow path. It also has a heater wire that runs the length of it. All of that is trying to do is maintain that temperature and humidity all the way to the newly released diffuser, which attaches to the end.
Awesome. If you recall, I'm sure you do.
I do.
When the challenge was set for you and your team to make a easy-to-use interface, that didn't get in the way of all the complex parts of surgery and delivered the right level of therapy. Can you explain to me, you know, what you've kind of done for the first two?
Yeah, absolutely. I've got the open surgery diffuser right here. How we've designed it is to try and make it as small as possible and as low profile as possible, so that it doesn't interfere with the surgeon's operation. It also has an adhesive backing that peels off and attaches to any retractor that they're using. There is also a deformable element inside it that allows it to conform to the shape of that retractor, so it can work on one like this or one that's more square. It also is able to stay there and last the duration of surgery. Anything from the three-hour ones all the way up to the really complex ones that are six or seven hours long.
Cool. The last challenge around how do you deliver the right level of therapy, can you demonstrate that to us?
Absolutely. If we come over here and I'll explain a little bit about the setup that I've got here. I've got a simulated open wound, and it's currently being retracted by very commonly available retractors, and the diffuser is attached there. There's a light here to help me visualize the delivery of humidity that's in there. It's normally invisible. It's currently being filled right now. In order to help with that, I'm gonna add some vapor into the flow path to help demonstrate that.
You can see the wound being filled with humidity, and it's nicely covering it and flowing over the sides. Now, why that's important is that that's how we get maximum heat transfer between the gas that we're delivering and the patient. By increasing that contact time between the gas and the patient, we increase the heat transfer that we're able to deliver, and by doing so, that's how we keep the core temperature to where it should be and prevent hypothermia. The other important thing that we can do with that is actually we prevent any evaporation from occurring from the patient themselves by preventing that evaporation and desiccation, and by doing so, we also minimize any effects on core temperature.
While you're developing this, you know , you and your team say it's very difficult to do.
It is.
Can you explain what makes it difficult to do? Why is it difficult?
Well, I think the easiest way to do that is if I demonstrate what would happen if I attempted to do that without a new diffuser in place. If I just use a normal, open-ended tube and try to fill this wound right now with exactly the same gas as I was using before, you can see what happens. It goes everywhere, and it doesn't actually create that, coverage that we were getting with the other products.
Excellent. That coverage is. You know, the filling of the wound is really important.
Absolutely. It's extremely important to get that heat transfer to the patient.
Cool. That heat transfer helps with hypothermia. You know, obviously, that hypothermia helps with reducing surgical site infections.
It does.
During the development that we went through, you also identified a mechanism of action that helps potentially reduce surgical site infections. Can you tell me a bit about that?
Yeah. I'm just gonna fill it again, so it helps me explain it. What you can see there, when the wound is completely full and we've got maximum coverage, is that we are creating a protective bubble around the wound. What that protective bubble does is actually any airborne particles that are floating around the theater environment, which often are viral or bacterial, if they make their way into that wound, they can cause a surgical site infection post-operation. What I've got here is just a demonstration of what happens with those particles when you've got a simulated wound model. On the left, you've got no therapy being delivered, so what you can see is the particles clearly making their way into the model and inside the where the organs should be.
On the right, you've got the wound being filled with therapy, and then you can clearly see a deflection line around the entire open wound. This is actually from a paper that we've published that shows a reduction of particles up to five microns, a thousandfold over between with therapy and without therapy.
Cool. No, nice work. No, well done to you and your team. Thanks, Ali. It's really great to have this new open surgery diffuser in place and really looking forward to continually improving the care and outcomes of patients.
Thank you.
We've now introduced the two new Optiflow interfaces, and now we're gonna talk to Matthew to talk about Optiflow Switch. Hi, Matthew.
Hi, Winston.
I briefly introduced that intubations, there's some patients can be very difficult, some can be easy, and, you know, some can be very unpredictable. Could you talk us through that a little bit and what actually happens there?
Sure. Well, I'll tell you a little bit about our new product called Optiflow Switch. Perhaps before I do that, I'll also tell you about a very, very special person in the world of anesthesia, and her name is Elaine Bromiley. Mrs. Bromiley was a 38-year-old mother of two. She suffered from a sinus complaint, and she presented for an elective procedure at a tertiary hospital in the U.K. She was under the care of a senior anesthetist and a senior surgeon. What happens when a patient comes in to an operating room from an anesthetic point of view is we first fill their lungs up with oxygen using a mask like this. Typically, that's held over the patient's nose and mouth for about three minutes.
I'll talk a bit about why we fill their lungs up with oxygen in a moment. After that, we give the patient an anesthetic, something like this, and that puts the patient off to sleep. It's also common to give a neuromuscular blockade like this one, and that paralyzes the patient, which optimizes conditions for surgery. But it also, of course, has the side effect of stopping them breathing. Now, when the patient's not breathing, for someone like me, I would go for about maybe two minutes before the oxygen level in my blood got down to a critical level. For people who have high risk factors like being high BMI, maybe being pregnant or being elderly, that could be as little as 30 seconds, which isn't very long.
Even with the oxygen that we put in at the beginning, that roughly doubles those times. It's still quite a short period of time. During that time, what we're going to try and do is put a tube like this down into the patient's airway, and that tube will then be connected to the ventilator. The ventilator will replace the patient's breathing, so it'll be providing oxygen, but also taking away the carbon dioxide. Now, in the case of Mrs. Bromiley, they had some difficulty getting that tube in, so her anesthetist had several attempts at doing that. When he was unable to do that, he called for help. Another anesthetist also attempted to put the tube in, and the surgeon also had a go at doing it.
Unfortunately, none of them were able to put it in, so they decided that they would abandon the procedure, wake Mrs. Bromiley up. They sent her to recovery to do that. Unfortunately, she never did wake up, and she passed away some time later. A subsequent inquiry showed that the oxygen level in her blood had been too low for too long, and she'd suffered an unsurvivable brain injury.
Yeah. Well, thanks, Matthew. That process certainly does sound very difficult and prone to a number of complications. Can you talk us through how Optiflow Switch can help with this?
Sure. This is the Optiflow Switch interface here. What happens is we just place that in the patient's nose like that, and we provide quite a high flow of oxygen through that interface. This has two benefits. The first is that we can fill the patient's lungs up with oxygen before the procedure begins, but we can also leave that in place while we're trying to place this tube, and that delivers a continuous flow of oxygen. Even with the patient not breathing, we can actually get quite a long time before the patient gets to a level of oxygen which is critical in their blood. That provides a greater sense of security for the anesthetist and also for the patient.
Now, one thing in anesthesia is that the anesthetist often will want to deliver breaths, and I'll just grab this mask again. They do that through a mask like this by placing it over the top. Now, normally with an Optiflow cannula, we wouldn't be able to do that. This one's unique. It's got a collapsing section here. When I place the mask over, that cuts off the supply of oxygen coming from the high flow so that we can then deliver the breaths through this mask. When we take the mask away, the oxygen automatically starts flowing again. The patient's never without oxygen. That's our new Optiflow Switch interface and a little bit about how we use it in general anesthesia.
Excellent. Thanks, Matthew. That really shows that, you know, the number of complications and the difficulty that you can experience, and how the benefits of Optiflow really provides, and we're really excited to see how Optiflow can be extended to anesthesia practice. Now we're gonna have a chat with Sam about Optiflow Trace. Hi, Sam.
Hi, Winston.
Could you talk us through one of the procedures where they use Optiflow Trace and where the patient's sedated?
Yeah, absolutely. Why don't I take you through a bronchoscopy? A bronchoscopy is used to visualize a patient's lungs and their airways for a variety of reasons. What would happen is the patient would come into the procedure room for their sedation. They'd be hooked up to various monitoring. We've got a blood pressure cuff, some oxygen saturation, and everyone would get ready. Once they are, what we're gonna do is we're actually going to sedate the patient with a drug like this. With the sedation, what's crucial is that the patient remains unaware of what's going on, but they keep breathing for themselves. Once that's all happened, we'll introduce a bite block so that they don't bite down on the expensive bronchoscope, and then we'll be able to go and visualize the lung and the airway.
I understand there's a number of complications that may cause a respiratory compromise. Can you explain that a little bit more?
Yeah, absolutely. I like to think about it in sort of three different groups. The first group of factors we have is our patient factors. That could be high BMI, pregnancy, elderly. All of these are gonna make it more difficult to keep our patient oxygenated. We have our anesthetic risk factors. This could be, in this scenario, we may over-sedate our patient, and they may stop breathing for a time, again, leading to compromises in oxygenation. Finally, we have our procedure risk factors. This, when we're using a bronchoscope, could be the unintentional obstruction of an airway, again, leading to that problem with oxygenation. When we have a problem with oxygenation, we're going to need to intervene. That could run the spectrum from doing a chin lift, removing the obstruction.
It could be waking up Bob a bit, going, "Take a breath for me." Or it could be stopping the procedure and having to reschedule. This all adds time and complexity to any of our sedations where this occurs.
Yeah, all right, thanks. I know you are one of the engineers who developed this product, so I know you're really passionate about it. Could you explain to us how it helps for these sedation procedures?
Absolutely. Optiflow, we know it's really great at oxygenating, and we also know it's really great about removing CO2. What we're gonna do is heat and humidify our gas through our humidifier up through to our nasal interface. Instead of the patient just coming in and getting hooked up to the monitoring, they'll now actually wear an Optiflow interface and continuously receive oxygen throughout their procedure. This means we can maintain their oxygenation, reduce the chance of a desaturation, and reduce those complicated interventions that may add time and complexity.
Very well. You probably can't wait for me to ask this one. What is this?
This is Trace. What is really crucial, as I said, for sedation, is that we know our patient is breathing, 'cause that is how they're going to stay oxygenated. With Trace, what we've got is a thin, flexible tube that hooks up to our monitoring. What we can do is sample the patient's expired gas and be able to see breath by breath that they're continuously breathing throughout the procedure. Do you wanna have a look?
Yeah, go for it if you can.
Okay. I'll just pop this on.
Can you hold your breath, Sam, and see? There you go, see a flat line. That's a desaturation, is it?
Absolutely. Now I'll start breathing again.
Thanks, Sam. Matthew and Sam have talked through Optiflow Switch and Optiflow Trace, and we are really excited to change clinical practice and extend Optiflow into the anesthesia setting.
Welcome back. You've just seen some demonstrations of our surgical humidification and diffuser, the Optiflow Trace, and also our Optiflow Switch.
Now, you may have a few questions about these products, but in the next segment, there is a dedicated Q&A where you can ask Winston and the rest of the team using the Slido application. As you can see on the screen now, there is a QR code and the event code which you will need to use to ask questions.
Each Q&A session is gonna have a dedicated Slido code. The code for this next session, as you saw, was #sphsurgical, and we're gonna repeat that code again. There you can see it. If you use the QR code, it's pre-populated, and so will probably take you straight to the Q&A.
Now, while you're setting that up and the on-site attendees are finishing their show and tell, we do have another product to showcase from our OSA business. Take a look. Welcome, everyone. Now we're joined by Bhavi Ogra, who is the clinical and marketing manager of the OSA business . She's here to talk about the Evora Full Face Mask, which is the newest mask from the OSA team.
Hi, Bhavi.
Hi. Thanks for having me today, guys. I'm absolutely here to talk to you about the new Fisher & Paykel Evora Full compact full- face mask. I've got a short video to play. I guess that video is gonna take you through a bit of the behind the scenes of how we came to develop this mask and also show the collaboration that our engineers have with patients and clinicians. I hope you really enjoy it.
Oh, great. Here we go.
The Evora Full Mask, a soft silicone seal that works in combination with our frame and our stability wings. It's super soft and super comfortable. When they move around at night, those stability wings, they keep the geometry of the seal, and they stop it becoming unstable. With full face masks, they fit over your nose and around your mouth. What we were trying to address with Evora Full was to have a more comfortable solution, less intimidating. It's smaller, fitting underneath their nose and avoiding the nose bridge altogether. People are gonna find that really comfortable. It's gonna seal really well. It gives them an alternative to an over-the-nose mask.
The low profile of the mask makes it stay in place really well while you're wearing it to really promote mask stability while you're sleeping, allowing a bit of freedom of movement while you're in bed. It also opens up the field of view. You haven't got anything encroaching on your vision and allows you to wear glasses while wearing the mask.
With the three different seal sizes of the Evora Full mask, we didn't simply just scale them larger and smaller to get the three different sizes. We try to make sure that they would fit a wide variety of people. People have all sorts of different nose shapes, different curvatures, and it is quite difficult to design something that does seal well for the majority of the population and still be comfortable.
We spent a lot of time with patients really up close, seeing how the geometry fit around the nose. We looked at a lot of different ethnicities as well to come up with our three sizes that cover a large percentage of the population.
The reason that we use such a rigorous testing approach here is that we need to make sure the mask is safe for the patient to use. Therefore, we have to make sure all parts withstand certain forces, and when it's used in the home for a certain amount of time, that everything still functions as it should.
We had to connect and disconnect the connection points about over 1,000 x, and we had to see if there's any unforeseen wear and tear on the part. We're always trying to find the absolute limits in how the users would use the mask.
In the usability lab, we will go through how to disconnect and connect a mask, how to clean it, how to set up the headgear to connect the headgear the most easiest way, and how they can put them on themselves, and yeah, show the ease of it.
We work with suppliers all across the world looking for the best manufacturing equipment that we can get. We have an ultrasonic welding process integrated with leak testing on the frame assembly, and that ensures that 100% of the frames are tested.
With a product like Evora Full that's optically critical to get those nice clear products, we use robots to remove the parts from the mold tools and avoid scratches. What we're looking to do is really make the same product over and over again as consistently as possible, so the user experience is the same for all.
We've just finished the validation of the Evora Full mask, and from that trial, we found that over 90% of participants found the mask stable, and almost everybody found that the mask was compact on the face. Care by Design, it really is about empathizing. We want them to be able to feel confident and know what they're doing every single time they put their mask on.
It's all about the patient. It is how can we improve their lives? How can we make it better for them?
The difference that your products can make, you really connect with those people. Everything that we do, you know, it has to benefit the patients.
Great video, Bhavi. As you said, that was a lovely back kind of insight into the development of the mask. Awesome examples of collaboration, which is what we've been hearing some themes about today. Obviously, a really important part of innovation is that collaboration. I see some similarities to the Visairo, which Laurence showed us earlier. Talk to that.
Yeah, absolutely. Laurence would've spoken to you earlier about the Visairo mask and, you know, that it's also a compact full- face mask. It's got this floating seal, and that's a real common element between the two masks. With the Evora Full, we've also got the stability wings to allow for the seal to maintain its stability and not create leaks at, you know, higher pressures. Leaks are a real disturbance for patients, so we want them to have continuous therapy throughout the night without any discomfort, irritation into the eyes, and actually pressure on the nose. That's a nice common element of the two, but really in the OSA mask, amplifying the stability wings and making sure that they work in combination to create, you know, dynamic support technology.
Perfect.
The Evora is used at home, and the Visairo is used in the hospital. These are pretty too different environments. How does one separate between the two?
Yeah, you raise a really good point. Visairo in the hospital, typically, patients don't really have a say about what mask gets put on them, whereas in the home environment, patients have a lot of choice. We want the mask to be really inviting for the patient to want to use every night, and we wanna make it as easy and simple for them to use on a night-to-night basis and really get the sleep that they deserve. I guess some of the things that are quite different from the Visairo mask and the Evora Full being in the home environment is that it's quite aesthetically pleasing. You've got the compactness of a full- face mask.
Traditionally, full- face mask would be over the nose, but, you know, you've got that compact under the nose. You've got the blue kind of ring going around to denote that those are the head straps that stay on the top, and also helps with orientation. You can imagine some of our patients, you know, they're at home, they've got, you know, poor vision and dexterity and those kinds of ailments that come with, you know, getting older, I guess. We just wanna make it as easy as possible and simple for them to remember these key things on a night-to-night basis. Then I guess what really sets it apart is this beautiful, breathable fabric that we've got on the back.
You know, you can imagine sleeping 8 hours a night with something, you know, warm air blowing on your face, you can get quite hot and bothered. We wanna make the back of the head not have too much headgear, but allow for segments to be breathable and really make it comfortable for the patients to sleep and get that sleep that they deserve again.
That looks like my running shoes.
Totally. Yep. I mean, there's some really common, you know, material choices that are related to high performance and comfort.
Breathability, obviously.
Absolutely. Yep.
Brilliant. I know you guys try out your masks. It's an important part of, you know, you guys making sure that we've got a great mask. You try it out on patients. I'm sure that was the same for this one. I think I've seen some of the data. It's really impressive on, you know, patient preference and comfort. Can you talk to some of that?
Yeah. I guess that's the fun part about what we do. You know, we always try and put the patient at the core of design. At every kind of iteration that the development team develop a mask, we wanna put that on patients and really hear from the patients how this has impacted the comfort, the performance, and the usability of this product on a night-to-night basis, and in their own home environments, not in a lab that's, you know, very different to their normal natural sleeping environment. Patients are on that journey with us through that development cycle, and we've just had resounding feedback based on the performance, the comfort. You know, that silicone is so fine and soft.
You know, patients have really enjoyed the pressure points being moved from the top of the nose to somewhere that's, you know, unobstructed and allows them to have that freedom and sleep in basically any position that they want to.
Yeah, that's awesome. Well, thank you so much for coming today, Bhavi. It's an amazing looking mask, and I'm sure it's basically another whole population of people who are gonna benefit from this incredible innovation that we do here at F&P.
Thank you so much.
Thank you. Thank you for having me.
You're welcome.
Welcome back. The on-site audience are still going about their show and tell, but as promised earlier, we have a video of Jonti doing our Daniell Building tour. Let's take a look at the first part of that.
Enjoy.
Jonti, apparently this building was built during COVID. Was there? Tell me more about it.
Sure. What we're standing in front of here is the Daniell Building. It's our latest building, the fourth building we've built on the East Tamaki site. We have 100 acres here in East Tamaki. This building here is 36,000 sq m.
Hang on. Let me see how big 36,000 sqm is. Okay. We've got that.
Cool. All right. In terms of the composition of the building, it's similar to our other three buildings. We tend to employ the same sorta, we call it the F&P DNA of how it's designed, and it comprises of R&D, technical lab spaces, manufacturing, distribution, and we've got our largest distribution center in this building. We call it NZ1 . It's 10,000 sqm . And that does all of our international exports, and you'll probably get to see a little bit of that maybe later on. The Daniell Building is a 5 Star Green Star building. Environmentally, it's one of the highest certifications that you can get. There's a really big focus for us in our future infrastructure as we go forward here on the campus.
The building was finalized in the early stages of the COVID lockdown, which was extremely difficult to get all the trades and everybody to continue on and finish it. It was really, really fortuitous for us to have that come online right at the beginning as the company really had to respond to the huge demand for the products.
That was the first installment. We'll have more of that for you later. I have to say, I am actually in the Daniell Building. It's primo. Love it. Amazing. Now, we're gonna be starting the Q&A shortly. What we're gonna do is we're going to move you back to the room. I do just wanna remind you to get those questions in at Slido. You can see on the screen the QR code, scan that, and it'll take you to the question area for this segment. There will be separate ones for later segments. This is the hashtag FPH Surgical code that you need to use. We're gonna move you over to the screen now, and we'll see you shortly.
I think Hayden there is gonna be if he puts his hand up for online questions. I wouldn't mind if the team comes up and supports me with some of the, you know. I'm sure there'll be some challenging questions. Happy to answer them. Put your hand up.
Can you ask into the mic?
Oh, sorry. Yeah, thanks. Can you maybe talk about prevalence of for each of the independent use cases? For example, in bronchoscopy, how common are they? How common is a desaturation event? Therefore, you know, the number of times a consumable might be required.
Sure. In terms of obviously, I'll talk for the surgical first, the laparotomies. Hypothermia. You're talking about a patient getting hypothermic, even with the current standard of care, you're looking at 40% of patients going under these procedures still can get hypothermic. In terms of the, I'm assuming what Chris has said, I'm making some assumptions. Someone might have talked about some of the surgical site infections. You know, data shows that, you know, still 10% of patients will get a deep tissue surgical site infection. Then that's like the cost of the healthcare system in the U.S., not just laparotomies, but in total from surgery is a $10 billion healthcare impact to the healthcare system.
Some of the other prevalence, some of the data off the top of my head, you know, that could be somewhere between, it's quite a range depending on the types of procedures. I think Sam talked through bronchoscopy, but there's colonoscopies, cardiology, and so there's quite a range, gastroenterology. There's quite a range in the procedural sedation side, but anywhere between 30%-70%, I believe, off the top of my head, where a patient can have a desaturation. You know, challenges with intubations, I believe one in 1,500 or something around that range can certainly have a difficulty with intubation.
Wonder if you could talk through the approval profile of the various new products that you've got and, you know, by geography even, and whether they're just being approved for specific surgeries at the moment, or is it o pen label?
Cool. Again, this new diffuser was just released late last year. That is currently available in New Zealand, Australia, and the U.K. The team is working through the regulatory process for the other countries. In terms of Optiflow Trace, that is already available largely around the world. We're already directly selling in 20 countries, and that's available, including, you know, majority of, you know, U.K., Europe, Australia, New Zealand, U.S. In terms of Optiflow Switch, same countries, except it's currently at the early phase of 510(k) application. That can take anywhere, you know, maybe 12-24 months to get there. Hayden?
There's a question from online, from David Low from JP Morgan. What are the approximate revenues from sales of surgical humidification devices?
In terms of, yeah, I'm not specifically talk about it. We, you know, talk about that in regards to the overall hospital new apps. You know, it is early phase for this part of the business, but feedback has been very positive. T he microphone, sorry.
On statistics, what proportion of, I guess, some of the anesthetic procedures that have to or the surgeries that have to be rescheduled because of low oxygen saturation?
Ooh, I don't know that off the top of my head, personally. I don't know if Matthew or Sam you have that, those numbers.
Yeah, it's a good question. You're referring to when a patient's undergoing sedation, and they need to reschedule and do a general anesthetic, for example, because they are high risk. It's those things that Sam mentioned earlier in terms of patient risk, the procedure risk, and the anesthetic risk, and it varies a lot by different procedures. For example, if they were doing something called an ERCP, which is quite a complex procedure, the rate of those progressing to general anesthesia would be a lot higher than it would be for perhaps a standard screening procedure. It's difficult to give a number for all procedures, but it's not an uncommon thing to have happen.
J ust on the Optiflow Trace, I think over there. Are you sort of replacing your own product in terms of, so a cannula, a normal cannula would be there and now an updated cannula would be, so one product would replace the other?
Yes. I've mentioned we've been, you know, really focused on the last 10 years in making good traction across it. A lot of the learning has been with another Optiflow cannula. As we've learned about the anesthesia practice, the patient, the complications, that's where we recognize the benefits around these. As we develop these technologies, you know, with the collapsing side to enable the switching between Optiflow and an anesthesia face mask, as well as the CO2 side for the Trace, we've, you know, obviously built up strong IP around that as well.
Is it, at the moment, the standard of care to have a Nasal Cannula?
Standard of care today would be. Sorry. Again, different procedures — You're only referring to s—
Yeah.
Oh, sorry. Yeah, it'll be only the traditional anesthesia face mask. That process, potentially Matthew and I talked through originally. That'll be the standard of care today. Oh, no.
Thanks. What would be the indicative cost per patient for the consumables for all three of them?
In terms of the surgical product, obviously in terms of, it's about NZD 130, so constant currency in New Zealand. Then what I can sell you for anesthesia, you're looking about NZD 50 per patient, blended cost. Hayden?
We've got a question from online from anonymous. How many procedures per year requiring anesthetics would benefit from FPH's products?
Yes, we've been learning about this and trying to understand it. I think what Lewis mentioned potentially yesterday and today, it's very similar to the, you know, the general respiratory support, total addressable market. We are talking 50 million here who could benefit from Optiflow.
With your new technologies, particularly these ones, how does the adoption usually flow? Does it come through, like, one department in one hospital? Is it rolled out through a whole hospital simultaneously? How does it typically work?
I think it varies quite a bit. In some cases, at early phases where we're building strong relationships with key opinion leaders, it can be done by one. As stronger clinical evidence, which I've talked about, which is in a very strong, you know, more and more groups will certainly show interest. I know of, you know, our sales force, which is doing a really great job, you know, presenting to anesthetic departments, getting interest as a whole, and then doing evaluations and rollouts through the other hospital departments. It varies quite a bit, but it definitely includes large groups as well as individuals as well.
One from online. With your surgical humidification products, does the humidified air fill the wound? With the humidified air filling the wound, does that reduce visibility for the surgeon?
All right. I partly think the question was also through the demonstration where we helped you visualize the wound filling and the importance of completing that to have the heat transfer. That visualization we showed isn't what actually happens during surgery. It is. You don't see anything during surgery, so it doesn't obstruct the surgery at all. That would have failed the challenge if that's what it did.
What's the design IP or the patent protection? Can someone copy you with a different shape or what's the lead time for the HumiGard?
You know, we follow really strong, rigorous IP protection area. I think it really starts with what Andrew talked about this morning with unmet and unarticulated needs. We have the opportunity to really innovate and come up with novel things, and that really puts us in a strong position for IP. What I can say certainly around are the three products we talked about today, really strong IP protection across all of them.
We have another one from online. Are there competing products with Switch and Trace and the surgical diffuser?
Sorry?
Are there competing products for Switch and Trace and the surgical diffuser?
No. I think that's all the time we have for the Q&As. If you have more questions, there's certainly the opportunity in the afternoon, I think around 2:30 P.M. Thank you very much, and also thanks to the team for supporting us and communicating the great products that we have. We'll talk to you again. Thank you.
Wow. There was some good questions, eh?
Great questions from the online crew. Good performance.
That brings us to the end of our morning agenda, and of course, it's lunchtime. Enjoy your break, and we'll see you back at 12:45 P.M.
I think we're gonna have some analysts with Marcus, aren't we?
Oh, yes. Analysts and Marcus.
Marcus Driller is gonna come in. Do some interviews for you. So please be back 12:45 P.M. for that.
Welcome back, everyone. Hope you had a good break. What'd you have for lunch, Fi?
Wow, Harris, what a spread. I went with the sushi, stew and sushi and those little prawn things. They were amazing. How about you?
I actually managed to get a slice of the federal before they were all taken from me.
Yeah, I saw the fight for those. Yeah, nice.
Anyway. Now, we managed to twist on a few. Who is that?
Yeah. We have someone you may already know, in fact. Marcus Driller, our VP of Corporate. We're gonna give him the reins for the next segment, and he's gonna do some interviews with some analysts for you. Over to you, Marcus.
Thanks very much, Fi and Harris. Very pleased to be here with Dan Hurren. Dan is one of our sell-side analysts who provide research coverage, writes some very interesting pieces of research on Fisher & Paykel Healthcare. Dan, great to have you here in New Zealand. You've come over from Singapore and Australia?
Via Australia.
Via Australia.
Yeah, that's it.
One of the people who have come the furthest today, great to have you here. Dan, just interested to get your views on the company, Fisher & Paykel Healthcare. What do you see as some of the short-term challenges and opportunities? Then into the long term as well, the challenges and opportunities for Fisher & Paykel Healthcare.
Sure. Look, I think in the short term, I'm sorry, but you're just not very unique at all. You've got the same problems as everyone else and, you know, they're largely chips, components. You know, chips, freight, staff, trying to get enough staff to sort of boost that sales force you were talking about yesterday. I guess where you differ is just that surplus of installed base that you have at the moment w hich, of course, comes from the COVID period where you had just that massive injection of hardware into the market. Working through that bolus of equipment and getting it employed over the next couple years is, I think, the real challenge.
Of course, that's the challenge today, but it flips to a significant benefit, if you can actually get the g et the sales force in there and get that utilization up there. I mean, my mission in life at the moment is trying to figure out when that inflection point occurs. When it stops being a problem and becomes that benefit.
Yeah. You've been up in the U.S. recently, I know, sort of, you know, talking to, you know, our customers in the OSA space but also, you know, trying to understand what's going on in the industry. Any thoughts on what's happening in the medical device industry in general up in North America?
Sure, yeah. I was lucky. I got to spend three months there last year. I've had another trip back recently to attend Medtrade, one of the big conferences up there, mainly for home healthcare. Look, I think it's not dramatic to call it a bit chaotic at the moment. I mean, hospitals are exhausted. They're a bit broke. They're trying to find their way out of the end of COVID and, you know, staffing issues, all those sorts of things. I think, you know, one of the challenges that you have, and your sales force have, is just trying to navigate that, you know, really kind of, not broken, but perhaps bent a hospital system. Now of course, you know, your technology, you claim, y ou know, has a way through that.
That's right.
You know, and I think that's gonna be the challenge for us, getting the sales force physically into those hospitals, and to the right people.
Yeah. Yeah, great. Maybe just one last question from you, Dan. Really appreciate you joining us. What are your... You know, you've spent the morning, I think, went and looked at the anesthesia and surgical rotation, but any thoughts that you have from this morning? Anything new that you've learned?
Look, okay, it's certainly great to see the new products. Always good to see that. I guess the other thing is that it's what we expect. I mean, you're a company that, you know, you set the target for double-digit revenue growth in the future. You know, we'd expect nothing less. We must see this stuff every time. I'd go as far to say that the year that you don't have one of these and you don't have a bunch of new products, that's the time when we start to panic.
No pressure, F&P team. Every year.
Look, I think it's exactly what we expect, but you know, it's great to see them. It's great to see the products and actually understand it. Just having a look at the campus as well. I haven't been here for about 10 years. It's pretty spectacular. It's interesting to see that.
Yeah. Thanks. Hey, Dan, look, really appreciate you joining us today. Have a safe trip home when you head back to Singapore. But yeah, thank you.
No problem. Thanks, Marcus.
Cheers, mate.
Thanks.
Take that off you. Thank you very much, Dan. Our second interview is gonna be with Adrian Allbon. Adrian's from Jarden, so welcome Adrian on. Adrian, thank you very much.
No problem.
You haven't come quite as far today, Adrian, but you've come from somewhere in Auckland.
Yeah, that's right. Britomart via Commercial Bay. There you go.
Great. Adrian is another of our analysts, works for Jarden here, based here in New Zealand. Adrian, just interested in your thoughts. Similar question that we had for Dan around, you know, the short-term opportunities, challenges for Fisher & Paykel Healthcare versus the long term. How do you see the business?
Yeah, look, I mean it's clearly a long-term company. I think most people wanna appreciate it as a long-term company. It was nice within the result, I guess, to have some sort of forward-looking stuff of what has been a pretty, like, I guess for this company, quite, like an opportunity with the COVID disruption over the last two years. Obviously, also to kind of appreciate what sort of new products are about to be launched. Also, like even if you go to home care, what new products are already in the market and starting to get some traction. I think that was really good. Often we kind of lose sight of that 'cause, you know, being in the markets all the time, we can get trapped in the very short term, which is difficult for this company to provide any great degree of certainty.
At the moment, yeah.
At the moment. T hat's right.
That's right. Yeah. You know, I think you've been on the Airvo rotation this morning, but I'm actually quite liking this opportunity to ask the analyst questions. Usually, Adrian's throwing them at me. It's quite weird, isn't it? Being in the reverse situation.
Reverse service situation.
Yeah. That's right. Yeah, I think you've been on the Airvo 3 rotation this morning. Anything that you've picked up in your conversations or anything new or the way that you think about the business?
I mean, I think Airvo 3, I mean, taking us on the line today. I think that product we would probably expect is an evolution of that therapy for a company like Fisher & Paykel Healthcare. What's quite nice to sort of see come to life by, I guess, being there for 30 minutes and experiencing the product in various different forms is. Just the depth of knowledge that the company has in its particular key market a cross a range of whether you're the patient, whether you're the clinician whether you're the hospital. Just the different feedback that you've taken in and over years kind of incorporated into a platform that you can now scale as your next evolution. I guess COVID sort of probably mucked up the timing of that in some respects but none of this .
It's been a challenge to keep going through. The team have done a great job. There have been challenges, you're right. Yeah.
That would probably be the main thing. Like, from my perspective.
Yeah. Cool. In terms of, you know, as you look out, you know, look out over the next few years, is, you know, anything in particular that you're looking for from us as a company? What are the milestones or the signposts that you look at for our continued trajectory?
Well, look, I mean, I think without a doubt, like everyone, we'll be looking for, you know, what is a brilliant business model. We have an installed base and a whole set of consumables, revenues that tick over for many, many years. We'll be looking for the utilization of that installed base across a range of therapies. How powerful actually the clinical evidence and first-mover advantage you've actually got in that space translates? I guess to be even more kind of specific, you know, do the sales reps turning up at hospitals really make a difference once you've got access?
That's probably on that side. I think anesthesia is an interesting opportunity. Like it's something you've probably been doing in small pockets. You can advertise it, but given now, i t feels like a natural complement to some of the high flow stuff. On the home care, I mean, it's sort of been the poor cousin for the last couple of years, so.
It is for a while, yeah.
There's a lot of reopening, the other one sort of normalizing, so.
Yeah, yeah. I t's great. Hey, Adrian. Adrian, it's been great having you on here.
No worries.
Thank you very much. I appreciate you taking the time.
Cool. No worries.
Thanks, mate.
See ya.
I'll grab the microphone from you, if that's okay. We've got our last visitor, Stephen Ridgewell. Stephen, how are you? Good, I'll give you that. Stephen Ridgewell and I have been doing this now for what? 10 years, actually. I look back, I think it'd be been 10 years since you and I have been talking about the company. Stephen's with Craigs Investment Partners. Really appreciate you coming in, Stephen.
No, it's like it's been a long time. I think of the first stock I picked up as a junior analyst was doing a piece of work on Fisher & Paykel, and it was the OSA business back then w hich was the focus.
That's right, yeah.
15 years has gone pretty quickly, actually . It's been great to see the company grow over that period of time.
Yeah. That's right. I guess similar question that I asked for Dan and Adrian, but you know, the things that you see in the short term, in the long term for Fisher & Paykel Healthcare, what are some of those opportunities and challenges as well for the company?
Yeah, look, I think short term, I'd probably echo what Adrian was saying, that you know, there's the conversion of an installed base. I think it was touched on this morning. You know, I think from a financial market perspective that the timing is uncertain. I think it's uncertain for the company as well. You know, we are obviously looking for proof points of that and we're engaging with customers and trying to get a sense of how long it will take. Just trying to calibrate that is challenging. You've got a company with a 40-year, 50-year time horizon that is trying to look through that volatility and kind of investing for the future. There's, you know, it's a bit choppy at the moment.
Certainly, I think today we've, you know, just reiterated the long-term thinking of the business. The long time frames for success in the market. You know, just to cast my mind back, I do remember when I first started looking at F&P, there were five or six different therapies which were in the model. All of which could be successful, and no one was quite sure which one was gonna work. As it turned out, high flow, you know, invasive was somewhat successful, but high flow's obviously been hugely successful, and l ately they were seeing some really innovative products coming through that you know the next leg hopefully for the company going forward.
Yeah. Yeah. Well, you've been out here, you know, a number of times. Is there anything that sort of struck you or, you know, that you've seen as new or you've learned, you've picked something up as you've come here this evening?
Yeah. I mean, you know, I think with the growth of the company, I mean, it's, you know, there's a lot of construction going on. The pace of adding new buildings has certainly picked up since the early days, Marcus. I think as well, just in terms of what we talked about this morning, you know, the Airvo 3, and I think it's a very impressive product. You know, you can see the clinical use case for that very clearly with the auto-titrating ventilation. You know, that's gonna be a very interesting product to follow. It's probably one of the bigger leaps I think I've seen for a while, in terms of new product coming out. You know, that's certainly one for the future, and we might hear a little bit more this afternoon about other new products.
Anesthesia and surgical. I think you're on that rotation. Now tell me, I'm actually really liking this because, you know, it's usually the other way. Now, are you up for an award tonight?
No, it's not.
No. Neither are we. We have the big finance awards here in New Zealand. Stephen has been a regular winner. Fisher & Paykel Healthcare obviously hasn't helped you out this year. Stephen, really wanna thank you for taking the time to come and speak with us and our audience all around the world. All the best. Thank you very much.
Pleasure. Thanks, Marcus.
Okay. Cheers, Stephen.
Cheers.
Thanks. Now I think we'll hand back to your host, Fi and Harris.
Thank you, Marcus. I'm sure he really did enjoy sitting on the other side of the fence there, asking those questions of the analysts. What's up next, Harris?
Coming up next is our presentation from our Airvo team, hosted by Chris Crone, the General Manager, and Sam Frame, Marketing Manager. Let's take a look at the situation right now. I think they're preparing their studio. We'll see you after the presentation.
Hey everyone, we brought you back here because it was just taking a little bit of time for the on-site audience just to get to that room, and we didn't wanna have you staring at the back end of the back room there. I think we're gonna play the second installment of this Daniell building tour for you. What do we have up next for the second installment?
I think it's the new Daniell building, so the actual building itself. Hopefully,
It's the new construction, isn't it?
Yeah. Sorry.
Yeah, the new construction. You're gonna-
We haven't named it yet, yeah.
We haven't named it yet. We don't know what it's called. We'll head on over to that for you, and at the completion of that, we'll take you back to that room, and the team will be ready to tell you about the Airvo. Enjoy.
Hey, Jonti, I'm pretty sure staff don't drive forklifts, trucks, and cranes, so what's going on here?
Yeah, look, this is our latest construction site, and we're really, really excited about this. This is Building 5. It's our last largest building here on the site in East Tamaki. It'll be close to 36,000 sqm when it's fully constructed. It'll have R&D, clinical, pilot manufacturing, laboratory space, warehousing, and it's gonna complement the final stages of this site. It's gonna be a 5 Star Green Star building as well, so a really high sustainability rating, which is really important to us in our future construction as we're growing. It's under construction, as you can see right now, and we expect that to be completed in the next few years. It'll take us a little time because these are really complex builds, but they are designed to support the development of our, I guess, world-leading innovation here at Fisher & Paykel Healthcare.
That's awesome. I'm gonna zoom in. Do you have any cool stats about the earth moving or?
Oh, gosh, I have so many. I mean, the volume of earth moved, off the top of my head, I can't remember those exact numbers, but they're actually enormous. You can see the basement car park being constructed at the moment. That'll hold about 500 cars. We've got behind them, where the big operators are, a bunch of mountains, I guess. They're preloads, so what they're doing is compressing the soil ready for the distribution and manufacturing areas. All around the edge all the native plants to the property. We're gonna have the perimeter walkway that'll go all around the history, all around our campus, so people will be able to continue to enjoy those walkways during their breaks and their lunchtime. Yeah, it's a fantastic space.
I think probably the one off the top of my head, yeah, 36,000 sqm , so that's a huge, huge building. The manufacturing space is inside it. I think there'll be two large manufacturing halls, and then complemented with the same DNA we use across the site, which is I guess our whole mantra here is continuous improvement. What we do in infrastructure is we apply what we call evolution, not revolution, and we just continually iterate on what we know is a really good design and keep making it better and better for our team here to be as productive as they can and as efficient as they can and to enjoy their work. That's the most important thing for us.
Awesome. Well, I'm looking forward to it. How about you?
I'm ready to sit in my new desk in the new building.
My name is Chris Crone. I'm the General Manager of the Airvo Group, and to my left is Sam Frame, the Marketing Manager of the Airvo Group, and also around the sides of the room, we've got some of our colleagues from the Airvo team. Sam and I are gonna say a few words. We're gonna talk about some of the new features of the Airvo 3, and then we'll have a 30-minute expo. In the expo, we encourage you to go and visit the 5 stations we've got set up. You can talk to our colleagues, you can ask them questions, and you can have a bit of a play with the new features that we've got on the Airvo 3. I'd like to begin by talking about the Airvo 2. The Airvo 2 has been a fantastic success for us.
It's enabled us to treat millions of patients all around the world with Optiflow nasal high flow. During this time, we've learned a lot more about how clinicians treat their patients and a lot more about how clinicians want to treat their patients. Every day we come to work, and it's our job to better understand the patient journey, better understand the clinician journey, and from that we identify problems that we can solve for our customers. There's different kinds of problems. Sometimes they're relatively clear from the outset, and we go and solve them, and we do it really well. Other times, there are problems which are a little bit more complicated. They require a bit of digging beneath the surface, and often those are the ones that are more valuable for our customers when we solve them.
Today, Sam and I are gonna talk through some of the problems we've solved with the Airvo 3, and we're gonna talk about how that enables us to treat more patients around the world, in more areas of the hospital and by more clinicians. Optiflow as a therapy has often been a little bit tricky to move around a hospital. To deliver Optiflow, we need to deliver humidity to the patient, and to create humidity, we need to heat water. Heating water requires power. It requires continuous power, mostly from a wall, but often we've used battery solutions as well. These tend to be quite bulky and heavy. These kinds of constraints have created doubts in the mind of clinicians.
They've had to ask themselves, "Look, do I really wanna put my patient on this therapy when I'm gonna have to change it in 20 minutes, put them on cold, dry oxygen in 20 minutes when I send the patient down for an X-ray?" We've solved that issue with the Airvo 3. What we've done is add a battery to the Airvo 3. It's seamlessly integrated. It means that the clinician can pull the power cord out of the wall, and they can take their patient anywhere in the hospital and be assured that they're still getting that Optiflow Nasal High Flow all the while. Sam's gonna tell us what that means for treating more patients in more areas of the hospital.
Thanks very much, Chris. The integrated battery is a really exciting part of the product and a really exciting part of the project. We think it's gonna make a big difference for the implementation of the therapy and the effects of the therapy. I guess really what it means is that once a clinician makes that decision to institute Optiflow Nasal High Flow, that decision doesn't have to be unmade later. It doesn't have to be challenged later because of the circumstances, and basically, that continuous provision of the therapy free of interruption can occur no matter where the patient is or where they might have to go later. A couple of ways to illustrate that is to imagine a patient in a respiratory ward, for example, and they're on Optiflow.
That might be a patient who needs to be moved to another part of the hospital, a diagnostics area of the hospital for X-ray imaging, for example. The clinician who started the therapy or is managing the patient on the therapy doesn't need to worry about whether the patient needs to go or when they need to go and get an X-ray. They just go and get the X-ray, and they just continue to receive the therapy the entire way there. It might be down a corridor, up another bay or across another corridor and all the way back to their bed space. That's a pretty obvious one. A slightly less obvious one is when you think about patients who are pre-admission. They haven't actually been admitted into the hospital.
They hadn't been allocated a bed space anywhere in the hospital yet, and they're sitting in, for example, they might be sitting in emergency room. At that point, some quite important decisions are made that will affect the rest of the patient's journey throughout the hospital. We think that this, the presence of the in-built battery is gonna make the decision to implement Optiflow nasal high-flow therapy at this early stage, a much easier one to make and one that won't be impacted by whatever happens to the patient next. You can start Optiflow therapy earlier and have the continuation of that therapy, you know, remain all the way through the patient's admission journey and then beyond as well.
In other words, we think there are gonna be areas of the hospital that would've otherwise been more difficult to start the therapy in that will be much easier to make that decision, and there'll be patients who will be receiving Optiflow therapy much earlier. We've set up a station here which is manned by our colleagues, Lisa and Lily. They'll be able to show you what the integrated battery looks like, how the device interacts with it, and show you what happens when you pull the plug. Back to you, Chris.
Thanks, Sam. Now, one of the big issues when we introduce new equipment into hospitals is that of the consumables, and by consumables, I mean the tube and the chamber kits and also the patient interfaces for those particular patients. Hospitals really don't wanna stock more of these than they absolutely have to. There's a couple of issues. First of all, there's space. There's only limited storage space in hospitals. There's another issue of training. That's actually quite a big one. When we introduce new equipment into hospitals, often there's a matter of inservicing tens or hundreds of staff. That might be nurses, doctors, respiratory therapists, to make sure that they're aware of the equipment, and they know exactly how to use it, and that can be quite burdensome, that whole training process. The third one is a patient safety issue.
If you've got storage cupboards full of all different consumables, then at some stage, the wrong one's gonna get taken to the bedside, and there's implications for patient care there. The problem we've solved with the Airvo 3 is that we can use the consumable sets from the Airvo 2 on the Airvo 3 as well. That's gonna mean that hospitals which are already set up to use the Airvo 2 consumables, it's really gonna be an easy process for them to start using the Airvo 3 as well. Not only have we kept the same sets, but with the Airvo 3, we've expanded the range of flows that we can deliver with those sets and also the ranges of interfaces that we can deliver with those same consumable sets. Sam's gonna talk us through what that means for more patients being treated around the hospital in more areas.
Cool. If you think about, you know, what's happened over the last 10, 15 years, we've deployed a lot of Optiflow systems for use in hospitals, and a lot of those are Airvo 2s. We're bringing a whole new platform, purpose-built from the ground up, which is the Airvo 3, and we're gonna be introducing that to hospitals all over the world and asking them to implement them in their hospitals. It's gonna take a lot of work from the hospitals and also from our folk. But one thing that's gonna really help with that is the fact that we're not actually asking the hospitals to change everything. The tube and chamber sets, which, when I say tube and chamber sets, I'm talking about the chamber, this manifold and this heated breathing tube.
Those sets are already stocked in the hospitals that are using Airvo 2. Part numbers and the entry in their operating systems are already there, so they can reorder them easily. There's already stock, there's already space on the shelves for them in the clinical areas and in the storage areas, and people already know how to interact with the parts when they open the bag. Most importantly, if you set up one of these kits on an Airvo 2, you will already know how to set it up on an Airvo 3, so that component of the training is already inherent in the minds of those who are familiar with the Airvo 2.
Chris also spoke about the expansion of usage with other interfaces, and probably the best example of that is this little interface here, which is suitable for a one-week-old or a two-week-old bronchiolitis baby that might come into an admissions center. My own daughter was one of these at one time. That'll fit nicely on that patient's face. That'll now be compatible with Airvo 3. That's an expansion. The cool thing about that is this isn't new to the hospital. These are already available as well. We've got a nice standardization effect there that's gonna help us lower the barrier to expanding the fleet in terms of numbers, but also in expanding where the fleet can go in the hospital and which patients it can be used on.
We're gonna be able to demonstrate that to you. You can have a look at these little interfaces as well, on the station over here, with Blake and Katie-Ann. They'll take you through that, and you can try fitting the consumables yourself. Back to you.
Thanks, Sam. Now, hospitals are really busy places, and time is of the essence, and one of the processes which takes time in a hospital is that of reprocessing. By reprocessing, I mean cleaning and disinfecting a unit so that it can be moved from one patient and used on a new patient. With the Airvo 2, we had the red disinfection tube. How that worked was after patient use, you'd put the red disinfection tube onto the Airvo 2, and it would run for 55 minutes, and it would disinfect the internal elbow of the device. It's a built-in elbow to the Airvo 2, which contains temperature sensors and things like that. Now, we got a lot of good feedback on the red tube. It meant that clinicians could disinfect the device in all different areas of the hospital.
They could put it in the storage cupboard. They could put it in the hallway. It was very handy for them. The downside of the red tube was the 55-minute cycle it required for disinfection. That meant 55 minutes that the device couldn't be put onto a new patient. With Airvo 3, we've kept the option of the red tube. Some hospitals love it. Some hospitals wanna keep using it. We've also added a new feature, which is the removable elbow. Which means that once one patient is finished on the Airvo 3, this could be taken out, sent down to the central reprocessing area, and then a brand-new one can be taken out of its packaging, put straight back into the device, and a new patient can be used. That's almost zero time between patients there.
Sam's gonna take us through what that means for broadening the use of Airvo 3 within the hospital.
Thank you, Christopher. There's two ways to look at this. You could look at hospitals who are already familiar with the Airvo 2 and understand the process for making it available for the next patient. You could look at hospitals and maybe even just hospital areas that are not currently familiar. We think they'll see this in different ways. Those who are already familiar with it are likely to just see this as a straight gain in workflow efficiency. They just get more time, basically. If you don't have to wait for the device to be reprocessed, because the reprocessing procedure comes down to something that's very close to zero, then you've got more uptime for the device to be treating patients.
If you've got more uptime for the device treating patients, you can treat more patients. They'll see that as an improvement. For those who are considering expanding the device to other areas, with staff that aren't familiar with the machine or even hospitals that haven't used it before, they're gonna see this as just a nice flexible way of, you know, two flexible options, for reprocessing the machine, and it'll fit more flexibly, I guess, into the hospital systems that they've already got in place. For example, they may want to only use the red tube process. They can use that locally. Anyone can do it. It's quite unique.
The device is essentially disinfecting itself, and it can be done at the point of care. They may want to exclusively take the elbow out, send it to the central sterilization department, receive it back, and they fit into a system like so. They might want to just run both systems in parallel ad hoc and whichever process works for them at the time will be the one that gets used. There's good flexibility there. Both systems are very thoroughly independently tested and validated to achieve what they're supposed to achieve, which is different patient populations.
They've got two really nice options that they can trust, and we think that's gonna help lower the barrier to expansion of the fleet and use of these devices to use Airvo 3 in more areas of the hospital, which will make it available for more patients. To show you how it works, and we can show you what red tube means and what elbow swapping means. Ashley and Ollie are over here at this station. They'll be able to show you how easy it is to switch the elbow in and out and how we would set up the red tube process. Back to you, mate.
Cool. Thank you. Airvo 2s found a great home in a number of different parts of the hospital, but occasionally clinicians raise a concern about treating patients with Nasal High Flow in parts of the hospital where perhaps there's less patient monitoring or perhaps there were lower levels of staff training. With the Airvo 3, we've done our best to allay these concerns, and we have a fantastic new graphical user interface, which really allows senior clinicians to set therapy parameters within the Airvo 3 and all Airvo 3s that are going into the hospital in accordance with hospital policy. That means that clinicians are gonna have the confidence that patients, wherever they're treated, no matter the day or time of day or night, are gonna have that therapy that's been prescribed by that hospital policy.
It also gives confidence to the clinicians at the bedside at 3:00 A.M. in a ward down the other end of the hospital, that the care that they're giving to their patients is possible. Sam's gonna talk us through what that means for Airvo usage in the hospital.
Thanks, Chris. If you imagine being a clinician who is trying to figure out what's the best treatment for the patient in front of them, they've kind of got two things they have to balance out. Chris spoke about both of them there. You've got a human in front of you who needs to be treated, and they have individual needs, and the progression of their disease is having a special effect on them at this particular time, and their history is playing into that. You know, it all comes down to what you know about it. That's all going to impact your decision-making.
You've also got the other paradigm. You know, it's not necessarily contradicting that, but it is a different paradigm, which is the fact that your peers and the hospital administration have developed a policy to govern care of the overall population. That's based on evidence. Evidence is based on the effect seen in a population. You've kind of got these two paradigms, the individual and the population, and those have to be held simultaneously in the mind of the clinician. What our user sort of menu system does is it gives you that simultaneous ability to address both. You can. The clinician who's using it is presented firstly with a, let's call it a path of great convenience, where they can turn the device on.
The initial settings that are displayed on the device are essentially the suggested settings. They can be set by a hospital administrator to marry up to the policy that's been set out for that area of the hospital or that hospital in general. You look at those settings, and if you're in broad agreement with those, that's your starting point. You start the therapy. That's a very rapid way to start a therapy that will be in line with the protocols and procedures of the hospital. Layered on top of that, you've got the other method, which is at any time before the therapy starts or after the therapy has begun, the clinician can jump in and adjust those parameters based on what they know about this individual.
They can change the flow, they can change the temperature, they can change the FiO2, they can change the alarm settings on the pulse oximetry reading. They can change all of that stuff, and they can do it at any time. In that way, it kind of gives them the ability to practice both of those or have both of those paradigms impact the patient's care. What that means is that the hospital administrators can have confidence that whatever is being practiced, it will be within the realms of the policy that they've created, and it gives the individual clinician confidence that they'll have the ability to operate inside a clinical window that allows them to do what they need to for the patient at the time.
Again, these paradigms and, you know, in the way that our understanding of the paradigms and the way that we've designed the user interface, we think that's going to really create a nice on-ramp, and a low barrier to adoption of these devices throughout the hospital. Now, there's a lot in that, and there's a really nice way for us to show it to you. We've got that set up at the station over here with Ching and Jose, and they'll be able to show you how the user interface works. They've also got a simulator there which will give you a sense of how we're going to scale the training of this for all of the staff that we're going to need to teach over the years. Back to you, Chris.
Cool. Thanks, Sam. One thing we're really good at at Fisher & Paykel Healthcare is managing and the oxygen feature of the Airvo 3 is one of the things we really think is gonna fundamentally change the way that care is delivered, particularly in the delivery of oxygen. Oxygen is a drug, and it's often under-delivered or over-delivered, and clinical guidelines typically give ranges for a particular patient. Let's say you've got a group of patients that might be assigned a range of 92%-96%, and what that means is that their blood oxygen saturation, the SpO2, should stay between 92% and 96% for ideal care. Then you might have other group of patients where that ideal range is actually a bit lower. It might be 88%-92%. Keeping the patients within those ranges can actually be quite a manual process.
It's called titration, and what it involves is a clinician turning a dial on a wall which changes the amount of oxygen that's going to the patient. Then the clinician's gonna have to wait a couple of minutes and see what values appear in the patient's blood. The clinician might have to tweak that a couple more times and wait to see what happens until that patient ends up in that range. That procedure might need to be repeated four hours later, eight hours later, and it can be quite burdensome just making sure that that patient stays within that range. We're really excited about the OptiO2 feature because it enables us to do automatic oxygen titration.
The Airvo 3 can interface with pulse oximetry sensors, and that allows the Airvo 3 to know what's going on inside the patient's blood. The Airvo 3s also got an oxygen valve which can change the amount of oxygen that's being delivered to that patient. The clinician can set up the ranges that they want delivered to the patient. They set up the ranges that they want in the patient's blood, and the Airvo 3 is just gonna keep that patient within those desired ranges. We've done a lot of clinical work on this. We've done some great trials with the Medical Research Institute of New Zealand down in Wellington, and they've been really, really encouraging results. We think we're really gonna have something which is gonna fundamentally change the way that oxygen is delivered around the world.
Sam's gonna take us through how it means we can treat more patients, more areas of the hospital, more clinicians, and also change clinical practice.
Thank you, Chris. Obviously, you know, we're talking about a particular vital sign, which is SpO2, the amount of oxygen attached to hemoglobin in the blood for the patient. Keeping all vital signs within a range that's appropriate for the patient is important, everywhere in the hospital. I just wanna talk specifically about something or areas of the hospital which we'll refer to as lower acuity areas of the hospital. Just for the discussion, I'll just explain what I mean by that. A lower acuity area of the hospital could be defined as a place in the hospital where the ability to intervene with an emergency, you know, emergency medicine or a critical emergency sort of critical care intervention is slower or more difficult to intervene with, I suppose.
Also a place where the average distance between patients and the clinicians is longer or larger, and the number of walls between patients and clinicians is larger. It's generally harder to observe patients, harder to monitor them, harder to intervene if they need it. The reason I wanna talk about this is because in these areas, the consequences of having a patient who is unstable or becomes unstable over time is greater. Because the consequences are greater, it sparks more concern among the clinical community. So what we think OptiO2 is going to do is, you know, well, what it will do is have the ability to keep patients within their target range of SpO2 without continuous intervention from clinical staff.
That should help lower the barrier, the quell the concern about having the potential for an unstable patient in a lower acuity environment. It'll have an impact on clinical practice with high flow. It'll have an impact on clinical practice with oxygen deployment, and it'll have an impact on, you know, the areas of the hospital that hospital administration are happy for the devices to be used in. On top of all of that complication, you've got the fact that, you know, we can, we could stand here and suggest a band that, you know, an SpO2 target range that might be appropriate for one person right now today. The knowledge in this area is changing all the time.
What is an appropriate band within the hospital protocols today might be a more narrow band or a wider band, or it might move up or down. That could happen for different patients at different phases of their acuity, and it might be different for each of the hospital areas. The ability for OptiO2 to take input from the clinician about how tight that band should be and where it is is another area of flexibility that we think is gonna really help. Again, we're going to show you how this works. We've got an electronic finger there that we can use to simulate a patient with specific clinical needs, and we'll be able to show you how the algorithm adjusts to those needs.
We'll also be able to show you how the device learns what the SpO2 of a patient will be and how we can adjust oxygen output to suit. That's gonna be with David and Angelica at the station, just at the back of the room. We're gonna move to that in a moment. Before we do, we've kind of come to the end of the different technology sections that we were gonna talk to you about. Just to summarize, you know, I guess we've got a long runway ahead of us in terms of bringing Optiflow to its full potential. With the Airvo 3, you know, we think this new platform is really gonna help.
We've got, you know, a unique, very user-friendly collection of technologies in there, all developed here at Fisher & Paykel. You can sort of get a sense of how they're going to together as a package. It's going to lower the barrier and create a nice on-ramp to use of the Airvo 3 in new areas of the hospital, staffed by clinicians that wouldn't have otherwise used it in the past, perhaps. Of course, populated by patients that may not have otherwise benefited from Optiflow. Altogether, you know, you can kind of get a sense of why we're so excited about this platform and what it's gonna mean for helping Optiflow reach its full potential and changing, improving patient care and outcomes. That sort of caps off the presentation. I'm gonna throw you back to Chris for some instructions about what to do next. Cheers.
Cool. Thanks, Sam. Okay, now we're gonna move [audio distortion].
Thank you, Chris and Sam, for all of that insightful information about the Airvo 3, a truly awesome system. For me, I think a key takeout was how this device is gonna be able to facilitate treatment of more patients in more areas of the hospital, and by more clinicians. How about you, Harris?
Well, you know, I really liked the fact that they used a closed loop OptiO2 technology, and not only it will provide the most optimum O2, it won't give you too little, too much, but just the right amount.
Just right. I like that. I like that. Now, just like before, it's product show and tell time. We can see in the live room that the audience is now dispersing to see these little product demos. As previously, we've recorded these for you as well. We're gonna move to those. Please enjoy.
We've presented some of the key features of the Airvo 3 that will allow us to treat more patients in more areas of the hospital by more clinicians. I've invited some of the Airvo team to come down and give us a closer look at some of those features. Okay, now we're gonna move on to the integrated battery of the Airvo 3, and for that, we're gonna talk to Ching. Ching, can you take us through how someone might move a patient on an Airvo 2 right now?
Good question, Chris. Because the Airvo 2 doesn't have an integrated battery, so the customers will have to source their own battery solution or probably an UPS. More often than not, the battery they find can be a little bit bulky and heavy, and once it's mounted on the stand, it could be a little bit hard to push around. For those who can't find a battery, most likely their patients will be transported on conventional oxygen therapy, which is called dry medical oxygen. These patients will miss out on the full benefits that Optiflow Nasal High Flow can provide.
Okay. We have the Airvo 3 with an integrated battery. Can you take us through that?
Yeah, sure, Chris. The Airvo 3 does have an integrated battery at the back that is much smaller footprint compared to an external battery. Because it's integrated into the Airvo 3, the Airvo 3 is able to tell whether the battery is fully charged or not. Of course, overall, it has a much smaller footprint compared to a full Airvo 2 setup with an UPS. That makes this whole setup a lot more maneuverable and easier to push around. We believe that patients will be able to continue to use the therapy during transfer, and they can even take the therapy with them wherever they go in the hospital.
Great. Can you give us some examples about where patients might be transferred from one place to the other within the hospital?
Good question. For example, in the ED, patients having to be escalated into the ICU or being de-escalated into the ward, or simply they need to go to a chest X-ray scan, or if they simply just wanna get up, go for a walk.
Okay, great. This is really gonna help clinicians to get their patients mobile and moved around the hospital and give them a lot of confidence in doing so. Brilliant. Thank you very much, Ching. Cheers.
Thanks, Chris.
Okay, now we're gonna talk about the consumables for the Airvo 3 device. Katie-Ann, we talk a lot about consumables. Can you explain the consumable kit that we use for the Airvo 3?
Yes. I'll walk you through the setup. We've got exactly the same chamber as used on the Airvo 2. That heats and humidifies the gases. We've got the AirSpiral tubing, and that continues heating the gas until it gets to the patient. It works with exactly the same.
That's fantastic. What are some of the advantages of having the same consumable kit on the Airvo 3 and the Airvo 2?
It means that, you know, if the hospitals are trained up on the Airvo 2, and the consumable is used with that one, there's no retraining for the Airvo 3 'cause it's exactly the same consumables. Additionally, hospitals will be stocked with our consumables already. They don't need to have two different sets. It's usually, and they can just rotate between the two.
That's fantastic. If a hospital bought a couple of Airvo 3s for their emergency department, they could take a patient up on the Airvo 3 up to a ward, and if they had a couple of Airvo 2s, really, they're already stocked and ready to go to treat that patient further.
Exactly. They've got everything that they need there already. They just need to bring in the patient and set them up.
Fantastic. Can you take us through some of the new flow and interface features for the Airvo 3?
The new Airvo 3 model can go up to flows of 70 L per minute, and that means that we can treat patients that have high therapy needs. Additionally, it goes down to 2 L per minute, and that can be used down to the neonates and use the medium-sized cannula.
Okay. Fantastic. Thanks very much, Kadiane.
Thanks, Chris.
Okay, now we're gonna move on to the graphical user interface on the Airvo 3, and for that, we're gonna talk to Jose. Jose, can you take us through the differences between the Airvo 3 and the Airvo 2 displays?
Yeah, absolutely, Chris. The main difference is up front that you'll see between the Airvo 2 and the Airvo 3, is that the Airvo 3 has a larger touchscreen display with on-screen controls. It also has a new graphical user interface. The larger screen has allowed us to design the user interface in a way that helps facilitate user workflows and actions to make it more intuitive. This in turn helps it to be more accessible to a wider range of users.
Great. One of those workflows we've heard about in the past has been trying to control the flows that are set on the Airvo in particular parts of the hospital. Let's say I was a clinician and I wanted to limit the flow in a particular area of the hospital from 20 L-40 L per minute. Can you show us how we might do that on the Airvo 3?
Yeah, absolutely, Chris. The Airvo 3 allows us to precisely set the settings, so we can set up the device in a way that does help it to follow hospital's policy. Let's just double-check what the settings are currently. As you can see, it is between 2 L and 70 L right now. We wanted to change it to between 20 L and 40 L b ecause that's what the hospital policy says.
We'll go down to the menu. We'll jump into system settings, which is behind a pin lock. We'll jump through that. We'll go to Optiflow settings, and as you can see, we've got the settings here for flow min and flow max. We'll jump in, and we'll change the flow minimum to 20 L. We'll jump in and change the flow max to 40 L. Let's double-check that those changes are applied. As you can see now, we have a range of 20 L and 40 L.
Fantastic. That's great. That's gonna give senior clinicians a lot of confidence about putting the Airvo 3 into different areas of the hospital, knowing that they've got precise control over what therapy is being delivered to their patients.
Absolutely.
Cool. Thanks very much, Jose.
Yep. Thanks, Chris.
Okay, now we're gonna talk about reprocessing, which is making the device ready for the next patient. For that, we're gonna talk to Ollie. How's it going, Ollie?
Hey, you? Good.
Good. Can you take us through the current disinfection process on the Airvo 2?
Yeah. Sure. What we've got is this red disinfection tube. Basically, what you do after you're finished treating a patient, you take your device, you set it up with this tube, and you run it for about an hour, and that will go through your full disinfection cycle.
Okay. I see it can be used on the Airvo 3 as well, but we've got the new feature, the removable elbow. Can you take us through that?
Yeah. We've set the Airvo 3 up to use the same system that is already in place. In addition to that, we've actually identified how to improve this. What we've done is we've set this up so you can actually remove the one contaminated part of the device, which is your outlet elbow. This is actually the only part of the air path you need to clean. What you can do is you can take your contaminated part out. You can take a new, fresh, clean one. You can plug it back into your device, and your device is ready to go, ready to use on another patient.
That's great. That's gonna fit in with a whole lot of different hospital policies. People who prefer to use the red tube or some folk who prefer to use the washer disinfector. What other benefits do you see about using the removable elbow?
Yeah. This basically removes the amount of time required to treat a patient. With an Airvo 2, it's about an hour for your device to be disinfected before you can actually use it to treat another patient. If you're using this removable outlet elbow, it's basically an instant swap. Instead of having to have your device away, not being used, you can use it straight away.
Great. That's gonna encourage clinicians to get their patients onto the Airvo 3 a little bit quicker. That's fantastic. Thanks, Ollie.
Cheers.
Okay. Now we're gonna go through OptiO2, which is one of the new oxygen control mechanisms on the Airvo 3. For that, we're gonna talk to Angelica. How's it going, Angelica?
Good. How are you doing, Chris?
I'm good, thanks. Can you take us through some of the features on the Airvo 3 that enable this OptiO2 mechanism?
Sure. Here we have an Airvo 3 with a standard setup. When we add a pulse oximeter and connect high pressure oxygen, we get a feedback loop. The device can use the blood oxygen levels from a patient to determine what oxygen mix they need to deliver, of course, within the limits set by clinical staff.
Great. How does that differ from the standard hypoxia therapy?
The standard hypoxia therapy, clinicians have to set the oxygen mix and then adjust it manually throughout the day as a patient's oxygen levels may vary. This means that patients may get too little or too much oxygen for their needs. The OptiO2 combats this by responsively and efficiently delivering oxygen as required by the patient.
Great. There's been a lot of clinical work gone into this. Can you take us through some of that?
Yeah. Sure. We have partnered with Medical Research Institute of New Zealand at Wellington Regional Hospital and clinical staff from across New Zealand to test the performance of oxygen closed loop control, as well as the usability of the graphical user interface with OptiO2.
Fantastic. What problems are we solving here for patients and clinicians?
For patients, they'll stay within their target blood oxygen levels for longer, and clinical staff can have the confidence that no matter what area of the hospital their patients are in, they know that the patient's getting what they need.
Fantastic. Thanks very much.
No worries.
Hope you guys are impressed with our new Airvo. As you can see, the innovation doesn't stop. We're always looking to improve. The on-site attendees are still working their way around through their show and tell. When they're done, we'll have the Q&A session slide 4. We'll provide the Slido code when it's the right time. What's next?
Yes. This next video, it's installment three. It's called Manawa Ora. Let's see what that's all bout.
Hey, Jonti, what's this carving doing on the seat side here?
This is a carving of a leaf, and it was actually carved by one of our employees, and it was gifted to the building when we opened the Daniell Building a couple of years ago. It's called Manawa Ora, and basically, the carving pays tribute to all of our Fisher & Paykel Healthcare employees. Just as a leaf supports trees and their role of being the earth's lungs, our people breathe life into the essence of the business, bestowing life and care to people and the world over. I guess ultimately it sort of represents that together we're all one. It's a really special piece of art that we have here on site because it was not only is it beautiful, but it was created by one of our own team members here, Melissa Bornholdt. Really, really neat to have little pieces of our employees contributing all over the company.
That is so beautiful. Beautiful industrial design. That's what that is.
There you have it. That was Manawa Ora, that beautiful kauri leaf. Like before, we now have the dedicated Q&A section for our Airvo team. It looks like they're almost ready to kick that off. Reminder about Slido. This is a different code, so please scan that QR code that you see now. The event code is hashtag FPHAirvo. The QR code should take you there automatically as it's pre-populated. Get those questions into Slido, and we'll take you across to that room now.
Hi, everyone. Sorry to interrupt. We're gonna move to the Q&A session now. So if you can just head back over this way, that would be great, please. Thanks.
Thanks, everybody. Now is an opportunity to ask a few questions of Chris and I. So if we could ask you to terminate your conversation and head back over this way, it'd be great. Thank you. Okay, we've got a couple of wandering microphones around the crowd. So if you've got a question, just put your hand up and the mic will come to you. Here we go. I'll pass that to Sam.
Yep. We'll make this available at a premium. I think, is that what you mean, cost, price? Yeah. We'll be making it available at a premium. It'll be proportional to the value increase. We think that, you know, that's significant. Probably the best read I can give you on that is a significant premium. I think if you ask the question again in the next session, Lewis will tell you something like 2x or 3x .
Yep. We've got one question from online. The Airvo 3 battery allows you to be mobile, but what about the connection to oxygen at the wall?
Yep. Cool.
Yeah, I can take that. The Airvo 3, it entrains air from the room, and that gets filtered and passed to the patient. When the patient needs oxygen, then they'll have a bottle. It may not be visible to those at home, but there's an oxygen bottle holder that you can see in front of you there. An oxygen bottle will just go onto that, and that's plumbed into the Airvo. We have a little valve adapter assembly, so when the oxygen is pulled out of the wall, the bottle will take over and you can move your patient straight away.
Can I also add to that? I know you said, I think you meant oxygen, but you also said air. Just in case there's any confusion over that, both devices, Airvo 2 and Airvo 3, have the primary flow source is an impeller inside the machine, so that's drawing in room air all the time. Air is a required input, but it's being drawn in from the room. You know, for the folks who tried Optiflow over here earlier, we were able to give you essentially Optiflow respiratory support without supplemental oxygen. The supplemental oxygen is required for many patients, and that's what comes from the bottle. There is air as well, if you think about it that way. Room air is being used as the primary source.
Yeah. Just wondering what the Airvo 3 means for myAirvo, and is there a similar upgrade to that device and any changes expected?
Well, that's probably another good question for the next session, I think. Probably can't say much more than that. Marcus, would you agree?
It's a good suggestion .
Yeah. Thanks .
We had a question.
I just wanted to know the timeframe between the Airvo units and also what happens to the sales of Airvo 2 with the introduction of Airvo 3.
Great. Thanks. Well, the Airvo 2 has been great for us. It's a great product a lot of people are still very interested in, so we've got absolutely no plans to ramp down the Airvo 2. We see the Airvo 2 and the Airvo 3 working in concert with each other in hospitals, and we imagine that our sales teams will be selling both at the same time.
Another question from online. With the Airvo 3, how long does the battery last for, and what is the battery lifetime?
Okay. The run time on a single cycle, so the time between pulling it out of the wall and the battery running completely flat, that depends on the settings of the device. Let's say you're running it at full flow. It's 37 degrees. You're running it at 60 L per minute, for example. It'll give you about 40 minutes. At that point, it'll actually go into a lower sort of power mode. It'll give you about another 40 minutes with a reduced humidity amount. We, you know, we think that's plenty of time to get to where you're going to and get back or get from emergency room to through the admission process. That's the first part of the question.
Second part of the question is how long would the battery live for? The answer there is it'll be 300 full cycles or 600 half cycles or 1,200 quarter cycles. Each time, you know, if the battery is depleted by only 50%, that's not counted as a cycle, that's half a cycle. Think of it as 300 cycles, and it'll also have a notification that'll come up every two years that'll indicate to the user that they should consider replacing it.
We have another question from online. Is the Airvo 3 U.S. approved? If not, when do you anticipate the launch?
To sell medical devices into the U.S., you have to go through the 510(k) process, which is an FDA process. We will be thrashing out country plans over time. We don't have any distinct dates which we could say about when it will be available in the U.S.
Hi. I was just gonna ask, so 3x the price with a couple of extra features. Is this being marketed to a different part of the hospital, or are you going after exactly the same market at 3x the price?
Like, you know, as we were saying earlier, there's a big runway with this. The number of different parts of the hospital that could be accessed by Airvo 3 to provide Optiflow is big. You know, there are a lot of new areas.
Even relative to Airvo 2?
Yeah, we think so. Yeah. We think it'll unlock areas that were potentially unreachable by Airvo 2, for sure. Yep. It's sort of the same market, but it's probably a greater number of parts of the same market.
Okay, we've got time for one more question.
If you look at that flow rate of the 60 L for the Airvo 2 and the 70 L for the Airvo 3, what does that mean in terms of, I guess, patient size or, you know, potential increase in the market size as a result?
Yep. Good question. You think the number of patients that could benefit from Optiflow at 60 L versus Optiflow at 70 L is probably the same. You know, what happens between 60 L and 70 L is kind of yet to be discovered. If you look at the body of evidence for Optiflow usage on patients requiring respiratory support in hospitals, which is the market we're talking about, there isn't anything really looking at flow rates above 60 L yet. Having said that, you know, most of it used Fisher & Paykel equipment like, you know, devices like Airvo 2. The way to think about that is it's an expansion of the clinical window.
We'll have to see once Airvo 3s make their way into clinical research and go into protocols for studies that actually use flows above 60 L per minute, what that actual value is. It's kind of the best read I can give you on that. Probably doesn't change it. It might help tease out what flows above 60 L are useful for, but that's kind of yet to be seen. It's, we're opening the clinical window first and then see what effect it has.
Great. Thanks everyone for your questions. We're gonna move across now to the room we were in earlier, and that's where we'll have the bigger Q&A session with the rest of the team. Thanks very much.
Thank you . Cheers.
That is it of our product presentations. As you saw there, the audience is moving to the main room for the final closing. We do have time for another video, and I believe this video is how products can move from our building to the world.
Jonti, this looks really long. Like, what's going on with this long hallway?
Hello, Harris. The corridors here are something that a lot of people are quite amazed with when they first come in. These ones are actually 250 m long from end to end.
250 m?
Yeah.
I reckon I can do it about 10 seconds.
You reckon?
Yeah.
Well, I don't think so. Hang on. Where's he going? Yeah, look, it's a massive piece. You know, one of the things most people are amazed with here is the scale of all of the buildings. It's a really positive thing. It's just reflective of how big the organization is and the growth and all the people that are working here. Anyhow, where's that guy gone? Where's he gone?
There he is.
Yeah, he goes all the way to the end. It was a bit longer, yeah. 250 m is quite long.
Yeah.
You're not even puffing.
No, no. I kinda walked a bit quicker.
Okay.
This looks serious, Jonti. What's behind this door?
Okay, we're at New Zealand's main export center, NZ1. Let's go in. All right, we're down here in NZ1. This is the primary export center for New Zealand. It's 10,000 sqm , so it's a huge distribution center, and it does everything. This is where all the wonderful products get moved out around the world. You're gonna hear behind me, you're gonna hear sirens, you're gonna hear tape machines, you're gonna hear labelers. People are working here. We pump out a huge volume of products every week. We can send, you know, a lot of our products are really small, but they need to be packaged extremely carefully and sent all around the world.
We send out thousands of cubic meters of product every week all over the world to over 126 end destination countries, and we've been doing that throughout the last couple of years without any kind of failure getting products to our customers everywhere. Let's take a pan around and have a look. What you can see is the main outbound export area. Teams are packing products, getting ready for an air freight shipment. Behind, up in the racks there, you can see some products with red security tapes on the top. Those are air freight shipments that are going out. Red security tape is to make sure that they don't get interfered with throughout their journey.
You can see all the racks have beautiful pictures of our products, what we're doing, and they're very narrow aisle racks. The forklifts are all wire-guided, run back. Our forklifts that we use are called a turret machine, so the people go up with them right to the very top story. What you're seeing just in front of you here is the customer specific labeling area. This is making sure we've got all the appropriate labeling and registrations on the products before they're sent out around the world.
Awesome.
All right.
Thank you, Jonti.
No worries.
Amazing. I've actually never been here before, so it's good to actually get a tour.
Yeah. No, it's a pretty neat part of the business. Again, it's that same principle around evolution, not revolution. What you see behind you and throughout the pictures that we just showed you was largely designed by our employees. We don't bring consultants in to tell us how to design our spaces. We create the spaces and then people that are working in them to design how they want to use them. All of the floor layout, all of the packing layout is done by the people that are doing the job. It's a pretty special part of, I think, why we've been so successful here in the export distribution center.
That's what you call innovation. Is that a wrap?
Yes.
You know that hallway was actually. I didn't make it all the way to the end. I was actually puffing.
What?
Yeah.
Yeah. 250 m, Harris.
Oh, dear. Oh, dear. The guests are still making their way to the main room, which we will host the last and final Q&A session for the full panel. The Slido code is FPH panel, #FPHpanel. We encourage you to get involved in this last discussion so that you can get your questions answered.
Yeah, it's gonna be a great discussion, so get those questions in. Well, here we are, Harris. We are coming to now the close of the day, and so this is actually the last you're gonna see of us. Look, on behalf of both Harris and myself, we wanna just extend a really sincere thank you for your online attendance and your attention today. We're now gonna pass you over to that live room for that official closeout and that last panel Q&A. From us, ka kite.
Ka kite.
Welcome back, everyone. Hope you enjoyed the two breakout sessions we ran today. Some really exciting products. Airvo 3 with the new battery and OptiO2 technology is really gonna allow us to treat a lot more patients and a lot earlier in their cycle as well. That's really, really exciting. With anesthesia and surgical, the surgical diffuser, it's gonna be some brilliant patient innovations there. The Optiflow Switch and Optiflow Trace will really allow us to sort of push that Optiflow technology into more areas of the hospital, so it's incredibly exciting.
Cool. For this panel session, we will be taking questions from everyone in the room. Just raise your hand and we'll get a microphone to you. Don't worry for those online, we will also be taking questions from you guys too.
I guess we'll get everyone up on stage and sitting on the couch. I'd like to invite Lewis, Lyndal, Andrew, Winston, Chris, and Sam Frame, our marketing manager from Airvo Optiflow, who I haven't introduced yet, up and onto the stage, please.
I would like to encourage you to take advantage of the team we have here. Get the answers straight for any questions you may have. This is your chance, or online as well.
Hi, good day. Dan Hurren from MST. I was just gonna ask, from what we can tell, products in the surgical space have been a pretty slow grind for Fisher & Paykel over the last 10+ years. First of all, is that fair? Secondly, will it change now that we've got more products going into that surgical suite?
Yes. No, I totally agree. It is from my perspective, it's certainly slower than desired. If you ask the team, they probably know I'm quite dissatisfied with that. No, we've learned some really good lessons from that, and it's about, you know, really understanding what is the problem you're trying to solve, developing the right product which the customer is gonna value, and obviously addressing the problem that the customer values. Then we're in strong progress of, you know, the innovation, and I think Lewis kinda mentioned in the morning, you know, making improvements to the current products and the therapies we are focused on today, as well as expanding the portfolio like we have with laparotomy.
I'll just color in that a little bit. I mean, we're not kinda hiding from this. We have learned a lot of lessons. We do think we need to get the product right. The way that we've learned these lessons is by being out there selling the product. We've had good clinical data. We have a product that does what it needs to. You know, some of the lessons are that's a hard sell. We've learned the lessons by selling the product with people in the field. I think that's part of the process. I think, you know, if you were talking to us 15 years ago, we would have thought we'd be a bit further ahead than where we are now. You know, I think that's part of the game.
It's Steve Wheen from Jarden. Just wanted to ask about Airvo 3 and the data capability of that new device. What sort of data do you collect or intend to collect for it, and what are the commercial aspects of being able to utilize that data going forward? Thanks.
Thanks, Steve. Yes. Yeah, there's a clear need for data to move in and out of the machine, I guess. We'll have the ability to do that. We need to work with probably all parties on that so that customers have lots of choice. You know, as far as the hardware goes, we're in a pretty good place to make that happen. You know, the rest of it, commercial agreement and things like that are still part of our development program.
Thanks for holding on that, Steve. It's capable of doing anything that you want in terms of data transmission or collection, Wi-Fi, 3G. Well, not 3G anymore, is it? It's 5G. You know, you name it, all the Gs, Bluetooth.
USB.
USB.
USB.
USB stick to cloud. Yeah, you can see we've been a little bit cagey on that 'cause, you know, really, and you've heard all day, we don't really have a data strategy. We have how can I improve patient outcome strategy? It's not quite in place yet.
Hi. Stuart Williams from Nikko. I wondered if you could just talk in hospital land about sales force numbers, and, you know, potentially how many people you'd be looking to add and, you know, the strategy across the various states. I think I'm thinking about the U.S. primarily. If you can just give us some idea about the people who are deployed now and, you know, drilling down a level in terms of SG&A, I guess, to how many people you're looking to employ and how that changes with Airvo 3.
Yeah. These numbers will be off the top of my head. You know, let's just go with round things. I would say, pre-pandemic end of 2020, we were something like 1,100 people in the sales operations. I think it's somewhere around 1,400 odd people now, something like that. As we've talked, planning on growing that strongly through FY 2023 as well. Regionally, you know, at a rough cut, and we've done this for the whole duration of the business, the people go where the revenue will support them. It's actually been the kind of default strategy for us forever. The strategy of putting people where the hospital hardware's gone is actually just kind of business as usual for us.
I suppose as a rough take, you know, regionally, from what you can see of the regions, that's proportionally where our salespeople are. We've got a couple of trends going on. One is building out a surgical sales force. To be fair, we've kind of sat on that for a couple of years while we get the product to where we want it to be. Then the other strategy that's kicking in there with salespeople is in the anesthesia space. I suppose it was about five or six years ago, we piloted a specialist sales force selling anesthesia. We are now pretty confident that's a good idea. That gets a much better result. We are increasing that sales force at a much higher rate than any of the other parts of the sales team.
We have a question from online, from Shane at Morningstar. With the scenario analysis for hospital consumables yesterday, was that factoring in the new anesthesia interfaces to help lift utilization above the 60%-70%?
That is a very good question. Sales was affected but not, 'cause they're really not available in the period we're comparing it to. [audio distortion].
Yeah, thanks. Andrew Paine from CLSA. A bit of follow on from that. The Trace and Switch have addressed some issues you've identified in the application of Optiflow. Are there any other issues that you're aware of that you may look to innovate, maybe to. I know we're looking past the Trace and the Switch now, but any other issues that you see could you know increase the penetration of the Optiflow and work towards that 85% utilization rate?
I don't know what everyone behind me here is doing, but I guess we're all smiling, would be my guess, b ecause Andrew alluded to it, in terms of things we'd like to do, improvements we'd like to make, opportunities we can see, that list is longer than probably everybody here's lifespan. The challenge for us is choosing the right one to pursue next. If you want to ask any questions, you have tons.
Just in terms of like, I guess on the call and it's sort of factual, like you spoke about the 10 years of hardware placement in two years. Like if we fast-forward out any of Airvo 3s in operation through the States in a general kind of more general application, surgical consumables start to get some traction and drive, I guess a hardware story. Is that? Are they the two main components that you would sort of see filling in over the top of what we would as analysts kind of think of as a post-COVID hole?
Well, I think when they're referring to a post-COVID hole, my take would be that's FY 2023, maybe FY 2024. That would be my interpretation. I might be wrong. You know, over a multi-year timeframe, we don't really think of it like that. Let's say if you wanna jump just to FY 2023, I wouldn't expect to see anything material in surgical to that impact o f anesthesia.
I'm more of a kind of concept in terms of helping us thinking about future hardware sales. Does surgical drive hardware sales? Does the Airvo 3 or Airvo 2?
In the long term, yes. Yeah, absolutely. Absolutely. Beyond COVID, absolutely. Surgery and anesthesia, yeah. That's kind of the business model for all of the hospital business. We place some hardware, in normal times, the customer uses it and generates consumables. Surgical is no different, anesthesia is no different.
It's Andrew Goodsall, also from MST . Just interested in your views on what the hospital environment looks like after COVID in terms of trading. Obviously, they're willing to see people again, but just their finances and so on in terms of taking up new product.
I don't know if I can comment on that from a factual or experiential basis, to be honest. You know, the backdrop is that almost everything we do, we will have a way of demonstrating that it saves the system cost. From time to time, historically, when there's been extreme cost pressures on hospitals and hospital systems, that's actually worked for us. When they're coming to us and saying, "How can I save some money?
That's great. Thank you.
It's Matt Montgomerie from Forsyth Barr. Just given the, you know, acceleration in high flow therapy, would just be interested in broad-based comments you can make on the competitive environment today versus maybe what it was pre-COVID for high flow therapy.
I'm really sorry. I missed the beginning of that. I was trying to find where you were.
Just given the pull forward in high flow demand over the last couple of years. I 'd just be interested in comments you can make on the competitive environment today versus maybe what it was two, three years ago.
Sure. Throughout the journey we see competitors enter. We saw more competitors enter over the last two years during COVID. I think fair to say all the competitors over the last two years would have been out of China. Fair comment. You've got to imagine we're in a much better position to convert the installed base to being used than any of those competitors, and that would be our take on it. I mean, you do see the Airvo 3 today as well, so you can see there's a step forward in technology there as well.
Lewis, hi, it's Craig here, from ANZ. Just interested, picking up on the comment you made before about a question around the cost savings piece. I'm interested to sort of understand what role the bean counters or the folk writing the checks play in that sales process. I mean, is it. If you can get the surgeon or the anesthetist convinced, 'cause it doesn't feel like there's a lot of CapEx or extra expenditure required for some of the products we've seen today, but there's a huge potential cost saving, so it should actually. They don't feel like they are a major stumbling or hurdle to get over in the sales process.
Yeah. I actually don't know your industry that well, but I imagine the answer to the question is like asking, well, who in a managed fund makes the decision on final decision on what stock you buy or sell. I imagine it's a lot of variation across the room here. Am I imagining that about right? I hope so. 'Cause there's all the variation, and it is hospital to hospital, system to system. It's all over the place. It's a little bit personality dependent. Sometimes it is procurement have the final say. They'll say, "No, I don't care what the clinical benefit is. I'm not doing it." Sometimes a strong physician, you know, will do whatever doctor whatever wants. Sometimes they have committees. Sometimes there's groups of hospitals that band together and have a clinical practice committee.
It's all over the place. Every variation you can imagine. One thing that's constant is sooner or later you go through procurement, and sooner or later you go through a clinical sign-off. Whether that's an individual signing okay with that or a committee or something, you know, those are two steps that everybody has in common. Sometimes I mean, I've worked with one where it was the central sterilizing department that seemed to have the power to say yes or no to any purchase or change in practice.
Just on Airvo, Lewis, you know, sort of identified Airvo in your talk earlier as one of the future pillars of growth. Just interested in what you think that product, if you like, needs to really accelerate in terms of adoption. Is it, you know, a bigger sales force? Is it more clinical data? I mean, the Airvo 3 this morning, very impressive, and particularly the auto titration. Would that be solving a problem potentially for respiratory support in the home?
There's probably technology in Airvo 3 that will translate through to the home, and that's for sure. I guess I'm not giving much away to say that's in our future. Pre-pandemic, we would have said clinical data. We would like more clinical data. Pre-pandemic, we were capturing either early adopters to prescribe myAirvo in the home, or we were capturing people that used it throughout their hospital, especially in a general ward, they're likely to prescribe it for home. That's the pre-pandemic experience. Probably not much has changed post-pandemic other than we'll probably have more wards using Airvos. Hopefully, that'll pull some through, bring forward some myAirvo work. But the need and want for the clinical data, I think actually hasn't changed in the home environment.
If anything, we maybe lost two years 'cause studies we did have going on in that home environment kind of came to a bit of a standstill during the COVID era. You know, we're kind of feeling a real sense of urgency there. As you know, some of these clinical studies take years.
Just maybe one more from me. Andrew, you have good presentation this morning on R&D process. I think that's really interesting. If we sort of look forward, you know, Lyndal was identifying, you know, a couple more sites, maybe one more in New Zealand, one more overseas. We'll find out where that is. Just interested if you feel you've, you know, you can continue to expand R&D focused in, you know, New Zealand or Auckland or whether, you know, you do need to start to go further afield for R&D talent and have campuses overseas. Just how that might evolve over the next five to 10 years.
Yes, that's a really good question. It was one of my concerns, I guess, about where we were going to go next when we go beyond this site. We feel like with the growth rates that we've got, New Zealand can support us for a long time into the future. The number of graduates that are coming out of engineers and that sort of thing. We feel like we've got enough talent to fill that R&D pipeline for a long time into the future.
Probably, you know, we've demonstrated that we're able to bring talent to New Zealand.
Yeah. That's absolutely right. That's not gonna change either.
You know, about, I don't know, over a decade ago, that was a real problem for us, trying to get people to move to New Zealand. In our tiny little niche, sort of global industry, we're a recognized name globally, and people will move to New Zealand because they wanna work for Fisher & Paykel Healthcare. That's been a recent, last 10 years kinda phenomena r ather than, you know, just move to New Zealand for fly fishing and stuff or whatever it is they like. We're good there.
Yeah. Come for the fly fishing and to work for Fisher & Paykel Healthcare.
Hi, Peiting from Northcape . Maybe a question for Lyndal, just on cost inflation. We've heard a lot about, you know, freight costs being high sustainably, but I was just wondering about some of the other costs of raw materials like resin or plastics that go into the consumables or the chambers. Are you seeing impacts of, you know, rising costs from those elements? Also with the integrated battery in the new devices, you know, we've heard about the price of raw materials like lithium going up, will that also impact those prices going forward?
Yeah, we definitely are seeing some pricing pressures coming through our materials. We've got dedicated teams who are focused on negotiation, negotiating with our suppliers and minimizing that as much as possible. From what we're seeing to date, there's probably an annualized about 50 basis point cost increase coming down the track. Obviously, with the inventory levels that we have, that won't all flow into FY 2023. Yeah, we're certainly seeing that as all industries are.
We have a question from online from John Deakin-Bell. The question is, why won't gross margins increase from here? As you continue to grow sales, why is there not leverage?
I think I made it. Well, obviously, I didn't make it clear. We do anticipate our margins to grow over time. Not putting a timeline on that. FY 2023, if we experience the same sort of freight impacts that we do this year, or that we currently have, we'd expect our constant currency margin to remain flattish. In terms of sales, I think Lewis mentioned on the call yesterday that we can't see why we would necessarily, without additional COVID surges, do the same level of hardware sales in 2023 as 2022. Certainly over time, we'll continue to do more manufacturing in Mexico, which gives us a bit of a cost advantage. We are working through our regular price increases with customers.
We are managing the cost increases and inflation increases with that as well. We actually think keeping flattish, all things the same, next year is a good sort of first start, and we do anticipate growing that over time.
Yeah. I just wanted to add a comment to that sort of general economic model in that for us, at this size and for quite a while, in our history, we don't realize an economy of scale, when we double our output, we double the number of buildings, we double the support, and we double the overhead. We don't think like that, and we don't expect that. It hasn't really been the history.
The other thing I would add that we've got up our sleeve is manufacturing in Mexico is cheaper than New Zealand. We've still got that up our sleeve. Mexico is a relatively small proportion of our output at present. Smaller than we'd planned because we've put a lot of that capacity increase into New Zealand due to COVID and due to the urgency, and that's where the 500 engineers were. I think we got time for maybe one more question.
Yeah, Arnault Vessier from Foresight . Just, a very related question on pricing strategy. I guess, you know, a lot of innovative companies like yourself talk very much about pricing for value rather than cost. But whenever we ask you about, you know, gross margins, it's always 65%, so it almost feels like you have a cost plus model. I'm just curious, why not some of your products have, you know, 95%? Some of these surgical plastic bulbs that seems to make a massive difference and costs a few bucks to put together.
I mean, you're right. The 65% is self-imposed. I wouldn't really call it cost plus. When we think about 65%, we're thinking about that over the long term and sustainable, so that's against all scenarios. Currency scenarios and cost scenarios, which means that at times we will overshoot the 65%, you know, when exchange rates are more favorable and things. At times, we might be a bit under the 65%. We chose 65% as a target on the basis of looking back at other medical device companies, what can you sustain over a very long period of time? Certainly, you can go over 65%, but can you sustain it for a long time for us, 20 years, 30 years, 40 years? Can you sustain it for that long period of time?
What plays in there is where you do have the ability, shall we say, to go, "Yep, this is the price I'm charging 'cause you got no choice, buddy." If we do have that, we exercise a bit of self-control because I guess the flip side is you make that business much more attractive to other people as well. It's keeping a balance between an attractive business, a sustainable business, and attracting competitors into it.
Thank you.
I think we're at time. I appreciate the questions. Thanks for your interest. I'm going to hand over to the team here. Thanks very much, guys.
All right. We're good. We're good.
Okay.
See you.
Okay.
You got us.
So
Oh, we go. Okay, thanks.
Get out of here.
Bye. Let's go.
That concludes the forum part of the day. We'd like to thank everyone for attending in person. It's fantastic to be able to have these events again. Yeah, it's been a pleasure hosting you. Fi, any comments?
Yeah. No. I hope you had fun. I hope it was exciting. Hope you explored all our new products and had a good site tour, and ate all the food, of course. In the interest of relentless healthcare innovation, we will be sending out a survey. It's a brief survey, don't worry, for you to complete, just so that we can keep hosting fun events like this in the future.
Yeah. Thanks again to our online audience as well. Hope you guys enjoyed it at home. Now, a tip for young players, we have a shift finishing in about 15, 20 minutes, so there'll be about 1,000 cars descending on Highbrook Drive. I'd highly recommend you get ahead of that. Thanks so much for attending today, and enjoy the rest of your day.
Thank you.
Have a good day.