| Level Ex, a Chicago startup that makes medical-training video games for doctors, has been acquired by Berlin-based medical-technology company Brainlab, the companies announced today. The companies did not disclose the terms of their deal, although Level Ex CEO Sam Glassenberg told MobiHealthNews that his company would continue to operate under the new ownership as an independent entity. "We're a bunch of game developers that have been parachuted into the healthcare industry, and we're constantly seeing technology that is, like, two decades behind what we're doing in the entertainment industry," he said. "Brainlab is the exception. If you go to their offices and see their tech, it's incredibly forward looking. And not just from the standpoint of amazing 3D graphics and rendering technology, but the integration of all the tools into a seamless digital experience in the operating room." Level Ex offers a handful of mobile video games that challenge physicians with hypothetical cases or procedures within different medical specialties, such as interventional cardiology. These scenarios are designed to refresh players' knowledge or help familiarize them with the use of a new medical device, and in some cases can provide continuing medical education (CME) credits upon completion. Level Ex funds the development of these games through deals with pharmas and device manufacturers, in which the customers' specific devices and treatments are featured within the game. Brainlab is a roughly 1,400-person company that focuses on a range of hardware and software technologies for cranial, spinal, trauma, orthopedic, otorhinolaryngology and craniomaxillofacial surgeries. Glassenberg said that Level Ex has had a relationship with the company for years, thanks to a project involving the game-maker's graphics-rendering technology, and he is most excited by Neurolab's work on emerging new software technologies. "You know how neurosurgery and brain surgery have the reputation of sort of being the most cutting edge in medicine? It's Brainlab. It's unbelievable," he said. "They are on the absolute cutting edge of digital transformation in medicine – completely digital ORs, trajectory planning, where you can overlay 3D volumetric MRI data, and ultrasound data, and everything. These are the first guys to jump on augmented reality for use in the operating room." WHAT'S THE IMPACT First and foremost, Glassenberg described the acquisition as a chance for his startup to scale its business. The German company gives Level Ex an opportunity to pursue international clients, and to establish immediate business relationships with Brainlab's existing medical device, pharmaceutical and life sciences partners. "Right now we're already working with six out of the top 10 pharmaceutical companies, and a number of the top 10 medical device companies ... to help disseminate best practices and accelerate the adoption of their products," he said. "Being part of Brainlab only helps accelerate that, and accelerate our growth." At the same time, Glassenberg said that his team's game design expertise will also have a role to play in the advancement of Brainlab's various digital products. "They have a digital OR where different medical devices can integrate so they can be tracked. So inside the operating room you get to see where the device is inside the patient by looking at the imagery. For us, we can use our video game technology and video game design to not only help doctors train on those devices and understand how to use them, but develop their skills on a virtual patient." THE LARGER TREND The news comes just a few weeks after another medical game-maker, digital-therapeutics company Akili Interactive, received its long-awaited De Novo clearance for EndeavorRx. And while Level Ex's video games have fairly unique goals – physician education versus treatment of pediatric ADHD symptoms – Glassenberg said that both the clearance and his company's acquisition signal an increasing recognition of video games' role within the industry. "This really demonstrates that gaming in healthcare is no longer theoretical," he said. "We have real solutions here that are going to have long-standing impacts on the healthcare ecosystem." Prior to these developments Level Ex released free additions to two of its respiratory-focused games, which were designed to help providers prepare for challenging COVID-19 patient scenarios. Glassenberg said they have so far received "incredibly inspiring" feedback from physician players. The company also has an ongoing project with the Translational Research Institute for Space Health (TRISH) at Baylor College of Medicine that's focused on building virtual simulations of how routine medical procedures can be upended during low-gravity. | 
