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[00:00:00] This episode is brought to you by Neteera Elevate patient care with Neteera's contactless passive monitoring solutions. The FDA clear technology uses precision sensing to monitor critical vital signs and behaviors, all without physical contact, providing near real time insights and supporting early detection.

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I'm Drex Deford, president of Cyber and Risk here at this week. Health and the 229 project where we're transforming healthcare one connection at a time. Welcome to this solution Showcase, where we spotlight solutions that work. Let's see what's protecting patients and families today.

Drex DeFord: everyone, I'm Drex. Welcome to Solution Showcase. We have a couple of great folks with us today.

I'm really excited about this conversation. Terri and Rachel, say hi gang. Hi Terri, [00:01:00] introduce yourself and then we'll have Rachel introduce herself and we'll get to the meat of the content

Terri Couts: here. Sure. I'm Terri Couts. I'm the Chief Digital Officer at the Guthrie Clinic. And happy to be here,

Drex DeFord: Rachel.

Rachel Weissberg: Hi, Rachel Weisberg. I'm head of Neteera's Provider Strategy in the us.

Drex DeFord: I'm happy to have both of you here. I want to start with a question about how the collaboration began. You guys worked together on some really cool stuff. How did Nara and Guthrie, how did that come together? How was the timing right to make this work?

Terri Couts: I think timing's the actual secret sauce there. Rachel was just starting her adventure with Neteera and, she knew Guthrie very well and we were on our journey to care for our patients and what we were calling care in place. And so we were trying to figure out how do we approach the care either in the home, in this case, long-term care facility, which is their home.

And how do we prevent [00:02:00] utilization in our eds, in our hospital beds, and, and it was just a conversation that then ended up in a contract signing and and launch and we're learning together. It's been it's been great. What she said.

Drex DeFord: Well, it's good. I mean, I think a lot of this is the true partnership, part of it. Right. I see. You've, the two of you worked together. It hasn't really started at Neteera. You have both known each other for a long time, and so that trust is clear and evident and has become a big part of this.

Right. Rachel?

Rachel Weissberg: Yeah, I mean, when I decided to join Neteera, there are several people that I spoke to. Terri was one, Drex actually was another, which is kind of the irony that both of you're sitting here today. I was introduced to neteera. six years ago before COVID, when we were working on the project, the patient room next project, and thinking about all the different ambient tools and technology.

So when I was looking for a next place to go, I saw a lot of promise for this idea of being able to get ambient understanding of our [00:03:00] patients without having to be there. And I thought, let's go for it. Obviously I did a good job of vetting it with some friends and got feedback that yeah, you're really onto something and we agree.

And Terri was one of the first. That raised her hand and said, I'm willing to go first. I'm willing to, partner with you on this. And it's really been a journey. And that's what I would say. When you talk about the importance of doing business with any startup, it's about trust, it's about partnership, and it's about willing to learn together.

And that's what Terri's really given to, not only me, but to the organization. And so we're really grateful to have such a strong partner to help us.

Drex DeFord: Yeah, that's great. Terri, what is it about, besides Rachel, what is it about Neteera's approach that kind of made it a fit for you, given where you were at in the cycle, thinking about care and place and the other work you're doing?

Terri Couts: the tech was easy, so it essentially plug and play. So the implementation was not something that we had to put a lot of capital in. [00:04:00] So, the risk to learning on how the technology could actually enhance the care model that we were looking for. Was very low. They actually installed it all for us as far as coming out, hanging it making that simple.

I think that, the biggest challenge for us was really about change management and how we can get caregivers to see the why to why we were using a tech like this. Our patients they don't even know that it's in the room. It doesn't change how they interact with their caregivers.

But it changes how we get alerted to subtle changes in their physiology. That would if left undone would take them to the ed. And most ed docs are going to admit those patients. Because they don't know what to do with them. They're not gonna send 'em back to the nursing home.

And so I think, it allowed us to reimagine how we might shift those care models to be less ED focused. And then [00:05:00] more kind of, data-driven insights. And so. One, it was easy. The cost was fairly low too. So like for us, the risk was almost null. It was just really about being able to apply our resources and making sure that we had the right people at the table from, not just from the technical standpoint, but clinical and really providing good feedback to Neteera so that they can take that and make something that works for us.

Drex DeFord: Rachel a big part of what I just heard was the frictionless part of like, it's really easy, it was easy to install, you made it simple. You actually did the work for her. Tell me more about that and how you guys think about that whole process when you're dealing with customers like Guthrie, but also patients and families.

because you're out there.

Rachel Weissberg: So, I think that it's twofold. I think one is certainly when you look at the technology and you think about how we install that, where it goes, that's easy. That lift to Terri's point, we do that, we install it. [00:06:00] It's the adoption and the change management that Terri said that it's critical.

For us as an organization, we have a clinician on staff and I think that makes a huge difference for it. I think having somebody that is able to sit down, I've been there, I've been in your shoes, I get it. Understanding that translation of that language so that when it goes back to our technical team, we're getting it right.

I think anyone that's in healthcare technology's great, but at the end of the day, we're solving clinical problems. And you have to understand those clinical problems that you're solving in order to be able to make an impact on that. And I think that's what we as an organization, that was one of my strong missions when I started, was we need to have clinical support.

And bringing that on has made all the difference to Neteera. It's that translation. I've never been a nurse. I mean, I've worked with hospital or a doctor for that matter. I, I've worked with hospitals my entire career, but I don't profess to know as well as the actual user. So I think that's what it really takes.

It's not as simple as, okay, let's [00:07:00] go. It's really about understanding the current workflow, understanding the dynamics of the organization, the people in the organization. Terri's been great in bringing everyone to the table, and I think that makes a huge difference. Everyone had a stake in the process.

Everyone was part of, what are we gonna do? How are we gonna do it? And then working with us so that, we ensure that we're all charging toward that same mission. I think that's made a huge impact on the success that we've had with Guthrie.

Drex DeFord: there's really no substitute for that alignment.

And the understanding that it's not just the technology, it really is about a much bigger project than just the tech. It sounds like you guys have pulled that off, Terr

Terri Couts: Tech is just the easy part.

But if you don't understand what problem you're trying to solve, if you don't have the right players at the table and engagement it's just implementing a piece of hardware that likely will fail because it's not the used,

Drex DeFord: I wanna ask about the baselines in the threshold.

So you guys are looking not just at 24 hour data, but you're looking at trends across [00:08:00] days and weeks. You're using this data over a longer period of time. How are you using that insight to detect early signals of other concerns that can wind up with patients getting sicker or being readmitted to the hospital?

How are you doing that?

Terri Couts: that was actually something we learned together so that this is really, something we didn't actually predict. One of the things when we were implementing early on was, we wanted to make sure that from a legal risk standpoint, that people understood that it was not

an acute care setting that we were monitoring, like you would monitor in an ICU, right? So that we put the framework in place that, you know because Neteera has that ability to alert when anything goes out of thresholds. On the minute, right? And so the but the care setting did not meet that requirement. And so we started looking at just 24 hours where we were predicting that once a day, we were round with the patients we're [00:09:00] using the staff in the Pulse center to facilitate that. And we were round with the patients. We would look at the 24 hour data and if there was any deviations into that, we would escalate it.

There would be a medical director that would see the patient. Would then provide some sort of care and prevent some sort of escalation in their deviation. But what we were finding is that the deviation wasn't enough in the 24 hour period. Because you gotta remember that you're looking for things that are out of the norm for that patient. And so that patient, normal, or respiratory rate may be 14, but 16 is still considered normal. But if you see a trend over a course of a period of time that is at, going from 14 to 15, then three days later, a 16 and just continues, it's not gonna necessarily do a threshold alert from a abnormal standpoint, but it's abnormal for that patient.

When you actually expanded out that view, then you're actually seeing, okay, this patient's actually starting to decompensate. How do we intervene here? And prevent an admission And What actually [00:10:00] alerted that to us is that we were finding that patients still had some sort of ed visit and we were wondering why.

And so when we started digging into the data we were seeing that and we were able to readjust, okay, this is how we want to use the data. It wasn't the way we actually thought. So we're adjusting our model and then also working with Neteera to actually give us the dashboards and the views.

That actually fits that. Now if we take that somewhere else, that model may change will likely change, particularly if you're in the ED or something. But for that care setting how we use the data was really important and defining that, and we learned together because that was not something either one of us actually predicted.

Drex DeFord: it is a great innovation, right? You started with, here's how I think we're gonna use the data. And then Rachel, you guys kind of looked at what was happening working with Terri, working with the team. You figured out the longer term trends, and as Terri said, like, what's normal for that patient?

What about changing the visualizations and those kinds of things to make it work? How [00:11:00] did you all think about that?

Rachel Weissberg: It's interesting because I think we keep saying this has been a learning process and so this has been a true learning process and there's been a lot of feedback that's come from Terri, but also from, we have quite a significant amount we have over 30,000 units deployed today in long-term care settings.

So there's a lot of data that's out there. We just conducted our own efficacy study and, the interesting part is, it's the exact same thing that Terri found and that what we're seeing is it's usually around five days. Is when you'll start seeing changes. Or when, that's when the change starts, and then it'll start increasing over and over, until you get to,

day, four days before you would have to be readmitted or sent back to the hospital or moved.

all of that takes that, starting with that five day marker. So what we did was we changed some of visualization on our end so that you're seeing, as opposed to the day now you have a weak viewpoint. You can start seeing who are my patients, trending upward. So those are the types of things that we're starting to customize, but it is, it was learning through Terri, it was learning through others and that in that study, [00:12:00] like I said we just finished that study.

So it's like everyone's sort of proving out what we already knew. I mean, it's, you don't all of a sudden change in a matter of an instant. There's certain things inside your body that are happening and changing before it becomes. Something that may need attention. And so how do we get to that?

How do, what do we see before that can be early predictors and early warnings that we don't have those bad incidents. And so that's the data is showing us that we can do that. Now, it's okay. How do we get that message to the right person at the right time so that they can make some kind of decision about that patient and offer that level of care so they can either stay where they are.

Get different medication. We, We just wanna keep people in place where they are and have the best possible outcome.

Drex DeFord: I love that for patients and families. It's really kind of the key to the operation too, right? They don't want to crest the hill. They want to keep that. Excitement is not a good thing when you're in that environment.

And Terri, you're seeing a lot of real clinical impacts on this. Tell me a little bit about that.

Terri Couts: Yeah. So, obviously one of our goals that [00:13:00] we're measuring is around ED utilization. Because again, those patients who come to the ED typically also get admitted. And so, hospital beds for us can't just build more.

And so we wanna make sure that we save them for those who need them and prevent that admission. Plus patients of that age and even being immunocompromised, like they're gonna likely get worse in the hospital. So, we wanna make sure that they don't have that.

So we're seeing less ed admissions, which then, translates to, our utilization numbers from a payer standpoint is better, we're getting. Financial return on that, but also, we're not using our EMS services. We're, not using some of the other things that have a high cost to our health system.

And as we need to be very prudent, particularly now with some of the changes that are happening in some of the bills that money is just not gonna. Come out of the woodwork for us. The other thing that we're actually learning is that Neteera can [00:14:00] actually document vet exits.

And so when you think about if somebody's getting up in the middle of the night more frequently are they getting ti i, those kinds of things. And so we're actually seeing some of that. Are they getting more anxious? All those things. It can intervene a little earlier.

But if you think about how we can use the bed exit. Model to think about pressure ulcer reduction. So are they being turned? We're actually seeing particularly on the night shift that maybe patients aren't being turned the way that they should be to prevent some of those bed ulcers, which then also has, not only a high revenue impact to us, but also, from a quality and patient experience standpoint. It is also a negative impact. So, we're learning and I think where we wanna go is outside of the long-term care facility and be more into the home. And to be able to kind of get as close to medical home or a hospital at home kind of scenario where we can also

use the same kind of methodology for retooling our [00:15:00] population health initiatives.

Drex DeFord: Yeah, makes sense. How are integrations going? Are you doing integrations with Epic or other tools? What's the process there and how's it going?

Terri Couts: So we have a great partnership in trying to look at how that integration can work.

Because of the long-term care facility and the frequency of filing, we wanna make sure that we're not presenting ourselves with, we're monitoring this 24 7. So of course that is something that we're looking at. But I do think when we get into something that's more of a home structure.

that will change. But we're a hundred percent committed to getting this right into the EHR where the providers are doing most of the work. Right now, because our pulse center is. Rounding and using dashboards to round. It's not as nuanced as not having it in the EEHR as if we were to have, a bunch of patients in the home that large cohorts of population health that somebody needs to be monitoring that data.

And so I think it does need to be an A HO,

Drex DeFord: One last question probably for both [00:16:00] of you. And I'll start with Rachel. For other people who are considering going down this path, what's your best advice to them?

Rachel Weissberg: Well, first of all, you need to start somewhere, right? And figuring out somewhere, a place to start. That's the easiest point. So with Terri, it's, thinking about the hospital admissions, right? Getting back into the ed, right? Or if it's treating place, don't boil the ocean with trying to solve so many things.

It's really, think about maybe one thing that you're really trying to go after as an organization and start there. Pick something that's easy, that's palatable, that may not have as much change management associated with it so you can get comfortable with the technologies. This is a new way of doing things, and so I mean, you just don't bite off more than you can chew because change is hard.

So start somewhere that's gonna be impactful, that's gonna be an easier lift, and you can show some of that return easier. I think it's, how do we show that return on investment in a quick six month, eight months? We don't wanna wait two years. I mean, I think we've all heard of those IT [00:17:00] projects where they start and you're like, you're waiting forever for it to get off the ground. So that's why you say it. Really start with something palatable. If it's a unit and it's a, doesn't necessarily be, need to be a full department, but just get that. Because the reality of it is, I don't think that if we look at the future of, where care is headed, we're not gonna be able to do our job without these tools.

So you've gotta figure out how to get comfortable with them and also be patient. That would be my other thing. And this is a, it's new for everybody and I think that's part of is there's patients that's involved. And Terri's obviously a great partner, so I mean, it's really about being, as, and I would say to anyone that's on the supplier, on the vendor side.

So you gotta listen, you gotta be a partner. I mean, we're, take the risk together. I mean that, that's the only way you'll succeed.

Drex DeFord: I like it. Hey Terri. Same question for folks who are thinking about starting. What's your best advice?

Terri Couts: I would say know what you're trying to solve for. Regardless of the [00:18:00] tech, there's a lot of things out there that can be used in many different ways.

And what works at Guthrie may not work at another institution. But I would also say. Learn fast. Don't try to make it perfect out of the gate. And just be willing to put time in to understand where the data is, understand how you're using it, make sure you have Monitoring in place and learn from it and be able to pivot quickly, which is, something that Rachel and I have been able to help our teams understand. And I think, having that key leadership there is super important. This is not an IT project. I just happen to be, the CDO, but I'm also a nurse and so I can speak the clinical language.

Most of these are clinical or business driven projects that need IT to support it.

Drex DeFord: Innovation is really about learning and failing fast and learning again, and just continuing to create better performance. I really appreciate you both being on the show. It's been eye-opening and it's good to see both of you.

Yeah, you too. Thank you.

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