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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.

Now is the time to step into the future of healthcare. Visit ThisWeekHealth. com slash Neteera and transform your patient monitoring capabilities.

ultimate goal here is for you not to have to change your behavior in order to utilize our technology.

Where do you visualize this data? Where do you collect this data? Where does your team spend their time? Is it in Epic? Is it in Cerner? Is it in PCC? That's where we want to deliver it.

Welcome to This Week Health. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, where we are dedicated to transforming healthcare, one connection at a time.

Now, onto our interview

(Interview 1) [00:01:00] All right. We have an interview in action today and I'm excited to be joined by Joe Zaccaria. Joe, we were just talking about your title. Tell us about what you're doing

Yeah. So I guess my formal title is VP of strategy and finance.

I've been with the company for just about seven years now, a little longer. So I've been really through the journey with them from the ground up. I was part of the initial investment round way back in 2016. So I got to know the C suite pretty well and ultimately joined them at the very beginning of 2018.

We really had this vision of, How can we take a different type of technology and leverage it to really impact different markets? And one of the big inspirations in the company was Steve Jobs. And I see the picture behind you. There's a picture of him when he was very ill, laying in the hospital bed.

And he's we've come all this way with wireless, everything. And I'm sitting here strapped to an EKG and a breathing tube and all these things. And we really haven't come far enough in the healthcare journey. An Israeli technology company Israeli tech in general is very good at taking a piece of technology that might not be specific to a market, but [00:02:00] adapting it for a different use case.

And that was really what drove the vision of using a contactless system for healthcare. .

That is what the conversation's gonna be about. It's really the patient room of the future. And as we look at this, we're the patient room of the future. There's almost an interesting debate of what is the patient room of the future?

Where is it going to be? Is the first question people want to ask. Is it still gonna be in the acute care hospital on the campus, or is it going to be in the home? We know more and more care is being provided in senior care centers and whatnot. And the contactless really does open up the opportunity to do a lot more out of the home and in those senior care facilities, I would imagine.

Yeah, for us, I think when we went into this, we thought that we'd start in the home and work backwards, and then we realized that you need to get really clinical buy in and clinical utility and learn from the people who are using it. So we actually had to go back and start in that clinical setting, which for us today is predominantly skilled nursing, as you mentioned, but more and more in areas of needs within the hospital.

So if you think about emergency departments [00:03:00] and labor and delivery or care. Areas where you typically don't have telemetry or ICU data, but that data is valuable. That's where we are starting and then ultimately you look at the home as the ultimate extension of where you can give care or where you can have some degree of comfort with the patient status and to your point, the contactless nature, the scalable nature the over the air updates and the new features that come along really give us a unique ability to deliver that care in whatever setting makes most sense for the patient, where they are in their journey.

When you talk about The health system and hospital setting. Obviously, would imagine you get a lot of questions around the clinical viability of contactless. are the answers to those questions? What's the response?

The response is that if you can't trust it, then you can't use it.

So we've had to go through the FDA validation process. And we thought, at that point we got FDA approval. We were done. Then each customer says, no, we need to validate it to our standards too, and in [00:04:00] our environment, in our use case every new customer touch point. Is both an opportunity, but we have to validate that we do what we say we can do.

We're working with one of the largest hospital systems in the Northeast right now in a telemetry unit. And it's validation of the data because their team and their clinicians need to trust the information coming out of it, not just say that, the FDA said this is great, so we're going to go with it.

Wow. So a project like this. starts with a pilot, and then scales some more, I would imagine.

It does. So it starts with a pilot. There's a couple of phases to it. The first phase is, let's install it and see what the data says versus the ground truth, which is a typical telemetry system.

The next one is, what is this data showing us that the telemetry system is not? And how do we interpret it? Because it's not apples to apples. Even a telemetry system, there is. There's dozens of flavors of it, what data is coming out, what metrics are being pulled from it. So we're incredibly accurate in both heart rate and respiration rate, and the ironic part is, most clinicians [00:05:00] don't use respiratory rate because it's a, your breathing pattern looks fine, we're going to put a 16 down in your chart, but the reality is, that information is probably the most dynamic and the most useful.

So the clinicians have to go back to figuring out, okay. How do we use this? How do we change our approach to delivering care based on a whole new set of information that we didn't really know the meaning of prior to it? There's that second phase of the, okay, how do we implement this? And then there's the word of mouth within the organization of, I wonder if they can help us solve this problem.

In that case, it could be labor and delivery, or I wonder if it can help us solve this problem, which we've had adverse outcomes in emergency department waiting rooms. So it's really amazing to see every clinician you talk to has a different axe they need to grind.

And one of the things about a flexible, scalable platform is it allows us to solve a lot of those problems with the same system.

Is it one system, one patient? You just said a waiting room and I'm picturing a bunch of people sitting around and it's monitoring a bunch of [00:06:00] people.

I can't imagine that we're doing that yet.

No, so that's down the line. Our system will be hopefully one device for multiple people, but that's not where we are today in the waiting room environment. These are actually installed either in the waiting room chairs or just behind them.

So it's assigned to a chair versus a patient this way. It's agnostic to who's there. If it's Mrs. Jones or Mr. Smith's wife we want to just know that somebody is stable. And it doesn't really matter because they're not admitted yet. We just want to know what's going on.

That's a fascinating use case because so much happens in And the health systems that are taking you into going at scale and whatnot, are they predominantly within the four walls of the health system? Or are they starting to? take you outside of the health system as well?

I think

we see a lot of commonality in the goal, which is we want to have this across the ecosystem to deal with continuum of care with consistent data flow from a consistent device. There's different approaches to it. We have a [00:07:00] group in the Scottsdale area that's starting in the emergency department.

And then they'd like to go into a new facility they're building, and then ultimately into skilled nursing. So they're across organizational structure. There's some that are saying, hey, you've proven that you do very good work in skilled nursing. We're going to start there. So we can work on all the integrations that are important to our organization, figuring out how we're going to use the.

The ability to monitor from a centralized location before we deploy across the hospital system, or there's people in, systems in rural areas that are looking at starting in skilled so they can prove out the use case and then have the home as the next frontier, if you will. So it really depends on , what problem they're trying to solve and how they want to go about it.

let me think about the different problems, and I always think about the economics of it. a finance guy as well. The economics of it does play into it. So for a health system, they're solving either a specific problem that they are not able to solve any other way, or they're replacing [00:08:00] devices.

So the financial model is really replacing existing devices, I would think.

It is. There's also a manpower element to it. There's a, what don't we know? There's how do we reduce readmissions within the organization? There's a lot of different pieces. The thing that we found is we typically have to lead with a hard dollar savings because finance people say, It will be nice if the soft dollar savings can come with, FTE replacements or nurses can do more with less, but the reality is they're so constrained from a resource perspective that anything you can give them in soft dollars isn't so much as a savings as it is a gain in utility.

But there are programs in place that can actually. offset these costs, they can turn into profit centers. So it allows the organization to see a glide path to, okay, we can take this financial risk now because there's programs in place that could potentially offset the cost and maybe make it profitable.

But we see where we want to go. And those are the soft dollar savings that we'll know we'll get to, but we got to really be sure in the [00:09:00] beginning that the hard dollar value is there. And then one of the cool things about our system is there's over the air updates, so we'll push new features. We recently launched something with a motion index, and down the line we're talking about blood pressure and atrial fibrillation, and these don't require a hardware change.

They're just an over the air software update because it's a reinterpretation of the same signal. It's a different algorithm layered on top of it, so What we're trying to do is give them something that has a defined ROI today, but has an incremental one as we go forward.

Yeah, you're almost defining the Tesla car, right?

Software changes the world. Yep, software assigned

medical system.

Yeah, so senior care, There actually is reimbursement for this kind of device, I would assume.

Yeah. There's a couple different programs. There's remote patient monitoring. There's remote therapeutic monitoring. There's a bunch of different things that can go on.

We see, people depends on how the organization is set up and how they want to use the technology. But this can be a full enterprise business for a group that wants to specialize in remote patient monitoring [00:10:00] billing. Or it can be an augmented workflow tool if there's a physician group on the ground that wants to just utilize the data differently.

And home care is predominantly readmissions that we're addressing, Home care is,

it's a little bit like the next step down, which is, you're ready to leave, but we're not ready to let you go. So it's that next level of patient care where you may have a visiting nurse that's part of the program, but our tool is going to give a data element to that to give that quantifiable, qualitative.

Feedback loop to the clinicians.

\ is really interesting, because talk to CIOs all the time about the patient room in the future, and mention wireless, and they'll mention cameras in the room, and it's all these devices that are going to be around in the room. That are going to be monitoring the patient.

And this is just the natural next step. Instead of all those things attached to me, I'm going to have something that's monitoring my vitals and whatnot. vitals are you monitoring at this point? And, the next step there?

Yeah, so we have respiratory rate, heart rate, the derivatives thereof, meaning we can see heart rate variability, heart rate [00:11:00] interval, respiratory rate, respiratory variability, respiratory depth which is how deep or shallow your breathing is, which is incredibly important contextually, not just the absolute number.

We do motion, so we can see things like, how restless somebody may be in bed. Have they left bed? We can see some of the behavioral patterns around that. Have they left three or four times in the middle of the night? For how long have they gone? We're working on blood pressure. Like I said, atrial fibrillation.

We can see the flutter in the waveform of the heart. There's a lot of different things. Basically if your body delivers a mechanical signal, we can pick that up. Everybody knows an electric cardiogram is right. It's the electrical activity of the heart.

What we're measuring is what's called a ballista cardiogram. So it's the mechanical activity of the body. So we're hoping that we can see things like stroke output stroke volume, cardiac output, things like that. if there's a mechanical element to what your body's producing, we're hoping that we can, deliver that in the future.

What does the installation look like? It's interesting when we talk about all these devices and whatnot. And then I talked [00:12:00] to the CIOs and they're like, yeah, you know me. I'm going to have to retrofit all these rooms. I'm going to have to do this. I'm going to have to pull this in, whatever. Is this a significant project to put these things in no,

as a matter of fact, that that customer I was talking about here in the Northeast, we just did the 34 unit installation there in one of their telemetry weddings. They kept saying we know that you told us it's going to be easy, but we actually had no idea how simple it was going to be.

We pre programmed these devices. They get mounted on the ceiling with a clip that we have that attaches to the drop ceiling. And then the wire goes up and gets plugged in and it's over Wi Fi. Future generations will have power over Ethernet. Incredibly simple. Takes our guys a few minutes for every room.

And it's completely, scalable and flexible. It's remarkably simple.

So all they need is power

right now.

Power and

Wi

Fi.

Power and Wi Fi. Yeah. Wi Fi, is sometimes more difficult for people to want to give us access to. But other than that, yeah, power and Wi Fi is all we need.

it feeding all the devices into the normal tools that I'm going to see at the nurse station?

So right now our data flows [00:13:00] either into their bespoke workflow, if they need to use our APIs to pull it in there, or we can push it into an EMR system and have it go into whatever. ultimate goal here is for you not to have to change your behavior in order to utilize our technology.

Where do you visualize this data? Where do you collect this data? Where does your team spend their time? Is it in Epic? Is it in Cerner? Is it in PCC? That's where we want to deliver it. But, if you're an organization that's built a business around this technology, and you have your own bespoke workflow that you're pulling it in, we have partners that do that too.

Who does this sale start with, out of curiosity? Does it start with the chief medical officer? does it start with a CMIO? Where does it start?

Yeah I wish I could tell you because that would make our lives a lot easier, but typically it starts with somebody who's got some type of innovation in their title where they're looking at what is the future of patient care look like?

What is the future patient room look like? How do we future proof what we're doing? We tend to have clinical informatics [00:14:00] people are very interested in what we're doing. CMIOs folks with a clinical and an innovation tilt are usually our best friends.

That's awesome. Yeah.

Joe, I love the work that you guys are doing. I appreciate the fact that hopefully by the time I'm sitting in that room, I'm not strapped in and wired into. Or hopefully we can

keep you at home.

Yeah, that would be even better. And do hope that is the future of healthcare, that we could figure out a way to keep more people at home.

I think that is the desire. Hey, thanks for your time. Really appreciate it. Appreciate it, Bill. Thanks.

Thanks

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