Anesthesia Insights with Bobby Wong of Neximatic

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David Henderson: Welcome everybody to another episode of Time Out for Anesthesia. I'm really excited to welcome back a guest that we had previously... First, I wanna welcome John Lutes, my co-host. At least most of the time. [chuckle]

John Lutes: Hello again. How are you guys going? Back again.

David Henderson: Good to see you, John.

John Lutes: Love doing these things. [chuckle]

David Henderson: And with us today, again, we have Bobby Wong, Founder, and President of Neximatics. Bobby, great to see you again today. How are you doing? 

Bobby Wong: I'm doing very good, how about you guys? 

John Lutes: Great.

David Henderson: Oh, I'm doing great. So Bobby, while I have you back on, we had a great time with you previously, and you speak so well about things in the anesthesia and just the healthcare industry in general, we wanted to bring you back on and talk about it, just in a more general kind of conversive way about the industry itself. Specifically, when we think about healthcare, specifically anesthesia, and technology, software and hardware alike, what are some trends, what are some patterns that you see developing around you right now? And you can include Neximatics and their work with integrations with vitals, machines, and everything that you want.

Bobby Wong: Yeah, so thank you for bringing me to your show. I really appreciate this opportunity. So what we see in the industry as the trend is that... I guess the electronic health systems is not a new idea, right? It's been with us for maybe the past... Maybe 15 or so years.

David Henderson: Sure.

Bobby Wong: What we are seeing right now is people want automation to make their work easier in the workflow, right? So at that, moving on to your electronic health workers is a big giant step, and people are moving in already... Now that people are using it, they want automation. And so what we do... And Neximatics is... We are one of the company that help automate some of the work process in Y shout in the area of vital sign charts. So we have a solution that pulls vital signs, like the heart rate, the blood pressure, the best, and we will stream to the electronic health record system like Graphium, and inside Graphium the providers or the user would not need to write down the vital sign anymore, it's like the number will just come out, they will be put in a nice grid or nice graph for people to see and to help everything down the row, right, from viewing a case to building to anything. And I think this kind of automation is gonna be a sort of like a driver to help people use the electronic health system, health record system more. And this is the area that we help in the industry.

John Lutes: I have a question.

David Henderson: Oh, absolutely, yeah. Go ahead, John.

John Lutes: So I've got to tag along to a bunch of your on-boardings, and you always talk to a bunch of different providers about their opinions on any number of things, right. And it's funny, it's like some people are like, oh, I don't like vitals integration, some people absolutely love it, and I guess my question is, is it as the industry matures just like anything else, adoption just increases? Is it the stigma of, "Oh, I like doing it on paper," I mean we see this too. Obviously. People coming off of paper going to digital, but obviously, like adoption just seems to go up as it becomes more just ubiquitous in our everyday lives. So is that combination of things are changing, plus hardware is getting better. What's the difference between now and five years ago, I guess? 

Bobby Wong: Yeah, I think this is a good question. So just like anything new, right, I mean there's always gonna be early adopters, and there's gonna be people who like to do things the old way, the same situation on vital sign charting automation. And I think what has been... What we have seen that has changed, sort of like the landscape is, I would say iPad. 10 years ago, you will be on a laptop that you will do the case, right? 

John Lutes: Right.

Bobby Wong: The visualization would not be there... I guess it's not very easy to see the benefits of the vital sign automation, right? Now, when you move to the iPad, things are easy, nicer, you can touch and move stuff around. The graphical user interface is much more user-friendly. I don't know whether it is because of the highway platform that has changed or people started saying, "You know what, we can not just see a grid all the time right, you got to see some chart and stuff like that." So I think when we start to see this iPad platform, the user interface are getting better, and people are more open to see more thing populated into the systems. And then on the clinical side, I would say... There's always a... For people who understand the value of charting or automation of charting, they will understand that this, at the end of the day, is about quality of patient care. Instead of putting the numbers in every five minutes, you pay attention to the patient, you anticipate what's going on in the OR. Pay attention to the surgeon everything, right? 

Bobby Wong: And those are the people who will say, "Okay, you know what, I will just solve... Let the system do it's work. Let the computer pull in the data and populate a case." There's also... One reason why people believe in automation, that may not be too obvious, is that when you do paper charting versus some kind of automation, the automation has no bias. Meaning, it's the data that comes in that got put on to the case, no one will have any interference in what the number should be...

John Lutes: That is a fantastic point.

Bobby Wong: Right. And if the provider has to... "Hey, you know what, the sensor got off." He's flipping the patient around, the sensor got off. Then the provider will have to say, "Okay, you know what, the sensor got off." Like these numbers are not right. So now the numbers are right. The sensor have to back off.

Bobby Wong: So when you think about it it's like we don't want everyone to go there, but there's certain unbiased quality of the data when you do this kind of automation. And I think it will be a much stronger impositions. If something goes wrong and you have litigation... Unbiased data is better than something that is hand written.

David Henderson: I love that point, Bobby. I think the only real objection that I've ever heard to adopting vitals integrations, other than things like the expense or things like that, has been... Well, no, because... We don't wanna do that because we want to ensure that our eyes are on the patient and monitoring things. And when you do automation, it removes the human and then we might be tempted not to pay attention any longer.

David Henderson: So I guess... I want you to speak more to that, but I think you started answering it by saying... Well, first of all, the data that you have coming in is actually unbiased, so you're actually removing a problem that comes with humans. But how else would you speak to that objection? To, well, what if... Do you find that automation ever encourages someone to not pay as close attention to the patient? 

Bobby Wong: Well, I would say... Okay, so I'm not a clinician, so I don't want to be...

David Henderson: Sure. Neither am I...

Bobby Wong: Something that may not be relvant. But I've been to the OR quite a few times and I've seen a live case going on, just to see how things work. I think the provider will get attentioned. Let's say that your heart rate goes down, the patient monitor is still gonna start making alarm and make you aware if something is wrong.

Bobby Wong: So I would think that the provider inside the OR would know where their attention should go to. So in that case, we pull the data from the patient monitor. So if the patient monitor has some issue with some number... Like heart rate is dropping too fast, the provider will know. So I don't really see how taking your eyes off, because of automation is detrimental. Because the rest of the system is gonna help catch the attention of the providers.

Bobby Wong: But having said that though, maybe in the future... Maybe Graphium, can also generate alarm. Think about it... You've got the data. You can have it signal alarm.

David Henderson: You've hit towards data a couple of times. And one of the things that Graphium prides itself on is our deep dive into data and analytics that we can then deliver back to the providers and to the anesthesia group so that they can improve both the quality of service that they're offering, they can improve their efficiencies, they can even improve patient turn around and their own payment turn around. All these kinds of things.

David Henderson: But I think one of the things that you're bringing up that I wasn't making the connection to before... And maybe I should have. I'm kinda slow on the uptake. But is the idea of, we can now take... Using Neximatics we can take the vitals information and include that as part of our data capture. And with automation now we can be even more sure that the data that we're bringing in is unbiased. So then when down the line you're making correlations between things you can have a little bit more confidence in the data.

Bobby Wong: Yeah, I think so. You also bring up... It's like a very interesting point too. It's like you know when you compare paper charting versus early day vital sign automation, versus what we do today. Our system actually pull the data maybe three to four times per minute. So for example like heart rate, we've probably got five heart rate per minute. When the data get into a chart, the user may chart it per 10 minutes or per 15 minutes, depending on the case or the policy inside of hospitals. But the fact that we got the data in such a fine granularity give you much more capability to do data analytic.

Bobby Wong: Sometimes I felt like... I've never done a study... But if I were a physician I may want to look at how the heart rate and maybe the respiratory rate correlate, when you're under anesthesia.

David Henderson: Right.

Bobby Wong: Right. And before we didn't have the data, or the data was hard to... How should I say it... Collect or analyze. But now when we have a very fine granularity of data of many types, this kind of correlations start to become interesting, and maybe bring an extraction and, conditions or phenomenon out of it.

David Henderson: Right. Well, that's fantastic. We're always gonna get super keyed up when you start talking about data and analytics, just kind of the nerds we over at Graphium. But... Yeah, that's fantastic. John, did you have anything else that you wanted to ask? I'm satisfied. I think let's just take that.

John Lutes: No, I don't think so. I think that's it's just really interesting information. It's just kind of been interesting to learn about... More about this over the last couple of years... First coming into the company and hearing the feedback and how it changes throughout the years as people are becoming more accepting of this. So it's just... It's kind of funny, you can always see like, "Oh, this is where things are going for sure." So a good spot.

David Henderson: Right. Yeah. I totally agree. And Bobby I'm thrilled that we are in league with you. I think you are... I'm very impressed by your subject matter expertise. I'm not just glad that we had you on the show... Of course, for me personally, that's beneficial, but for Graphium Health, and our users, I sure I'm glad to be partnering up with you and Neximatics. I think we've got some exciting things in our future.

Bobby Wong: Well, thank you so much for the opportunity, and I'm always available to talk to you and to work with you guys.

John Lutes: Well, I think this is your second time on the show, and I'm guessing this probably won't be your last. So yes, please, we'll have you back, hopefully sooner than later.

David Henderson: Absolutely.

John Lutes: Thanks guys.