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David Henderson: Hey everybody, welcome back to another, to me, really exciting, episode of Time Out for Anesthesia. The reason it's really exciting for me is because I've actually never been involved in what we're talking about today. Today we're gonna cover vitals integration, so our system integrates with vitals machines. I won't get too far into it, but back in the day, I used to run support and customer service and things like that, and we didn't have this feature back then, and so I never touched it. So, I'm super excited to welcome everybody today to talk about this. First of all, with us today, again, John Lutes. Welcome back to the show. How are you doing, John? 

John Lutes: Hello, everybody. Yes, the sometimes co-host of this I suppose. [laughter] As we're going through the onboarding stuff, I'll at least stick around for these, for sure. I guess I'll kinda take off.

David Henderson: Yeah, go ahead.

John Lutes: I'll go back into the screen we're at. So obviously we're gonna continue our onboarding series here about just what we do during onboarding and why it's so special for us and all the wonderful things that we do and the wonderful people that we work with. And we'll get to our wonderful guest here in a moment, but back to here we go to our project plan. At this point, we've again, identified the organization and the facility names, and we just talked about this area in the last podcast, which was the client info pack. There is a special section of this client info pack that we don't always do, but if the client needs vitals integration, here is a special section, here we're gonna go talk about what is important about getting that going fast in this process, and this is the site survey. And for that, we are bringing on the CEO of Neximatic, the company we work with, Bobby Wong. So Bobby, how about you kind of introduce yourself. I'll stop talking here, and you can kinda talk about, I guess, the site survey here that we have in this section of our onboarding and what that matters to the clients.

Bobby Wong: Well, thank you so much for inviting me to this podcast today. So, my name is Bobby Wong. I'm the founder and the president of Neximatic. In Neximatic, what we offer is a vital signs streaming, so essentially our device connect to the medical devices in your facilities. And we're able to pull the data out, and then we can stream the data into a electronic health record, like the Graphium systems. So, in order for us to do that, there's a few key informations that we need to have before we can procure the equipment, set-up the equipment and ship them to you. And this is contained in the site survey that we have. So in the site survey there are three areas of information that we need: One, of course, is information about a site; the name of the facilities, the location, the shipping addresses, and that sort of stuff, and the contact people, if we have questions.

John Lutes: Is that this... Sorry, I haven't brought in this screen yet. So this is the site survey we're talking about, right? 

Bobby Wong: Yep, exactly, right. So this page should be fairly straightforward. We understand in any facility, there are different people working together. So sometimes maybe the site manager, sometimes it is the bio-med, sometimes it's the IT. IT can be in-house and outsourced. And what we want to do here is to get a good solid list of contact information, so that when we have a question, we know who to talk to. So, it's gonna help us a lot and it's gonna save you a lot of time. And also, the important thing on this page is toward the bottom, there's this target go-Live date. We do receive a lot of site survey every month, and we look at that information with a lot of emphasis because we want to make sure that we can support our customers, so if you know your go-live day or if you have a rough idea what that will be, please put that in, so that we can understand the urgency of this project versus the other one, and we can prioritize, if necessary. So, if you don't mind, please go to the next page, the network page.

John Lutes: Gotcha.

Bobby Wong: Now, I didn't really explain what our solution is, but you can think of it as almost like a internet of things that is attached to the medical devices. So, one of the key things that we need to have is to be able to connect to the internet or the network in the facility to go to the internet. And this page will help us understand what is your networking infrastructure inside your hospitals. And we'll be able to pre-program our devices to work for your network. So our devices, they can be on WiFi, they can be on Ethernet. If it is WiFi, we would like to have it on a very robust WiFi, right? So, we don't want to have our device on the guest network. We want our device to be on the corporate network, something that you will monitor for connectivities and issues. We will be able to support all the encryptions on the WiFi, so if you know you're doing WPA2, PSK, please specify that. If you're doing WPA2 Enterprise, please specify that. And we can talk about this when we find out a particular encryption method that you use for your WiFi.

Bobby Wong: We also support static IP, if this is something that you would like to do. So one thing I want to mention though is that a lot of times when the IT team come in and do this site survey, they might think that our devices are medical devices. And sometimes they have the understanding that, "Oh, all the medical devices have to be on a free line and they have to have static IP." That's not true for our devices. Our device can be on DHCP, and we prefer to be on DHCP, so that it's easier to support. So just bear in mind that our device are more like internet of things. If you can do DHCP, that's good. If you still want to do static IP, we can support that too.

John Lutes: Gotcha.

Bobby Wong: And I think that's pretty much all on the networking side, if you don't mind we can move on to the next page, the room page.

John Lutes: Gotcha. On the networking side or like the internet of things, so if we put in the Alexa in the operating room. Can we say Alexa start vitals? 

[laughter]

Bobby Wong: Sure. We'll have that in a few years.

John Lutes: We'll put the feature request in. [chuckle]

Bobby Wong: Maybe we will call John.

John Lutes: I'll work right on that. Sorry, go ahead.

Bobby Wong: Okay, so we got through the networking side, so the next part is we need to know what the medical devices in the room. And bear in mind that you got GE, Philips, Mindray. Every manufacturer have their own protocol. They all have their own port that we need to use. So in this page, we would like to have all the rooms and all the medical devices make a model, so that we know how we should program our devices when we ship them out.

Bobby Wong: Now, sometimes I understand that when you look at a medical device, especially some of the older model, to make a model may not be so apparent from the front of it. And this is where we would like to ask for some pictures of your medical devices to... Along with the information, so that we can figure it out if you do not know what it is. So here is some picture. For example, this is a Multara site surveyor. This is a single patient monitor and it is on a wheeler. So when we see this picture, we understand that, "Oh, okay, this is the mobile devices." We will advise you to put a power outlet on the wheeler, so that everything can be all on at once. If you go to a second example, John. So here is a Fabius, and it's good to show this picture here, because what we want to see is that we want to have the front and the back of the devices. The reason being is that sometimes there may be some cabling that are using the port that we need to use. So for example, like here on the Drager Fabius, the com one is the part that we want to use and it is available. So we have seen situations where when we see the picture, we see the port that we need to use is being used. And when we see that, we can start to have a dialogue with the bio-med and find out what's going on. And so when we find out what's going on, we can figure out a solution, that way we can make the installation like way easier and more seamless.

John Lutes: Very cool. Let's see...

Bobby Wong: After the rooms. Okay, so this page, this is for the IT team. So if your site has a firewall or any other security appliance. You might want to pay attention on this page, these are the IP addresses that the Nexi will push data to. The Nexi is our devices that were put in place to pull the data, and I think one key thing that would help you understand is the Nexi or this system, that pull the vital sign and push it out, they only do outbound traffic. So we are not exposing any internal IP of your systems, so this three IP are the IP of our servers. And we only use the port 443 for the outbound traffic.

John Lutes: Gotcha. These are other notes here and just pictures of what? Examples of these? 

Bobby Wong: Yeah. So you should... When you receive the site survey, you should go through some of the sample pictures. They act as kind of reference in the previous page. So we need to source power, the transmitter has to get power. So the ideal case is to get the power from the back of the anesthesia machines, so that the anesthesia machine, the patient monitor, the Nexi, they can all be together at one, in one piece. Now, if you move away from the OR room. John, you can go back to the previous one? 

John Lutes: I'm sorry. This one? There you go.

Bobby Wong: Yeah, that's good. Perfect. So if you move away from the OR room and say that you're in the PACU or this may be the Endo suite, you only have one patient monitor, say it is wall mount. So you can put the Nexi on the wall, there will be a cable connecting from the Nexi to the patient monitor, and then there will be... You have to go to power, so this will be a typical installation situation for a medical device that's wall mount inside a room. Now, John, can you go to the next page? 

John Lutes: Can do. There you go.

Bobby Wong: Okay, so I kind of have mentioned about that earlier when we were looking at the Mutara picture. So sometimes a medical device can be on a wheeler like this one. And the issue of that is, we don't want to have two things, the patient monitor and Nexi, to go to the wall for power. So in this situation, what we will recommend is that you install this medical grade power strip onto the pole of the wheeler. After you put that in, you will put the power of the Nexi on it and the power plug of the medical device on it. And then there will just be one cord going to the wall, so that way there's only one cord, only one power cord that you need to manage and everything will be in one piece.

John Lutes: Gotcha, makes sense.

Bobby Wong: Yeah.

John Lutes: That's great. This is a lot of really good information here. And it's really a pretty straightforward workflow about getting the information you need, so this is wonderful. So we kick off the onboarding obviously, and they're doing vitals. We send this out there as soon as it can to their points of contact, we start to get them working on this. And how long does it usually take for people on-site to get this done? 

Bobby Wong: Yeah, so if we get good information, the installation part is actually very fast. The reason why it's fast is because that we pre-program everything beforehand and we package everything per room, so you're gonna get a package, they include everything. For OR-1 you're gonna get a package, for OR-2. The reason why we do that is we know sometimes in the hospitals the OR can be very busy, you may not... When you go in there, maybe it's being used. And OR-2 is the only room that you can get in. So what you do is when you pull OR-2 package out, you will have the cable for the medical device, you have the Nexi, you have the power, you have the print out with the instructions, and all you need to do is you plug in the power, connect the cable per the instructions on the print out, and you can do that in 10-15 minutes. And what you want to do after you put everything in place is to hook yourself up on a pulse box to generate some data, 'cause you can do it on your schedule. And at the end of the day, when we go to our place, we can check to see which room got installed and which room got bailed on that day. So we can track the progress of the installation. So a typical surgery center with like five or six rooms, you can get done the installation in one and a half hours.

John Lutes: That's great. This all seems really pretty straightforward and simple.

Bobby Wong: And also, service is right away, so you can go in between cases, put the stuff in, and the case that come in after you, after the installation, would have vital signs.

David Henderson: So Bobby, what would you say, so it sounds super straightforward and fast on the installation piece... Throughout the onboarding, what would you say is the number one hurdle that you come across most frequently when we're going to do an install? Would it just be the information, getting the correct information or what? 

Bobby Wong: Usually, it is the... Well, it kind of depends. So the bigger the organization is, usually the information would not come very cleaned. Part of it may be you have different people doing things. The people who want the vital signs are not the people who fill up the forms. So the bio-med would be the one filling out the forms. So one thing that I've seen has helped us do it is you can actually have this form, once you fill up the facility page, you can give this form to different people and tell them to fill in the relevant part of it. And then they can send it back to us individually, so separately. And we can correlate all the information together. Yeah, so once we clean up all the information, like the installations is actually super easy. It's like we just did one that has eight rooms, right? We just sent the equipment out last week, they got it. It is a general hospital, so the bio-med called me, "Hey, okay we are gonna do the install today." And I just told him, "Hey, just follow it, follow the print out, do the post-ops at the end." So by the end of the day, he got all the rooms done. I think he probably spent at most two hours in the different ORs.

David Henderson: Okay, so it sounds like you have a similar story to I think what John would say about Graphium users when they're on board, and that is you're never waiting on us.

John Lutes: Right, yes.

David Henderson: We're always ready to roll. If you can just get the information to us that we need, we're good.

John Lutes: Cool. Well, that's great, man. I can't thank you enough, again, for taking the time to do this.

David Henderson: Yes, thank you so much.

Bobby Wong: No, you're welcome.

John Lutes: If anybody has any questions, of course, we're always here to help, and so is Bobby. Bobby and a team, I sense. Not always just Bobby. So fantastic. Well, thanks again, everybody. David, anything else I'm missing? 

David Henderson: That's it for me. Thank you guys for joining. I hope you enjoyed it. And Bobby, thanks again. Appreciate you.

Bobby Wong: Thank you so much guys.

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