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David Henderson: Hey. Welcome everybody back to another episode of Time Out for Anesthesia. I'm David Henderson, the producer of the show, usually behind the scenes. Also welcoming again John Lutes. John Lutes is also an onboarding specialist, you heard from him previously, and we wanted to dive a little bit deeper into that subject. And so John Lutes actually suggested that we bring on another guest, and we're gonna have him, another onboarding specialist with Graphium Health here with us today, and I'll let John go ahead and introduce him.

John Lutes: Sure. So in my onboarding overview call, it was just a very programmatic way to clip through everything that we do, but like David said, we thought it would be a good idea to bring in some of the actual characters that we'll see during onboarding. And none more important, of course, than Frank Dansby. I'm looking at my screen here, 'cause I'm gonna bring up my screen here in a second here, but I'm gonna bring in... We're gonna bring in Frank Dansby to go through a couple of important parts. In this section, we'll be talking about the site prep area. Alright. Welcome, Frank Dansby. So Frank, we've done a little introduction of you, I'll do a little bit more. Frank Dansby leads up our support. Usually, if you come in with support questions, he's gonna be the first person that quarterbacks all those questions. So that's where you get handed off after the onboarding, but during the onboarding, of course, he's crucial in a number of roles. One that we'll be focusing on today would be that area that I call site prep, specifically all the equipment and the hardware that we talk and recommend for people, and how that goes about, best practices we've seen, and that kinda stuff.

JL: So Frank, I'm sharing my screen right now, and a demo Go-Live project plan, where we've established the Oregon... The facilities here. Of course, we don't have actual names here, but I would say just start talking over this section right here. Why do we get demo bar codes and what we use them for, and really hit on the equipment, why we like different iPads, and which ones we like, where they can find that.

Frank Dansby: Oh, gotcha. Yeah. So barcodes, yeah, they're important, especially when using the iPad or our application, it basically puts you right into the patient, where they encounter information, so that way you know that you're definitely matched up with exactly the patient that you're looking to charge.

JL: Perfect.

FD: Yeah. On that, so as far as the iPad itself, like mentioned, typically what we tend to recommend for our iPads, the iPad use, is a current iPad Pro. Reason being is that if you were to purchase that today, or one of the current iPad Pros that Apple just put out, then it'll be good for the next three to five years. So it has adequate memory and storage and a good battery, so that way you won't be having to repurchase new hardware with each new iteration every year. So it just really becomes critical going forward with our platform to have something that is the most current that you can get.

JL: Buy it nice or buy it twice kinda deal? 

FD: [chuckle] That's good. That's funny. Right. Yeah.

DH: And Frank, have you ever... What kind of issues have you experienced in the past? Have you ever had anybody purchase an older iPad, and if so, what kind of things do you see happen in their workflow when they do that? 

FD: Well, essentially, there is this idea that, "Use what you can get by with today, 'cause it works," and it makes sense. But one of the things that Apple does not publish is the amount of memory in an iPad, that you can find it, it's online. It's not really hidden, it's just not something they broadcast. But you run into memory issues. So with our application specifically being that it is cloud-based and it needs a real-time connection, memory becomes a big deal. And so when you're storing multiple photos, things like the ultrasound screen, any of the demographics, etcetera, or nerve blocks, any of that stuff will actually increase the memory usage, and therefore you experience a lot of lagging and issues on the application. So older hardware really does slow you down. So you get by by going slower and/or not working.

JL: And when you said memory, obviously what you're talking about is RAM. I think it's probably confused a lot, like people saying, "Well, which one do I get? The 64-gig one? That's the memory we want, really." We really don't care about that, right? I mean, that's really completely... But yeah, the actual RAM. And like you said, they can find it places, and stuff like that, so.

FD: Yeah. Fair point. Memory and storage are totally different, although often confused.

JL: I definitely saw one user using an old... The first-generation iPad Mini that worked with a pencil, and I was astounded that it worked. And she said she liked it and we're cool. I'm like, "Okay." And I just wanted to let her know it won't... It might not work forever, especially as we add more features and stuff like that. But yeah, definitely those iPad Pros. Yeah. And we also talk about cases a little bit, and of course, we have a help article on this, where we go through all of our best recommended things, and we're always keeping that updated, and during the onboarding process we'll of course send it out to people, but...

FD: Of course.

JL: I don't know, I love talking about cases too.

FD: Yeah. It's funny, 'cause everyone has their particular variation of color of what they like, and for home use, that's great but when you're actually... You gotta think about the different scenarios, like when you're at home, you're gonna be sitting, rarely standing or moving, and so you found what's comfortable, or you may be actually docking it on a desk, whatever. However, when you are in anesthesia, or are actually working in healthcare, you are often on the move, or you are standing, or you are moving with it. You need something that actually has a grip and not a flap that will go over the screen and it rolls back behind, it covers the camera. So we tend to recommend... It's a phone case originally started just for kids essentially, but it protects the iPad, and it usually has a carrying handle, and so it makes it easy to grip. There's a lot of variations.

JL: I love that case.

FD: Yeah, I do too. I mean, yes, my...

DH: Yeah, that's got that thing on the... It's got a hole in the back for the camera too...

JL: Yeah, right.

DH: So you're not covering it up. All kinds of good stuff, yeah.

JL: And it costs you like 15 bucks, they're amazing.

FD: Yeah. Yeah.

DH: So many times we'll go into hospitals and they'll be these wonderful $50 cases, and like, "Those are great. They're gonna be horrible, don't use that."

FD: Yeah, and it doesn't matter what brand you buy of those things. They're on Amazon for so cheap. Everyone makes it. But yeah, and you can throw the iPad, and it usually is fine. Not that I recommend it, but you can.

JL: Right. Screen protector's always a good best practice to swallow but I think we'd probably ad nauseum on the actual hardware. So great. Check out the hardware section, get a good iPad. It's worth it. Buy it nice, buy it twice... Or buy it twice. Don't buy it twice, of course. Another big deal of course is printers. Obviously not something that people think about like, "Wait a second, aren't we going digital?" "Well, yes, you are going digital, but sometimes there are use cases for printers." So Frank, what are your recommendations on printers? What do we usually tell people? 

FD: Well, the bottom line is that the printer has to be on the same network as the iPads, as well as air-print capable, because these are iPad, iOS devices and they can only print to devices that are capable of doing AirPrint. So there is that as a caveat. As far as brands, most brands work very, very well. We tend to recommend a Brother, Brother printers because they are efficient, they are more often not just monochrome printing, and ubiquitous. You can get them out almost anywhere. But it also makes... The toner restock is very inexpensive. And really all you're doing is just printing a basic report or a record. And that's if you're printing of course. So we tend to recommend those. There is scenarios in which we can utilize an existing printer, and those almost always have AirPrint capabilities. And so we work with the IT teams to make sure that the printer that they have is compatible and so on and so forth, but basics, AirPrint capable.

JL: And even if printing is not a part of your workflow, you might just be working and somebody'd be like, "Oh, can you just rip me off a print of that real quick?" And yeah, the answer is yes, as long as there's a printer on your network, and you might not be using it everyday workload, but hey, if you need any quick printing, it's an easy way to do it. Now, there are other ways to do it, obviously from the dashboard, depending on what you're doing, of course. But yeah, if you wanna try to do it on the fly, we always wanna make sure that...

FD: One of the interesting questions I think that comes up is, well, why print? What would be the scenario? Often, the scenario is PACU nurses, so they may actually need to see a printout of the record, and so therefore you print out to the PACU. And so that way they have a copy. But that is almost always a reason why, if we have back integrations with billing and the host DHR system, et cetera, the only reason why we'd print in that scenario is for the nurses that they don't have access.

JL: Right. Alright. The biggest, most important part of hardware that we ever talk about when we go to hospitals, surgery centers, whatever, you know where we're going with this, Wi-Fi internet connectivity. Bring it on, bring it home.

FD: Like you mentioned, right? So our application uses a real-time interface, so it has to have a solid connection at all times to work. So basically testing to make sure that there is adequate coverage everywhere that you'll be using the iPad is critical, so OR PACU, even as you, basically traverse the network, sometimes in pre-op or holding. So there is that to discuss, typically the way that you can test that just as a really basic test is to take an iPad and literally walk to those locations and around, and test your signal strength, also using the application in a test environment or a test facility and actually just charting on a test patient, that will also let you know literally how our application is gonna work in that scenario. So what we tend to recommend to the IT team, we have a whole list of recommendations, like it needs to be within, such a signal ratio... Noise to signal ratio, I'm sorry. Within certain signal strength, how close the access points need to be, or how many of them need to be, whether it's on a 5 GHz versus 2.4 GHz network, et cetera. But another one that we also recommend the most is if the IT team can put the iPads on its own separate Wi-Fi network so that way there's no other traffic, there's nothing else that can be in the way, no other floating variables. We know what's going on essentially.

JL: Alright. All year of course. Yeah. And I would say like the majority of the time we go into facilities and the internet is fine. The IT group always say that we have the best internet in any hospital in America of course. And then the doctors will all say, "I don't know if that's true." It's usually somewhere in between. Rarely we run into an entry where that's really an issue. And if we do, I don't we've ever not figured it out with their IT groups. So, but yeah, crucial, crucial, crucial, internet connectivity. Right? 

FD: It is. It's always a misnomer to always just say, oh, it's just the networks, just blow it off. Well, in this scenario, we really can help you figure out what is going on with the network in that case and so forth.

JL: Right. That's certainly least in our opinion, the required software. Simple, right? 

FD: Yeah. Our app is a free download from the Apple store, the App Store. But one of the things that we haven't talked about is MDM, mobile device management, it's not necessary, let's put it that way because everything in our app is end-to-end encrypted. So there's no PHI store in the device. So there's not a whole lot of need to manage every device from a security point of view in terms of lockdown. It is a good practice though. So especially if you have a larger organization or you're deploying like 10 to 15, 20 iPads, that kinda scenario, or you manage other iPads within your environment that aren't gonna be used for Graphium. Mobile device management allows you to manage all of the iPads in your network remotely, so you can push app updates, you can push the iOS updates, you can lock them down if need be, et cetera. It is extremely valuable to an IT team to be able to do that quickly, having to go to each iPad, install software, make sure everything's up to date, put in passwords, make sure they all have the right iCloud account. It is time consuming. So yes, we recommend it, but is it needed? 

JL: Right. Got it.

DH: The only thing I think we don't talk about in here that we definitely probably talk back on the equipment is like, securing your hardware, depending on again the size of the organization, do you want a cabinet to put your hardware in at night, charge it, make sure your stuff is charged. That's of course all the hardware stuff, that hardware article that we send out to everybody. But, yeah, I think in a nutshell that pretty much wraps up. That's basically the site prep communication that we go through, still at a high level, but that's a lot of good information. Thank you, Frank. Appreciate it.

FD: Yeah, no problem.

JL: We'll see you next time.

DH: Yeah. Thank you, guys. Both. Frank, thanks for being here, John, thanks for being here again. Hope to see you in the future.

FD: Of course.

DH: All right, guys. Take care.

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