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 Welcome to this week in Health IT News, where we take a look at the news which will impact health it. This is another field report where we talk with leaders from health systems and organizations on the front lines. My name is Bill Russell Healthcare, CIO, coach and creator of this week in Health. It a set up podcasts, videos, and collaboration events dedicated to developing the next generation of health leaders.

Are you ready for this? We're going to do something a little different for our Tuesday Newsday show. Next week we're gonna go live at noon Eastern 9:00 AM Pacific. We will be live on our YouTube channel with myself, Drexel Ford Sus Shade. And David Munch with Starbridge Advisors to discuss the new normal for health.

It, uh, with you supplying the questions with live chat. Also, you can send in your questions ahead of time at hello at this week in health it.com. Uh, I'm so excited to do this and I hope you'll join us. Mark your calendar. Noon Eastern 9:00 AM Pacific on April 28th. If you want to, uh, send the questions, feel free to do that.

Um, and, uh, you can get to the show by going to this week, health.com/live. This episode and every episode since we started the Covid 19 series has been sponsored by Sirius Healthcare. Uh, they reached out to me to see how we might partner during this time, and that is how we've been able to support producing daily shows.

Special thanks to Sirius. For supporting the show's efforts during the crisis. Now onto today's show. Hello everyone and thanks for joining this week in Health it. I'm Drex Deford CI Securities Chief Healthcare Strategist and President at Drexel Innovation Network. And today we welcome Tony Langi, system Director of Clinical Engineering at Rochester Regional to this week in health.

It thanks for being with us here today, Anthony. I know you're exceptionally busy and uh, we really appreciate you being here. It's my pleasure. Thanks for having me. Yeah, for sure. Um, so tell us a little bit, maybe a good way to start is tell us a little bit about Rochester region or regional and you and your team, and, um, I'm sure everybody really wants to know how it's going with the Covid outbreak there and the work you guys are doing right now.

Sure. So Rochester Regional Health is uh, a five system hospital. Um, network. Uh, the flagship is Rochester General Hospital and Unity Hospital, which are in the metropolitan areas. And we have, uh, three others in the, uh, rural area. Mm-Hmm. , we're probably, um, 50% of the market in the upstate New York Finger Lakes area.

And we provide the, uh, the sourcing for our, for the labor and um, the, uh, for the clinical engineering. Uh, work, uh, of, of ensuring the safety, reliability, and effectiveness of the medical equipment for the systems. Got it, got it. So you, you do most of the clinical engineering work in-house. You have, you have some contracts.

I know some every organization sort of organized differently on that, but Yeah. And we're, we're a blended uh, organization. We try to do as much in-house as possible. We have an imaging team, although we don't have a separate category, so as you get higher up in, in the ladder, so to speak. You, uh, you have a technician, you have a senior, and then you have a senior with imaging.

And so we do a lot of biomed and imaging work. Uh, so some of those technicians have, uh, specialized training with our vendors and we have an in-house agreements, we have some OEM contracts, depending on if it's. Uh, not worth it to us, you know, from a cost standpoint or manpower standpoint. And we do use some independent service organizations as they might be more cost effective and they provide similar quality to, uh, the, um, OEMs, right?

So Nice. So we just try to maximize our, our, um. Our team and, uh, and our, our resources to get the best cost effective way of, uh, of achieving our goals. Totally makes sense. Sounds like you guys have a, have a great strategy, a great plan. So I know you're mostly focused on, uh, medical devices and medical equipment.

Um. In that space and given the relationships you have with your partners, what are you, what are you all seeing in regard to threat activity during the pandemic? What's, uh, what's, what's got you worried and what have you, what have you been sort of really alert on? I. Well, I don't think we've changed a whole lot compared to what we, what pre, um, COVID life.

Mm-Hmm. . So the, that team in the IT team, it's a specialized security group. Uh, they've been working very diligently over the last few years to, uh, cover up what they call the penetration points. Uh, looking at all of our policies, uh, as you know, uh, clinical equipment is, uh. Nowadays tied into a network, whether it's through your EMR or through your, your, um, internet, uh, or telemedicine, et cetera.

So they've been, uh, working diligently to, to ensure that safety and, uh, it's, it slowed things down a little bit. It can be frustrating when you want something done right away and. You gotta go through this process of ABAA and answer all these questions to make sure, you know, there's no chance of, of personal health information or protected health information, uh, getting into the wrong hands.

So, but with respect to Covid, I haven't heard of any, uh, particular threats for our organization. Now that may be 'cause they were keeping it close, vested, or there really hasn't been much more activity than normal. Okay. Um. Generally speaking too, there's been sort of this crazy amount of health IT activity over the past month.

Um, tell me about some of your adventures in clinical engineering. Sure, sure. At Rochester and you know, how you've been able to keep security integrated into that whole process. 'cause I'm sure you have been juggling a lot of balls. Yes, so good question, because it happens fast and there's no time. To wait and do it, quote unquote, the right way.

Right? So in the old days, things were done very quickly. You know, the term stat comes up. Well, by nature it doesn't work that way. In my experience. It's okay, hold on, let's scope it out. Let's, uh, figure out what's going on. Where are the risks? Uh, so we had to. Quicker. And, uh, fortunately we had, uh, processes in place and, um, a network that is, uh, easily adaptable to, um, to growth.

Uh, as we manage it, we don't have, uh, outside vendors managing it. Uh, even our, our patient monitoring, uh, network, which is, uh, we're a GE house. Uh, we, we, we use what is known as an EV land, meaning that we, we own it, they bless the, the architecture, and then we, we manage it. So, um, the only areas where I think there was some struggle is in, uh.

We wanted to develop a video system for traditionally non ICU floors because we had to create space, right? So like a tele ICU kind of workaround. Yeah. So normal ICUs, they're open or they have glass and you can, you have one-on-ones. So as we needed to expand that type of care to non-traditional ICU floors, uh, you close the door, keep the, the covid in there, but you can't see the patient.

So you're monitoring the vital signs. We want it to be in, in the leadership, the nursing leadership system. We need to see them. Yes. So we worked, we worked with, uh, our, um, our contractor who provides our security cameras and set up some IP. Uh, cameras to, to, so they could view the patient without going in.

We've done a lot of that kind of remote interface and maybe longer cables push the, the, um, the, uh, ventilator into the room closer to the patient and keep the interface, the gooey outside through the, through a cable Right. That's longer than traditionally, uh, available so that the person doesn't have to go into the room.

Yeah, yeah. Yes. So we reduce the use and the burn rate on PPE, uh, and reduce the exposure. Uh, risk Makes sense. Great innovation. I mean, I think everybody's been thinking outside the box this whole time about how to, I mean, especially when PPP when PPE, um, started to, uh, be the challenge, people really got innovative in innovative in ways to, to extend, um.

to extend the life of the stuff they had on the shelf. Mm-Hmm. . And not use it all up. Yeah, absolutely. Ha. Have you had to add a bunch of new ventilators or did you, have you gone through that drill and, and how hard was that? And was there any issues around, uh, working cybersecurity, parts of that, kind of adding new equipment really quickly?

Well, so I'm not sure how it affected cybersecurity, but to the first part of your question, uh, as we started to see. What was happening in, in New York. And, um, you know, the first few cases became public and it, and it went upstate a little bit in the New Rochelle area. Uh, and in some reported cases in, in our general area, which is Rochester, uh, some people came from Italy.

They, they got, they got out and they, they were, felt they might've had some exposure. Uh, we started to look at what was gonna happen by using those models. What would . How that would work. So we immediately reached out to see what we could buy and what the cost was and what kind of funds we had, and we looked at renting.

And so we, we were one of the first people to grab available units that were the similar model that we're used to using. So we grabbed, uh, you know, about 10 of those. We looked at third party, um, repair shops that across the country that had them for sale. We bought a handful of those, but they, it started happening really quick.

So we thought we were ahead of it. We were only ahead of it by 24 hours. And then it just blew up. So now it became very crowded and very, uh, you know, uh, chaotic, right? Yeah, exactly. Yeah. Like a bidding war. So you guys just got in right in the nick of time? Yeah. So some of us were a little bit ahead of it.

Uh, some of the leadership, uh, was lagging a little bit because they were trying to . Figure out how we were going to manage this, you know, through an incident command. Should we do it by the local hospitals? Should we do it centralized? Hmm. And as that, that few days went by, you went from, you know, we can get you these items in a couple of weeks to, you know, six weeks, eight weeks, 10 weeks, 15 weeks, 31 weeks.

And so the gap behind the eight ball and, and understandably so, New York City needed. The, um, being of the stuff, probably more so than we did, we're prepping. They're buried. Mm-Hmm. , they're, they're underwater. And as you can, everyone knows by watching the news, what had happened since in the area, whether it's, if you're watching what the governor was talking about, sharing and developing a network of, right, of sharing healthcare equipment and, uh, and so forth.

So, uh, even, and even the vendors stepped up and said, look, even though you may have had this ordering for a project down the road. We're gonna not ship you that stuff and send it to them and we'll take care of you after this is over with. Hmm. Have you, are you part of that network? Have you all had conversations about how you would wind up ultimately shipping and sharing devices with, uh, with another organization down the road?

Sure. So we're working with the leadership, the, the executive leadership and the chief medical officer. We identified what we are using currently and our current rate of infection went from four doubling every four days to eight days, which was good. Some of the distancing and mitigation strategies may be working right, or the virus is, is slowing down for what reason?

Whatever reason. Um, we've identified what we, the percentage of, of units we could give to the state to be used, uh, along with anything else that we have that was in surplus at understanding. When it dies down in that area or, or they get a handle on it and we, if, if it were to peak in our area, we would then be afforded the same courtesies.

Right, right. Yeah. Tony, thank you, uh, so much for your time. I, I want, I always try to give everybody that we interview the opportunity to, uh, to tell us anything else that I didn't ask. 'cause I don't always ask, uh, all the right questions. I try to, I try to just put it out there. Is there anything that you wanna tell, uh, your peers across the country, healthcare, across the country, stuff that you've done that you think they would find useful or interesting or, or, or, or anything else that you wanna share?

Um, well first just apologize, I didn't have a whole lot to, to contribute to the, uh, uh, cybersecurity rules. Oh, no, you were great because we're collaborators with, with that group. Uh, with respect to some of your other questions there at the end, one of the things I'd like to share is the idea of collaborating and innovating with your local universities.

We have done that with, um. Um, Rochester Institute of Technology. Hmm. And Xerox. Xerox is a headquartered in their factory, is here in Rochester, New York. So the three of us got together as the University of Rochester, Rochester Regional. Uh, RIT and, um, Xerox to, to modify what is known as the Go vent. And it's a portable vent used in emergency situations.

It's kind of one you would put on to wean you off of a, of a more sophisticated critical care event. Hmm mm-Hmm. Or, or a step to that. Uh, so we're, we're gonna increase it so that it can be used. We're gonna increase the peep on it using, using their design capabilities at RIT and the manufacturing abilities at, at, uh, Xerox to, to manufacture, uh, an improvement to that go vent.

That's amazing. You guys have done this in pretty short order then, right? Oh, yeah. It was super fast. It was like a two, three week turnaround. That's incredible. How, how, how hard or how easy was that? I mean, it sounds like everybody was just all hands on deck. Yeah, exactly. So we, from the. Provided, uh, the medical input, the RIT, the reverse injury using, um, and then did the prototypes using three d printing and then the manufacturing people, they, you know, you tell 'em what the help with the manufacturer and that's what they do.

So, wow. And it's not a, a, a big blown, uh, electronic device. It's, you know, it's pieces of plastic, but they have to be con constructed in such a way that, um, that allows the, the flow of air. It seems like three D printing has kind of blown up in all this too. Have you, have you done any other three d printing for other, other uses or other components that you've had to sort of invent?

Yeah, so when it's hard to source a part, especially when it's been, uh, end of life sunsetted and you can't get parts for it, we've, we've done some things like that. Uh, mostly covers because you don't wanna get into violating, uh oh, right. F fda five 10, you know, five K, five 10 K issues. And so, um, we, and we helped out with shields for a short period of time because we, we, our capacity is low.

So until other manufacturers could pick up the, the slack, uh, we helped out here and there. Got it. Hey, again, I know your time's exceptionally valuable. Um, I really, I really appreciate you taking time to share observations and best practices with us, Tony. Um, thanks again very much and uh, thanks. Thanks for being on the show.

I. Well thank you. Thank you too. And thank you to everyone out there. I appreciate you, uh, having me on. And I tell this to everyone during this time period is to endeavor. To persevere. Endeavor. To persevere. . Thanks. I'll talk to you later. Alright, take care. That's all for this week. Special thanks to our sponsors, VMware Starbridge Advisors, Galen Healthcare Health Lyrics series, healthcare and Pro Talent advisors for choosing to invest in developing the next generation of health leaders.

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