Today in health, it,
Bill Russell:Another one of our interviews and action.
Bill Russell:This comes from the healthcare to healthcare event, which I was a guest
Bill Russell:at from the serious health care team.
Bill Russell:It was in Montana.
Bill Russell:And I was able to sit down with a handful of CEOs.
Bill Russell:And I'm going to share those with you here shortly.
Bill Russell:My name is bill Russell.
Bill Russell:I'm a former CIO for a 16 hospital system and creator of this week in health.
Bill Russell:It.
Bill Russell:A channel dedicated to keeping health it staff current and engaged.
Bill Russell:I hope you're enjoying these interviews and action.
Bill Russell:We were able to do these interviews at the health conference, the
Bill Russell:chime conference, and now the healthcare to healthcare event.
Bill Russell:I've really enjoyed doing them.
Bill Russell:, just a reminder.
Bill Russell:We're going to get back to our normal programming where I take
Bill Russell:a new story, break it down.
Bill Russell:And talk about why it matters to health.
Bill Russell:It.
Bill Russell:We're going to be doing that as soon as the interviews are done we have
Bill Russell:done 10 from the chime conference eight from the health conference and
Bill Russell:we have five from the healthcare to health care conference so i hope you
Bill Russell:enjoy another one of these interviews
Bill Russell:All right.
Bill Russell:We're doing an interview from the healthcare to healthcare event.
Bill Russell:It's a serious invite only event.
Bill Russell:And I'm joined today by Dr.
Bill Russell:Andrew Gustine, our CEO, CEO,
Andrew Gostine, MD:founder
Bill Russell:CEO, founder of artist site.
Bill Russell:And we're going to talk a clinical automation essentially
Bill Russell:is what we're gonna do.
Bill Russell:So tell us a little bit about artist's site
Andrew Gostine, MD:before we get going.
Andrew Gostine, MD:Doug artist's site is it's really an IOT sensor-based automation.
Andrew Gostine, MD:To bring automation into the clinical space.
Andrew Gostine, MD:You know, as a practicing physician, I was looking out at the different automation
Andrew Gostine, MD:tools that were available and I realized most of them were focused on back office
Andrew Gostine, MD:types of automation, but the biggest problems we have in healthcare often,
Andrew Gostine, MD:not in the back office or at the bedside.
Andrew Gostine, MD:And I saw a huge gap in the marketplace.
Andrew Gostine, MD:And so developed this platform as a solution to a lot of the problems
Andrew Gostine, MD:I was seeing at the bedside.
Andrew Gostine, MD:Th
Bill Russell:the reason we do it on the administrative side and not the
Bill Russell:clinical side is the quality of data.
Bill Russell:And so I think it's fascinating that you're getting the data raw
Bill Russell:data directly from a camera that's embedded in that clinical setting.
Bill Russell:And then that obviously for our listeners is going to create a whole
Bill Russell:bunch of questions, but talk about
Andrew Gostine, MD:the solution.
Andrew Gostine, MD:So you talk about the first part of your statement, you know,
Andrew Gostine, MD:the back office automation.
Andrew Gostine, MD:Just the first evolution of automation because of all the discreet data
Andrew Gostine, MD:that was available, uh, you know, the amount of charges we generated,
Andrew Gostine, MD:the, um, different insurance broker that was handling the payments.
Andrew Gostine, MD:All of that information was quantifiable and available.
Bill Russell:Just brief data easily to work off of.
Andrew Gostine, MD:Okay.
Andrew Gostine, MD:All of the information I have available at the bedside to
Andrew Gostine, MD:me is coming from a clinician.
Andrew Gostine, MD:It's a clinician that is seeing.
Andrew Gostine, MD:Is talking to the patient is feeling the patients and then putting
Andrew Gostine, MD:that information into the EMR.
Andrew Gostine, MD:If you don't have the clinician that is there to capture the data,
Andrew Gostine, MD:you don't have any discrete data.
Andrew Gostine, MD:And so what we saw in the marketplace, uh, really at the
Andrew Gostine, MD:bedside was that there was a gap.
Andrew Gostine, MD:We didn't have access to the discrete data.
Andrew Gostine, MD:So we developed these IOT sensors to structured data for us, putting
Andrew Gostine, MD:a camera in the room and developing.
Andrew Gostine, MD:To look for events or pieces of information that we can capture
Andrew Gostine, MD:in real time and build automation around so that we could remove
Andrew Gostine, MD:the human component of data entry.
Andrew Gostine, MD:No,
Bill Russell:we only remove the component, but actually assist them
Bill Russell:because now you take that error away there, you know, they forgot
Bill Russell:to put in information about whatever whatever's going on in that room.
Bill Russell:That's missing information.
Bill Russell:You can't really act on it, but the camera is there.
Andrew Gostine, MD:The camera's always there.
Andrew Gostine, MD:It's a lot cheaper than a clinician.
Andrew Gostine, MD:It doesn't need a bathroom break.
Andrew Gostine, MD:It can always be watching, looking for things that we tell it to, to see,
Andrew Gostine, MD:and kind of to the other side of that, won't look for things that I don't
Andrew Gostine, MD:want it to see, because I don't want to put a system in a hospital that
Andrew Gostine, MD:clinicians feel like his big brother.
Bill Russell:And that was interesting.
Bill Russell:So looking at some of the video clips that you were showing
Bill Russell:yesterday, everything's blacked out.
Bill Russell:The patient's face is blacked out.
Bill Russell:Blacked out, but you're still picking up that data.
Bill Russell:You're still processing that data.
Bill Russell:So what are you doing around privacy?
Bill Russell:Obviously that's one step, but you're doing some other
Bill Russell:things around privacy as well.
Andrew Gostine, MD:So I think people have to change how they think about a camera.
Andrew Gostine, MD:When people think about an IP or security camera, they think of it
Andrew Gostine, MD:as the closed circuit TV system.
Andrew Gostine, MD:That's recording video.
Andrew Gostine, MD:That was a lot of the initial use cases.
Andrew Gostine, MD:When we talk about an IP camera, we really think of it as just a light switch.
Andrew Gostine, MD:That if you look at those pixels makes a picture, but we don't have to record it.
Andrew Gostine, MD:We have elder rhythms that just watch the video feeds in real time.
Andrew Gostine, MD:And we'll look for different combinations of pixels that represent
Andrew Gostine, MD:objects or events of interest.
Andrew Gostine, MD:They will structure some type of data from the event that it's witnessing, but
Andrew Gostine, MD:we can then just save the discrete data.
Andrew Gostine, MD:We don't have to save the video.
Andrew Gostine, MD:So we can just retain the parts of that video feed that are interested
Andrew Gostine, MD:to the hospital, but not any of the risks or any of the concern
Andrew Gostine, MD:that a clinician might have.
Andrew Gostine, MD:If we don't train the camera to see something, it is totally blind to it.
Bill Russell:Yeah.
Bill Russell:And it was interesting.
Bill Russell:One of your users was here and they said their legal team came back and said,
Bill Russell:Hey, can we get access to the video?
Bill Russell:And the answer was, it doesn't exist.
Bill Russell:It goes into the AI engine.
Bill Russell:It gets.
Bill Russell:It generates those insights, if you will.
Bill Russell:And then it's,
Andrew Gostine, MD:it's, it's somewhat like time where we live
Andrew Gostine, MD:in the present and I don't really have a recording of the past.
Andrew Gostine, MD:It's the same thing with our video feeds.
Andrew Gostine, MD:We run inferencing on them in real time, but we don't save videos.
Andrew Gostine, MD:There are some exceptions for other use cases where surgeons want records of their
Andrew Gostine, MD:surgical videos for education purposes.
Andrew Gostine, MD:But for the vast majority of our use cases, we don't say that.
Bill Russell:So let's talk about some of the use cases.
Bill Russell:So people are probably thinking right now, if I had a camera in there,
Bill Russell:obviously we're doing tele-health, uh, fall detection, hand-washing clean rooms.
Bill Russell:I mean, it really is limitless.
Bill Russell:Really?
Bill Russell:What if it's really limited by people's creativity of what they can imagine?
Andrew Gostine, MD:Computer vision is very powerful, uh, in many
Andrew Gostine, MD:ways, a lot better than humans in some ways it's not as powerful.
Andrew Gostine, MD:That's the best way to think about computer vision is it's
Andrew Gostine, MD:a much more cost efficient way that can capture the same data.
Andrew Gostine, MD:As if I put an educated person in every part of the hospital, just
Andrew Gostine, MD:collecting data with their eyes.
Andrew Gostine, MD:Computer vision can see the same way that humans can see.
Andrew Gostine, MD:And if a human can witness something with their eyes and tell me about it,
Andrew Gostine, MD:I can most likely train a camera to do the same thing for a much cheaper.
Bill Russell:It's really interesting.
Bill Russell:So you showed up fall detection.
Bill Russell:So I assumed, is there training that needs to go on at each
Bill Russell:institution or do you have, are the algorithms already trained to detect?
Bill Russell:So
Andrew Gostine, MD:it's again, similar to humans.
Andrew Gostine, MD:You know, if I teach you at one hospital, how to monitor what it looks like when
Andrew Gostine, MD:the janitors are cleaning a room and then I take you to another hospital and
Andrew Gostine, MD:you witnessed janitors cleaning a room, you're going to be pretty accurate.
Andrew Gostine, MD:They might use.
Andrew Gostine, MD:They might have different scrub colors on, but you're going to be able to
Andrew Gostine, MD:tell me with reasonable certainty that you're pretty sure a janitors cleaning
Andrew Gostine, MD:an operating room or a room or whatever, same thing with computer vision.
Andrew Gostine, MD:If I train it at one institution and take it to a second out of the box,
Andrew Gostine, MD:it's going to be pretty advanced, but we will do some retraining over a week
Andrew Gostine, MD:or two to make sure that it lends the peculiarities of that new institution.
Bill Russell:What's interesting.
Bill Russell:So I want to talk to you about deployment, but.
Bill Russell:The, you talked a little bit about the highest, um, use case, the highest best
Bill Russell:use for the first couple of, of, of things that you're gonna use it in your
Bill Russell:health system, because the platform can really return almost a complete
Bill Russell:return on investment with one or two use cases, but you still have the platform.
Bill Russell:And I find that interesting in of itself.
Bill Russell:What have you found to be some of the, some of the things
Bill Russell:that people have deployed?
Bill Russell:The initial.
Bill Russell:So
Andrew Gostine, MD:there's a, there's a lot of business strategy
Andrew Gostine, MD:that goes around technology.
Andrew Gostine, MD:And there's a lot of very interesting use cases that, you know, as a physician
Andrew Gostine, MD:really interests me, but healthcare is still a business and we have to make
Andrew Gostine, MD:sure that we're justifying the things that we're doing in the hospital.
Andrew Gostine, MD:So we build business, use cases around some of what I would
Andrew Gostine, MD:consider the first best use cases where hospitals are collecting.
Andrew Gostine, MD:And we can show this is your baseline performance.
Andrew Gostine, MD:And after you put in our fall algorithms, this is by how much you've reduced false.
Andrew Gostine, MD:Well, the problem with healthcare is we don't collect data on most things.
Andrew Gostine, MD:So if I could build an algorithm that reduced the amount of infections, but
Andrew Gostine, MD:you have no idea what your baseline infection rate is, then I can't show you.
Andrew Gostine, MD:You made X.
Andrew Gostine, MD:You saved this many dollars and it will justify its existence.
Andrew Gostine, MD:So all of the first use cases that we recommend to hospitals like reducing
Andrew Gostine, MD:falls, reducing pressure ulcers, uh, bringing them up to compliance with new
Andrew Gostine, MD:regulations for hand-washing is around things that we know they're measuring
Andrew Gostine, MD:where we know they might be sustaining penalties, or they have a large expense
Andrew Gostine, MD:to maintain some level of compliance.
Andrew Gostine, MD:We go after those first to help them show to their board and decisions.
Andrew Gostine, MD:That this is the quantifiable value.
Andrew Gostine, MD:And then once the platform is in there returning that value from those first
Andrew Gostine, MD:use cases, you can now use it for things that might be more interesting,
Andrew Gostine, MD:might provide a greater impact to society, but are harder or more
Andrew Gostine, MD:nebulous to quantify in terms of the
Bill Russell:value.
Bill Russell:So I thought the other thing that was interesting is innovation partners really.
Bill Russell:I mean, when I think about the academic medical centers could really use this.
Bill Russell:In a lot of different ways that we probably couldn't even imagine ourselves.
Bill Russell:And, uh, you talked about sort of incenting that, that environment
Bill Russell:of innovators to, can you talk about that a little bit?
Andrew Gostine, MD:Yeah.
Andrew Gostine, MD:So it kind of a two part answer.
Andrew Gostine, MD:So I, I may be the world's best physician, most likely I'm not, but even the world's
Andrew Gostine, MD:best physician is not going to think of all of the use cases for this technical.
Andrew Gostine, MD:And the goal for this company is not to become the richest company
Andrew Gostine, MD:in the world it's to fix healthcare.
Andrew Gostine, MD:And the only way we're going to be able to solve as many problems as this platform
Andrew Gostine, MD:can solve is if we get everyone to help us, if we crowdsource the ideas and
Andrew Gostine, MD:the opportunities, and co-develop the solutions now for the institutions, most
Andrew Gostine, MD:often academic or very large medical.
Andrew Gostine, MD:That want to help with that and are very interested in helping us bring new
Andrew Gostine, MD:solutions on the platform to market.
Andrew Gostine, MD:They should totally be able to share and the financial gains from those solutions.
Andrew Gostine, MD:And so we have revenue sharing agreements.
Andrew Gostine, MD:We have cost reduction terms and all of the contracts where if they help us
Andrew Gostine, MD:develop a solution, we will start spitting back revenue from other clients that are
Andrew Gostine, MD:using the solutions they co-developed to chip away at the contracts.
Andrew Gostine, MD:These.
Andrew Gostine, MD:As kind of a way of saying you participated, you helped provide this
Andrew Gostine, MD:value to the healthcare ecosystem.
Bill Russell:The overused phrase of app store comes to mind, essentially,
Bill Russell:you're an app store for computer vision solutions in the hospital.
Andrew Gostine, MD:And I think we will ultimately evolve into something that
Andrew Gostine, MD:is even beyond the applications that we develop, where people who research.
Andrew Gostine, MD:Develop a very interesting algorithm to solve a problem, but have no
Andrew Gostine, MD:way of managing a camera network of 10,000 cameras securely behind the
Andrew Gostine, MD:health system, firewall with security compliance and firmware upgrades.
Andrew Gostine, MD:We can be that portal for them to deploy their algorithms on
Andrew Gostine, MD:the infrastructure we maintain.
Bill Russell:The nursing shortage is written about a lot at this point.
Bill Russell:And I think we're, we're looking at potentially half a million
Bill Russell:in the next three years, right?
Bill Russell:How does this help in that with regard to that?
Andrew Gostine, MD:So we're going after things that nurses have to do
Andrew Gostine, MD:now, but shouldn't have to do tomorrow.
Andrew Gostine, MD:So in some of the literature I've presented here, we see that nurses spend
Andrew Gostine, MD:about a third of their time documenting.
Andrew Gostine, MD:So eliminating some of the things that don't really require a nurse to do,
Andrew Gostine, MD:like documenting that he or she turned to patient, eliminating that from their
Andrew Gostine, MD:workflow is going to make them more.
Andrew Gostine, MD:It's also going to burn them out less because they didn't go
Andrew Gostine, MD:to nursing school so that they become a stenographer in the EMR.
Andrew Gostine, MD:They went to nursing school so they could be at the bedside
Andrew Gostine, MD:taking care of the patients.
Andrew Gostine, MD:So we're trying to bring the joy back to nursing, eliminate the
Andrew Gostine, MD:nonproductive non-patient care aspects of their workflow so that we can help
Andrew Gostine, MD:them see more patients, more timely and take better care of patients.
Andrew Gostine, MD:The
Bill Russell:lastly, I want to talk to you about.
Bill Russell:It's deployment because you're not talking massive, expensive care bros, and you guys
Bill Russell:even have a mobile solution to move in.
Bill Russell:It seems like you could actually ramp this up pretty quickly at a health system.
Andrew Gostine, MD:So we, we did that even in the middle of COVID
Andrew Gostine, MD:where there was a lot of challenges of getting into the patient rooms.
Andrew Gostine, MD:We deployed 1300 cameras across 10 hospitals at Northwestern.
Andrew Gostine, MD:In six weeks.
Andrew Gostine, MD:So with the mobile systems, we can do that in a few minutes of bringing
Andrew Gostine, MD:them into a hospital and adding them to the secure wifi network.
Andrew Gostine, MD:When we talk about server infrastructure, for those that have
Andrew Gostine, MD:a hybrid or a cloud presence, we can turn on new virtual machines
Andrew Gostine, MD:for AI processing and a few hours.
Andrew Gostine, MD:So the rate limiting step is typically camera installation.
Andrew Gostine, MD:The rest of it is hours to minutes of the bringing new systems.
Andrew Gostine, MD:So
Bill Russell:people are going to ask me about security, talked about privacy.
Bill Russell:They're going to ask about security.
Bill Russell:You're streaming this information.
Bill Russell:I'm not sure that this information itself has value to someone who's going
Bill Russell:to hack it and that kind of stuff.
Bill Russell:But if it did what, what's the, uh, what's the information around security.
Andrew Gostine, MD:You know, just the, the first things we're going to do to
Andrew Gostine, MD:keep this secure is always deployed behind the health system firewall.
Andrew Gostine, MD:So the cameras for obvious reasons being in the patient rooms are by definition
Andrew Gostine, MD:behind the hospital firewall, but even the server infrastructure or the
Andrew Gostine, MD:cloud, we enter and deploy these on virtual machines in our client's cloud
Andrew Gostine, MD:tenant, so that we're not streaming this outside of their ecosystem.
Andrew Gostine, MD:So the first and second line of defenses are always the.
Andrew Gostine, MD:Security measures the VPNs, that directly route things up to the cloud.
Andrew Gostine, MD:If that's how they deploy us in terms of the data that we collect by not saving
Andrew Gostine, MD:any video or in cases where we do save video, but de-identify, or anonymize
Andrew Gostine, MD:the video, we're preventing that risk of any Phi leaving the health system with
Andrew Gostine, MD:the data that we generate and structure for them from those unstructured.
Andrew Gostine, MD:We send that into their enterprise data warehouses or their EMR is we're never
Andrew Gostine, MD:holding our own version of the data.
Andrew Gostine, MD:So we're trying to make sure that we're putting this data in a place that is
Andrew Gostine, MD:super safe and controlled by the client.
Bill Russell:Andrew, thanks for your time.
Bill Russell:We're really excited to solution.
Bill Russell:I'm looking forward to seeing what you guys
Andrew Gostine, MD:do.
Andrew Gostine, MD:Yeah.
Andrew Gostine, MD:Thank
Andrew Gostine, MD:you.
Bill Russell:Don't forget to check back as we have more of these interviews
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