Portrait Mobile with Chris Lawman and Peter van Heezik | ESAIC 2023

Top Med Talk

Desiree Chappell:  This is Top Med Talk here at Euro Anesthesia 2023. I'm Desiree Chappell, your host today, and Monty Mythen. Hello, Monty.

Monty Mythen: Hey, Desiree. Oh, hang on. The pipers are cutting back in.

Desiree Chappell: Here they go. I think actually it's very fitting. We have them playing while we're talking about being here in the exhibit hall, Monty, some wonderful booths. Today, here, the very first day of ESA, we have the privilege, the opportunity to be with GE HealthCare, one of our platinum sponsors for Top Med Talk.

Monty Mythen: Absolutely. Very generous, loyal supporters of Top Med Talk. And just to reiterate, it wouldn't be possible to keep this as free, open access medical education for the world if it wasn't for our great sponsors. And recently, GE, who used to sponsor us, transitioned into GE HealthCare, which we heard about particularly at the American Society of Anesthesiology at the back end of last year. But more about that in a moment, I'm guessing.

Desiree Chappell: Yeah, we definitely will dive into that. Monty, this is our third year here at the European Society of Anesthesiology Intensive Care, here in Euro Anesthesia meeting. Prior to COVID, we were here last year, we were here as well.

Monty Mythen: So, we were in Vienna.

Desiree Chappell:  Yeah.

 

Monty Mythen:  And we're going to catch up with some people that we met in Vienna talking about projects that they had planned at that stage. Now, some of them got “Covided”, but I think they got back on track. And then last year we were in Italy.

Desiree Chappell: We were in Milano for ESA there. And actually, we were on the booth for GE HealthCare last year.

Monty Mythen: The launch of one of their amazing products. And actually, I think we've got a version of it. It's just not great radio me holding up to let me.

Desiree Chappell: Get a picture of that, Monty. I'm going to get a picture.

Monty Mythen: Here we are with the team.

Desiree Chappell:  That's right. We got it, perfect.

Monty Mythen:  And it's part of what we're going to be hearing about is more remote monitoring. And we actually were there at the launch of one of the products last year.

Desiree Chappell: The launch of Portrait Mobile. Well, we wanted to catch up with the GE HealthCare team again this year and hear more about where they've been this last year, what's happening, what's new and upcoming. We see a lot of new products on the stand here. So super excited about that. So, this morning we have Chris Lawman, the senior modality leader for GE HealthCare. Chris, thank you so much for joining us.

Chris Lawman: Pleasure to be here. Thanks.

Desiree Chappell: Yeah, absolutely. And then we have Peter van Heezik, the Anesthesia digital leader for GE HealthCare.

Monty Mythen: Correct.

Desiree Chappell: Thank you so much for joining us.

Peter van Heezik: Thank you very much for having me.

Desiree Chappell: Yeah, absolutely.

Monty Mythen: Well, anesthesia, digital, I know.

Desiree Chappell: Lots to break down there.

Monty Mythen: Okay. Yeah, we'll go into that, because I don't know what one of those is.

Desiree Chappell: I would think I would like one of those. May I have one of those, please? Well, gentlemen, it's great to be here with GE HealthCare. Last year we were here for the launch of Portrait Mobile. We know that that has been a major feat for GE HealthCare and a lot has happened over the last year. So, Chris, I wanted to start with you and talk to you a little bit about that particular product, but also how that's being integrated into the hospital setting to help improve connectivity. And there's this word that we throw around a lot, interoperability. But I want to know a little bit more about that and how the solutions that you guys have with GE HealthCare, how all that's contributing to interoperability and connectivity?

Chris Lawman: Okay, it's a bit of a challenge, and I think when we look at it as a whole, we speak with a lot of the other vendors as well, and we've come together as a collective to actually discuss interoperability and connectivity and sort of standardization within the healthcare arena. And it is really challenging because we find that you look at the NIHS right now, they've got this kind of drive around artificial intelligence, the big data, primary care versus secondary care, and having that interconnectivity and be able to have patients records available for everybody. But I think one of the main challenges that we see is it's great, let's talk about AI, let's talk about big data. But sometimes we have to go back to basics. So, if you look at 90% of the operating rooms in the UK don't have a network.

Desiree Chappell: Right, okay.

Chris Lawman: So actually, trying to be able to get that data to be able to use the AI is a challenge.

Monty Mythen: When you say they don't have a network, do you mean that they don't have the wiring there for the Internet?

Chris Lawman: Absolutely.

Monty Mythen: Okay.

Chris Lawman: Absolutely. So, in many cases, obviously, we need to have a network point in the OR so that we can connect the patient monitoring. So, we're getting just those standard demographics coming from the patient, being able to get them into an electronic medical record system, and then being able to use that sort of data to do a little bit deeper dive looking at from a research perspective. But we just can't get the data there.

Monty Mythen: When one goes into that environment, I mean, I mainly come from the intensive care world. We happened where I worked at University College London Hospitals to have had an electronic health record for quite a long time. I kind of think that everybody has got all those connections, like all our infusion pumps and our ventilators all talk to each other. Do I live in a weird place? Is that not normality?

Chris Lawman: Not in every case. No, you're absolutely right. So, you're right, where it's easy to put a network in, we'll do it right. But there's challenges in terms of the OR specifically because of the environment that it is. It's a clean environment. The only time you can get in there is on an audit day. Or they have to shut down theater, and that's expensive. We know we've got the backlog in the UK in terms of getting that elective care done. We haven't got the time to close down theaters to put the networks in. The infrastructure is old in many cases. So, you've got old hospitals in London, for example. You've been there, you know, brick built really solid hospitals. Trying to put infrastructure in there is a challenge.

Desiree Chappell: Well, I was just going to say that's really interesting because you just assume, especially with the NHS I mean, I work in the US. There's lots of variability. I'm vice president of clinical quality for North Star anesthesia. We have over 200 facilities. I'm still surprised that we have paper charting in some of our facilities. I would say that networking, you wouldn't think that the structure of a building or shutting down an OR would really impede that. You would think everybody would want to be connected.

Chris Lawman: Absolutely. I mean, not so much in the or, but in other areas around the hospital site. When was the last time you actually went and had an X-ray, and somebody gave you a film and you were walking back to the ANE and holding it up to the light to see if you'd actually broken a finger or whatever? That doesn't happen anymore. But we still do it with a 12-lead ECG. We're still printing 12-lead ECGs everywhere when it could be all digital.

Monty Mythen: Why?

Chris Lawman: I don't know. I don't know whether it's just an adoption. I think it's that change management that's probably needed in terms of education and getting guys to actually understand the capabilities that we have there.

Monty Mythen: Because the X-ray thing is a great example because that seemed to happen fairly quickly and fairly smoothly. And is that because they changed the x-ray machine from being the camera. Is that the switch?

Chris Lawman: Absolutely. I mean, you're using the DICOM protocol to be able to take those images, we're able to share those images to wherever they're needed. You're getting information at point of care, point of need. But it just seems like with a 12-lead, I don't know whether it's people just need to pick up a piece of paper and feel it and touch and actually be able to look at it rather than actually seeing it on a digital screen, where you can put your calipers on, you can do your measurements, and you can do your interpretation.

Peter van Heezik: Because once it's digital, you can really deploy it or make it available throughout hospital.

Monty Mythen: When you can let the computers help.

Desiree Chappell: Exactly.

Monty Mythen: Most of us are not very good at looking at ECG

Desiree Chappell: And we're not even talking about AI. This is basic stuff.

Chris Lawman: And this is where we need to go back to basics. Just another brief example, we're trying to deploy equipment into hospitals and we're trying to utilize the wireless infrastructure. But when you sit down with the IT department, they have several challenges. You've got to have Wi-Fi in all the areas. Some of the Wi-Fi is a few years old and not necessarily robust enough to support what we're trying to put on there. Or an IT department will be really reluctant to put real time patient data on their network because of the instabilities. So that can provide another challenge.

Desiree Chappell: The security risk is a huge thing.

Peter van Heezik: Security risk, but that is also the performance and having the data available all the time, it's like having your Wi-Fi in your own house back home and then expect that you will have the same quality Wi-Fi at the attic, or at the basement of the house.

Monty Mythen: Is Wi-Fi the answer, though, isn't it? Would be better off just being hardwired, or am I being a bit old fashioned about that?

Chris Lawman: Well, you mentioned earlier about Portrait Mobile.

Desiree Chappell: Yeah. Let's talk about you're holding this up right now. I'm going to get another picture.

Monty Mythen: Holding up something looks like a mobile phone. It does. A hint fatter than some of the modern ones, but very elegant, small. And you're holding the other hand, something's about the size of an old pacemaker with what's looked like an oximeter probe on it and a wristband. So very elegant combo of two things.

Peter van Heezik: It is.

Chris Lawman: And a part of this probe is a battery.

Monty Mythen: Okay.

Chris Lawman: And within this battery, we have a protocol that's called Byndr^TM, which is for medical body area networks.

Monty Mythen: Right.

Chris Lawman: Okay. So, we're used to talking about Wi Fi networks. We're used to talking about Bluetooth or Zigbee or other communication methods. This is a medical body area network with a protocol, as I say, it's called Byndr. But what this does, it sends data on three different frequencies three different times.

Monty Mythen: Right.

Chris Lawman: And therefore, the connectivity method that we have, it's as good as a wire.

Monty Mythen: So, this is the patient's mini hub, correct? Sort of thing.

Chris Lawman: Yeah.

Chris Lawman: So, because it's as good as a wire, we've got that reliability. We're not going to be susceptible to interference around the hospital environment. There's a lot of noise. When I talk about noise, I'm talking radio frequency noise. Not the noise that we can hear, not the ambient noise that we've got going on behind us right now, but it's actually RF, it's hidden

Monty Mythen: What's it called again? 

Chris Lawman: It's called Byndr.

Monty Mythen: Byndr.

Monty Mythen: It´s the protocol that GE HealthCare has developed. If I'm thinking simple lay terms, that's your alternative to Bluetooth, but it's-.

Chris Lawman: Hundred times more robust.

Monty Mythen: Exactly. But that's the idea. It's a communicating thing, but the patient wears this so they communicate from them.

Monty Mythen: Problem solved. 

Chris Lawman: And it gives them that flexibility to be mobile, they're ambulatory, that's going to aid in recovery. So, you're not tethered to a bed.

Monty Mythen: Okay. So, one last question from me, because I tend to talk a lot, is that every time I've been to the IT department with anything new and novel that's a solution like this, they seem to have a problem committee and it doesn't take them long to find a problem. So, they have problem experts, and they usually start with the problem with that is. Okay, so what barriers have you come up against so far?

Chris Lawman: To be fair, because the Byndr protocol is literally between the sensor and the hub, we're not actually putting this on the hospital infrastructure. Those challenges are not always there in this situation.

Monty Mythen: So, it skips internally, and the robustness of the encrypted envelope of the hospital is for them to worry about. You're just skipping data into it, and therefore you think you can't be cyber-attacked?

Chris Lawman: No. I mean, obviously, there's always risk out there. And then when we go onto the hospital wireless infrastructure, then there is risk in terms of cyber security. We have to make sure that our protocols are secure, and that's something that we build into every product.

Desiree Chappell: Yeah. Well, that was going to be my question about this as well. I'm thinking as a nurse, and I'm using Portrait Mobile, and I'm getting my real time data for all my patients in my pocket. I don't even have to go to this nurse’s station. I don't have to be in the ITU. This can be on a regular ward unit. Fantastic, right? I think last year we talked a lot about how the filters are really good for this to filter out some of that other noise, patient factors. They're moving around. It's not picking up their pleth. It starts to alarm, so on and so forth. I think that's great. We can talk more about that. But the other thing that is a huge burden to me as a nurse is having to chart all the vital signs, either on paper that their blood pressures were this or that it comes over into an electronic medical record. Is there a solution for this that those vitals actually go into the patient record? Or how does that work?

Chris Lawman: Absolutely. We're using standard IHE protocols in terms of being able to export patient data integrated health. They're standards that we have.

Monty Mythen: Is it a standard thing?

Chris Lawman: Absolutely. We're taking the data, we're sending that over a server, we're translating it into HL7, which is a standard language that we use at Health Level 7. Then we're able to get that data into those electronic medical record systems. Whether it's Portrait Mobile, whether it's Canvas 1000 in the ITU or in the OR, if there's a network, we're able to get that data into the electronic medical record system. That's when you can then use that system to be able to collate that data and get your early warning scores and things like that.

Desiree Chappell: Fantastic. Some limitations when it comes to networks and things like that, but this really sounds like it can help me as a nurse, Monty, as a physician, to have data at your fingertips.

Chris Lawman: It's going to get better, going to get easier, because we're going to integrate this into other patient monitors. Okay, so, like I said, keep an eye on.

Desiree Chappell: Yeah, we will. Well, Peter, you're the anesthesia and respiratory care, digital person. So, tell us, all this conversation, I'm sure, is near and dear to you, and probably had a lot of influence in this space.

Peter van Heezik: For sure. So, what was explained by Chris is really the monitoring side and making sure that the connectivity, the wireless connectivity is as high quality as possible. I think you were explaining the connectivity in the ICU as well as the operating room, and we're very much relying on the network connectivity. So what Chris was explaining is that when there is no network infrastructure available, then obviously you cannot deploy this data as we would like to offer it. The part we're offering is really the analytics part. So, gathering data in its high fidelity, so it's like comparing with a camera of 10 years ago. If you would like to see what's happening in the background of you, you zoom in today with the high-fidelity image. We do the same thing with our devices. So big data, we send all the data, every breath. So 500 data points, every breath from both the anesthesia machine as well as from the patient monitor, and allow clinicians and managers to analyze their processes, whether it's to do with low-flow anesthesia, whether it's to do with the actual use of the anesthetic agents, or whether we're talking about long protective ventilation part here.

Desiree Chappell: Yeah. Go ahead, Monty.

Monty Mythen: I mean, we already have a lot of data to... If you just look at regular chartered data, we're a bit overwhelmed already. That sounds like super overwhelming, but I'm guessing it's not. I've been seeing some analytics and some ways of presenting the data that says, thank you.

Peter van Heezik: You're spot on. I think offering more data is not the answer to the question. It's really providing ready, made analytics. It's okay. If you're focusing on outcomes on, for instance, sustainability or on the lung-protected ventilation, then having a ready-made dashboard, which does not take any IT involvement, or processing, and just drawing conclusions.

Monty Mythen: Because you were mentioning, because you were doing a display to Desiree yesterday about some of the outputs, very cool graphics, etcetera. There's a lot of discussion in the anesthetic community, there's a lot of discussion in the anesthetic community. There's a lot about it here about anesthetic vapors for example, and its negative contribution to global warming, and the choice of agent and vapor versus TIVA. But in the first instance, and I think we probably got there a little bit earlier in Europe, we could just turn them down, couldn't we? We could just turn those. We could just actually use lower flows and harvest some of the vapors. Is that one of the drivers of that component of it?

Peter van Heezik: Correct. So low-flow anesthesia has been around for a long time. We can clearly see the various level of adoptions of actually low flow being at the minimum flow, half a liter or even less fresh gas flow. In a circle system, which is still high enough to provide more oxygen than the patient is absorbing. But that's really helping out and giving that visibility on whether you use Sevoflurane, Desflurane, Isoflurane, or Nitrous Oxide, and what the impact is both on the cost as well as the emissions. So by having such a longer to tunnel view in the dashboard, it really helps to visualize where were you a month ago, what do you want to target for, and how.

Monty Mythen: So, Desiree, back to you, as you had a chance to look at that, think about that yesterday, as a Vice President for Quality for a very large anesthetic group, something that's not far the size of the National Health Service. What would you do with that data?

Desiree Chappell: It's interesting. The models in the US are slightly different. Our anesthesia groups are usually contracted with the hospital. So, we don't always get this data. We don't always, for sure, exactly what... We don't see the analytics side of this, like how much the flows are and things like that. I started thinking about we had a big push on Earth Day about using less gas, about changing your flows, reducing your flows. I think having that data in our hands, we can just target more efficiently. Where are we using more and what type of gasses are we using and what is the efficiency of the machines that we're using? Being able to have that data to go back to our hospital partners to say, hey, let's work together in cost. I'm not paying for the gas myself that's coming out of the hospital budget. How do we work together to improve cost savings? How do we improve the environment and make that together? So I think just having that data and being able to see it in a way that I can understand as team anesthesia, and that the hospital can understand as care providers, but also good stewards and financial stewards of the organization.

Chris Lawman: I'm sorry, big data is absolutely brilliant, but it's got to be tangible. You've got to be able to read it and it's got to have meant and you've got to be able to use it to your advantage. We can all store loads and loads of data, but it's useless unless it's tangible.

Desiree Chappell: I think you were showing me yesterday, too. You could even look into the rooms, OR12, and we can say, well, so-and-so was an OR-12 yesterday, and maybe we need to have a conversation with them about their practice. What is the solution name of that product that you're showing us? 

Peter van Heezik: The overall solution is Carestation Insights. Okay. And obviously the individual application, so it's an app, you can run it on your phone, and you can view it on your computer, are for agents, the agent dashboard, lung-protective ventilation dashboard, adequacy of anesthesia. So, it's containerized apps. So, you don't deploy, and you don't show all the blob of all the data, but rather focus, okay, this is the theme which is addressing.

Monty Mythen: So, I hate to bring you back to my committee of problem experts now. I know we have a tendency to ask these questions which must sometimes feel insulting because you think, well, of course, we thought about the problems and of course, we thought about the solution. We're not that stupid. But we have to ask anyway. The immediate things they probably say as well, you're now walking around with a phone with patient's information on it. That would be one side of it.

Monty Mythen: And the second side of it would be, well, if I've got low saturations on a phone in my pocket and I'm not looking at it and I'm the responsible officer on the floor, where's the culpability lie there? Who's getting food? You know that. So, I know that would have been common discussions. Those two points. I know you can't necessarily address the second one, but Desiree might have to.

Peter van Heezik: No. So, coming back to the second one first, because when a low saturation is actually happening, in Carestation Insights Live, you actually can have this in your pocket. But the notification will buzz, or the tone will definitely ring when that alarm is ringing into your operating room, the one you're responsible for. That's clearly helping on focusing on these patients.

Monty Mythen: I'm walking around here, and I accidentally put my phone. I've got an example has just been called up for me here, which has got all the rooms on it and everything's looking pretty good. Not sure about the SATS in that room and the heart rate. We can go and chat with them in a second. Let's imagine this had patient identifies on it and I put it down. I've now done a HIPAA breach, I think. But I don't see any names on here.

Peter van Heezik: Exactly. So, the question you raised is something we did consider. There are no identifiers on the app itself. So, no patient identified nor the physician that's responsible for that operating room. So as a physician, you know that you're responsible for operating room one and two and three. Those are the ones you activate on your app. So, you will receive those notifications for those three patients.

Monty Mythen: So, whoever is in OR3, we need to have a chat as we think about that.

Desiree Chappell: I know. Oh, that's bad.

Monty Mythen: I know. I'm all three. We're coming to you next time. 

Desiree Chappell: So, you've deployed this now for some time. How is it going? Some good feedback on that.

Peter van Heezik: It's gone well. We initially introduced our Carestation Insights Live app on the iPhone. And we could clearly see that when discussing with the IT departments of hospitals, that some hospitals really standardized on Android. So, we in the meantime now launched the Android version and implemented this Android version because the initial idea of the hospital said, okay, let's invest in iPhones for those anaesthesiologists. But they were carrying the Android of the hospital. They had their own private iPhone, and they were planning to carry the third phone. So, you can imagine that how successful this would be.

Monty Mythen: And the first thing they did in COVID is take them all off us. The infection control police came around, put them all in a, oh, that is my phone. Took them away and said you can't have those now.

Peter van Heezik: So, from an implementation perspective, those are other elements which we initially did not think would be an issue or a challenge. But having network infrastructure available, this is the other one that´s overcome now.

Monty Mythen: So, I'm holding up your own device here in my hand as opposed to looking at my own phone, if you see what I mean. Why not stick it all on this then, if you see what I mean? So, it becomes like my page, my bleep, my clearly hospital device. I'm not taking that out to the pub to text the kids on, if you see what I mean. That's clearly hospital kit.

Peter van Heezik: The way it works on the phone is that it's really relying on the hospital network. So as soon as you move out of the hospital, you don't need to have your notifications from the OR-3, because if you're on holiday in Glasgow...

 

Monty Mythen: You should talk to your company about it. I don't see it that way.

Desiree Chappell:  I've been very good about my PTO. So, one last question, gentlemen. Again, thank you so much for sitting down with us. I think it's so important to have these conversations to hear more from the voices of those who are developing these solutions for us, and how do we actually deploy those and use those as providers. So, one of the big themes here at the meeting this year and for you as GE HealthCare is patient safety. And how do we improve patient outcomes with the solutions that you have? So just wrapping up, let's tie it all back to that. How do you think Portrait Mobile, Carestation Insights, all these different solutions that you have are really going to make it safer for our patients? Chris?

Chris Lawman: 70% of patients in the hospital are unmonitored. Obviously, that's a massive amount. Most of the cardiac arrests happen outside of the high acuity arena. So, by putting on wearable sensors, by measuring just whether it's respiratory rate or the SPO2 rate consistently across the board, we've got an eye on that patient. We can detect early deterioration of a patient, and we can interact before there's any reason to take that patient back into a high acuity area. This is the story that we're trying to work on, because people get it, but they're not doing anything about it. We're really focusing a lot in getting the story out there, making everybody aware of those issues. I don't have a clinical background but speaking with people doing the voice of the customer and understanding everything, we know that the 30 days post-operative is that key area, especially for post-operative respiratory depression or whatever. So just by putting that resp sensor on, even if it's for seven days afterwards, if someone's going into a step-down or into a ward space, it's really going to help in terms of early detection of deterioration of a patient.

Desiree Chappell: I think getting the information and the word out that this actually is easier technology for us nurses and the hospitals to use, because I think there have been previous versions that have been not so great. So, we're a bit biased whenever some new technology comes up, and we're like, oh, God, more alarms.

Chris Lawman: It's a really good point because bringing in technology into the ward space is probably where the healthcare professionals are not used to using technology. When I've been out and spoken to a customer about this solution, we're talking about cloud-based services. We're talking a lot about network infrastructure, and we can scare the living daylights out of people. But actually, when you use it.

 

It is so simple to use. That's the key driver for me. People have to see it working and seeing how it's going to benefit them. Whereas today, like you said earlier, they're just going to think, oh, there's going to be a load of alarms going off. How am I going to manage those alarms? What's the escalation protocol?

Monty Mythen: Sorry to talk across. Do you or the hospital allow the patient and/or their loved ones to see the data? Because we're now used to looking on versions on our smartwatches or whatever it is. It's rare to bump into somebody who can't tell you their steps and heart rate now. Yeah, exactly. I would imagine as a patient suddenly being confused as to why I can't look at my data. And if my mum's there, why I can't look at mum's data? I'm guessing that's not your call, that's the hospital's call. Is it?

Chris Lawman: I guess it is. But I'm holding the hub right now and this hub would remain with the patient. Okay. So, the hub would connect to a Wi-Fi network, there'll be a central patient viewer. So, the clinicians can keep an eye on up to 48 patients at any given time. But this hub remains with the patient.

Monty Mythen: So, they can.

Peter van Heezik: Look at it. So, your beloved one can actually look. Yeah.

Monty Mythen:  It's like a bedside monitor.

Chris Lawman: Or whether they're ambulatory, it still sits in their pocket or in a pouch. So, they can still look at it. And we're talking about things like human factors and bringing all that into it. So why not in the morning, they look at here and there's a traffic light system and they say, how do you feel today? And it's red. I feel really bad today. Or it's green. I'm feeling good. There's all of that that can be bought into it in the future. 

Desiree Chappell: Maybe they should tell you before they see the red or the green. Absolutely. I'll ask the question before they see the call. Well, I'm thinking there will be a lot more education. This is the change management. It's a change management, absolutely. Not only for the nurses, but for the nurses to patient families, because not everybody understands all that. But what I can see and envision is that because you're going to have more time, there's a lot of burden that is taken off of nurses for this. I actually will be able to do what I was trained to do and why I went into nursing, is patient and family interaction.

Chris Lawman: The anxiety level is reduced dramatically, whether it be the caregiver, knowing that my patient's being continually monitored, or the patient knowing that they're being continually monitored and not somebody popping in and seeing them every four hours. So, it's really a really huge benefit.

Desiree Chappell: Interesting. Peter?

Peter van Heezik: Yeah, you mentioned improvement of patient care. If you're looking to our guidelines, we have guidelines in healthcare for a lot of things. In this case, care system insights could really help to visualize the adherence to these guidelines and really help to focus on, okay, this is where there is room for improvement, and this is where we can further enhance outcomes because the guidelines are developed to drive these more standardized outcomes and predictable outcomes. And if you look into the sustainability part, it's obviously shown that saving costs, and saving the planet and improving care quality really can go hand in hand. 

Desiree Chappell: Absolutely. Gentlemen, this has been a fascinating conversation. Thank you so much for taking the time out. Thank you so much for listening to Top Med Talk here at the Euroanesthesia 2023 meeting, the annual Congress of the European Society of Anaesthesiology and Intensive Care. Good to get it? Here in Glasgow, Scotland, we'll be here over the next several days. Please do check out all of our other wonderful conversations. Monty.

Monty Mythen: See you all soon.

Desiree Chappell: Thanks.

Monty Mythen: Cheers.

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