Portrait Mobile with Neal Sandy and Karla Asikainen | ESAIC 2022

Top Med Talk.

Desiree Chappell: Well, hello and welcome to Top Med Talk. We are at Euroanaesthesia 2022 in beautiful Milano, Italy, coming to you live from trade exhibition which is crazy cause we haven't been live for a very long time. So, this is wonderful for us at Top Med Talk. I'm your host Desiree Chappell and I'm joined by colleague Solomon Aronson. Hello, Sol. 

Solomon Aronson: Hi, Desiree. So good to see you. We made it here

Desiree Chappell: (laughs)

Solomon Aronson:  ... and we synchronized our flights together and, um, excited to spend the next few days in Italy in Milan. 

Desiree Chappell: Yeah, absolutely. Sol, the buzz in this trade exhibition is amazing, isn't it?

Solomon Aronson: It- it is! I'm just, you know, amazed at the- the- it- it's past 4:00 o'clock, there's people all over the place mingling, talking. Um, there's energy and it's palpable. Isn't it? 

Desiree Chappell: Yeah, it is.

Solomon Aronson: Yeah.

Desiree Chappell:  Absolutely. Well, Sol, we are in person. We're actually here this year with GE Health and they have sponsored us to be here, Top Med Talk, on their booth, so we're really excited to partner with- with them this year.

Solomon Aronson: For a good cause. They have a lot of exciting new things that they want to share with us. 

Desiree Chappell: That's true.

Solomon Aronson: So, I'm looking forward.

Desiree Chappell: Part of the buzz that you hear in the background is because we just- or, not we, GE- (laughs) just launched a new solution in- in mobile monitoring and wireless monitoring. Now, we want to hear more about that. So, we had the opportunity to sit down with GE leadership to explore these, um, exciting solutions, really. We just heard the launch. Wasn't it awesome?

Solomon Aronson: We just heard the launch minutes ago

Desiree Chappell: Yes.

Solomon Aronson: ... and now we get to do a deeper dive. 

Desiree Chappell: That's right. Well, we're joined by Neal Sandy who's the global manager of monitoring solutions. Hello, Neal. How are you? 

Neal Sandy: I'm well. It's a pleasure to be here with you. 

Desiree Chappell: Yeah, absolutely. Neal, for, um, everyone listening here today, tell us just a little bit more about yourself. 

Neal Sandy: So, I'm the general manager of monitoring solutions. It's, uh, one of the divisions of GE HealthCare. And I've been in the role a couple years, but in the business a long time, uh, in the field. And, uh, we’re excited to be here in person, uh, launching, uh, several new products, actually, but Portrait Mobile in particular, which has been a- a- a great journey for our development team and we're just really excited to put it in front of customers now. 

Desiree Chappell: Yeah, absolutely. I feel like we should have a drum roll- (laughs) that's on

Solomon Aronson: Yeah, indeed.

Desiree Chappell: So, Portrait Mobile is the new- is the new solution and there's a suite of things that kind of go with that. Correct?

Neal Sandy: That's right. I think we should probably tell the listeners a little bit about, uh, the problem statement. The problem is that in- in monitoring, historically, we monitor patients continuously in the operating room, of course, in the ICU. Uh, but in the ward, uh, after surgery, uh, patients are often not monitored or only checked occasionally by the nursing staff, and that's because the acuity level is different, uh, in that space.

Desiree Chappell: Yeah.

Neal Sandy: But- but what the community, the clinical community has learned over time is that a lot of risks, uh, that patients experience is actually not during surgery. They're after surgery. And, uh- and so, uh, traditional monitoring is difficult there because the patient's tethered to the bed, but the clinical team wants that patient up moving around, and so, uh, the advent of wearable, wireless technology becomes a little more important. And that's, uh- that's how we got to Portrait Mobile as a wearable, wireless, continuous monitor in the ward space, and we're very excited about, um, bringing it to market.

Desiree Chappell: Yeah, absolutely.

Solomon Aronson: And- and I want us to just put this on the shelf, so we pull it down and- and talk about it a little. When you say wireless monitoring, we're not talking about Bluetooth necessarily, and I want to make certain that we differentiate what you mean by wireless monitoring, as opposed to what most of us immediately resonate with when we speak about that as a concept. 

Neal Sandy: Yeah, that's- it's super important and- and the reason is because you- you- you don't want to miss what you're measuring in- in this environment. You want to be certain that the- the parameters you're measuring, in our case, SPO2 respiratory rate and heart rate, uh, as we launch this product Portrait Mobile, you don't want, uh, anything to not come through to the clinical team. And so, we're- we're not using Bluetooth because in- in the hospital environment, there can be interruptions and- and lots of traffic that- that-

Desiree Chappell: Signal traffic, yeah.

Neal Sandy: Yeah, e- exactly. And so, we use a medical body area network with some proprietary technology that we would characterize as, as good as wired, uh

Solomon Aronson: Right.

Neal Sandy: ... and- and the signal moves from what the patient is wearing, uh, to a hub device that we have in Portrait Mobile, uh, and that, uh, basically doesn't drop. That signal doesn't drop

Solomon Aronson: Okay.

Neal Sandy: ... as a result.

Solomon Aronson: So, there is a secret sauce to differentiate. 

Neal Sandy: There is some-

Desiree Chappell: (laughs)

Neal Sandy: There is some secret sauce-

Solomon Aronson: Yes.

Neal Sandy: ... going on here, yes.

Desiree Chappell: So how do you really feel, let's dig in just a little bit deeper, the benefits of Portrait Mobile to clinicians and patients. I'm a clinician myself. 

Neal Sandy: Mm-hmm.

Desiree Chappell: I'm a nurse in essence, but I worked in the ward

Neal Sandy: Yeah.

Desiree Chappell: ... and the ICU for a very long time. 

Neal Sandy: Well, I think, you know, in the ward environment, as I said earlier, the- the clinical team wants the patients to get up out of bed, move around, uh, on their journey be sent home, uh, essentially. And so having a comfortable, wearable, uh, type solutions very important. You don't want the patient to have to lug around a monitor or wheel around a monitor with them. And so has technology has miniaturized, it becomes more possible to get it to be wearable. Um, so that patient comfort certainly is- is an important piece. From a nursing perspective, uh, you know, in the ward, the nurses are covering a little more patients.

Solomon Aronson: (laughs)

Neal Sandy: Uh, it's not an ICU environment where it's one to two or one to three, and so you want the solution to be catered to the ward environment, only generating alarms when the patient deterioration is actually being detected over time. Uh, and- and so we- we've turned the, uh- the solution Portrait Mobile to be just that, uh, and- and again, we're super excited to bring it out. 

Desiree Chappell: Yeah, that's great. Well, to talk a little bit more about some of those details, um, we have your colleague here with us, Miss Karla Asikainen, and she is the global product manager- (laughs) for GE HealthCare. Karla, it's so wonderful to have you. Thank you so much for joining us. 

Karla Asikainen: Thank you for having us.

Desiree Chappell: Yeah. Well, Karla, one of the things that, uh- that Neal had mentioned for clinicians is alarm burden, you know, and- and being fatigued. Really, fatigued with alarms.

Karla Asikainen: Mm-hmm.

Desiree Chappell: (laughs) You just start to kind of- they just are background noise after a while. Tell us a little bit about how this product, the, uh, Portrait Mobile, is a solution to that. 

Karla Asikainen: First of all, uh, throughout the development, we've been working very, very closely with our customers, with clinicians to understand really what the adoption criteria are, if you will. We cannot bring, as Neal explained, ICU or higher 3D level monitoring into a space where the standard of care today is different. We need to build the full system to be very conscious of the workflow challenges and the environment where this is being, uh- being catered to, or what this- this is catering for.

Uh, so alarm management, indeed. Uh, there's several pieces in the design where we're being really conscious of this. First of all, then being the robustness of the actual clinical measurements themselves. We did not want to bring technology into this space just because it is lower acuity by giving up or compromising anything on the clinical accuracy of our measurements, which is obviously building on the decades of clinical knowledge and excellence from, uh, G- GE HealthCare monitoring already. So, robustness of the measurements, making sure that every time we're detecting something, it is a true event. We're not giving false events or false positives or false negatives to the clinicians. Definitely, uh, contributes a lot to the topic.

Second, it is- second is, a lot of al- algorithm work that has been done to adapt these measurements particularly to mobile patients and to this type of environment. So, when we're talking about wearables, we're talking about patients actually being able to be mobile which is a good thing. We want this in the recovery period. But it can also cause artifacts, some interference that we're actually correcting on our measurements and taking into account to deliberate a bit longer if we see that there's a lot of movement, a lot of interference in the signal, again, just to make sure that we are not calling out the clinician's attention for nothing. 

Solomon Aronson: And help me just understand some of the operationalization. Are those parameters fixed or are they customizable? Um-

Karla Asikainen: That's a very good question. 

Desiree Chappell: [inaudible 00:08:27].

Karla Asikainen: So indeed, um, when we're talking about continuous monitoring in the ward, the basic premise that Neal was referring to in the clinical problem statement, if you will, we're really trying to bring more the trending of the patient to the clinician's knowledge. But indeed, in that worldview, we're not so tied to your traditional alarm triggering limits, but those do exist indeed, of course, in the background just to make sure that we do give that- that safety net.

Um, but we are expecting indeed there to be- the trending ability to be primary source of information for the clinicians. And then there is a lot of configurability in what do I as a clinician in my unit consider to be, uh, the limit where I do want to get notified or where I do indeed, um, trigger an alarming event that can then be also, of course, uh, noted in my- in my data. 

Desiree Chappell: Yeah. Karla, you mentioned that, uh, you know, the different monitors that we have, you know, that you may be rolling around, I would always take care of patients where we had telemetry

Karla Asikainen: Hmm.

Desiree Chappell: ... mobile telemetry and it was a bunch of wires falling off and they never really did much. It, you know, doesn't really do much for- how is the Portrait Mobile really differentiating itself from other continuous monitoring and mobile monitoring? 

Karla Asikainen: Very good question. So first of all, it's indeed that we have considered the skin to screen workflow really from not only innovating on the wearable side, which is obviously the most visible piece maybe for clinicians and patients alike, but we really thought of the every- every step of the way, from how the signal gets from the sensors to our monitor which is where our robust wireless connectivity comes into play. We really wanted to make sure that we're not causing issues by going wireless. Uh, for example, technical nuisance, these types of things.

Next piece is indeed how do we communicate from our mobile monitor onwards. We're making sure that we're utilizing existing customer infrastructures and effectively use- utilizing that bandwidth. So we have done a lot of development work in making sure that we're very effective in controlling the- the traffic and moving from our- from our monitor to- to the network. And then of course, all the way to the clinicians, how do we alert and visualize data to clinicians if there's anything that they- they new- do need to be aware of. So the system robustness and really the consideration of designing to the workflow in the ward area has been, uh- has been a key thing, and we're one of the only ones providing this full experience and full system.

From a clinical perspective, we are very, very, very excited to bring to market for the first time a continuous dual vector respiration rate measurement. So we have innovated not only bringing SPO2, so saturation and pulse rating, to wearable form factor, but actually also developing a completely new clinical measurement that we are calling dual vector respiration. 

Desiree Chappell: And that's designated as RRDV. Is that correct? 

Karla Asikainen: That's correct. That is RRDV.

Desiree Chappell: So this is something new as a clinician. We're gonna be a new parameter for us then. 

Karla Asikainen: Absolutely. So we are- we are confident. We have the studies showing comparative accuracy to CO2, base respiration rate, which remains the golden standard today, but with a completely mobile, chest-based, um, electrode composition that is much more comfortable for the patients to use, and tolerable also, when we're talking about this type of, uh, moving, awake patient population.

Desiree Chappell: Yeah.

Solomon Aronson: And- and with respect to other user case scenarios, and I would just simply pull back and say I love the fact that you're, um, rec- you're- you're- you're creating in a- in an innovative way sort of a- another spot within that continuum of monitoring with intensive ICU surveillance at one end of the spectrum, and there's so many opportunities along the way in a set function. So, um, that's cool. Um, what- what other user case scenarios have come forward by the introduce of this sort of niche, um, opportunity that we're now talking about?

Neal Sandy: So I- I probably have to thread the nee- needle a little bit here

Karla Asikainen: (laughs)

Desiree Chappell: (laughs)

Neal Sandy: ... Sol, because, uh, we- we're- we can't really talk much about futures, but I can assure the- when the clinicians see Portrait Mobile, they have lots of ideas about what we should do next. 

Solomon Aronson: Oh, I can think of a ton right now. 

Desiree Chappell: Yeah, right now.

Neal Sandy: Um, and- and for sure, uh, we are just getting started. We are just getting started on this platform. Uh, there's a- there's a lot, uh, already in the lab and a little more to come. Uh, so- but we're also quite willing to hear from the clinicians about their ideas because, you know, we have ideas, of course

Desiree Chappell: (laughs)

Neal Sandy: ... but, uh, all the good ideas don't come from inside GE HealthCare. 

Solomon Aronson: Yeah.

Desiree Chappell: Correct.

Neal Sandy: So we're very open to it.

Solomon Aronson: We'll I'm a clinician so I'll just throw out there, um

Desiree Chappell: (laughs)

Solomon Aronson: ... obviously, surveillance of sleep apnea

Desiree Chappell: Yeah.

Solomon Aronson: ... like, considerations, post-anesthesia and the drugs that we use that- that would potentiate problems with that, uh, syndrome, um, and- and I'll just say, that's one. 

Neal Sandy: That's one. (laughs)

Solomon Aronson: I could think of many, many more. Um, it's very exciting. 

Desiree Chappell: Yes.

Neal Sandy: Indeed.

Karla Asikainen: That's a very good- good use. A couple of more that we already actually are going to be addressing in a very innovative way with this solution: pediatric population. 

Solomon Aronson: Hmm.

Karla Asikainen: When you really start talking about mobility for kids, even bringing- you know, taking technology out of the way of family togetherness in this very frightening situation, even

Solomon Aronson: Yeah.

Karla Asikainen: ... if, uh- if your child needs to be hospitalized. 

Solomon Aronson: Mm-hmm.

Karla Asikainen: Definitely, we have gotten very, very good feedback on those types of use cases because it takes the patient comfort aspect to a whole completely different level when a child can be a child even when hospitalized and still be monitored.

Second piece, uh, that definitely is interesting and- and a lot of, uh, customers are excited about, is to be able to, for the first time, get really, um, access to continued data from these patients.

Solomon Aronson: Yeah.

Karla Asikainen: Due to the fact that we are currently only relying on temporal spot-checking data, we actually don't know what we don't know. 

Desiree Chappell:  We're missing a lot.

Solomon Aronson: That's a great point.

Karla Asikainen: Exactly.

Solomon Aronson: That's a great on the.

Karla Asikainen: So getting access to the continued data probably opens up a- a lot of new opportunities in doing analysis and maybe finding out things that we just didn't know

Solomon Aronson: Right, right.

Karla Asikainen: ... that we need to focus on

Desiree Chappell: Yeah.

Karla Asikainen: ... on this patient board.

Desiree Chappell: Things that may be more sensitive that we never even realize

Karla Asikainen: Mm.

Desiree Chappell: ... that- that are, uh- show a signal, so. 

Solomon Aronson: Yeah. No, it's a great window of opportunity to teach us what we don't know. 

Desiree Chappell: Yeah.

Solomon Aronson: And-

Desiree Chappell: That- that's super exciting. Now, people will say, as we're going to remote and mobile and all these different, you know, untethered type of technology, cybersecurity is an issue. What are you guys doing to address that? Is that something that, I would imagine, that you're spending a lot of time on? (laughs) 

Karla Asikainen: Correct, and I think we can indeed all- all say that it's- it's a growing concern not only for our customers, but obviously then for industry as well, that we do need to address. So first of all, it's an ever-moving target so obviously we're scanning the space as our customers are expecting as well all the time. The premise of how we've built this new- new system, the Portrait Mobile platform, is actually more of an IOMT system, so Internet of Medial Things, if you will. We are running on an edge compute based platform that makes this also much more manageable and serviceable from a perspective if

Desiree Chappell: Break that down for us just a little bit. (laughs) 

Karla Asikainen: (laughs)

Solomon Aronson: (laughs)

Karla Asikainen: So edge compute, uh, means cloud based, uh, type of computing, so in- but- but installed into a hospital enterprise. So your hospital's own private cloud, if you will. And we are tapping onto that type of an architecture which allows us to operate almost like as an IT company when it comes to things like cybersecurity. So we are expecting to provide regular updates to our customers, and obviously, as different types of things move in our environment, we will be always operating and updating our system to be responsive for- for any of the, um- the current, uh, external situations. 

Solomon Aronson: Um, yeah. Yeah.

Neal Sandy: So I think maybe I'll just add here a little bit, a little bit off the cyber topic, but, uh, when Karla mentioned that it's Internet of Medial Things technology, there's a fundamental change in how we're gonna manage data that's a little bit subtle and maybe not, you know- not the first thing you'll see when you take a look at Portrait Mobile. But today, on any monitor system that- that you've used before, you admit the patient to the monitor. That's just how it works, right? You- you come in and you either pull an ADT feed down and you admit the patient to the monitor.

In the new system, you'll actually be admitting the patient to the system and why that's important is because as the patient moves from one place to another, from one care location to another, the- the data that's flowing flows to the system, not to- not- it doesn't stay in the monitor. Okay? And when it- and when that happens, you can move the data very easily to any display on your ph- you know, on a phone, on a- on a-

Desiree Chappell: Tablet or- mm-hmm. 

Neal Sandy: ... computer display, on a bedside, wherever, seamlessly. You can also analyze the data anywhere. You can also, uh, interrogate the data anywhere, and the whole damn management and use story opens wide up-

Solomon Aronson: Mm-hmm.

Neal Sandy: ... from what you can do today. And so the- this notion of having connectivity solutions everywhere that bring data together, the- that sort of goes away in the future state

Solomon Aronson: I-

Neal Sandy: ... because the data all is in the same place

Solomon Aronson: Yeah.

Neal Sandy: ... already, from the beginning. 

Solomon Aronson: Brilliant. Brilliant.

Neal Sandy: Yeah.

Solomon Aronson: There are two this that came out, uh, this discussion that I really want to emphasize. One, skin to monitor. Wonderful s- expression. 

Desiree Chappell: Mm-hmm.

Neal Sandy: Yeah.

Solomon Aronson: Um, and- and the- you know, admitting the patient to the system

Neal Sandy: To the system.

Solomon Aronson: ... versus to the monitor is just also brilliant. Um, I always, you know, remember saying, you know, monitors work for you.

Desiree Chappell: Mm.

Solomon Aronson: You don't work for them. 

Neal Sandy: Right.

Solomon Aronson: And- and this is really a and opportunity for that to come home to life and that- that the- the monitor will work for you in the context of how you want it to.

Neal Sandy: That's right.

Solomon Aronson: Um, it's a neat concept. 

Neal Sandy: Indeed.

Karla Asikainen: Yeah.

Desiree Chappell: That's fantastic.

Neal Sandy: Yeah.

Desiree Chappell: Well, just in closing here, um, for- kind of a question for you both, patient safety, patient care is top priority for all of us and we all have to work kind of together in this space, clinician industry, together.

You know, ultimately, how do you see Portrait Mobile improving the safety and care of our patients? 

Neal Sandy: So I- I'll start here. Most non-clinicians like me or your mother or

Desiree Chappell:(laughs)

Neal Sandy: ... your brother think that the most risky time when you're having surgery is when you're having surgery. That is categorically false. The most risky time is after surgery and it's usually in the first couple of days after surgery, but it could be in- even in the first 30 days after surgery. So what we're trying to do with Portrait Mobile is address immediately after surgery, when you- when you go into a step down unit or aor a ward and you're just recovering, this is a risky time and people need- clinicians and citizens of the world need to understand that this is a risky time. And by introducing continuous, wearable, wireless monitoring in this space, we are absolutely gonna help patient safety. Absolutely. Um, there- there's no question about it because it's not happening today. Karla, I don't know if you have anything to add to that.

Karla Asikainen: Absolutely. I would also [inaudible 00:19:36], um, add as a mega-trend that we're all also aware of

Desiree Chappell: Mm-hmm.

Karla Asikainen: ... as populations are getting older and sicker, as well as from another side, more consumer technologies even being used at home or in more consumerized spaces to do continued monitoring more on wellness factors or more chronic disease management. It is a very, very, uh, logical assumption that hospitals become more and more acute care delivery systems. So the idea of not monitoring my patient continuously to be able to avoid these adverse events when I am hospitalized specifically after risky procedures or- or step down- stepping down from the ICU becomes almost like a fault in logic. And because technology now exists where we can avoid tethering patients, where we can avoid causing massive workflow issues that would just eat up resources from these spaces, we can actually solve for it, get the data that we need, and help clinicians indeed be more proactive and getting more visibility into early onset of situations that indeed can change the course of the, uh- of the- of the patient's outcome.

Desiree Chappell: Yeah.

Solomon Aronson: And- and- and I would add, you don't have to say this, I will, um, that- that juxtaposed to safety and quality which is always paramount and center, um, is capacity management

Karla Asikainen: Yeah.

Solomon Aronson: ... and utilization. Um, and- and those- that's the other tension in the room that- that always exists andand I would, uh, expect that our abilities to manage capacity constraints

Desiree Chappell: Mm-hmm.

Solomon Aronson: ... better without having to compromise safety is gonna be enhanced with the utilization of this tool thatthat enables you to stretch, if you will, those resources

Karla Asikainen: Correct.

Solomon Aronson: ... in a safe way.

Karla Asikainen: I'll add just one more thing. Obviously, we are all coming out of, you know, COVID and- and all the learnings that we got from there. But I think one thing was the need for hospitals to be more prepared for situations that we can't really prepare for. (laughs) No one knew that this was coming and then we needed to flex up the- the- the capabilities of- of hospital inpatient care in- in- in- in very, very, very short periods of time. So the ability to introduce monitoring that can be flexible and can help in some of that also unprecedented capacity changes in hospital, I think that's also where technology like this can help. 

Desiree Chappell: Wow. And as a nurse that has taken care of 10 to 12 patients at the time and you never know if your technology's right, and now as a quality director thinking about all the data that we get, like, this seems like a solution that is a dream come true

Karla Asikainen: (laughs)

Desiree Chappell: ... on a- on- in the trenches, for sure. So, congratulations to you guys.

Karla Asikainen: Thank you.

Desiree Chappell: This has been a fabulous day

Neal Sandy: Thank you.

Desiree Chappell: ... for GE HealthCare. The launch is fantastic. Um, we're gonna hear more about it throughout the rest of the conference. I know we have a couple more conversations. Um, and- and the launch will be going out on TopMedTalk here in- in just a little bit, actually.

Karla Asikainen: Exciting!

Desiree Chappell: Yeah.

Neal Sandy: Outstanding. Outstanding.

Karla Asikainen: Thank you so much for having us. 

Desiree Chappell: Thanks so much.

Solomon Aronson: Nice to speak with you. 

Neal Sandy: Thank you very much.

Desiree Chappell: Well, you know, you can always find Top Med Talk on, uh, your favorite social media platform, Twitter, LinkedIn, Facebook, we are there. TopMedTalk.com as well as live.EBPOM.org. You can find all our information there. Be sure to check us out and, uh, stay tuned for other amazing conversations during Euroanaesthesia 2022. 

Solomon Aronson: Ciao.

Desiree Chappell: Ciao. (laughs)

Solomon Aronson: (laughs)

Top Med Talk.

 

Desiree Chappell:  It has been an exciting year and there's so much more to come. Now, I'm joined here Monty Mythen. Monty, what is coming up?

Monty Mythen: Well, next TopMedTalk, we're gonna coming to you live from the European Society of Anesthesiology from Milan in Italy. You'll find us on the GE booth in the trade exhibition. We'll be there intermittently. We'll probably pop up in a few other places. So I'm there with Desiree and Sol Aronson's coming in, and Henry Howe. And after that, Desiree, where do we go? 

Desiree Chappell: It is time for the 25th anniversary World Congress of Perioperative Medicine in London, right? Live! 

Monty Mythen: From the UCL campus to celebrate our 25th anniversary. So that's really exciting. And then I think we've got the next one in August with your organization in America. 

Desiree Chappell: It is. It's in Chicago. It's the American Association of Nurse Anesthetists. Monty or I are gonna pop up there, have some great conversations, and then it's onto... 

Monty Mythen: Dingle. So that takes us into the autumn and winter season. More about that to follow.

Desiree Chappell: And then of course, we're gonna be rounding out the year with the American Society of Anesthesiologists in New Orleans for their annual congress. So, super excited about all the events for the year. Don't miss us. Be sure to check us out on TopMedTalk.com and on your favorite pod catcher. We are there with late breaking anesthesia and perioperative news. Right, Monty? 

Monty Mythen: Absolutely. See you soon. 

Desiree Chappell: Cheers.