<v Jordan Cooper>We're here today with Randy, maybe the director of Cardiology Informatics at Integris Health. Randy, thank you for joining us today.</v>

<v Maib, Randy K>Thank you for having me.</v>

<v Jordan Cooper>You're welcome. So, Randy, at Integris Health, so Integris Health is Oklahoma's largest health system with 14 hospitals and 1500 beds. Integris Health also has rehab centers, physician clinics, mental health facility is independent living centers and home health agencies located throughout Oklahoma. Really, there are a number of topics that we're gonna cover today, many different projects you're working on would like to kick it off by asking you to tell our listeners a bit about your acquisition of a heart and lung transplant area.</v>

<v Maib, Randy K>Well, that just recently happened, Jordan, and it was something that's been toyed with for the last, you know, several years and trying to see how we can seamlessly provide more of a, a better infused cardio service line. So we just acquired the heart and lung transplant area December 1st of last year and are continuing to make changes in.</v>

<v Maib, Randy K>Staffing arrangements, acquisition arrangements for heart and lung organs. We're also trying to streamline efficiencies in clinical and admission spaces within the hospital as well.</v>

<v Jordan Cooper>And what are some of your? What have been some of the challenges from an informatics perspective with integrating the new cardio service line in terms of integrating different sorts of data from different sources? What have been the challenges?</v>

<v Maib, Randy K>Well, I think when you acquire any new asset or department or anything that you're looking at in a healthcare data.</v>

<v Maib, Randy K>You're always trying to find, you know what CPT codes are gonna be there. What DRG's are gonna be looking for? And, you know, just really trying to culminate the the vast amount of data that you have to go through. And in this instance, just trying to discover some of the trending information volumes costing data to get a better handle on exactly what types of you know, barriers are going to be there. And then also looking at forecasting out for their next five years.</v>

<v Jordan Cooper>Uh-huh. And. And so for our listeners, many, so M&A is a big topic across the United States and many of our listeners may not be directly acquiring heart and lung transplant service, but their employers, these large health systems are acquiring different imaging practices, provider practices, et cetera. This is very common for many of our listeners to be handling mergers and acquisitions. So what sort of advice would you have for them over some lessons that you've learned? I know it's kind of recent over the last few months.</v>

<v Jordan Cooper>You know, you're a leadership identifies. OK, here's some heart and lung transplant area, a service we're going to acquire them, OK. They make that decision. Then what's next? What happens? How did you bring it on online and what kind of things do you wish you would have known a few months ago when the process started?</v>

<v Maib, Randy K>I'll try to start out on the more simplistic side. You know when you're doing a merger, you know the best thing to do is take the.</v>

<v Maib, Randy K>Resources that you have internally that have a very deep and familiar.</v>

<v Maib, Randy K>Intelligence about what type of acquisition you're going through, and we leaned hard on the leadership for the heart and lung area as well, so.</v>

<v Maib, Randy K>You know, getting those grassroots details help kind of build that foundation that you're looking for when you're trying to.</v>

<v Maib, Randy K>Uh, you know, merging new areas or service lines. So really the the basis of every merger also comes the challenges with trying to figure out what you don't know and what you can't see. You know, there's unknown items and just digging deep into each of the service areas.</v>

<v Maib, Randy K>You know, we we usually discover about, you know, 80% real quick off the top. But you know that other 20% takes a a insurmountable amount of time sometimes to actually get all the detail you need. And I think in this case we really did, you know, find some challenges in trying to one truly understand every component in this merger and acquisition and you'll find it out the regulatory component in the background that you have to now deal with as part of your integrated.</v>

<v Maib, Randy K>Workflows and your business decision making processes. So I think those are some of the bigger challenges as really discovering how deep you need to go into those regulatory processes and some of the fundamental processes that you may not get those details on up front.</v>

<v Jordan Cooper>Appreciate that. Thank you.</v>

<v Jordan Cooper>So, OK, so we've we've now brought a new heart and lung transplant service into Integris health. Now we're we're looking at utilizing a new event monitoring device from biometric city. Tell me about some of the challenges with bringing that online and and what you've what kind of issues you've been handling on that project.</v>

<v Maib, Randy K>While previously in our clinics, we've leaned heavily on Holter monitors that were, you know, they've been tried and true technology.</v>

<v Maib, Randy K>For gears, but the issue with those types of devices is the that you bring the patient in place the monitor on the patient's, they go home.</v>

<v Maib, Randy K>Where the monitor. Sometimes they may bill it back or come back in and we take it off of them. But during that process we have no idea of if a lead falls off or if you know the patient takes a shower and the device quits working. You know, there's a lot of unknowns with that older technology. And then when you get back, you have to dock it, do the report and then you do that, put that into the EMR and then let the physician report on it with this new technology through.</v>

<v Maib, Randy K>Biometrically utilizing the bio trace device as soon as the monitor is paced, placed on the patient's, we actually start getting real time data that can be viewed through their website and also the patient can download an app on their phone and also see that information live. So it does give us a lot better functionality and stuff. We can also change the function of the device during the the wearing session, so if it's.</v>

<v Maib, Randy K>48 hour holter. And we want it to become an extended event monitor. All we have to do is make a check in the software and it can send it out to seven days, 14 days, etcetera. And we still have that full functioning capability. So one, it's a better process for the patient. It's better process for the provider because we're getting that real time data.</v>

<v Maib, Randy K>And it's just a thing that has never been accomplished before in my tenure here at Integris.</v>

<v Jordan Cooper>So I'd like to ask about the implications of these outcomes. For example, now that you're able to get real time data, are you seeing improved patient satisfaction, improve patient health outcomes? It sounds like you may have a reduction in staffing hours required to dock and report and monitor these devices once they're returned, a reduction in would justics cause associated with tracking and getting these devices returned? Is that true? And and and really back to the first part.</v>

<v Jordan Cooper>What is the health implication or or the revenue implication on the company?</v>

<v Maib, Randy K>Well, the the outcomes, you know, we're still kind of in the early stages. We just deployed this new vice device back in November. So we're still in the early stages of that, but all the providers.</v>

<v Maib, Randy K>That have patients utilizing these, these devices have been extremely happy with the reporting, the ability to see things in real time, the ability to change the monitor type from a holter to an event monitor.</v>

<v Maib, Randy K>You know, and it has significantly reduced the amount of time that our technicians have to deal with the devices and the reporting capabilities. So we also have the ability to now build out items utilizing this device that we couldn't before.</v>

<v Maib, Randy K>Utilizing the halter because previously we used a device that was a a patch and when we utilized that that company got all the technical revenue instead of us. So we're seeing gains in you know income and revenue as from utilizing this device as we move through trying to deploy it more frequently than when we have what we have previously.</v>

<v Jordan Cooper>Alright, so I hear new games and revenue reduction of operating costs and improvement and provider and patient satisfaction, right?</v>

<v Maib, Randy K>That is correct.</v>

<v Jordan Cooper>Wonderful. There's another use case, similar remote monitoring for device implants through octagons. I guess that's somewhat. Tell me what's going on with that project.</v>

<v Maib, Randy K>Well, traditionally, remote monitoring uh was a process to where you actually had, you know, four or five different software portals monitoring.</v>

<v Maib, Randy K>Each of the patients devices depending on what brand of device they had and those would be out on their websites. Then you would have to take that data and put it into a another piece of software which we use pace art here for that process.</v>

<v Maib, Randy K>And you can actually, you know, culminate all those things in one spot. But The thing is, is that that software is not timely and really telling you what is outstanding on your cycle processes. So we went out and looked for other software. We evaluated several vendors. This was done a couple years ago and it was very new technology.</v>

<v Maib, Randy K>But utilizing this platform, we can bring all of those different vendors portals underneath one platform that is now integrated with our epic EMR and we can actually have everything at our fingertips from the time that the check is done. The reports processed and then even now we're getting billing information through our interface as well to match up. So it really makes it a lot more seamless.</v>

<v Maib, Randy K>And for everyone. And then we can also, like I said, get our frequencies back and check. You know we got.</v>

<v Jordan Cooper>Mm-hmm.</v>

<v Maib, Randy K>Devices that you can have 12 billable items within a year. We were seeing previously that we're only doing about 5.8 on average and that number continues to increase be utilizing the software and getting closer to that at 12, we know that will never be a a true, you know possibility, but at least we'll get close.</v>

<v Jordan Cooper>So is there an integration engine that's taking the data from the device implants and embedding it within the EPIC EHR instance, or is octagons doing that on its own?</v>

<v Maib, Randy K>Octopuses doing all of that information transfer through their platform.</v>

<v Jordan Cooper>OK. Thank you.</v>

<v Jordan Cooper>OK, let's see here. On the topic, kind of relevant to the first topic, M&A, there's a lot of going on over at at Integris Health right now, a new Heart Hospital is going to be completed in about 18 months.</v>

<v Jordan Cooper>Well, you know, we're talking about acquisition, but now you're you're you're actually developing a denovo facility. What are the implications of for IT and and for your team?</v>

<v Jordan Cooper>Informatics.</v>

<v Jordan Cooper>Mm-hmm.</v>

<v Maib, Randy K>Like in, you know, building out any new facility always again have the the logistics component and you know those are the challenges that we're really trying to work through now as you know how how different will the movement of patients be in our facility building on this new tower, you know and within my area we manage all of the.</v>

<v Maib, Randy K>Stevie packs software, and the hemodynamic systems that will go into the new Cath labs and hybrid OR rooms inside that facility. So again, for, you know, trying to preplan as the building goes up to make sure that we have the appropriate IT accommodations for chase ways, connectivity, power.</v>

<v Maib, Randy K>You know and which the any big building project which we've seen over my 24 years here, I've seen many, many new hospitals and facilities being built which I was involved in on multiple levels. But you know the the biggest part about building on this heart tower, which has been something that's.</v>

<v Maib, Randy K>Been tried at multiple times throughout my years here at Integris is that it is going to be a standing beacon for the community in the terms of Heart Hospital because with our programs we do do everything from the beginning to end. When it comes to cardiac care since we do cardiology, you know we have invasive cardiology, we do heart transplant, we do mechanical.</v>

<v Jordan Cooper>Well.</v>

<v Maib, Randy K>Uh parts, so it's everything.</v>

<v Jordan Cooper>Let me ask I think many of our listeners have a healthcare delivery systems that have.</v>

<v Jordan Cooper>Probably multiple cardiac units.</v>

<v Jordan Cooper>And they may be interested in hearing what are some of the newest trends, right? So so Integris health you have?</v>

<v Jordan Cooper>You have all these cardiology units, you know you have 14 different hospitals. You have units in each hospital, and then you're building a new hospital. What's new and improved, especially from from the informatics perspective, what's different, right? They already know what they have, but what is being incorporated in the new hospital that other, that our listeners may not have and and and why? How is it adding value?</v>

<v Maib, Randy K>Well, I think that the.</v>

<v Maib, Randy K>Stuff with the new park tower going up is the fact that we're now going to have an entire service line operating in the same area, utilizing the same resources. When it comes to cardiac care, we do do a lot of research on different types of implantable devices in the heart and lung area, so we have a tab or program WATCHMAN program which are considered to be some of the more complex.</v>

<v Maib, Randy K>And procedures and devices utilized and cardiac care. We also do a lung valve implants and L Vads and all kinds of assist devices so.</v>

<v Jordan Cooper>Mm-hmm.</v>

<v Maib, Randy K>You know when we're trying to talk about a program in the state of Oklahoma, we're really the only facility here that does a transplant program. So we bring a lot to the table whenever it comes to any type of research.</v>

<v Jordan Cooper>Umm.</v>

<v Maib, Randy K>Coming out of new new companies or existing companies with new devices and we've got several providers here that are always on the forefront of utilizing those devices in patients where applicable.</v>

<v Jordan Cooper>You're also integrating a new video, video telemedicine program and Cath labs with Med inbox. Tell me about the motivation for incorporating that and the implications.</v>

<v Maib, Randy K>Well the the medium box solution provides our caregivers the ability to actually have a look in from other facilities. So with our partnerships outside, we can have experts abroad or in the states.</v>

<v Maib, Randy K>Actually looking on the case provide feedback, we can also utilize the technology to record sessions. So if we are doing you know something new with some type of device, we can record that.</v>

<v Maib, Randy K>Actual case and make it available for training to our other providers that are interested in and utilizing that implant or technology. So it provides a lot of robust capability that we have not had inside the procedure room previously.</v>

<v Jordan Cooper>Interesting.</v>

<v Jordan Cooper>So it sounds like external consults and recording, which is helpful for education, especially when new implants or technology or are used.</v>

<v Jordan Cooper>Umm, we're kind of. I just have a few more items to get through and a few more minutes. So you spoke about an upgrade on merge to CV packs.</v>

<v Maib, Randy K>Yeah, that's the merge CB packs we've actually had and this system for.</v>

<v Maib, Randy K>Several decades now, and you know, this is one of the challenges that I found over the years is when you're an early adopter of a.</v>

<v Maib, Randy K>That technology for cardless of usually what it is.</v>

<v Maib, Randy K>You get what I call legacy residue. That makes it to where sometimes it's not as easy to upgrade to newer versions due to hardware constraints and other items that may be a financial impact to your organization. We are upgrading to the latest version.</v>

<v Maib, Randy K>Uh on the cardiology packs and you know, like I said, with Earliers, we're finding out we need new hardware. You know, expanding our current archive for imaging, things like that. But when you're blending in a new environment, you're taking legacy pieces and trying to figure out how they fit into the new architecture.</v>

<v Jordan Cooper>I know Intersystems has many customers and there many listeners to this show that have been early adopters and there's and and these and our listeners are interested in. Alright, so I've been in early adopter maybe a few decades ago, kind of any recommendations for how you should kind of handle being an early adopter and then seeing the product mature and looking to upgrade later.</v>

<v Maib, Randy K>Yeah. And I think that the the thing that happens, you know with every organization in leaders is that you get busy, you get tied up in what's in front of you and often you don't keep up with what has been there and worked for a long time. So I think you know, taking a close look at least, you know on an.</v>

<v Maib, Randy K>Probably an annual basis. If not, you know, sooner than that, you should probably review those systems more often and make sure that your technology is locked and step with upgrades. They're available, integrations that are possible with the other resources inside your product portfolio, you know and it's it's, you know, we bought Tom Tech to do auto strain on our ultrasound echoes and we installed it and found out that the version of.</v>

<v Maib, Randy K>CV packs we were on would not let us fully use the Tom Tech solution because of, you know, the software version not being compatible. So again it is one of those things that.</v>

<v Maib, Randy K>Really behooves a company to just make sure that you're up and always on the latest, greatest and make those investments into the technology to make sure the platform is up to date.</v>

<v Jordan Cooper>Well, Randy, we've covered a lot of ground. We are approaching the end of podcast episode. We've spoken about the acquisition of heart and lung transplants on a similar note, we spoke about building a new cardiac heart cardiac tower, which spoke about device monitoring that brings data into an EHR. It brings data to providers in real time and some video medicine bringing.</v>

<v Jordan Cooper>Expert help into the OR any kind of.</v>

<v Jordan Cooper>Final points you'd like to make to our listeners.</v>

<v Maib, Randy K>Well, we covered quite a bit today, Jordan, and it's it's one of those things and being in this business for a long time, I think that you know.</v>

<v Maib, Randy K>Uh, my everyday job is always relying on those around me and and keeping them my ears and my eyes open. So you know that is the biggest thing, is not selling yourself off for what's there in the daily work and making sure that you listen when people are saying something within your team. So I think that's been the the biggest driver in us keeping our, you know, ball rolling downhill, if you will. So you know I always appreciate a good team.</v>

<v Jordan Cooper>Alright, well this has been Randy. Maybe the director of Cardiology Informatics at Integris Health, Randy, thank you so much for joining us today.</v>

<v Maib, Randy K>But thank you for having me.</v>