We're going to allow a few minutes for people to log on, but while we're doing it, I'd like to go through a few housekeeping items. This is Chris Romeo. I'm the Senior Vice President of the Ventures team here at Medaxium. Thank you all for joining us on today's webcast sponsored by our partners, Artegos. So there are a couple of different links on Zoom for those of you that are not familiar with it. There is a chat feature. In the chat feature, we're going to be putting today's presentation. You can download this, you can share this with your colleagues, and all the contact information for the Artegos personnel will be there. On the Q&A button, if you go in there, you can pose your questions in the Q&A section, and if it's time-sensitive, we can answer them in the Q&A function itself, but more than likely, we'll save those for the end and pose those to the moderators. So with that, let's get started. Today's title is Ignite Remote Monitoring and Wearable Efficiencies, Leveraging AI and True EMR Integration. Today's moderator will be Dr. Benjamin D'Souza. He is the section chief of cardiac electrophysiology at Penn Presbyterian Medical Center. I'm going to turn it over to Dr. D'Souza to introduce the other panelists for today's presentation. Again, thank you all for joining us. Dr. D'Souza. All right. Thank you, everybody. Good afternoon. Thank you to Artegos and the folks from MedAxium, and I am honored to be hosting this session. As mentioned, my name is Ben D'Souza. I'm the section chief of VP electrophysiology at the University of Pennsylvania, Penn Presbyterian, and prior to that, and still currently, I'm the head of remote monitoring at the University of Pennsylvania. So before I introduce our first speaker, I did want to go through and explain essentially what this session is. It's going to be an interactive discussion where we're going to have our speakers explain various approaches to optimizing workflow for both the clinical and administrative perspective, which I think is very important. And then we're going to address the challenges that are posed from the data deluge that comes from these implantable devices, whether they be pacers, defibrillators, implantable loop monitors. And then we're going to discuss the rising role of artificial intelligence and AI in enhancing the decision support that goes with taking care of our patients. So I'm going to very briefly go through our workflow and sort of how we came to the use of Artegos at the University of Pennsylvania. Next slide, please. So this is how we used to do remote monitoring, which is essentially, this is my wonderful team of nurse practitioners, teletext, physicians, et cetera, who we manually tried to sort of integrate all of this data into our patients to be able to take care of them. And quite frankly, even with a strong team of people, we really didn't do a great job. Our compliance was less than 50%. We were not following the appropriate patients. There were dead patients in our portals. It really was a disaster. And so we determined early on that the only way we could do this is with help. And essentially, we shopped through different companies, tried to figure out what we were going to do in terms of monitoring our patients, then thankfully, ultimately came across Artegos as an option to help treat our patients. Next slide, please. So this was our growth at Penn. You can see that the timeline there is between 2019 and 2021. I'm sure you can all remember what happened during that time, which was the pandemic. And we recognized that remote monitoring was not an option for our patients. It was required. It is now the standard of care and is in the guidelines for the ACCHA HRS. And for us, we really struggled with being able to get our patients monitored correctly, appropriately. And as you can see that that volume grew, so did our need for a company like Artegos. Next slide, please. So my job was to pitch this to administration, which I do on a regular basis. And it really was not a hard sell, to be honest. When we talked about, again, a same-day discharge program for all of our devices, improving compliance, actually increasing revenue, actually gaining revenue for the practice and for the University of Pennsylvania. Not to mention the patients actually really enjoy that they are being followed and monitored and know that someone is keeping an eye on them. And to be honest, the last part is that as we've all dealt with device recalls that have occurred over the last few years, this has continued to occur. It's not just a, as I mentioned, it's a standard of care. It's required that we follow our patients and do it appropriately. And we really needed a company like Artegos to be able to do that. But I'm going to do less talking now and start to introduce some of our speakers and looking forward to a fun, interactive session today. So next slide, please. So it's my pleasure to introduce Jodi Reyer, who's a nurse and is a clinical EP nurse at the Hart House. She holds a Bachelor of Science in Nursing from the University of Scranton and specialize in electrophysiology. And I'm looking forward to hear more about true bi-directional EMR integration and customization. I'll take it over, Jodi. Thank you. Hello, everyone. My name is Jodi Reyer. I am an EP nurse and manager here at the Hart House, which is a private cardiology practice in New Jersey, just outside of Philadelphia. At the Hart House, we have 34 physicians, including four EPs, and we follow almost 5,000 of our patients. I'm excited to talk to you today about how EMR integration, and even more specifically bi-directional EMR integration, has really revolutionized the way we streamline and operate. I thought to really think about how EMR integration has impacted us at the Hart House. In doing so, I realized it really hasn't been that long since we have had EMR integration. We have come a long way from the old days of writing thresholds and impedances out on a piece of paper and scanning them into the chart, of handling all administrative tasks such as billing and scheduling, and going into the patient's EMR for all the patient's medical information, including medications and diagnosis. It seemed like an eternity ago, but in reality, it was less than seven years ago. So by now, we all know that remote monitoring is the wave of the future. This is for many reasons, obviously for financial growth and prosperity and stability, but most importantly, for better patient care. With increased remote monitoring comes transmission data overload, which are true EP department nightmares. So without adapting to innovative EMR integration, not only are we missing out on potential income and revenue, but we are putting our patients at risk. Without the use of available tools such as EMR integration and customization that we'll be talking about today, your clinic really may struggle to keep up with financially and clinically. Next slide, please. So honestly, it was not until we joined with Octagos just about a year ago that we adapted true bi-directional EMR integration. In fact, other platforms we were working with prior to Octagos told us it was impossible for us because of our EMR system. So we don't use one of the top EMR places like Epic or Athena. We use GEMS, which made things a lot more challenging for us. But here we are now. They did it. Octagos made it happen. So today, it's a real thing, and I'm here to talk to you about how true bi-directional integration really does help. It improves and optimizes clinical care by ensuring patient safety. It enhances administrative efficiency by taking administrative work away from us health care workers, which in turn optimizes time management and enables us to focus on what truly matters, our patients. Next slide, please. So with automated remote billing and scheduling, for those of you who are not already doing automated billing and scheduling, I really, really, really cannot emphasize enough how beneficial EMR integration has been in improving remote billing and scheduling. And trust me, once you start, you will look back and don't know how you ever did it before. I actually remember timing me before we had EMR integration, and it would take me longer to do all those administrative tasks, such as looking back to see if the patient was due to be billed, putting the order in for their next check, and all these administrative tasks took me longer than it did to actually sit down and review a patient's chart. So I'm glad it's a thing of the past. With integration, automatic scheduling, and billing, our nurses now review the transmissions right from the site, right from Octagos. We don't have to go into the EMR really at all, and that's just something, you know, we need to look up more information than we have access to in Octagos, but for the most part, we're really just working right from the platform, right from Octagos, and it saves us a lot of time and administrative work, not having to go back and forth and do all these administrative tasks. So the way it works is once the bill is e-signed, if it is a billable transmission, it will be billed. If it's not a billable transmission, that report will still go into our EMR once it's e-signed. It just won't be billed. So as nurses, we don't have to look and say, do anything to not bill this report. It's an automated process that if it's billable, it's billed. If it's not, it's still there for our doctors to look at, but we don't have to worry about it being billed, getting declines, claims, and anything that goes along with it. So one other thing I did want to touch base on that Octagos does to help us ensure that we are capturing all of our billable opportunities is if a patient misses a scheduled transmission, say they're on vacation or their monitor got disconnected, if there is another report that at one point was not billable because it was in their cycle, but it didn't land on their billable date, Octagos will do what they call a send back, and they will send that report to us so that it will be able to be reviewed and e-signed and therefore become a billable transmission. So instead of missing out on that month's billable opportunity because a patient missed a bill from that date or a report from that date, we will be able to use a report as long as it meets the criteria, which Octagos will check for you and make sure it does meet that billing criteria, then we can use that report and not miss that billable opportunity. Next slide, please. So automating the transfer of e-signed reports. So basically, reports are only valuable if they're accessible. And doctors can only treat patients appropriately if they have the most up-to-date data, which before we had this process where e-signed reports automatically went into their EMR, it was taking us a month at a time to get these reports from our system, our platform, into the EMR because they were being manually matched. So now once the report is e-signed, it will automatically go into the report to the EMR for the doctor to review so that they have the most up-to-date data. You know, data even a couple days old when it comes to loop recorders and devices can soon be insignificant because something else came up. So it's definitely important for our doctors to have the most up-to-date information on our patients. Next slide, please. So this is where it gets good. The benefits of bidirectional EMR integration for our in-person workflow. You know, something I didn't even know I wanted. Octavia said to me, would this be something that you would want to have bidirectional in-clinic workflow? And I was like, I mean, sure, we'll try it. Why not? Can't hurt, right? Well, let me tell you, I needed it. It has made the world of difference in our workflow for in-person clinic. I'm going to give you a work through real quick, our workflow process and how it works for us to really enhance our in-clinic experience for not only us, but for our patients. So what happens is the patient walks into our office, the front desk, they check in either via the kiosk or through the front desk. And as soon as they check in through the EMR, a profile for them, they're added to our list in Octagos. So when I pull up Octagos, I have a list of patients that are already there for me to stay. I don't have to search by them by name. I don't have to search by them for anything. They're already there. And I want to also add that if you're working in a facility that has different offices, for example, you might have an office in Haddon Heights. You might have one down in Cape May, if you're lucky. And so I can pull up my personal schedule for all the patients that I'm seeing today in the office that I'm seeing. And that's the only list of patients that are on that schedule. So right from there, I can upload that patient information right into Octagos. I can write my note. I can use their dropdown where I can choose my CPT code. I can choose my diagnosis, which by the way, once you choose your diagnosis, it will stick for future use. So once you choose that diagnosis, unless you want to change it, that's not something you have to go in and change each time. And one thing I do want to add is that with this process, if you have a new patient, a patient that is new to your practice, that has never been seen before in clinic, a new patient profile will automatically be created and put into Octagos. So when you're uploading that report, you don't have to go in and create a profile for that patient. It's automatically done for you. And it saves a lot of time. And it gives you more time to spend with the patient, which is really why they're there. And once that report is finished and a doctor assigns it, same process, it will automatically be put back into the EMR for the patient. So next slide, please. Okay, so the next thing I want to talk about is bi-directional medication. Is that the right slide? I can't tell. So medication. Yeah. So back when we were negotiating with Autagus, they asked me what was number one on my bucket list, and that number one wish list was, I needed bi-directional medication. So that medications could go from REMR, Narcates, which is GEM, into Autagus. Different platforms that we work with prior to Autagus told me, it's not going to happen, there's no way, just impossible. But somehow, Autagus pulled their magic and they made it work and they did it. So we now have medications that go from our EMR into Autagus. It has made a world of difference for us. Now, when somebody has an AFib episode, we do not have to go into their EMR for every single visit and make sure they're on an anticoagulation medicine. What was happening before was, we would put on the platform, say, Autagus, and it would say, yes, they're anticoagulated. It would be stopped in the EMR, but because we didn't have that bi-directional communication, we never knew on the Autagus site, whether or not patient was still on a blood thinner. So if it was stopped, we didn't know it, we were treating that patient like they're still anticoagulated and we're putting these patients at risk. So for each AFib episode, we just had to go back to the EMR and double-check, and it was very time-consuming. If we didn't do it, that would be the one time the patient, something was stopped and we didn't know it. So that was great. Next slide, please. I think I'm running out of time, so I'm going to speed it up a little bit. So once we realized how great this bi-directional medication experience was, we realized quickly that we still had some flaws we needed to work out. We still had to realize how to manage these patients that were on anticoagulation medications. But now for a different reason. You know, with these great medications coming out for anticoagulation, such as DVT and PVD, these patients may be on anticoagulants for PE, and they need to be on 20 milligrams, and 15 is just not enough for them. Octagos and myself, now the only patients that will be labeled as being anticoagulated in Octagos are patients that are really on therapeutic anticoagulation for atrial fibrillation. So we don't have these patients fall through the cracks that are on the wrong dose for AFib that are being labeled as anticoagulated. And so that's really helped us. It's been better for our patients. It's been safer, and it's really given us the confidence that we're treating our patients the best that we can. So I'm running out of time again, but last but not least, I wanted... Oh, next slide, please. Sorry. I wanted to touch on the benefits and impacts of website customization. Octagos embraces the fact that clinics come in all shapes and sizes. We have different needs. We have different facilities, different things. We have to overcome, and they've really been gracious at helping us really work with us to see what we have needed, and we have a long way to go, but it's been a great experience so far. I think I'm out of time. Sorry about that. So anyway, in summary, I hope you can see without a doubt that efficient EMR integration enhances safety and efficiency in patient care, which in turn leads to increased revenue and more effective utilization of the healthcare workers. Thank you. All right, thanks, Jodi. That was a great talk, and really sort of highlighted what true bidirectionality is in a platform integrating with your EMR. All right, so we're gonna move on. So I'm gonna introduce Amber Rogers. Amber and I have worked together in multiple, mostly in-person forums. I think this is our first virtual one, or maybe second one. So Amber is the senior department manager at AdvenHealth, and she brings a very extensive experience, and I learned a lot from her over these years, actually, in terms of how they've integrated Octagos. So she works with both clinical cardiology, electrophysiology, and healthcare management. She has a bachelor's in business administration focused on healthcare administration, and excels in sort of clinical operations, IT interface, and business development, which, quite frankly, a lot of us need help with because we may be good at putting in pacemakers and ablating arrhythmias, but not necessarily dealing with all the other stuff that we have to deal with in healthcare. So I'm gonna turn it over to Amber, and her talk is gonna be covering the economic impact of remote monitoring. Hi, everyone. Thank you for having me. Yes, so my name is Amber Rogers, and I work with AdvenHealth. Our system is a little larger than Jody's. We're more in an enterprise setting. We do span across the nation. What I've done with my slides is I've just pinpointed one location in particular, so I'm gonna share the economic impact that will allow you all to see what happens when we bring Octagos in to one of our clinics. So our goal mainly was to look for a centralized model that made it easy for when our enterprise would acquire or start a new practice. So that's what our goal was when we started to shop vendors that were gonna be able to assist us from a third-party aspect for our implantable patients, as well as our wearable monitor patients. We can go ahead and start with the next slide. Next slide. So we've created a unique approach to this type of service line. We have a virtual care center that's been developed, and we do provide a team of nurses that monitor our patients on a 24-7 basis where we can escalate all of our alerts up in an organized fashion. And again, it's a centralized process that's interchangeable no matter which clinic that we launch this solution in. So this slide's just talking a little bit about that and how we've been able to leverage those workflows to improve our technologies that we provide to the clinics for them to be able to be more productive and also follow protocols, which allows us to work with limited physician supervision. You can skip to the next slide. We're gonna start, like I said, we're gonna talk about implantable devices. So I'm gonna start with that, then I'll move into the wearable devices, which we specialize in as well. This is gonna just go through our growth in this one center in particular. You can go through to the next slide. What Octagos has done for us is we've been able to, just like Jodi, decrease our staff time. We've been able to reallocate them to other workflow. One of the big things that you're faced with when you go into these smaller practices is there's always concern for when you outsource that someone's gonna lose their job, they're going to take over once they come in. And we really pride ourself on supporting our staff and reassuring them that that's not what's gonna happen. So we've been successful in reallocating and that's allowed us to expand services and how we've been able to centralize more of our services as a whole. Increased net revenue and cost savings they've helped with. We do more for a lot less. We've been able as well to automate our billing and our scheduling. There was a lot of wasted, unnecessary time throughout the day just trying to figure out what the next date of the appointment was with the global billing periods. It's very specific. We do not want to have denials that again, it's just a waste of redundant workflow that we've been able to eliminate by having the Octagos provide us the date. As long as you follow the platform, everything's pre-populated. As soon as you see that patient that day, it'll tell you when the next billing of an appointment should be. So it's a very seamless process once you go into the automated billing and scheduling. Patient care, we're able to actually focus and prioritize the alerts at this point. We'll talk a little bit further in some of the slides, but being able to really focus on actionable reporting versus weeding out all of the noise and unnecessary reports that will come in through the vendors, it's more of like a raw data. And you also, it comes into patient compliance as well. That's been something that we've been able to vastly improve because by having the engagement team that's able to see and watch that that device or that patient didn't send a transmission, they follow up on all of that. So that's all been alleviated from our staff as well. You can skip to the next slide. Here, we've been able to show how, again, we've been able to weed out all of the noise, which has allowed us to increase the revenue. When you do reduce, we would go on just an average and this clinic in particular, they would come in every morning. There would be between the vendor sites, anywhere from 130 to 150 alerts. Again, raw data. By switching over to the AI-based system with Octagos, you'll come in now and it's anywhere from 25 to 30 alerts that are actually actionable. So that's a significant reduction in alerts showing 77%, which again, has allowed us to utilize our staff in a more productive manner. It automatically recognizes the billable transmission. So you're not having to look up the last transmission, just alleviates all of the manual processes to alerts and billable transmissions that come in. Automatically can schedule the appointments. Our system is a little more complex. We haven't, we're not where Jody is, unfortunately, with the interface at this point, but just being able to utilize the portals in a manual fashion has significantly improved our workflow. Just from alleviating the fact that the team member has to calculate the 90 day global period, and it's just provided for them in an automated fashion. And the portal, again, has significantly improved our workflow, even though we have a lack of the interface. We've shown a 80.4% sent transmissions were billable. And that goes into the fact that the portal is able to look up and determine what is an actual billable transmission versus the unnecessary transmissions that come in in between with your frequent button pushers, we'll call them out here in the operation side. So you'll have patients that are constantly sending out a transmission and your team members sitting there trying to figure out what is this? Why is it here? It has no alerts. No, is it a billable? Is it not? That's all been alleviated. We have now the actual system that shows us whether it's billable or not from the beginning. So it's nice. Next slide. This shows how we've been able to increase our patient count. We really do leverage the engagement team. When we obtain or we acquire these practices, a lot of times the patients have declined remote follow-up. It's just not their thing. The team members are, you know, they're maybe not as educated as to why it's important for the patient to be on remote. So it's just been something historically that just goes unaddressed. Well, having the Octagos enhancement or engagement team has allowed us to really connect with the patients. They do it for us. They call them, they educate them, they troubleshoot them. I mean, our teams are for years or forever been getting the calls from the patients. I don't know what's going on with my box. It's not connected. Just troubleshooting whether the signal's coming through. Octagos alleviates all of that from our workflow and they're able to productively get the patients enrolled, ensure that their transmission's coming through. They connect with the patient. They communicate. They take all of that off of our practice workload. So that's been significant for us. They document all of the interactions for the patients. You have a chat that's built into the portal and that allows you to stay connected even though you have outsourced this, you're able to still follow what the communication has been with the patient. And that makes the patient feel like everyone's aware of their care and everybody's on the same page. So that again has been very effective for us. And you can see in the graph, the growth, we also just, I grabbed some dates here. This was back, I mean, we've been with Octagos for about three years now, not in all of our practices, but in this practice in particular. And you can see the significant increase just over utilizing the engagement team to get the practices or the patients enrolled into remote monitoring. Next slide. Battery status. I like to really focus a lot of times on the analytics that Octagos has. And I chose this one for this talk just to kind of fine tune why we use the analytics. I'm involved a little bit more in the supply chain side and we're always leveraging our bulk ordering, utilizing their analytics helps with that. And I just wanted to highlight some of those points here in this slide, battery status evaluation. It allows us to do more than just determine whose battery is where and what's going on with that individual patient. It's a bigger picture. It helps us with the bulk ordering. No one likes to buy devices and have them sitting on the shelf. So by utilizing their actual analytics, we've been able to improve that process. So now we're able to evaluate this through their analytics and determine how many devices we need to purchase. We're able to leverage our pricing based on that. Staff planning, as far as when we're going to need to increase FTEs based on the projection of how many devices we're going to be changing out. We can see and project revenue directly related to change out. So there's a lot of significance to their analytics and not everyone's really aware of how to look at that and how to utilize it. So I wanted to share this, cause this is something that we've found it's been very useful. You can skip to the next slide. This is a growth chart. This just is basically, it just rolls back to the fact of how the billables since we've moved into the automation and actually utilizing the third party portal to let us know when we need to truly bill something. So you can show on the shows on the graph here, we've had a 62% growth in billable opportunities, 55% growth in patient enrollments and a 52 increase in patient compliance. So that checked many boxes for us. It not just increased revenue, it true revenue and alleviated unnecessary denials. It also allowed us to get those patients enrolled and grow the remote volume as well as patient compliance, which is just a huge reduction of risk and liability, especially when you're dealing with the volume that we're dealing with across our system. Octagos currently is managing a little under 9,000 patients for us nationwide. So when you're looking at those sizes and the span of that, it's very important to have an organization that you work with that can help you manage that in a seamless process. Next slide. So we're gonna move into the wearable monitor aspect. This is something different. We haven't talked about this yet, but we also, we've really grown a revenue and from an economical standpoint, as far as utilizing our wearable monitors. We purchase monitors at this point and historically it's typically been vendor-owned monitors and we're doing split bill style where we're looking at the wearable monitor style where we as the organization are only billing for the professional component and the vendors have always been able to bill for the technical component. What we've done is we've been able to work with Octagos and we've been able to leverage that and create a model to where it's profitable for us both versus just the vendor at this point. So next slide. This is just the breakdown of the different type of monitoring. Everyone's probably familiar. There's MCOTs, MCTs, there's event monitors and then there's extended halter monitor. This slide is just telling you basically what those types of devices are, what type of responsibility comes with the different modality of the device. You can skip to the next slide. Past has always been, like I said, split bill. For all and that would be where the vendor would bill the technical component and which is your larger revenue generating component from a billing aspect. And you as the organization would only be able to bill for the professional component. Currently we're in the global bill for the majority and we leverage the IDTF. And what we're doing is we're paying them a monitoring fee. We purchased the devices ourself and we're able to bill both of the professional and the technical and we pay the vendor for the monitoring fee, which has allowed us to increase revenue, which you'll see on the next slide. Future scope is gonna be where we are going to eliminate the monitoring fees altogether, own all of the devices and we'll only be moving into a software based on that. And we'll only be moving into a software based only. This is just our growth chart that shows how the monitor use has grown over a three year period. And you can see that we've moved mostly into utilizing the MCT devices. It's not just important from an economical standpoint that we've done that. It's also due to the fact of it's the better reporting. It's the better data Intel for your patient. We're able to actually evaluate and treat that patient better and more in depth. We're able to see more from the MCT model versus the event monitors or your halter monitor, which has been the historical views that we've been able to obtain through a monitoring aspect. We've been able to 56% increase in total monthly studies that have been managed since we've been working with Octagos, 92% increase in utilizations of the MCOTs. All of the studies, because it is the better quality monitor as a MCOT, they help us with the billing aspect as well as the prior authorization. And the only time it really gets flipped or downgraded is if it is insurance restraint. So they work very closely with us. And overall, we've been able to significantly increase. As you can see, we've gone 92% in utilization for MCOTs alone, which not, like I said, gives the patient the better quality reporting, the provider, the better quality reporting for their patient, but it also allows us to grow economically for our organization and make more money. Next slide. This shows the significance and the different scenarios that I've already talked about. You've got the split bill style, which I said historically is where we as the organization would only be able to bill the professional component. We would be able to make $30 on each time the monitor was worn. Scenario two is where we are currently, which is where we bill both components, the professional and the technical, and we pay the vendor the monitoring fee. This has significantly increased our economical revenue for $480 is what we're now able to profit on each time the monitor is worn. Now we do own the monitors. Of course, we do have the cost associated to purchasing those monitors, but you make your money back in three wears of that patient or of that monitor. So just to break that down for you a little bit, I usually will use my monitor twice a month. So you'll, after three uses, you make back your money that you spent on the monitor. So that's where it makes sense for us. Then there's a scenario three, which is my future scope that I'm moving into, which will be a software only use model. And that will allow us to pay a very, you know, reduced amount for that software. It's $30 a month per device. And the profit for the organization is $800. So big numbers, it also takes a lot more responsibility. You as the organization are responsible for prepping, cleaning, recirculating those monitors. They do not assist with anything other than provide, the vendor doesn't assist with anything other than providing access to their software. You have to have an internal team that monitors those monitors 24 seven and so on. So next slide. Amber, another 30 seconds. Yes, thank you. So this is just showing a mix of the devices and the growth and the revenue that has been able to, we've been able to grow and increase. It's over a 300% increase in financial value at this point. You can go through the next slide. This is the device itself. And we, you know, I wanted just to share this. I mean, they have this device available, Octagos, and I'll tell you why we've moved to utilizing this device is it's really the latest technology. Historically, you've had the patient that would come in sometimes wearing the monitor or they would come in, they just mailed it back yesterday or last week. And we haven't been able to obtain that data with these new devices that have the cellular enabled chips inserted into them. We're able to end the study, get the results, whether the patient's sitting in the room, driving down the road in the RV. So this is a significant value added to our practices. And I just wanted to share this slide so that you would all be familiar that they have that aspect available. Next slide. Yeah, perfect. So any questions? All right, thanks, Amber. That was a great talk as always. We're gonna save questions actually for the end just so that we save enough time for all of our speakers, but we'll get back to you. I think it was great that you highlighted a lot of the obviously economic benefits that your institution has benefited from. We also utilize the wearables in addition to the implantables at Penn. And also that you commented on that there is a chat function where there actually is a human being on the other side of Octago so that it is not purely a software solution because I'm actually down in Cape May right now on vacation with my family. And there's a lot of retired older folks down here who don't know how to use their monitors. And I think that the engagement team has been very helpful in that regard. So again, all wonderful information. So we're gonna move on to our last speaker, Dr. Colin Moskowitz, who Colin and I know each other very well for many years. He's an esteemed electrophysiologist at CCP, the Cardiology Consultants of Philadelphia, which I learned is not just the biggest private practice group in the area, it's actually in the country. And he specializes in electrophysiology treatment of both arrhythmias, ablations and devices. You can tell from his slight accent that he completed his medical education in Cape Town in South Africa, which I would argue is one of the nicest cities I've ever been to, and I'm sure he would agree. And then he completed his residency at Albert Einstein and then his cardiology fellowship at the University of Pennsylvania and Penn Presbyterian, which is where I completed my training as well and currently practice. So I'm gonna turn it over to Colin for our last talk of the day, which is in regards to one of the many banes of our existence in electrophysiology, which is managing alerts. So alert managing, reducing data deluge efficiency and alert management. So I'll turn it over to you, Colin. Well, thank you. Thanks, Benjamin. Could we go on to the next slide, please? I'm gonna try to really speed through this as I think we have limited time. So in private practice, we talk about service lines and one of the service lines, obviously, is arrhythmia service line and remote monitoring is one aspect of the service line. Obviously, there's also ambulatory monitoring device clinics and electrophysiology lab. Go to the next slide. And with cardiac implantable electronic devices, we are monitoring our pacemakers, defibrillators, BIV devices and loop recorders. And then we're monitoring the data we monitor, as you all know, is for system integrity, arrhythmias and heart failure. Next. And now the number of tasks that are required to run a remote monitoring service line, and these have actually been outlined in great detail in the consensus report by the Heart Rhythm Society. And today, I'm gonna briefly talk to you about the data evaluation and management of both scheduled and unscheduled alerts. And I really want you to focus on those two terms because they are key to this talk. Next, please. So the anticipated impact of remote monitoring was a paradigm shift in our healthcare. You know, what we were doing was we were telling patients who had pacemakers and defibrillators to see us every three to six months in the office for basically well-baby visits. And we were hoping that we would be able to eliminate well-baby visits by using continuous remote monitoring. And we would only then see patients who had device alert-driven unscheduled sick visits, and that this would unburden our device follow-up clinic, and you know, we'd have much more time. And yet, next slide, this just hasn't turned out to be what's happened. Well, the actual outcome is that now, instead of having scheduled in-person visits, we now have to schedule remote transmissions for patients who are out there in, you know, space. They're not even in your office, and you have to schedule them. And they have to be scheduled on a routine follow-up. And you have to, and you also still have unscheduled alerts. And unscheduled alerts often drive alert-driven office visits. And then we're still seeing patients once or twice a year for, say, a defibrillator, once a year for a pacemaker. So at the end of the day, it appears that we have even more work now than we had before. Next slide. So the unforeseen challenge of remote monitoring was that continuous monitoring also generates an enormous amount of data. A lot of it is just false positives. A lot of it is normal. And instead of now being overwhelmed with in-person evaluations, we swamped with scheduled and unscheduled transmissions. And what we really just want to look after, we just want to see patients who have actionable alerts. That's really what we want. Next slide. So the current reimbursement model forces us down this road because the current reimbursement model reimburses for scheduled downloads. And there's a specific billing cycle, as you all know, and we specifically have to download the information in either 30 or 90 days, depending on the device, so that we can bill the patients accordingly. This is a fee-for-service model, and that's how it currently works. There are alternatives. Next slide. So, you know, in private practice, things have to be fiscally viable. We're not running, you know, hospitals can run in the red, and you're constantly reading about hospitals lost a hundred million dollars. Well, in private practice, you can't run in the red because we wouldn't be able to pay our staff. So we look at remote monitoring billing, we see these codes, and we say, is remote monitoring fiscally viable, and how are we going to get there? Next slide. So we've been told you can either do this in-house, and we started out doing it in-house, and the societies have actually told us how many, you know, full-time equivalents, how many people do you need to hire to look after a thousand patients? And they say you need three full-time people. Three full-time people will run you around $250,000 a year, if one of them is a nurse practitioner and you have two other administrators. That didn't run well with our practice, so we looked to a third party, which in this case was Octagos, and we were looking specific. They provide staffing, so we don't have to hire staffing to do the clerical work, and they also use artificial intelligence to make this whole process move more quickly. Next slide, please. So when we were looking for a third party, so just go up next on that slide, we were looking for the following. These are the things that we needed. We needed a company that could integrate data from multiple vendors. They needed to provide us with a user-friendly interface so that when we got to looking at the data, it was easy to get to. We didn't want to deal with patient connectivity. We wanted them to do it. We wanted easy access to all the electrograms that corroborate what the issue is with a patient. We wanted contextual reporting, which is what you've heard about, which is when Octagos goes into our EMR and collects some data and then presents it to us with a patient, say the patient has atrial fibrillation, you know that they're ready on anticoagulant therapy, that makes interventions much more clear as to what the nurse practitioner needs to do for that patient. And we want actionable alerts. We don't want non-actionable alerts to review, and that's what we want them to do. And obviously, we had to have an arrangement with Octagos that made sense to us. Now, there are a whole bunch of companies that fit all these parameters, but what we found particularly good and inviting to us and why we went with Octagos is their population analytics, which is not common to most other companies, and we'll talk about that. Now, what you can see is we've all now been emphasizing the downstream solutions to alerts. So you have a whole lot of alerts, what do you do? You hire people to look after them either in your office or you get a third party. Next slide, please. And this third party for us, as well as Octagos, gives us these patient population analytics, which are really helpful. They show us exactly how many documented alerts and transmissions are being downloaded every month, and they even can calculate, and it's a very good calculation, and tell you how much money you could collect if you build all these patients appropriately every month. And this is information from out of 6,000 patients, now 7,000 patients. Next slide, please. Octagos also helped us get a better understanding of what we were dealing with, right? When we did it, we were dealing with individual patients. Now we can look at our patient population and know what are the alerts that we're dealing with? Are they high ventricular alerts? Are they pacing percentage alerts? And atrial fibrillation alerts. We know where the alerts are originating. And if you look at that slide, you can see that of the multiple transmissions that are sent based on our almost 7,000 patients, Octagos doesn't send us all that information. They're trying to send us clinically relevant information, and they are coding those transmissions so that we know what ones we need to look at first, the red alerts, which only make up 2%. But when we go into Octagos in the morning, we can say, show us red alerts first, then yellow alerts, then white alerts. And we know we can triage those questions. And our allied health professionals who have a full schedule of patients can actually do this in between patients. Next slide, please. So what we've been talking about were the downstream solutions. But if we're going to really get our arms around a remote monitoring, we're going to have to think about upstream solutions. So what do I mean by upstream? Upstream means what are we doing about the alerts before we get them? And we can modify incoming data stream by the best way to do it would be to eliminate scheduled transmissions. Now you say, that sounds crazy. We paid for scheduled transmissions. That's correct. That's the current reimbursement structure. But going forward, when there are large cardiology practices around the country, maybe Advent Health could do this. When they could go to the insurance companies and say, we want value-based care, and they may be able to eliminate scheduled transmissions. Now my time is limited, so let's just move on. Could we have the next slide? So there are at least two publications pointing out that we could look after patients with alert-driven transmissions only. This is one of them. Go to the next slide, please. And this is the second one where it shows you that alert-based therapy for ICDs will be just as good as having scheduled transmissions. Next slide. But these are not the only upstream solutions that we need to look at. We need to modify our unscheduled alert transmissions too. We need to press the device companies to reduce false positives, and physicians need to take ownership of the alerts. So I only have a minute left, so let's go next slide, please. So device companies need to reduce false positives by using artificial intelligence. Next slide. Device companies need to standardize their actionable alerts. There's so much confusion driven by the fact that all the device companies are learning differently that that creates alerts which often are not necessary. Next slide. And then physicians, and physicians need to take ownership. Next slide, please. So what we're looking at is right now we're asking, we're looking at all this remote monitoring data and we don't even know what we're doing with it. Because we don't know, we still don't know despite the NOAA and ARTESIA trial, what the burden of atrial fibrillation is that requires anticoagulation. We're still asking the remote monitoring companies to send us information on non-sustained VT in patients with pacemakers when nobody even knows what to do with that. We don't have a good protocol as to what to do with the heart failure data. So we need to get the physicians on board with more studies, more research to understand what alerts we really need, what are actionable alerts. And until we get that, we're gonna be throwing manpower at all this data which isn't really all that valuable clinical information. Next slide, I think I'm almost done. So we want more uniform alerts. Next slide. We want to know what to do with heart failure data. Next slide. We need physicians to understand that they need to, they can't just put pacemakers and defibrillators in or loop recorders without actually programming them appropriately. Out of the box programming causes all kinds of problems. If we program the devices better, we would have less inappropriate non-actionable alerts. And you can program the device at the time you put it in, you can program the remote monitoring at the time you put it in. Next slide. Once it's put in and the patient leaves, you can program remote monitoring. And this will be the last slide then. Next slide. And if you have, if you dynamically, if your alerts, if you reprogram your alerts appropriately, and here's one study that did it. They said, let's program alerts off for a further less than five hours. If there's persistent AFib and it's already alerted, program it off. We don't wanna know about non-sustained VT and ICDs. And if you do that, non-actionable alerts, next slide, will reduce and you can have less inappropriate alerts. I'm gonna stop at this point because I think we don't have enough time. I want you guys still to have some questions. But I do wanna make this point. We've been putting all our emphasis on downstream looking after the data. We need more emphasis on upstream looking at the alerts so that we get better data in and more valuable, actionable alerts. I'll leave it at that. All right, thanks, Colin. Wonderful as always. And I think your struggles are the same as ours certainly are at Penn and everywhere, every institution in the country. So I had a question that came through for you and then also a question for Amber. So I'll start with you, Colin. So you had mentioned just the massive amount of alerts and the data that's coming through from all these devices, especially the ones that are now transmitting via your smartphone all the time, that kind of thing. Given that and how much your team has to dedicate to that. And as you had already mentioned, these are not billable transmissions. You're not getting paid for the work that we're doing. It's just required as the standard of care. What would you say is the most important thing in selecting a company to partner with in terms of remote monitoring in that regard? So the reason we went with Octagos is because they fulfill all the tasks. We don't need to do all those clerical tasks. And remember, when you're in a practice and you hire people, as somebody said, people get sick, people get pregnant, people change jobs. And often when you're training people, if you start out and train somebody, as soon as they get good enough, there's another practice who may pay them a little more and then they leave, and then you're left with nothing. So this isn't a, we never, well, we decided this was not for us. That kind of redundancy in workforce is something that Octagos should take care of. And they do a wonderful job of it. And that's why, that's what really helps. They cull the data and what we get is mainly actionable data or data that we can sign off on because we know it's normal. Yeah, no, I agree completely. It's definitely changed the way that we certainly practice. And I'm glad you also mentioned some of the analytics, which honestly I only thought analytics were, for my Philadelphia Phillies playing baseball right now and not so much for electrophysiology, but it definitely has, it has very applicable implications for electrophysiology. So now Amber, I had a question for you that came through as well. And we talked about this platform. We talked about all the wonderful things, the bidirectional integration, the analytics, the ability to sort of improve patient care, which we all think is the standard. So given all of that, you still have to convince your administration to buy it and to purchase it and to use it. And so I've heard from many administrators, including our own at Penn, that they don't want to outsource remote monitoring because they think we will lose money. And so I wanted to ask for you guys at Advent, how did outsourcing remote monitoring impact you economically? I know you did touch on this somewhat during your talk, but specifically how Octagos helped you sort of accomplish that goal? Well, I think ultimately it goes to the fact that we weren't, we were leaving a lot of money on the table. I think that's what I had to show them from the beginning and able to continue to paint that picture as our growth increased and we continue to expand across our enterprise. So the big picture for us was, it was of course the economical side, but also the reduction of risk and liability. I hit on that heavily with leadership as well as the economical aspect, as you mentioned. So those were both huge. I think also we had a lot of cost savings associated to the vetting process. When you are looking at these different vendors, we still have a couple other vendors that are in our system. Mind you, we span across nine states. Of course, there were already certain outsourced options in place. We have some that maybe there's a physician relationship and they're just tied to those vendors, but we're little by little showing them that the centralized process is more effective. It's something that we can utilize in a more seamless aspect. And I think that our leadership was able to see the cost savings just when you're looking at these IT reviews, the third-party risk assessments, things that we really have to tune into as a larger enterprise, because there's a lot of costs associated to all of that. And when you've already checked all those boxes with one vendor that's providing high quality service as Octagos is, it just makes sense for them across the board and that's really truly what I've leveraged to get my point across as to why we need to have this one model. Got it, terrific. Well, I wanna thank everybody. It was a very engaging and interesting hour of presentations and again, I wanna thank the folks from Octagos and also the folks from MedAxiom for hosting.

remote monitoring

healthcare setting

webcasts

chat and Q&A features

AI

EMR integration

patient care

revenue growth

data quality