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Mister Beacon Episode #99

Real Time Location Systems in Healthcare

December 10, 2019

Midmark is the 100+ year old company that “we all know, but don’t know”. The last time you were at the doctors or dentist, you were probably sitting on one of their chairs or tables, and most likely surrounded by many of the products they produce like cabinetry, lighting, and diagnostic equipment. HT describes Midmark as the market leader in providing “everything you need to outfit a medical environment”. HT Snowday, VP of Innovation and Technology Development at Midmark, joins us today to talk about how Midmark is also in the business of Real Time Location Systems (RTLS). This week we get a different perspective, a customer-orientated view, of RTLS technology in one of the largest organizations in healthcare. Join in to hear about the different technologies they use in a variety of healthcare use cases, such as asset tracking, device management, patient/caregiver management, and work flow processes.


  • Steve Statler 0:07

    The Mr. Beacon podcast is sponsored by Wiliot, scaling IoT with battery free Bluetooth. Welcome to another episode of the Mr. Beacon podcast this week, we're gonna be talking about RTLs. In healthcare, that's real time location systems. And we're talking to HT Snowday of Midmark. Welcome to the show HT. Thanks, Steve. Well, I am very glad that you joined us, we spend quite a lot of time looking at technologies specific individual technologies. And you're really an antidote to that, because you work as part of one of the largest organizations that's engaged in healthcare. So you have a very vertically focused customer orientated view of this, you have a perspective on what works, what doesn't work. And you work across a broad portfolio of technologies, not just Bluetooth, not just infrared, you look at a whole bunch of them, and you're big enough to be technical and dispassionate about what works where. So lots of good reasons for having this conversation. I hope out of it, we get an insight into this healthcare market, which is one of the strongest for indoor positioning technology and RTLs technology. And I am looking forward to getting your views on the what's what's good for what and how you use it, and a bit about Midmark. Before we launch into that, I just want to give a shout out to the folks at Starbucks, this is not a paid endorsement. But as well as having great coffee and being my office away from home. Starbuck offers this amazing program for kids, adults on the autism spectrum and provides employment which provides meaning to their lives and some very passionate, really engaged team members who are great for visitors. So I want to thank them for that. My son is one of the kids that's part of that program, and it's meant the world to us. So thanks to Starbucks, and let's get back to UHT perhaps you can start off and just tell us a little bit about what your role is, where in Midmark, you fit. And then we'll go back and talk a bit about how this organization that provides the chairs that we lay on in our dentist got into all this crazy technology that you deal with?

    HT Snowday 2:46

    Yeah, that's brilliant. I cannot walk away from your intro. Steve. That's, that's wonderful stuff. I love hearing that. And I appreciate you taking the time to call that kind of work and engagement out that that's really cool. Yeah, so I am HD started with Midmark Corporation, specifically Midmark RTLs, which is the part of the organization focused on real time locating solutions. I am the Vice President of innovation and technology development, which really means I'm focusing on what we're doing next and in the broadest sense. But you know, relative to our TLS, and specifically our TLS, and healthcare, I've, I'm an old gray haired guy in the space and bend. My first engagement was in 1995. In a long term care environment, and you know, the, the technology has changed some of the physics that we have to deal with haven't which, which I can talk about that from our perspective, that's part of the broad perspective on on these kinds of solutions. But importantly, and what's always hooked me is the ability for this technology and this information to have a positive impact on on care on patients and on caregivers. And that wonderfully speaking is part and parcel with part of your implied question about above Midmark in the space.

    Steve Statler 4:17

    Yeah. Tell us. How do most people see Midmark? What the What do you guys do?

    HT Snowday 4:25

    Well, Midmark is the enormous company that you all know but don't know. Ben Mark has over 100 years old manufacturing discipline in the heartland. Primary operations are in and around the Dayton area in Ohio and I can provide some more detail but primarily today mid marks business is spread across three different healthcare focus areas Dental, animal health and medical. In the RTLS space. We're focused on of the medical industry and within the medical space, you know, Midmark has a range of products across the spectrum of things that you need to outfit a clinical environment. And that's a really broad definition, the thing that Midmark is probably most well known for our patient positioning devices, which is a fancy way of describing chairs and tables in a clinic environment, I can assure you that most, most of the people viewing this podcast and yourself have spent a fair amount of time on a Midmark table at some point. It's a very common component of a clinical environment. But min marks product base goes well beyond that. So cabinetry and other ancillary chairs and tables, lighting equipment, diagnostic equipment, which is a very specific technology, discipline for the organization. You know, it's fairly comprehensive, or we are fairly comprehensive in our approach to making sure that a clinical environment has the best possible tools available. And it all centers around a fundamental care for improving the patient experience. And that's, that's really a wonderful thing about Midmark, I am relatively new to the organization as a whole. While I've been in RTLs, for a long time, we joined the organization in 2016. But it's been a very good synergy, anchored around what we can do with products and technology, to improve the patient experience and improve in particular, that engagement between the patient and the caregiver.

    Steve Statler 6:45

    So we're used to lying on these, these chairs, tables, having lighting systems and cabinetry, it also like super high quality furniture that's very robust. Looks like it could withstand a missile strike and still be there. But how did Midmark get into the real time location space? The world of radio technologies quite different. And it's your and that sort of thing?

    HT Snowday 7:14

    Yeah, I mean, there are some certainly, you're right about the heritage of Midmark. But when you look at the strategy, it makes a tremendous amount of sense. The Midmark has, you know, historically long had expertise in how do we really well define and improve patient engagement and patient experience? And I mean, from a level of, of technological and scientific and strategic detail like exactly what is the orientation of the caregiver or relative to the patient? And how does that improve the experience? And how can our products fix or maintain issues that may be in that engagement? What's what are the best kinds of adjustments and environmental conditions that we should have, and really approaching approaching solving the problem? Not from, hey, what's the best, you know, individual thing we can make, but what's the best possible environment? And the wonderful thing about that is, it's a relic from that kind of strategic engagements relatively short leap to say, Okay, we're experts at making sure engagement is positive in the room, in the moment of interaction, there is a spectrum of experience for the patient outside the room as well. And RTLs has a lot to say about how you can improve that spectrum of experience the full patient visit, if you will. So

    Steve Statler 8:41

    making that jump, so very holistic view of it, which is good, whereas some of us come from the chip world, you're coming at it from looking at the people that are being cared for. But was this an acquisition or organic creation of a technology team?

    HT Snowday 9:03

    Yeah, it was an acquisition. So previously, Midmark RTLs was versus technology, relatively well known in the healthcare RTLs space. I, my history with the organization goes back to its, you know, modern inception, which was in the mid 90s. I left the organization for a while, but I came back, I've always been hooked on the the ability for the application of technology to make a positive impact. I had some early experiences that were, you know, sort of dramatic and anchoring for me about how this technology can have that kind of an impact. But But fundamentally, you know, what the technology is able to do is is automate or at least automate communication of things that are kind of impossible to automate. When you're in a healthcare environment, your primary tool if you want to come Prior to manufacturing any kind of process flow design, your primary tool is a human. And that's kind of difficult to lock down into a process, your output, which is the product that you're up putting is another human or if you will, the the positive outcomes for that human. So, you know, you really have to, if you're going to automate that environment, you have to have passive systems that can detect what's going on, without requiring any particular path or any particular process or timing. And I, you know, passive is a difficult word, because we're all used to the description of active technology, but it's the passive collection of the information that lets you do these cool things that help out in healthcare.

    Steve Statler 10:45

    Yeah, you're the people in the clinics that you support, busy thinking about things that shouldn't be how technology that you shouldn't have to get them to do anything, it should the technology should require, really nothing of the user. And every time you do, then there's an opportunity to, for things to not work. So maybe we should move into some examples and talk about the kind of the categories of offerings that this RTLs umbrella encompasses. I mean, first of all, maybe about let's address the not the elephant in the room, but the tag that's on your collar, what what are you wearing that.

    HT Snowday 11:29

    So I'm wearing one of our personnel locating badges. This is a hybrid infrared and RF device, meaning it's transmitting infrared and RF. And that's the, as you said, one of the mechanisms mechanisms, but the primary mechanism we use to determine location in a healthcare environment. And we have different designs and places of attachment. I'm also wearing one of my wrist right now, which is a silicone band based system. But the you know, as you pointed out before, the real magic is in what you do with the information. While the technology has changed fundamentally, for a long time, one of the advantages of of incorporating infrared into our environment is it's, it's well defined by any opaque material, right? So it's, and it's also it doesn't require any kind of algorithms or complexities to provide a focused area with infrared, we can, we can create relatively small, different well defined zones for locating. And that's, that's really critically important in healthcare because the the, the power in what you're doing is making some assumptions about what is happening, or at least documenting things that you can make assumptions about, like in a clinical environment, caregiver and a patient have engaged in a patient room. And in fact, earlier in our history, we created some automation for third party systems, particularly in the nurse call space that were, you know, was required that you get that information. And it can't really ever be wrong, if you're going to run that kind of automation. So historically, we're stuck with the physics of infrared to provide that kind of surety of information. And that, you know, sometimes people refer to it as clinical grade or hear the term no false positives, but it's part of the way in which the platform provides the rock solid information that we get. But then once you have that, you know, the real power is in the software and the analytics and the automation that you provide in the environment, which is, which is a large part of what Midmark RTLs is about.

    Steve Statler 13:46

    So just to recap, radio, the infrared technology respects walls and doors and screens. So you pull a screen back and the infrared signal stays within those boundaries. Whereas if you have, say, a Bluetooth beacon, that's blasting out at plus 20 dBm, it can penetrate that wall. And so if you're trying to figure out if a patient, a doctor and a nurse together, then the false positives are, you know, that signal could fluctuate. And if you're just looking at the radio frequency signal, rather than the light, then you might get the wrong idea. So why have RF in the tag at all if infrared is so great.

    HT Snowday 14:34

    So infrared is is great at that part of it, right? But it has other issues inherent in the physics of infrared, which is you can block the signal. You can be in a scenario where you're not receiving infrared in a consistent way. So RF at a minimum gives us reliable constant contact with the badge. Right so status information from the badge is that is the button being pressed? Is it in motion? You know, the kinds of basic telemetry that you want from a device, it also gives us, you know, in a, in a rough sense location information that you can use to compare or generalize or make exceptions to the kinds of information you're getting from inference. So we're really complementary, we've always invested in hybrid technology, from that perspective, for the purpose of getting the best possible location, we can. RF, you know, as you said, is the technology continues to develop, there's value there, but ultimately, any RF system is somewhat grounded in a statistical reliability, right. Whereas I'm getting this level of granularity at some percentage of reliability at some percentage of time. And with infrared, you kind of throw that out, you know, like, if I got the signal, the badges there, it makes, you know, it makes a building some of the assumptive stuff we do much easier,

    Steve Statler 16:06

    and what kind of RF is there in that tag on your colon?

    HT Snowday 16:09

    So we, we support a few different kinds of RF, this particular tag right now is transmitting RF at 433. We also have a hybrid IR and Wi Fi based solution that gives us you know, a different kind of RF and a different kind of location, that's a Cisco environment compatible device. We're not, you know, relative to the RF channel, it's more about that, does it serve all of the secondary needs that we have for the system? I should even say secondary, the complementary needs that we have for the system?

    Steve Statler 16:42

    Yeah. So why would you go for Wi Fi, in one case, and this 433 band, which is a lower band, so Wi Fi 2.4? gigahertz, five gigahertz? And so 433 is a lot lower? What are the pros and cons of those respective parts of the spectrum? for your purposes? Yeah,

    HT Snowday 17:07

    so they're really simple reasons of a 433. from a fundamental standpoint, you know, it's an available frequency, it penetrates very well, you know, the lower frequencies you go and also strikes that balance of, it's high enough that you can get a fairly decent amount of communication, it's low enough that it penetrates environments, and you don't need as much as many receiver points with 433, as you would with a higher frequency like 2.4. On the other hand, Wi Fi is pretty ubiquitous and environments. So as an RF channel, you know, do we, if we leverage Wi Fi, do we have to worry about our RF platform, penetrating the environment, no Wi Fi in healthcare environments, at least these days, is a pretty reliable source of the kind of information that we need. So you know, it really it's somewhat environmental dependent for us. But Wi Fi makes a perfectly acceptable RF channel for our platform?

    Steve Statler 18:06

    And will the to continue to just sit side by side, if there's a bunch of Wi Fi access points, you'll use those what's the I think you've done a good job of demarcating those two, the strengths and weaknesses of the two, but I'm just trying to think, is there a winner or or Elisa?

    HT Snowday 18:24

    I think it's environmental environment dependent or solution dependent, right. So you know, if we're, if we're in a, if we're in a smaller clinic environment, the clear winner might be the standardized platform at 433. If you're in a large healthcare environment that already has a clear vision and handle on the capabilities, their Wi Fi environment, and they can deal with our leveraging some of that bandwidth, we take a very little bit, but it's it's worthy of analyzing that the Wi Fi Channel makes sense. You know, but I can certainly describe to you those types of environments where the solution is flip flopped. I think they're, you know, there's considerations across the board for us. They're

    Steve Statler 19:14

    interesting. And so, for 33, we don't I don't think we've ever talked about that on this on almost 100 episodes. So is this an ITSM? Band? It's as you said, it's available, it's unlicensed, so you don't have to pay for any telco for using it correct. Right. Exactly. And then what sort of protocol are you using in that piece of bandwidth?

    HT Snowday 19:39

    It's a proprietary protocol our own in primarily because, again, our needs are in this, this would be true for most RTLs vendors, you know, like the on the RF channel side, regular, reliable, but relatively small amounts of communication, right. So this isn't a A stream of information communicating the kinds of things that an internet or a Wi Fi Channel typically would the RF side for RTLs, we need to have insight into, you know, secondary things like signal strength and other things that you can use to improve location over RF. But from a communication standpoint, it's, you know, small bursts of information.

    Steve Statler 20:26

    Interesting. And then any other tools in the toolbox that you use, we've got infrared, we've got Wi Fi, we've got 433 Are you using Bluetooth? Today,

    HT Snowday 20:41

    we support Bluetooth, from an infrastructure standpoint today. So when you deploy one of our systems, we're typically deploying infrared sensors throughout the environment as a way to define our primary locations, we have a variant of that sensor, which acts would provide support for a beacon. And that's a that's a fundamentally valuable component for healthcare environments, because it serves as location sensor for our platform, it also provides the ability to create a true powered beacon since we're providing power at that source for infrastructure systems that might take advantage of of static beacon environments,

    Steve Statler 21:27

    and what sort of use cases that we're talking about. And so

    HT Snowday 21:31

    wayfinding primarily, and other kinds of, you know, anytime you want to make the Locate device that is able to locate itself, more granular, you know, static beacons and environment is a typical enabler for that. So wayfinding systems are probably the most common thing, but there are other systems that can take advantage of, of beacons, other kinds of automation systems. I mean, frankly, Steve, I would I would ask you that question.

    Steve Statler 22:02

    Oh, no, it's all about how you're finding it. In your vertical. And and I do want to actually, let's just flip back briefly to Midmark. Are you at liberty to talk about the number of clinics that and locations that you have your products in? And I'd be interested to know, what kind of proportion of those are using your RTLs systems? Is that something you can talk about? Yeah, I mean,

    HT Snowday 22:33

    we we have looked we versus prior to Midmark. been in the industry a long time. Positioning solutions and healthcare again, since 1995. We have over 1000 licenses out there. So over time, with over 1000, established locations. Some of those are very simple bits of automation, maybe a single nursing unit using an automated nurse call system, all the way up to, you know, very sophisticated IDN level enterprise implementations with multiple use cases in our software. So there's, there's a lot of variability in the type and size of application and healthcare. But we're certainly, if not the most deployed RTLs in healthcare. One of the most

    Steve Statler 23:26

    Yeah, that's an impressive footprint. And then Midmark as a whole, how many locations roughly how many clicks

    HT Snowday 23:34

    Midmark is a whole has a, we'll put it this way, a very dominant footprint in the patient, positioning devices, so chairs and tables in a clinic environment. It is it is difficult to make an estimate, but but certainly many of them

    Steve Statler 23:57

    a market leader, if not the leader in that space,

    HT Snowday 24:00

    definitely the market leader in that space.

    Steve Statler 24:02

    Okay, good. That's, so I just wanted to do that. Because sometimes we talk to people and they're brilliant. But they're just kind of scratching the surface. And my point here is you guys are in hundreds over 1000 locations. And so I think we're, we're very lucky to be able to have this conversation. Let's pivot slightly to the use cases. So I think most people in the business except healthcare is a great vertical for RTLs and indoor positioning technologies to be used. What are they being useful?

    HT Snowday 24:40

    Yeah, sure. That's, that's an excellent question. So I'm trying to think of the right way to order the description of the use cases. I'll go with what's sort of most most commonly recognized so asset tracking is the is the one that most people would recognize. That's all So the one that's easiest to contemplate, and there is a true need in healthcare, you have large fleets of high value clinical devices, I think the product typical device for asset tracking is the IV pump. So, particularly acute care, healthcare environments have lots of important devices. But just as an example, you know, large fleets of IV pumps, these are shared devices, they're critically important to the delivery of care. managing and maintaining them is not only really important for the health of your environment, and your patients, but regulated. So you know, having an understanding of where your fleet of devices are like that, just having that information alone is important. In the asset management world, we can apply different kinds of automation solutions, like power leveling, or direct management of, of the kind of deployment you want. So managing the availability, and the balance of devices across your enterprise.

    Steve Statler 26:05

    And just to interrupt paralleling, what's part leveling,

    HT Snowday 26:09

    part leveling is, is the concept that you want to set a particular number of devices for a given unit or a given location. So take a typical nursing unit, I my power level for IV pumps, is maybe 15. For the unit, a and I want to have a certain number available have that 15 At any given time. So there's thresholds that you want to meet. And what is wonderful about using our TLS to manage that is you get real time information to know if you're ahead or behind of those targets. So I may have a par level for 15 IV pumps on a unit I fall below it, I'm as low as 13, but I have five available so I'm in a good place, then suddenly, I have 10 on the unit and I have zero available. Now I'm in a critical state, the idea that as an entity, the healthcare environment can get ahead of that, manage it, deliver new IV pumps to the unit, rebalance IV pumps in the environment before, that becomes a truly critical scenario, like I need one and I don't have one. That's really amazing. It also, it also helps dramatically manage the amount of communication required, because in a in a non RTLs environment, this becomes more of a feeling or I'm using, you know, ad hoc location management, I've got a clean utility and a soiled utility and the clean utility looks low, but I really don't know what's going on, I'm gonna make a call down to biomedical engineering to get some more IV pumps without having a true scientific sense of what's going on in the environment. So powerleveling is an amazing application for asset management,

    Steve Statler 27:58

    great, and others other applications.

    HT Snowday 28:01

    So, you know, the, really, the other applications, from our perspective, all relate to the management of people, and primarily patients in the environment. So there are simple examples of that. One of the things that we have done historically very well, throughout the history that's throughout the history of the organization, is nurse call automation. So, acute care environments have a requirement to provide the ability for patients to contact caregivers. And that is the genesis of a nurse call system goes all the way back to using bells to you call for a nurse. But a modern nurse call system is a fairly sophisticated platform that allows the patient to press a button call for a caregiver. Usually a nurse call environments multiple things happen, like lights light up in the corridor, notifications happen at the central nurse's station. Most modern systems have the ability for patients and caregivers to communicate in some form. But what is required is closing the call. And frequently it's required for the caregiver to go into the room, attend to the patient and document that they've responded to the call in the room, which is usually as simple as pressing a button on a wall, which sounds like something that you wouldn't actually need to automate. But in reality, there are many many scenarios where caregivers have to deal with the patient first. And you can imagine a patient in some Distress the last thing on a caregivers mind is dealing with cancelling the nurse call event. It's caring for the patient. So getting accurate, reliable documentation of caregivers responding to calls is something that can be done by RTLs. And we have long been a partner diverse called companies and in for that particular use case. From a from my perspective, though, the most powerful kind of use case that we engage in, revolves around workflow processes in a clinical process. So in an environment where you're putting the patient through some kind of standardized process, and it can be as simple as I'm getting a patient to a room, I'm engaging with them with different types of caregivers, and I'm sending them home in say, a primary care setting, all the way to very sophisticated environments of providing treatment and care like and oncology clinic, where you know, multiple stages of care happen in a given period of time. And getting it right and getting the timing right is really critical. Across the board, both from optimizing, you know, valuable resources you're providing to the patient as well as valuable pharmaceuticals. Our system can provide both tremendous operational insight and retrospective analysis of exactly what you're doing in that environment. So allowing you to put a patient through that kind of process with less weight, more engagement, is is in my mind, where we really make a difference in terms of of making things better for patients and caregivers in the clinical environment.

    Steve Statler 31:28

    What about the check in process? I can't you know, the number of times he I have this vision of the doctor who's kind of waiting to see the patient. But then there's this big line of people and some harried receptionist who's not. Is the bottleneck in that system? Is there any progress in automating that?

    HT Snowday 31:50

    Yes, that's a that's a appreciate the opportunity to talk about it. Self rooming as a concept is something that that many of our clinics take advantage of. And the the idea here is that when there's multiple things wrong with waiting and queuing for care, among them simply it's a waste of space, right? A waiting room is non value, add non treatment space. And so to minimize that square footage, if you will, from a, from an architectural and strategic analysis standpoint, it's really important. So we have helped pioneer the concept of allowing patients to go straight to an exam room. And the reason that RTLs can provide resources to make that effective is because you imagine the flow of patient comes in checks with registration, you're provided a real time locating badge and directed to go to an exam room. And the premise here is that if if patients, you know if people are able to find their own hotel room, they can find their own exam, right. So you also, frequently a self rooming environment is paired with an on stage off stage concept for clinical care, which is to say the the exam rooms typically have multiple entrances, one from the off stage area, which is where the clinical staff work, and the onstage area where the patients can come in and get to their exam room. So a patient comes in as a real time locating badge goes straight to their exam room, and they as they've been directed by registration staff. Now, the issue is, how does every one who needs to orchestrate the delivery of care know what's going on? And with an RTLs system that's made, very straightforward. So notifications and screens that identify Okay, a patient has just arrived in this room, we, we frequently deliver the concept of documenting alone time, which is how long have I left the patient alone and a caregiver? Yeah, right. The timer starts the moment they hit, they're minimizing that alone time is really important, because it's important to, obviously the perception of care from the patient's perspective. But it's also really important to maximize the utility of that clinical space, right? When you're not when you're leaving the patient alone in clinical space, you're not using what is frequently a very expensive bit of real estate to create. So using an RTLs to drive a process, or at least notify staff where you are in the process is really important to making that processes effective and efficient as possible. And I'll stop but I can I can talk about this all day long in the different steps and yeah, it's

    Steve Statler 34:44

    fascinating. I am convinced that if clinics would adopt all of the things we've talked about our lives would be better the costs would be lower the wait times will be lower. Patients will be happier, doctors will be less frustrated. Tell me a bit about where the momentum is in adopting these technologies, because it all sounds great. You know, why? Why don't we have 100% penetration? And where where is where? Where are the reasons to be happy? Where? Where are the biggest trends in terms of adoption of some of these applications that we've just been talking about?

    HT Snowday 35:22

    Well, I think there's there's way there's there's a lot of different moving parts to this in healthcare, right. So by the way, I, obviously I completely agree with you. This is something that every clinic environment should do. And certainly, both from personal experience and anecdotal experience from patients in a highly automated environment driven by RTLs, are, are much, much better. I think, you know, reasons to be happier, probably the best place for me to go there's there's a few things going on in healthcare in general, and one of them is a move to clinics in general, right. So you have the historical concept of, of I go to a hospital to get care well, other types of healthcare technology and other improvements in treatment have made it possible to deliver care, to put it bluntly, between eight and five. And that's a much more efficient mode to deliver care, it's actually much better for the patient, in many ways, better outcomes, if you have the patient going home, for recovery, but you've got to have the type of care that can be handled between eight and five, well, that world is expanding. So you have, you know, surgery centers, and oncology centers, and even even cardiac treatment centers that are doing things now between eight and five that, you know, 10 years ago, and certainly 20 years ago, you wouldn't have even possibly considered so what that does is it makes the clinic environment much more important to get right and much more sophisticated compared to you know, primary care, I'm gonna visit my doctor about the, you know, not feeling well, as opposed to, I'm going to come in and I'm going to get a catheterization or I'm gonna get some kind of chemotherapy treatment through an IV, getting those intervals of care, right is really important. I think that's driving the adoption of this in a clinical environment, fairly materially. So that kind of change in focus in healthcare, I think is really an important part of raising the visibility of this kind of solution, which again, isn't necessarily what people think of initially, but the healthcare industry is getting smarter, they're getting more educated. There's certainly more of this out there, the momentum is very high relative to solutions like this, and we're certainly really excited about the future.

    Steve Statler 37:58

    Yeah, it makes sense. I mean, hospitals are kind of dangerous places, you know, to be spending any more time there than necessary so I can see, and I see it myself, my you know, people are having amazing eye surgery, and they're in and they're outs and if you can optimize that, then that's going to create huge value. Huge, huge savings, better experience for people. So So you guys are doing good work and congratulations on on all these amazing solutions. It's been great hearing about them. Appreciate you're dipping into the technology but also relating it back to things that we can all relate to as people that are going through this system. So so he thanks very much for your time.

    HT Snowday 38:45

    Steve Brilliant, thank you