635 - Vital Signs Monitoring Reimagined: Predictive, Not Detective, and Ahead of the Alarm

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0:33Peter Birch: Welcome to the Talking Health Tech podcast. My name is Peter Birch. Today on the show, I'm joined by Andy Hurt, Head of Strategic Accounts at Ericom, and Sam Yang, Co-Founder and CEO at Zandercardium. G'day, gents. How are we going? Couldn't be better. Good morning. Nice one. Good to have you here on the show. Looking forward to diving into it on a topic that I don't think we've covered too much or not in this amount of detail either and exploring some of the ways technologies can really get in front of some issues in ways some people maybe haven't thought about or it might break some of their preconceived ideas on how to do it.

1:11Peter Birch: So let's kind of dive in. But firstly, let's give some context. Andy, tell us a bit more about you and Eric Holman and the work you do and we'll go from there. I'm Andy Hurt. I focus in the Australian New Zealand market, primarily focused in the health sector. My job is to spend all my days talking to clinicians, facility managers, IT people in the health business, understanding their needs and understanding how to improve care models for each of those different environments that they're trying to pass on and do every day. whether it be a workflow in the business to improve care models or it is introducing technology really just to enhance the ability to see how individual residents or patients are actually performing each day.

2:03Got it.

2:04Peter Birch: What about you, Sam? Yeah, so I'm the CEO and co-founder for a medtech startup company called Xander Cardian, and we specialize in using radars to collect your heart rate and breathing rate, health information basically, ambiently. So non-contact, through the air and continuous real time. Interesting. Because when I think about continuous monitoring in healthcare and if my mind went to like, oh, I'm managing a healthcare facility or like a location where I need to know like what everyone is doing, My mind immediately goes to, well, the technology that we've got available to us is cameras or wearables or, you know, audio, like all the different detection things.

2:55Peter Birch: But not too familiar with this, you know, contactless monitoring through radar, did you say? Maybe tell us a bit more about the technology there, Sam. Yeah. So the camera you mentioned, privacy issue. Wearable is compliance issue. But that's the obvious thing. The thing that people don't really associate radars is with the accuracy of the measurements, as well as the unique information that you can collect with radar. We're not, you know, trying to have you put down your, you know, smart ring and, you know, use our device. No, you can do whatever you want. You can use a ring, you can use a wearable, but you're collecting information differently.

3:37Now, let me explain why. The radar that we use is something called an impulse ultra Y-band radar. Now, the impulse signature is pulsing about 15 million signatures, so radio frequency signatures per second. And these are 40 times safer, so lower power, 40 times lower power than home Wi-Fi routers. So, no, it's not going to radio. It has no impact. Hearing aids, pacemaker, no problem, right? So, it's actually been tested in NICU. We have clinical trials on NICU, so neonatal intensive care unit. So putting this sensor around your bed, so it can be above your bed, near your bedside, or wherever it is, it will automatically collect how you're moving.

4:22So first data that we collect is your body motion. So tossing and turning during your sleep, we can use that. If you leave the bed in the middle of the night, bed exit, we can use that information. When, how often, how long are you away? But then when you're still, we actually know that you're very still, head to toe. So unlike wearable, which is collecting information from one part of the body, like a finger or wrist, we're scanning your entire body. So that means by definition, we know exactly when you're very stable. And only that's when we start collecting your breathing motion. So unlike wearables where it's guessing your breathing rate through HRV correlation, we are actually looking at how your lung expands and contracts.

5:08So your inhale-exhale motion. That means that we get how deep you're breathing or how shallow you're breathing. If you're doing apnea and then if you do rapid breathing, that's all RRV, so respiration rate variability. Now on the heart, we start collecting your pumping motion. So again, EKG, electrostatic, PPG for the wearable, it's blood volume information. But we use radar to collect how your heart is moving. So, ba-bam, ba-bam motion. Which means not only are we getting super accurate PPMs, we are able to get how clear your pumping is and also how irregular that is. So yes, everybody knows about erythemia, AFib, but that's once in a while.

5:57What we do is we collect consistently and see if there is a clarity score going up or down. And that gives us the data to predict heart failure, COPD, and things like that.

6:15Peter Birch: Well, that all sounds remarkably fancy, doesn't it? Like, I don't know. I mean, the amount of wearables and devices I've got ready to kind of, you know, measure what's happening on my finger or my hand or my whatever. No, the ability to do it without wearing anything in an environment. Andy, I mean, I can start to think what potentially this type of technology has application for in healthcare. But, you know, you're speaking to a lot of facilities, not just in hospital either. So, you know, you've got connections to all kinds of places that potentially would, you know, are already doing this, but in probably more lo-fi, for want of a better term, ways.

6:56And that's right. I mean, I spend a lot of my time working with clinicians and facility managers and IT people, defining use cases. Because as you can imagine, once you've got that base data, once you've got the information being stored and you can then review it and analyse it and look at what is possible with all of that data, you can then start to really apply that in a use case environment. And let me give you an example. For someone who is or a facility that is trying to make sure they're optimising the rounds being done by clinicians to ensure we prioritise which one of the 160 patients we're going to go to first, overnight we can see potentially if there was a deterioration in a particular set of individual residents and we can prioritise that kind of ward round monitoring.

7:49and so the use case definition and working with the different parts of the business really gives us the ability to be able to work with them to see where their their insert of this technology can do the most benefit and so it's that continuous monitoring piece that is that differentiates this it's the in-between um the the ward rounds um that normally happens day to day where you have a clinician going in and taking the vital signs of an individual, then going back out. It's in between those monitorings where the actual deterioration may well happen. So we're getting some real interest in how do you make sure that you've got that continuous monitoring and the data storing.

8:33On top of that, you've got some real regulatory issues that are coming in or regulatory requirements coming into a lot of those facilities, whether that be aged care or hospitalisation, where we need to be able to properly govern the data when things happen, how often this happened, and this is being stored and time checked. And so we can actually put some overlays over this. This is revolutionary in a lot of ways, where you don't have to have that. And Sam articulated it beautifully, where you can combine it with wearables or whatever else. But When you're talking about aged care or palliative care or mental health environments, having wearables and charging batteries and those kind of things is not an option where you can actually put these in play.

9:19We're getting some real interest from people that have this challenge every day and they can see something like this, which is contactless, which we call it, where we have this ability to better monitor individuals and their vital signs. and just three really important pieces, which is the heart rate, breathing and movement. Combine those three together and you can get some really interesting outputs and we're getting some good sleep information. We're getting good ability to be able to diagnose and clinicians are loving this.

9:50Peter Birch: Well, that's what I was thinking too, because I know Ericom has got a lot of the work you do across healthcare and aged care and palliative, like you mentioned, but in corrections too. Like there's all kinds of like situations where you need information to be able to inform decisions. But I guess information isolated by itself is only one thing. It doesn't matter how accurate or how clever it is. You kind of need that knowledge and expertise to be able to then tie it all together, partner with that facility wherever they are to be able to say, well, what do you need to know? And like we've kind of got in the toolkit the ability to pull this together as part of a broader workflow.

10:29Peter Birch: Is that kind of on the right direction here, Andy? Absolutely. And one of the things that I emphasise continually, this isn't to replace clinicians or replace existing things. This is to enhance, to be able to ensure that you've got what you need to make the right decisions. This isn't to predict certain things and basically replace any of the normal processes you have. It is to help with training, help increase the baseline in what you're doing, give the right information to the right people to give them the ability to make the right answers. That makes sense to me. Yeah, can I actually add to that there, to that comment?

11:08I think it's very important. So Eric Emizar is our partner for Australia, but in the US we have now deployed over 49 ,000. So we have monitored, sorry, 49 ,000 unique patients. And they're all tied to an EMR system in the US called Point Clear Care. And what we have been able to independently validate is to see how many people are showing signs of deviation from the baseline and therefore being transferred to the hospital. The number came back 75.6 % of those people who are hospital transferred. Our alarm was going off seven days earlier. Now, so that's what we call POBC, probability of baseline change score alert.

11:54informing out of 100 beds on average, so out of 100 beds in a skilled nursing facility, we are able to pick out that three to five residents have a deviation from their baseline. That baseline change is very important because you're not getting heart rate, breathing rate when you're moving, you're just getting when they're still for hours and hours. Every three seconds we collect. So going back to what Andy just said, we are informing the staff which of the residents, which of the hundred that you need to prioritize, you need to focus on care. So take a blood pressure measurement every so often and do more intervention.

12:39So we're not replacing, but we're assisting. We're the AI machine that's basically saying, hey, you need to go check on Peter, Tom and Barbara because of these baseline changes. So that is our role to inform.

12:54Peter Birch: Very cool. So working in digital health can feel a bit isolating, especially if you're the only person in your team or your company who really gets the space. That's one of the reasons why we built the THT Plus community. So this is our individual membership for people in or moving into digital health who want to be in the vicinity of others that are doing the same thing. So you get access to member-only meetups and workshops and a lot of content from me. Make some really good connections in the community too. We keep it fun. Got a leaderboard. All these other crazy things that you'd expect from me.

13:30Peter Birch: And it's a good mix of people too. There's founders, clinicians, and operators, investors, policymakers. It's all there. And it's definitely one of those things that you get more from by giving more, if you get me, but that's like all good communities. And it's a paid community too, which means we've really dialed it in to just be a wonderful bunch of humans who dig the Talking Health Tech vibe and who care about this industry and want to do good work in it. So you're probably a good fit for it. Check it out. Go to talkinghealthtech.com slash THT plus and join up today. the um point that andy raised in uh earlier was around you know regulatory requirements which made me think about you know it's one thing to have very cool technology but hey we're in health care so everything needs to be fda and tga and xyz um uh cleared um but you know you mentioned that you've got a pretty strong presence already or growing presence in the US, Sam.

14:34Peter Birch: How does that kind of stack up in terms of your capability and the requirements from a regulatory system? Yeah, so we're class two FDA cleared, 510K in the US. We also have TGA clearance in Australia as well as four other countries, Canada, Singapore, even Thailand, South Africa. We're now in line to be getting South Korea, Japan, Taiwan, China. So we're rapidly expanding. But we are a full, for Australia, we are a TGA class too. Well, I mean, that provides that reassurance, that confidence. And I guess with that assistive tool, I guess, as you kind of alluded to earlier, I feel like that's a real kind of power and a use case for AI and other kind of newer technologies, you know, like you've kind of emphasised too, it's that there's the scarce resource that we have of human carers and staff that, you know, all are an investment in time and even just cognitive load as well.

15:40Peter Birch: So the more information we can surface that is meaningful and provides direction, that's super helpful. Now, with that regulatory piece aside, like, you know, with that regulatory piece kind of established then i guess i think about the not just the um return on investment for a particular health care facility you know the problem that it seems like we're talking about too is if we can get in front of a particular admission early or you know transfer from a patient into a more cute setting or whatever and that has knock-on implications to all parts of the health care system i'd imagine Andy like the the decision to implement this kind of capability within say one particular setting surely has a knock-on benefit to other parts of healthcare too absolutely look the flow on effect I think is that is the right way to put it in that there's there's cost for early detection and there's cost savings in all of this in so many different ways but the cost and burden of having to admit someone to hospital, the flow through that from the individual all the way through to government care with hospitalisation, through ambulance, through transport, through the doctor environment, et cetera.

17:02I'd like to use a bit of a story. And that is, you know, when we've got an aged care individual, usually they show symptoms at midnight, let's say, because they've got a urinary tract infection. And this is actually a very common situation in most aged care facilities where they have already exhibited a lot of signs but not necessarily symptoms up until that time. And communicating to an aged care or someone with limited verbal generally is difficult to get that they're just about to really get to a very painful state. Then they have to be transported to hospital. That's the only route because there's no doctor environments late at night in most aged care facilities.

17:45An ambulance is called, generally speaking, then it goes into a stacking problem in hospitals where they've got multiple ambulance stacking going into and admissions inside a hospital. They generally get admitted. They then get the standard care of a doctor, giving them some antibiotics to overcome the urinary tract infection that they've got. And the next day they're sent back to the aged care centre. The disruption for the individual, the cost for the hospital bed, the cost for the ambulance and the cost for the individual having to be transported and totally out of sync of what they're normally doing.

18:24This could all be adverted by the fact that early signs and symptoms can be detected by the POBC score that Sam talked about before, where we're talking about the probability of baseline change of an individual's heart rate, breathing and movement showed agitation, showed the heart rate going up, showing the breathing change of the individual. in most cases could be days earlier and therefore during normal business hours a doctor could have admitted to the antibiotics and the whole problem would have been averted so the cost flow is incredibly impacted if you don't early detect if you wait for being reactive rather than proactive it changes everything so the care models that we're talking about it just shifts the ability to be able to give that ability back to the clinicians and gives them the ability to prioritise the staffing, the nursing staff, et cetera, when it is necessary to actually get the best result.

19:27Peter Birch: That makes sense to me. I did think while, you know, Sam was speaking about, sorry, Andy was speaking about that example and other ones that Sam has too, you know, I think I'm trying to think about how the technology works in practice as well. And the reality is of the more things we have in, say, healthcare that monitor stuff and then alert someone that something is outside of, you know, a reasonable band, the more and more things that we add that can provide alerts, it then creates that awful concept of alarm fatigue and like, well, hey, you know, there's, you know, the everything's okay alarm that from, you know, that is not overly helpful.

20:09Peter Birch: So, you know, and I think at one point you were talking about, you know, like it's somewhat real time and other times you were talking about how it's giving insights over a longer period of time too. Is there kind of a sweet spot in like, is it just observing information over a couple of days and be like, hey, you know, we're pretty confident now? Or is there, is it just different based on whether it's, you know, based on seconds or days or weeks? Yeah. Let me, if I, let me answer that question. So it's all about longitudinal health data. So actually, let me ask you a question, Pete. Please. Do you know your baseline heart rate and breathing?

20:44Your true baseline?

20:45Peter Birch: My true baseline? Yes. I know that mine is, it kind of hovers between, it's quite lower than them, like 55 to 60. Yeah. But I could be wrong. I just said that confidently. I don't know. You would think I'd be well across it all with the amount of things I measured, but it just pings me to say that, oh, this is no good. there's a reason i mentioned that because we collect uh about an average of six to ten thousand measurements of your breathing and your heart rate every night right just you go to bed you wake up and already collected that many times but like i said only when you're at rest mode which means only baseline we are the best tool if you want to know what your real baseline is now you said 55 so some for for you if you went from 55 bpm baseline and for eight hours 12 hours and 6 000 times measured you went to let's say 70 something is not right right you're not you're not you're not talking you're not moving but your your baseline just jumped up not doing a podcast you should have asked what the podcast episode bpm is but uh you know that's a chill state but no i know what you mean though yeah no but uh but by the way that's a good healthy uh number however you say hey doctor hey nurse uh pete's bpm is 70 what do you think that the doctor is gonna say what do you want me to do yeah yeah he's fine right he's fine yeah uh so it's uh but then for you it's not fine right now my being a startup founder my probably every founder has a high baseline heart rate i'm like 85 maybe mine was aspirational to be fair too i don't want to oversell myself uh maybe i should check my data um yeah but if i if i go from 85 to let's say 88 i'm totally fine nothing wrong with me so my point is this you going from 55 to 70 is is very concerning me going from 85 80 is not concerning so then why are we still using that threshold for alerting, right?

22:54So that's the whole basis of this POBC scoring system. Everybody's different. So, and then we are very proud of saying that we are in the business of informing, not alerting. You see, alerting is reactive care. Informing is proactive care. So alerting is after something happens. Informing is before something happens. There's a trend happening that's very concerning. That's so wrong. So again, going back to the whole longitudinal data, if we are collecting this true baseline information every single day, thousands of times, day after day after day, that creates the longitudinal data of insight for any clinician physician to see, hey, for Pete, this is not right.

23:37Let's do something, right? That's the whole basis of this.

23:40Peter Birch: makes so much sense the um and if i was to take the view of you know uh healthcare or care setting andy that is you know it's got their attention and they're like look this these are things that we need to model that we're monitoring now through xyz capability or hey that that's striking a chord like what what are the at what stage are the companies best to have a conversation with you Like what's the most productive time to have a chat with Ericom about how this all kind of fits in with, you know, the broader workflow they have? We're finding that different organisations have the conversation and it's actually easy to interject any new environments at different stages, whether they're building a facility, whether they're upgrading a facility, whether they're looking to make different decisions about their care models.

24:36Now, where Erocom comes in and differentiates ourselves when we look at technology like this, because it is an ecosystem at play, and when you're talking about alerting and when you're talking about other technologies that can be potentially seen in an ecosystem care model for different environments, whether it's residential aged care, whether it's independent living, whether it's at-home care, whether it's in a hospital or ward care and so on, where you've got those different environments, Aerocon come to its own where we can start integrating the cabling system, the data cloud monitoring and bring it into how the different facilities are actually wanting to run, whether they have a single nursing station, whether they have clinician stations, whether they have remote environments, as Sam was talking about before, where potentially we have, it's not all of that information being monitored.

25:35and dissected on-site. It might be off-site. So we actually work with different people at different times. And so when would it be necessary? The way that we've found that a lot of people are taking some momentum is finding a use case, finding an environment, doing it in a trial environment where they can actually say, I can see how this technology is going to actually benefit what we're doing and how we work. And then we work with them to actually get the most out of it when they can get those models right. So there's no one answer to that, Pete. It actually is a case of the different people.

26:11And as you know, in the health industry, it's an incredibly moving, incredible moving target where we've got acquisitions, mergers, acquisitions, changes happening. That's also a good time to actually get some consistent care models.

26:26Peter Birch: Yeah, 100%. I'll come back to Andy in a sec for any kind of final thoughts for this discussion, but I thought I'd take the chance to, while you're here, Sam. thinking about this cool use of new or emerging technology in healthcare, great application and great opportunity in Australia. What else are you seeing outside of the region that could be interesting to healthcare leaders in this region or anyone else that's tuning in that you're kind of getting involved with as well? Yeah, so we're very privileged to be in discussions with various nonprofit organizations in the fight against Ebola in Africa.

27:04You guys maybe have heard from the news, WHO is flagging this as a big emergency. Now, Ebola is a virus. And just like how COVID did the whole devastating impact to the world, every virus has an attack on the immune system. And that's why it's very difficult. Now, with Ebola, it's actually even very serious. It's destroying the immune cells. And so the death rate is about 47 % right now. Our sensors are being studied now to be deployed on site in the Congo, in the hot zone, because of exactly what we just talked about today, helping to continuously monitor, helping to remove the exposure from the healthcare professionals, having to go in in person to get all their measurements.

28:01and knowing exactly, so informing once again, informing exactly when to react when there's the tachycardia and the increase of heart rate, increase of breathing. That's when you go and provide IV fluids, provide oxygen so that you hope that the body can naturally fight off this virus. So it's an extreme privilege and we're very honored to be even talking to them. And fun fact, two years ago, we were named by WHO 2024 Compendium for Innovative Medical devices for low resource setting because our devices can be used even without lte or wi-fi it can be used even on battery power so if there's lack of constant power no problem battery packs just keep replacing it so yeah mission yeah yeah you got a lot of things going on no that's

28:55Peter Birch: fascinating it's great to hear like the i guess um the use case in you know the more complicated technology scenarios and right down to where you need it most as well. And lastly, Andy, just thinking about the broader suite of stuff that's going on at Ericom and your priorities, where are you seeing the ball going or where's a lot of your attention and effort going to help healthcare and broader care situations in the next kind of 6, 12, 24 months? Look, we've been focusing ourselves on the use cases, and Sam touched on a couple of really interesting, more innovative ways to use this technology.

29:34But the fundamental sort of core of what we're trying to do is to give that innovative smart room, smart bed, smart environment where we can actually provide that baseline continuous monitoring and data information that gives an incredible amount of rich data to different scenarios and use cases, whether that be in aged care, whether that be in the mental health environment, whether that be at home, in palliative care. There's all different sides of what we're trying to do. And where I see it is instead of technology for technology's sake, but then really spending time with the different healthcare environments, drilling down and giving that use case principle of giving the best outcome based on the use cases that they are struggling with giving the best outcome.

30:26And in Australia, you've got these remote environments, as Sam rightly said, in the Congo. We've got that all over Australia. We've got that in the outback. We've got in the remote areas of even just New South Wales, you've got hospital systems that are performing different things to different people every day, and they're trying to work that out with giving the best and the lowest cost resource models over the top of that. But when you've got technology that can overlay that, it gives a great outcome. The conversations we're having are, you know, it's keeping me very busy, Pete, in being able to just talk to the clinicians, the facility managers, IT, the executives on how they get the most out of technology like this.

31:07And the great part is that it's not ridiculously expensive to actually do it. And this is the great thing. It's worth giving it a try, putting it in a POC or proof of concept, proof of value, and then let's get moving with it.

31:22Peter Birch: Yeah, 100%. Look, it's been great to sit down and, like, dive into a particular capability and just demonstrate from an Erecom point of view, just the breadth of kind of tools in the toolkit that you've got to be able to help with care facilities and love learning more about the technology, Sam, on the Zandikardian side. So all the details will be in the show notes of this episode for people to check out. Erecom's got a listing on our website as well as company partners. So do check it out and I'm sure we'll have some more conversations in the THT Plus community too. But Andy, Sam, I really appreciate making the time today.

31:56Peter Birch: Thanks so much. Yeah, it's been great.

32:01Peter Birch: We hope you enjoyed this episode of Talking Health Tech. Make sure you like and subscribe and share this episode with someone who might find it valuable. For more information and resources about healthcare innovation, visit TalkingHealthTech.com.

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