In this episode we interview David Niewolny, market development director at RTI, to talk about how the IoT is impacting the Healthcare industry. We’ll discuss how medical companies can enhance current healthcare practices by implementing connected, real time devices that improve the patient experience, and most importantly, reduce the number of medical errors that occur in hospitals every year.

In Episode 19 of The Connext Podcast:

  • [1:00] Medical errors: The third leading cause of death
  • [2:05] The increasing cost of healthcare and how technology can help
  • [3:23] Can current healthcare systems handle the load of a increasing population?
  • [4:48] How do we address the shortage of skilled doctors and nurses?  
  • [5:58] The digitization of healthcare  
  • [8:46] Securing IIoT data in the healthcare industry
  • [14:20] The impact of healthcare AI and connected devices
  • [23:43] How blockchain can be leveraged, specifically in regard to security
  • [25:57] Are there ways to expedite technological trends in the healthcare industry?

Related Content:

  • [Blog] Healthcare IIoT: Ideas are Easy. Execution is Hard.  
  • [Case + Code] Integrated Medical Devices
  • [Datasheet] RTI in Healthcare
  • [Webinar] Healthcare IIoT: Ideas are Easy. Execution is Hard.
  • [Whitepaper] A Data-Centric Approach to Developing Digital Health Solutions within the IIoT

Podcast Transcription:

Steven Onzo : Hi and welcome to episode 19 of the Connext podcast. Today, I'm pleased to present an interview with RTI Market Development Director David Niewolny, hosted by Lacey Trebaol.

Steven Onzo : In this episode, we'll talk about the most popular trends happening in the healthcare industry today. We'll also discuss the importance of security and encrypting data in motion, as well as how IoT technology is helping to reduce medical errors in hospitals across the country.

Steven Onzo : We hope you enjoy this episode.

Lacey: Welcome to the podcast, David. Thanks for joining us.

David: Great to be back.

Lacey: Just so everyone knows, today we're going to be talking about the vertical market that David happens to be in charge of on the product and market side, and that's healthcare and medical. For those of you who don't know, I'm really quickly just going to go over some of the big driving forces for change in the healthcare industry. There are things that I'm sure you've all heard about and read about because I know that we talk about them a lot and we're definitely not alone in this.

[1:00] Medical errors: The third leading cause of death

Lacey: The first point, it relates to medical error, and medical error is the third leading cause of death. That's crazy. And when you consider how often many of us have to go into a hospital when we're in a vulnerable state, things are already not going well for us if we're there, most likely, and the fact that you're in there and the third leading cause of death is on the other side of that door, is a little scary.

David: Every time I hear that stat, you always think of cancer, cardiac disease, all of these other, to me, major chronic disease problems. You always hear about healthcare cost but when you start really thinking about the personal aspect of going to the hospital, your chance of accidental death goes up significantly.

Lacey: Over 200,000 deaths a year they think are caused by medical error, according to John Hopkins.

David: Yeah.

Lacey: 200,000. I don't like that number.

David: No, no. It's exactly why we at RTI and I'd say the entire technology industry's focused on healthcare. I think a ton of opportunity there.

Lacey: Definitely. Reducing error, that's a place technology can definitely help.

[2:05] The increasing cost of healthcare and how technology can help

Lacey: The second point is the cost of healthcare. Now, pretty much everyone knows whether you're getting that amount taken out of your paycheck through work or if it's something that you're actually having to pay out of pocket for, healthcare is incredibly expensive. Doctor appointments, prescription refills, therapy sessions, whatever it is that you're needing to pay for that relates to healthcare, the cost of it goes up every year. And the healthcare's percentage of GDP has increased two to three times globally.

David: Yeah, another amazing stat. The US is definitely on the high-end of that 3x but this is definitely a global problem, not something that is just a United States issue. Something we see across the board. It's just crazy to think and again, looking at technology. Technology, generally, makes businesses more efficient and that's again, another reason I think a lot of the technologists are really focused on seeing what we can do here. For years, healthcare has gone down the path of extending life at a cost and that cost continues to increase actually, in the last 10 years much faster than we're actually extending people's lives.

Lacey: So the cost is increasing as well as the possibility of a medical error resulting in your death.

David: Yeah.

Lacey: I don't like that.

David: Yeah, two not ideal trends coming together.

[3:23] Can current healthcare systems handle the load of a increasing population?

Lacey: Okay. A third common point that people talk about is the aging population and it's noted that by 2025, 1.2 billion of the 8 billion people on earth, will be considered elderly which 1.2 billion is equivalent to the population of India. That is a lot of people who are going to be hitting a point in their life where they will be needing to use the healthcare system which, with the cost of it and the medical errors that line up behind it, you kind of wonder, is the system capable of handling such a load, and what's going to happen if we don't make some big changes?

David: I think that's definitely the case. We talked about the cost, cost of healthcare is  increasing but we have made some significant progress in the last 50 years in terms of extending life. And I think with that, now you're seeing the baby boomers is kind of this first group of folks that is going to be living well into their 80s, maybe 90s, even over 100. So having that many people over the age of 60 is definitely going to be taxing the healthcare system. Another stat that I saw was, I think it was something on the order of 75% of your healthcare costs are spent in the last year of your life.

Lacey: I've seen that one.

David: It's crazy to think about that and now we're all living longer, trying to age as gracefully as we possibly can but at the same time, that's really where the cost comes into play. And that's all the hospitalization and everything that goes along with that.

[4:48] How do we address the shortage of skilled doctors and nurses?  

Lacey: The last point we're going to go over really quick, it's the shortage of physicians. I don't think anyone, in any country has not noticed that it takes a really long time to get an appointment for things. Not just for specialists, to see your primary care physician can take weeks or months, and that is not considered to be abnormal. And I know that hospitals are drastically understaffed, especially with their nursing, and how do we address the shortage of skilled, talented doctors and nurses?

David: I think that tees up perfectly and obviously I'm biased here but looking at the way business is run, there's a lot of different businesses globally that have adopted the use of both hardware, software, just technology in general to make themselves more efficient. In terms of the auto manufacturers, starting to move towards more automated factories, has not only lowered the amount of quality incidents, but also ended up saving a ton of money. And this is really where I think the personal aspect of healthcare is very, very important. Interacting with someone is very, very important. It's not as, we'll say, cold as manufacturing but still, you have that opportunity to make a significant impact.

[5:58] The digitization of healthcare  

David: Just to kind of tell you what that looks like, some of the trends that I see happening within the market, and really there's kind of two big ones and the third's more of an enabling technology but the digitization of healthcare in general. There isn't a medical company on earth today that isn't looking at developing a digital strategy. The internet has changed so many different businesses. From consumer businesses to industrial businesses and transformed them to really being a product company, which I'd say most of the medical device companies are today, to a much more services model. And I think the trend that's coming there is the value-based care that a lot of the major insurers, at least in the US, are putting in place. And I know for the single-payer systems, they've had this in place for awhile-

Lacey: What's value based care?

David: Basically, it's only getting paid based on outcomes. So hospitals, if they have someone in their hospital for longer than what is deemed appropriate for a certain modality, they're not going to get paid for the extra days in the hospital so it really kind of behooves them to take care and take the best care of that patient. So now the fact that their business model is changing, they're needing to work with the medical device manufacturers and you can't continue to have these capital equipment models where you're paying for something and you really don't know, are you getting the results from it? You want to only pay for the results that you're getting.

Lacey: Because you're only going to get paid for the results that you give.

David: That's exactly right. And I think that's really one of the main driving factors in this whole digitization of healthcare and causing a lot of these medical device companies that take a look and rethink what they're strategy is.

[7:36] The consumerization of healthcare

David: Another area, which I think is actually positive for all of us, is just letting all of us take a little bit more control of our own healthcare, is the consumerization of healthcare. I think you're seeing a lot more devices that generally 5, 10 years ago would have been only available in a hospital or doctor's office, now essentially being available at your home.

David: It kind of started with some of the chronic disease products with blood glucose monitors, they've been around for awhile but now you have blood glucose monitors that do have Cloud connectivity that are actually making recommendations for you. You have continuous glucose monitors that are actually connected to insulin pumps and we haven't gotten to the point of closed loop control yet, but we do have communication between those two devices. And I think actually, this year the consumer electronic show, you saw a lot of hype around some of the connected cardiac devices and these are not just, am I alive, this is actually doing a pretty detailed diagnosis of ... I think AFib was the main modality that they were looking at but basically it can actually, through algorithms, detect some-

Lacey: Cardiac events.

David: ... pretty serious cardiac events, yeah.

Lacey: That's awesome.

[8:46] Securing data in the healthcare industry

David: Yeah, it's fantastic to see those two key trends but I think the one thing that really connects both of those is the internet and medical things, or the healthcare IoT, I mentioned earlier, that I think the internet does have the ability to transform businesses but all of that said, it doesn't come without its own hurdles. I think there are certain aspects of healthcare that I mentioned, make it unique. One is, how do you continue to keep that personal touch while you are really moving to-

Lacey: Streamline efficiency.

David: Almost a ... yeah, efficiency, kind of outsource model for a lot of these type of products. And with that, not only the human aspect but as much as I'm a technology advocate, there's plenty of technology challenges that come along with that. In terms of, one you need to create a connected product. So first, step one, connecting to the internet, and everybody knows all of the issues that you find out immediately in terms of security considerations. It's like, okay, yes, you're grabbing this efficiency but how much additional risk are you putting on yourself, your hospital, your patient base, just in terms of security. So those are kind of-

Lacey: And there's the additional risk added by, in the medical community they have the HIPAA requirements that they also have to meet so you cannot simply send data around on any connection in a hospital. You can't just leave files even out. You have to actually, truly secure that data before it even is in transit.

David: That is true. Security strategy for connectivity is exceptionally important and that really kind of breaks down to all forms of technology and I think we're all kind of in this hardware and software space, looking to work together to create a complete solution for the medical device community. Looking all the way down to the chip and silicon level and some of the security that you can actually put into hardware, down to designing your actual board level, and then some of the most important is, now that you're connected to the internet, how do you actually secure that data both at rest and in motion? I'll talk about this a little bit later but it is one of the core components of the RTI Connext DDS is, as a connectivity framework, having that focus around a secure architecture, and not only securing the data that is at rest, but also making sure that data in motion is encrypted.

David: So, again a strategy that I think needs to be thought of top to bottom, and probably one of the most important pieces of a healthcare IoT or just a connected health strategy. And I guess, you know, the other piece that I kind of briefly glossed over is the connectivity portion, and I'd say that's one area that, at least from a connectivity standards standpoint, I think has worked itself out over time. I mean, I think almost every medical device ... You know, when I started focusing on the healthcare medical community about 10 years ago and it was actually pretty rare to even have a USB port on a medical device.

Lacey: Seriously?

David: I mean, it was ... Yeah. You're now 10 years after they've been introduced on PCs and they just saw it as a risk.

Lacey: What did they have?

David: RS-232. I mean, basically just serial port. So it was like, you just had serial ports in the back of the devices and that was what they used to do any sort of software or firmware updates. But they did them so rarely, just due to the risk that was associated with it. When they developed a product, we'll say the old mantra was, "If it works, definitely don't change it." The verification and validation that they needed to go through to get that product to market, huge time and effort. So there was a pretty big incentive, unless there was something major wrong-

David: ... to not do updates. And then I think it kind of came to the point of ... technology was just changing so fast that your products would become outdated, that you needed to constantly be making some sort of firmware updates, software updates to not only stay current with your product, but also make sure that if you did find any bugs-

David: ... you're actually constantly resolving them, and I think the speed at which that's being done is just only increased, which is one of the reasons I think we went from RS-232 to USB. I think most things are now ethernet connected but, on top of that, I think almost every device now has WiFi and Bluetooth integrated for the thought that eventually, you can move towards wireless sensors. I think one of the craziest pictures is not only in hospital do you have all of this equipment around a patient, the amount of wires and sensors that are on an individual is-

Lacey: Is a hazard.

David: ... pretty unbelievable. You can't get up, you can't move. You're supposed to get up and you're supposed to move, but it's almost like you need to walk with this whole train of stuff.

Lacey: You do.

David: ... as you're moving down the hall.

Lacey: Sometimes when you walk, they'll hold your stuff for you because you have to hold your own clothes.

David: Yeah, and-

Lacey: Good times.

David: ... it is kind of nice to see forward thinking. Again, this is more along the lines of patient care, ease of use. I mean, getting to a wireless sensor model and actually designing products with that in mind, I think is a step in the right direction. But all of that said, you do need to make sure you have that security component involved because connectivity's one piece; wireless connectivity's a whole new ballgame. I think it opens up a lot of doors. And also, specifically, just in terms of wired versus wireless, when you're making your connectivity decisions, you also need to be looking at latency and payload. I mean, how much data-

Lacey: Absolutely.

David: ... is actually coming from these sensors and does it make sense to have it wired? You definitely don't want to reduce the level of care you're giving just for convenience. So it's, how do you keep the same level of care, improve the patient experience, and really, that involves around choosing the right connectivity and choosing the appropriate security for that as well.

[14:20] Accessing data and other advantages of connecting devices

David: So the next key piece — and I'd say this is almost the holy grail of a healthcare IoT system — is, once you're connected, I think the vision is you now have access to a whole lot of data-

Lacey: All the data.

David: ... that you may not have had before, which, again, opens up an immense amount of business models from the medical device manufacturers and potentially whole new ecosystems of partners that could spawn up from this healthcare IoT revolution. But the real key piece, I think, for those of us that are patients, and especially from our insurance providers, is looking at the power of that data, and what can you do in terms of probably two overused words in the technology industry: AI and machine learning. Everybody thinks that that really is going to save the world and I think we're just in the early phases.

David: It's step one, get access to all of the data from these devices, but we do have that opportunity to begin actually creating algorithms and even self-learning algorithms that are going to continue to improve themselves over time, which is really going to address, I think, that first point that we brought up in this podcast, of how do you reduce the amount of medical error in a hospital? So the real benefit to AI is the ability for clinicians to have decision support software, so now they can take a look at all of this data and then make sense of it in a much quicker means. I think a lot of people think of AI-

David: ... replacing jobs. Your health care is never going to be done by robots. I mean, that personal aspect, I think, is very, very important and you're going to have a doctor there, but wouldn't it be great to have a doctor that has access to all of the information and a machine learning algorithm that’s actually advising him based on years and years and years of data on what to do. Yes, they'll still have the final say, but there's no way that your doctor or any doctor could process the amount of information that-

Lacey: Exactly.

David: ... I think we all know-

Lacey: That you contain in your medical record.

David: Yeah.

Lacey: I mean, just as an example, I was in a hospital — and I know this is such a big problem — two years ago, and I, over the course of a couple of months of treatment, had a binder of my own medical data that they were printing out and the surgeons were passing back and forth before I had a really simple operation. I'm looking at this. They walk in with a binder. They walk in with this thing, and I ask them, "What is that?" They're like, "Oh, it's a portion of your medical record that we all review before we go and perform any procedures." And I'm like, "Can I see it?" And they're like, "Oh, we're not supposed to." I'm like, "It's mine," you know?

Lacey: And then they left and I might've taken a look at it. And it contained everything I've said to them. Now, the most well-meaning surgeon does not have five hours to prep before they meet me and perform a surgery, right? To go over that, and then to ask follow-up questions and to gain clarity, and to me, I feel like a big benefit of AI — especially in types of situations like this because it's one of the only ones I know — is that it has the ability to give the actionable data to the person who needs it. So think, a surgeon only needs to know certain things, but the anesthesiologist needs to know a different set of things about the same person. And some of those data variables, they might overlap, but, at the end of the day the view on the data that is most important for the surgeon and for the surgical staff — the radiologist — it's different for all of them. AI can give you that at the press of a button, whereas the most well-meaning surgical staff team, it would take hours to do that properly.

David: And then they don't have that sort of time.

Lacey: And they don't have hours because they're operating in a very reactive place where my surgery got pushed back four times because people had real, pressing emergencies, so that could be huge for them.

David: Yeah. I think that's probably the biggest opportunity here, but-

Lacey: And for patient error.

David: ... it's kind of a step by step process of, how do you actually, one, get these devices connected; two, make sure that that data is secure enough that you can actually begin capturing it and storing it and you don't have that security and HIPAA concerns, that you can actually take and move forward with AI and create these clinical decision support. And I will say, a lot of that is going on now. I think there was a nice push for getting electronic medical record data online. It was a slow process, but it is there and you're now starting to see some new technologies.

David: I think one that I've been following, actually, really closely is a couple technologies called SMART on FHIR. FHIR's really a interoperability protocol that allows data to be published and extracted from electronic medical records. So regardless of vendor, data can be put in these medical records, but this is all data that would be ... How do we say it? Probably many minutes, hours, months of data. We'll say anything the opposite of real-time. Real-time is definitely not capturable.

David: So this is a time slice of your medical record. And I have to give them credit; I mean, it's much more information than we had before, but the smart app platform actually allows you to now write apps, start using clinical decision support software on top of that. But really, I think where the holy grail is in the real-time. You know, how do you get to your real-time closed-loop control real-time clinical decision support because that's…

[19:38] The benefits of real-time connection

Lacey: So what kind of data is real-time data? Can you give an example?

David: I'd say the area where you see more real-time data than anywhere is in the operating room and in the ICU.

Lacey: Patient monitoring type of things.

David: So this is patient monitoring, taking all of your vital signs, your ECG, your body temperature, your respiration rate, flows of any of the different pharmaceutical products that you may be on when you're in the hospital. It seems like just entering the hospital, you're at least on one drip of some sort. So it's monitoring that, and when we say "real-time," I mean, this is seconds down to microseconds, where time really makes a difference.

David: Going back to that 200,000 people potentially dying due to medical errors, those are not the medical errors that take 30/40 minutes, an hour to make a decision on. This is, something happens immediately, someone needs to make a judgment call quickly. We're humans. I mean, you make errors. I think that's just life and we need to understand that, but I think there are opportunities to leverage technology to make that happen, and that's really where ... kind of tying this a little bit back into where RTI is focused and some of the core competencies of the Connext DDS product is really focusing on real-time connectivity and enabling the market to do real-time connectivity.

David: So I mentioned, yes, there is a solution and yes, there is an app platform for non real-time data, but that's not, I think, where you're going to make the most significant impact, and the most significant impact is going to come into the real-time aspect. The other nice thing about RTI Connext DDS is, yes, it solves the real-time problem, but it also opens the door to interoperability with other medical devices. The fact that it provides syntactic interoperability ... really you just need a standard data model, which yes, it is a challenge in the industry. But I think it's just nice to see ... across the board, I think major medical device companies are open to the idea of step one, integrating their own devices and integrating their own solutions, and then, I think, down the road — you know, 15, 20 years — we may get to a point where we're completely interoperable and we have an interoperable healthcare system, and I think DDS and Connext DDS sets up a framework for that.

Lacey: Enabling technologies.

David: Yeah, enabling technologies are great, and it's so cool to be part of enabling technology that can enable so many different areas within a market.

David: Tech that can enable so many different areas within a market-

Lacey: It really is.

David: Rather than just a single technology and a lot of fantastic applications for DDS and RTI DDS in the market and I know you do have different opportunities to use DDS. I think there was just actually recently an open source model that was put out there but I'd say for anyone considering the creation of kind of a real-time, interoperable healthcare IoT system, the questions you really need to be asking yourself is at this point you're signing up an extension of your software development team and you're looking for someone who is a trusted advisor, someone who has a history of implementations, highly secure, really reliable applications. So, someone who has a history in aerospace and defense, I think, really is a perfect play for a healthcare type customer base.

Lacey: The five 9s reliability, all that stuff.

David: Yup.

Lacey: It comes into play in that one too, yeah.

David: All very important.

Lacey: That's a great point.

David: I'm mean, we'll say some of the good and bad about the healthcare market and I think it definitely benefits them is they're generally not on the cutting edge of technology and there're reasons for that. I think it's definitely safer to adopt technologies that have been tried, true and played and things that have either aerospace and defense type certifications or even automotive specifications generally resonate really well and are adopted, I think, much more quickly and I think, I was talking a little bit about using AI for autonomous type applications, what better technology to use than things being used in autonomous vehicles both in the air and on land and that's really where RTIs had some great success.

[23:43] How blockchain can be leveraged, specifically in regard to security

Lacey: Okay. So another very hot topic, not just ... Well, actually, I have not yet really seen it applied to the healthcare industry but hot topic in general, so blockchain. Now, blockchain can be leveraged here and specifically with regard to security. So, could you talk a little bit about how that might work and what that looks like?

David: Yeah, definitely. I mean, I think outside of AI, blockchain's probably the latest and greatest buzzword and I think that's-

Lacey: We're hitting them all.

David: Yeah, even more on the forefront of what actually can you do with it. I mean it took me a little while. I'm not huge into the cryptocurrency world but I did look at the underlying technology and with a lot of other industry folks, I mean you see the opportunity for really securing digital health records. So, you look at the way that EHR is today and Lacey, I think you mentioned, today you don't have access to your EHR. I mean it's basically for your doctors and it's a great first step to actually get that digitized and put into an electronic record versus a giant binder but the next piece would be how do you actually secure and timestamp that. Those of us as consumers could all get access to that data whenever we wanted to. The doctors could all get access to that data whenever we wanted to. I mean it's really just a ... it's nothing more than a secure, distributed EHR. I mean that's really the key in the way I see blockchain being used. I mean it gives secure access to anyone and that does include, I think, the patient that it's involved and the other nice thing, specifically with blockchain and this kind of goes along the lines of HIPPA, is it's much, much easier to then take that data and share it with research communities anonymously. So, now you essentially get the patient name, all of the sensitive patient data out-

Lacey: Data analyzation.

David: And now you have the ability to really begin creating software applications, medical device. I mean the pharmaceutical companies, I mean the access to the data will be huge and that's really where I see this going is step one, get access to that data. Then they're gonna be applying some AI and machine learning. Once blockchain really comes to fruition, that's going to secure and democratize that data even more that I think there'll be huge innovations and huge value in that data.

[25:57] Are there ways to expedite technological trends in the healthcare industry?

Lacey: Great. So, there seems to be literally no shortage of opportunity here for us to actually really create some big change and for a lot of customers, our customers, medical device manufacturers and other people to jump on some of these great trends but healthcare historically moves as you mentioned the slow, slow, slow pace. Do you think there is a way to drive it to move faster? Are there things happening that are helping to expedite approvals? What does it look like here?

David: Well, I will say healthcare is gonna continue to lag I think some of the cutting edge markets but I think the nice thing we've all seen is the technology cycles continually get faster and faster and faster and along with that, healthcare, though lagging, I think, some of the bleeding edge technology, it's continuing to get faster and faster and faster and I think one of the things that had held it back much more 10 years ago than it is today was regulatory and standards. So, you really had no standards organizations kind of driving a lot of ... I don't want to just say interoperability but just driving reuse. I mean we know all these devices ... As you begin creating technology, it gets complex. And the medical device-

Lacey: It does.

David: Companies, they're generally really good at developing medical device technology. The question is as you start adding more and more new technology, where do they want to be experts. They want to continue being experts on really what their core competency is, is servicing the hospitals and the doctors and the patients.

Lacey: I want them to continue to be experts where their core competency is.

David: Exactly and with that, they're needing to really explore new areas and I think that's where standards organizations come in and then just from a pure regulatory standpoint, the FDA's done a fantastic job in the last five years in actually building out a digital health group and with that you're getting certain specifications around cyber security, interoperability. They're really doing great work there. They even have a new process called the 510(k) pre-approval process just to save time in terms of bringing your product to market. Almost engaging with them earlier and enlightening them on the new technology that you're developing just so they can get up to speed and it's not you submit something and it's the first time they've ever seen it.

Lacey: They've ever seen that, great.

David: And you can almost think in that case you're gonna reject and get a whole bunch of questions but if you actually engage them and begin working with them early, I think that's the type of stuff that's really gonna help us all and bring some of these new technologies to market faster as well as just shorten the cycles and along with that, I mean, you do have quite a few other groups that are developing, I don't want to say necessarily regulations but more of that standards base that I was talking about. I mean IEC's been continually coming out with new documents specifically in the software world designing to IEC 62304's become basically the standard in the industry and then some other areas that we at RTI are engaged with and trying to stay close with because they are starting to define some of the standards for security and interoperability. Our AAMI, which is the Association of Advancement for Medical Instruments and then Center for Medical Interoperability is another group that we're beginning to get a little bit closer with and they're working very closely with some of the hospital groups to define some standards for interoperability and then another government agency, health and human services, specifically the office of the national coordinator for health information technology is starting to take a little bit more of an active role.

David: So, some of these are new and we'll continue to monitor and follow but to me it at least says people want to speed up this cycle. They want to make it better. They see those of us in the technology space, the speed at which we're used to moving and I think they're trying to accommodate the need for introducing new technology faster.

Lacey: I'm glad to see that.

David: Yeah, it definitely is nice and again, it's great to see to me all of the pieces of the healthcare puzzle being put together. I mean you definitely don't want to see strain being put on the healthcare system but all of that said, that's really what's kind of creating this inflection point which is driving the digitization of healthcare, driving more adoption of the healthcare IIOT and this need for real-time data, which we've said it before, that's really where RTI is. I mean we are at that intersection of ubiquitous connectivity and artificial intelligence. So you have all of this data and you're looking for a way to process it. You really need, using plumbers terms, a pipe.

David: Someone mentioned that data is the new oil and the combustion engine is analytics and I'm kind of trying to put that into context of what we do at RTI. We're nothing more than a pipe in a refinery. It's how do we get that oil out of the ground. How do you make sure you get it there safe? No loss and then refining it into something that that combustion engine can use and we are really directly right in the middle there and I think it really is a great place to be. Specifically, having all of the experience we do on really solving these same sort of customer problems for other industries and it really allows us to, I think, be in a leadership position, be that trusted advisor, provide that best in class support and then I think the other key piece that kind of transitions into the regulatory environment, having that history of working with regulated customers, we have a very detailed software creation process, all well documented, all that we provide to customers. We do support regulatory audits and this is not outside of our normal course of business.

Lacey: No, it's not.

David: I mean this is the way we've been operating for years.

Lacey: We've all been part of it. Yes.

David: So, all of that said, I mean it really is a great place to be and really a great piece of technology that we do have from a connectivity framework, when you're looking at the healthcare IOT, the best pipe out there. I mean if you're looking-

Lacey: And the history to prove it.

David: Yeah, the history to prove it and I mean I want the medical device manufacturers focused on, just like you mentioned, solving this next generation of problems. I want them focused on the analytics. I want them focused on the real clinical healthcare needs and they should really be looking to technology companies like RTI to outsource areas of the technology that they really don't want to and don't have to be experts in. Let the experts handle that communication. They can focus on the data and what to do with it.

Lacey: Okay, do you have anything else you want to say about healthcare and the IIOT and Connext DDS or puppies, I don't know?

David: I'm out of gas.

Steven Onzo: Thanks for listening to this episode of The Connext podcast. If you have any questions or suggestions for future interviews, please be sure to reach out to us either on social media or at podcast@RTI.com. Thanks and have a great day.

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