Evolution of wearable and medical device adoption in healthcare
Common communication protocols — Bluetooth, MQTT, IoT Core, and beyond
Why EHRs struggle with continuous monitoring data
How Smart on FHIR enables real-world EHR integration
The growing need for data platform consolidation
Examples from cardiac monitoring and hospital-based IoT systems
Impact of wearable data on population health and value-based care models
00:01.39 Ratnadeep Bhattacharjee yeah 00:06.38 Ratnadeep Bhattacharjee hello and welcome to another episode of leaders perspective i am your host radnadeep co-founder of tech variable where we focus on data life cycle management interoperability ai to power real world healthcare innovation today we are exploring one of the most exciting and fast evolving areas in digital health you wearables medical devices and their integration into the healthcare ecosystem The episode is titled Connecting Care, you know Interoperability for Wearables and Medical Devices. 00:38.36 Ratnadeep Bhattacharjee Joining me once again is Keith Deutsch, an expert advisor in medical devices, interoperability, healthcare care applications, e etc. Keith has extensive experience working with HL7, FHIR, and standards-based integrations. 00:52.80 Ratnadeep Bhattacharjee And he has been a valuable thought partner in exploring how medical devices can become a seamless part of the healthcare data ecosystem. Keith, it's a pleasure to have you back for a second round. 01:03.72 Keith Deutsch It's a pleasure to be here. I enjoyed the last one a lot and i expect to enjoy this one even more. 01:11.98 Ratnadeep Bhattacharjee No, Keith, thank you so much. Keith, the last time we spoke, I know we touched on interoperability, you know, very broadly. This time we are kind of narrowing it down on wearables and medical devices. 01:24.46 Ratnadeep Bhattacharjee So, So could you could you start by sharing how have seen this space kind of evolve in recent years, right especially in terms of adoption in clinical and you know consumer health settings? 01:37.58 Keith Deutsch So the adoption has been happening in fits and starts. There have been periods when I thought it was happening a lot faster a few years ago, and then ah look around and it's still not quite there. 01:48.43 Keith Deutsch So I've given up trying to figure out just how quickly this stuff, this transition will really happen, but it's definitely in process. um You know, the older generation of devices didn't connect at all. 02:02.41 Keith Deutsch they they They operated completely out of band and you know A company would gather some data, an example this might be like a Holter device or that kind of device that you wear for a week, you mail it somewhere, the data essentially disappears and what gets produced is a report and that gets sent to the provider. 02:21.22 Keith Deutsch So level of integration, the difference now is a greater interest in continuous monitoring, using wearables and doing this either remotely or even in the hospital setting. 02:33.64 Keith Deutsch doesn't necessarily have to be remote it's a transition into continuous monitoring that's the difference um and that presents a number of challenges so we can we can talk a bit about that but you know what i see happening is an awareness of the the value of continuous monitoring i i think there's a lot of still a lot of um 02:57.38 Keith Deutsch lack of comprehension in the in the medical world as to what that means, but that is the interest. 03:07.01 Ratnadeep Bhattacharjee Okay, okay, fair enough, fair enough. So, keep you know, that's that's from the overall side of things right now. Let's really get into the nuts and bolts. You know, one of the key challenges I believe in this space is ah protocols, right? Different protocols, you know, devices generate data in different formats and and you know, through different communication standards. 03:29.54 Ratnadeep Bhattacharjee So, Whatever you have seen ah throughout your journey as an innovator, what are the most common protocols and standards we see today in the wearable and device ecosystem? 03:41.13 Ratnadeep Bhattacharjee And also to add to this, you know, where do you see the biggest gaps in terms of standardization and interoperability? 03:50.58 Keith Deutsch So when you talk about protocols, there are protocols at every level of the stack. And so there are a lot of them that we can talk about. Some of them, you know, most of the devices that I've seen talk some variation of Bluetooth or low energy Bluetooth to some local device that picks up its information, either continuously or at intervals. 04:13.94 Keith Deutsch the The actual on the wire protocol on top of the Bluetooth, it tends to be proprietary, it tends to be between the device and because the device that's doing the capture and the device that it's sending to, or you're generally both from the same manufacturer. And a classic example is I have a device that's on me that, you know, whether it's a watch or something taped to my chest or some other part of my body, and it's reporting to a cell phone. 04:43.42 Keith Deutsch you know, a mobile phone through Bluetooth. Great. The exact format of the data is nobody else's business because both sides are controlled by the manufacturer. 04:54.80 Keith Deutsch And whether it's and the reason it's typically Bluetooth is because that's what's available. That's the low energy signaling ah protocol that's available with a cell phone. 05:06.04 Keith Deutsch um Folks who are building their own devices might use some other strategies, some other protocols that are more exotic, you know a wire you know signaling protocols over over the wireless space. 05:19.49 Keith Deutsch A Bluetooth is is the classic example. So that's probably not the area of controversy because you know both sides, as I said, ah of the both the generation and the capture side are controlled by the manufacturer of the device. 05:33.24 Keith Deutsch Where it gets interesting is where it goes from there. So science as we said earlier, earlier devices you know would capture, gather up data, and just at some point send it up to some mothership where it would be turned into a report. 05:48.97 Keith Deutsch That level of integration is is not, I think, what we're talking about right now. That's not continuous monitoring. So the challenge is how do I get that data from the edge into essentially the cloud? 06:01.41 Keith Deutsch And typically that would be with streaming protocols like MQTT. uh you know and and if you're using that so ah i'm going to say to talk about this in terms of aws because and and treat that as the destination uh because that's the one i'm most familiar with but for example you might build a platform that had the iot core listening to a device via mqtt and routing it internally to wherever it needs to go again Typically that is be that is a choice that's made by the manufacturer of the device because they're making both the the the they're making the device, they're making the the the edge device, and they're making whatever is picking up the data in the cloud. 06:47.46 Keith Deutsch And so you have a lot of freedom there if you're if you're building a device like that. You want to use standards because they're cheaper, right? Why do you want to build your own cloud receiver when you can do something like the IoT Core? 07:01.62 Keith Deutsch and it will tend to guide you towards MQTT. So that's what you'll probably use, but it's not anything that anybody outside of your organization cares about. So that's not where the interoperability and so forth is interesting. 07:18.12 Keith Deutsch Where it gets more interesting is what does the medical community do with that data? Because again, in the old days, they'd issue, it would go to a manufacturer that absorb the data, issue a report at some interval and send it up to the EHR. 07:36.85 Keith Deutsch But that's not continuous monitoring. But it does highlight a problem with the EHRs. If you think about what's in an EHR, everything in an EHR is some form of codable object. 07:53.73 Keith Deutsch It can be notes from a doctor. It can be a report from a service. It can be an event, but it's a codable object. EHRs have no real provision for data as such. 08:09.76 Keith Deutsch And so you can't just integrate with an EHR to a known protocol and send it the data because it wouldn't know what to do with it. And by the way, that's counter to to the interests of most device manufacturers because they don't want to be purely device and data providers. 08:25.25 Keith Deutsch So, again, the data tends to accumulate in the cloud, and then the question is, how do you make that data usefully available to doctors who are used to seeing, you know, codable artifacts in an AHR? 08:39.29 Keith Deutsch A report, a, you know, a test result, which is a form of report, some notes from another doctor, you know, a prescription record, these kinds of things. 08:51.86 Keith Deutsch That's the challenge. um And so, you know, if you look at continuous monitoring artifacts in, say, an ICU, there are none that live in the EHR. 09:05.54 Keith Deutsch There is continuous monitoring. It goes on to a display that's monitored by a person. And if there's a problem, they might hit a button that generates and an event in an EHR, which is codable. 09:17.90 Keith Deutsch But they're not storing that data. So this is the transition that's happening now. Not just human beings watching a screen to make sure you're okay on a continuous basis, but actually storing data on a continuous basis so that we can analyze it. 09:31.64 Keith Deutsch And then turn it into artifacts that a doctor, a provider, a nurse, whatever, knows what to do with. And eventually, has to as the result of all of that probably has to hit the EHR in the form of some codable event. 09:48.73 Keith Deutsch and This is why you have this this roadblock here, because and this is why you have we talked, I think, last time a little bit about Smart on Fire. so The reason that you need something like Smart on Fire is, if you think about it, there is no place in an EHR, in an EHR itself, for this free-form data. 10:09.28 Keith Deutsch There might be for some and analysis that you're going that a doctor might perform, but not for the free-form data. 10:17.34 Keith Deutsch So you need a way to launch a platform that a doctor can access in the course of their normal workflow where they can look at this data in a form that makes sense to them and render your decisions in the form of notes or what have you that represent things in the EHR contract. 10:36.73 Keith Deutsch This leads to the proliferation of external platforms because each device has its own platform. where the doctor can the data in some form, reach some conclusion, or run some analytic you know over a large amount of data that produces an artifact that is codable. 11:02.88 Keith Deutsch So, mean, just try to make sure that we're still on the same page here, give you chance to respond to all that. 11:05.96 Ratnadeep Bhattacharjee Yeah. 11:08.94 Ratnadeep Bhattacharjee Yes, yes, yes. No, I think this is, this is, ah this is good information, Keith. Actually, I wanted to dive a little deeper, ah especially on the smart on fire implementation for, you know, device data within EHRs. 11:26.82 Ratnadeep Bhattacharjee You know, even before going into some examples, probably I would like to understand why you think, you know, you know smart on fire has gained momentum it has gained so much of momentum as a preferred you know integration path right you know we have been getting so many you know requests and inquiries from different you know prospects almost on same lines you know they want they already have an application of their own for their own device but then they want to be able to integrate uh within the provider workflow as well right so 12:00.77 Ratnadeep Bhattacharjee Why do you think the sudden surge of such requests and inquiries? 12:05.26 Keith Deutsch but So you call it a sudden surge, but quite frankly, I first encountered Smart on Fire around the same time I encountered Fire itself back in, I think, 2019. And we're still... but but but But yes, recently you're seeing much more emphasis. so So the reason I gave you that background was to understand that there is going to... if Devices are and and continuous monitoring are going to lead to a situation where there is a proliferation of external applications... 12:35.75 Keith Deutsch that provide access to the results of this monitoring. So that was the reason for that whole bit before. Now we get that. What is Smart on Fire? 12:47.94 Keith Deutsch Smart on Fire is a way, is an e hr launching tool. It's a way for ah physician or some other professional within EHR, it's a way for them to launch an external application or an external platform or portal seamlessly from within an EHR, and not only from within the EHR, but in the context of you know themselves and a patient. 13:17.51 Keith Deutsch right So you're in there looking at you're a nurse or a doctor or or provider of some sort in the EHR, examining the record of this patient. Maybe the patient's on the phone, maybe they're not, but you're looking at this. 13:31.08 Keith Deutsch and you're saying, i need to see, because of what I'm seeing right now, I need to see, let's say, make it up, but we talked about Holter monitors, some so some cardiac and continuous cardiac monitoring system, I need to see what's going on there. 13:46.90 Keith Deutsch Well, don't want to log out of the EHR, and in fact, in in most settings, that you can't, because they can't even control the terminal. The doctor can't log out of the EHR and log into be something else in a browser. 13:58.82 Keith Deutsch You know, what they see is not a general purpose computer. What they see is EHR, right? so anything they're doing is doing in the context of that. So the challenge is how do i seamlessly click on something and find myself looking at a portal, you know, into somebody else's application where already knows, I don't have to log in separately. It already knows who I am and it already knows who the patient is. 14:24.24 Keith Deutsch And maybe it's even gotten some of the current records. you know, fetch some of the current records so that it's not just, you know, a snapshot of some data being collected, but it also is combined with whatever records I'm interested in looking at conjointly. 14:40.40 Keith Deutsch That's what Smart on Fire provides. It's a way to launch these external applications from within the EHR. And the reason that folks are more and more wanting to do that is because there is a proliferation of these devices that require external platforms. 14:55.34 Keith Deutsch Now, that does create a bit of a problem it because at some point, if you and I think we talked about this last time, I predict that at some point there'll have to be a consolidation in these data platforms because if you're a hospital, how many different devices are you going and and suit and and related applications are you going integrate with? If i have 50 devices, that's 50 separate integrations. That's a lot. 15:24.48 Keith Deutsch putting that as and And to me, that that calls for consolidation, which I'm a big fan of seeing happening, and I see some folks trying to do it, but it hasn't happened yet. So in the absence of consolidation, you've got individual devices with individual applications, all of which need to be launched from within the EHR. So that's wheres what I think is driving this modern fire service. 15:48.89 Ratnadeep Bhattacharjee Okay, okay. So, Keith, can you give me some examples, you know, probably some live examples or some projects that you are working on where, you know, Smart on Fire is being leveraged to really improve or rather, you know, ah give important insights within the EHR workflow itself and and it is really creating an impact within a certain health system. 16:15.79 Keith Deutsch Well, again, it's this it's it's smart and fire is just it doesn't itself do anything allowed to allow these external things to be launched. It's why it was the question you have to ask is, why is there this surge of interest in these external systems? 16:31.61 Keith Deutsch And so, for example, one company I'm working with that I've mentioned before that says this cardiac monitoring has just gotten very a lot of interest from the Mayo Clinic, not for remote monitoring, but for in-hospital monitoring. 16:45.04 Keith Deutsch continuous monitoring in hospital. Now they already have that in some sense, because we said, you go to the hospital, you're attached to a bunch of stuff, and it shows up on um on ah on a monitor, on ah on a computer monitor at some nurses station, and they look at you, but they don't store that data, because they have no way to store it or make any sense of it. 17:03.03 Keith Deutsch They're simply looking at it, and if something weird happens, if your pulse suddenly drops dramatically, they know something went wrong, they they light up a a sign, and things happen, right? 17:18.20 Keith Deutsch But the shift in interest is now saying, hey you know, we've recognized that if we continuously monitor this patient and store that data somewhere, interesting things can be done with it. 17:32.92 Keith Deutsch But again, those interesting things are not going to happen within the EHR because it's not built for doing that. So this leads to the need to launch this thing somehow, have it running continuously. So a patient may come into the hospital in this case, they may get this device attached to them, which is different from the traditional devices that get attached to you because this one reports to some edge compute node that continuously sends the data into the cloud. 17:58.75 Keith Deutsch And now you've got, as long as you're in the hospital, hours and hours, days and days, maybe months in some case of data flowing into this platform. that's enormous the the interesting thing that happens at that point is you start beginning to apply big data techniques and i can give you a number of examples of kinds of things that these signals are allowing folks to provide you know again um one of them i'm fairly familiar with is when you're collecting ekg data but there's other kinds of data as well there's you know um pulse data there's there's a variety of of of signals that can be 18:36.91 Keith Deutsch collected, even within the hospital, continuously. Suddenly, you can identify, you know, disease spikes that happen by analyzing this data. 18:48.43 Keith Deutsch You can, you know, that's a word I'm looking for, but I'm forgetting. But, you know, when there's a a leakage of toxic materials internally in a patient, it's something that somebody worries about, what hospitals worry about. 19:04.37 Keith Deutsch And you can just Decide, know, the typical way, for example, right now, when you have a cardiac patient in a hospital, if you want to decide whether they need a pacemaker, you can to give them a stress test. On the basis of that one test, you decide whether they're going to be able, whether they need a pacemaker or not. 19:21.08 Keith Deutsch It would be much better if you could deduce some underlying causes by doing big data analysis. And that's, again, the realization that's happening. That's great, but now you need a place to do it. 19:36.10 Keith Deutsch And that place to do it is not the EHR. 19:41.18 Keith Deutsch So, you know, you have to do these platforms, whether it's in hospital or remote. 19:43.01 Ratnadeep Bhattacharjee Right, 19:47.00 Keith Deutsch So, again, this is what I'm seeing. I'm seeing this recognition on by big players like the Mayo Clinic, you know, like Sutter Health, you know, and and and Kaiser and other, I'm talking about American ah institutions because that's what I'm familiar with. 20:01.91 Keith Deutsch And, you know, A recognition that continuous monitoring matters. 20:09.89 Ratnadeep Bhattacharjee right. 20:10.70 Keith Deutsch And that's what's driving 20:10.49 Ratnadeep Bhattacharjee like 20:12.78 Keith Deutsch It's not that smart on fire is some magical thing that suddenly everybody's saying, oh, smart on fire. That's a tool that's existed for a while that allows you to do these integrations. And there's suddenly an interest in getting access to these kinds of technologies in a clinical setting. 20:32.53 Keith Deutsch whether it's in a clinical setting or in hospital clinical setting. 20:32.42 Ratnadeep Bhattacharjee Correct. Correct. 20:36.62 Ratnadeep Bhattacharjee Absolutely. You know, I completely agree with you right now. You know, it's it's an interesting segue to, you know, some, some, use cases and I would like to mostly stress on the value-based care use cases, right? You know, wearables are often kind of marketed as lifestyle devices, you know, but they, you know, also have a huge potential in value-based care models, right? 21:02.70 Ratnadeep Bhattacharjee ah How do you, how do you see, I mean, this is purely your views, right? How do you see wearables and device data contributing to, let's say, a population health management, chronic disease monitoring, or even Medicare advantage, you know, risk adjustments and stuff like that, right? 21:16.77 Keith Deutsch okay 21:23.23 Keith Deutsch so So you're talking about, so let's divide the world into two different classes of devices. The devices I've been talking about are high grade devices. They are continuous monitoring devices, which is different from what you get in in classic treatment within a hospital or such. 21:39.19 Keith Deutsch And they are remotable, but they are clinical grade devices. and That's a lot easier for your typical medical provider to accept. If the FDA has blessed it as a medical clinical grade device, the data means something. 21:54.80 Keith Deutsch The interesting thing is transition that's taking a lot longer is these other kinds of wearables that are not necessarily clinical grade. You know, I have a smartwatch. It monitors my pulse. It monitors my temperature. It monitors a bunch of signals. 22:11.35 Keith Deutsch The FDA will never certify that device as a medical, as a clinical quality device. And yet, you know, the data is there. It's probably a lot noisier than the clinical quality device devices are. 22:25.27 Keith Deutsch It is more hit and miss. I might, you know, because it's optical techniques and so forth. 22:33.83 Keith Deutsch And the issue there is The place where that data becomes useful is when you have enough of it, even very noisy data can be analyzed to produce potentially clinical grade results. 22:48.53 Keith Deutsch Now, getting that trusted and integrated in the way we just talked about is is taking a lot longer. We've seen some big players go through FDA you know kinds of of approval cycles and do trials and so forth. 23:06.77 Keith Deutsch based on taking large quantities of this lower quality device data and trying to do something that can be rise to clinical levels. It's a challenge. you know I think it will be longer before that take that really um sinks in as as as an accepted mode of of data collection in the clinical setting. 23:32.56 Keith Deutsch Lots of lifestyle companies are doing this and they're claiming to tell you fairly high grade things. And, you know, maybe they are. But it's a different setting. 23:43.67 Keith Deutsch It's not a clinical setting. And that's the differentiation that um we're making here. Does that make sense? 23:50.13 Ratnadeep Bhattacharjee Yes, yes, it does. It does. And, and, uh, you know, to, to add to that, you know, I mean, so even for the, uh, device data though, that, you know, junk out these clean, you know, non noisy data, right. 24:06.65 Ratnadeep Bhattacharjee Uh, do you think in in this current scenario, uh, it, how, how valuable is this for a provider ecosystem and how, Do they kind of trust and rely on this data? 24:19.64 Ratnadeep Bhattacharjee Is this ah already happening? 24:22.07 Keith Deutsch Again, most of the uptake that I'm seeing in sort of um non-clinical device data, trying to come up with a term that isn't pejorative, that isn't putting it down because it's it's it's good data in its way, but it's noisier and it doesn't rise to the clinical standard. 24:31.44 Ratnadeep Bhattacharjee Okay. 24:42.28 Keith Deutsch Most of that I'm seeing in sort of wellness applications that are not Anything that the medical community is going to look at. 24:53.77 Keith Deutsch But they're useful to individuals. um You know, great. But that's a different universe. At what point does that rise to clinical levels? Again, it's a very high bar um to get by. 25:10.88 Keith Deutsch um yeah if you If you look at a lot of these low you know commercial, what we'll call commercial wearables, um they're easily fooled. If you happen to have a pacemaker, for example, none of these commercial grade EKG devices can do anything useful because they aren't programmed to handle that. 25:36.28 Keith Deutsch that's an obstacle to adoption. It's fine for a broad range of wellness applications, but it's a big obstacle for for use in a clinical setting. 25:51.01 Keith Deutsch So I'm seeing that taking a lot longer because the the level of work you have to do, um I predicted back in 2018 or 2017 when I originally wrote some articles about this, 26:04.89 Keith Deutsch that this would happen, but it hasn't happened yet. And again, the barriers, the quality of the data is such that you need to go through a lot more work to prove that you can, if you collect enough of this data, do something useful that is noise independent and gap independent and still use and and takes into consideration all these things where they fail against um you know clinical requirements, if that makes sense to you. 26:38.28 Ratnadeep Bhattacharjee Yeah, yeah, yeah. It absolutely does. 26:40.11 Keith Deutsch So I actually am am not um not really bullish on a near-term, um ah you know <unk>ve I've seen Apple a while ago did start doing some studies to demonstrate that they could do clinically useful things around you know, AFib detection and so forth. 27:01.81 Keith Deutsch The question is, can they do that across across the generic, you know, swath, ah you know, the full swath of ah ah folks that are out there? And my guess is that they can't. Because their collection techniques that that these devices use are not sufficiently robust. 27:19.62 Keith Deutsch And that's a problem. And so despite all of that, I still don't see the medical community, you know, outfitting folks with AFib detectors that are simply your your your your i you know your your your Apple Watch. 27:37.20 Ratnadeep Bhattacharjee Right, absolutely. I completely agree with you. ah but But Keith, you know, um that is all, you know, still, you know, out there and, you know, people understand a lot of these things. And even though some some people may not want to admit it, but it's true what you're saying, right? 27:56.78 Ratnadeep Bhattacharjee But looking ahead, right, what does the... ah future of device and wearable integrations look like according to Will we will we will we see more plug and play ecosystems or will it continue to be you know kind of fragmented as it is now? 28:12.53 Keith Deutsch ah One of the things I said to you earlier was I see a barrier being here or it's but let's not call it a barrier, let's call it a hurdle that's going to be hit at some point in the not too distant future where the good news is that there will be a bunch of least clinical grade devices ah available in the clinical ecosystem. 28:34.57 Keith Deutsch And the bad news is hospitals are going to be looking and and providers and so forth are going to look at these things. how am I going to do 50 integrations? with 50 different platforms. How am I gonna train you know my my staff across 50 different platforms? 28:50.71 Keith Deutsch That's gonna require some kind of plug and play architecture where a single provider is providing core data platform that allows these various device folks, manufacturers, to plug in both their devices and their analytics in a tool that looks the same across a variety all these devices and applications. 29:15.13 Keith Deutsch And that's where you get some interesting interoperability. um and And I've seen some folks struggle with this in trying to figure this out. I haven't seen anybody crack it yet. 29:27.76 Keith Deutsch um So I'm looking forward to some somebody coming up with a clever strategy that I haven't heard of. And we can talk about all the different strategies I've seen in terms of how to make that happen. 29:42.01 Keith Deutsch I've seen folks have, you know, have the insight. Oh, it's the payers that really want this. So let's do something for the payer side. You know, great. 29:53.07 Keith Deutsch But that makes a lot of sense. I don't know if it's true. I'm i'm not qualified to type say if it's really true, but I can see where it makes a lot of sense. Right. um OK. But they haven't yet gotten traction. 30:05.64 Keith Deutsch good and that's the challenge here how do i get the the folks who come up with that platform are going have to get traction both with the provider side you know in the ehrs and so forth and the device side because they know they need to persuade a bunch of device vendors to interoperably integrate with their platform It's an interesting challenge. 30:32.01 Keith Deutsch We'll see how that plays out. But that's the next hurdle that I see coming when the good news is there's a bunch of these clinical quality devices. So let's put aside the lower quality wearables, just the clinical quality devices that are emerging. 30:47.33 Keith Deutsch There's enough of them that there's going to be a proliferation of these platforms. And that's probably why that proliferation of these platforms is probably why you're seeing requests for smart and fire integration. 30:59.87 Ratnadeep Bhattacharjee right 31:01.01 Keith Deutsch But think of the problem that creates. At some point, you know, Sutter or Mayo or whatever wakes up and says, oh my God, I've got 50 different platforms integrated here. 31:13.50 Keith Deutsch This doesn't work. 31:17.43 Keith Deutsch That hasn't happened yet, but I see it coming. 31:17.86 Ratnadeep Bhattacharjee correct no no i i agree i agree and and this is this is great right you know all these things that are happening all the movement that is happening in this sector is something that i'm really excited about and i'm pretty sure you working in this space must be excited about as well right so 31:37.94 Keith Deutsch Oh, sure. 31:41.16 Keith Deutsch and And the interest level is, does seem to be swelling. it It took longer than I expected, but it does seem to be swelling. 31:46.16 Ratnadeep Bhattacharjee correct 31:50.05 Keith Deutsch you know So I'm just trying to predict the next roadblocks that will come up and problems that have to be solved. And if somebody out there has a brilliant idea for how to, and again, the challenge for this interoperable core platform that i'm talking about is not building it, it's How do I target it so that I get traction on both sides? 32:12.34 Ratnadeep Bhattacharjee Correct. Yeah. Agreed. No, this is great. Uh, you know, oh you know, thank you so much Keith for joining me and sharing your insights today. Uh, this has been great. 32:23.83 Keith Deutsch Ah, we're done already. That was quick. Time flies when you're talking about interesting stuff. 32:26.80 Ratnadeep Bhattacharjee No, this, 32:29.84 Ratnadeep Bhattacharjee ah No, this is this is really great. yeah I think are you know your expertise on device interoperability, know technologies like Smart on Fire, you know these really helps cut through the complexities and focus and really focus on what really matters. right and to our listeners uh i think this these whatever you have mentioned today must be very valuable so and yeah thanks to all our listeners for tuning in if you enjoyed today's episode please subscribe and share leaders perspective with your peers and please do not forget to connect with keith here who loves talking about interoperability loves talking about medical devices and its evolution and uh 33:15.99 Ratnadeep Bhattacharjee And yeah, thanks for tuning in guys. And this is Ratmanadeep Pachacharji and you have been listening to Leaders Perspective, connecting care interoperability for wearables and medical devices. 33:27.54 Ratnadeep Bhattacharjee Until next time, stay connected and keep innovating.
