ON RECORD

00:00:01:21 - 00:00:21:06
Unknown
Welcome to the On Record Podcast podcast, where we talk with professionals and other various subject matter experts from diverse markets are using video and audio in innovative ways to support their organization's objectives. My name is Andy Simmons and my co-host is Mike Anzalone. How are you doing, Mike? Good. And, today our guest is Justin Fincher, who is a systems engineer from Children's Hospital of Alabama.

00:00:21:11 - 00:00:44:02
Unknown
Thanks for joining us, Justin. Hey, good to be here. Well, we, start simply just, give us, you know, an overview. Who's who's Justin Fincher? Yeah. So my name is Justin Fincher. I, like you said, a systems engineer here at Children's of Alabama in Birmingham, Alabama. I've been at children's for almost 20 years. Started in January of 20, 2006.

00:00:44:04 - 00:01:03:07
Unknown
And so, at that time, actually, started doing telehealth. Using Polycom, using, you know, that kind of stuff back in the day. On a T1 line before, it was all IP based stuff. So that just kind of, takes takes you way back. But I've been here for 20 years. I worked in our conference center that we had there.

00:01:03:09 - 00:01:23:00
Unknown
So we did a lot of telehealth stuff, a lot of video recording, a lot of video production. Which ended up feeding over into the operating room, using, you know, integrated ORs video platforms, video storage for surgical cases. So, I did that for about 8 or 9 years and then shifted over to it, where during Covid.

00:01:23:02 - 00:01:48:15
Unknown
As you probably are well aware, video really kind of took a huge leap forward, whether it was telehealth or the need to monitor patients from a distance. And so clinical observation recording really kind of took off. And so, I've been at the forefront of that and dealing with that from, you know, since Covid, especially when it comes to clinical based recording.

00:01:48:16 - 00:02:16:04
Unknown
From that need. It sounds interesting. Just I'm kind of curious. You you're talking about your experience in the OR. Can you expand on that? Is was that capturing live surgical procedures or was it a simulation based scenario? Yeah. So actually, it was all live. And so we had a couple of different options. We could record and archive anything.

00:02:16:04 - 00:02:37:19
Unknown
It was all HIPAA based, secure. It was, you know, locked down to the specific surgeons that were doing the operations. But we could export that, you know, and de-identified, de-identified patients. But we could also view the OR as live. We had through their integration. We had conference rooms that were integrated in the OR. So we would have groups of people come in.

00:02:37:21 - 00:02:59:06
Unknown
Whether it was, donors, whether it was our board members doing rounding. We would bring them into the conference room. And be able to pull up live surgeries and actually have our physicians talk to us from the OR. And kind of guide some of these, you know, whoever it is, community members, board members, through some of the surgeries that we were doing.

00:02:59:08 - 00:03:21:08
Unknown
And that just really was it was a lot of PR. It was a lot of just keeping, people that aren't necessarily in an operating room session or they're not in on the patient floors on a day to day basis, but they help run, you know, parts of decisions throughout the hospital to keep them connected to what we're actually doing in the hospital on a day to day basis.

00:03:21:10 - 00:03:45:10
Unknown
Yeah. It's interesting. So I know you mentioned HIPAA compliance, which is certainly, you know, a really big consideration, particularly in health care. And when you're working with live patient. So how were you able to address some of the privacy and ethical considerations in using video in that kind of environment? Well, in that kind of environment it was a little different.

00:03:45:12 - 00:04:05:17
Unknown
You know, the board members and people that were coming into these pieces, they're they're essentially, a form of an employee for the hospital. And so, with that plus with, you know, consents that parents on when they're coming in for surgery that really kind of covered all of those bases that we were need. We weren't recording those sessions.

00:04:05:18 - 00:04:29:03
Unknown
Those were just strictly live viewing. In the past, these board members would scrub up and walk into an OR. But then you run, you've got infection risk. You've got, risk where we've had people pass out, you know, years ago in the middle of an OR. And so to reduce some of that, it's probably been 15 years now.

00:04:29:05 - 00:04:50:08
Unknown
That we stopped doing a lot of the people walking into the OR, people, you know, having to scrub up and do that and then just showing it live, you know? So how you you started using video in the OR. And prior to that, how have you been able to expand the use of video throughout the hospital?

00:04:50:08 - 00:05:18:20
Unknown
And, and what kind of use cases are you using video for? Yeah. So it's really grown a lot, especially since 2006, as you well know. We were running a T1 line with very expensive Polycom hardware. Or Tin Berg hardware, you know, back in the day. And of course, that's, that's shifted so much because now you have so much more accessibility and to that kind of stuff.

00:05:18:20 - 00:05:52:14
Unknown
And so it's grown from, behavioral health psychiatrist meeting with kids and, you know, 3 or 4 hours away in lower Alabama. Being able to, you know, do that in a very small capacity because we had very few people. This is prior to even physicians being able to be reimbursed financially, for this. And so we it was a very small group of people that wanted to basically almost give their time away to meet with kids that, you know, are four hours away.

00:05:52:16 - 00:06:16:15
Unknown
But, you know, since Covid. Really? Well, let me back up just a little bit. You really had to have a stakeholder when it come to having some sort of telehealth or video recording that was medically needed or that had served a medical purpose, and those were few and far between. Honestly, you had people that were just blazing the trail, and those were the people that you'd have to get behind.

00:06:16:15 - 00:06:45:03
Unknown
As a technical person like me to be able to push something. I would love to have pushed telehealth. Back in 2006, 2008. In that timeframe. But I'm just a technical guy to provide the solution, not the guy that blazed the trail. And so you really had to have these physicians that were driving that. And so what ended up happening is some of these people begin to, you know, either fade out, they would move away, and then you'd have, you know, a project to kind of die off.

00:06:45:05 - 00:07:13:11
Unknown
But when Covid happen and I bring that up, just because that really kind of help shove the, you know, if it's telehealth or video recording or video observation for me and for our facility, that really kind of helped shove that forward, super accessible were an Apple iPad based house, so I run I'm also the MDM admin for all of our Apple devices here at children's.

00:07:13:13 - 00:07:49:07
Unknown
And so iPads in 2020 became a hot item when it come to using, you know, a third party video conferencing, tool. And then clinical observation reporting and needing that, became an extreme need because we'd had patients with Covid and you'd have behavioral health patients on lockdown and trying to reduce the amount of infection and trying to reduce the times that a nurse had to enter a room, and being able to monitor those patients from, workstation just outside the room.

00:07:49:09 - 00:08:09:19
Unknown
There was a lot of benefit to that, and that's what helped drive a lot of the need. And then to it just it continues to drive forward with, even Iverson VALT being able to, give us a camera on an iPad and using that as a streaming platform, being able to use that as a recording device.

00:08:09:21 - 00:08:35:15
Unknown
We're doing that now through our simcenter our simcenter. It really helped push a lot of that clinical observation. They're actually the first ones that had, VALT here at Children's. And when they got, I was the original person that developed their recording system. We used an iMac with a video switcher and cameras mounted on the wall, and they would video switch from room to room using this manual switcher.

00:08:35:17 - 00:09:04:08
Unknown
And then, of course, when VALT came along and I found out that they had kind of gotten that put together, that just really it answered a need that I had from an I.T professional for so many other people. And, you know, we'll probably dive into that, but we were using, VALT and clinical observation recording is what I refer to it here on a lot of different platforms and a lot of different ways in, in the simcenter.

00:09:04:10 - 00:09:30:18
Unknown
But, who are the major learners or is it generally used for professional development? Are you affiliated with a medical school? How are the scenarios created for those particular groups of learners? I don't know all of those details, but I will tell you that, a lot of the people that are running, it's a collaboration, I think, between children's and UAB, which is, just next door to us here.

00:09:30:20 - 00:10:16:09
Unknown
A lot of the UAB Patricks docs are our doctors that are here at children's as well. And so it's a collaboration between those, and so you've got physicians, you've got nurses, you've got a wide range of people, operating room techs and nurses that are doing stuff like that. I know we have done, death and dying or death and coping, simulations as well, where we have actors that are brought in and work with our, social workers or our pastoral care staff in, in the case of, patient person in a way, and having to know how to handle those parents, and how to help them in the middle

00:10:16:09 - 00:10:50:19
Unknown
of, you know, a time like that which we see, unfortunately. So it's such a broad use area and honestly, they really help drive a lot of that clinical observation recording, which just ended up spilling over into so many different areas. Whether it's our imaging department, whether it is our sparks clinic, in collaboration over at UAB. Screening kids for, autism, to, just monitoring behavioral health patients.

00:10:50:20 - 00:11:11:06
Unknown
And in our, we have an emergency room area that is strictly for behavioral health needs. And so all of those have two cameras in it and monitoring stations that it's it's basically virtual sitting, with these patients who are high risk. You had mentioned, early on when you're just using the air that it was just like, I'm sorry.

00:11:11:07 - 00:11:30:20
Unknown
And, and then we kind of we jumped a few years to like where we're at now, where you're talking about recording all over the place, like, when did that transition kind of happen where it's like, you know what, we might want to actually use this footage that we're watching. So we opened our newest facility, our, our main hospital in 2012.

00:11:30:20 - 00:11:53:20
Unknown
So we, did a major construction. And when we did that, integration happened at that moment. That's when I moved in 2012 from our conference center doing telehealth on a day to day basis and video editing and all that kind of fun stuff, to the OR because, and already built a relationship with the OR and worked with the integration for years.

00:11:53:21 - 00:12:19:09
Unknown
Prior to that, when we moved into that building, we we planned for live observation and planned for recording at that time. It was about a year later after we opened the door. So it was probably around 2013 where the technology for recording was finally implemented. And, and released, and we worked with the other company to get that taken care of.

00:12:19:11 - 00:12:53:02
Unknown
When we did that, what what really happened and that was so beneficial. I know for one, one group and one specialty for our neuro group. They were building a training catalog for surgeons, and so they were recording these items through the system, downloading them, putting together edits for talks, for training material, for other surgeons and for training, those and maybe even going overseas and training people in third world countries, being able to, to share that information.

00:12:53:02 - 00:13:22:03
Unknown
So that's really where a lot of the recording happened, especially from the surgical standpoint. And that's what that kind of benefited the most. And I think one of the things is being able to, I know some of our surgeons would review some of their footage before a patient would come in for a second surgery to review what was done prior, not only just reading a note and reading something in the EMR where, okay, this is describing what we did, they can actually go back and refer to actually seeing if they had taken.

00:13:22:03 - 00:13:37:13
Unknown
Yeah. And so there was a lot of info there. You could also mention that like, you know, a lot of spillover and you named a bunch of different areas that are now using this. If you were to just kind of guess the next couple of years, like, where else might this spill over to? Like, who who's not recording that?

00:13:37:13 - 00:14:02:12
Unknown
You think like, yeah, I think there's probably a use case there. Well, I think, I can foresee in the near future us having some sort of maybe it's not recording, maybe that's more live. But I'm thinking we can end up having cameras and microphones in every patient room for, you know, communication, with, you know, nursing and helping with that kind of stuff.

00:14:02:13 - 00:14:25:14
Unknown
Now, when it comes to recording, I'm not 100% sure. I think we'll see it grow in more areas like, you know, autism screening, screening for other pieces like that. I think that's where we're going to see a lot of growth. We this sparks clinic that we just deployed, two cameras in this one room, two cameras.

00:14:25:16 - 00:14:47:15
Unknown
They're really kind of blazing that trail for from from their standpoint. And I think we'll see that grow. I think they're going to see a lot of benefit from that, being able to review footage and, you know, chain of command physicians being able to be involved. I think we'll see growth there. I think we'll see multiple rooms outfitted with cameras where they see patients.

00:14:47:15 - 00:15:31:09
Unknown
And that becoming a normal thing for them. But just off the cuff of my head, I, I don't have anything really going right now. Just an as you've used video and you've expanded the use of video across the hospital system. What have been like the biggest challenges and obstacles that you've had to overcome? I think certain employees and certain, physicians or nurse people just being comfortable with it and not feeling like it's this almost taboo thing, like, why are we recording things like, you know, I mean, I think you see a lot of that, there's also a technical limitation to what can we do?

00:15:31:10 - 00:16:11:07
Unknown
You know, what what kind of strain on our network is this going to put. So you have a lot of these different worries and concerns, come in from different angles. But as technology has gotten better, network technology, video technology, it's really become a standard, especially with behavioral health. You know, I mean, we already had so many cameras and our behavioral health units, as a whole, but being able to deploy cameras into the rooms where we're able to help monitor patients and keep patients safe with limited number of staff, I mean, as you know, if you just do a quick Google search, you'll see that behavioral health is just.

00:16:11:13 - 00:16:46:00
Unknown
And mental health is such a huge growing space, which is terrible. I hate that, but that also puts us in a place where we have to make sure that we've got the technologies in place to help keep those patients safe when they're in our care. You know, I know there's, a nationwide nurses shortage. And I'm curious, from your perspective, particularly with patient monitoring, is that a potential solution to offset nurses nursing shortages?

00:16:46:02 - 00:17:20:13
Unknown
Oh, I've I've had this exact conversation. I think absolutely. I think you have, nurses who are probably ready to retire, nurses that are considering the strain. Maybe they maybe they're having kids, and maybe they're wanting to reduce the amount of hours that they're working. I think that opens up such a huge opportunity for, for especially like onboarding patients, maybe, you know, admitting patients and having to do that in that admission consult with a patient.

00:17:20:13 - 00:17:39:00
Unknown
Or maybe it's a discharge consult. You know, right now, a nurse on the floor who maybe is taking care of a sick patient. You know, they're backed up and maybe they've got three patients that are ready to be discharged. You know, it's not uncommon for us to get a text on any given day going, hey, we've got a high census alert.

00:17:39:02 - 00:18:01:08
Unknown
You know, we've you we've got a lot of patients in the hospital. We're almost full. At what point do we start discharging? And so at one point when we started hearing the the phrase virtual nursing, I was at a Jamf user conference, a couple of years and some, you know, colleagues from California, Cincinnati Children's, we were all just having conversations around virtual nursing.

00:18:01:09 - 00:18:30:21
Unknown
And so we began to go, hey, you know, what benefits does this bring? I mean, you can have these nurses that want to retire, but what if you could keep them on and give them a job where they could video conference with patients in the room and go over discharge instructions, freeing up a nurse that's on the floor, being able to, you know, care for another patient who's sick or need some more than just coming into the room and discharging them and having to take that time away from the nurse that's busy running around on the floor.

00:18:31:01 - 00:18:56:09
Unknown
But what if that nurse could virtually discharge a patient? And, you know, I just think there's a lot of really cool options there. And I'm looking forward to seeing where that goes down the road. I know you're a you're a tech guy, right. And you're putting these systems together in, in the hospital environment. What, what engagement level if that's the right word.

00:18:56:10 - 00:19:41:18
Unknown
Have you had with like the risk management team and the patient safety team in terms of again I know one of the one of the goals is to reduce readmission, through patient safety and other measures. And some experience I've had is, you know, using video for things like latent threat analysis or root cause analysis, things of that sort, when an incident or a near miss type of thing has occurred within the environment, how how have you engaged those individuals, not just from a tech perspective, but from an overall operational perspective?

00:19:41:20 - 00:20:04:17
Unknown
Yeah. I haven't had to engage them very often, but I do know that a lot of our risk managers, and some of our, I forget, I can't think of what they're called, but anyways, we'll just call them risk managers. I've had them come to me and go, hey, can you fill me in on what this is?

00:20:04:17 - 00:20:32:00
Unknown
Whatever that project may be, if it's especially with video. Whenever you hear video or recording or audio, you know, red flags go off with the risk managers. But honestly, when I've had these conversations with them, when you really look down to the security that we're adding, when you break down the security, when you break down what we're doing with it, how it segmented, how we're keeping it safe.

00:20:32:02 - 00:20:59:07
Unknown
How we've created these containers for these different groups where content from one group isn't spilling over into the other. They walk away and go, oh, okay, that's awesome. You know, I mean, so I think it's the unknown is when you start getting a lot of the, the concern. I do see concern when it comes to, probably operating room type stuff.

00:20:59:12 - 00:21:22:20
Unknown
And we've done recordings in the past. We will go over, policies and procedures. You know, there's a lot of concern of, you know, from a risk standpoint, especially from a, you know, a legal standpoint. There's a certain there can be some concern with, well, what if we're recording this and something goes wrong, you know, I mean, but that's that's always going to be the case.

00:21:23:00 - 00:21:53:08
Unknown
I don't I think any hospital in the nation is going to worry about that and make that a concern, in a way that for sure. But I think the benefit definitely outweighs all of that. So let me ask you this question just in if, if our listeners are working in the health care system thinking about, putting in video what kind of advice, guidance, lessons learned, can you offer them?

00:21:53:10 - 00:22:13:16
Unknown
I think get buy in from you know, for us we have you know, we've got our server team. We've got our network team. We have a lot of different teams within it. I'm a little on the special side, and there are probably people that would say that I'm a special person, as well, that I work with on a day to day basis.

00:22:13:18 - 00:22:39:10
Unknown
But but I handle a lot of special projects and a lot of things that are typical it things. I mean, I'm right now I'm looking at deploying Nintendo Switch, consoles in our behavioral health area for these kids to, you know, have stuff and, work with Oculus and virtual, you know, headsets and, push out Apple TVs and, you know, different streaming services for our child life group.

00:22:39:10 - 00:23:14:06
Unknown
And so I get to work on a lot of fun stuff. So I'm, I'm super grateful because I get to do a lot of fun things. But no matter what project you've got going on, whether it is deploying video, or recording capabilities, I think having people, in all of those areas, whether it's network, server, team being on the same page, and I think finding those people that want to have a stake in that project, because, look, I mean, we all have people that just it's a job every day.

00:23:14:08 - 00:23:39:16
Unknown
And you don't you get frustrated when you got to do something you don't want to do. But for me, I look at my job is I love what I do, and I love coming in here every day. And if I can do something that's going to benefit a patient, if I can do something that's going to help a nurse, or a physician with their job day to day and make it better, or you know, provide this, you know, cool feature that they never thought they'd be able to have.

00:23:39:20 - 00:24:02:15
Unknown
If I can do that, then that's just, I like to innovate and and that's a joy to me. But just finding those people that can be a stakeholder with you and help build out a project the right way. And then just planning, it's it's never easy to just throw something together. And I think it's just plan it out, right.

00:24:02:15 - 00:24:32:18
Unknown
And just find the people that are going to help continue to push forward that project. Justin, we had we had someone in a similar role to yours, but at a university that we spoke with a few weeks back, and this might be bringing the conversation back. Couple minutes, but you just mentioned a bunch of like really cool work and and no, you know, you know, deep discussion with this gentleman about, balancing like being an early adopter with a lagger with technology and making sure something's not a fad when you implement it and you know, you're talking about using some products, I mean, switch is not new, but using it in your capacity might be.

00:24:33:00 - 00:24:58:15
Unknown
So how do you kind of way that with the team that you're working with to say like, okay, we're gonna spend a lot of money on this, but we know it is worthwhile for these reasons. Yeah. It's definitely, you know, purchasing test equipment and research, getting demo equipment in here. The, you know, being an Apple MDM guy, and working on different projects, when it we're, we're an epic EMR house.

00:24:58:15 - 00:25:22:04
Unknown
So, we've got a lot of new projects going on. We went live with epic EMR in 20th March of 2023, and we have not stopped. And we're continually rolling out new pieces. Along the way, whether it's hardware, for us to the nascent Nintendo Switch two is the new one. So, one of the big things that let me just I'll talk with that project.

00:25:22:04 - 00:25:43:19
Unknown
For instance, this is probably the newest one on my brain right now. We've got a need. And that need came from our behavioral health group, to have. I think they're using Nintendo Wii right now. Of course, those are those are dated. And so they brought the need to want to do Nintendo Switch Two and all of their common rooms.

00:25:43:21 - 00:26:01:19
Unknown
And how do we lock it down? How do we keep it safe? How do we make sure, you know, kids aren't able to get on the internet? How do we make sure they don't mess up these units? And I went, we have to get one in. First off. And foremost, we've got to get one in before we ever move forward with the project.

00:26:01:19 - 00:26:19:19
Unknown
And we've got to do all of our due diligence here on it. How can we manage? How can we purchase games? Can we, you know, purchase one, use it one unit and download all the games there and make it like a master unit to where the others are, like, you know, child units and you know, what can we do?

00:26:19:19 - 00:26:57:04
Unknown
So it's just just a lot of testing. And with Nintendo Switch Two it'll be a lot of playing, to make sure that we're doing the right thing and not. Know, but it's from an IT standpoint when we're managing thousands and thousands of devices here, we always ask the question, can we manage it with something, whether that's an MDM or is there a management console for something to help us keep these things updated, keep whatever it may be?

00:26:57:06 - 00:27:20:06
Unknown
So that's always, kind of our first look when we start talking about devices and hardware is how can we manage it? And sometimes there's not a really clear answer for that. And so sometimes we deploy them one way and then a management solution comes out later, and then we have to kind of backtrack and go, okay, now how can we get all of these units managed into this system.

00:27:20:08 - 00:27:41:10
Unknown
Oculus headsets. That's exactly what you know. When we first deploy them, we had to deploy them all with their own accounts. Now, I think there's some management capabilities on the back end. So now I have to eventually get to the point where we go back and we retrofit those back into that management system instead of just managing them individually.

00:27:41:12 - 00:28:02:17
Unknown
Well, just and I think this has been a very informative conversation. I think our listeners will walk away with a lot of great information. How can our listeners get in touch with you if, if they have questions? Yeah. So, they can reach me at Justin Fincher at childrenal.org work. Well, thanks again. We really appreciate your time.

00:28:02:19 - 00:28:06:10
Unknown
Yeah, absolutely. Thank you.

00:28:06:12 - 00:28:18:09
Unknown
On Record is a podcast presented by Intelligent Video Solutions, hosted by Mike Anzalone and Andy Simmons and produced by Kyle Shelstad. Find us online at ipivs.com/onrecord and on social media at Intelligent Video Solutions.