Transforming Patient Care with Handheld Ultrasound Technology with Dr. John Martin, CMO of Butterfly Network, and Dr. Mike Rotondo, CEO of the University of Rochester Medical Faculty Group

[00:00:01] This podcast is produced by Outcomes Rocket, your healthcare-exclusive digital marketing agency. Outcomes Rocket exists to help healthcare organizations like yours to maximize their impact and accelerate growth. Visit outcomesrocket.com or text us at 312-224-9945.

[00:00:32] Hey, everyone. Welcome back to The Beat Podcast, recorded live here at Health in Las Vegas. Today, I have the privilege of hosting two amazing people, Dr. John Martin and Dr. Mike Rotondo. Dr. Martin is the chief medical officer of Butterfly Network, a transformational digital health company that's democratizing medical imaging around and across the globe. And I also have Dr. Mike Rotondo with us.

[00:01:01] He's the chief executive officer of the University of Rochester Medical Faculty Group, a seasoned healthcare executive with an accomplished surgical career in academic acute care surgery, and he leads an academic multidisciplinary physician practice composed of 2,100 faculty. Welcome to the podcast, gentlemen. Yeah, good morning. Thank you. Thank you very much. Pleasure to be starting the day with you guys. There's a lot of interesting things happening at healthcare, but just to kick things off, what brings you to health?

[00:01:29] Well, this is my first time at this massive gathering of healthcare technology, and it's clearly a tremendous opportunity to find out what's happening in the market and try to understand how these sorts of companies and forces are going to really reshape healthcare in the future. It's a great place to do it. Yeah, I've been coming a number of years now, and I think what you're starting to see now, and Dr. Rotondo and I were talking about this, we've seen this a few times in our career, both of us as surgeons, where the inflection point of change actually hits healthcare.

[00:01:57] And it started off with just a few things, a few AI things here or there, a few digital health things, and then the next thing you know it's you show up at a conference and there's a million companies. Yeah. And now we're here now to try to figure out what's the right direction to go, which are the right applications, the right companies to work with. Yeah, that's really great. And by the way, John, it's been a while. I know we had a chance to connect first, like many years ago when you first started the company. Yeah. So good to see you again. Yeah, it's like we were baby butterfly now. Now we're growing up. We've gotten to the teenage years and we're looking at adulthood coming. Metamorphosis.

[00:02:27] Yes, it's very nice. Yeah, it's very nice. So you guys are both surgeons. And so two surgeons on a podcast, this is going to be good. It could be said by our colleagues, how did you get two surgeons in a small booth? Because with their egos, they actually don't fit. If it doesn't go well, you can be sure we're going to blame each other for it. I love it. I love it, guys. Well, look, some of the best things happen through partnership. And I know you guys have a strong partnership. Tell us a little bit about the work that you're doing together. Yeah.

[00:02:54] Now, Butterfly has just a phenomenal technology in handheld ultrasound or point-of-care ultrasound testing. And we connected, the University of Rochester connected with Butterfly around 2021. And we were enamored with the technology. We said this really could be next level bedside diagnosis, bedside planning, making plans for bedside care on patients.

[00:03:19] And so we got into a broad-based relationship that would allow us to really work with them to explore the large-scale deployment of this technology and to understand what it meant to train a workforce and to use this in daily patient care. And we saw the value proposition and the potential that it had immediately. And that started the relationship. That's great. John, what do you have to say? Well, I think what makes Dr. Rotondo and Rochester different is ultrasound has been around

[00:03:48] since the 50s. Point-of-care ultrasound, bedside ultrasound probably being more popular in the 90s and moving. And people then saw the evolution of devices getting smaller and the shift toward what we call POCUS, point-of-care ultrasound. And you see all these institutions and all these clinical studies are starting to get involved, but they get involved. I want to do a pilot. Let's just try this. And what was really unique about Rochester was, and through Dr. Rotondo's leadership, we see the value. We're not going to tiptoe into this swimming pool. We're going in the deep end.

[00:04:16] We're going to go because we know ultimately this is where healthcare is actually going. And we don't want to dabble in the beginning. We want to make that commitment, do the hard work of paving that trail. And that's really what set this apart and what makes this collaboration so unique. That's great. And Butterfly made it easy for us because we recognized that we were going to have to start with training. We were going to have to gather resources to train the workforce, convince the workforce that this was something we should do.

[00:04:42] There were technical aspects to bringing the technology and bringing the device into the organization. We had specific investigators on faculty that were interested in this technology, had done work in that area. So that was a good alignment that occurred there. And we started to connect on all of those points, not just on a vendor relationship. We're going to buy these devices from you. Thank you very much. But really a partnership. That's great. That makes a big difference.

[00:05:10] And this thing about pilotitis, you never get anywhere with it. And so the commitment gets you farther. Dr. Rotonda, how did this partnership come about? And what were some of the major challenges that the health system faced? And what goals were you targeting with this implementation? The partnership started again. We discovered each other through the leadership of Butterfly reaching out to us and us getting to know them. The challenges that we've had are common to any new technology, bringing any new technology in.

[00:05:40] On the one hand, you've got to make sure that you've got the capital to invest in the technology. You've got to have integration of whatever it is you're bringing to the institution into the tech stack that you already have. And then the other side is convincing providers that this is something that they should put into their workflow. And the aspects of organizational change, when you are in a complex organization and you're

[00:06:03] working with that organization to think about what happens in that patient-provider interface, what's actually happening in that workflow, and how does that workflow need to change now that you have a new tool to use? So I think those issues are common. Do you have enough money and the technical expertise? And can you really institute the change and convince people to use it? That's great, Dr. Rotonda. John? I would add just a couple things.

[00:06:29] You have to have committed leadership at the top, and then you have to have some guys on the street who are committed as well. You need physician leadership that can lead by and they can lead others to follow, and you need the key at the top. And then you'd have to look at that armaterium of resources across the organization that have to be there. I think it really matters. It's an interesting challenge for physicians. Say you've crusty old guys like us, and we've been practicing for 20 and 30 years. Think we're okay at what we do? We get pretty good outcomes? Now somebody's going to step in and say, you need to change the way you practice.

[00:06:58] And I said, well, wait a minute. I know what ultrasound is. I can order an ultrasound today. And we're going to say, no, you need to do it and learn how to do it. Why do I need to do that? Because it's faster. It's better. It's more efficient. You can get better outcomes and make better decisions. It's a challenge to our own ego, if you will, and our own thinking about how we practice medicine. That's not easy. It's great with the kids. When medical school residents, they're hungry for this and they run to it. It's harder to have that established faculty to make that same change. That's a good call out, John.

[00:07:25] And I'd like to just take a moment to zoom into the value proposition. And because the workflow points out that you're doing things differently. So help us understand the value proposition of the shift of ordering an ultrasound versus having it done at the point of care. Yeah. I'm going to start with the patient, you know, because there are- That's not fair. I was going there first.

[00:07:51] If you really think about it at the bedside in an evaluation, what are the things that we use? We take a history. We do a physical examination. We may use our stethoscope. And then we start thinking of imaging studies. Think about what happens now if you have a patient who has, let's say, red upper quadrant pain and you're concerned that they might have gallstones or cholelithiasis and maybe even inflamed gallbladder. Now you can take a device out of your pocket.

[00:08:19] You can, if you're trained, you can use that device to make that diagnosis right at the bedside right at that moment. So it's a shorter path to definitive care. On the other hand, if you look at the cloud-based solution that Butterfly has come up with and the workflow process, that study is captured immediately in the electronic health record. And it's, it is not only subject to performance improvement review.

[00:08:48] You can educate around it, make sure the study was done correctly, but you're also capturing the event. You're capturing that work that's been done with the patient and you can bill for it in a compliant way. So soup to nuts, you've got more expedient diagnosis at the bedside all the way to more effective charge capture. That's awesome. Yeah. And I guess I'll add, I don't think there's many of us out there that haven't either been

[00:09:14] a patient or have had a family member that was a patient who has felt the agony of waiting. Time is the ubiquitous foe in healthcare. And we almost take it for granted. Rarely is it ever actually talked to, we have waiting rooms for God's sakes. We're called patients to be patient. Everybody has to wait. And that gap from history, physical to, I don't know what's going on to, I know is really the underbelly of healthcare that Butterfly is trying to challenge because time is not our friend. It is, it adds anxiety.

[00:09:42] It has us making decisions sometimes that we don't want to make with incomplete information. And the data is very clear that if you do history, physical image, we're going to redefine HPI for all our doctors out there. You make better decisions. In fact, there's an interesting study in primary care where 50% of the time we changed their diagnosis and decision-making. There's a great study that was done in the end where they put it on ambulances and it reduced the time to treatment of patients that were short of breath from 129 minutes to 21. So think about that.

[00:10:09] There's two hours, somebody short of breath waiting for treatment that isn't waiting anymore. That's really what's special. And the beauty of this is, it's exactly what Dr. Rotundo says. It's more cost-effective. It's more efficient. The patients are happier. The doctor's happier. The system works better. When all of these things align and the stakeholders all have value. The adoption of this is inevitable. What it takes is institutions like Rochester to say, this is the way. We'll go through the chaff of building that path through the forest and show you how to do this. But it is the future of where healthcare is going.

[00:10:39] That's fantastic. Yeah. The differentiator here too, because as John mentioned earlier, point-of-care ultrasound testing has been around in our institution a whole variety of ways. But the difference here is the portability of the device. It's with the provider, wherever the provider is. And so you can deploy it in non-traditional backgrounds, not necessarily in the emergency department. CART ultrasound exists there. The ICU, same. Other diagnostic areas in the hospital, same. But this allows you to deploy that device.

[00:11:07] And it isn't just a rogue study that you're doing at the bedside because you can. And it's actually integrated into the workflow. And it can be reviewed from a performance improvement quality perspective as well. So, you know, it differentiates itself on that basis, clearly. Yeah. And just one more question on that. Thank you, by the way. Very clear value proposition. Removing friction for the patient. Getting what they need when they need it. Huge. And then capture, right?

[00:11:37] Helping with billing. It's an amazing opportunity for folks listening. But let's get more granular. I love that you said, hey, look, there's a visualization in the ICU. You've got it in the ER. Where are you seeing the most value, right? Like what area of care is it being deployed for most value? We made some careful tactical decisions about how we were going to deploy this device at our

[00:12:01] institution because, as John's alluded to, people do get ingrained in their process of care patterns. And our zealots in for card ultrasound or point-of-care ultrasound testing in, say, the emergency department, less apt to change what they're doing. So we didn't try to compete in that area, though we had a couple of really strong champions in that area as well. Same thing in the critical care units.

[00:12:27] We decided to deploy in more non-traditional areas, our primary care physicians in the offices, to our nurses, to our medical students so that we could invest in the future. So we went to areas where they didn't have the technology and started there. And it just made a lot more sense to us not to try to compete with an alternative method to doing this, whereas we could deploy in areas that they just didn't have the technology of any kind.

[00:12:56] So it made a lot of sense to us to go in that direction. Home care, another example. Yeah, I love that. Go where there isn't something already. It's always the best way to go. And the profound thing about that is the incremental difference that you're making in care becomes huge. If they've already got a card around the corner in an emergency room, you're not going to see as profound a difference because it's not the difference of waiting until sending a patient to x-ray and waiting for results to come back. It's a guy running around the corner. But up on the floor, in the home, in a clinic, being sent out to the, okay, go to radiology.

[00:13:25] A couple of days later, I'll get the results for you and you can come back and tell you. That's where the huge opportunities are. And this entire thing in this conference is a lot about this, is shifting to care to the home. As we move to the left of the care continuum, I'm going to say something that's going to get all my telemedicine guys mad at me. But telemedicine without diagnostics is a teleconversation. When you add up to 70 to 80% of the time when we have a diagnostic dilemma, it's imaging that answers that question. The conversations are great. If you can answer the questions, terrific.

[00:13:53] But if you can't bring diagnostics to the table, you haven't really delivered care in the home that you could do at the level that we're trying to take it to. And I think Butterfly changes that. Well said, John. We now have just under 1,000 providers. We've deployed about 850 roughly around numbers of units so far. Within the next couple of years, we'll have another 1,000 that are out there. And those just under 900 providers have done just about 50,000 encounters. We have a very high capture rate.

[00:14:23] We're across 64 different departments and or specialties. It's been fascinating to watch it grow. I love it. Well, guys, thank you so much. One last thing. The theme for this meeting is bold. So can you share any bold moves you're making? Obviously, we're looking at bold moves with the partnership, but anything beyond that that you could share that's improving health care? Do I have to go first again? Can't he go first this time? No, wait. I want to go first. That's right.

[00:14:54] I think the bold move is, and I heard a comment out here on the floor that I loved, that there's more pilots in health care than in Delta. I think the really common means stop with the pilots. We actually have plenty enough data out there. Go. Go. And I think this signifies in Rochester that this is bold. I think we have a lot to learn on how to do it better. That's fine. We can learn in the process. This isn't like we have to learn how to fly the plane while we're up there. We can refine the plane while we're up there flying.

[00:15:21] And so I think the bold move is go big or go home, as they like to say. And I think that's what Rochester is doing. And what they've done, which has been so important now, is they published the data to say, you know what? This wasn't a crazy risk. This is actually making sense. It's working in the institution. We have the economic and clinical data to prove it. So bold actually can be not only a curious step. It can be the right step to take of that. Yeah. And for academic medical centers, it's about collaborations and relationships with maybe

[00:15:48] non-traditional partners, non-traditional companies. People always think of, I think academic medical centers work very well with vendors and that vendor relationship. But to really have a collaborative, thoughtful relationship where you're aligned across a whole variety of endpoints, that's where the value really can come if you can get to the relationship to that point.

[00:16:13] Right. And it's tricky when you've got non-for-profit and for-profit entities that are working together. And you've got to make sure that you watch those boundaries very carefully. But if we keep the patient at the center of this and we're transparent about what we're doing and how we're doing it, why we're doing it, make sure that we manage any potential conflicts that might come up. It's unbelievable what we can achieve together. Well, congratulations on the partnership, on the technology and all the work you guys are doing together. If people want to learn more, where can they go?

[00:16:45] Butterflynetwork.com. You can read all about actually Rochester's early results from a clinical and financial perspective. It's actually well-documented there. And part of measuring what you do actually is really helpful and you'll find that data there. Outstanding. Yeah. We're in the literature. Just go look for us. You'll find us. Love it. Gentlemen, thank you both. And for everybody listening, make sure you check out the show notes. Where you could find links to all the things that we discussed, the short notes. And again, the amazing Dr. John Martin, Chief Medical Officer at Butterfly Network, and

[00:17:14] Dr. Mike Rotondo, Chief Executive Officer of the University of Rochester Medical Faculty Group. Thank you both for being with us. Right. Thanks very much. I look forward to it. The next couple of years we do this again. Hopefully sooner. We're going to go out in the lounge area and argue now. It's been great to be with you guys. Thanks. Thank you. All right. Thank you. Take care.

[00:17:58] This podcast is produced by Outcomes Rocket, your healthcare exclusive digital marketing agency. Outcomes Rocket exists to help healthcare organizations like yours to maximize their impact and accelerate growth. Visit outcomesrocket.com or text us at 312-224-9945. Goodbye.