KSEA Video, OR1, and ENT marketing team up to demonstrate the value KARL STORZ brings through truly Enabling Anywhere Care via TELE PACK+ with StreamConnect®. The audience for this virtual Tech Center visit was BOTH external customers, and internal (sales) stakeholders.
Hello and Good afternoon. I'm chris smith and I'm introducing our tech cast today. Today's tech cast is about anywhere care and how we bring a portion of anywhere care to today's alternate sites of care, our clinics, our offices and even the bedside. Today's tech cast will be powered by our tele pack plus, which is our all in one video endoscopy or visualization platform as well as our content management software or workflow enhancement software known as string connect we think today is gonna be an exciting hour or so live demonstration with three very talented marketing managers who are going to bring this this system to life for all of our attendees today. Throughout today's meeting we are tech cast. We will have uh, some polls and I'd like to start with our first question today. Before we go into the rest of our introduction as we look at our audience, I'd like to ask you guys one simple question. How important is patient throughput in your practice? one not important. five, extremely important. If you wouldn't mind, go ahead and make your selection and then we'll look at the results of our initial poll question. Again, there'll be poll questions throughout today's tech cast. Let's take a look and see how important through if it was to our audience. As you can see from our results, the majority of our attendees feel that patient throughput as we affectionately call. Wait times as well is an extremely important aspect. We're using the results of today's polls throughout the tech cast to make sure that we're bringing you what you've asked for and that as customers of ours. We're designing solutions and systems that make sense in the alternate sites of care in the world you work in? We're hoping today that you guys are, our audience sees that this specific system that we're going to introduce to you today will help you achieve some new milestones as it relates to patient Throughput physician satisfaction, lowering the cost of care and bringing endoscopy to care sites throughout your care areas that were never possible before. You're gonna see a quick video of this system in action. And from there we're gonna jump right into our text center or we begin our live introduction. Mhm. All hospital systems and practices should have visualization solutions that allow the integration of care across the entire continuum. This includes visualization from the office to the operating room and back again. The tele pack plus has really allowed us to take our practice to the next level by truly enabling anywhere care. Yeah, yeah. Yeah. The higher definition really allows me to show our patients in great level of detail, their nasal endoscopy and what we've done to them surgically. I think by the patients seeing this level of detail. It helps us to create a partnership going forward to manage their care where they can better understand their disease and what we're doing to help them. I really value the versatility of the tele pack plus, it allows me to use a unit with a small form factor and a wide variety of spaces and with a wide variety of peripherals. Yeah, yeah. Yeah. Mhm. I can use the same tele pack plus for nasal endoscopy for flexible. They're endoscopy or if my partner wants to perform strongbox copy all of us have that ability with the unit and I have a choice to use reusable endoscopes or single use endoscopes all while using the same unit. Today medicine is practiced as a team. I rely on my staff, my medical assistance, my nurses and my patient care coordinators to really deliver state of the art care. The telepath Pluses, responsive touch screen and intuitive user interface. Makes it very easy to use. Having a system that is easy to use is integral in our practice and allows everybody to work together. Well as a team, the video output capabilities of the tele pack is very crucial to the way I practice. I can replay endoscopy is for patients on the integrated touch screen or using the video output capabilities. I can immediately enable a much more cinematic experience, allowing not just patients but their families and other caregivers to experience and visualize the endoscopy. The implementation of string connect has really allowed us a level of collaboration and inter connectivity that wasn't previously possible contents that we capture from the tele pack plus is now easily available. Also a wide variety of devices, whether it's my personal computer, our office computers, ipads, mobile devices, we can now visualize endoscopy from anywhere. One of the things I try to teach our residents is about the importance of preoperative preparation before a final logic or endoscopic skull base case. This often involves reviewing the preoperative endoscopy so they understand the patient's examination before we step foot in surgery. This additional crucial element allows our residents to prepare with a greater level of perspective. The software enables us to perform side by side comparisons, video and picture editing and also enables us to collaborate when we can sit down with the patient and show them how they look now versus how they looked in the past. We can help them to understand the course of their disease and the effect of the treatments that were recommended, the network ability of the tele pack plus and the integrated stream connect platform gives us the ability to enable anywhere here. Yeah. Hello and welcome to our technology center here in El Segundo California. My name is johN Flowers and I'm the marketing Manager responsible for our tele pack plus compact endoscopy solution. We wanted to share that video up front because we think it's an exciting way that the taliban plus and stream connect, enabling anywhere care solution are being leveraged in a real world scenario and we wanted to perform this tech cast to give you a deeper dive on both the tele pack and stream connect solution. So starting with the tele pack, uh we call this solution or compact endoscopy solution because we've taken all the essential components of an endoscopy tower and consolidated them down into a small yet powerful footprint. And so this system has an integrated display. This display also serves as the owner user interface. Uh, it's touch screen making a very simple to use and you guys expressed uh, the importance of patient throughput. So having a simple to use interface does add incremental value and in terms of time and efficiency. Uh this also has a camera control unit that actually has two camera connection inputs that allows a wide breadth and compatibility. Today's meeting, we're really focused on TNT but this system has applications in urology, gynecology, anesthesia and other specialties as well. Additionally, the system has an integrated light source, integrated capture module and network module, which makes it again, a very versatile system that has a variety, a wide variety of clinical applications. And today I currently have a full HD camera plugged in using a rigid endoscope. This will also allow compatibility to fiber scopes but having the two camera connection input also allows for a variety of video endoscopes to be plugged in. And so with that, I'm going to introduce our marketing Manager for R E N T solutions. Mr johnny podia to speak to those. Thank you john as jOHn just mentioned, the camera head from the tele pack system allows you to use your current fiber scopes over the years, flexible endoscope technology has evolved to diesel chip, vastly improving the image quality. Karl stoltz is the only endoscopy company that gives you the choice between reusable and single use endoscopes in the reusable is you have the choice between the HD and the scope that is also compatible with the apostrophe or the slim line 2.9 millimeter and the scope. And from my own personal experience in scoping myself, I can tell you that that 2.9 millim really makes a difference. Lastly the single use endoscopes, those are there for when you really need that kind of solution. The nice thing about our single use an endoscope is that it plugs directly into the tele pack as well, eliminating the need for an additional monitor in your practice as a company. Having the ability to give you a reusable and single use gives you the opportunity to implement a hybrid approach to your flexible endoscopy solutions. That hybrid approach can impact your cost per procedure, reduce your patient wait times all while maintaining a high image quality john thank you johnny. So I just unplugged our full HD camera to make way for our HD video scope, which is what we're going to utilize for our first workflow today, we're going to show you two workflows and to begin our first workflow. Uh, we want to focus on that efficiency of the system. So we like to affectionately call this workflow are easy button and so in the effort to increase patient throughput, we want to make sure that we have a system that allows you to efficiently get through your day and treat multiple patients in multiple treatment rooms. So um in this in both workflow scenarios we're going to be showing you an external view of the tele pack where you can see what we're doing on the outside of device. But we're going to simultaneously show you the endoscopic image so that you can see the image quality of our various scopes. And so at this point we've plugged in our HD rhino laryngoscope and uh this system is already integrated with any HR system so the work list is automatically loading. If I click on the patient area, I can see the patients I'm expected to see for the day. I simply select my patient In this example, I'll go ahead and select Jon jones. You verify that information, Hit select and now you're ready to begin the endoscopy. So I'll have a johnny initiate the endoscopy. So as he begins, I'm gonna start capturing video by simply selecting the video function on screen that begins the recording. I can also initiate capture via the video scope or johnny had initiated the capture via the video scope. So for those that are attending that are administrative, you may have never seen a diagnostic endoscopy before. This may be your first time john is very accustomed to bringing this to your viewing pleasure if you will. We've seen him do it for many years. The beauty of the image. This is not a recorded image. This is the actual image you should expect when using our high definition um cmos rhino laryngoscope on the tele pack. Plus for those that are caregivers. You can you've seen this many times and you probably understand the value of an image of this quality. So an added benefit of this solution as it does also allow for the incremental value of Shebaa Skopje in addition to diagnosis treatment and endoscopy ease. So uh getting close to wrapping up the procedure. And as we finished, I'm just going to select the video function one more time that ends the recording. So at this point I've finished uh capture with my patient and before I move on to to close out this procedure, I want to throw up a quick poll question because this system has a couple of ways you can manage content. And I'm curious of how the audience manages their clinical content, images, videos and and so forth. We'll get that whole question on the screen. And so how are you currently managing your clinical images? Are you printing them out? Are you managing them via thumb drives or affordable hard drives? Are they already making it to the patient record or the HR or do they end up somewhere in space? Ultimately on mars couple more seconds to answer that pole. And let's see the results. All right. So a lot of thumb drives a few prints and and it's good to see there also ending up on the patient record and um exciting for the mars rover to have a few uh captured cases as well. So um on that on that note uh the tele pack is capable of printing videos you can export to the U. S. D. But in terms of the easy button, we want to highlight that. We've just captured the content. I can click on the patient area and there's a finished procedure button as soon as I select this finished procedure, that content that that video that we just captured is now seamlessly on its way to stream connect and also the patient record whether it's epic or otherwise. And with that I'm gonna hand it over to john hill who is our marketing manager over our integration solutions. All right. Thank you john. So we are flying over to our mock doctor's office, you see two views here on your left hand side. That's me sitting at my desk in the doctor's office. I'm in front of a laptop or tablet and that's the screen you see on the right hand side there. And right now I've got our stream connect application pulled up. This can be accessed from anywhere in the world on a tablet on an iphone, what have you. So john just pushed sent on the procedure. If I hit refresh here we're going to see our patient come through. So Jon jones was our patient the cases right there. If I select it, I can view the images and videos from that procedure directly from this web application. So I saw a lot of you answered. You're dealing with thumb drives today. Some of you dealing with Prince. Um no need for any of that portable media. This will all happen digitally over the network. So in the background what's happening is this is pushing to the patient record. So for those of you who have epic, this is an example of what it would look like when I'm in this patient's chart. I see an icon or a link I should say for the images from my auntie scope exam. When I click on that. I am launched into my packs viewer that my facility has and I can see the images and potentially video from that procedure. So this all happened with zero touches. So as soon as jOHN push finish there was no dealing with thumb drives, printing or scanning or any of that. It's all happening automatically in the background. So we're going to show you another workflow in a moment that digs deeper into what if you want to manipulate some of this media before it's archived into the patient record. But before we do that we're going to start another case back in clinic and for that I'm going to turn it back to john thank you john and welcome back to the clinic. So in this second workflow we wanna take a deeper dive on how this system can improve the patient and clinician interaction with this second workflow. We also want to demonstrate a different uh device. So johnny is in the process of plugging in a single use scope. This plugs into the other camera connection input. No need for an additional system or module single uses ready out of the box with our tele pack plus compact and gossipy solution. And um in this workflow I want to point out that we could go up to the same patient area. Again we've got the work list pulling in from our electronic health record system. If we do get an unexpected walking though I can simply select new patient, manually enter them here. So it still has that versatility. There's an on screen keyboard where I can enter information. Uh One other difference between the previous work clothes you might have noticed I throw on a glove. So this system works perfectly with or without gloves. Um and so I'm going to go ahead and close out of that area just for consistency sake. I'm gonna go back into my same Jon jones uh patient uh select them and I'm ready for the endoscopy. So mr johnnie padilla's beginning the endoscopy. I'm gonna go ahead and hit the same button as before the video capture button to initiate that recording a couple other things I want to call out with this view, I can also make it larger via the zoom function. So I simply select zoom, I can make it larger so that you've got a better visualization of the endoscopy. Um Also, if you want to have this appear to be cleaner, look and feel, I could simply tap anywhere on the screen, it hides all of that user interface to bring it back. I simply touch anywhere on the screen again, it comes back. Um I also got the ability to take still images while the video is being captured. So, if I know this is a important part of the procedure is where I ultimately wanted to end up the vocal chords. I could take a couple additional stills and you've got all that functionality right here with these functions which are by the way, these functions here are customizable. So you can tailor them to your need into your workflow again. Thinking of patient throughput. All right, so, we're done with the procedure. I just hit video again to end the recording and now I can see these thumbnails at the top that tells me what I captured um when I select the patient, I can finish this procedure. But this opportunity after you've captured contents are good uh time to build a, use this as an educational opportunity with your patient. So, by selecting video, the video automatically starts playing back and I could use this to show my patient their diagnosis, their, their progress and maybe a surgery at any point. If I want to focus on a particular area of interest, I could simply hit pause. I can also hit pause or play anywhere on screen. So as a person like myself who likes to talk with their hands, I could hit pause here. I can arrow through this video frame by frame using that forward and back arrows. If I want to grab an additional still from the video playback, I simply had still, I've captured a third image now and then I can continue hitting, play, continue having that dialogue with my patient. Um and then if there's another area of the procedure I want to focus on. I could kind of fast forward or drag to that area. Hit pause again, take an additional still have additional dialogue with my patient. And then when I'm all done I'll just hit the X at the top of the screen. This takes me back to my recorded file screen where I can then if I want to select images, I kind of take a deeper dive on these images. For those of you that still would like to print, I would have the option to print these images. But for a more seamless workflow, I can just simply select finish procedure. And those four images in that video are gonna flow directly back to the stream, connect application as well as your Hr with that back to you. Mr john Hill. All right. Thank you john Okay, so we're in our second workflow, we're gonna take a bit of a deeper dive into our stream connect application. So I'm back at my desk here. I am going to hit refresh on the application and we'll see in a moment how johN the jOHN jones second procedure has already appeared. So if I select that, I am now again presented with the media from that procedure so I can do a few things in here to manipulate this media. Before I actually dive into that though, I want to run a quick poll for those of you who are capturing images and videos today, give me some idea of how much time you're spending on that per week. So I'm talking about, you know, the transferring to thumb drives, moving those thumb drives onto your computer may be dropping those files into my movie, editing video down, putting those images into power points potentially if you're presenting. How much time every week are you spending with those tasks? So go ahead and choose an answer hit, submit. Just give me a directional idea and we'll present those poll results in a moment. Okay, so were little across the board. So some of you are not capturing images and videos today. So for those of you who are not doing that, I do wonder is that because it's challenging workflow, maybe this can actually help potentially solve that for you. And then most of you are in that 30 to 50 minute range. So um you know, over the course of a year that obviously is going to add up to a lot of time. So what I want to show you is an alternative option. So you already saw the the auto push right where those images were automatically pushed to the HR. Now we're going to take a little bit of a deeper dive. What happens if you want to manipulate that media in some way shape or form before it makes it to the patient record or before it makes it into a presentation of some kind. So here I'm looking at an image from the last procedure and I can do some editing of this so I can annotate an area. So if I'm sitting with a patient I can potentially call out an area of anatomy um and save that edit. Um If I'm looking at video um I can actually trim that video down to sort of a highlight reel of that procedure. So if I go into my edit mode here I can clip down to just the area of the exam or the procedure that I'm interested in and then extract that clip without having to deal with again. And I movie editor or some third party editor that can all be done directly within this application. Once I've done those manipulations I can then share this content out with either a patient directly. Um it'll show up in their email or a referring physician, potentially I can drop it straight into a power point or a pdf or I can send those edits I made along to the HR manually. Again, we can automate that HR step or we can give you the control to hit the images and edit them before they're sent along to the HR. Another use case I want to show you is what happens if I have a patient that maybe has multiple clinic visits throughout the course of their care journey. So maybe I've got a patient who came in first robots copy prior to surgery and then came in first robots copy after surgery. So I'm gonna show you what that looks like for us to sort of side by side that content. So we're gonna look at actually our patient steve martin. I enter martin's last name. The predictive search result tells me immediately kind of like google who I'm searching for and I see my before and after exams here. If I select them on the left hand side, I can go into what we call our compare mode. So when I compare I'm going to be presented with the content that was captured in both of these procedures. I can sync up and I can look at my post surgery and my pre surgery on the screen here. I can then go frame by frame forward or backwards and you know, this would allow me to potentially have a conversation with a patient talk about their progress. Maybe I would be sitting down with a colleague like you saw in the video with Dr R and you know, ultimately the goal here is to show in a single location the trajectory of this patient and their care. So that is the last piece of technology we wanted to demonstrate to you. I have seen some questions coming up and chat and so I'm going to actually turn it back to chris to kind of close this out and quarterback A Q and A. I would like to thank all three johns for bringing us this live tech cast. Just fantastic prevented presenters and excellent job bringing this technology to all of us on the call today. We did have a couple questions. The first question I'd like to direct johnny padilla on. The question is simply, can you record still images with our single use video endoscope johnny, Would you mind answering that question? Sure. The answer is yes. The once the images in the tele pack, all the functionality is available whether you're using the single use endoscope, the slim endoscope or the HD endoscope and specifically we cannot take stills from the hand piece itself, correct. The hand piece itself. No, that is not a function available with the single use that being said, we do sell a foot pedal that plugs into the tele pack. So if that's something that you're interested in, you could utilize a foot pedal to initiate capture without having to use the touch screen at the telepath. Thank you john and thank you john. Our next question is for jOHn but john Hill, this question is if you edit annotate the image, how do you resend it to the HR? Is there an automatic update via HL seven interface? Yeah, So once you make the edit, I don't know if you saw and I can re share but in the bottom right there was the ability to send to the HR so you make your edit and stream connect your annotation or whatever it is. And all you're gonna do is you're going to select that push thR button in the bottom. Right. Um and it does work via HL seven Common standard. So should be able to interface with any HR provider out there. Thanks. Mr Hill, last question. Does it interface with Cerner and our power chart? So yeah, we we do interface um we've actually interface with over 22 different HR providers to date. Um you know, obviously most of our implementations are epic concern. Er so that's uh you know, the market share sort of leaders there, but we can interface with any HR provider that works with NHL seven standard, which is basically everybody. Um so that's the short answer. We actually just got another question and I'll let you remain on stage? Mr Hill, how much space is allowed and how long will the images be available on stream connect? So that is really a function of the institution. So the hospital can decide the retention policy, which would define how long the images stay, we can go anywhere from, you know, we could say 30 days, we could say a year, we could say never expire. Um and the amount of space that's allocated is again dependent on the institution because all we do, we essentially install on the hospital provided servers. That's generally the preference of I. T. These days they call them virtual machines for the the I. T. Folks that may be on the call. They would allocate the storage um, and it could be variable, you know, up to hundreds of terabytes which would hold, you know, years and years of content. Ultimately the e H R is really gonna more act as your permanent archive but certainly we can have things live on stream connect for many years if that's the desired state stay on stage, we have one more coming for you can you hold images from interfacing until all imaging annotation are complete. Also, do you have a preferred packed solution? As the integration doesn't seem to be directly to the HR but to the packs so, um, as as far as the pax, um, we don't have a preferred pack solution basically um what we can support either workflow, either pushing directly into any HR or pushing into a packs and then putting a link in the HR um generally with epic, that is kind of the stance they take. I've seen other providers potentially be able to accommodate images indirectly. Um, it ultimately will come down to the desired state of the institution and what the HR can provide. Again, we can kind of accommodate either structure um and we're agnostic on what tax we send to or dycom compliant for those of you that are sort of on the technical side of the spectrum. Um, and so any packs we should be able to interface with. Um and there was another component of that question. Oh, it was, it was how long I think are you able to make those annotations before sending along to the HR? And that would again be a function of the hospital's retention policy. So it could be years or it could be days. It just really depends on the facility I would say. Generally speaking the average we see is we'll have content living stream connect for about a year before it moves on and we say the HR will be sort of the permanent archival location but it does vary. So there's two more questions and I'm gonna put them out of order for a second because I think the second question really dovetails on what you were just speaking to, which is who hosts the data on stream connect. So the facility actually hosted? Its behind the hospital firewall. So it's what we would call an on premise solution to an end user. Right. The look and feel is very much like cloud. Right? Because you're accessing it through a web application, you can potentially access it from home, provided you have VPN access, but it's not technically cloud. It's an on prem solution that lives behind the hospital firewall. And you are maybe seeing the chat because your question makes sense. So is this a cloud based system or must this be on a server? So it must be on a server of some kind. We have a very lightweight spec for that server if we're in a clinic office environment. Um, you know what we didn't really get into today is that this stream connect system is designed to work across an entire hospital enterprise. And so what we can have is, you know, situations where we've got multiple operating rooms connected multiple hospitals connected to a single instance of stream connect where we would probably have a larger server, but at the end of the day it's an on prem solution. Um and that's where it lives. Thank you. So, couple more questions here bandwidth if viewing a surgical procedure from home. And I know there's ways to scale that as well. So I'll let you answer the question if your remote with VPN access, How typical bandwidth do you think you need to view surgical procedures. So it's it's about as an end user. So someone accessing stream connect from your office. You need about two megabits to five megabits depending on the resolution you're dealing with. But you know, five megabit connection is pretty standard. Um These days we generally don't see any issues with the recorded content that we just showed you. Um in terms of bandwidth, sometimes we run into like if we have a live stream, for example, from an operating room, which is a totally different use case. Um you know, you really need to have at least five megabits to get a high quality image out of that. But for video on demand, you know, you're looking somewhere between two and five megabits per second, which I'm 99% of hospitals are going to support. There's a there's a couple more questions and I'll get to them. But I want to go back to the previous question of annotation. So how long do you hold the image? This was just some felt maybe we didn't get the full answer there. So how do how can you hold images from interfacing with the HR until all the annotation is complete. Yes. So we can support a workflow where there is no auto push as we like to call it like that First workflow. We can support a workflow where stream connect kind of is like a bus stop along the way to the HR and so the clinician comes in makes their annotations and then selectively chooses what is pushed along to the patient record. Um Obviously there's there's pros and cons to that it means maybe more clicks for a clinician. Um But you have more control over what makes it into the patient record. The other workflow the first one that we showed you is where content is auto pushed. Um And in that instance you wouldn't be annotating sort of in between. It would just automatically make its way along to the HR. We can support whichever workflow is desired by the hospital. We're gonna we're gonna keep going here. It seems like a lot of I. T. Questions first one or as we get going if you're if you have an institution with two separate stream connect connections. The question is can you can an institution have to stream connect connections and I'm going to rephrase it to modestly and just see what happens if there is two disparate stream connect installs. So generally we like to consolidate institutions to a single instance because like for example if you have multiple clinics connected and multiple O. R. Is connected to a single instance it facilitates cleaner collaboration. Um We certainly can accommodate multiple instances if that's the desired state of the hospital. I've seen that done for example if you sort of have a research wing um and a clinical wing or maybe you want to keep your outpatient content completely siloed from your inpatient content. So we can certainly support that approach if desired. It just means there's a little bit more segmentation you know for the end user in accessing content depending on what side of care there. At this. Next question I think we could probably tagged him the question the question is what is your experience with working with major academic centers? Does it take a while to go through all the I. T. Channels to get this set up and I'll attempt to start the answer and then handed over to jOHn. And that every I. T. Department is structured a little bit differently. Oftentimes we are already installed in the impatient side so clinic applications such as tele pack plus one stream connect those channels are somewhat set up already or it works the other way for us as well where externally in the clinic space they're using stream connecting are looking to use it in their inpatient setting. But again every I. T. Departments a little bit different. I'm gonna hand it back to jOHn for some of the uh pre set up that we do with our I. T. Checklist and really asking the facility to do some work up front so that we can make this installation a little bit easier when dealing with large academic institutions and I. T. Departments. Yeah and I'll just say as a starting point so we've implemented we just had 350 enterprise deployments of stream connect around the us. A huge portion of that is academic obviously academic institutions are probably dealing more with manipulating content and you know editing that content residents and fellows. This is a key thing, a key system for them to use but certainly That's a core competence for us at 350 implementations, I'm not aware of any other vendor that operates in the space that actually has that many deployments. Um secondly we consider deployment essentially a product. Um I think everybody on this call has had challenges with getting systems like this deployed with their IT departments, departments are struggling under a massive workload. Um I'm not going to say that this is something that happens overnight that's not the reality. Um any any system that interfaces with the patient record in some way, shape or form, there's work to do there um but simultaneously you know over years and years and years of deploying this and living that pain. We have a very well established system um It's actually like you know we we've called it one journey, it's a process that we've established to streamline that as much as possible. Um and so that we have a clear packet of information that's given pre sale to the I. T. Department so they understand what the responsibilities are on their end and are on our end what the requirements are. Um and then we have an excellent implementation team post sale. We've consistently ranked number one in the industry in terms of implementation, um that would help get the system stood up and then at go live, um you know, I think our service and training support is best in class and so that way we can ensure the clinicians are well supported after the system is made available. So that was a long winded answer. But certainly we're in academic institutions Over 350 implementations to date vast majority. Well, I don't want to say the majority but a huge amount of those are academic. Thank you. This is a question that I actually really like because I'm curious on the answer and I've never seen it often times, we get some similar questions from time to time, but have we ever supported or unsupported? Do we have any supported or unsupported installations? I'm not familiar with AWS or Azure cloud architecture, but I get what the question is is i e do we have any institution taking this to the cloud themselves, so I actually am not sure on that. I see, Mushtaq's answering questions and chat. He might know for sure. Um that's certainly an area that we want to go. Cloud is an obvious direction I think for any on prem um software provider, I can't say with Surety that we've done any implementations to date with AWS or Azure, um but we can certainly follow up with whoever asked that question directly, um once I can find out it's a great question and um we always try to learn different things. I think that would be a very interesting question to get back to our audience. So I think go ahead chris part of the answer to that question, maybe it doesn't matter where the server is hosted by the facility. So they can either hosted in their own data center or could be their own cloud server through any of these services through amazon or as your, as your, it doesn't matter. So as long as they had the right connectivity path in place for their facility, we don't care where the virtual server is. Thank you. #1 more question that I'll have here and again folks, if your question wasn't answered clearly or if we missed it, we will show you a website here in a minute or or email address Scuse me where you can get those questions answered. But let's uh let's go to this question here, which is can stream connect, also support competitive hardware or media captured through tele pack plus. So short answer is yes. Um the longer answer is that in some cases it may depend. Um but there's essentially the difference being, you know, there's some vendors that we can support a direct archive from like Olympus and Stream box as an example, um there are other vendors where we might have to actually put essentially a sort of a middle where hardware system in between their camera and our stream connect solution, but at the end of the day, that will then be a catch. Also really any competitive scope provider we could interface with stream connect. Thank you. And I do see it's one of our major benefits that when designing an all in one video visualization system for a clinic or in office. We have removed the need for that network appliance when using stream connect, which is one of the ways that we're lowering costs significantly in these alternate sites of care. So that that's, that's by design from carl Stewart's. So again, I want to thank everybody for joining us today. Again you see in the chat the E N T at carl starts dot com. We will take your questions and we'll get back to you most of you know who your representative is. That's probably how you found this tech cast but we have representatives in every major market that can come to you and demonstrate this technology as well. Again, I want to thank everybody who joined us today to part out of there friday to be with us. I want to thank our presenters. Excellent job by the three johns karl starts some fantastic marketing managers that that brought this tech cast to you and demonstrated our anywhere care, a piece of our anywhere care system, the tele pack plus and our stream connect software or optimization software in a way. Image content management. So thanks everybody. Hope you enjoyed this live tech cast from El segundo California. Thank you. Thanks everyone.