Monthly Archives : October 2019

First Case On Time Starts – Setting the Pace

Our very own Dr Bobby Lazzara has a new video posted for ORHub. Watch as he explains how First Case On Time Starts (FCOTS) impacts the financial bottom line of the OR.

Dr Bobby Lazzara explains how FCOTS impact morale and the financial bottom line of the OR.

The Cost of First Case On Time Starts

A recent JAMA article shows how an OR minute costs between $36 and $37 in California. An Article in OR Manager describing key benchmarks indicates that the median hospital performs at less than 65% on time for first cases. It also shows that FCOTS is a leading indicator of overall performance.

One of the key reasons that First Case On Time Starts are a leading indicator is because of the cascading effect that occurs when a case starts late. It sets the pace for the day both directly and indirectly. Directly, if the first case is late, then unless it runs short (scheduling accuracy is another indicator), the following case will also be delayed. This compounding problem can quickly lead to overtime. But FCOTS also indirectly affect performance by creating a culture of acceptable under performance. A culture of underperformance makes it progressively harder to improve processes.

Surgical Spotlight’s On Time Starts Dashboard

We designed Surgical Spotlight to make investigation of all of the key performance metrics easy. The On Time Starts metrics make it easy to quantify and qualify the impact of FCOTS. Combining this with our Cadence view helps understand overall time usage of the OR.

The On Time Starts dashboard helps you visualize the frequency and impact of FCOTS
The ORHub On Time Starts dashboard makes it easy to visualize how often cases are late and makes it easy to quantify the impact of those late minutes.
The dashboard makes it easy to dive into root causes for late cases.
The dashboard makes it easy to dive into root causes for late cases.

Surgical Spotlight is meant to help improve processes in the OR. It looks at the same metrics outlined in ORManager article (and more) to help measure the OR performance. Once the performance is measured, it helps you identify root causes, and monitor the impact of changes in your OR. FCOTS are important to measure on an ongoing basis; course corrections need to occur before problems become ingrained or insurmountable. Daily and weekly detailed reviews are far more impactful than quarterly, high level summaries.

Shareholder Letter – October 16, 2019

Dear Shareholders,

It is a pleasure to update you today as CEO of ORHUB. For those of you I have not had a chance to meet or talk to, I would like to introduce myself. My name is Robert Lazzara, everyone calls me Bobby. My background includes training in critical care, general surgery, and finally cardiac surgery, which I practiced for twenty years. My business background was born in private family enterprises, physician healthcare enterprises, and broadcast media for patient and physician education and engagement.

I came onboard ORHUB with great enthusiasm.  Prior to joining as Chief Medical Officer I invested in the company after a product demonstration from the companys sales team, and subsequently became Chairman and Chief Executive Officer after it became clear to our former CEO and the Board of Directors that a transition was needed to take the Company to the next level with our clients, while navigating the complexities of our marketplace.   My enthusiasm has escalated as I see great things ahead for our Company built around our focus on improving outcomes and costs for patients, physicians, ASCs, hospitals and their extended healthcare systems.

The initial focus in my first two months with the Company was on addressing operational issues, and working to end the noteholder litigation that has been draining our Company’s resources and inhibiting growth at multiple levels. In parallel, I have been focused on changing and expanding our sales approach and revenue structure by developing unique approaches to incentivize new customers and sales teams.  My belief in the Company and its product is best exemplified in utilizing my personal connections to significantly impact sales progress through physician and C-suite leaders.

The Company’s strategic approach to sales is proving successful with a new revenue structure based on a per case usage fee only, no implementation fee, and no long term contracts, and prepaid discounts. In addition, inauguration of a Premier Membership model for select customers that includes royalty rebates, referral rebates to other hospitals and ASCs system wide, advisory board membership, and priority opportunity to test new releases is also proving successful for growth. Our first three anticipated Premier Members are Baptist Medical, OISC, and Anderson Medical Center. We plan to update our shareholders through company press releases once new members are definitively engaged.

With success at each of these locations, their connection to larger healthcare systems has the potential for growth in case volume. The Company believes that revenue generation will begin in 2020 with growth beyond. Earlier revenue generation is a possibility with several of our incentive models rolled out in the last several months.   

I believe that the Company can become profitable and well respected by improving outcomes and the bottom line in healthcare providers beginning in surgery and moving rapidly throughout the business and organization.  Our role as a SaaS provider gives us a unique opportunity to rapidly land and expand to create additional products around all procedural specialties. To that end I would like to announce the deployment of our newest product extension, Interventional Cardiology Spotlight, developed in conjunction with Anderson Medical Center in Mississippi with Cardiology Chair, Dr. Wes Bennett, where it will be launched.

The Company continues to evaluate the business structure and policies from the Board level down, and will remain diligent in making adjustments that will benefit sales and operations to drive shareholder value and Company health.

One of the issues impacting the Company and its resources, financial reporting, investors, employees, and customers has been the ongoing litigation with AXT Analytics, LLC, a company controlled by Mr. Rick Buonincontri. A letter to Noteholders is linked here and listed below, outlining the companys approach to ending this drain on Company resources. From this point forward, all of my efforts, and those of the Board, will be singularly focused on the successful operation of this Company, not participating in negative rhetoric. Suffice to say, the Company is moving forward and will not let any individual or group of individuals stand in the way of progress for our Company. ORHUBs sole focus is to proceed with what is in the best interest of all investors.

These next few months are critical for the Company and revolve around parallel tracks consisting of efforts to raise new capital, financial audits, growing our customer base and revenue, and initiation of our short and long term strategic plans which include evaluating joint ventures in telehealth, patient engagement,  streaming video, and virtual reality for patients and potential M&As. We are planning to host a Shareholder Meeting in Jacksonville, FL before year-end and will be in touch with additional details as we finalize.

I am confident in Surgical Spotlight®, a real-time surgical analytic product to springboard this Company forward.  Our investor base, and its physician leaders, are unique  among healthcare companies. Our core group of employees continue to work hard and have gone above and beyond what is required to keep this company afloat despite lack of capital and other outside distractions.

The coming weeks and months will define this Company and the direction it is heading.  I am asking everyone involved at any level to work together, focus initially on the near term, and get ORHUB to where we all know and believe it can be: a proud healthcare company that has risen to benefit its investors and customers.


Dr. Robert Bobby Lazzara

Chief Executive Officer and Board Chairman

ORHub, Inc.

Link to Noteholder Letter: