Michelle Noteboom: Give me a short overview of PatientSafe and your role in the company.
Joseph Condurso: I’m the president and chief executive officer of PatientSafe Solutions. I joined PatientSafe in 2011 with the focus of taking its skills and its core competencies as a mobile applications provider from the bedside to the enterprise to the home, which is my vision and goal for the company.
We provide a platform for creating and delivering an intelligent interactive workflow solution. We express those workflows through bedside applications that can be executed at the point of care by the frontline care team. We have also been building out an expression of those workflows to enable the patient to engage the care team as they discharge from the hospital and go into their home and into their daily life.
The company is rooted around mission critical, high impact delivery of services and workflows, around medication management, and was originally founded to provide safety checks at the bedside for administering medications timely, accurately, and specifically to the patient. We engineered a set of hardware capabilities to leverage and take advantage of what was then a very novel and disruptive approach to bedside computing. We disrupted the legacy market by introducing a consumer-based platform called the Apple iPhone. We were one of the first, if not, the first company to leverage the power and performance of a consumer-enabled smart device to allow frontline care teams to become mobile, and also to embrace a technology that they were familiar with in their daily lives so that the adoption and speed of education and familiarity with the mobile navigation through applications was immediately implanted into their daily lives. They could then take that into their professional lives.
We did have to engineer a set of hardware characteristics to ruggedize a smart phone for hospital use, and also to enable it to be specifically engineered to read barcodes. A lot of the safety mechanisms and safety checks in hospitals today employ a full range of barcode symbologies. In the hardware design, and in the medical grade engineering of the device itself, we built what we call a jacket for the Apple iPhone. It not only ruggedizes and secures it from physical assault and drops, but we also provision within the jacket an imager, which is a barcode reader.
It’s actually a camera technology that takes a picture of the barcode impressions in digital processing and reads the barcode. We have this notion of positive patient identification instrumented in various workflows through the use of the combined hardware and software. You scan the patient, you scan the provider. The device is wirelessly enabled over the Wi-Fi network in the hospital and it talks to the application, which then exchanges information bi-directionally and pulls it into the electronic medical record.
It’s in sync, if you will, with the EMR. What gets ordered by the physician through the CPOE system is then processed through the EMR and ancillary systems, whether it’s lab or pharmacy. We execute everything downstream of that order in a timely and efficient manner and provide the frontline care team with the tools to then document that electronically as a byproduct of their care process, which then gets returned back to the electronic medical record for documentation, either in the flow sheets or in the electronic medication administration record.
We’ve taken that ruggedized device over the years and have hardened it with certain infection controls. Computer on wheels that are carted in and out of rooms or leftout in the hall introduce a particularly challenging workflow problem for hospitals in terms of charging and being out of the way from patients and providers who may fall over them as a result of them being there. In addition, they’re very difficult to sanitize and clean. The mobile device in a handheld ruggedized jacket can be wiped, it can be sprayed.
We’ve engineered some very specific human factors engineering. We work with IDEO, the engineering and human factors company in the Bay Area. Most barcodes are sitting flat to the surface of the device. Ours is angled in a way so that you can read and see the screen information while you’re scanning the barcodes so you don’t have to take your eyes off of the critical patient information. It also has an additional battery so it can run a full length of a nurse shift, and it’s waterproof. When you’re wiping with anti-infective agents you don’t want to have fluid to get into the electronics. We’ve been able to engineer an impermeable solution in the jackets so fluid does not get into the device.
The next capability we introduced leveraging the smart phone platform, was a set of unified clinical communication facilities not only for executing workflows at the bedside, but also for improving and creating an asynchronous as well as real time communication between the care team. So what does that mean? It means, being able to use the platform as a phone either for communicating one-to-one or one-to-many in broadcast mode, for example, or being able to have a call by the nurse at bedside to the physician who may be in clinic outside of the hospital.
We can also provide secure texting and messaging. Text messages have patient identification and full clinical context. The provider can be outside of the hospital, in clinic, and exchange secure patient centric text dialogue and information.
We’ve also tried to harmonize and be an outlet for alerts so that any bedside activated alert, either coming from nurse call, coming from smart bed such as guard rails on a bed for patient falls, or coming from physiologic monitors, can get routed through middleware technology and be then propagated directly to the nurse who was responsible, or to the care team that was responsible for that patient. You then have a platform that’s multipurpose, reduces the footprint of computers on wheels, and that is a shared device. Nurses can pick up any device and utilize the system in the hospital for engaging in patient care, as well as for real time communications.
MN: How is the shift from fee-for-service payment models to newer pay for performance payment models impacting your business strategy and demand from the market?
JC: The company initially was addressing a market demand which was built around patient safety liability and performance of safely delivered workflows at the bedside. The mission of the company is to create a technology and mobile fabric that can lay down across the care continuum. We see CMS charting a path towards greater risk and we’re seeing pay for performance already in place in the healthcare economics today. We see the emergence of bundle payments, particularly around joint and ortho procedures and other bundle payment models for various care improvement initiatives.
I think that we will go from a period of shared savings to shared risk to full risk. We’re seeing definitely that the path that the CMS is charting for providers and for hospital systems and overall regional systems moving towards the accountable care organization is real and gaining rapid momentum.
That being said, I think the focus of where to apply technology dollars is now moving from investing in the infrastructure of the EHR to now leveraging and applying specific workflow tools that can exercise best practice, can ensure compliance of that best practice and also address some very specific financial metrics around reducing hospital-acquired conditions, preventing readmissions and also improving patient experience. The merit-based systems around physician boards, around hospital reduction, around age caps are all serious financial economics that are driving new technologies.
What does it mean for our business? It provides an opportunity for us in what we now call a post-EHR era. Now that the investments are made, how do we get better clinical productivity, get better clinical service with the frontline team? How do we prevent harm at the bedside, how do we decrease waste, and how do we start applying lean operational excellence to the delivery of care in a hospital?
The way we state our value proposition is that we want to be able to create an instrument, perfect care, and then execute that care perfectly. The essence of it is to introduce good quality into the clinical process and measure that quality, measure that variability in real time, and have a system that will allow the hospital to become much more efficient in terms of workflow, much more timely in terms of it its quality reporting, much more responsive to patient-centered care.
We don’t stop when the patient leaves the hospital. We are embarking on the second phase of our journey, what we’ll call PatientSafe 4.0, which is to extend the tools and capabilities of the technology that’s been available to nurses in the hospital. We extend that capability to care providers and the patient and then provide those capabilities for the patient to engage with that technology as they discharge from the hospital.
MN: What are some of the newer trends you are seeing on the horizon for clinical communications and mobile?
JC: I think the technology alone has not solved the ability to motivate the patients to manage and orchestrate their care once they leave, or to be educated in the hospitals right when they leave. I think the next trend to come is one that we are in the process of adding to our corporate portfolio today. We believe the trend will be a technology-enabled services solution. We believe that the opportunity to orchestrate care on behalf of the patient, for the patient, and in concert with the health system that the patient is a member of, is a trend that we’ll see and one that we are embarking on and we believe we’ll be a leader in.
This is the opportunity to apply a coach liaison on behalf of the health system who can act as a patient navigator and a patient coach through discharge as the patient moves from hospital to home to human. Our strategy incorporates not only a technology overlay, but also includes a dedicated care liaison who can support the health system and support the patient.
The health liaison is not just simply a call center. The idea for patient engagement is not only to be able to provide them technology and tools, but to truly motivate the patient so that they can become an active member of their care team. The care liaisons are specifically trained to motivate the patient to set personal goals and help develop a plan to get them there. As a result, the patient feels more connected than ever to their healthcare. That level of engagement will drive real results.
The company that we acquired will be announced in a couple of weeks. Clients will use what we’re going to be calling our Patient Touch Coordinated Care Solution to drive down unplanned readmissions for key conditions. We will also be playing a very key role in what is the chronic care management CPT code under the new CMS program in the immediate future.
MN: Will you be highlighting anything particular for the CHIME meeting?
JC: My intent is to be meeting with key technology executives. We’re looking for discussion specifically around the HIMSS Analytics movement for the CCM focus, which is the continuity of care model, which is very similar to the seven stages of EMR adoption. We see that the EMRAM approach to hospital-based and physician-based EMR provided a set of guardrails and sign post milestones for health systems, a roadmap if you will, a technology and functional roadmap. I think what HIMSS Analytics is doing on the continuity of care, which is pre and post-acute, is extremely important. CMS’s move to value-based and towards greater risk and accountability is movement towards this new bundle payment.
One of the true bundles coming in now is the comprehensive care for joint replacement. This is a very important key initiative for greater risk share between CMS and providers. I think the CCM discussion at CHIME will be important. I’d like to understand and also be able to get feedback on our solution from CHIME, CHIME members, and CHIME executives, in how both technology, as well as an enabled service, can provide this idea of an electronic care network that will allow providers to work with companies like PatientSafe Solutions to move logically and efficiently and economically up the stages from zero to seven of the continuity of care model.
MN: Anything additional that you’d like to mention?
JC: Where I would like to go is to this idea of integrated mobile technology, encouraging better care delivery. I do believe that we are at a stage and in an age where the digital health vision and promise is here. There are large organizations that have organized innovation teams. The focus on the full continuum of care will prompt these innovation teams to become proactive and innovative, allowing them to take on greater financial risk; the idea of doing well by doing good. Now that the investment in the EHR and EMRs have been in place, I think it’s extremely important that IT organizations, the CIO in particular, work together with the medical and nursing informatics teams to really look at IT as a strategic asset and begin to look at innovative companies like PatientSafe Solutions to extend both their brand and the investment in these technologies across a full continuum of care.
This notion of mobile care orchestration is also extremely important. Connected patient care will be a way of doing business for organizations that expect to be in business in 2020.