Interview with AirStrip’s CEO Alan Portela where he discusses the commercialization and role of mobile health in accountable care, etc.
The mHealth market may have burst with opportunities and subsequent startups seemingly overnight, but some companies have been developing mHealth solutions for more than a decade. AirStrip is one of those companies and now a leader in clinical software solutions, according to its CEO, Alan Portela. So what’s the secret to developing a successful handheld healthcare solution? Get to know the needs of the user holding it. You address those needs and they won’t let go, says the CEO.
It seems Portela knows what he’s talking about. After all, clinicians have been holding onto the San Antonio, TX-based company’s solutions for years. Its AirStrip ONE solution thrives on its technical integration, combining clinical data from disparate data sources into an intuitive platform that works across multiple mobile interfaces—to provide a plethora of patient-centric data as well as a conduit for care coordination. Clearly, the company has gotten something right, but what exactly? We at HIT Consultant sat down with Portela to find out more about the success of AirStrip and its solutions, along with the future of mHealth and the challenges and opportunities that lay ahead of it in the market. Here’s what he had to say:
Q
AirStrip’s focus has been on the commercialization of mobile health, can you tell me more about the challenges of doing that? Also, what are some of the lessons learned?
So, there are a lot of challenges as you can imagine. I think that the biggest challenge, when you are leading the industry in healthcare for mobility, is the assumption that technology is a driver of transformation. What people need to realize is that technology is simply an enabler of transformation. So, you do have to align technology, people, and process. A lot of people are used to apps that you download, and all of a sudden, you think they are ready to start using them. However, the usual reality is that adoption and utilization of apps is not very high.
So, in healthcare you need to do a lot of work on understanding the use cases, decision-making, work flow, care coordination, and the team, so it’s not just downloading an app and thinking that the users are going to adopt it. We had to put a lot of energy on clinical transformation, workflow analysis, workflow redesign, and transformation efforts. Then, [mentoring] performance adoption to make sure you’re bringing to the table what the customers are expecting. That is key. When you’re doing SaaS model you need to make sure that you bring the value proposition up front and you keep bringing that to the customer, otherwise they stop the subscription.
So it’s the best risk sharing model for a customer to be able to be on an SaaS model because it really forces the vendor to stay on top of the value proposition. Of course, value proposition for us, we measure it one service line at a time: cardiology, women’s services, critical care, and others.
Q
Right. In your opinion, what is the role of mobile health in accountable care?
First of all, it seems every time I talk to a healthcare organization they are telling me that they’re putting together a committee for mobile health. I think it’s a waste of time, because what happens is you have to have a committee to deal with your strategic initiatives, and then, you have to figure out what technologies you are going to bring to the table to enable those strategic initiatives.
A lot of people put a lot of emphasis on that, but if you think about it, mobile health is not about a mobile device; it’s about a mobile user. Physicians right now, with the shortage that exists, are seeing more patients coming to the system. There is a shortage of caregivers and reimbursement rates are going down forcing hospitals to cut costs. As a result, they are laying off some personnel. It brings the shortage to its worst case so you need to become more efficient.
Now, physicians they are mobile professionals. The care coordination team, they are mobile professionals. Now the patients, as we move into a patient-centric model, not hospital-centric, they are mobile. So what happens is health is no longer about the mobile devices, it’s about the mobile consumer, either the care coordination team or the patient at some point. It’s about the person as we get more proactive rather than reactive to chronic diseases. So I think that specifically if we look at mobile technology around accountable care—I will have to tell you the AirStrip story to give you that answer.
Yeah, absolutely.
So we started with obstetrics. We started mobilizing fetal surveillance, maternal contractions, so now physicians—and this was exactly ten years ago as it’s our ten-year anniversary—physicians were able to access remotely the fetal traces to detect if there was an adverse event. So, today one out of every six babies is monitored with the AirStrip technology, so physicians can actually look at those patients.
About three years ago, we introduced patient monitoring and cardiology. We also took the approach that we run natively on every operating system. Why? Because you reduce the bandwidth of the transactions that you are sending back and forth, so you’re running the application on your device, but you’re only transmitting the data, and we are rendering all that information into a mobile device natively. So, that’s important for performance, but you also leverage from the strength of each operating system on the user experience, the graphical user interface.
That helped us a lot for FDA, not just the performance, but also the ability to zoom into a waveform and keep the medical aspect ratio. So, we started doing that, concentrating a lot on interoperability and user experience. So, from the time we were doing L&D to the time that we went to cardiology, patient monitoring was always about the interfaces to those devices and being able to provide a good user experience with diagnostic quality.
Cardiology started giving us a very interesting connection to accountable care organizations (ACOs), because cardiology started helping us look at patients throughout the continuum. All of a sudden, we started looking at a patient coming in an ambulance with a heart attack or a full blockage called a STEMI. Now, you can make an impact on the time to intervention, because instead of taking 90 minutes from the event to the door of the emergency department to cut the balloon time, now you’re measuring probably 30 minutes from event to balloon time. That’s significant acceleration on time to intervention because now the heart of that patient is much healthier. It reduces length of stay in the ICUs. It also makes an impact on the quality of life, reducing readmissions.
So, with cardiology it became very apparent that we needed to start looking at the entire continuum of care, not just at the hospital, or in the ambulance, but also what happens to that patient when they go home. That’s why we partnered with CardioNet about a year ago, to start looking at sending patients home with a sensor, so now we can monitor them for 30 days after they get discharged to make sure that those patients are healthy and that they don’t come back within 30 days.
Of course, the Affordable Care Act added a significant component to this, because all of a sudden there are penalties. Five out of the six penalties in the first 24 months are heart related; the other one is pneumonia on readmissions within 30 days. So all of a sudden, we started recognizing that our customers started using our technology as a differentiator in the community. You used to see billboards on the freeway, “Your EKG will get here before you do.” They started putting a lot of ads in the newspapers, TV ads, because now they wanted to attract the population to their centers, basically saying, “We’re using technology that is going to better help us to better deal with this particular condition.” So when we talk about ACOs, and as you start seeing organizations partnering in communities to take each service line, I think mobility has a significant impact.
As we did patient monitoring and cardiology, it became obvious— if you look at the way we are mobilizing this data—the phone becomes a way to look at that patient coming in an ambulance using the defibrillator from one vendor and the EKG. You go into the emergency department and now you have an EKG 12 leads or 15 leads from another vendor, that patient goes into the ICU and you have a patient monitor from another vendor with real-time waveforms, and when the patient goes home, you have a card-unit sensor still a one to three lead EKG. But the doctors didn’t need to know about which vendor is behind the scenes and the administrators didn’t have to say, “Do I need to buy one vendor for the entire thing?”
A year and a half ago, we recognized that it was very important for us to introduce something similar to make an impact on the physician workflow by now mobilizing EMRs. So that’s when we partnered with Palomar Health, a healthcare organization that developed a similar tool to what we did for medical devices, but they did it for EMR viewers. So we acquired the IP and we imported that on top of our platform. On our platform we have a single sign-on, the device drivers, the ability to run natively, everything, security; it’s all there. So, we had the EMR data and now the concept was, “Well, if we can do the same thing. For example, if I am looking at patient John Smith, how can I pick his current record right now, but look at the previous history even though they’re in different systems?” We recognized that backend integration is going to take a while, but we said, “If we can provide for one episode of care, as the physicians are looking at the data with the ability to tap into all of those records, then that is going to be a significant tool.”
Fortunately, as we were doing this, the perfect storm came. Because of the Affordable Care Act, people started consolidating, buying more acute-care facilities and getting more into the community. And you know, the more you consolidate, the more you inherit all kinds of systems and the people don’t have the money right now to replace everything into one. Suddenly, the same thing that we did with medical devices we started doing with the EMRs, but now our customers were saying, “You should be able to plug in on top of your platform third-party components like video, secure messaging, imaging.” And that’s what we started doing as part of our AirStrip ONE strategy. So, now you can really pick John Smith, but look at his charted data, on this episode and previous ones, images, medical device data, and also conduct video conferences to talk to other caregivers. So, as we started doing that, you see the evolution here? Then customers said, “Well, I can use your tool for a TeleStroke, because you are already doing EMR data, the images, you’re doing the waveforms, and you’re doing video conferencing.”
So, now what we’re doing is we’re starting to partner with customers, that it’s not just around an ACO, it’s about any collaboration in your region where you can collect data from your partners, even if they are not part of an ACO. Now organizations are saying, “I can use your technology to sell my services in the community, because I have better ways of accessing their data and supporting them.”
So interoperability for us became a huge tool for clinical integration and now the next level that we are introducing in the first half of the year is the ability to aggregate data from multiple systems, data types, and vendors. Now, we’re going to start introducing the ability to do clinical decision support. Basically, storing some of that data to look at patients retrospectively and plug in off-the-shelf analytics tools on top of our platform the same way we do other things to provide decision support.
Q
Right, so you want the clinician to get a full view of the patient’s record, right?
Exactly. I’m sorry I gave you a whole story. So, this is how we started as a company. We started doing first L & D on the platform. Then, we added cardiology for the inpatient units and the ambulance. Then, we added patient monitoring in multiple environments. That’s when we realized that we need to bring in more data, deal with the EMPI algorithmic patient-mapping approaches, labs, security, and then, wrap third-party components.
The direction that we’re taking right now is going into clinical decisions for retrospective real-time analysis on the current event and retrospective, but also plugging in analytic tools. That’s the evolution of AirStrip. This is who we are today.
The next thing that we’re doing, which is very cool— if you look at the platform— is we’re starting to partner and this is exactly what we’re doing. We’re deeper into each of the modules. The partnership with MedStar and University of Michigan is to take science algorithms that they have developed (on top of cardiology, diabetes, a number of chronic diseases) and start plugging in on top of that data and those waveforms to provide more decision support.
Basically we are partnering with a customer like Texas Health Resources and saying, “How about if we do a 30-day readmission protocol to make sure that we’re taking care of patients after they get discharged with a cardiac condition?” Then of course the next thing will be body sensors, “How can I start connecting more, and more, and more with body sensors?” So, you’re going to see a number of announcements coming out on partnerships with body sensors to do things outside of the hospital way beyond CardioNet.
Q
So let me ask you then, where does telemedicine, telehealth fit into this picture?
We know that telemedicine right now is the hot topic. So basically, as we have a shortage of caregivers, more patients, and more chronic diseases, the only way to really deal with this shortage is to make the care coordination team more efficient. So, we need to get the data to them rather than having them get the data from a desktop computer. So, telemedicine is where mHealth and telemedicine all becomes one. It’s the ability to connect to multiple systems and multiple data types, enhance and enable care coordination through video, and provide it on all devices.
So that’s why our partnership with Microsoft, in my opinion, it’s going to be—and I’m not making a pitch here—transformational for us and for healthcare, because they are the first ones that are allowing us to take now this graphical user interface, and give it the same touch, look, and feel on any device. So, I can have a phone, a tablet, a laptop, and a desktop. It goes back to the mobile user versus the mobile device. Now a physician that goes to a desktop computer can look at an EKG and navigate that system the same way that they will navigate on a phone. We have a number of people that are still on flip phones and doctors that have been practicing for many years. They don’t want to go to other operating systems because they feel it’s a huge change, but now, if they see that one device does it all? I mean, one look and feel to support all devices; that is probably the best way to transition into mobile. It’s a good thing they waited, because now they can do every device using the same type of graphical user interface. Continue reading…
