Docent Health

Service industries like consulting, hospitality, restaurants or the local car mechanic, are judged on experience. Healthcare folks would like to think that it’s all about outcomes but no one would argue that experience is just as important. And most healthcare experiences suck from a patient’s point of view.

Docent Health caught my attention last year in July when they raised a healthy $15M Series A round from big names like NEA and BVP. Their ‘Docent Program’ is an intriguing service approach, to say the least. They offer docents -people who are familiar with the healthcare system, like ex-nurses- to act as a liaison between the patient and caregivers. These virtual and/or onsite docents integrate with the clinical staff to act as a representative of the patient’s anxieties and preferences.

Fair enough. Can’t argue with the benefits of having a personal concierge throughout hospital journey. Building a personal relationship with the patient allows the hospital to create a better brand impression. That kind of word-of-mouth marketing is priceless and spreads fast. Additionally, the learning from one patient’s preferences may be transferable to the next, creating a patient experience-related ‘best practices knowledge base’ that has never existed in traditional health organizations.

But it’s not a panacea. Revitalizing service experience shouldn’t necessarily be about adding more humans into the mix or creating one more layer of touch points. I understand that the current environment doesn’t allow clinicians to have the ideal 1-on-1 time with patients, but adding a new resource into the mix increases the human interfaces through which information has to travel. A new team member gets added to the physician/nursing rounds and the incumbent care team may not like dealing with someone else on their turf. The overall cost goes up too, since someone is ultimately paying for the added cost of docents. Needless to say this added cost will ultimately be handed-off the patient.

If healthcare service experience sucks, the solution should be to fix the fundamental issues (for example overworked caregivers and unhelpful EHRs). It’s the same argument I make against scribe services: fix the EHR user interfaces rather than adding another minion to the mix.

Criticize someone else’s solution is like shooting fish in a barrel. I realize that the current system is straining while waiting for salvation. Docents may be a good-but-temporary fix but tech-enabled services are here to stay. Omada, Livongo, Virta are good examples of how this trend can transform condition-specific care experience and outcomes.

Virta Health

Virta burst on to the digital health scene recently boasting a $37M funding round and a tech-heavyweight CEO Sami Inkinen who previously co-founded Trulia, the online real-estate platform.

Virta is the latest digital health star to follow the trend of what I’m now beginning to identify as tech-enabled care management. Think of it as a healthcare service delivery model where traditional care providers’ interaction with patient is enhanced (in terms of quality and quantity) using modern technology infrastructure like sensors, mobile, machine-learning.

Virta focuses on Type II diabetes management. They offer a dedicated health coach (someone who can help mentor and guide the patient through the health choices they need to make), a personalized nutrition plan and an overall physician supervision of care. All these service experiences are supported by technology that definitely includes a mobile app; and probably includes the needed wearable sensors (for weight, BP, etc. monitoring) along with relevant biomarker tests (like HbA1c).

Diabetes is a complicated multifactorial lifestyle condition that is often made worse with neglect of one/more aspects like exercise, weight, nutrition, mental health, medications, stress, BP, etc. So a comprehensive, closely-monitored program can surely make a difference. And technology is key for scaling services while keeping them personalized. So this kind of solution approach makes sense.

Omada (for diabetes) was an early player in the tech-enabled care management space. Livongo (also diabetes), Lantern (mental health), Hinge Health (musculoskeletal disorders) are some other examples. It’s a good sign to see standardizable niches of healthcare service delivery being scaled up with clever technology use. Of course all this still needs to pass the muster of traditional third-party payment machinery in our healthcare system. Given the accountable care trend I’m optimistic about the viability of such companies as long as they show real outcome improvements.

Glooko

In March 2009, Apple hosted an event to introduce the iPhone OS 3.0 software. What I really found interesting back then was a prototype showcased with Lifescan (a J&J company), where they demonstrated how a user could manage her diabetes using an iPhone-accessory glucometer. It was a much needed evolutionary conceptual leap for a widely-used consumer medical device category.

Turns out that Lifescan apparently did nothing with that concept. Anita Mathew (who gave the demo on Lifescan’s behalf in 2009) decided to take it forward on her own and founded Glooko. The company currently sells MeterSync, a cable that connects your iPhone to five popular glucometers in the market. Users can download the ‘LogBook’ app from iTunes store to document, analyze and share their data.

I’m not an investor (yet), but if I was, I’d put my money in Glooko. This is exactly what the future should start to look like for conventional consumer health devices. Instead of being isolated products that store a limit amount of quarantined information, they need to provide a service that enables longitudinal disease management. For a patient with long-standing diabetes, he/she needs to know how much insulin to inject for covering the meal they are about to have, not what their blood glucose number is. It reminds me of Theodore Levitt’s famous MBA quote “People don’t want to buy a quarter-inch drill. They want a quarter-inch hole.”

For Glooko, the long-term sustainability is directly proportional to how useful and sticky it’s users find the logbook iPhone app. The hardware (Metersync) may be critical at first, but end user experience and market differentiation will come from the software. There is competition, of course. Agamatrix  has been in the market with it’s iPhone compatible glucometer, and last year they announced partnership with Sanofi-Aventis that gives them the much-needed commercialization ability. Instead of augmenting diagnosis, another company Cellnovo takes a similar approach with therapeutic insulin pumps. Perhaps we’ll see a synchronized gluocometer-insulin pump offering or an intelligent, symbiotic ecosystem for diabetes devices in future.

I’ve talked about the ‘last-mile’ of remote patient monitoring in the past. Conventional medical devices produce digital manifestations of physiological parameters, but the information collected hardly goes beyond the device itself.  We need consumer-oriented medical devices to become monitoring services that automate/transform the last mile for consumers. The future is arriving piecemeal, and sadly enough, it’s not being delivered by the incumbent behemoths of the medical device industry. Withings BP Monitor (which I can personally validate since I use it) enhances the value proposition of a regular BP Monitor for hypertensives. Zeo does the same for people with sleep disorders. Granted these offerings are perfect yet, but all vectors are aligned in the right direction. As for Glooko, look out J&J.

 

Voxiva

 On the continuum of healthcare IT solutions, there are two distant ends. One extreme can be thought of as the complex, medical-grade enterprise EHR systems that cater to large institutions and mainly providers. The other would then be a consumer-grade solution that is designed for delivering health interventions to the masses. The latter is where Voxiva‘s offerings lie.

Voxiva provides the technology platform, professional services and support needed for designing and deploying a mobile-based health solution for consumers. When you read that, think beyond the now-hip smartphone app market. Less than a fifth of mobile handsets out there are smartphones. So to reach the remainder, the solution has to encompass relatively simpler mechanisms like feature-phone data entry, SMS and IVR.

There are a number of unique design challenges for creating an engaging public health solution that can work across any/most devices and be delivered through multiple channels to a varied set of end-users. It needs to work synchronously across web, mobile, email. It should support data entry across all kinds of user interfaces (feature phones, smartphones, different mobile operating systems, multiple-languages, etc). It needs to deliver real-time alerts (SMS, voice, email, web portal) and provide real-time analysis for decision-makers. And obviously be scalable and dependable with near-100% uptime. What appears to be a simplistic low-end IT solution on the surface is really a huge undertaking to communicate with an end-user population that is as diverse as it can be.

Voxiva’s real impressive achievement is doing a lot of what they do in international market- specially developing countries. They have created a HIV/AIDS mHealth solution for Rwanda Ministry of Health, disease surveillance solution for Peruvian military, diabetes management program in Mexico, and plenty of others. In US, their most famous offering was Text4Baby (see Multiplyd’s previous review on it), an SMS-based maternal health education service launched in early 2010. Since then, they have diversified into Text2Quit (smoking cessation) and Care4Life (diabetes management). Simple interventions, but designed for massive implementation and adoption. Which is why Voxiva continues to stand out.

 

 

Celltrak

Accounting for only 7.2% employment in healthcare, Home Healthcare is perhaps one of the lesser known and advertised sub-markets in the industry. It serves patients who prefer to stay at home but need ongoing care that cannot easily or effectively be provided solely by family or friends. These providers deliver a wide variety of health care and supportive services like professional nursing, physical therapy, occupational therapy, social work, nutritional care, medical equipment supplies, etc.

According to the National Association for Home Care, about 12 million people in this country receive care from more than 33,000 home health care providers. The market is made up of few large, publicly traded companies (see LHCG, AFAM, AMED stocks for example) and many small/mid-size players. The challenges faced by these companies are typical of those with field-based employees: scheduling the visits, then figuring out if their employee actually visited the patient, if they did then what was the real time and mileage, ensuring the data collected during visit is archived and accurate, etc.

Which brings me to CellTrak. It was founded in 2006 and delivers mobile-based automation to Home Healthcare agencies. I think it’s a brilliant application of healthcare information technology for alleviating self-reported information issues and paper-processes in a niche market. Given that everyone carries a phone today, using mobile modules to increase compliance and productivity makes a lot of sense for a field-based business. Some examples of the modules available:

  • Care Plan Management
  • GPS and Directions
  • Time and Attendance
  • Travel Time and Mileage
  • Supply Management
  • Alerting and Messaging
  • Scheduling
  • Nurse Care
  • Wound Care

Solving logistical issues like location, time capture, attendance, inventory etc. is pragmatic. But providing modules around clinical care is the more interesting strategy from my perspective. Usually, software solutions that enable care documentation and collaboration are associated with either care-delivery enterprises (e.g. fixed location hospitals using EHRs) or with patients themselves (e.g. PHRs). Neither of those have a particularly critical need to be consumable in a mobile form-factor- that is just a nice-to-have functionality. CellTrak has found a special need where the inherent care delivery workflow necessitates even the clinical Healthcare IT solution to be exclusively mobile. It is a good example of the hidden corners within the complex maze of healthcare system which require thinking outside the traditional bounds.

Other examples of using exclusively mobile-based electronic health records are mostly restricted to public health context in developing countries (see ChildCount for example). That skew is mostly due to the field-based nature of public health and mobile being the primary means of connectivity in emerging economies. With CellTrak, we see the same technology paradigm tackling the problems of a conventional health industry segment in a developed country.

CellTrak partners with some EHR (Cerner, Allscripts) and wireless providers (AT&T, T-Mobile, Sprint, Verizon) currently. I expect that the future iterations of most enterprise EHRs would include incorporating a solution like CellTrak which enables running operations in the field and  seamlessly connects health information to/from a mobile workforce.

 

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