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5 Apps That May Transform Healthcare

Talk about being in a room with a lot of smart people! Wow!

HITLAB, a healthcare innovation technology and teaching lab based in New York, just sponsored its second annual World Cup event at Columbia University for aspiring healthcare technology entrepreneurs and start-ups. The HITLAB staff, who blew me away with their creative energy, brought together the best and the brightest in academia, the business world, the insurance industry and the healthcare technology sector for this two-day event.

Out of 192 applicants, five finalists were selected to present potentially revolutionary technology and ideas on a wide range of global public health problems that have been around since the time Moses wore short pants and that someday soon may have the kind of impact Louis Pasteur and Steve Jobs did.

The beauty of these five finalists is that their solutions are so simple that even someone from Jersey City like me can easily understand. The health insurance industry and the malpractice insurance industry should stand up and take notice.

Noninvasix — Keeping Babies Safe

For starters, what if we could reduce brain injuries in newborns by 90%? That is what the CEO of Noninvasix (www.noninvasix.com ), Graham Randall, PhD, MBA, based in Houston, is working on.  The technology is designed to monitor the levels of oxygen molecules in the brains of infants; lack of oxygen causes many permanent brain injuries. This technology was originally funded by the Department of Defense and the NIH, among others, to address traumatic brain injuries in wounded veterans and other adults. Randall’s colleagues discovered a way to use this technology, known as an optoacoustic oxygenation monitor, to detect brain oxygenation levels in babies during active labor.

Gary Hankins, MD, who is the vice chair of the American College of Obstetrics and Gynecology Task Force on Neonatal Encephalopathy and Cerebral Palsy, said, “This technology has the potential to eliminate up to 90% of cases of hypoxic ischemic encephalopathy and subsequent permanent injuries such as cerebral palsy.” The problem with simply using current technology such as a fetal heart monitor-which dates back 40 years-is that it does not accurately measure the levels of oxygen in the brain. In fact, 80% of results are indeterminate or unknown. The new technology can help prevent brain hypoxia (or lack of sufficient oxygen) at birth, which is responsible for 23% of neonatal mortality in the world.

This technology may also help revolutionize obstetrics. OB-GYN physicians have the highest rate of malpractice insurance, with reported annual premiums as high as $200,000 in some states. More than 75% of OB/GYN physicians have been sued for malpractice, with an average of 2.7 lawsuits per physician. Most lawsuits relate to neurologically impaired infants, whose issues get blamed on the doctor during delivery. It has been reported that as many as 50% of OB-GYN physicians have cut back on their practice because of the fear of malpractice claims. Many have moved their practices to states that have less expensive premiums because of legislative caps on liability.

Hospitals, healthcare systems and health insurers should also take notice because the rate of unnecessary surgery has been widely believed to be too high since I walked the hallowed halls of Columbia University 34 years ago. C-section rates have, in fact, nearly doubled over the past 10 years from 17% to 34% of all births in the U.S. The World Health Organization (WHO) recommends C-section rates in the range of 10-15%. The Joint Commission on the Accreditation of Hospitals now requires hospitals to report C-section rates, and many health insurers now pay a bundled rate for deliveries and not a separate, higher rate for C-sections. Many health researchers believe the high rate of unnecessary C-sections is because of the fear of malpractice lawsuits, and Graham Randall believes that false positives from fetal heart monitors also play a huge role. C-sections are the most common surgery in the U.S., with 1.2 million performed each year, and they carry risks such as blood clots and surgical infections to both mother and baby.

Ceeable — Preventing Blindness

Chris Adams, the CEO of Ceeable, based in Somerville, Mass. (www.ceeable.com), won this year’s World Cup competition. “I am here to prevent blindness,” he said. Ceeable was formed in 2014 to commercialize a mobile digital eye exam platform that was co-invented with Dr. Wolfgang Fink at Caltech with assistance from scientists at NASA, the University of Arizona, the Doheny Eye Institute at UCLA and the Jet Propulsion Laboratory in Pasadena.

This mobile field test is a perfect example of the potential for telemedicine. Current technology, used by ophthalmologists, optometrists and eye care clinics in strip malls across America and around the world are expensive, and not very mobile. Today’s eye exams are tedious. (Bats have much better eyesight than I do, so I have experience with tests.) The equipment typically costs $35,000 and weighs roughly 100 pounds.  By contrast, Ceeable only needs a tablet with a touch screen and the Internet to perform a 3-D early detection for glaucoma, muscular degeneration disease, other causes of vision problems and the actual onset of blindness.

The test is user-friendly and can be performed anywhere in the world. The test can even be performed at home, which is brilliant. Although health insurers pay for eye exams at no cost under the ACA, patients are typically limited to two visits per year. With this inexpensive mobile device, people at risk can perform tests as often as they like.

More than 285 million people worldwide suffer from diseases that cause blindness, such as diabetic retinopathy, glaucoma and age-related macular degeneration. The Ceeable technology is now deployed in vision clinics in the U.S., Mexico and Russia and will soon be available in developing countries.

Rubitection — Managing Bedsores

Sanna Gaspard, the CEO and founder of Rubitection, based in Pittsburgh, received her PhD from Carnegie Mellon University, and her start-up has developed a handheld diagnostic device and software system to modernize the detection and management of bedsores. Rubitection has been part of Project Olympus at the Carnegie Mellon incubator program.

When I met her, I interrupted her within 60 seconds and said, “I get it.” My mother ended up in a nursing home when she was overcome with organic dementia. She became so fragile from old age that the nurses could hardly touch her skin without it turning black and blue. They also had to check her frequently for bedsores. 

Turns out I didn’t get it about bedsores at all. What I didn’t know, until Gaspard told me, is that bedsores can be life-threatening. Complications from bedsores, such as infections, kill 60,000 people every year in the U.S. The average cost to treat bedsores in acute cases is $43,000 each and may reach $70,000; there are more than 2.3 million bedsore cases a year in the U.S., costing $11 billion in total.

Medical expenses resulting from bedsores are not reimbursable under Medicare if they developed after someone was admitted to a facility. The facility has to eat the costs.

Current technology that monitors for bedsores is very expensive and difficult to use. The current standard of care is typically a manual skin palpitation and visual inspection. The Rubitech Assessment System (RAS) provides a reliable early detection handheld device for patients at risk with bedsores, helping to address a global public health problem that I didn’t even know existed beyond discomfort and pain for the patient. Rubitection www.rubitection.com came in a well-deserved second place.

Now I get it.

Homeward — Getting the Medication Right

Joe Gough, president and CEO of Homeward Healthcare in Toledo, Ohio www.homewardhc.com, told how his six-year-old son was misdiagnosed at a hospital emergency room and was sent home with the wrong medication. All his vital signs crashed. Luckily, his life was saved upon readmission, and today he is a healthy young man. Many others are not so fortunate.

Again, I immediately could relate to misdiagnosis and incorrect medications. My dad was diagnosed with congestive heart failure, and his cardiologist told me he had two months to two years to live. Several months later, I got a call: “You have to come home because your father is in the hospital, and we need to amputate both his legs because he is not getting enough blood circulation down there. We need you to tell him.”

I hopped on the next flight. When I told my dad the situation, he had the perfect answer: “Throw me out the window now.”

Turns out he was on all the wrong medications, and the poor circulation in his legs was actually more because of blockage in his carotid artery. The plan to amputate his legs would have done nothing to save his life. I got him admitted to a new hospital with a new cardiologist. My dad got to live a couple more years before he finally took his first day off from work, at his funeral. We buried him with both his legs.

So, I get misdiagnosis, wrong medications and poor discharge planning.

Gough and the researchers at Homeward Healthcare have created interactive software for hospitals, patients and payers that the patient can control on a touchscreen tablet from her bedside. Multimedia, real-time discharge planning that includes a patient dashboard will produce better outcomes, free staff time and resources and vastly improve communications.

Gough had begun his presentation by telling us that most people toss their discharge instructions as they walk out the hospital door — but no more. His technology has great potential to reduce hospital readmissions. A key component is a psychosocial assessment to determine who is at risk of not following the discharge plan.

There are also reminders about the correct use of proper medications, and I get the need for that, too. Patients must own their care plan. My oldest brother, upon release from a hospital a few years ago, was told he needed to lose weight and stop smoking. The first thing he did when he got home was have a large bowl of ice cream and a cigarette. I threw his discharge plan in the waste basket.

It is estimated that $26 billion is spent annually from readmissions. The reduction of readmission rates is now a major initiative under both Obamacare and the Joint Commission on Accreditation of Hospitals. The Homeward Healthcare technology is now being used in 23 hospitals, and I am told nurses doing discharge planning just love it.

Ristcall — a Mobile, Smart Watch Nursing Station

Srinath Vaddepally, the CEO and founder of Ristcall, with offices in both Philadelphia and Pittsburgh, has designed a wireless, wearable smart device for both hospital patients and nurses. I like to think of it as a mobile smart watch nursing station.

The idea for this technology, designed with researchers from Carnegie Mellon, came about when, as a hospital patient, Vaddepally fell in his hospital room and could not reach the call button on the bed. Turns out 70% of all patient falls in a hospital occur in the patient’s room, with 40% occurring while walking to the bathroom. The average cost to a hospital for a patient fall is $20,000 per case, and the annual reduction in Medicare reimbursements can reach $200,000.

Ristcall (www.ristcall.com) has a great point. How do you call a nursing station if you are lying on a floor and can’t reach the call button? In addition, how can you reach a nurse who is busy caring for multiple patients and is not at the nursing station?  Even when you ring the traditional call button, the nurse has no idea why you are calling; he has to walk to your room to find out.

As I told Dr. Michelle Odlum, a postdoctoral research scientist at the Columbia School of Nursing, nurses rock! They are the heart and soul of our healthcare system, but they are often overworked, and they don’t have eyes in the back of their heads.

Now, with the help of Project Olympus-which provided incubator space at Carnegie Mellon-nurses can soon have a real-time alert for all traditional patient requests. Nurses will be able to rock even more.

If you are a healthcare technology entrepreneur, I highly recommend applying for this award or sponsoring next year’s HITLAB World Cup Summit. It will be held once again at Lehner Hall at Columbia University in New York, from Nov. 28 to Dec. 2, 2016.

For more information, visit www.hitlab.org.

It was a real pleasure to meet these outstanding World Cup finalists and the HITLAB staff. I learned a great deal and made friends I feel I will now have for a lifetime.

The Next Frontier for Connected Cars

In 2006, UCLA Professor of Urban Planning Donald Shoup compiled the results of 16 surveys carried out between 1927 and 2001 on the time spent looking for a parking space. He reported that the average time spent looking for on-street parking was approximately eight minutes – a figure that has remained relatively unchanged since the 1930s.

This research also demonstrated that, on average, one vehicle in three in traffic is actually searching for somewhere to park. This figure has been confirmed more recently by a study from the San Francisco City Council, which concluded that an estimated one-third of weekday traffic was because of drivers looking for a parking space.

While solving the problem of road congestion via accurate traffic information has been looked at for decades – the RDS TMC protocol was invented in 1988 – and has already reached a good level of sophistication and accuracy, solving the parking problem via connected services is quite a recent topic and is still very much a work in progress.

As a matter of fact, most pure players in this field have been founded quite recently: as an example, JustPark in 2006; Parkopedia, ParkMe, Worldsensing and Anagog in 2009; and Parknav in 2011. The only companies to have emerged earlier are the parking payment companies, PayByPhone and Parkmobile, in 2000 and Pango in 2005.

On-Street and Off-Street

Parking essentially divides in two markets with two very different problems to solve: off-street and on-street. Connected services taking care of off-street parking are now quite advanced. In the three steps of information, booking and payment, the first is largely available (even if real-time data remains partial), but booking and advanced payment are still works in progress. Very few cars on the road today – or navigation apps – are able to find, book and pay seamlessly for a parking space in a garage.

The on-street parking problem is, by nature, more difficult to solve because detecting free parking bays in real time, at scale is complex and requires many sources of information. There are very different approaches to create this data.

Leveraging Traffic Probe Data for Parking

One is to make sense of the existing probe data currently used for real-time traffic. For example, Garmin is using this data to calculate the inflow and outflow of cars for each road segment in large cities and estimate availability (read here). The company has partnered with Parkopedia to include off-street parking information in their data model.

The GPS company launched this service in their mobile app during the third quarter in six German cities and is now adding cities in more countries: London, Amsterdam, Vienna and a few others coming in the U.S.

graph1

Inertial Data From Smartphones

Detecting parking and “unparking” events through inertial sensor data from drivers’ smartphones is another approach used by Anagog, which built a software development kit now embedded in several million apps (watch here). Through a signal processing algorithm, the company detects out of gyroscope, accelerometer and location data (GPS, etc.) parking events that are fed to a big data cloud that is now nearing 1 billion historical parking events.

Data From Car Sensors

Car makers such as Volkswagen (read here) or General Motors are also looking at producing data using car sensors.

In the case of Volkswagen, a pilot launched by the company uses the existing ultrasonic proximity sensors (used for parking) to assess the availability of free parking spaces on the side of the road when the car drives along a street. The data is uploaded in real-time and matched against map data to eliminate false positive (parking space for disabled people, etc.).

Parking Meters

Using data from on-street parking meters is another opportunity to get real-time, on-street parking information. Because a significant number of these meters are connected to the cloud, it is possible to build predictive data based on historical trends. Parkeon, a worldwide leader in parking meters, is among the companies enabling that opportunity and rendering this data through a mobile app, Path To Park (read more here), which is now available throughout France and in a number of cities in the U.S. and Germany.

Street-Based Sensor Infrastructures

Lastly, companies such as Worldsensing are placing sensors on each parking bay in the street, which obviously provides the most accurate data, but at a cost. Worldsensing, based in Barcelona, just closed a series B round of funding (for an undisclosed amount). Its largest deployment to date was in Moscow, where the company covered 13,000 spots. The next stage of the deployment will include more than 50,000 sensors.

Image processing is also a technology that could be used to sense free parking bays in streets. Data from fixed CCTV (used for security or traffic monitoring), smartphone apps, connected dash cams or even cars could be used for that purpose.

Obviously, the best information will come from the aggregation of these data streams (historical and real-time). Inrix, which announced in June that it will supply on-street parking data to BMW, combines data from cities, mobile payment companies, real-time parking data, connected car-sharing services and Inrix’s database of real-time vehicle GPS data (read here).

Parknav, a start-up based in the U.S. is also using a very diverse set of data (car-sharing, telecom, fleet, crowd-sourcing), including POI data (bars, schools, etc.) to infer probabilities about parking availability.

Accurate information about free on-street parking bays is a complex matter that will take many more years to solve, but the opportunities are huge for the whole car industry and beyond. The first opportunity is the time saved for drivers and the alleviation of stress and frustration. Once this first opportunity will be realized for drivers, its overall social impact will be big: less traffic, less pollution, less money spent on fuel.

Unused Parking Inventory

The last market opportunity in smart parking is to further eliminate barriers between the offer and the demand, between people circling in streets and empty parking bays, in enabling yield management of underused private parking inventory.

Residential buildings, companies, hotels, schools, hospital or churches have parking spaces that are empty or partially used during workdays, nights and weekends, vacations, etc. Companies like JustPark (UK) or Zenpark (France) are targeting this segment using connected technologies to unlock the value of this inventory and grow the total parking spots available.

On Jan. 28 in Brussels, the ConnecteDriver conference, in partnership with consulting firm Inov360, will gather the brightest minds and the most innovative companies to discuss the fascinating topic of smart parking:

– Hans-Hendrick Puvogel, COO at Parkopedia
– Anthony Eskinazi, head of product and co-founder, JustPark
– William Rosenfeld, CEO, ZenPark
– Bertrand Barthelemy, president of Parkeon
– Ruth Portas, sales manager, Worldsensing
– Ofer Tziperman, CEO, Anagog
– Martin Treiblmayr, product manager, Garmin
– Vincent Pilloy, co-founder and CEO, Inov360
– Parknow (speaker name to be confirmed)

Am I Good Enough?

Interesting question, right? Actually, it’s probably the most asked question by top performers. Further, it’s a question a lot more managers should be asking themselves. It’s the kind of attitude that works well in any competitive environment — sports, business or the game of life itself. The heart of the issue is really not am I good enough, but have I done all I can do to be as good as I can be?We have just come through some of the toughest economic times most of us have ever experienced. And we know we are not all the way through them yet. Many of my business colleagues are still trying to decide what strategic approach to apply to 2011. So, I am offering up here some thoughts on one very strategic move for 2011 — keep getting better.

There are some stimulating thoughts to consider for our strategic thinking along this line that appear in an article in the current Harvard Business Review — “Are you a Good Boss or a Great One?” The authors point out that most managers stop working on themselves at some point in their career. They seldom ask themselves, “How good am I?” or “What do I need to do better?” unless they are shocked into it. When did you last ask those questions? It seems it does not occur to most managers to ask that question. I strongly urge my colleagues to take charge of this incredibly important responsibility and don’t wait for the shock stimulus — take the initiative.

Recently I was leading a workshop that included a discussion on forced ranking, a concept made popular by Jack Welch while he was at GE. The process involves ranking a group of employees into performance levels graded A, B or C. The concept carries with it the idea that we should be helping the B’s and C’s move up a performance grade and expand the opportunities for the A’s. In other words, keep getting better. Where I have seen the concept in practice — in business literature or in live business settings, I observe it is the direct reflection of the commitment of the organization’s leadership.

The concept of always getting better ought to be on the leadership team agenda pretty regularly — I suggest monthly. Why? Because unless the leaders of the business keep emphasizing it — and doing it — it is so easy to get lulled into a malaise of false comfort.

I cannot help but think of Coach John Wooden (UCLA basketball) when thinking about always getting better. It was one of the main elements of his coaching philosophy. Not surprising, most of his wisdom on the basketball court applies to everyday living. Here is one of his many maxims that not only resonates with always getting better but reinforces some of the most effective leadership thinking: Success comes from knowing that you did your best to become the best that you are capable of becoming. That is one of the most critical ingredients for continued success on or off the court. Wooden coached his teams to be prepared and to focus on their performance capabilities. Then they would be prepared to face their opponents, regardless.

So, regardless of what the economy brings our way this year, I would argue our best strategy is to keep getting better. Here’s a closing John Wooden thought to support always getting better. Coach Wooden did not focus on winning. He focused on preparation. He taught that if his teams were better prepared than their competition, the right outcomes would be there. It’s tough to argue with ten national championships and 40 winning seasons.

Authors
Hal Johnson collaborated with Kurt Glassman in writing this article. Kurt Glassman is an executive consultant, founding partner and president of LeadershipOne.