“This is the most complex industry anyone could have created. If you don’t rapidly test your assumptions, you may find yourself down a rabbit hole before you find out, ‘Oh I didn’t know this payment schedule or that regulation could prevent that from happening.'”
Those were the words of advice to healthcare entrepreneurs at demo day for Dreamit’s latest healthcare cohort from Kevin Mahoney, Chief Administrative Officer for the University of Pennsylvania Health System and Vice Dean for Integrative Services for Perelman School of Medicine at the University of Pennsylvania.
Eight healthcare startups, half of them led by women, offered myriad approaches to solving specific healthcare challenges from more efficient nurse training to remote monitoring for home infusion and diabetic neuropathy. They developed their businesses with support from Dreamit partners Penn Medicine and Independence Blue Cross.
Group K Diagnostics is developing paper-based diagnostics, an emerging area of interest because they are cheap and efficient. The goal is to take the wait time and cost out of the diagnostic testing process and make this technology available to outpatient physicians rather than laboratories. The plan is to start with liver function and add other diagnostics to its pipeline.
“Eighty-eight percent of clinical decisions are made based on lab results,” said CEO and cofounder Brianna Wronko, who graduated from Penn with a bioengineering degree this year. “We increase revenue for outpatient providers and it fits into existing workflows.”
A Scientific American article noted that pharma companies sell millions of rapid, paper-based tests priced between $1 and $2 for HIV, hepatitis C and tuberculosis. Companies like Diagnostics for All, for example, is developing a liver-toxicity test for patients who take potent liver-damaging drugs. That test is in late stage development. Grand View Research projected that the paper-based diagnostics market would be worth $8.35 billion by 2022. One challenge Group K and other companies in this sector face is generating consistent clinical results.
Group K Diagnostics is looking to raise $1 million to support a clinical trial with Penn Medicine in August, a collaboration with Mount Sinai, and its submission for FDA approval in 2018.
Detecting diabetic foot ulcers before they happen
Bluedrop Medical is developing a bathroom scale device embedded with temperature and photographic image sensors for people with diabetic neuropathy to enable earlier intervention for diabetic foot ulcers by detecting hotspots. Users step on the scale once a day for 10 seconds.
“In the time it takes to record their weight we analyze soles of their feet and send that data to the cloud and analyze signs of pre-ulceration,” said Chris Murphy, the CEO, who previously worked for Medtronic. “If we detect anything worrying, we alert both the patient and physician. It allows for the earliest possible detection.”
He noted that one advantage the company had was that another company had developed a handheld device seeking to get similar assessments and had done three randomized control trials 10 years ago validating the technique but the device was too complicated to use. They showed that the technique could eliminate 70 percent of diabetic ulcers.
Murphy calculated that the company could help payers eliminate huge costs towards hospitalization and potential amputation that these ulcers cost to treat. The business model involves providing the device for free but to charge monthly remote monitoring service fees. It is rasing $2.5 million to support product development and trials through FDA approval.
Changing the way we think of training for medical devices and EHRs
Tine Health offered a way to help hospitals avoid adverse events by improving efficient clinician training to help them get their arms around increasingly complex medical devices and complicated electronic health record workflows.
The digital health startup attaches stickers with QR codes to medical devices which can be scanned with a smartphone for training options. Doctors or nurses can choose a checklist to ensure they are doing each step correctly, watch a short video to walk them through how to operate the device or opt for a workflow chart in which they are asked questions as they go.
Tine Health CEO Vik Thairani likened the refresher to the task of setting an oven clock for daylight savings time.
“Every time you go to do it you kind of remember how to do it but you kind of fumble your way through and it’s not that you haven’t done it but that you haven’t done it for a few months. Now imagine that’s a complex medical device and it could be the difference between saving someone’s life.”
Thairani offered up a use case with a hospital trying to reduce an 18 percent error rate around blood administration documentation.He said this hospital had tried multiple times unsuccessfully to address the problem. He noted that the company’s service was successful in reducing the error rate for blood test result entries by more than 50 percent in less than six weeks. It also impacted other EHR documentation errors and helped fix medical billing errors. The hospital went on to become one of two paying customers last year.
Although Thairani sees a $2.3 billion market opportunity for the nursing education market, he took note of other markets the service could be applied to such as therapists, general clinicians, and service techs, the market opportunity increases.
Car service scheduling as care coordination
Kaizen Health joined the growing healthcare car service trend but billed itself as a care coordination business. Its approach seeks to close the loop for patients who need a ride after being discharged so that they also get a ride to their seven-day follow-up appointment, with an eye to reducing readmissions. It also seeks to get patients to their medical appointments 15-20 minutes ahead of schedule.
From CEO and Cofounder Mindi Knebel’s perspective, the business is removing the middlemen (ie, the brokers) who complicate the ordering process. In addition to sedans, the company fleet network includes non-emergency ambulances and wheelchair accessible vehicles.
“We are connecting the healthcare providers, the transportation providers, insurance companies and patients through transparent communication.”
The value of these care coordination services is they stand to reduce missed follow-up appointments. Highlighting one use case, Knebel said a Mount Sinai managed care clinic using Kaizen’s service went from having patients show 17 percent of the time for seven-day follow-ups to about 50 percent of the time.
Knebel added that the Chicago-based company also sees the potential for its business to improve clinical trial retention, noting that 30 percent of people drop out of clinical trials with transportation the number one reason.
Using software to reduce home infusion costs
New York-based home infusion software business Citus Health founded by home infusion nurse Melissa Kozak sees a way to improve the support services for the 2 million U.S. patients who self-administer IV infusions daily. The company estimates that there are 1,500 home infusion providers in the U.S., dominated by CVS, Walgreens, Optum, and Biostrip.
“[Patients and caregivers] have to deal with IV pumps and syringes and inevitably they’re going to need help after hours,” Kozak said. The problem is that the after-hours services vary with some patients turning to emergency rooms when they don’t get help in time.
The two-year-old business provides a “Call Bell” app that connects patients with a call center and on-call nurse if needed. Although providing ready answers to questions is one aspect of its business, Citus also sees a way to cut down on logistics costs by helping infusion nurses take inventory through the app on their weekly visits. It also created an electronic billing document to simplify the process.
Kozak expects there to be huge growth in the home infusion market since, as she noted, it is a growing trend by providers to reduce costs and Medicare is expected to start reimbursing for home infusion by 2022.
The company charges home infusion providers $30 per patient per month and estimates that its service saves customers $60 per patient. It is working with Mount Sinai’s infectious disease department to assess the app and plans to use the app as a referral source for these providers.