Remote Patient Monitoring 2.0 - Exploring Deviceless Solutions

Transcript

Nicole

Welcome to the Digital Health Transformers podcast series. This podcast explores the dynamic world of healthcare innovation, one conversation at a time. I’m your host, Nicole Guevara, and today, we have an inspiring guest at the forefront of transforming the healthcare landscape. We are excited to welcome our guest to today’s episode, Joshua Liu.

Joshua is the co-founder and CEO of SeamlessMD. A visionary in guise, Joshua started his career as a physician and gradually delved into digitizing patient care journeys. As a strong advocate for digital health and innovations, he has worked as a chair of the Canadian Medical Association Dual Innovation Council. He is on the Business Intelligence and Data Analytics Committee for Sina Health Foundation.

During his physician training, he has extensively worked on hospital readmissions at the UHNS Center for Innovation in Complex Care. He also advocates for STEM promotions among youths. His work and vision are recognized across Canada.

He received honors as the Digital Health Canada’s Digital Health Executive of the Year, Healthcare Innovations 40 Under 40, Forbes 30 Under 30 in Science and Healthcare, and more. His company, SeamlessMD, a digital patient engagement platform, aims to reduce hospital readmissions, elevate patient experience, and improve care outcomes. Join us as in this discussion with Joshua as we delve into his journey and explore more about RPM 2.0. Thank you so much for joining us today, Josh.

Joshua

Thanks, Nicole, for having me. I’m excited to chat with you today.

Nicole

Wonderful. So, we are going to start with your personal and professional story. Josh, you’ve transitioned from being a physician to a digital health entrepreneur.

Can you share with us what inspired you to switch from a caregiver to an entrepreneur?

Joshua

So, when I did medical school a while back, I didn’t know what I wanted to do. Many folks enter medical school knowing what type of physician they want to be. I was lost.

I did, though, have some amazing mentors that got me more excited about actually non-clinical things. So, I researched quality and patient safety and specifically worked on preventing readmissions. I got really excited about the idea of using technology to engage patients better and monitor them to prevent problems such as readmission.

And long story short, in my last year of med school, I met a couple of brilliant engineers, and we said, hey, why don’t we go and build something to support patients and tackle problems like readmissions? We started a technology company called SeamlessMD. Then I graduated and got into residency, but I never started it because we decided to go full-time at the company.

It’s been my full-time gig for about 11 years and has been quite the adventure.

Nicole

That’s great to hear. What sort of challenges did you encounter in your career transition?

Joshua

Yeah, well, so we started this company back in December 2012. So this is 11, 12 years ago. So now digital health is incredible, let’s call it, popular or appreciated.

But back then, digital health was still very nascent. So, in 2012, only 50% of patients even had a smartphone. So, in North America, 90% of people have access to smartphones and the Internet.

It was half of that back then. Many folks were skeptical about technology, even more so about engaging patients. Very few health systems were ready to try something like what we do.

We needed a track record, right? I had some clinical training, but we were young, naive, and needed more experience building a technology company. On the one hand, our lack of experience and the early market had a lot of barriers to entry.

On the positive side, because we were naive, even though we kept running into roadblocks, we had the youthful enthusiasm and resilience to keep going anyway. If I had experience, I would have experienced it sooner. That youthful naivete helped us out.

Nicole

Well, I’m glad you didn’t give up because reading more and more about SeamlessMD is a great tool. It’s a great, important, and necessary platform today. SeamlessMD empowers patients throughout all care journeys from surgery, chronic care, oncology, women’s health, and behavioral health.

Can you walk us through the platform’s core functionalities and explain how it benefits patients and hospitals?

Joshua

Yeah, absolutely. So maybe I’ll take a step back and share with you how we think about the challenges and the patient journey, and then I’ll connect that to how the platform addresses that. The analogy I like to use is around travel.

So, imagine you’re driving a car from point A to point B. In the past, we had paper maps. And then decades ago, we decided, well, paper is not good enough.

Let’s switch to a GPS, a technology-based system. And we all know now that GPS is faster, safer, and better than paper maps ever were. And no one’s going back to paper maps.

The strange thing about healthcare is that when you think about a complex patient journey, whether that’s a patient going through surgery, a cancer journey, a pregnancy, or anything else, that is far more complex than driving a car from city to city. Yet, we still rely on paper and verbal instructions to guide patients through these journeys. The problem is that patients will tell you, and I’m sure you and your family have lived this way, too; patients forget what you tell them verbally.

They lose their papers. There’s no day-to-day engagement and support. So they need help following those instructions.

The healthcare team feels like they are sending a patient into a black hole between visits, especially after leaving the hospital. And if the patient falls off track and something goes wrong, the healthcare team only knows about it once you’ve ended up back in the emergency room. And so we thought, okay, why can’t we build a GPS to guide the patient digitally, keep them on track, and then all the care team can know what’s going on with you?

That’s what SeamlessMD does. We provide a platform that patients can access on their phone, tablet, or desktop computer, and they’re guided step-by-step and monitored throughout the journey. So, for example, let’s say you’re having major heart surgery.

A week before your surgery, you would get reminded to stop your blood thinning medication on time. The day after surgery, you would get nudged, saying, hey, it’s time to get up and walk. It’s time to start doing your exercises.

Here’s a video for how to do your rehab exercises. When you go home, we will prompt you to track your symptoms. Tell us your pain levels, tell us your temperature, and take a photo of your incision after surgery.

Then, we send all that data back into dashboards that can be integrated into the electronic medical record so your healthcare team can get alerted. They can look at the data, monitor you, and catch problems earlier. Ultimately, health systems use SeamlessMD to not only improve the patient experience but also patients have a shorter length of stay in the hospital, recover faster, stay out of the hospital, have fewer ER visits and readmissions, and save money for the healthcare system because we’ve driven down the use of healthcare services.

Nicole

This is great. Working in healthcare myself, I’ve seen case coordinators doing this over the phone or via visits with the patient. Most of the time, patients visit their physician two or three times a year.

So, within those times, what about the other 360 days of the year? This great platform requires other months and days that are not covered when a face-to-face visit occurs. So I love this idea.

It’s great to hear more about it. How would you define remote patient monitoring 2.0?

Joshua

Yeah, so why don’t I start with what I think, how I define 1.0, and then I’ll get to 2.0? Sounds good. So, remote patient monitoring 1.0, a traditional device-based RPM, is needed to manage our top 5% of patients at risk, especially after leaving the hospital. So think of the patients who are admitted for heart failure or COPD exacerbations or whatnot.

For RPM 1.0, we’d send a kit to the patient’s home and give them a tablet, a blood pressure cuff, a weight scale, and a pulse oximeter. So, a tablet plus these devices. And then we’d require, let’s say, the nursing staff or other care team members to be monitoring these patients all day long so that we could catch a problem earlier.

And that’s been quite effective, right? So, if you wanna manage just 5% of your patients and do it well, it’s a very effective way. The challenge is over the last five to 10 years, health systems have said, hey, what if I wanted to bring that level of care to not just 5% of my patients, but 100% of my patients?

I wanna engage patients digitally in orthopedics, women’s health, oncology, behavioral health, and all kinds of things. And it’s really hard to do that with this device-heavy RPM solution because, number one, it’s too costly to send devices and tablets to thousands of patients a year. It’s also very resource-intensive.

More nursing staff are needed to monitor thousands and thousands of patients monthly. And so the idea of RPM 2.0, which is what I use the term digital care journeys, which is what CMSMD does, is to say, hey, you know what? How do we do this scalably?

Well, let’s go device-less. Let’s do device-less RPM, leveraging the patient’s phone, tablet, or computer. We don’t require a kit to be delivered to their home.

It’s a pure software approach. And if you’re in orthopedics, we’ll engage you with the orthopedics care plan. If you’re in oncology, we’ll do that too.

We’ll do that if you’re a chronic care patient. But the idea is that we now have a scalable way to reach 100% of patients. Then the other piece is that we have a lot of algorithms built in so that we don’t need nursing staff to monitor every little thing.

We find that 80% of the issues patients record on the system are not emergencies. It could be that I’m constipated; I have low-level pain. Instead of having that issue go to a provider, we have these automation systems where the patient will get just-in-time automated education on managing constipation at home.

And so we’ve cut down on calls to clinicians by 50 to 65%. And then, there is an issue 20% of the time; maybe they have a fever or 10 out of 10 pain. Okay, escalate that to the care team, but only escalate the 10 or 20% of issues that the care team has to be involved with and automate the other 80 or 90%.

And so we’ve been able to help health systems go digital for nearly 100% of the healthcare journeys because we’re able to do it more scalably and without a bunch of devices all the time.

Nicole

This is great because, for instance, most of the RPM 1.0 has so much data that it sends to physicians and clinicians. And then, the clinicians and their staff have to shift through the data to determine which is more relevant and which is not. So, as you said, it’s great to be devices and have that automation in hand.

This also brought to mind what we currently have as a smart hospital, basically having, sending patients home instead of having them stay in the hospital for longer periods; they could leverage your platform for this as well because I don’t, right now, think they’re still doing it via Zoom for call meetings and whatnot. So, it is a great device for hospitals as well as for hospitals at home. My next question is, what were the core challenges of traditional RPM, which you mentioned earlier, and why is switching to the new RPM model necessary today?

Joshua

Yeah, it’s necessary today for a couple of reasons. One reason is that the expectations of patients as consumers have dramatically changed. When you survey patients now, the majority say, hey, I want to be digitally guided and monitored throughout my healthcare journey.

And what that means is that RPM or digital care can no longer be just for the 5% of patients at risk. It means that your 30-year-old mom wants to be guided, engaged, and monitored throughout her pregnancy, your 60-year-old patient having their knee replaced wants physiotherapy through digital video or your 80-year-old heart surgery patient doesn’t wanna travel two hours after surgery just to get their incision checked. They’re like, why can’t I take a photo at home and send it to you, and you tell me if it’s infected or not?

The idea is that consumers now have a higher expectation of going digital in their care. The other piece is that with the staff shortages and the clinician burnout, yet at the same time, there’s an increasing expectation that we have to improve quality, we have to have higher throughput in the hospital, and we need to get patients out sooner. Value-based care has been growing slowly but is still growing.

You have fewer staff members yet higher expectations to do better quality work, see more patients and keep them out of the hospital. Well, how do you do that at scale? And so you can’t do that by actively monitoring every data point of every patient.

You need a scalable way to actually engage patients for all conditions and all surgeries outside the hospital. Digital care journeys slash RPM 2.0 is a scalable way to do that without hiring more staff.

Nicole

That’s a good point because I was reading an article that for doctors, physicians, at least in the US, about 40% of them by 2040 want to either retire or switch to non-clinical roles. So, having either burnout or switching to clinical roles, you definitely need to be more staff in most clinics. This is handy, especially for rural communities or clinics with less staffing for physicians or nurses.

Now, let’s dive into device-less solutions and their impact on patient engagement. How can device-less solutions leverage the existing technologies to monitor patients remotely without additional devices or sensors?

Joshua

Yeah, so one of the interesting things is that when you look beyond, let’s say, chronic care management, you look at all those other disciplines, surgery, oncology, behavioral health, maternity care, and all that, you start to realize that a lot of the data that you want to capture about patient journeys is not biometric data that you have to have a device for. I’ll give you an example. So, for surgery, it’s so common that patients need to track their pain levels.

They need to track if they’re nauseous if they’re vomiting, they need to track photos of their incision, right? They need to track if they are having side effects from a medication. You look at oncology; it has many adverse events and side effects.

These are items that a device cannot track. There’s no sensor for your pain level. Pain is very subjective, right?

If you’re constipated, there’s no sensor for that. So, you can only get the vast majority of data points needed for most healthcare journeys by asking the patient directly. For device-less remote monitoring, you use the patient’s device, and through a software application, you ask them what their pain level is today.

Are you constipated? Are you nauseous? Are you vomiting?

Take a photo of your incision. Therefore, the patient can only self-report most data points through their own device. Then, we can connect those back into the core platform for the 5% of patients where you may want to leverage a pulse oximeter, a blood pressure cuff, or a wireless weight scale.

However, the idea is to realize that beyond 5% of use cases, you must go deviceless for most healthcare journeys to support every other patient situation.

Nicole

That’s a great idea because most symptoms are verbal or subjective. Having a devices category would be helpful for patients, not only in the long run but also for other hospitals. My next question is, how do device solutions ensure accuracy and reliability in capturing patient data?

Joshua

Yeah, so we’ve been studying this for a while. So, as early as 2015, that would be about nine years ago, we did a study, for example, with McGill University. They compared what patients verbally told a healthcare team member about their symptoms or health status to what they were telling the CMSMD application.

At that time, they found an 89% agreement between the two datasets, meaning that 89% of the time, whatever they were telling the healthcare team about their symptoms was exactly what they were telling our technology. On top of that, when the researchers looked at the 11% of the time that it was different, they concluded that if we had just phrased the way we asked about the symptoms more clearly, it should have been much higher agreement. And so essentially, whatever patients tell their doctor or nurse, they’re telling our technology the same information.

And so we have some pretty good data that as long as you believe what patients say, which if you can’t, what else can you do? But if you do believe what they say, they’re telling the application the same thing they’re telling their healthcare team. And what’s interesting is that, if you look at studies from decades ago, like 30 years ago, people were doing studies on electronic data capture from patients and electronic symptom interviews.

They found that, quite often, patients were more likely to either be truthful or disclose sensitive information to a technology platform compared to telling a clinician live because sometimes, for sensitive topics, they might be embarrassed to tell their healthcare team member directly face-to-face. But if you ask them to, you know, privately record it in an application, they often are more willing to be honest or disclose more information. So, beyond technology being a reasonably accurate, scalable way to collect data, you might be able to collect more sensitive data than you would otherwise have if you always had to collect data face-to-face.

Nicole

That’s a good point because, for some patients, collecting data through your device’s platform could be real-time. So when they’re feeling it, when they’re not feeling so well, or even when they are feeling the symptoms, they can report it right away instead of waiting for that physician visit and telling that physician face-to-face, which they will ultimately forget when they have so much more other things to talk about regarding their health. Thank you so much, Josh, for sharing your invaluable insights regarding RPM 2.0 and device solutions in this podcast. To close out, would we give you the floor to do a shout-out or talk about your current projects or anything under the sun that you are currently working on?

Joshua

Yeah, well, thank you, Nicole. I appreciate that. You know, we’re continuing to really just evangelize the importance of bringing digital care to patients everywhere.

We now have over 55 digital care journeys covering over 150 different conditions and procedures. And so we’ve realized you can go digital for many different healthcare conditions. The one lesson I’ll share is that we realize now that innovation requires people, processes, and technology.

Technology is not easy, but in some ways, it’s easier than people. And so we’ve found that the technology has to be good, but you need the right people, process, and playbooks from companies like ours to go from technology to results. And so I think just a reminder for your listeners that, sure, invest in the technology, but you have to invest in the people in the process if you wanna make all of this come together.

Nicole

That’s a very good point because there will be changes to workflows and clinical flows. When you do include technologies in your practices, your work and dedication are truly inspiring, and we look forward to witnessing the continued positive impact of digital health technology under your leadership. Thank you for coming out today and showing your expertise and invaluable insights.

Thank you so much, Josh. So, OSP, a leading healthcare software and product development and solutions enhancement company, brings this podcast to you. They have developed solutions for remedy cycle management, practice management, medical billing, coding, advanced telehealth, remote patient monitoring, healthcare payment systems, healthcare and cloud solutions, EHR development, and more.

Thank you to our guests, Josh, for your time, and thank you to our audience. Have a great day, everyone. Let me start recording.