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Imagineer Tech Showcase - Vision to Reality
Vision to Reality
Vision to Reality
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Video Transcription
Welcome to the HRS Imagineer Tech Showcase. It is my distinct pleasure to introduce our next speaker, Dr. Manish Wadhwa. Dr. Wadhwa is the Chief Medical Officer of BioTelemetry, the parent company of Geneva Health Solutions. Dr. Wadhwa is going to be talking about vision to reality. Thank you, Dr. Passman. I'd actually like to say thank you to HRS for creation of the Imagineer Showcase and certainly for inviting Geneva Health Solutions to speak about our offering. Geneva Health Solutions was founded by two practicing electrophysiologists, myself and Dr. Gail Anthony-Yungap. Gail and I both saw a problem with respect to how data was transmitted from point of care interrogations within the emergency room. So what we realized is that this is a paper-based process and there are problems associated with both data management and billing of these encounters. We thought of this issue in 2011 when the power of cloud-based computing was coming to light. And further, the IDCO subcommittee for HRS was creating a document. The IDCO stood for Implantable Device Cardiac Observation Nomenclature, which allowed for standardization of output of discrete data from implantable devices. We were able to take all these data elements, put them together, and in partnership with a medical industrial design firm out of Minneapolis, we were able to create the Geneva Dashboard. And the Geneva Dashboard allowed for patients who were being interrogated within the emergency room, for example, as a point of care setting, to have their interrogation uploaded by the emergency room staff and data presented on the dashboard, irrespective of the manufacturer, in a common presentation mechanism. So we instituted this initially at UCSD and other points within the San Diego community and we realized that we had created something of great value. There was value for the insurers and the hospitals who were caring for these patients. There was value for the manufacturers as they were often dealing with a service burden of following these patients within the emergency room. And also value for the physicians caring for these patients because we had now unlocked data and made the data on these implanted devices both usable and actionable. Remember that the implanted devices have functionality not only on the functionality of the device, but also on the health and wellbeing of the patient. As we were continuing to progress on our business model, our customers were coming to us and asking us to help them with the deluge of data that they were experiencing from remote monitoring. Remember that remote monitoring was released within the EP community within the 2008 timeframe. And between 2008 and 2015, there was a significant groundswell of patients who are now on the remote monitoring platform. So whether you are a small practice or whether you are a large institution, everyone was trying to figure out the workflow processes to manage this data. Compounding this issue in May of 2015, the Heart Rhythm Society presented a expert consensus statement, which now deemed remote monitoring as the new standard of care. At this point, the revolution was complete in that the care of patients with implanted devices had moved from the four walls of the office to the four walls of the patient's home. Fortunately, Geneva had a technology software solution and we were able to quickly pivot our platform to ingest not only data from the point of care setting, but also to ingest data from the remote monitoring setting. And we started to market this technology and this offering. And what we realized is that our customers weren't adopting this technology quite as quickly as we expected they would. And what the issue was, was that they had issues with people. And essentially, go back to 2016 when we made this pivot, the economy is booming, medical assistance are hard to come by, those that do come by are quite expensive, and unfortunately CMS continues to lower reimbursement rates for in-office services. So now practices and systems are being asked to do remote monitoring on top of care and servicing of patients in the point of care setting, and they're being asked to do more with less. So what we did is we built a patient engagement specialist and data management specialist, and essentially we wrapped the services around our software offering. It didn't take us long to figure out that we were now sitting on top of best practices. Practices would come to us and they would ask us, how should we program alerts? Remember, there's a fine line between too much data flow and not enough data flow. Practices would come and they would ask us, how do we build this? Again, remember, this is a unique billing model, the 30 and 90 day windows is seen nowhere else in clinical medicine. And as such, we became experts on billing and even to today provide best practices back to practices on revenue management and optimization. So it was really our CEO, Uri Sadakar, who led us through this transformation from software to services to solutions. And it was at this time that we realized that we were no longer Geneva Healthcare, but rather we were more aptly termed Geneva Health Solutions. So this slide is what I entitled the remote monitoring patient data revolution. Obviously, this is a play on words. What I'm really showing you is the revolution of data as it encompasses the patient. As data moves from the patient to the server, that data has to move to different elements in the circuit. So it can move from the server to the practitioners and the practitioners will interact with the patient. It has to move to the EMR, which acts as the repository of data. And of course, the data has to move from the EMR to the server. This is one of the secret sauces of Geneva and that we have done this interaction model very well between the EMR and the server. We're able to move data with respect to results, whether PDF or discrete data, ADT demographic messaging. We can create and close orders within electronic medical systems. And of course, we have patent pending algorithms around the billing models at both the server and EMR levels. So the second component of this slide actually shows you all the sections and teams that are touching the patient from the Geneva perspective. And what I'm really highlighting here is that at each point in the revolution of data around the patient, we have multiple teams that are key to movement of this data. And the net net of this slide is that a remote monitoring, a successful remote monitoring platform requires all these data elements. And if you have a successful remote monitoring program, you're doing this on some level. And if you're not, this slide may give you some insight as to where you may be having issues. So Geneva started along the remote monitoring pathway in 2016 with my 350 remote monitoring patients. At the time that BioTel acquired us in 2019, we had approximately 30,000 patients that we were monitoring. And now about 15 months after the acquisition, that 30,000 has now swelled to over 70,000 patients that we're managing across the country in 47 states. So when you look at the data that we bring into the Geneva platform, we call this the cardiac continuum. And more recently, we have actually now termed this the cardiac care continuum. So the data actually on the left side of the equation represents the discrete data variables that are so important to our care of patients. And these could be cardiac risk factors, data, or data variables such as telemetry, INR, blood glucose, blood pressure, weight, activity, sleep apnea. In the middle, we represent BioTel Heart, which is the largest provider of remote external monitoring services across the country, obviously encompassing Holter, extended Holter, trans-telephonic monitoring, and MCOT monitoring. And of course, on the right side of the equation, we represent the implantable devices, which Geneva has pedigree within, not only within the diagnostic devices such as ILR, but also the therapeutic devices such as pacemakers and defibrillators. All this data comes into the Geneva platform, and we wrap our software services and solutions around this data to really affect the quadruple aim of healthcare, namely to improve population health, satisfy providers, patients, and to ultimately reduce the cost of care. So the recent pandemic with COVID has really taught some additional capabilities of our platform. So the telehealth perspective, as we all know, in two weeks in March, we moved more rapidly in telehealth than we have in years in the medical space. And now what we realize is that while we have this audio video interaction with our patient, what we're missing are some of the data points that we get when the patient's in the office. For example, blood pressure, weight, telemetry recording. So we have the capabilities, and we ingest that data within our platform and systems, not only along the lines of remote patient monitoring such that we have longitudinal monitoring of these variables, but also along the pathway where we can create one-off encounters temporally related to the telehealth visit, such that the data is now available to the practitioner, and it makes the entire telehealth visit even a more rich experience. And as it pertains to the implantable device data, we have actually created new workflows and solutions such that once again, we create a temporal download associated with these telehealth visits so the practitioners and patients can look at the most recent data coming off of these devices and get a more rich interaction and clinical experience. This is a slide that we used to show myself and Dr. Anga back in 2014, and we used to talk about FutureMan and what we wanted to monitor with respect to heart and vascular parameters and wearable parameters in the future. Today is the future. This is the slide that we now show. So this is 2020, and no longer are we looking at FutureMan, but we're looking at TodayMan. I'm hoping that the presentation today on Geneva Health Solutions gave you a little bit of an insight on the future of connected care and our role with respect to the remote monitoring continuum and what I call the four S's. Software, services, solutions, and now with the acquisition of Geneva by BioTelemetry, the fourth S is sustainability. Thank you very much. I'll take your question. Manish, that was a great presentation, and while this COVID pandemic obviously affects us all in very negative matters, I think it does thrust to the forefront the importance of telemedicine and the fact that it's here to stay. I do have some questions. One is you're getting this huge amount of data that you then feed to clinicians like myself. Is that data scrubbed and adjudicated? If so, is it done by humans, and what's the role of AI, or are you just basically transmitting the data to me, and I now first need to sort out what's a true positive and what's a false positive? Great question, Rod. We have multiple models that we offer within the Geneva platform. The first one we call the SAS model, or software as a service model. There are large practices, for example, like Northwestern, who very well may have a team of nurses who are very seasoned, and you don't really need support services as far as management of data, but what you really need is a platform. You need a platform that allows for ingestion of that data, workflow of that data, and allow that data to move into the EMR and coordinate with the servers such that you open and close orders, for example, within Epic. We have a model where there's just an enterprise model. You pay for the software, and you can use the software and the capabilities that we built into the system. Now, as opposed to other software offerings, we have constant updates every eight weeks, roughly, and those updates are passed along to all customers in the system. That's one option. Again, that might be for a system such as yourself who may have the internal capabilities. Conversely, what we found, whether it's a large system or a small system, is that a lot of systems struggle to find and maintain these employees. It could be a cost issue. It could be a mobility of the employees issue. It could be finding the proper expertise issue. For those, we offer the ability to have that service. In one model, you would use only the software, but in the second model, you would use the software and the service. Then, you would garnish all the capabilities that come with the service, so not only data management and management and preliminary review of that data and management of the device portals, but also all the engagement that is required to maintain data flow. That is another one of our secret sauces, is the value of being able to reach out to patients and the teams that we have in place that go and maintain the constant flow of data. It sounds like there are multiple choices on this menu. One could choose to basically completely supplant an in-house device clinic, at least in terms of remote monitoring, to basically picking and choosing what one needs. Is that fair to say? I think that would be absolutely fair to say. We have some customers, for example, that only want us to follow ILRs. Then, some customers want ILRs and implantable devices. Some customers now also want to add the external monitors in from BioTel Heart, for example. Then, of course, we've got the entire left side of the equation, which is really being brought to the forefront with these telehealth models with respect to remote patient monitoring. You can pick and choose whatever the systems and complexity that you want. We have customers across the country who take the simplest model to the most complex model. To get back to that first question, though, do I get the data in its raw form, or is it scrubbed, adjudicated, and I'm only seeing the true positives? That's a great question. In a system, again, like Northwestern, what we typically do is we've created different buckets as far as the data flows. In your case, I'm sure you have nurses that are monitoring and reviewing the data. The data would come into Geneva. It would be passed along to your nurses, just like it is today. It would be adjudicated by them, and then passed along to you. Whatever processes that you have in place today, we work those processes. We just create the more efficiency in the flow of the process. Again, have the billing and EMR engines working in the background to help your practice. Let's say that I was in a practice that didn't have those nurses. Do you have the capability of adjudicating that data before it gets to me? Absolutely. For example, in my practice, I use the full service model of Geneva. The data comes into Geneva. Before I ever see it, it goes into the service teams. The service teams will review that data. They will pass along and then alert me to any issues that need to be addressed urgently. We've created escalation criteria, which define what criteria and what issues I want to be alerted on immediately. The rest of the information is processed and then passed along to the platform, and either provided to me to review in short order or perhaps at the end of the billing window. We have full customization on all that. Again, we have a pure software and a software and a service where that data can be adjudicated. Okay. Well, listen, I want to thank you for an excellent talk. It sounds like you're in the right place at the right time. Thank you for your contributions and for speaking with us today. Thank you. I really appreciate the opportunity once again.
Video Summary
Dr. Manish Wadhwa, Chief Medical Officer of Geneva Health Solutions, discusses the evolution of their platform. The company was founded to address issues with transmitting data from point of care interrogations in emergency rooms. They created the Geneva Dashboard, which allows for the upload and presentation of data from implanted devices in a standardized manner. As remote monitoring became the new standard of care, Geneva expanded their platform to ingest data from remote monitoring devices. They also offer customizable software and service models to help practices manage and analyze the influx of data. The COVID-19 pandemic has highlighted the importance of telemedicine, and Geneva has adapted their platform to integrate data from telehealth visits as well.
Keywords
Geneva Health Solutions
evolution of platform
remote monitoring
telehealth visits
data management
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