William Cameron Powell, MD is president, chief medical officer, and co-founder of AirStrip Technologies of San Antonio, TX.
Tell me about yourself and about the company.
My name is Cameron Powell. I’m actually an OB/GYN physician by training. I don’t practice any more; I haven’t for about two years. I currently serve as the president and chief medical officer of AirStrip Technologies.
We are a medical software development company that is completely focused on remote patient monitoring and telehealth, with a focus on mobility, primarily in our niche capabilities and technologies to deliver a real-time historical waveform information to physicians and nurses anytime, anywhere, on mobile devices like the iPhone, Blackberry, and mobile Google Android.
The company was actually founded about six years ago. We think we really started this past June when Apple chose to feature AirStrip during the Worldwide Developers Conference in their keynote address. Things really changed for us at that time.
Six years ago, we had a focus on trying to develop a technology that would clearly work to mitigate risk and improve patient safety and improve communication between physicians and nurses when physicians are temporarily away from the caregiver environment. Given my background in obstetrics, we started with the AirStrip OB product.
Tell me about the components of AirStrip Observer.
The AirStrip Observer suite is really built off of a platform referred to as AirStrip RPM or Remote Patient Monitoring. AirStrip OB was the first product that was built off of that platform. That platform is basically a completely reusable and scalable software platform that we spent many, many years developing, which allows us to very rapidly roll out additional mobility solutions.
AirStrip OB is actually the first FDA-cleared solution build off of the RPM platform, but we have additional solutions that we’re awaiting FDA clearance and have already been submitted. Those are the AirStrip Critical Care and AirStrip Cardiology products that are currently submitted to the FDA.
We have several other products that are currently in our pipeline that are being built off of that RPM or Remote Patient Monitoring platform that we developed.
How hard is it to get FDA approval?
It’s challenging. We certainly don’t mind that challenge from a competitive standpoint.
The thing that we like about FDA clearance is it really forces us to maintain a level of quality and control around our software designs that ensures that our hospitals and our physicians, as our end users, benefit from just a great solution that has a great user interface, is HIPAA compliant, and is very secure. But to get FDA clearance, you do have to know what you’re doing. You have to have the right people involved. So it’s challenging, but I will say the FDA’s been a very good group to work with.
Can you tell me more about the actual technology and what kind of folks you have to maintain and develop on it?
We do all of our development in-house. My senior partner, Trey Moore, is actually our CTO, and he is the lead architect behind the entire platform. He is supported by a team of in-house software developers that have really built out the rest of our platform and help us to support all the different mobile devices and the interfaces to various HIS vendors or CIS vendors that are required to operate the solution.
Our application works by interfacing to various vendors or device manufacturers. There are several different architectural formats, but essentially, there’s a system in the hospital that’s pulling that data real time and then securely exposing it through the Internet to our mobile client. I think where our real uniqueness is in how we handle the presentation and the user experience behind the waveform data; the ability to see and interact dynamically with virtual, real-time waveforms, to be able to scroll back over time and pinch and zoom and analyze those waveforms.
One thing that’s important to realize in healthcare, especially with the problems that we’re trying to solve, is that so many decisions are made based off of visual interpretation of data, especially with obstetrics. For example, a vast majority of adverse outcomes in labor and delivery are directly related to communication errors involving the fetal strip, or the fetal heart tracing. So the ability to close that communication gap and deliver that real-time historic data to the physician anytime, anywhere, we think will have a significant impact on patient safety.
The reality is we live in a world where there’s a relatively decreasing number of physicians and an increasing number of patients that need to be monitored. Anything we can do from a technological standpoint to allow physicians to be able to adequately monitor these patients makes a huge difference. We’re in nearly 150 hospitals right now across the U.S. with AirStrip OB and are beginning our international efforts with several large partners.
It’s great in the field of obstetrics to go to trade shows, to go to hospitals, and the physicians and the risk managers and the executives. They all know about AirStrip OB and they’re asking about it. That’s been very rewarding for us. If you look on our Web site, I think one other thing that’s really rewarding is just the enormous volume of unsolicited emails and stories we get from doctors that tell us how AirStrip OB is making a significant difference in their lives, and especially in the lives of the patients they care for.
We’re seeing large hospital systems actually create their own videos about AirStrip OB and promote them on YouTube and through other social networking efforts in the markets, to patients where doctors are talking about how great the technology is. That’s also quite rewarding for us to see that kind of take off in sort of a viral nature.
Do you see the boundary of your product being those applications that involve waveform data, or do you see yourself advancing beyond that at some point?
Oh no, not at all. Currently, if you look at the AirStrip OB product even just at its base technology, when a physician logs on … First of all, no data’s ever stored on the device, it’s just available during the view session, but they’re able to see the labor and delivery census; the patient name, the cervical exam status, the most recent blood pressures, the admitting diagnosis, and vital signs. They can then drill in further and review all the nursing notes, they can look at medications, they can look at trended data, and then all the waveform data.
Currently, we present a voluminous but focused amount of data to the obstetrician. When you get into the Critical Care and Cardiology applications, we also provide a whole host of patient monitoring data beyond the waveforms.
Now with the platform, the platform also allows us to pretty rapidly extend this technology to encompass imaging solutions, solutions outside of the hospital. For example, there’s a lot of interest right now in AirStrip with regards to what we can deliver on the ambulatory cardiology front, and in the home health monitoring front.
We built our solution to truly be data independent. We don’t really care what the data is as long as we have access to the data through our partners or vendors / device manufacturers that we’re able to effectively AirStrip that data in the back end and expose it to the mobile client, really, in a way that hasn’t been done before.
Do you think it will be competitively important to be the one-size-fits-all single solution for doctors, or do you think there can be several niche applications that doctors run separately?
I think there’ll be niche applications, but we think from the broader remote patient monitoring standpoint, I think a single solution that would apply to everybody is very likely. Our idea is that our client changes dynamically depending on who the physician is logging onto the system. We eventually envision the obstetrician logging on to the client and they’re presented with what they have access to in labor and delivery; whereas the intensivist or the neurosurgeon logs on and they’re presented with the information they want to see in the ICU.
In the L&D market where you started, there probably wasn’t much competition when you started it. Do you think once you get into the cardiology and critical care modules that you’ll be competing against a broader array of competitors and also have to figure out how to transition the company into a whole different target market?
Certainly we’re not naïve enough to think that we’re not going to have legitimate competition, but the reality is what we’re really focused on is being first to market and continuing to advance our first mover advantage, from a software standpoint and a UI standpoint, try and stay several years ahead of the curve. I think we’ve done a good job at that and that’s our focus is to try and just stay out in front and continually iterate, continually innovate, listen to our customers, listen to our physicians.
One thing that’s nice about our development team and our development platform is that we can very rapidly iterate and make changes and dynamically adjust to what the market’s demanding, rather than going through traditional software development life cycles that require extensive rewrites. We have some proprietary technology that allows us to do that and adapt.
You’ve also got an advantage in that you have a big footprint in a small segment of healthcare, which I assume then can fund the development and also provide the experience to move outward as opposed to trying to develop the whole package and then sell it to the world.
Yes, sir. Our focus was if we can deliver a solution to the market that works really well that is fast, that is secure, that the doctor is able to use with relative ease that has … For example, even just delivering a solution that can be installed quickly. I mean, a lot of our installations can take a day or two at the most and most of them are done remotely, so it’s not like installing an entire HIS system in a hospital.
We knew if we could deliver something like that to the market from end to end, from the requirements of the hospital IT staff to the CIO, to how hard is it for a doctor to get logged on, to managing all that — if we could deliver all that and do a really good job of it with AirStrip OB, that we would be 80% done with every other solution that we ever wanted to create. Reusing and repurposing what we developed, that’s how it was architected from the very beginning.
Was the plan up front to do more than just L&D?
Yes. We had some very good senior executive guidance that forced us to put the blinders on and really focus on delivering AirStrip OB to the market first, and doing a really good job.
I think where some people fail … they’re tempted to go down every rabbit trail that’s presented to them. It’s really hard to maintain focus to get that last 5-10% done and to really do it right. We had some really good guidance and help along the way that coached us in how to do this just from a philosophical standpoint. It’s probably one of the best decisions we ever made, was to make sure we did AirStrip OB and did it right and made it available to anybody who wanted it.
I have seen the throughput from our company as we roll out these additional applications. It’s just been incredible to watch. I’m so proud of my team and my developers and everybody that I get to work with, to see them have such success as they’re having now. Really, they’re standing on the shoulders of a giant, Trey Moore, who knew from the very beginning that if this was architected in the right way and done correctly, and learning from mistakes he had seen other companies make in his previous career, that we would be able to do this some way. I’m now seeing that come to fruition and it’s really humbling actually, to work with such a great team.
How hard is the integration piece for hospitals to accomplish?
From the OB standpoint, fairly easy, because once we go to the hospital, we’ve already had that integration done with the perinatal vendor.
We have good relationships with almost all the perinatal vendors in the U.S. So if a hospital has any perinatal system — let’s just say it’s the Hill-Rom NaviCare WatchChild system — we can go and tell the hospital that, “You know what? We have an interface. The NaviCare WatchChild, it will handle it all for you. We’ll install the server, or we’ll virtualize it, or we’ll host part of it. The vendor will remotely install their piece, and we will remotely install our piece, and it’s very little required from your IT staff.” That’s one thing that the hospitals, I think, really, really like.
You definitely run into different environments, but from the OB standpoint, it’s pretty straightforward. For the Critical Care/Cardiology solutions, of course we’re not installed anywhere yet, but as those roll out of the FDA we have our beta site that’s already lined up and we will try and replicate the success that we’ve had with AirStrip OB.
Certainly, I think we’ll learn along the way, but we have some really strong partnerships with some great vendors and device manufacturers. They’ve been really great to work with. We think that makes it a lot easier on the hospitals if you can go in and present to them a solution that works, and it’s a breath of fresh air for them to install an AirStrip system.
How is the product licensed and hosted?
Currently, it’s a Software-as-a-Service model; a hybrid software and service model. Currently, the application server resides on site at the hospital. There have been some very large IDNs that will host the Web server component at a central location. That Web server will serve all the hospitals in that IDN around the country. We also virtualize so the hospitals are installed in a virtual environment.
As far as a fully hosted solution, that is definitely something that we’re looking to move towards. With some of our partners, that’s how it’s being designed from the beginning. But it is a subscription model — a hospital, they will pay a certain amount per physician, per month or per bed, per month depending on the product and size of the hospital, the number of physicians, and whether or not they belong to a GPO. There are a lot of different variables.
I think you mentioned earlier that you have applications for other caregivers, like nurses.
We currently have a lot of interest from nurses right now using AirStrip OB, but using it in a hospital. For example, a charge nurse who’s responsible for all of her nurses. Or, she may be in the middle of a C-section, or in a meeting, and she wants to keep track of what’s happening in labor and delivery. She can also use AirStrip OB even though she’s actually in the hospital.
But yes, we see a broader remote patient monitoring-based solutions being able to be used by a variety of healthcare givers in a variety of settings. Right now, the focus is really on physicians and nurses, but I could clearly see applications beyond that scope as we expand. I think those markets and those needs; some are already making themselves available to us just from a recognition standpoint, so we’re certainly interested in providing the technology wherever it’s useful.
I saw on the Web page that the application supports a ton of mobile devices. Which ones are the most popular?
Well, the most popular right now is the iPhone, but we also see markets where there’s a lot of strong demand from BlackBerry users, and some strong demand from Windows Mobile users. Our goal is not to be necessarily focused on the device, but to remain device agnostic. The reality is the market demands change and at this point and time, a large majority of our users are iPhone users.
Mobile applications, in general, improve the quality of life for providers. What’s the impact been for your users, and what opportunities do you see there in the future?
Honestly, because of our regulatory requirements and the nature of our application, we’re not really so much focused on the quality of life of a physician. The reality is where AirStrip becomes most useful, is when the demands of a physician’s day necessitate their periodic absence from the bedside. We’re not trying to ever keep a physician from the bedside.
However, the reality is that there are several times, and often, when a physician has to be away from the bedside. They may be at another hospital, they may be at the surgery center, they may be on call. In those instances, currently they’re limited to having to listen to an interpretation of what is going on over the phone. If they’re away from the hospital, we just want to be able to provide them with this data virtually in real time so they can better assess a situation.
I think, from a quality of life standpoint, that mainly helps them have peace of mind knowing that they’re looking at the same data that a nurse is looking at; and therefore, until they can get back to the hospital, they can more clearly understand the situation and hopefully, it provides a meaningful advice in the interim.
Now, do doctors tell us this does dramatically improve their overall quality of life having this access to this information? Yes, absolutely.
Where do you see the company going, strategically, over the next few years?
We really want to set the standard of care, both domestically and internationally, for remote surveillance from a mobility standpoint — for remote surveillance in healthcare. We currently are relatively agnostic to the market. We want to raise the bar as far as remote surveillance goes. We see ourselves helping to establish that standard of care.
Do you see that happening under the current business form, or do you see either being acquired or acquiring someone else?
I don’t really want to speculate on those types of events. Currently, we’re in a high-growth mode; really growing the company to make sure that we deliver the best technology that we can possibly deliver to both our doctors, who are the end users; and the patients, who quite frankly, deserve the technology. In that effort towards growth, certainly there are a lot of different things that could happen to a company like ours. We remain focused on growing the company, but also keep an open mind as to what might come.