Jay Deady is president and CEO of Awarepoint of San Diego, CA.
Tell me about yourself and about Awarepoint.
I’ve been in health IT for over 20 years, most recently at Eclipsys. Post the Eclipsys-Allscripts merger, I opted to take advantage of a few opportunities throughout the marketplace and ultimately selected Awarepoint. I had the opportunity to step up to be a CEO of a growth company and I’m pretty excited about it.
How would you characterize your time at Eclipsys?
I think in some ways, we had a lot of success, and in others … well, I think in the end it will be very good for clients. It was disappointing that we didn’t execute better ourselves.
When a number of us came to Eclipsys a little over five years ago, we had a great CPOE and documentation system with Sunrise. We had a revenue cycle business that had not been invested in. We had a decision support business that really had been ignored for quite a few years, and in fact, had fallen to the bottom of the KLAS rankings even though it was quite large.
When we looked at the clinical business, we filled out pharmacy, medication administration, emergency care, clinical analytics, and came out with ambulatory. Clearly, we didn’t hit the mark on ambulatory. Ultimately, that proved to be post the capability of gifting from acute care institutions out to non-employed physician groups. Once Meaningful Use hit, it was such a focus on ambulatory. We had made progress on ambulatory, but it was nowhere near where some of those other modules were.
Ultimately, for the benefit of our clients as well as to compete in the marketplace, we had to make a strategic move because there wasn’t enough time to market. Allscripts had a significant footprint on the Microsoft platform. We had a great footprint on the acute care side. I think the benefit post-John Gomez pulling together the development teams and the product management teams and pulling integration off … I think it can be a really great value proposition. But I wouldn’t be truthful if didn’t tell you that I wished we had executed better in the ambulatory space over the five years.
RFID solutions have been around for a long time and with mixed success, it seems. What differentiates Awarepoint?
Until I got into this, I didn’t realize that, from an RFID or RTLS perspective, there are about six or seven types of technologies being used to execute in hospitals. That was just on the active RFID side. There are many that are passive, so that essentially until an asset or a person passes a range point, you don’t really know that they attract on an active basis. The tag that’s attached either to a patient or a caregiver or a particular asset is actively pulsing out a signal being captured on a repeated basis.
From that standpoint, there are about six or seven technologies that are different. A number offer just the technology or the hardware. Others that are software players that utilize one of the hardware-only company’s technology.
Awarepoint is one of the few that actually crosses both bridges. We have the technology running on a ZigBee wireless network, which we think gives us an advantage in the marketplace. We combine that with SaaS-delivered software modules and back-end analytics so that we can come to market with a full solution versus just one or the other, or asking a client to patch the two together.
It seems that you’re productizing it a lot more in marketing a solution instead of just, “Here’s some technology that you can figure out what to do with.” Is that something that changed when you came, or was that already underway?
That was underway. There were a lot of software modules already here. I’m a big proponent of that, so we’ve stepped up that investment and also created a solutions group, which is fairly new.
We have people, for instance, starting to deploy temperature tracking. One of the things we can do besides the active tracking is that we have tags that can monitor the temperature in all the hospital refrigerators. Joint Commission is very interested in that, whether it’s for food or particular types of drugs.
You have a lot of institutions that are still manually doing that today by somebody walking around and looking at the thermometer and writing it down on a clipboard. If you’re a current client of ours, you can add that in and basically be up and running in less than a day on temp tracking.
But what we found is that causes a change in workflow. We’ve been working with pharmaceutical and biotech manufacturers, and while they recommend standard ranges for storage, they don’t give much guidance on when it’s out of that standard, what’s the shelf life? What should be done with the pharmaceutical or biotechnology agent? We have a number of people on staff that are clinical experts and working with them.
At any rate, we needed to develop the solutions teams to be able to work with clients versus just giving them a piece of software and giving them a piece of technology, but not helping them implement it effectively.
One area that hospitals probably want to talk about most often is asset tracking. What assets are most advantageous for a hospital to track?
Fairly expensive pieces of equipment, items that are leased, and those that are often lost to shrinkage or somebody walking out with them. Smart pumps are the clear winners. Our average hard-cost ROI is four to six months. We go in looking at the low-hanging fruit and where they’re renting equipment. In fact, we have one client who actually rented a smart pump that had been stolen from them previously. [laughs] The CFO didn’t enjoy that too much.
We’re able to show them the inventory they have. In many cases, they’re contemplating buying more, because they can’t track what they already have, and so they’ll either buy or lease. We can help them right-size that solution pretty quickly and cut out the rentals. In large institutions, that’s a very fast hard ROI of the entire solution just based on that.
Downstream of the smart pumps, you start to look at wheelchairs. We had one client spending $300,000 – $400,000 per year on wheelchairs because they were being stolen like shopping carts out of a store.
It also helps in terms of discharge planning. For effective discharge, you have to coordinate transport, and in some cases, valet parking at the front door. You need certain equipment to be present, like the wheelchair. So besides the ROI of not losing as many wheelchairs, it effectively helps the discharge process as well.
In the old days you had to wire all the door frames and find all of the dead corners of the hospital where assets might wander outside of the monitored zone. What’s the infrastructure requirement for the Awarepoint solution?
There are a multitude of technologies out there. A number of competitors use standard WiFi. In the US acute care hospital market, it’s only about 12% penetrated today, and of those, many are just a single department solution versus being enterprise-wide. We offer the ZigBee network.
ZigBee networks are used in many homes. They are starting to be deployed by power and gas companies and electric companies to measure flow. In some cases, it’s going inside the house for television and next generation wireless for entertainment within the house. We have a number of patents for using it in healthcare, specifically for using it to track location.
When you plug in our devices, they create a seamless virtual mesh network. They run on a different standard — 802.15 instead of 802.11. It separates from the standard WiFi that’s running in the hospital. It’s pretty efficient. It handles low-volume data, but you can multi-channel it.
A standard hospital running their Epic or Cerner or Eclipsys enterprise clinical system and then a variety of other personal devices and other applications can start running it … you’re seeing stories about how, on standard WiFi, it’s very difficult to prioritize that data flow and who’s going to have the right of way.
With ZigBee, you can design channels so that specific types of communication protocols are running through each channel much more effectively. It’s low power, so it’s just plugged. It can’t handle the large data loads like an 802.11 standard WiFi can, but for telemetry data and for active RFID data, it’s a great protocol.
Because it’s such low power, our repeaters and access points actually plug into the wall like a Glade air freshener. There’s no big heavy investment required. You don’t have to pull cables, you don’t have to drop down repeaters through the walls, or go through a six- to eight-month implementation. You have OSHA requirements in terms of construction and hospitals and things like that.
With us, you’re literally just plugging them into outlets. Our average hospital install time is about 28 days to start tracking the first class of assets.
Early on, people worried about the use of locating technology to track people. Are hospitals doing that?
On the patient side, that seems to be less than an issue than on the staff side. On the staff side, particularly in a union institution, it becomes more of an exciting conversation to have.
Instead of just tracking location by asset class, we allow defining caregivers across multiple asset classes, whether it’s a housekeeper, transporter, nurse, RT, PT, or whatever. You can decide by asset class how you’re going to track. We guarantee a 100% service level agreement within the hospital to within two and a half square feet. In some cases, you’ll track assets simply by location. In other cases, you can track caregivers based on interaction with other tags.
What we find is that when you talk to nurses and others, saying, “We’re not going to track you walking around and how long you were in the lunch hall or how long was your break, but instead, just the physical assets you came into contact with and/or what patients you interacted with,” they seem to get more comfortable with that.
From an infection control standpoint, if a patient gets an infection, you can pull that string back very quickly and see exactly what housekeepers, transporters, nurses, other types of staff had contact with that patient. What assets, like vents and pumps, touched that patient as well. Today in most institutions – because again, these systems are only about 12% deployed – that would take a multi-day, very manual effort of pulling charts or looking things up electronically and then trying to track back how you actually interacted across that space. Our clients can do it in a matter of minutes.
That conversation, quality and infection control versus tracking every caregiver’s whereabouts, is one people are more comfortable with.
One company developed an OR supply cabinet that automatically charged patients as expensive items like implants were withdrawn. Are you doing anything with that or helping surgery coordinate the bringing together of people, equipment, and supplies?
Those were passive RFID tags. When the caregiver wore that and walked up to the cabinet to extract the material, it was only then that they got registered versus their location and broader interactions. Many of those are in place today.
From an OR standpoint for us, where we tend to get deployed is that we have a sterilizable tag. These surgical cases that have $75,000 to $500,000 worth of surgical instruments inside of them — and again, tend to get lost and go missing — you an actually track those cases all the way through the entire sterilization process and track them around the hospital. That’s more where we’re seeing our clients want to invest versus the passive RFID. Many of them have those and that’s fine, but that’s not a space where we play.
You mentioned that the company holds some patents. What do you see developing around the technology?
This year, we will really go upstream to start to affect workflow and process flow more effectively. I’ll give you an example.
Prior executives here didn’t have a lot of healthcare experience. They were very, very smart technology and wireless folks. One of the things I found was that all of the workflows and tracking points for all the assets from all our clients are stored in the database, because we run SaaS model.
When a smart pump is pulled out of a patient’s room, it’s considered dirty. It has to be cleaned, versus brought to another patient’s room. But 12 to 15% of the time, it’s brought to the next patient, which is clearly a potential for infection and outside of the protocol of what that hospital would like to see done. We can track that. We can show the client the data of how often it’s happening and where it’s happening.
We have an alert engine and a rules engine similar to EMRs. I asked the question, “If we have that data, the workflows, and a rules engine, can’t we fire an alert as soon as that asset is moved to another patient’s room instead of going back to be cleaned?” If you have the caregiver tagged, you can shoot an alert to that caregiver in real time that they have a dirty pump that needs to be pulled back out and cleaned.
That’s just one example where you start to think about the various assets that we can track as you get near real time in alerting people that their workflows are out of alignment with care standards. That’s where I want to take things. The company is on the way to doing that this year. It’s more than just tracking and driving the ROI, which is great as a starting point, but actually impacting workflows and patient care versus after the fact reporting on it.
Since you know from the active tags where personnel are, you could look at a dispatch model, such as during a code, locating the nearest respiratory therapist.
We’re working with two clients and they’re doing that exact thing with transporters. Those are unassigned resources that you have to get marshaled and deployed, but they flow all over the hospital and need to be directed where to go. I think that’s where we’re going to have the first documented results of that. It could be brought forward into broader care team capabilities. We’re going to need clients to lead us and the best way I know is to listen to clients. As they expand to the broader care teams, the technology wouldn’t be the limiting factor. It would be the desire of the clients to do that.
In the announcement the company made about your hiring, there was a mention of Gartner’s definition of the real-time enterprise. What is that how does it fit into the strategy?
Gartner’s model, after significant hospital adoption of Meaningful Use, sees a replacement of revenue cycle systems as pay-for-performance starts to occur. They see that through both analytics and an RTLS system you get an aware enterprise. Instead of looking at quality standards 90 days after the fact and changing best practices to make a positive impact on future patients, how do you use real-time analytics and real-time awareness and other new technologies to make a difference while the patient’s actually in the bed or in the waiting room to improve the patient outcome and experience?
We started that at Eclipsys with the combination of clinical analytics and looking at our costing analytics with EPSi. I definitely supported that model. We started to drive that integration from an analytics standpoint. Here at Awarepoint, we think we can play the role with the RTLS making those enterprises aware.
However healthcare reform ends up, I think there will be an increase in capacity. I don’t think there will be an increase in reimbursement. Hospitals will be asked to handle an increase in volume without getting additional staff and without getting the dollars for investment. I think there will be a convergence of HIT and analytic systems and RTLS systems.
It’s going to be interesting to see where that convergence comes and how the platform develops. That real-time awareness that Gartner talks about, or that real-time aware enterprise, is one that has as much of the enterprise automated as possible, then using it in near-real time to make decisions and workflows on the fly to optimize outcomes with the patient volumes.
Any concluding thoughts?
I think it’s an exciting space. I’m excited to be here. We have a good amount of runway for the company to grow. I’m excited about the opportunities.