Matt Sappern is CEO of PeriGen of Princeton, NJ.
Tell me about yourself and the company.
I’ve been the CEO of PeriGen since January 2012. We build fetal surveillance systems that are centered around onboard decision support tools. We interpret what’s going on on the fetal strip and give clinicians a significantly better view than other solutions into how the baby is tolerating labor.
What trends are you seeing in the labor and delivery area?
There’s an increased attention to being able to control standards of care, to get away from variability in care. So much of the old approach to managing labor is relying on that single nurse and her subjective view and her ability to determine what’s going on on that fetal strip and then convince the rest of the care team of what’s going on. Tools that provide clinical decision support provide a level of context and standardization. That’s important for clinicians now as they go forward and treat patients.
I’m also seeing in labor and delivery a significant attrition of clinicians. There’s fewer OBs, fewer maternal-fetal medicine docs. Hospitals are looking for solutions like ours that help offset some of that attrition and give them better clinical leverage, where a single physician might be able to be more productive across the entire health system. They’re looking at tools we provide that will enable them to do that.
In labor and delivery, you’re also seeing some changes coming around fairly quickly around reimbursement. C-section reimbursement is coming down. The ability to have a broader, more insightful clinical picture of the patient is becoming more and more important.
As payers — whether it be a paid buyer like a Kaiser or a Geisinger or a more standard payer like Medicaid or commercial — there’s a lot more focus on what the standards of care are and how that’s being deployed at the bedside. That is becoming much more important. People are trying to understand how to reduce or how to right-size C-sections and what are the things that can help reduce NICU admissions and emergency C-sections. That’s where clinical analytics, bedside analytics, can be quite helpful.
Does L&D still draw a lot of malpractice lawsuits?
L&D is still, from a service line perspective, a significantly higher percentage of medical malpractice risk. Even within L&D, there are areas where that risk is even greater. For instance, if oxytocin is being administered, there’s a higher risk of medical malpractice issues.
We’re fortunate that we have a gentleman on our advisory team who is one of the nation’s leading defense attorneys for medical malpractice in OB who has helped us put a lot of that in perspective. Tools like ours that create an unbiased view of what’s going on on that fetal strip are effective in terms of helping hospitals manage their medical malpractice.
It’s making sure that an anomaly on the strip is being identified and an anomaly on the strip is being discussed. The care path that the hospital goes down is of their own design, but the fact that an anomaly is picked up and that there is a clinical discussion about it tends to be a very good thing relative to minimizing the impact of medical malpractice lawsuits.
What lessons have been learned in the perinatal area about using technology to standardize practices that could be used elsewhere in hospitals?
Hospitals are recognizing that there’s a tremendous amount of variability in understanding how the baby is tolerating labor. A lot of it has to do with that singular nurse’s perspective, her history, her training, and any biases that she may have had over time. All of this injects a significant amount of variability.
That’s just not what hospitals want in different service lines. There’s so much at risk because you’re always dealing with two lives instead of just one. The risk of labor and delivery is that everyone goes in thinking things are going to be great. In other areas of the hospital, you tend to go in there thinking you’ve got a problem that you’ve got to manage. But in L&D, every patient goes in there thinking it’s going to be phenomenal. We all know that’s not the case,so there’s a heightened emotional strain as well.
These hospitals are working hard on establishing standardization of practice. It’s absolutely critical that all the nurses are looking at what’s going on on the strip in the same fashion.
How are hospitals using OB hospitalists?
The concept of a hospitalist continues to gain traction. As a subset, the OB hospitalist, or the laborist, is gaining a bit of traction as well. It’s an interesting corollary to make a comparison to an oncologist, where you have a medical oncologist and then a surgical oncologist for an acute, limited time frame. A lot of hospitals benefit from it.
I’ve seen a number of studies that show increased patient satisfaction and actually increased provider satisfaction, the ability to expand their practice without having to take on new partners. There are financial benefits to the providers as well.
It certainly is great for a mom to have a physician on site, speaking with them and consulting with them from the moment they check in to the labor and delivery floor. It still has a way to go to become centralized. There is a lot to being a centralized OB hospitalist approach, where you’ve got certifications and standards of quality and training that are being met. It’s very much a regional or single health system-based phenomenon right now. But I think it will continue to gain traction.
Telemedicine is largely a technology-enabled service. We have had some great strides forward in that. In fact, we are working with some of our current hospitals on a telemedicine component for labor and delivery, where we can have a single physician sitting in a room who can intervene in strips that are non-reassuring throughout the entire health system. Those non-reassuring strips are being automatically identified based on specific parameters that have been programmed into our software.
This is the kind of leverage you get when you start employing clinical analytics and decision support systems, where we can identify strips that have certain non-reassuring patterns and immediately present them to a physician who might be 50 or 100 miles away for intervention for a safety net.
That’s something that is exclusive to PeriGen. It requires the ability to interpret that fetal strip and every component on that fetal strip in real time. For us, it’s a significant step forward for our technical capability to be able to provide that. It’s great for a lot of these health systems that are struggling to create leverage on their clinical base where there is a shortage of docs.
Are you doing anything with analytics using perinatal data?
Yes. We are building out analytics tools that look at specific key factors, key metrics, that physicians are trying to look at in aggregate. How often are babies in a Category III labor versus Category II labor? How often are you titrating oxytocin when you’re seeing negative signs? How often is it a uterine tachysystole?
I call our solution little data. We know a lot of factors that we can track. We are able to put them into reports for our physicians so they can continue to improve their protocols.
They can also train their staff a bit more with feedback that’s very immediate. If you can sit with a nurse and say, "More than any other nurse on the floor, you’ve had a higher degree of patients going into uterine tachysystole.” That’s really effective feedback for that nurse to get. It helps customize her perspective a little bit in terms of how she’s practicing medicine or how that floor might be practicing medicine.
Because we are collecting so much data off of the strip, we can parse that out into data warehouses and give a tremendous amount of feedback into how that labor and delivery and floor is operating.
Do you have any final thoughts?
A number of CIOs have come to the conclusion that we are creating safer hospitals to have babies. I’ll share an anecdote with you from HIMSS. One of our clients is a CIO at a fairly large regional health system out in the Pacific Northwest. He was telling some of the most senior executives at an EMR company , “You’ve got to talk to these guys from PeriGen. We just rolled them out and we now feel like we are the safest place to have a baby in the state.”
Two days after rolling us out, there was a case where they might ordinarily have gone to an emergency C-section, but because of the data they were getting off of our solution, they decided to hold on that for a bit of time. Thirty minutes later, the woman gave birth vaginally. The baby had perfectly fine Apgar scores. Emergency C-section averted. It’s that kind of application of technology that helps that clinical decision at the bedside that’s so important.
We’re seeing a lot more of that. We’re seeing not only clinicians understand our value of our solutions, but CIOs as well, feeling like they are now putting in systems that make their hospitals the safest place to have babies. That’s what we all want.
This platform has been remarkable for us. We doubled sales in 2014. We tripled sales in 2015. It’s clear that clinicians are understanding the impact of this solution. We’ve got a bunch of studies that show it.
It’s really been an exciting time for us. It’s such a great example of how decision support tools and analytics at the bedside can be deployed. It’s not conceptual at all. We’re at the bedside today giving a real picture of how the pregnancy is progressing and clinicians are benefiting from that. It’s been an exciting run for me personally.