James Lakes, MSc is president of Mednition.
Tell me about yourself and the company.
Mednition works with healthcare leaders and providers who are looking to improve the clinical, financial, and operational performance of their emergency departments. The ED is the front door for about 40% and up to 60% of all their inpatient volume.
We believe in the concept of catching things early, whether that be high-risk conditions or sepsis. Catching the problem early, putting people on the right care track, and then leading to better outcomes from clinical, operational, and financial standpoints.
I spent almost 30 years of my career working in health IT, primarily at big platform companies like Microsoft, VMware, and Salesforce. Over the last four or five years, I’ve focused more on startups, which led me to Mednition.
How is AI for nurses and operations philosophically different from physician-focused AI?
No ill intent towards any of our clinical leaders, but when we’re investing in innovation, in the provider space in particular, the focus is typically physicians. These are your highest-cost employees. They have high benefit, whether that be thoracic surgeons or orthopedic surgeons.
We often see that because EDs have traditionally been considered a loss or cost center for most providers, there hasn’t been a lot of investment in innovation for ED nurses and ED departments in general. The nurses in triage ED are the first people to meet and assess the patient. Helping them get more accurate within their acuity setting to send them on a path with providers leads to better outcomes across the board.
Upwards of 55% to 60% of clinical staff are nurses. We believe that helping them is just as important as helping physicians.
How do nurses choose that path or make triage decisions?
We based our software on the ESI model, the Emergency Severity Index, which is sponsored and built by the Emergency Nurses Association. This is a scale from one to five, five being the least sensitive or least urgent, with one being the most urgent. About 85% of all ED nurses in the country are trained on that model. We based our model on that, and we have a deep research partnership with ENA to improve our model to make sure that we’re taking best practice into consideration.
Nurses spend more time with patients and have intuition about outcomes that aren’t found in charts. How do you incorporate that?
A nurse has two to four minutes in that triage moment with the patient. They are interviewing, getting their primary complaint, taking their vitals, and observing that patient to make a decision on what care path this individual should be on. In that time, they interview you and observe you, but they really don’t have time to check all of your clinical history, the accuracy of what you tell them about the medications you take, or what conditions you have had previously.
Our product is called Kate, which is the name of the daughter of one of our co-founders. She showed up in ED with an inaccurate acuity setting and was in serious condition. She survived and is now a young adult. The founders wanted to prevent other families from going through that.
Kate goes to work in the background. The nurse does their observation. They set their acuity setting. Kate looks at the patient’s health, their history, their medication lists, all those things. She compares that to millions of cases in our model and comes back with an acuity setting only if she differs with the nurse. If not, she doesn’t send anything, which means that she’s not disturbing the nurse unnecessarily.
The only time the acuity does not matter is when Kate suspects sepsis. Then she will automatically send an alert regardless of the acuity setting of the nurse. Sepsis is the biggest killer in hospital settings and testing, getting antibiotics in them, and acting quickly, leads to better outcomes. That time to action is important.
Executives in some health systems influence software decisions more than frontline clinicians. How do you sell the product?
Like any startup, you work early on product-market fit. Next you figure out what your target audience is.
We know, and can see in our engagements, that ED nurses who are on the front line, their managers, and their directors are our biggest champions. However, often they are not the ones who make the final decision or have the budget. We understand the nurses deeply and work with them collaboratively to take that to their leadership. We highlight the issues, how Kate addresses them, and then build the case for the ROI from a clinical, operations, and finance perspective to justify the investment.
We’re getting better and better at it. The nurses are getting better and better at advocating for themselves with our support. But we do see that it’s a broad stakeholder sales engagement. It requires having champions at the front lines, but then making sure that the leaders at the top who are making the decisions where those critical investments go are aware of the impact of Kate.
What is the value proposition that you present to the CEO, CFO, or CIO?
I’ll use an example of a provider that we worked with recently. Within six months of going live, Kate actually paid for herself. They tracked a number of metrics. One was left without being seen. Patients who show up in the ED will leave if they wait too long, and that can lead to worse outcomes. The might have to come back, or it could be lost revenue because they go someplace else.
Length of stay is also a big issue. This organization was able to not only lower their left without being seen rate by 1%, but also lowered their length of stay by 23 minutes in less than six months.
On the financial side, because they had better accuracy and better documentation, they saw $400,000 of additional financial revenue because they had fewer down charges and fewer denials from payers.
How well do health systems integrate what happens in the ED with opportunities for long-term patient engagement or revenue generation?
The market is getting better at recognizing the value of getting things right at your front door and the downstream impact of that. It’s definitely a shift in mindset and a shift in focus.
How does Kate integrate with other health system platforms?
We integrate with the EHR, specifically Epic and Cerner. We are working on a couple of others, such as Meditech and Medhost.
The good thing about Kate is that she’s working in the background. She alerts or notifies nurses only when she has to. It’s not obtrusive to them. We talk a lot about alert fatigue for clinicians. We have made it a distinct focus of our company to not be a notification alert problem for our clinicians.
How much evidence or background do you provide along with the recommendation?
Kate provides a message. The nurse says it’s a three, Kate thinks it’s a two, and she delivers why she believes it’s a two. The nurse then has the option. We don’t make the decision for the nurses. They have the option to change the acuity setting to a two.
Typically when they do that, it’s because Kate has identified something they may have missed, or they may have made an error. Then they correct that error or they improve the documentation when they do the up-triage, as we call it, that then drives the decision, which leads to better outcomes downstream.
When they don’t act, they typically document why, which leads to feedback to us. We have a clinical team of physicians and nurses, some of the top in the space, who review those cases and feedback from the nurses. We use that to generate cases and continuously improve our model.
Having come from big tech companies, what are their advantages and disadvantages in their involvement with health technology?
Those companies have incredible R&D teams, incredible market reach, and incredible flexibility in those platforms that provide a tremendous amount of value. But when you start to get down into deeply research-oriented, specific use cases, the specific clinical decision support, they will struggle, because they are trying to build a big platform to then fit into various scenarios in healthcare. Whereas when you’re a startup and you’re focused on that specific problem, you can get very, very good at it.
I’m a former athlete. It’s like thinking about Steph Curry. He’s a marksman, maybe the best marksman we’ve ever seen. He’s a specialist. He’s deeply talented at that one thing. If I tried to make him an all-around player where he was going to be the best defender, the best rebounder, the best passer, and all those other things, he may not be able to be world class across all them all. I might dilute his talent. It doesn’t mean that there aren’t any players that can do that, Michael Jordan being one of them, but there aren’t many, and that’s why they stand out.
If I have a person, system, or solution that is really targeted and can be world class at that, that is the benefit of the startups. The platform companies can bring broader value across broader spectrums, but they may not be as specific as you need for things like sepsis identification or triage acuity.
What is the present state of the healthcare buying market from the viewpoint of a startup that is trying to scale, and how will it look in a year or two?
We’re all concerned about what will happen with changes in Medicaid and any reductions in Medicare expenditures. What does it mean? In our particular space of EDs, a recent Vizient report says that they anticipate higher volumes in the ED because more and more people who lose coverage will use the ED as a form of primary care. When they use that as primary care, they typically wait until their state is dire or even worse. Acuity and severity will become more difficult and intense for our EDs.
If you have increasing volume and increasingly complex cases, it becomes a recipe for potential chaos in our EDs. We are hoping to help them alleviate some of that by being proactive with something like Kate.
What is the company’s strategy over the next three or four years?
We will have a sepsis breakthrough designation for our Kate sepsis model in early 2026. We are submitting for final approval from the FDA. We hope to have that by the end of Q1. I think we will be the only software product with FDA approval for sepsis early detection.
We are including more and more models. We have a partnership with a leading children’s hospital and research center for building triage models for people under one year old. We are working all the way down to infants, both for triage and sepsis.
Another model that we’re working on is continuous monitoring for sepsis post-triage. You’ll see some of that come out in early 2026.
We will continue to add models. Our focus will primarily be early detection of any high-risk patient condition.
The biggest thing is being an advocate for our ED departments and the ED leaders out there, They are sometimes not the first line of thought for for our healthcare leaders. If you talk to a CEO of the health system, they can often tell you who all the cardiac thoracic surgeons are and who their family members are, because that’s a high revenue focus area for them. But if you bring that attention to their ED leaders or ED departments, that’s not their focus and they don’t have that same familiarity. We try to be an advocate for that space because that front line sometimes gets forgotten.
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I'll bite on the disagreement side. 25+ years in EHR implementation, sales, and support. First, regarding the decision effect. Sure,…