...which is strongly suggestive, that the VA's problem with Cerner implementation? It's coming a lot more from the VA, than…
Clement Goehrs, MD, MSc, MPH is co-founder and CEO of Synapse Medicine of Bordeaux, Nouvelle-Aquitaine, France.
Tell me about yourself and the company.
I’m a public health physician. I have been involved in a lot of research. I was a researcher in biomedical informatics, first in France and then at Stanford University. I returned to Europe, where I co-founded Synapse Medicine with another physician. Synapse is improving medication safety and helping clinicians achieve medication success. We help physicians, pharmacists, nurses, and patients with prescribing, deciding what drugs to take, and how to take them. We provide reliable information on drugs.
How does your offering improve on existing technologies such as as point-of-care drug information, clinical decision support, and order checking?
As a physician and in talking with my colleagues, we were aware of clinical decision support inside the EHR and various resources online. But we came to the conclusion that for a good number of people, it was frustrating to use these tools. They aren’t always up to date, sometimes you have to use several different tools to get your answer, and it can be too time-consuming. As a result, it was not really used. If you ask a pharmacist or physician if they love the clinical decision support tools that they have, such as those found in their EHR, most of them will answer that they don’t use them and aren’t even opening them because there are too many alerts and too many things in the EHR.
We want to improve on that in two ways. The first improvement concerns the content itself, by providing information that is always up to date. We do this using algorithms. It’s using a lot of natural language processing that goes through all the guidelines from the FDA continually, every day and every night. The algorithm processes all the documentation regarding how you should use the drugs and builds a huge knowledge base regarding drugs that is always up to date. The content part ensures that you always have the best-in-class information and that it is always up to date.
The second way that we are trying to improve these tools is by displaying this information in a good way, not just a long list. We have developed software and components are used as standalone products or plugged directly inside the EHR to display drug-drug interactions, side effects, and contraindications in a way that is super easy for the physician or the pharmacist to understand.
How does the EHR integration work?
We are Europe based and we have completed a number of integrations with basically every major EHR. We see a similar context for EHR integration in the US and Europe, where a number of leaders say they want to interoperate with startups, but in reality, we see a lot of resistance. You have to find ways to do deals and motivate them to do their part and do the interoperability work.
We are just entering the US market. We are working with Vanderbilt University Medical Center and Brigham and Women’s Hospital in Boston. We are in the process of integrating with Epic, but for the moment, just inside these two hospitals.
The study description says that pharmacists on rounding teams will use the system. What does that look like and what results do the organizations hope to achieve?
The use case is for very complex patients. Let’s take a patient who is on 15 drugs for several comorbidities. You want to do a complex medication reconciliation. It’s complex because this patient has a regimen of 15 drugs and you want to determine what the best possible medication history is. You need to check for side effects, drug-drug interactions, and contraindications.
As a pharmacist using our tools, you would log into our app on synapse-medicine.com. You are getting all the information on the patient and the medication history from Epic, because there is interoperability. You are going to do first a complex medication reconciliation, where you will have a visual representation of the different sources of information regarding the patient’s current drug regimen.
Let’s say you have one set of information from Surescripts and another set of information from the main caregiver or the nurse. Using the software, you can compare the different sources of truth for this patient’s medication history. As the pharmacist, you’re going to choose which source of truth you want to follow for each drug, and you are going to complete the best possible medication history. Then you are going to go through a complete pharmaceutical analysis. Our tool is going to give you insights regarding drug interactions, managing side effects, and managing contraindications, so that you can write the best possible prescription for this patient at discharge. Lastly, you are going to be able to automatically generate the necessary documentation for the patient and their care team as a record of their treatment, along with any changes that were made and why.
Your website mentions the platform’s use in telehealth. How would those providers use it?
That’s a cool story. Three years ago in Europe, just before COVID-19, there was a growing number of telehealth companies. Basically every single one of them was building their own EHR for their providers. A number of them came to us saying, we want to improve our EHR. We want to have a best-in-class clinical decision support system for prescriptions. We want to improve patient safety inside the EHR.
These were young companies that didn’t have the resources to integrate drug databases and for build the complete system that they needed. We came to the conclusion that we would be able to help them by creating components. It’s not just an API, but rather like an API with a UI on top of that. You write one line of code and you can import them inside your tool. We created an entire library of components. We have, for example, a drug-drug interaction component, a side effect component, and a number of other front-end prescribing tools.
The value proposition here is for a young telehealth company or a more mature one that wants to improve the EHR for their provider. You can easily integrate this library of components, and in less than one or two days, you can improve the entire clinical decision process for prescribing by adding the components that your prescribers need. That’s how we partner with telehealth companies. In Europe, we are the leader in prescription assistance for telemedicine and telehealth.
Can it support pharmacovigilance and reviewing a patient’s profile for opportunities to de-prescribe?
Our objective is to save as much time as possible for the provider in the case of a 12- or 15-drug regimen. This means also to consider de-prescribing. Our business model is constructed so that we are not incentivized based on the number of prescriptions, because we want to advocate for fewer prescriptions and de-prescribing.
When it comes to pharmacovigilance, we are trying to close the loop . You and I have been talking about prescribing, dispensing drugs, and reconciling medications, so let’s talk about patient information and that last item of pharmacovigilance. In that way, you’re closing the loop for the entire pathway of a drug after commercialization. In terms of pharmacovigilance, we’ve been working with the French FDA on a tool that saves time for the people in charge of assessing side effect reports for their level of severity and classifying the side effects.
This solution is driven by the same technology. It uses natural language processing. It can interpret the side effect reports very efficiently. For example, let’s say a patient says, “I took acetaminophen this morning and then I felt lightheaded.” The tool will understand everything that is reported and will recognize the side effects to make a first assessment of the severity of the case. Subsequently, a pharmacist and a physician can just say, “We think the technology made a good assessment” or they can correct what the system has been doing.
This is already up and running in France nationwide for all declarations of side effects. Every single side effect reported in France goes through our system first, and the initial assessment is made by Synapse.
How are you working with First Databank?
We are just starting our collaboration. We will see how it evolves. There is a lot of movement in this space, and First Databank has been trying to do more and more. We have a long history of partnering with commercial drug databases, which may be surprising, but we help them find new ways to ensure that their content is always up to date. On the Synapse Medicine side, we use this commercial database as a gold standard for our algorithm to think, “This is the truth.”
What opportunities and challenges do you see in increasing your presence in the US market?
The key for the US market will be EHR integration. The strategic path that we have chosen for Synapse is to offer a tool that has already been proven clinically. In Europe, our tools are used to prescribe, to do medication reconciliation, and to manage complex regimens like oral chemotherapy. We are directly inside the workflow, which is super important because in healthcare, nobody wants to add another tool. If you are outside the workflow, you will have low adoption and will probably end up with no adoption and die. Or, you do the hard work needed to be inside the workflow.
To do this, it is necessary to focus on EHR integration, and integration with the systems that are already in place. This is definitely difficult. It takes time, but then once integrated, you are there for the long term. This is exactly what we are working on right now with a number of EHRs that are being used for prescribing.