How CipherHealth built a best-in-class patient-rounding tool

Sometimes an entrepreneur sets out to solve one problem, but winds up with the winning solution for another.

That's what happened to Alexander Hejnosz, who launched CipherHealth in 2009 along with co-founders Randy Cheung and Zach Silverzweig. Their initial goal was to build a “big data” company focused on preventing hospital readmissions, where excessive rates can now result in losing up to 3% of Medicare revenue.

“When we first raised money, it was around the idea of large data analytics,” Hejnosz said. “The initial concept was to analyze readmissions, like figuring out why a patient would go into Mount Sinai and later be re-admitted to NYU—basically studying readmission patterns in New York City.”

After scoping out possible ideas for about five months, Hejnosz and his colleagues hit a brick wall. They soon realized that health systems had little interest in sharing their patient information with CipherHealth or each other. And without data, the startup's original concept couldn't move forward.

“Our problem was that we couldn't get our hands on the data, so we thought, let's create technology where we're creating our own robust data set,” he said. “In effect, we ended up becoming a big data company focused on how to make the patient experience better.”

After being in incubation mode for several months, the New York-based company decided to pivot towards creating software designed to improve patient satisfaction and engagement. The team started with Voice, a program that calls or texts patients given post-discharge follow-up instructions to identify those most at risk of an adverse event.

“We realized we had been doing a great job in collecting data from patients after discharge, so let's move upstream to communicate with them effectively while they're still in the hospital,” Hejnosz said.

They had stumbled on a pressing problem for most hospitals. Poor patient satisfaction ratings can have a major impact on hospital revenue under the Center for Medicare and Medcaid's value-based purchasing program, which penalizes or rewards hospitals up to 2% of revenue based on a composite quality score—a quarter of which is determined by patient satisfaction.

Since the results of the paper or telephone surveys with discharged patients aren't known for weeks or even months, many hospitals have determined that real-time monitoring of patient experiences—and then acting on that knowledge—is the key to improving their patient satisfaction scores.

Recognizing administrators and clinicians needed an easy way to capture data and send messages for immediate rectification of problems, CipherHealth in 2010 first thought about a bedside, tablet-based questionnaire that patients could fill out themselves. But because many patients had trouble using the technology, the application morphed into Orchid, a digital rounding application which enables nurses and other hospital staff to use a tablet, smartphone, or computer to efficiently collect patient experience data themselves.

“We used to describe Orchid as our nurse rounding tool, but after putting in the hands of so many nurses, doctors and administrators, we quickly came to realize that the use cases and scope were significantly broader than that,” Hejnosz said. “We think of it now as a point-of-care data collection tool.”

Orchid streamlines the rounding process by removing manual, time-consuming steps — for instance, jotting down notes with pen and paper or transferring written data into a computer spreadsheet. Instead, nurses can tap patients' responses to a customizable rounding script on a touchscreen, and the data are automatically logged into individual records unique to each patient. On-demand reports can display trends so that patient preferences can be documented over time.

Also, real-time alerts ensure that issues are addressed quickly, with certain responses triggering a pre-programmed notification that goes to another department. For instance, if a patient answers “poor” to a bathroom cleanliness question, the nurse can take a photo with the Orchid application, which sends an automated message to the hospital's environmental services department.

“Orchid is a tablet-based survey tool that nurses are using to collect information from patients, but what's really powerful about it isn't just the surveying aspect,” said Timothy Schulte, director of provider solutions at Avia, which screens innovative start-up companies for major hospital systems. “It's Orchid's ability to identify issues and automatically triage them to the appropriate person or group.”

By highlighting these features, CipherHealth has successfully differentiated itself from other technology companies offering similar tools. In 2014, it won a “Shark Tank”-like event in front of health system executives looking for a winning technology that would help them tackle their common challenge of improving real-time patient satisfaction.

CipherHealth's Orchid rose above the pack because of its easy-to-understand interface and seamless integration into hospital workflow, Schulte said. “The rounding process was already in place for many of these health systems, so implementing Orchid wasn't a huge change to workflow,” he said.

CipherHealth begins its engagement with any health system with a questionnaire that determines whether it is willing to implement real-time patient monitoring through rounding. Using that knowledge, they can then decide the best way to use Orchid and integrate it into its workflow.

Providence Health & Services in the Pacific Northwest and OSF HealthCare in Illinois are among the systems that have used CipherHealth's tool. “When you've got a system like Providence Health & Services, and Swedish Health within that, they had been rounding in the past and were adept at it,” said Hejnosz. “For those kinds of folks, deployment can actually happen quite quickly—they understand the benefits, and so getting those folks onboard with Orchid is quite simple.”

On the other hand, trying to persuade health systems that aren't used to rounding to use an unfamiliar tool like Orchid can prove challenging. In those cases, Hejnosz takes the approach of first identifying a couple of key users that can act as champions for change.

In part five, learn why bigger systems need easily shared solutions.

Meeri Kim is a freelance healthcare writer based in Los Angeles.