Hospitals partner with industry to co-create digital tools

As cases of the novel coronavirus swept across Florida this spring, leaders at a local health system knew they needed to streamline how they monitored employees affected by the disease.

It was a significant undertaking to manually track not only which employees needed to isolate at home after being exposed or experiencing COVID-19 symptoms, but also where the employees were in that process and when they were ready to come back to work, said Gina Mangus, vice president of strategy and business development at Flagler Health+.

“Doing all that manually was very time-intensive,” she said.

Meanwhile, nearby businesses were asking leaders from the St. Augustine, Fla.-based health system for advice on how to keep their own employees safe while re-opening.

Flagler executives realized they could build a COVID-19 back-to-work tool on top of a project they had started working on just about a year ago—a patient-engagement app, dubbed Flagler Health+ Anywhere.

Flagler partnered with digital health company Healthfully for the app. But instead of just becoming a customer of Healthfully, Flagler invested in the company, with an agreement that the organizations would work together to build on an existing patient engagement platform.

More hospitals are opting to co-develop products with technology companies, rather than purchasing them out-of-the-box. While the process can reap significant rewards in the form of more tailored products, it also comes with pitfalls—hospitals need to select the right partner, as well as commit resources, including their own time and money.

Tom Kiesau, leader of the digital transformation unit at the Chartis Group, a healthcare advisory firm, said he’s noticed an uptick in these co-development partnerships in recent years, likely in part because healthcare organizations have felt frustrated by off-the-shelf products’ inability to fit into their workflows as they wanted.

“Health systems have been burned, frankly, in a lot of cases over the last several decades,” Kiesau said. He pointed to software systems—such as electronic health record systems—that may work as stand-alone products but have trouble interoperating with other tools.

By partnering with a technology company, hospitals can “make sure that the software product is actually delivering the solution to the discrete problem that they’re experiencing,” he said.

Flagler CEO Jason Barrett said the health system had been thinking about launching a patient-engagement app for years, but couldn’t find anything on the market that linked up to the hospital setting, remote care and consumer health the way they wanted.

Flagler’s leadership team also didn’t want to develop an app alone. “We know this is not our core,” Barrett said of software development. “Rather than trying to do something internally and failing gloriously, we thought, ‘There are people in the market who are market leaders in doing this type of work.’ ”

The resulting app allows patients to schedule physician visits, conduct telemedicine visits, pay medical bills, complete paperwork and even connect with other patients who have similar conditions, such as diabetes.

And Flagler’s feedback now helps to inform adjustments for Healthfully’s app broadly—not just in its own Flagler Health+ Anywhere version, which is why the health system was able to develop a scalable COVID-19 back-to-work tool so quickly.

Flagler and Healthfully collaborated to build Healthfully @ Work, an app that provides employees with COVID-19 education, daily symptom screening, telemedicine visits and other services to help manage bringing them back to work, on top of the patient-engagement program.

In addition to deploying the COVID-19 back-to-work app at Flagler, Healthfully is selling it to other U.S. businesses for a monthly subscription based on a business’ number of employees, beginning at $7 per employee per month.

Health systems can purchase and customize the app with their own branding.

Flagler receives a percentage of revenue from sales to area employers who purchase its version of the app, called HealthySite+.

Flagler holds a 30% equity stake in Healthfully.

Working with industry to build and refine products is a major part of Aurora, Colo.-based UCHealth’s innovation strategy. That said, the health system is selective: More than 600 companies have approached UCHealth’s innovation center in the past three years, but it only partners with “very, very few” of them, said Dr. Richard Zane, UCHealth’s chief innovation officer.

He stressed that building a tool isn’t the first approach his team will try after identifying a problem; they’ll first see what’s generally available in the market. But if there’s a problem UCHealth can’t seem to solve with available technology, it’ll start searching for partners to build a solution collaboratively. “What’s important is being able to identify the problem that you’re trying to fix,” Zane said. It’s not creating new technology for the sake of development.

Selecting a partner is a delicate process. A company needs to have experience, but it’s also important for companies to approach Zane’s team with a willingness to learn about an identified pain point at UCHealth it can help with, rather than assuming the company already knows how to fix it, he said.

One of the companies UCHealth invested in, BioIntelliSense, had developed a sticker designed to be worn on a patient’s chest, which monitors their vital signs from home. The product, dubbed the BioSticker, attracted the health system’s interest, since it had been looking for a medical-grade, but affordable, product to support remote monitoring of patients that could prompt alerts if a condition was growing worse.

BioIntelliSense, founded in summer 2018, developed the BioSticker before working with UCHealth. But the company tapped UCHealth to act as a “beta test site” for the device, helping to refine the service and provide feedback into how to incorporate it into patient care, said Dr. James Mault, founder and CEO at BioIntelliSense.

That includes looking into how to present patient data to clinicians, as well as considerations like whether it’s better to give patients the BioSticker at the hospital or mail it to them at home.

UCHealth also played a role in the BioSticker’s Food and Drug Administration clearance, which the company received late last year, by helping with a human factors study to submit to the agency. “They’re really the clinical proving ground,” Mault said of UCHealth.

Baystate Health in Springfield, Mass., launched its digital innovation team, TechSpring, in 2014 to facilitate partnerships with tech companies. TechSpring mainly works with mid- to late-stage startups and established companies, rather than early-stage startups. Those partners have the opportunity to build, test and validate products at Baystate, with support from the TechSpring team.

In one project, TechSpring worked with startup Praxify Technologies—which has since been acquired by Athena- health—to refine a mobile app that links up to the health system’s EHR, essentially providing a quick way for physicians to access medical records while rounding, on call or otherwise not at their desktop.

The goal was to create an app that improved EHR usability and made workflow more convenient for physicians. Baystate began letting physicians download the app in 2018, and many have welcomed the option, said Joel Vengco, Baystate’s chief information officer and founder of TechSpring. He said about 60% of physicians have downloaded the app.

Baystate was not an investor in Praxify. In fact, Baystate doesn’t provide funding for projects that are part of TechSpring—instead, companies pay TechSpring for project management services and access to the health system.

In exchange for its work with Praxify, Baystate also received a less expensive software license, “commensurate to our sweat investment,” Vengco said. Working with outside partners helps health systems stay competitive and “keep their view on the horizon,” according to Vengco. That’s particularly the case as health systems see more nontraditional players—such as tech and retail companies—trying to disrupt the healthcare industry.

“We can get so caught up in what’s happening right now, and the fires that we’re dealing with right now, that sometimes we forget to look up at the horizon,” Vengco said of healthcare organizations. “That’s when nontraditional players and competitors start to come in to our space and innovate and start to take our market.”

When selecting a partner, startups and more established companies offer different benefits. Startups are often more nimble and able to move more quickly, less bogged down by bureaucracy. On the other hand, a more mature company will likely need less hand-holding, and could have more experience with the industry and these types of partnerships. “It’s a sliding scale,” said Allan Cohen, a partner in law firm Nixon Peabody’s healthcare group.

Encompass Health, a Birmingham, Ala.-based network of post-acute care facilities, in 2015 opted to partner with its EHR vendor, well-established Cerner Corp., as part of an effort to reduce unplanned transfers to acute-care facilities. Together, the organizations created an algorithm that flags patients who are trending toward needing a transfer so clinicians can intervene.

Cerner’s population health and data science groups analyzed health records at Encompass to identify data points that were strongly associated with patient deterioration and future transfers. Encompass clinicians then reviewed their findings to draw out a few dozen clinical factors—such as vital signs and missed therapies—that were most relevant to putting a patient at risk.

Armed with that information, Cerner’s team developed an algorithm, dubbed Reducing Acute Care Transfer, or ReACT. It’s been integrated into Encompass’ EHR, alerting care teams about patients’ transfer risks from within the software system.

Encompass spent nearly a year with Cerner creating an algorithm to pilot, and another year to roll out the algorithm across the system, said Encompass CIO Rusty Yeager.

Then in 2017, the organizations launched the Post-Acute Innovation Center, a joint effort to continue collaboratively developing clinical decision support tools for Encompass’ facilities. That can include retooling capabilities originally developed for acute-care providers to better fit the needs of the post-acute market, as well as building capabilities from the ground up.

Encompass and Cerner both put resources and “multimillion-dollar commitments per year” toward funding the center, said David Klementz, chief strategy and development officer at Encompass. Under the agreement with Encompass, Cerner has the option to make tools developed through the Post-Acute Innovation Center available to other customers.

That said, the tools are developed specifically for Encompass, and Cerner hasn’t presented the tools to others yet, said Mike Liggett, a senior director and client accountable executive at Cerner. “We expect that we will have clients who will have interest in some of these tools that we’re developing with Encompass,” he said. “I don’t think Encompass Health had any interest in getting into the software business, so they’re going to leave that up to us.”

To be successful, innovation needs to be approached with intention. That’s everything from selecting a partner to setting concrete goals. Health system executives who have had success in these partnerships stressed establishing a charter before kicking off a project and outlining the scope and who’s responsible for what tasks, as well as expected deliverables and timelines.

“It has to be exceedingly clear what each party is contributing,” the Chartis Group’s Kiesau said. It’s important to remember that innovation is like any other project—it needs a plan, said Baystate’s Vengco. “While innovation sounds like an improvisational type of arrangement, it really isn’t,” he said. “It has discrete steps. It has deliberate tasks.”