"Covid-19 is the 9/11 moment for healthcare"

Will O’Connor, M.D., Chief Medical Information Officer, TigerConnect in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast –“Covid-19 is the 9/11 moment for healthcare”

PP: Hello, everyone, and welcome back to my podcast. Today’s special guest is Will O’Connor, Chief Medical Information Officer of TigerConnect. Will, tell us a little bit about who TigerConnect is and what marketplace need you are serving?

WC: We are one of the several providers in the clinical collaboration and communication space. And mostly we work with providers, some big and some small. We have about 6000 customers all over the world now, mostly in the United States. At the core, we provide a communications solution that removes barriers, removes friction, and is designed to let health care practitioners and other people involved in health care, including patients, communicate easier, faster, better, more accurately.

PP: You are privately held, are you VC funded or mostly privately closely held. What’s the structure of your company?

WC: We’re privately held and it’s a pretty small investment group.

PP: What has been your company’s observations on healthcare enterprises, specifically health systems, big challenges in responding to this pandemic? They went overnight from running the business as usual to something they were completely unprepared for. What did you guys see first when you started seeing health systems confront this problem?

WC: To some degree, we saw this coming a little back. Singapore is a very large customer of ours. And as you know, they were impacted by Covid-19 several weeks before the United States and really had their surge before that. And since our customer, we were able to see their message volumes and a big spike in the volumes. We knew how serious this was, based on how they were communicating. It really gave us some good hints at what we needed to do here to help prepare our overall messages. To go to 4 million messages to 5 million messages, it took us about one hundred and sixty days and that happened late last year. We went from 5 million messages to 6 million messages growth in just 10 days. So, we saw this tremendous growth starting in Singapore and now that has translated across the United States as well. A lot of our big customers like Geisinger, St. Luke’s, Temple, New Mexico, RJW Barnabas have really seen the numbers of messages they are sending go up and up. I think what you’re seeing is just more open communication and constant communication related to Covid-19 and a lot of these places are trying to use our system to coordinate. One of our CIOs just told me yesterday that we’re in every single workflow that they have, and she could not imagine what they would be doing without us. So, we’ve seen communication really regarded now as something premium and really needed. This was not always the case. CIOs have definitely had to flex and to be ready for that. I think it was a wakeup call for lots of people including CIOs. I think this is sort of become our 9/11 moment for healthcare. What we’re seeing in the last two to three weeks is 10 to 15 years of advancement in telehealth both in policy and in practice. Folks are now able to get reimbursed for this. And we’re seeing a massive uptick. I think Geisinger has seen a 500 percent increase in telehealth visits. Another big issue CIOs are having that have been moving a lot of people to become remote workers, like Geisinger. They saw more than a doubling number of remote workers that they, almost overnight, had to figure out how to support and move all those people out of the hospital and move them home. So that was another big thing for them.

PP: John Kravitz, who is the CIO of Geisinger, was a guest on this podcast. Through these podcast series, I am essentially taking a look at how technology is enabling the response to the pandemic in the short term and also looking at how this is going to play out in the new normal, whatever that new normal may be. Everyone that I’ve talked to, they are saying any virtual care models has seen a dramatic spike in volume. Whether it is telehealth, synchronous video consults, e-visits, symptom triaging tools, all of the above. I talked to Providence Health as well, and they have seen the same kind of spike. So, most of the messaging that you’re talking about is it between caregivers, or caregivers to patients, or is a combination of the two?

WC: It’s a combination of the two. But I think the preponderance of the communication increase has been on the clinical side with clinician to clinician trying to coordinate care for patients and coordinate it quickly. We’ve seen an uptick on the patient side as well. And there’s a lot of use cases that we’ve seen really come into play overnight that we would not even have even imagined just a month ago or so. Certainly, we’ve seen an uptick in virtual care and that’s where we’ve seen an increase in the patient communication volumes. Even though HIPAA has been partially waived, you are still responsible for a breach. So, we’ve seen a premium placed on being able to communicate with a patient in a HIPAA compliant way that you can still report on. But keeping that patient at home and keeping them out of that physical location so that you can save the care givers for the patients. This has done a couple of things; it has certainly helped organizations address the surge that they’re seeing. They still have all the normal patients that need care. Excluding the amount of flu patients, which has dropped off the chart and has essentially been replaced by Covid-19 patients. But you’re still seeing all heart failure patients, diabetics, hypertensives, many of whom can be managed remotely. So, I think there is a permanent sea change that we will see. It saves time, money, and you can deliver a great quality of care. But being able to address the surge in patients has been a big use case that we’ve seen that has really spiked the volumes. I think the other big one we’ve seen right away is using the application to keep onsite workers safe and being able to connect staff and then being able to connect patients and staff and do so in a virtual way where now the practitioner doesn’t necessarily have to enter the patient room. They can have a secure conversation, voice, video or text with the patient from a location. They could be in the hallway or in their office 50 miles away giving care to that patient. And it’s become exceptionally important. Every doctor takes an oath when we graduated medical school and then becomes a doctor. At the beginning of that oath is first do no harm. That includes us too, and our families. The lack of personal protective equipment that is out there and some of the problems that we’ve had, being able to keep practitioners, nurses, physicians, respiratory therapist safe and giving them the ability to interact with a patient but be outside their room in a sterile area, where the patient is not and keep that patient in isolation. I can’t think of anything more important that we’re doing. Henry Ford in Detroit came out today, seven hundred and thirty-four workers have already been infected with Covid-19. And we’re just getting started. So, I can’t think of a more critical issue for a CIO than enabling their practitioners the ability to provide telehealth and real-time virtual care.

PP: I imagine that the communication tool that you’re referring to is a simple app of some kind, and you use that to have secure communication between caregivers as well as between caregivers and their patients. How does any communication tool like this integrate with a backend system like an electronic health service system? I imagine there is more value than just communication. There’s value in analyzing the nature of the communication to see whether there is some additional insight that you can get. You mentioned in Singapore, I have friends in Singapore and they’ve done some interesting things, including the contact tracer, which is a phenomenal tool that has really helped them keep a lid on their infections because several thousand people have downloaded them. Is there a utility to this messaging platform that is more than just a communication tool is something that can provide you with a indicator of something that is going to happen or provide additional insight? Let’s say, a pattern in one hospital that you could then abstract and maybe make available to another hospital. Is there any aspect of that you are working on?

WC: It is an application., we developed natively on both iOS as well as Android. But the beauty of it is you don’t need the app. If you’re communicating with someone who is using TigerConnect and you don’t have the app, it simply sends you an SMS with a secure link. You click on that link and you immediately open into a browser window where you have a very similar experience as if you have the app itself. It reduces the amount of friction we’ve seen as an industry. I would say a relative lack of success with patient portals that are relatively heavy and hard to use requires the end-user to have some sort of internet connection and a phone. Reducing that amount of friction has helped tremendously. But most of the end-users we have who use it every day will have the application that they download in their phone. As far as patterns, we do have a full reporting suite that comes along with the application and that can be used for reporting on things like the amount of telehealth someone is providing, links to conversations. But within hospitals we can really help them both inside the hospital and then out in the community as we can see the amount of communication going on. We, of course, can’t see the messages. Those are all secure, but we can see the numbers of them. And then folks that have our service and report on those and see different things like this department’s not really using the application or they’re not connecting or sending as many messages as we would expect to this other department. It allows them to dig into those data and perhaps they are maybe a department within the hospital that’s not connected the right way. Maybe their end users aren’t fully deployed on it for different things like that. So, we can spot some patterns and help people get more utility out of it. And then out in the community as well, we can check referral patterns. The applications can see if there are messages going within their network or there’s a lot of messages going outside that network and they’re losing patients and losing referrals elsewhere. We can see that as well. So, there’s a lot of data that you can tease out of the application that becomes helpful as far as spotting patterns as well as spotting different utilization jumps or lack thereof within current clients that we have.

PP: The referral tracking is a very interesting use case. You can very clearly see where it’s going, and act as required. So, your product is a communication platform. You don’t really see the actual content of the communication. So, you are like cloud providers. You’re hosting the data, but you don’t really see what the data and so you maintain privacy of the patient. So, I imagine the hospital has the data. They can see the communication, where does it go. Are they storing it or is it transient data? What is happening to all this communication?

WC: It’s HIPAA compliant. We’re also high trust certified. We’ve got the highest level of security available. It’s encrypted on the device itself within an app container and in transit as well. We cannot as a company see any of the messages at all going back and forth. A healthcare system typically takes two options. First, they may just store the metadata and keep the metadata and let the conversations fade into the ether. We have the patterns on the ephemeral text message. And I would say about half of our clients choose to keep the messages somewhere between 15 and 30 days. And then they’re gone forever. There is no way to retrieve them after that. The other half of our clients choose to either do integration with an EMR and actually store the conversations within the context of the electronic medical record or the more preferred method for them is to store those conversations and archive them. We provide an archiving service as well for them. If they like they can archive them themselves, or they can archive them with us as well. We can keep them for up to 50 years.

PP: So, they’re probably not digging deep into the text right now, except maybe to look at recent messages to understand the here and now and what to do about it. But maybe in the future some insight that comes out of analyzing these vast amounts of text data, especially if they’re going to be combined in some way with clinical notes in the electronic health record system. So, it’s kind of TBD, as I understand.

WC: There’s a lot that goes back and forth and it’s hard to know even if you’re talking to a patient. Beginning of that conversation, may be very friendly, very colloquial, not something you would want to store in the medical records. There’s a lot of picking and choosing what you’re storing. Then within the data itself there may be some useful things in there. But we’ve really shied away from that in order to maintain the highest level of privacy we can. What we’ve done to leverage the network for medical information, best practices, a couple of weeks ago we launched a physician only network which was by invitation. It was open to physicians within our client base as well as physicians outside of our client base and establishing a network where we could connect verified physicians to comment on and share information on the best and the latest treatments available for Covid-19. And we’ve seen a very large usage of that network so far. As far as I know its one-of-its-kind. We’ve been sort of comparing it to some of the Facebook physician groups that are out there where you have hundreds of thousands of folks involved and you see lots of political content that’s not sourced. Information is coming at us so quickly nowadays, as healthcare practitioners, we felt we wanted a place where folks could go to the field to share the best and the latest around what has come out. So, we’re taking time to curate some high-quality content and then sharing it amongst those physicians. In a way, we are mining our network in different way. We’re still leaving all the messages that go back and forth private, but we’re allowing folks now to go on there and do something a little bit different than we have before but share high-quality content across the United States. And we’re really seeing some nice up to date and quality content being shared because this is still such a new disease for us. Information that’s a week old is often dated. So, we wanted to provide a place where they could keep up to date.

PP: We’re coming up to the close of our time here. How do you see all this changing the way healthcare is delivered in the future? And what does a new normal look like to whenever that may come about?

WC: I hope that this represents a sea change. As I said earlier, I think this is the 9/11 moment for healthcare. While this has been crushing in some respects for us, I think that a lot of good is going to come out of this. We’re going to see a lot of these changes be permanent. I think Medicare in the past has demonstrated, if they can find a way to save money, they’ll do it. And I think the changes that we’ve made to telehealth are going to end up saving them a lot of money and being a lot more efficient. That is one of the things I would like to see permanently change. And being able to have people receive care from within their homes rather than dragging them into an office for a checkup that could have been performed remotely. That is a change that hopefully will not go away, because I think we’re going to be in this for a while here. As far as we’re going to see some improvement. But the desire to keep patients away from your physical facility and away from your office is going to be something that’s with us for a long time. Hopefully sticking around permanently and one that’s really here to stay. I think the other one is going to be healthcare systems establishing a communication network. We’re in the CC&C that is Clinical, Collaboration and Communication space. I think most people would be surprised at how relatively undeveloped the entire space is. I would still say that most providers, especially big providers, do not have a good handle on the breadth of their network and can’t communicate to all their physicians or all of their practitioners in a meaningful and connected way. We see patchwork communication systems all over the place where they might be using six or seven different applications as well as a couple of different EMRs trying to communicate. And what we found is most people end up not using that at all and either going to an application like ours or simply resorting to a text message or I-message something not secure or not trackable and not reportable and really not good for healthcare or for the patients. I think you’ll see a big uptick after this is all over in these clinical communication and collaboration platforms. I hope that’s one that’s here to stay as well.

PP: We are suddenly seeing a lot of money coming in to support this. We saw the FCC announced A $200 million investment the other day, which is exclusively for telehealth. And then, a lot of the money that comes out of the fiscal relief package, 100 billion or so has been set aside for hospitals and providers. As providers get used to virtual care as more of the norm than the exception, a lot of this money is going to go towards strengthening these technologies and modifying the treatment protocols and care protocols and so on, so forth just to get on board with the notion of delivering care virtually as a matter of routine and only for the exceptions, you bring people into the hospital. So, it’s going to be interesting times for sure. First of all, congratulations, you guys seem to be in the right place at the right time, no matter what the circumstances may have been. And wish you and your team all the best. And thank you for joining us today on this podcast Will.

WC: Thanks Paddy for having me on and best of luck to you as well.

PP: Thank you very much!

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Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.