Innovative Zigbee-Based RFID Tech Enhances Hospital Efficiency and ROI
Discover how AwarePoint's Zigbee-based RFID technology improves hospital efficiency, reduces costs, and enhances patient care through real-time asset tracking and management.
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Jay Deady Eliminating Bottlenecks in Healthcare
Added on 09/27/2024
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Speaker 1: The first presentation was related to a solution that's going to go to market in 2012, very innovative certainly. The second presentation was a $48 billion entity applying its process and capabilities to healthcare in a forum and now here's a where point myself. So, and we're in between. So, this is our third year of launch. We are a venture backed company. Full disclosure, two of the folks that were up here if you sat through the VC session are actually either on my board or their firms are on my board, so probably how I ended up being invited to this I would imagine. And the business that AwarePoint, excuse me, completely independent, okay, I appreciate that. And AwarePoint is in the business of enterprise awareness within hospitals and we use a Zigbee based technology platform with a software layer to create that. That technology platform is an active RFID technology with a set of software solutions that are all focused on the premise or service of taking cost out of the system, making it highly more efficient and allowing for better throughput through the healthcare system, principally the acute care environment. From the standpoint of enterprise awareness, talking about that definition, we talk about tracking, managing, and alerting based on those assets and locations and interactions of caregivers, patients, and high value assets. The problem that where the solution to starts here, first at the macro level that you've heard a lot about today, whether it's the reduction in reimbursement, it's some type of health reform that's going to go through, it's the accountable care organization initiative, it is the reduction of reimbursement associated with hospital acquired conditions or the never events. Ultimately what that points to is today in healthcare, principally US based, which I'll come back to my market sizing in a second and talk about since 90% of the US market is not penetrated, that's where we are focused principally right now, but we do have the NHS as a client, I must add, so we are over in the UK as well. Essentially you have to do more with less because your patient volumes are going to increase, you will not be able to get additional skilled staff, and you will not be able to get additional money for resources to take care of those increased patient volumes. That's the thesis of where we come in. If you look at the market drivers, we drive a very hard ROI. We have a monthly service price for our technology, software, and service, and our average install time to get going on our base level asset management and tracking is less than a month based on the type of technology we use versus some of our competitors. Since we're only asking people to pay us on a monthly basis, the average client that we have is in a positive cash flow standpoint within three to five months of what is an average of a three to five year contract. The way we do that is to look at these mobile assets that clients have such as smart pumps, wheelchairs, vents, other high value assets. The average US hospital owns 100% more on average than what is required to take care of their patient populations. On top of that 100% more, they rent even more. In one case, when we acquired a client, University of California, San Diego, what they found was actually one of their assets had been stolen and was being rented back to them because they found it as a rental product in their own hospital. CFO really did not care for that very much. During the sales process, we go after their hard rental charges. We actually go through their major asset counts and design the ROI, not with industry averages, not even with our client averages, but with the real information straight from that very specific institution. Yes, at some point, and in three or four cases, we've been willing to go at risk associated with that ROI, sharing in the benefit. Particularly, we did that with Kaiser. After we proved to the regional controller of the southern region of California of Kaiser that the technology would work and they would get the ROI, she did the math and determined that she was going to pay four and a half times based on the sharing of the benefits of what she could have bought the system from us originally, requested a renegotiation. We did that. They ended up paying us two and a half times what they could have bought the system originally for us. She's our biggest advocate within Kaiser today. We're up to 14 hospitals in Kaiser negotiating for the 19 and extending across the US to the mid-Atlantic as well. That's a relationship that turned out quite well. Once the hard ROI associated with right sizing, the mobile assets, and the appropriate utilization of those assets, which has a lot of variability, it starts to impact clinical and patient care. The average nurse spends at least an hour a day looking for, believe it or not, the patient or equipment and assets. Our technology can massively reduce that time period. That is a contributing factor in the US to 30% of all scheduled surgeries not starting on time. Reimbursement today is driving everything out of the hospital and appropriately so in many cases to a higher client satisfaction or patient satisfaction area in a lower cost setting of care. What that's resulting in is the average acuity of the patient in the hospital or their level of sickness or severity is increasing as the hospital is becoming more appropriately an escalated area for more sophisticated care settings or diseases, which means that the throughput related to the operating room is much more vital than ever before as well as the ED because 60 to 70% of everyone who is admitted to the hospital today on average in the US comes through the emergency department. The impacts and clogs in those two areas cause extreme problems with patient satisfaction, which as you heard today now is going to impact reimbursement. It's also causing big ROI issues associated with hospitals as well. How does our technology work? We use a Zigbee-based technology. For those of you that have a residence here in California, Pacific Gas and Electric is deploying Zigbee smart meters, which they use the TI chip set just like we do. We love that because our cost keeps coming down every month of the sourcing of that product. We have 14 patents that allow us to use Zigbee as a location-based algorithm solution that no one else can use, and those are global patents. Johnson Controls and others are using Zigbee technology for purposes of measuring water, electricity, and other types of usage. Essentially, what you have is a series of form factors that we can tag. Those form factors and tags can be sterilizable. We can do temp tags for refrigerators. Then you have wearable tags for different types of form factors for patients, for staff members, et cetera. They are battery-powered and emit every 8 to 12 seconds their location. They are picked up by, to the next right, a sensor. That sensor is plugged into an outlet. That's why we can do installs in less than 30 days when most of our competitors who are using either Wi-Fi or, you know, ultrasound technologies, as well as a couple of others, they're taking 6 to 8 months to do implementations because they're tripling their current Wi-Fi gear. They're pulling repeaters. They're doing construction. They're ripping through walls. They're going through ceilings. We plug stuff into an outlet. It's a lot simpler. They connect to a bridge. The bridge goes to an appliance. The appliance goes over the Internet to our network operating center, or a NOC, where we manage actively this entire infrastructure down to the individual asset level remotely. And it also is, if they lose the Internet connection, the entire system can run locally without relying on having to go back to that back-end system, okay? So automated workflow and documentation. So I spent 21, 22 years in the electronic medical records industry, and most people assume that if you get to physician order entry where they are deploying, ordering the best practice of care with real-time clinical decision support, and then you have a series of documented tasks that are the best practice of how to take care of that patient, that magically this entire throughput and workflow situation will just automatically happen. And, in fact, it doesn't. And it doesn't because just because you're ordering the right thing and then you're going to administer or perform tasks of the right nature, the location of that patient, having the right equipment, and having the right skilled caregivers in order to execute on all those tasks are assumed by those systems to be all in place. And, in fact, in any hospital in the world, that is not the case. So what we have is a series of workflow and content software solutions that leverage that underlying knowledge of both location and interaction of caregiver-patient and high-value assets and harness that to make, you know, workflow far more efficient. We also can attack helping to reduce hospital-acquired conditions. I realize this is after lunch, but nevertheless. So 20 to 25 percent of those assets that are shared, they're mobile, which means they're shared between patients, are not appropriately cleaned or sterilized between patients, including vents that people breathe into, smart pumps, and other assets. That is a big, big issue. And we can track that because with our Zigbee technology, we can track the location of that asset down to two and a half square feet and the interaction of that asset with the patient and with the caregiver. So if somebody takes that asset out of a patient room, does not put it through the cleaning process, it is stored or hidden, which is the normal practice, in a closet to be made available for when that next patient comes in, and they grab it and bring it into a new patient room, we can shoot an alert real-time either to that caregiver or to that floor notifying that that is a non-cleaned item that is about to go into a new patient. That's how we can start to attack clinical workflow. The way it should work is they take it out of that patient room, they put it into where the dirty equipment is supposed to go, which, by the way, today, central service walks around just kind of checking, and it's a big medical system like Stanford, there's probably a few hundred places that they're just going to do rounds and check to see if there happens to be any dirty equipment there. What we can do is par level so that area knows that after it gets above three dirty items, send a notification automatically to central service to come up and get them instead of just walking around the hospital looking to see if there's some dirty stuff somewhere. And then in the same standpoint, if a new patient comes in, the nurse goes to get a clean smart pump from that location, let's say there's normally eight or ten of them, and now suddenly there's three, automatically sends the note to central service, bring me up five more because we're down to a par level of three, that caregiver starts to have confidence that the system's going to work, that the items they need to take care of the patient are actually there, and as you heard about today, evidently this morning, and I missed it, but a psychologist kind of talked about if you want to change behavior and you want people to do the right thing, you have to make it easier. So today, for that caregiver, it's easier for them to take that asset and hide it in a closet or somewhere else so it's available to them because they don't have confidence that where they're supposed to go and do the right thing, that there's going to be anything there when they need it for the next patient. When they start to get the confidence that the system works, they change their behavior because now it's easier for them to do the right thing than to hide the stuff and do the wrong thing. So that's one of the first things we see in terms of that reaction. So why now? People talk to me, if you have these reference accounts and if you're getting this type of adoption, if there's a hard ROI, why doesn't everybody have one of these? Well, five years ago or so, some technology companies, mainly Wi-Fi folks that are no longer in the industry, got a bit over their skis. They started to really promise capabilities that were not executed on and in general, the entire global market took a step back and said, look, this seems to have a lot of promise but if you're only tracking at 10 to 15 feet, you can kind of find something sort of in some place in the hospital but you can't get to room level. You can't track the interactions of the caregivers and the patients and that type of thing. So the whole system sort of took a little bit of a wait and see attitude of can this technology ever meet the real capabilities of what the promise holds and the reality is both ourselves being a wear point as well as others in the marketplace and we have technology and software competitors. On the technology side, there are companies like AeroScout and Sentrac that are technology competitors. On the software side, there's this little company called GE that I've competed against for 17 years and done just fine but they bought a company called Agility and so they're one of my top software competitors. So from that standpoint, we're starting to get awareness both domestically and globally that the technology has matured to a point that the outcomes that can be expected absolutely can be achieved. And so to talk about a few of them, these are U.S. based outcomes but I won't go through all of them but you look at some of the results and the ROIs and the throughput. At the end of the day, if you deploy these solutions in the OR and the ED and you can, for instance in the OR, on average get anywhere from 19 to 40 more cases and it all depends on how your quality of throughput is today as to what the improvement opportunity is but if you're getting 19 to 40 more cases through that OR on a monthly basis, that is a substantial impact to the efficiency and bottom line of the hospital. If you're taking emergency care environments and you're making them 20 to 35% more efficient, that again has amazing throughput and ROI capabilities. If you are driving hard ROI associated with just an operating cost model versus an upfront capital model, which is not a good way for those of you who are thinking of particularly focusing on any type of U.S. acute care based solution whether it's medical device, IT, it doesn't matter. Some of the advice that Brian Roberts from Benrock gave in an earlier session which is you better make sure you are not competing for upfront capital. I could not reinforce that any stronger up here as advice. Going after an operating cost model and taking out costs in the system to drive the value for your solution is absolutely a requirement to gain market share. AwarePoint has gone from zero to we'll do 25 million in revenue this year, 35 million in bookings and our goal is to be up over 100 million in revenue over the next three years. The market size and I've had global responsibility as an executive of publicly traded companies in the medical imaging and in the HIT environments, pretty similar to what those environments are. Typically the rest of the global market equals the U.S. market and the rest of the global market is trailing by four to seven years the adoption of this technology. We do have clients in Melbourne, Australia, the NHS for two trusts just invested in the asset capability. We have a couple of sites in the Middle East and I'm in negotiations with Sing Health right now who is a client of mine and my last company as well. We will be doing global expansion. There is a global market there but again similar to medical imaging and HIT, that global market based on an acute care market segment is about equal to the U.S. market. From the enterprise value cycle to understand the adoption curve is you just start with tagging the assets and driving the ROI. First off the assets don't argue much when you stick a tag on them so it's not really very political and absolutely you cut out the rentals and that's phase one which we call trust, tracking rentals, utilization, shrinkage and temperature. That infrastructure of technology then can be used for improved clinical efficiencies in the departmental areas of the OR, the ED and then heading upstream into affecting enterprise workflows like discharge management and frankly if you think about it, items that we haven't even come up with yet so we're going to start to enable our clients and others to actually create content and workflows and publish into a public library what other options might be when you think about the interactions and knowledge and location of assets, patients and caregivers. There's a lot of workflows that certainly we haven't thought of yet that could drive some high value from that standpoint. For purposes of timing I'll move through this pretty fast. Essentially we have a .NET SQL architecture with embedded workflow engines and we run on a native Microsoft stack which allows us quite honestly and particularly in the US healthcare market to have great success. And then relative to clients that are adopting this so kind of a frankly a who's who in healthcare domestically, clients that are starting to scale this across their enterprise that we have agreements with and for the past couple of years so the UC system, San Diego and San Francisco alive, UCLA is in the process of going live right now. I talked about Kaiser, Ascension Health, Walter Reed, we have DOD and VA sites as well and really starting to get wider adoption. And frankly one of our next steps that we need to do is to start to focus similar to the electronic medical record market did on what is the packaging and the pricing and the adoption model for the average community hospital where many of these folks already have their meaningful use EMR system set, they're very comfortable with it and they're looking for additional technologies like ours that can make them more efficient, increase their throughput, help them address some of the challenges, the macro level that we talked about relative to cost containment and reimbursement. And today from a wear point standpoint we're up to in just less than three years of having commercialized this solution on both the technology and the software side, 85 healthcare organizations representing 133 hospital sites and we have 158,000 assets that we're actually monitoring today and under contract is about 250,000 which will be by the end of this year, driving some meaningful return on investment in making the healthcare system more efficient. Thank you.

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