Health Pilots

The Impact of Patient-Centered Communication

Episode Summary

(A previous series available on SoundCloud) Welcome to Health Pilots, where we interview people pursuing new solutions for health care in low-income communities. You’ll hear about new technologies and workflows, human-centered design, and how to collaboratively innovate. We talk with Sims Preston, an experienced executive with an extensive background in technology and health care. Prior to joining Polyglot, Sims spent fourteen years as a lawyer, both in private practice and as in-house counsel. Sims was drawn to Polyglot by the clarity of its mission and by its capacity to quickly and significantly benefit groups that have been underserved by the health care system.

Episode Transcription

To get started it would be really good to hear a little about yourself and your journey on your way to joining Polyglot.

I m a lawyer by training. I practiced law for 15 years or so. First in private practice then I went in house many years ago. My focus initially was on intellectual property – soft IP trademarks, copyrights not so much patent prosecution. I m not a patent attorney. But I always wanted to start my own business and I went in house with a client that was a software company and worked with them for a number of years. I eventually took a job with another company that was a pharmaceutical research organization.

Polyglot was founded by Dr. Charles Lee. He s an internist, also a medical informatist, and first generation Korean immigrant. So he s someone who is really really sensitized to language barriers to effective communication and healthcare. He had set about developing these sorts of technology based solutions to these issues back around 2000. By the time I had begun actively looking for an opportunity, Chuck s latest grant from the NIH had just been completed and he didn t have anything to top up the coffers after that grant and I sort of came into the picture at just the right time.

He and I partnered up and I invested some of my own money and we hit the ground running. What I saw with Chuck was that he had developed this whole portfolio of amazing solutions all directed at addressing health literacy and language barriers but his latest product called Meducation was the product that captivated me and that s the product we ve spent the last five years essentially since I joined the company focusing on developing the business around. So that s sort of my background and also a little bit about where Polyglot came from.

So tell us more about Polyglot Solutions and Meducation in particular from a patient s perspective. What does it do?

Well, from a patient s perspective what Meducation does is pretty straightforward. It delivers medication instructions that you can actually understand as a patient. In fact, its so straightforward, its so simple, it sort of sounds like, what s the big deal? And maybe that s just an indictment of healthcare that something as basic as understanding your medication is an innovation in this industry. I joke around that in every other industry its taken for granted that communicating well with the consumers of your goods and services is something that you ought to do well, but in healthcare we talk about how important it is for patients to really understand how to use Warfarin for example. If they take it incorrectly it can have adverse effects.

It seems like it s a big insight. The point is that patients can t follow their medication instructions if they literally can t understand them.

And about 1/3rd of patients are what the Institute of Medicine calls low health literate, meaning they have so much trouble understanding medical information that they can t really manage their own healthcare appropriately. In that context for years and years and years, patients have been getting their medication instructions like probably your audience members are familiar with, stapled to the outside of the pill bag in 6pt font written at a sophomore college reading level, and pretty much invariably in English. For all of those folks that don t speak or read English, for all those folks who don t read at a 12th grade reading level or higher (don t understand what hypertension means in plain language). For all of those people what Meducation does is it provides instructions and information that is clear and that they can follow. So in a nutshell that s really what it does from a patient s perspective.

That s awesome. I would include myself in that list of patients. I don t take a lot of medications now but if I ever do if I have an acute injury or something I am flabbergasted by the confusion that arises in my head about what I should really be doing.

Yeah its really remarkable. One of the inspirations for the product was Dr. Chuck Lee s own experience of getting sick and being given a prescription for an inhaler. It was sort of a new type of inhaler a new mechanism. And here he is, he s a doc, he s an MD, he was a national library medicine fellow in medical informatics at Duke and UNC. He read the package, he read the instructions and he still took the medicine incorrectly.

So he thought if I am having this experience what are our patients experiencing. Then he went and visited his grandmother out in LA who really never spoke English very well and saw all of her pill bottles lined up on the kitchen counter and they all had pieces of paper taped to them with Korean characters handwritten on them and he asked her what that was all about. She said that she would get her prescriptions filled and was unable to have any type of dialogue with the pharmacist. What is this for? How do you use it? So she would get the prescription and take it back to her apartment complex and have a good Samaritan a neighbor translate it for her. So these weren t medically trained people and they d just write this down on a piece of paper and she d tape it to the bottle. So those two experiences were two of the key inspirations for the Meducation product.

Perfect examples. So tell us a little bit about Meducation from the health providers point of view. How do they use it?

Well its interesting when I jumped into the business like so many new entrepreneurs I was pretty naïve. I thought Chuck has built this product under a grant from the NIH, its fully built. In fact he had back to your question about Chuck s efforts to commercialize his inventions. He had actually secured a few customers. So I looked at and thought he has a built product, he has some market validation, it serves a real need, its something I can really get behind. And so I thought what the company was really confronting was just a sales and marketing challenge.

But the fact was that it was a stand alone product. So if you wanted to use it as a nurse, or doctor, or pharmacist, it was a stand alone web application basically. So you would log into your accounts with a user name and password and you would build the content you wanted to provide to the patient. So you d enter the drug name into a lookup field and then you d enter information about the prescription you know is it 1 pill twice a day by mouth? You could also enter other information this was more optional – indication, side effects. You d enter that information and it would build this tailored content for the patient and would allow the provider to then immediately flip that into different languages.

At the time I joined the company I think we had 12 languages we supported. We now support 22. So it all seemed really great but what I didn t appreciate that that process I just descried was sort of a non-starter for most healthcare providers and pharmacists because its too much of a work flow interruption. So what we have spent much of the last five years doing is refining the product so that it integrates with an EMR or in the case of the pharmacist with the pharmacy management system.

So we built an API – an application programming interface. So the way the provider or pharmacist would access the product and use it typically we would spend a little time with them to see where they want to access it in their existing workflow. But it seems like it always ends up to be the case a hospital for example wants to access it when they are ready to discharge a patient after all the medications have been reconciled. They want to provide the patient with a very easy to understand list of their discharge medications potentially in their language if they don t speak English. And so they will hit a button or some other triggering mechanism in the interface and that will trigger our API. Via the API, we consume the patient s medication regimen.

Each element/drug in that last will be represented by the drug name, some kind of code like an NDC code or a RXnorm code these are standard forms for representing drugs. Then also the so called SIG the instruction the prescriber has written (i.e. one pill twice a day by mouth or as 1POBID). Its SIG! I learned this I don t know how long it took me to learn it. Apparently there s some Latin word from signature and SIG is an abbreviation of that. And so the thing the doctor writes or scrawls on his prescription pad that s a SIG. They use this kind of pigeon Latin abbreviation thing (1QID, 1 POBID).

All of this is a shorthand they use to communicate the information. We ll consume all that data and then essentially what we are doing is were automatically entering the data that had to be entered manually with the stand alone version in the past. Its now being entered automatically through our API. And then we return this interface element its like a little window that might pop up in an Iframe or floating over the EMR. It depends really on the pharmacist and the EMR they support.

At that point the provider can decide how much or how little content they want to provide to the patient. Its often just printed and given to them in paper format. Many of our patients don t have great connectivity they don t have computers, some of them don t have smartphones. It turns paper is one of the best ways to provide them information. We do support other ways of delivering the information of course. So that s really what it means from a providers standpoint from a use perspective.

If somebody wants to adopt this or pilot this in their own institution, what does it take to implement it?

We are integrated with a number of EMRs and pharmacy management systems and I d be happy to provide a complete list to anyone who is interested. Off the top of my head the major ones on the EMR side are Allscripts, Cerner, Cerner Millenium, Greenway (that s ambulatory), Athena Health (we re actually looking for our first site to deploy with we ve integrated but we need a first beta site) and then NextGen and ECW. With those we didn t actually do through the EMR vendor itself, we went through a third party system integrator.

And then there s a whole number of pharmacy systems as well like Mckesson, Enterprises RX, Guardian RX, Pioneer RX, Cerner Etropy (we ve integrated with all of them). All of these cases were we ve directly integrated with the vendor its really very simple.

In the cases where we ve integrated with a third party system integrator there may be a minimal effort involved in doing a deployment. Where we haven t done anything it can be frankly more difficult and more complicated. That is the hardest barrier we have of things separating our solution from our customers and their patients is the really the EMR.

Sometimes it just comes down to a question of getting the EMR vendors attention their willingness to work with you. They can have a lot on their plate, with meaningful use and so forth so that can be the single biggest barrier. But we can get it done. Many cases when it comes to a safety net we are in discussion with one in Texas right now a community health center that s running GE Centricity.

And we have offered to absorb the costs of the integration for them because its an opportunity for us to get our first case of GE Centricity integration under our belt. Anyone who is running an EMR system I haven t mentioned, that may be a good thing because you may get to use the product for free for a period of time.

So let s use that as a way to dive into a section where we talk about more specifically about your work with the innovation hubs and the safety net in California. How did that come about originally?

Chuck s been in this world of providing different solutions for patients that are underserved. There s a lot of overlap between the patients that our solutions have benefited primarily and the patients that are the focus of the groups like the California Healthcare Foundation and the Center for Care Innovations.

So Chuck knew some folks at the California Healthcare Foundation already, we had some dialogue with them. But then in 2011 or 2012 I attended a Health 2.0 conference where I met with Margaret Laws who is one of the people with the California Healthcare Foundation. I did a presentation for her and that lead to trying to remember exactly how this panned out. It was basically through that connection and Health 2.0, the Center for Care Innovations invited folks to pitch to them at next years Health 2.0 and I made the cut and did a presentation.

They decided they wanted to take a risk with us and do some pilots. That would have been in 2013. It took awhile just to get off the ground contractually so we didn t start thinking about this in earnest until last year or they weren t really in a place they could work with us until last year. Then we decided to pursue pilots in three of their innovation hubs specifically San Mateo Medical Center, Petaluma Health Center, and a number of clinics within the San Francisco Department of Public Health. We are now in test environments at two of those sites San Mateo and Petaluma. We actually haven t rolled out yet at San Francisco at all. They are waiting to see how it goes at the other two before they proceed further. We believe we will go into production potentially this week or next at San Mateo in particular.

Tell us you said you were in pilot how does that work when somebody pilots your solution or somebody else s solution what does that entail essentially for those not familiar with technology and communications?

Yeah. Pilots there s no hard and fast definition. Its something similar to a beta test or a trial of a new technology. And often during a pilot what might distinguish it you as the customer establish the metrics you want to apply to the use of the product. Your decision whether or not to purchase it for a full fledged commercial license is contingent upon how well it performs against those metrics.

We ve worked with CCI to develop a list of metrics and we will be held to those when we are in production at these three sites. The pilot is typically either free or minimal cost just to cover costs. There is no real profit in it. The idea is the technology provider is getting valuable feedback and potentially getting a customer in the long run if you perform well. It s a very collaborative process you are partnering in what can be almost like a co-development arrangement depending on how much back and forth there is. We have spent a fair amount of time talking to folks at Petaluma talking about the work flow design. Like where do they want it to appear on their EMR and doing a screen share and via gotomeeting and actually watching a doctor navigate through their various screens in their EMR and pausing and saying yeah it would be really great if it appeared in this menu. And then we have to go back and figure out how to make that happen.

There is a lot of back and fourth. That s one reason why it has taken a pretty long time to get to production.

That s right, but that’s co-development there isn t anything better when you have a willing developer or vendor and institution looking to help shape it. Ultimately it should look really familiar to new customers that said wow you really put thought into how this might role into an EMR.

That feedback if I say its invaluable, I m probably not overstating it. The reality is that work flow and the degree to which you are or aren t interrupting work flow is almost the most important issue whether your intervention is going to succeed. The most important is frankly whether to trust is a real problem that the doctors and pharmacists really care about. But assuming you ve passed that threshold, the question is whether they can use it in a way that is consistent with their existing work flow because they don t have any time, they are under so much pressure, many require that you establish click counts (you have to stay under a number of click counts). Its really pretty intense. For anyone who s working on a healthcare solution that might be listening to this podcast, keep that in mind. Its really important. I was not aware of it when I jumped into this.

I would say its one of the things we are putting together an infographic on how to pilot technology and safety net. One of the key sections is mapping the work flow prior to the implementation so that the vendor knows how you actually do your work. Walk through that workflow with them to ask where would your solution impact this, help it, eliminate redundant steps, etc etc. Really imagine that workflow with the new solution long before you start trying to implement it so you are on the same page and use the implementation to make it even better.

Yeah. That s exactly right.

Can you highlight some of the things you ve learned in one of these pilots say, with San Mateo?

Yeah. There s a whole lot of stuff we ve learned actually. I would say in some ways what we just discussed was the most important. There are more detailed points around the particular value or not of some of the functionality. Our product does quite a bit more than what I described initially. It does what I described initially but in different ways. We don t just provide written content to patients, we also provide video demonstration of proper medication use and technique. And so feedback on these different kinds of functionality how valuable are they to different kinds of users? The pilots are giving us access to ambulatory primarily doctors and nurses to a lesser extent in these 3 CCI pilots. But the pharmacists who we deal with in other context they value very different functionality. So it allows us to approach the development and ongoing refinement of our product in a much more valuable way. That has been really really valuable.

Can you talk a little bit more generally about the opportunity for technology in the safety net and health care per say. Is it just fancy new technology that everyone needs to adopt or why does it matter?

I remember going to a conference hosted at the Federal level by some folks from Health and Human Services. And they had a guy get on stage and it was really remarkable because the whole audience was filled with entrepreneurs all these people developing new health care apps. This guy got up there and said, You know health care is really broken and you hear that a lot and that s the good news because the bar is really low.

So technology in general painted with a very broad brush, one of its great virtues that it promises is increased efficiency. I think one of the things that distinguishes health care as an industry is how inefficient it has been up until now. So if you had to identify one thing it would be the promise of health care to make patients synercare more efficient. By efficient I don t just mean the efficient allocation of financial resources, I mean the efficient allocation of time and what they have to fuss with. We have talked with nurses who ve shared stories about the difficulty they ve had explaining to patients and pharmacists how to use an inhaler. Just to use an example.

And the ability to use one of our videos can just shave off a huge amount of time for someone like that. The other thing I ll say more specifically about the safety net one thing I ve discovered is that safety net providers and entrepreneurs are really kindred soles.

They aren t motivated by money (there s a stereotype of a startup founder being motivated by money) and in fact they are forced to be very nimble (often resource constrained), so they can make decisions very quickly, they re creative in the way they tackle many problems they deal with. So they are very much like entrepreneurs who are trying to build a business while selling and everybody is wearing every hat. So it can be really really refreshing to deal with a safety net provider, get on a call (this happened to me last week). I got on a call with a doctor, he was the one practitioner at the site, and I didn t eve have to show him my slides.

He said I want to give it a shot. Let s do it next week. That compared to the experience you have when you talk to a big health care system is a universe apart. Eighteen month sales cycles are typical in that environment. This safety net world allows you to move fast, to refine your product very quickly, and to get real time feedback and it s a tremendous win-win opportunity for entrepreneurs and folks trying to do this work for patients. I think its great.

Nice. So well stated. Its been my experience as well working with the safety net you have some of them that are so entrepreneurial, so willing to find new ways to care for their population because they have to do it in new ways and figure out new things. And the ones that are open versus the ones complaining every day they don t have any resources. It is exactly the entrepreneurs journey. What a great analogy.

Yeah. Its been a blast.

Thank you so much for spending time with us today. If people want to learn more about Meducation and Polyglot where do, they go?

Well they are welcome to contact me directly. I d love that. They can go to my website. My email is spreston at pgsi.com. My number is (919)-653-4398. You can also go to our website which is www.pgsi.com and there is a link there to ask for more information. You can also learn about our Meducation product and another product we are developing that s up there.

We d love to hear from you.

The post Polyglot’s Sims Preston shares the impact of patient-centered communication appeared first on CCI Innovation Hubs.