GRAPEVINE, TEXAS — The competition among the four finalists was fierce, but in the end two sharks emerged victorious from a yearlong battle of innovation staged by AMDA — the Society for Post-Acute and Long-Term Care Medicine’s Innovation Workgroup, and showcased at the Annual Conference.
The final round of the Shark Tank competition pitted a wearable device that alerts caregivers about patient wandering, against communication and data gathering technology. The device, CareBand, earned the Judge’s Award. Patient Pattern, a risk assessment tool for frailty that can be used at the bedside, won the Audience Award from the audience members voting at the Innovation Forum presentation.
Innovation rarely happens in light bulb moments. It takes time, goals, and an understanding of the process of transformation. Chris Laxton, the Society’s executive director, said innovation is a process “where you can make meaningful change that creates new value. It’s a discipline, and it requires leadership. If it doesn’t have elements of process, meaningful change, and new value, then it isn’t innovation. It’s marketing.”
Arif Nazir, MD, CMD, chair of the Society’s Innovations Workgroup, explained the genesis of the Innovations Platform Advisory Committee (IPAC), comprising clinicians, entrepreneurs, and academicians who will promote the Society as an innovations leader in the PA/LTC setting. With innovation in mind, the committee developed a robust platform and created a set of goals: locate, develop, and adapt technology and other solutions to key nursing home clinician challenges; support and innovate new businesses that offer potential solutions to improve the quality of life for patients and residents; and promote a culture of innovation within the Society and the community. From there, the group created a problem statement: “What would be the best platform to promote Society innovation leaders in the PA/LTC setting?”
Enter the Shark Tank competition, modeled after the popular TV show. The IPAC panel created a website related to the competition, developed a judging process, and created a winning prize package that includes membership to the Society, a booth in the technology pavilion at the next annual conference, and the chance to judge the finalists next year. The competition began with 19 submissions in three categories — device, system, and technology — and then was whittled down to 12 that were selected for review; from there, four finalists were selected to make their pitch.
Each contestant had 5 minutes to make their case to the audience, then 3 minutes for questions and interaction with the audience and judges. The friendly interaction was intended not to be “sharkish, but more like ‘dolphinish,’” joked Cari Levy, MD, CMD, PhD, the new Society president. The winners were announced at Sunday’s General Session.
Patient Pattern. Patient Pattern is risk assessment software that allows the clinician to measure frailty at the bedside and track how the condition changes over time.
“Frailty is a great prognostication tool,” said Steven Buslovich, MD, a geriatrician and medical director. “The evidence that we have for frailty is disease-driven, not patient-driven, so we have really no guidelines that make sense for our patients at the bedside. We wanted to incorporate frailty as a validated predictable mathematical model.” The tool lets clinicians set expectations and align them with an individual’s risk of frailty, which allows them to manage patients according to their individual needs and offer palliative care sooner, if appropriate.
“I created software by us, for us, because I didn’t have the tools required to do my job well as a medical director in nursing homes, and I needed clinical data that I couldn’t find anywhere in a timely way to provide care to my patients,” said Dr. Buslovich, the cofounder and chief executive officer of Patient Pattern. “I assembled a team of technologists, geriatricians, experts from around the country, an advisory board, [nurse practitioners], administrators in facilities, policy, and research, to help create this software.”
The team’s premise was how to get the data that are already available from sources like the Minimum Data Set or the system’s SMART survey at the bedside to provide care, and how to use frailty as a validated, evidence-based tool — but “operationalized in a way that automates it from the data that’s already available in the facility.”
Patient Pattern has been validated in more than 700,000 patients and is in use in about 3,000 facilities nationwide, Dr. Buslovich said. “We’ve helped reduce hospitalizations, costs, mortality, insurance claims, and get a higher Star rating, so they value our work,” he added.
eMediCall. Clinical communication in PA/LTC can be overwhelming, according to Jackie Jones, CRNP, cofounder of eMediCall and its vice president of operations. Regulatory demands require that nurses make providers aware of every detail of their patients’ care. The current options to address communication challenges, including the SBAR (Situation, Background, Assessment, Recommendation) and INTERACT (Interventions to Reduce Acute Care Transfers) tools, help but can fall short, she said. “We don’t want to eliminate the communication between providers and nurses — we want to enhance it. But due to regulations in long-term care, there’s extensive amounts of communication back and forth,” she said.
eMediCall, a web-accessible, template-based call system, addresses these challenges. In the system, nurses are prompted to key in detailed information so when providers get calls, they know exactly what’s going on with their patients. “There’s a running call log that documents everything that’s happening in the facility, and the providers and nurses have access to it. You can go back days, months, years, and see everything that’s happened to your patient in that facility,” she said. The data are stored in a HIPAA-compliant manner and encrypted in the cloud. Because the system is web-based, the data can be integrated into any electronic health record that allows it, she said.
“The nurse in the facility can choose options: FYI, call back within an hour, or emergency. The provider receives a text notification that alerts them to the urgency. The provider can then send back orders and also sign electronically if it’s a complete order,” she said. “An escalation system is built in. If the doctor misses a call, the system sends a reminder call. The nurses and provider see the reminder call.”
FYIs are “held” in the system for a brief time overnight, and they have to either be acknowledged or answered, and orders are sent back to the nurse.
A tracking system lets anyone with a user ID and password into the system to view and track calls. “Are they frequent enough? Too frequent? Do they contain appropriate information? Are they appropriately labeled as emergency? The [director of nursing] and administrator/educator can track these calls and use them to teach nurses,” she said.
The system helps providers better manage their time by delineating what calls are most important, she said. By allowing nurses to input all their FYIs at one time, the system lets them spend more time doing what’s important: patient care.
eMediCall is currently installed in 100 buildings and is being used by 500 providers. “Nobody has opted out,” she said, noting that the system has never had an instance in which a call did not reach its intended recipient.
TriageTRACE. Anirudh Ashok called TriageTRACE a “cheat sheet” for the bedside nurse to help them “think like a physician” during a change in condition. TriageTRACE provides point-of-care-based, closed-loop communication to allow nurses, physicians, and facility administrators to observe changes in conditions and follow appropriate care paths to make informed decisions for minimizing hospital readmissions in skilled nursing facilities.
“We need to be able to predict what can go wrong with a patient,” said Mr. Ashok, a product manager with the company. “The system helps nurses overcome the ‘fight or flight’ response when they see a change of condition, by guiding them through the steps necessary to accurately assess the patient. Information falls through the cracks when there’s a change in shift or a change of doctor, and that’s what we want to improve.”
TriageTRACE works on cell phones, tablets, and other electronic platforms. After the nurse performs the assessment, the system creates the SBAR document, which gets instantly sent to the physician’s phone. There is no need to log in to another device (like a desktop computer), and the receiving physician will know which nurse sent the note.
This point-of-care system reduces the turnaround and response time from the physician, Mr. Ashok said, adding that it also reduces caregiver stress by eliminating the time off shift that nurses spend to transition the information to the next shift.
CareBand. Wandering affects more than 60% of the 5.5 million seniors in the country with dementia, said Adam Sobol, the founder and chief executive officer of CareBand. “This behavior leads them to nursing homes, and into locked units that limit dignity, and lead to quicker decline,” he said. The confusion of being in a new environment with the potential for hospitalizations due to falls makes the risk even worse for these patients.
CareBand, a wearable, watch-like device, was designed to eliminate injuries and deaths due to wandering, said Mr. Sobol. CareBand provides 24/7 realtime patient location information, both indoor and outdoor, up to 3 miles around the facility and without the need for a cellular or Wi-Fi connection. A nurse call button is on the top of band. “It tracks behavior and activity to look for early-changing conditions,” he said. “We tried to build it to provide as much dignity as possible, to look good and feel good.
“Since 2016, we’ve had tremendous progress. We’re currently testing in three environments: in an assisted living [center], a nursing community, and a community based-pilot, with about 40 devices being used now. This summer we’re going to iterate the product, make some changes, and manufacture 1,000 units and sell those to existing partners as well as to early adopters,” Mr. Sobol said.
The device has a long-life battery and is the only such device that provides clinical insights, Sobol noted. The data CareBand accrues are protected by three levels of encryption built into the device. A lock on the device requires two hands to take it on and off, which necessitates a caregiver’s assistance.
The projected cost of the CareBand system, while high, could be considered a bargain if it reduces hospitalizations and costs due to falls. “We built it to be as affordable as possible to help as many people as possible. There are three main costs: installation, device cost, and software ongoing. For a typical 60-bed facility it’s about $15,000 to install, map, and do all the training; $300 for each device to last 5 years, and a $6,000 fee per year for the data and analytics for the entire facility,” he said. The company is still modeling price points for different usage environments.
The IPAC considered the Shark Tank competition a great success and looks forward to offering this platform to give future innovators exposure and support throughout the year.
Carey Cowles is the managing editor of Caring for the Ages.