Monitoring in the Medical Home
This week I am talking to Tom Hale, MD, PhD, Chief Medical Officer at VirtuSense a company providing monitoring in healthcare settings for automated fall detection and is now adding biometrics sensors for broader insights and opportunities for intervention in the medical home. Tom’s early work found him heading up Mercy Medical group and helping steer the organization and physicians through the new era of managed care and implementing EMR and speech recognition technology.
We talk about the value technology brings to healthcare and the importance of data and relationships that must be in place for the technology to work so it can augment the practice of medicine. He was involved in the early success of telemedicine and virtual care at Mercy Health and launched the world’s first virtual care center.
We discuss the challenges in our current fee for service system and how some of the newer plans such as Medicare Advantage, ACO’s and MSSP’s are starting to improve the healthcare system all being accelerated by the COVID19 pandemic.
Technology is now offering new capabilities to solve problems in healthcare with VirtuSense systems taking data from LIDAR sensors in patients rooms and using algorithms processes large amounts of data to turn this into timely insights that can tell when a patient gets up or gets out of their bed or chair alerting staff 30-60 seconds beforehand, so they can meet the patient rather than finding them on the floor. This one problem alone costs Medicare $52 Billion each year.
Listen in to hear him talk about “Hales Economics” and where this technology is headed and the exciting addition of other sensors and more data and biometrics that can now be sent home with the patient offering reliable monitoring at home
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Raw Transcript
Nick van Terheyden
And today, I’m delighted to be joined by Dr. Tom Hale, he is the chief medical officer at virtue sense. Tom, thanks for joining me today.
Tom Hale
Nick, I’m really happy to be here, particularly to talk about some of my favorite topics and healthcare revolving around the technology aspects and how that can improve care.
Nick van Terheyden
Absolutely. So for the benefit of the listeners, as I always do, and tell everybody a little bit about your background, you’re not just a doctor, you’re actually a doctor, doctor, and share a little bit of how you got there and some of your sort of journey to that point, if you would.
Tom Hale
No, I appreciate that. Actually, it’s been very secure this one, which I guess most of us have a straight line in has not been. I got a PhD in pharmacology from St. Louis University, back in the 70s. And from there went on to medical school, board certified in internal medicine and started my own private practice. You know, it’s during that time that that was the onset of managed care. And it came to the realization that if physicians and caregivers didn’t band together, that we might not do well. And because we didn’t have the information basis that that the insurance companies had. So I became president of mercy Medical Group, which grew from rip roaring 17 physicians to actually 750 and was that President for 15 years, during that time, was asked, because I had big interest in, in technology actually, in electronic medical record. And you’d appreciate this, I actually had a group of physicians sitting in a room with Dragon speak on a laptop trying to do our notes that way, it was a total disaster at that time, back in the 90s. As you can imagine, as the speed of the computers couldn’t keep up and became the the the lead physician for our epic implementation of 44 hospitals in 2000, physicians, NASDAQ really cut my teeth in that technology and software business. It was during that time that I got a master’s in medical informatics. And the reason I did that, honestly, was that I didn’t know whether my IT people were telling me the truth or not, because I didn’t have any kind of basis for it. So I got the Master’s in medical informatics. And, and I will tell you afterwards, I still didn’t know, but they didn’t know I didn’t know. So I got a lot more truthful information from them, at that point in time, became the executive Medical Director for our Center for Innovation, which evolved into virtual care because that was where all the innovation innovation was happening. And was the the clinical architect for the world’s first virtual Care Center, which was erected in St. Louis, where I stayed for another five years, where I we were actually my age and my frustration with not for profits intersected and I retired, which lasted about 30 days, when my wife put her finger in my face and said, You need to go do something which she was right. And ran into some really, really bright people in Peoria, Illinois of all places, which is where virtue sense is headquartered. And we’re I’m the Chief Medical Officer now.
Nick van Terheyden
Wow, I so many interesting intersection points. It’s fascinating. You bring up the speech recognition, because I’ve been circling around that domain for a long time. And based on the timing, you describe, I’m not surprised to hear it didn’t work. I think one of the things that we failed to do was sell appropriately. we tended to oversell not that the technology wasn’t capable, but the hardware wasn’t, as you rightly surmise, and, you know, I think it was nice and for it, the radiology conference where the demo was taking place, and the the PC that was underneath the desk, was the most souped up. I mean, if it was a car, it would have had jewel turbo charges, extra mount. I mean, it was just, you know, blazingly fast for that era. And of course, when you went to implement it, you didn’t have that technology. And of course, it started to cause all these problems. And, you know, that men, it took a lot longer, but I think we’ve reached you know, a different time and it’s starting to add value. You know, in helping I think in the EMR, especially where there’s a lot of challenges. You’ve obviously had a lot of experience implementing you’ve seen that, but you remain a believer and I have this conversation with a lot of physicians, you know, many have been so challenged, they’re, you know, extraordinarily frustrated, but I think you principally see the value of technology, and what it can do to help deliver better care higher quality and more Equity across the population that needs it.
Tom Hale
And I appreciate that. And, you know, interestingly, I also seen what it can’t do. And, and, and and what it does do to physicians and people who are trying to manage patients. So I think I’ve seen both sides of it, in that regard. And that’s, you know, honestly, that’s where I formulated my own understanding my own sense of what I think this all represents. And it’s more like a triangle, where you have technology, you have data, but then you have relationships, all of them have to be in place in order for things like what and that’s how I define virtual care that virtual care can make it the impact that he needs to make. So to me, the technology and the data end up being an augmentation to the to the caregiver is not a replacement for the caregivers. Nor is it the sinequan on to the final solution, so to speak. When it comes to healthcare delivery.
Nick van Terheyden
Yeah, no, I think that, and that’s one of my favorite words around innovation. It’s I bristle a little bit when people talk about artificial because that tends to imply a replacement. But I think that’s exactly right. It’s the augmentation, that allows you to replace the mundane tasks or tasks that don’t need human interaction. You know, those relationships are essentially the foundation and anything that gets in the way. And I think that’s what we did with technology was, we put it in in such a way that it became a barrier as opposed to a supporting agent. Tell us a little bit about your thoughts around how we reverse that. And in particular, as I think about this, you know, you you were part of the sort of original push for telemedicine telehealth, which, much like speech recognition was two years away for 10 years. I think we’ve crossed that barrier now.
Tom Hale
Yeah, I think and actually tech, not technologically, we crossed that barrier a few years back, whatever it It took a pandemic to actually generate the interest from, from health care givers and physicians who move at glacial speed at the end of the day. I mean, one, it’s interesting to see a bunch of scientists, but I experienced this both in my work as as a PhD candidate, and then later, running the Medical Group, and practicing myself is that physicians and scientists don’t move very rapidly, they think of solutions in terms of decades rather than the type of and the pandemic once again, was an example of that look at what happened with vaccines, we created vaccines in less than a year, rather than a decade, which we’ve seen in the past. So we’ve had an acceleration because the pandemic uncovered the weaknesses in our health care delivery model, to which now one can see some of the advantages of telemedicine, but more importantly, virtual care because asynchronous communication and the gathering of data through sensors becomes just as important as as the actual communication through face to face telemedicine.
Nick van Terheyden
So, as you think about this innovation before we sort of dive into, you know, the the expansion of this across additional devices, the augmentation with oversight intelligence and the supporting act, how do we start to address a system that has essentially, I don’t want to say failed is the wrong word, but it’s certainly not serving the widest population to deliver the best possible care within a budget that, you know, doesn’t keep expanding beyond you know, any reasonable boundaries?
Well, you know, I
Tom Hale
see you follow the money at the end of the day, economics has driven the healthcare system that we have today. And that’s not to say, I mean, physicians and nurses are absolutely wonderful people. There’s nothing more inspiring to see them at the bedside or in the in the exam room talking to the patients and working with all their their issues. However, the healthcare system in general from an economic standpoint is saying, the more I do, the more I make, and therefore the value that is placed is placed on things that you can charge a lot of money for. I the perfect example that I always gave when I was talking to my primary care physicians of which I was one of them was that I could manage a complex diabetic and make him be able to build $35 in my podiatry compatriots could get $35 a toe for trimming a toenail. The value it was placed on doing things and testing things and large hospitals. So you saw an economic driver that essentially gave us the absolute perfect system for the results that we’re getting. So I’m a believer that you got to change the economics in order to change the entire health care system now. Okay, so that’s like, that’s like getting the Queen Mary to change on a dime, which isn’t going to happen. But if you change the economic incentives, the the infrastructure to, to keep people healthy and well into to be preventative rather than reactive, are all in place. We’re seeing that once again, with a pandemic, when, when all of a sudden virtual care where you could, people did not come to the doctor necessarily, they could stay at home. And now you’ve made your rear physician much more efficient and effective and increased access a small portion of what needs to happen in order to change the healthcare system.
Nick van Terheyden
How do we fight? I mean, I have this conversation over and over again, do you think we’re moving towards a model? I mean, this, you know, paid to do seems like a core problem. And unless we move it, or change that, it will continue to and you get what you unsent? And I agree with you 100%. I mean, this is not about the individuals in the system, this is the system driving behavior that is inevitable with all the, you know, externalities to that, how do we change the way that care is delivered, so that that’s no longer the case. I mean, it just seems like this is such a challenge to move away from this pay for activity.
Tom Hale
And so first one has to understand that that the economic drivers are already beginning to be put in place, you’ve got 35 to 38% of the Medicare population, which is some 20 million people 20 million patients that are in a Medicare Advantage plan of some sort, a Medicare Advantage plan, shares and savings, if you are able to keep people the utilization down, but also keep people healthier. And what a great incentive, let’s keep people well, rather than react to them being sick. You look at a CEOs and the msps that are out there. They also do the same thing. So the economics are there. In fact, if you look at a health care system, and we did this, when I was at the virtual Care Center, we put a whole model in place to decrease the cost of that 5% that they spent 50% of the dollars, we decrease that cost by 60%. So you’re talking about 30% decrease in the entire population, that you’re managing that those that those patients are derived from, right. So if you take a health system that has a billion in revenue, just just take a general generalization, they have about 20 million Medicare Advantage patients, if you put a virtual system in place, it just manages at 5%, you generate 27 million and new net, you know, high level high level numbers. But that’s a pretty big incentive. Now, all of a sudden, people are saying, Well, how can we people? How can we? How can we help people not fall in the hospital? Because there are technological ways to do that, which is what my company does today? How do we keep people at home instead of in the hospital? Well, maybe we can monitor them at home. with wearables, our biometrics are other types of technology, and have those video businesses all kinds of technology that, you know, it says though, when I tried to do the dragon speak, which then became nuanced later on, as you’re well aware of? It wasn’t ready. It’s ready. We are ready right now. And I think the economics are there. I think Nick will and you probably know better than I do, because you talk to people across the country as well as across the world. The people who are in place today in health systems who have the power or not incentive today, in order to make radical changes because of economic uncertainties. To a new economic model, it’ll be those. It’ll be those we’ll look at the only the only hospital system that probably didn’t lose money during the pandemic, who was Kaiser because Kaiser is already in that model. Right. And I think that’s a fact. So, but I and once again, I hate to keep harping back on the pandemic, but it was a it was a catastrophic change of this country, from a healthcare standpoint, that that is beginning to unravel the the inadequacies of our healthcare delivery model. And it is a delivery model. It is not. The diagnostics are wonderful. The physicians are good, the nurses are good, but it is is a delivery model that needs to change.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick the incrementalist and today I’m talking to Dr. Tom Hale. He is the Chief Medical Officer of virtue sense. We were just About the pivoting or the move of the healthcare system away from this fee for service to a much more holistic total coverage with shared risk along the lines of Medicare Advantage plans, ACS mssps. And, you know, the the silver lining, I think you and I probably share this view and you know, nobody would wish the pandemic ever. But given that we had it, I try and seek those silver linings. And I agree with you 100%, we have exposed the soft underbelly of inadequacy of our system in so many areas, and it is our opportunity now to really drive change. And some of that change, we started to see, I think, you know, it’s going to stick with telehealth, telemedicine that’s being delivered. But there’s more to it. And I think this is where some of the technology that you’ve started to work on. And you know, your organization, which is pushing out insights into the home, I know you’ve started with just surveillance, tell us a little bit about what virtue sense is doing and how you’re going about that.
Tom Hale
No, I appreciate that neck. So So virtue sense is is a company that that is actually deals in significant artificial intelligence, and taking data from sensors, and then turn that that data into knowledge by utilizing algorithms, artificial intelligence. And I like you bristle a little bit at the thought of artificial intelligence because it does sound like not only an oxymoron, but it’s probably not true. It’s just, it’s just that pure gut, the ability to be able to power through mountains of data, and then turn it into some knowledge that someone who actually has intelligence can then do something with. So we use LIDAR sensors, to put surveillance on patients in acute beds, to hospital beds. And we do that because of the information that we get from those LIDAR sensors, we can tell when a patient has decided to exit the bed or a chair, that leads to a fall, by the way, in most cases, and in fact, $52 billion dollars in Medicare is spent on falls every 20 minutes, Medicare patient dies of a fall. And a fall happens almost every nine minutes. So it’s not a small issue. And so what we’re able to do with the artificial intelligence by getting the sensing is that we can then alert our caregivers, the nurses are, are sometimes there’s false specialists, and on the floor much earlier in the process of exiting the bed so that they can get their 30 to 60 seconds, they get the alert 30 to 60 seconds ahead of that patient exiting the bed. And, and so they greet the patient, rather than find the patient on the floor, which is what happens today without that kind of technology. And sensitive to the fact because I think I lived it when when I was at the bedside, is that we only have a half of a false alert every 24 hours. So it’s not like they get a bunch of alerts, which we pick and choose some of those that can help the patient. It’s very sensitive. And it’s also very specific.
Nick van Terheyden
So that’s fascinating. And I think, you know, big progress on the many of the methodologies that we have. And you know, we’ve struggled with this for a long time. It’s, it’s, it’s not a new problem. It’s something that’s been going on. But you know, those are staggering numbers that, you know, if you could just bring to bear just a little bit of innovation that prevents and it sounds like, you know, there’s a real opportunity to actually play some intervention. I like the thought, you know, meet the patient before they get out of bed as opposed to finding them on the floor. I think that’s, you know, a great visual. And but what else can you do? I mean, it sounds like you know, the acquisition of this data starts to bring more value, what else is going on? And where do you see this going?
Tom Hale
So it becomes natural at that point time because we’re even though our first product was a fall prevention, what we really are is artificial intelligence taking in sensors, sensor information, so why not? Why not use biometrics on patients to protect that information as well. We learned something when I was at virtual Care Center was that if we are able to obtain the heart rate and the pulse and the temperature on a patient while they’re in the acute setting, that we can actually intervene into sepsis much earlier and we had results where we decrease the the progression of severe sepsis to to septic shock by 95 percent, not because we use new treatments, not because because the treatments were good, they just weren’t getting into the patient in time. So just think in COVID. As an example, if we can take a patch that can check patient, so to saturation, their blood pressure, their pulse, their core body temperature, singly lead EKG, and do that every five, every five minutes, or even every 15 minutes, you’ve all of a sudden got 9615 minutes, you get 96 new data points where in the past, you only had four. So now we can take that, that and we’ve done this actually. And we’re moving now to to an arm band, so that person can actually go home with it. So think of during COVID, if you had this patient with the arm band, you could send them home earlier where everybody does better if they’re being monitored, and if they have access to patients. You know, finally, Nick, I’d be remiss to say that the other things that we put in our, in our module that’s on the wall is that HD video and HD audio. So it actually virtualizes the room almost immediately. So the nurses actually can can get the alert and camera into the patient’s room and see the patient should they so choose. And so can physicians and so on and so forth.
Nick van Terheyden
So I think it’s interesting, you talk about, you know, adding in additional and pushing the patient back into the home. I mean, if you think about that in the pandemic crisis again, you know, another opportunity and, and more acceptance, I think, you know, pre COVID the idea that we would say to a patient, no, we’re not going to admit you, we’d rather keep you and monitor you at home was a far less palatable position than I think it is now and it certainly, you know, the preferred modality unless there’s a good reason to admit people. And here we have sort of technology that says, hey, we can do this and do it. So you’re gonna see, I imagine this going into what I would call the medical home.
Tom Hale
Oh, definitely, you know, I definitely say that to be the case. The 5% that we were monitoring very crude technology in the virtual Care Center some 10 years ago, now is much more sophisticated. So so we can be monitoring these patients at home preventing we you know it if someone has cancer monitoring doesn’t cure the disease. What it does do is keep stupid stuff from happening, right? The stupid stuff of oh my gosh, I’ve I’ve getting some chest pain. So instead, they call their and they just fallen down hit their chest, right? But they call their neighbor who’s their favorite consultant who then says you need to go the emergency room then next thing you got someone in the hospital and a $30,000 bill later to be told you have chest wall pain. The same thing if they could, if if they’re being monitored, and and they fall and hit their chest and then get on them. They get a telehealth telemedicine visit and that and all that information is there for the the nurse or the physician to be able to monitor you stop the stupid stuff from happening. I mean, honestly, stupid stuff accounts for about a trillion dollars in cost, right. And and
Nick van Terheyden
I don’t think I’ve ever seen that as a line item just to be clear, but but I’m sure you’re right.
Tom Hale
Well, I always say that there’s Hales economic sales economics is a triangle, there’s three three levels. One is you invest money into preventative care, you know, tell people to stop smoking, stop drinking, exercise, difficult long term payout. And then you got the middle part of the triangle, which is the acute care, you react to that that’s what the whole healthcare system is today. And then the third part of the triangle is the stupid stuff. And stupid stuff is honestly got all about increasing access and decreasing variation in care delivery. And that can’t be done unless you put the infrastructure in place in order to increase the access which can be done virtually with both face to face telemedicine and also asynchronous care, like texts and emails and so on so forth. And then decrease variation and carry you use those that you can’t do that without having data, analyzing the data and being able to give solid information. Just I mean, if you think about it, a patient today sees the they’re even the sickest patient sees the caregivers, maybe 10% of the year, 36 days, maybe 50 days, that leaves 85% of the rest of the year is a dark hole, which we know nothing about that patient or what’s going on. And we rely on the patient to be our VR sensor VR alert system and the patient raises their hand and says I don’t feel well and off we go.
Nick van Terheyden
Well, I think I think a perfect note to end on hails economics. I like that. So unfortunately as usual, we’ve run out of time. So it just remains for me to thank you for joining me on the show. It’s been a great pleasure, I think some great insights and you know, tremendous opportunity. Thanks for joining me.
Tom Hale
Now, I appreciate that and that is one can see as I got worked up, I guess a passion for me but it something that really can work.
