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Optimizing Workflows and Productivity in Acute Care Facilities by Combining Remote and On-
Dr. Edward Barthell
Interview conducted by:
Lynn Fosse, Senior Editor
Published – November 22, 2021
CEOCFO: Dr. Barthell, what is the idea behind EmOpti?
Dr. Barthell: I worked as an emergency physician for over 20 years, and saw the same problems, again and again, leading to overcrowded departments and poor patient experience. What we realized is the care process in acute care facilities can be broken down into different work components, and some of those components can be done more effectively by a remote resource or person, instead of always doing everything with face-
We built software that helps optimize workflows in acute care facilities, that use a combination of both remote resources and onsite resources, to coordinate and optimize the patient flow.
CEOCFO: Where might remote resources be appropriate?
Dr. Barthell: The most common example is the intake process in emergency departments. In a busy department the old traditional model is a triage nurse will do some vital signs and find out why the patient is there, and then, tell the patient to have a seat in the waiting room for several hours and wait. This is a bad patient experience, and it can actually be unsafe. So instead, some providers have tried putting either a physician or a PA at the front desk with the triage nurse, to get orders started right away. However, we have found that by doing a provider-
CEOCFO: Would that be something where the triage nurse would call upon them at a specific point and give them the information? Do they need the look, the feel, the touch of the patient? Is that able to be done easily with the nurse?
Dr. Barthell: The nurse contacts the remote clinician, and the remote clinician then pops up on a video connection on a tablet computer, and then a telehealth session or interview is held between that remote clinician and the patient. You are right that the triage nurse who is onsite controls when that session occurs, and because it is a 3-
CEOCFO: What are the feelings of patients in a situation like that?
Dr. Barthell: For the patient the alternative is to have a seat in the waiting room and not see anyone for 3 hours, so they universally say that they like the interchange with the remote clinician to get things started and get the initial orders placed, get the initial tests going. Then of course, the definitive care is provided by the onsite provider, but they need not get involved with that patient’s case, in most cases, until the results of any testing have come back. They can then review x-
CEOCFO: Where else might EmOpti come into play?
Dr. Barthell: When you move to the inpatient floors, there is sometimes a conflict for hospitalists. Hospitalists are trying to see new patients very rapidly, to meet a metric of seeing every new admission in the first hour after the patient hits the floor. At the same time, they are trying to get people discharged rapidly, so they can free up more rooms for more patients. They are especially trying to identify patients that are ready for discharge first thing in the morning. However, if they are doing their rounds in the morning, and they are trying to decide who is able to be discharged that day, and then they get new patients coming up at the same time, those are two different conflicting priorities.
We find that if hospitalists use a remote technology to make, what we call, lightning rounds, checking in on each patient virtually early in the morning, they can rapidly determine who is going to be a candidate for a rapid discharge that morning and start the discharge process. And then they can make a virtual connection to a patient who is, maybe, down in the emergency department ready to go upstairs and be admitted. They make contact with that patient virtually to satisfy the desire to rapidly connect with new inpatients. The virtual capability just helps them do their job better, faster and less expensively.
CEOCFO: What has been the overall feeling in hospital emergency rooms about this type of treatment?
Dr. Barthell: The overall feeling has been positive, and that goes for the physicians and the nurses working in the department as well as for the patients. Then of course, the hospital operators are pleased because they have higher patient satisfaction scores and they have more rapid room turnaround times, so they are essentially increasing the capacity of their departments and their inpatient floors, without having to add extra physical plant spaces and without having to add extra staff. Therefore, they are ultimately saving significant costs and at the same time realizing incremental revenue from more patients.
CEOCFO: Are there points in the system where there is some type of a requirement, either from the hospital or from the regulatory community, where a doctor must see someone physically before you can be admitted officially?
Dr. Barthell: The regulatory environment clearly governs where and when you can and cannot use remote services. Because we are very focused on in-
Also, as I mentioned earlier, by doing some of the work components with remote personnel and having them simultaneously service multiple hospitals, it helps to address the problems you otherwise have with variability in demand for unscheduled care, which increases and decreases at different times, even within a single day. If you are only using onsite staff you have very limited methods to try to adjust to that increasing or decreasing demand, whereas if work is done by remote staff spreading their efforts across a group of hospitals, they can very easily divert their attention and their prioritization of care processes to those facilities that are busy and divert it away from those that are having a slow day, resulting in much better productivity from the staff.
CEOCFO: With the increased use of telemedicine, are doctors, nurses and patients more used to this and more receptive, along with the shortages of personnel these days?
Dr. Barthell: Yes, and certainly the COVID pandemic has had a big influence on that, just because of the need to decrease patient contacts, to decrease exposure risk for both patients and staff and to preserve PPE gear. All of a sudden, a lot of remote technologies were applied in many new ways, and it very rapidly increased the acceptance of using virtual care for different parts of the care process.
CEOCFO: If a hospital or a group of hospitals is looking at employing your system, what do you need to know about the hospital, about their workflow, about perhaps their philosophy, in order to have a program that is best for them? I am guessing it is not the same, hospital to hospital.
Dr. Barthell: We certainly do some significant consulting in the early phases of a project, in order to understand the environment, what the philosophies are, as you mentioned, what the constraints are of the physical plants, what the patient volumes are that they are seeing now, where do they see their patient volumes going in the future, and what their staffing limitations are, what their desires are in terms of improving staff productivity. Or maybe it is looking at their staffing shortages and saying, “Are there new ways we can go about business with more of a tiered staffing approach, more technicians, as opposed to always using the nurses that are in particularly short supply right now.”
We try to evaluate all of those things in the early stage before we recommend a specific solution with our technology. I should also mention, just for clarification, that EmOpti is the technology company and we certainly do consulting. We have clinicians on staff that help with that up front, but the patient care is always provided by the existing clinical staff. Although we try to reshape the way they do their job, we are not trying to replace them in any way with alternative clinical staff. We are just the technology provider.
CEOCFO: Are there certain ideas that hospitals embrace more easily or certain parts of the technology? Are there things that you could help a hospital do, but they do not quite recognize the value?
Dr. Barthell: It is interesting. In our experience, it is not that hospitals and clinicians do not recognize the value, but hospitals have so many different competing priorities at this time, and certainly, they have all been stressed by the COVID pandemic and the response to that. Therefore, it is sometimes kind of crazy when you go and present a solution to a hospital and you say, “I am going to improve care for your patients, improve the lives of your clinicians and I am going to give you $100 for every $10 you give to us, and yet they say, “We have got competing priorities, we cannot do that.” That is just the nature of the hospital business right now. There are many competing priorities.
I am very hopeful that as hospital operators and clinicians look at their environments and realize we are coming out of this COVID pandemic, we now need a strategy to be more efficient and productive with our existing staff. With the staff shortages that are out there being the big pressure they are trying to respond to, I think they are opening their eyes in terms of looking at new ways of doing business, and that is where we are ready to work with them.
CEOCFO: Do you find that across the board at hospitals or do you find, let us say, nurses more flexible than administrators or certain specialties or maybe certain routines that are being done, where people are more willing to, seemingly give up control, which they are really not?
Dr. Barthell: I hate to characterize responses on an entire group. I think there are people in all of those different groups that you just described that all have their own individual styles and philosophies for the work they do, so there is kind of a bell curve and there are early adopters and then there is the big mass in the middle and then there are the laggards on the end, and that can happen whether you are talking to physicians or you are talking to nurses or you are talking to administrators or you are talking to IT people.
You do have to have people that are willing to try new things, because just the generic resistance to change is certainly out there. In particular, in emergency medicine, many of the staff are trained to be skeptical when they initially hear about new things, and that is okay. We are happy to spend time and educate them on what we can do and spend that consulting time up front to look at possibilities and how it can best fit their environments. However, we acknowledge that there is a lot of alignment that needs to occur between those different groups, whether it is the IT team and the clinicians or the hospital administration; they all have to be aligned to have a successful program.
CEOCFO: Are there similar programs available today, either stand alone or through other organizations, or are you ahead of the curve in what you have developed?
Dr. Barthell: In the programs that we are offering, the most common thing that we have to compete against is either A, “we have too many priorities, so we cannot do anything.” B is, “Oh, that is a good idea, I am going to have somebody build that in their garage and we will just build it ourselves.” Then C would be, “You know, I think my EMR vendor is going to have that solution in the next few years, so we will just wait for them.”
There are very few existing telehealth companies that are using the same approach and focused on the same thing that we are, which is unscheduled acute care and helping patient flow in facilities in dramatic ways. There are folks that are doing telehealth consults for, what I call, once-
CEOCFO: You mentioned some of the responses you are getting, but how do you reach out to potential customers and the various organizations?
Dr. Barthell: I am happy to say, we just went to a large conference for the American College of Emergency Physicians, which is the first one in a couple of years, which is nice, to actually go in person to a conference. We are trying to go to other industry conferences that are relevant to get the word out. We have reached out though many electronic means, from emails to LinkedIn campaigns, to other types of engagement tools, webinars and so forth. Then, we have channel partners we are working with. On the technology side where we are an AWS shop and we have worked closely with the AWS teams and the AWS sales reps to get the word out about our success.
On the physician staffing company side, we have teamed up with staffing companies to help them deliver care better for their hospital clients. Then in so doing they introduce our software to the health systems for which they are contracted to provide staffing.
CEOCFO: Who is it in a hospital that is going to pay attention? Have you identified the 2 or 3 people or titles or does it really vary by organization?
Dr. Barthell: It varies somewhat, and as I said, you need alignment between several different groups. Therefore, ultimately the C suite folks are going to need to endorse the program and sign the contract, but they listen quite a bit to their clinicians, so there are clinical leaders, which would include emergency physician leaders and the nurse directors for the departments.
There are definitely telehealth and IT people that are going to be involved with any decision-
CEOCFO: Are you seeking funding, investment, or partnerships as you move forward and reach out to more and more organizations?
Dr. Barthell: We are a small company, and we are looking for investors, of course. Not all of the time, but at certain strategic inflection points, and we see one of those coming up in the near future.
CEOCFO: What has changed in your approach as people are using EmOpti? What have you learned from your experience with the product in that period?
Dr. Barthell: From our early days we were selling a concept and we were trying to look for early adopters that would be essentially development partners for us. We have now had enough experience rolling this out in enough places (with over 500,000 remote consults delivered across our customer base) and seeing enough recurrent positive results, that we think this can now become much more mainstream. This is because there is both peer reviewed literature that has come up with positive results, and we have many customer case studies that we can present and reference sites that we can present to people, just to show how it can work.
CEOCFO: Why is EmOpti important?
Dr. Barthell: I think EmOpti has an interesting and innovative suite of products for both emergency departments and inpatient floors, that can change the way traditional healthcare has been provided for the last 40 or 60 years, when it has all been based on face-
EmOpti | Dr. Edward Barthell | Telehealth | Telemedicine | Optimizing Workflows and Productivity in Acute Care Facilities by Combining Remote and On-
“Our system is the only one that I am aware of used in emergency departments where 85% of the patients being seen receive one or more virtual consults as part of their care process. Therefore, it just becomes a routine part of the care of almost every patient.”
Dr. Edward Barthell