UW Health Surgeon’s Startup Expanding Software to Monitor Patients
[Editor’s note: This is part of a series of stories on physicians at the University of Wisconsin Hospital and Clinics who have become full- or part-time entrepreneurs.]
Though he now works as a neurosurgeon, there’s always been a little bit of computer geek inside Josh Medow.
While growing up in Illinois during the 1980s, Medow says, he had so much fun using the local library’s Apple II Plus that he resolved to save money so he could purchase his own machine.
“I bought a Commodore 64 and I lived to program on it,” Medow says. “All I wanted to do was to use it to solve problems. My intention was to go to college and become a computer engineer.”
But when he was in high school, his cousin died of acute myeloid leukemia, which made Medow decide instead to pursue a career in medicine. He stuck with it, first as an undergraduate and medical student at the University of Illinois, then as an intern, resident, and fellow, all at the University of Wisconsin Hospital and Clinics (UW Health) in Madison.
Still, Medow says he remained “a code junkie all the way through” his time climbing those rungs on the medical ladder. Today, he’s as passionate as ever about innovations in computing and technology, in particular how they can be harnessed to improve healthcare.
When he’s not in an operating room, or a classroom—he’s also an assistant professor of neurosurgery at UW’s medical school—Medow passes the time developing software that he believes can lead to better outcomes and lower costs in intensive care units (ICUs), and possibly other departments in hospitals and clinics.
“I firmly believe there are algorithmic ways to treat medical problems that exist with patients,” he says. “And there are [existing] algorithms that can be made more efficient and can help with imaging and all types of other things that we haven’t developed yet.”
The algorithms Medow created and has since helped to refine have been used in UW Health’s Neurocritical ICU for more than four years, he says. Medow founded the program in 2008 and serves as its director (he has a board certification in neurosurgery, but also in neurocritical care and clinical informatics).
Medow says that at first, he was essentially “a one-man show in the Neuro ICU,” and “was pretty much living in the hospital 24/7.” Even so, one of the nurses who worked in the unit approached Medow to express her concerns about the ability of care teams to manage patients there, he says.
“She came to me and said, ‘Look, Josh, we desperately need more help, particularly when you’re not here—at times we don’t have what we need,’” Medow says.
His initial solutions for addressing the challenges around staffing levels were basic—flowcharts that clinicians could follow by hand, and sets of orders stored in the hospital’s health records software that could be called up instantly.
“All of a sudden, things started turning around,” Medow says. “From there, I developed more complicated algorithms that would be too confusing to follow by hand, which then needed more extensive programming. And that’s when I started building the team.”
Digital Intern, the company’s flagship product, is aimed at decreasing the amount of time physicians spend in the ICU monitoring patients, he says. The software can be configured to alert a doctor when patients’ lab test results don’t come back normal or their vital signs are not in the ideal range. But since the definitions of “normal” and “ideal” are unique to the individual, Medow says, the “adaptive physiology algorithms” within Digital Intern incorporate patient-specific attributes by communicating with hospitals’ record-keeping systems.
While the software is designed to be used in hospitals by clinicians who work there, Medow says the startup is initially targeting organ procurement offices (OPOs) as potential customers.
The reason OPOs would be the ones footing the bill for Digital Intern has to do with the payment model behind organ procurement. According to Integrated Vital Medical Dynamics company materials, when a hospital has a dying patient who has agreed to be an organ donor, the hospital notifies an OPO. That organization then sends someone over to coordinate the process of harvesting the donor’s organs. The OPO pays for the patient’s care, in theory knowing that it will be able to find others who need the organs. At that point, it can charge transplant recipients—or, more likely, their insurers—for organs, and stay in business.
Medow says he and other physicians who specialize in critical care are regularly tasked with trying to keep alive organ donors who are brain-dead or have conditions that are “completely not fixable.” Putting Digital Intern in charge of managing these patients does two things. First, it lets OPOs keep tabs on some of the donors who are close to dying and therefore prime candidates to have their organs harvested in the near future (some employees at OPOs would be given iPads with Digital Intern installed, according to the startup’s website). Second, it allows doctors to devote more attention to the other patients in the ICU.
Medow says that as a result of using the software at his hospital, the number of organs donated has increased to 3.5 per donor, from 2.8. There has also been a 61 percent decrease in critical care hours billed, a cost savings of $2,685 per donor.
Now the challenge for Medow, along with his colleagues and advisors working to further develop and commercialize Digital Intern, is getting OPOs and other healthcare organizations to see its value. In addition to organ donation, Medow says that Digital Intern could help clinicians manage conditions like diabetes, sepsis, shock, and traumatic brain injury.
Regulatory requirements are a hurdle the startup will need to clear for Digital Intern to be used in its fullest capacity, Medow says. OPOs can use Digital Intern for organ donors, he says, because software used to care for those patients does not need to be approved by the Food and Drug Administration. However, if the software is to be used for areas beyond organ donation, it may need to get FDA clearance.
Earlier this week, Medow and Richard Galgon, an anesthesiologist at UW Health who does consulting work related to regulatory approvals, traveled to Washington, DC, to meet with officials at the FDA. Medow says the trip went well.
“We are hopeful that we will have a clear direction from the FDA within the next couple of weeks about the regulatory pathway to commercialization,” he says.
Integrated Vital Medical Dynamics raised $342,000 in equity financing last August, according to a regulatory filing. Medow says Wisconsin Investment Partners provided the capital in exchange for a 12.7 percent stake in the startup, which valued the pre-revenue company at $2.7 million.
Asked whether he and others at the startup expect to bring in additional outside funding, Medow says there are currently no firm plans to raise another round, but, “You never want to close doors.”
“I think so far we’ve done reasonably well with a relatively small burn rate,” he says. “But if a time comes and we need to raise money, or [Digital Intern] explodes and we need capital to be able to deal with everyone coming in, then we may have to.”