EmOpti Aims to Help Patients in ER Get Seen by Doctors More Quickly

Ed Barthell doesn’t mince words when describing the poor experiences many patients have when they go to the emergency room.

“Emergency medicine is still an industry that essentially delivers lousy service for really high cost,” says Barthell, a doctor who worked in the ER for more than two decades before leaving his clinical practice in 2008 to focus full-time on healthcare technology development.

His latest venture is EmOpti, a Brookfield, WI-based startup that aims to shorten emergency room wait times and hospital stays by having offsite physicians examine some patients over a video feed upon arrival.

Launched in 2015, EmOpti’s tools are currently being used at eight hospitals across four healthcare organizations, including three Aurora Health Care hospitals in southeastern Wisconsin. The startup’s customers have used its Web-based software to perform nearly 100,000 video consultations, Barthell says. EmOpti is now working with its existing customers to shift more of their emergency departments to a “remote provider-in-triage” model, he says. (More on this in a minute.) Meanwhile, the startup is also in talks with additional hospital systems in the U.S. and other countries about making the shift, with EmOpti’s help.

Patients who have suffered life-threatening injuries or are otherwise in need of immediate care are put in rooms right away after they arrive at the ER. Meanwhile, most patients with less urgent injuries or illnesses typically see a triage nurse. This person is responsible for documenting a patient’s chief complaint and taking his vital signs, after which the nurse usually tells him to wait in the lobby until a doctor is ready to see him.

Barthell says that for these “lower-acuity” patients, it makes more sense to place orders for medications and request diagnostic tests like X-rays and blood analyses shortly after the patients arrive, rather than waiting until they’ve been seen by a doctor in-person. The issue, he says, is that at many hospitals, triage nurses and other care providers do not have the same ordering privileges as physicians.

Barthell founded EmOpti based in part on the idea that it’s more efficient to have a doctor or physician assistant (P.A.) give patients a once-over while they’re at the triage desk—and, if warranted, order tests and treatments for them. But rather than station a physician next to the triage desk at the front of the ER, hospitals that use EmOpti put a doctor or P.A. in a remote “command center.” That way, the person in the command center can perform video consults with triage nurses at multiple hospitals—another efficiency gain.

Remote healthcare consults enabled by software—known as telehealth or telemedicine—have been touted by supporters, who say these virtual visits can improve access to care and lower costs. Some applications of telehealth (though not all of them) involve enabling patients to “see” doctors without leaving their homes, or to connect with specialists remotely. EmOpti’s business demonstrates how startups and healthcare organizations are experimenting with such technologies inside hospitals.

The question is whether EmOpti’s approach will catch on. But some of the company’s early customers say its product is making a positive impact.

“It’s a change in how you triage patients,” says Paul Coogan, a physician and the president of emergency services at Aurora. “There was initially some resistance. The nurses thought it was going to add a lot of time to triage. [But] I think they appreciate having some extra help.”

At Aurora, having doctors and physician assistants enter orders during or just after video consults with certain patients who come to the ER has shortened their hospital stays by about 45 minutes on average, Coogan says. Two examples of orders they might request are an electrocardiogram test for a patient experiencing chest pain, and an X-ray for someone who thinks he sprained an ankle.

The approach seems to be improving the ER experience for patients, too.

Mike Rodgers, Aurora’s director of strategic innovation, says under the typical ER triage model, some patients end up walking out because they don’t feel it’s worth the wait to see a doctor. That’s less of a concern at hospitals that use systems like EmOpti’s, he says.

“We’re able to put this in front of a patient within 10 minutes,” Rodgers says, describing tablet computers that run EmOpti software in ER triage areas. “We ask patients for feedback and have so many quotes. [They say], ‘I’m going to come back here because I actually see a doctor.’” (Albeit one located miles away.)

Inside Aurora’s command center, which is located at the organization’s St. Luke’s campus in Milwaukee, there are six large computer monitors mounted to a desk. (None of the three Aurora hospitals currently using EmOpti are located on the St. Luke’s campus, meaning the organization’s command center is truly remote.) Between two of the screens is a webcam pointed at the clinician who sits at the desk, so that she’s visible to patients and nurses during videoconferences.

Video signals travel up to 30 miles from Aurora’s command center to triage areas in the three hospitals’ emergency rooms. The patient and nurse sit side-by-side so they’re both able to see and communicate with the caregiver in the command center, who appears on a camera-equipped tablet computer.

The startup’s management team includes founder and CEO Ed Barthell (at left), director of product management Tim Fischer (in foreground), and director of software engineering Jared Rufer. Photo courtesy of EmOpti.

A two-way video feed was not part of the original setup for EmOpti, Barthell says. He and other early employees at the startup—including chief technology officer Bob Hedgcock, director of software engineering Jared Rufer, and director of product management Tim Fischer—originally planned to outfit triage nurses with Google Glass eyewear. At the time, EmOpti’s team envisioned the high-tech glasses wirelessly transmitting a live video stream to the command center, so the clinician there would see exactly what the nurse was seeing.

“As we started working with Google Glass, we realized it didn’t have very good battery life—it wasn’t going to be able to get through a whole shift,” Barthell says. “And when you streamed real-time video for more than about 20 minutes, the glasses became hot to the touch, which caused discomfort for some users.”

(EmOpti experimented with Google Glass before the tech giant introduced a new “enterprise” edition, which reportedly features a new type of computer chip that manages heat better than previous versions.)

EmOpti eventually scrapped the Google Glass concept, figuring it would be more appropriate for consults to have the feel of a Skype video chat.

“Patients like being able to see the face of the doctor while talking to them,” Barthell says.

Aurora served as a development partner of EmOpti early on, and has invested in the company. (The hospital network plans to rev up its collaborations with local tech startups, in part through a new $5 million investment fund.) EmOpti has raised a little over $5 million in outside financing from investors to fuel its growth, including a $3.2 million funding round that closed over the summer, Barthell says.

Rodgers, who oversees Aurora’s collaborations with startups, says when his team first learned of EmOpti and discussed the concept of remote provider-in-triage, some suggested Aurora copy the idea and independently build a command center and software for remote consultations. Others, including Rodgers, disagreed, he says.

“If we could’ve done it ourselves, we probably would’ve already done it,” Rodgers says.

The technology may have a similar look and feel to Skype, but with EmOpti there are some important additional pieces related to security and compliance, Barthell says. In order for a hospital to use a communication tool that stores or transmits patient health data, it must comply with HIPAA, a law that regulates the use, disclosure, and transmission of protected patient health information.

EmOpti’s software uses a standardized collection of communications protocols and application programming interfaces, which Barthell says is a popular way of handling video signals on the Web. The startup developed its own method for routing consult requests and arranging them into queues, and also added custom security functions, he says.

In early 2016, prior to turning on EmOpti’s software in Aurora’s emergency rooms, the two organizations began testing the tools in simulated patient care environments. Around that time, Aurora worked with Verona, WI-based Epic Systems—which develops electronic health records (EHR) software used by Aurora and many other large healthcare providers—to set up an interface between Epic’s software and EmOpti’s. This interface enables the caregiver in the command center to see information the triage nurse enters into Epic’s software before requesting a consult—data such as the patient’s name, vital signs, and chief complaint. (Clinicians in the command center can also use Epic’s tools to access patient information and place orders after completing a consult.) Yet another Wisconsin company, Redox, helped Aurora build the software connection between Epic’s and EmOpti’s products.

The startup has also worked with Redox to set up interfaces for EmOpti customers who use other EHR vendors’ software; one example is MedStar Health in Washington, D.C., which uses Kansas City, MO-based Cerner’s (NASDAQ: CERN) record-keeping tools.

Barthell says EmOpti has two more customers besides Aurora and MedStar: Charlotte, NC-based Carolinas Healthcare System and Thomas Jefferson University Hospitals, in Philadelphia.

EmOpti has a number of prospective clients in the U.S., as well as ones in England and Mexico, says Jack Berkery, the startup’s VP of sales and marketing.

When a hospital shifts its ER to a remote provider-in-triage model, it brings changes for patients, nurses, and physicians. Coogan, the emergency doctor at Aurora, says his first shift in the command center felt different from any he’d worked previously.

“We’re not used to sitting for eight hours,” he says. “We’re used to a lot of noise and interruptions and busyness. There’s none of that [in the command center]. You’re completely by yourself.”

Nevertheless, Coogan says Aurora’s use of EmOpti’s technology might lead veteran physicians at the organization to continue working in emergency medicine longer than they had planned.

“Some of the older doctors have said, ‘I can’t do night shifts anymore,’” Coogan says. “Maybe this is something they could do to help extend their careers.”

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