Bringing Hospital-Level Care Inside the Home: CareLoop’s Platform-Building Journey
It’s no surprise that multisided platforms are revolutionizing industries -- including healthcare. And perhaps nowhere is this more important than in healthcare coordination and communication.
In this Q&A with CareLoop’s founder and chief medical officer, Dr. Foster (Fiji) Goss discusses the tremendous opportunity he saw for technology to support real-time, EHR-agnostic communication and collaboration across disparate care settings to close the loop and keep all parties informed in the care delivery process.
Summit Health (SH) Question: What problems did you see that needed to be addressed which led to the creation of Careloop?
Foster Goss (FG): As an emergency physician, I’ve observed first-hand the many cracks that exist in our healthcare system -- disparate systems and a lack of communication being two of them. I kept asking myself, “How can this be solved?”
As a clinician, physician-scientist and informatician, I became very interested in translating experiences gained from my clinical practice into technology based solutions. My interest grew in how to improve healthcare delivery leveraging technology and experiences I had with the CMIO where I did my residency training. I went on to pursue a fellowship in biomedical informatics at Harvard, which really gave me the foundation to create CareLoop and pursue a career in informatics. Over the last 10 years, I have been studying patient safety and quality, clinical decision support, EHRs, and artificial intelligence.
“I kept seeing that patients were falling through the cracks.... We take excellent care of patients when they are in the hospital, but when they leave, care all too easily falls apart due to the lack of effective systems in place to communicate or coordinate care.”
Clinically, I kept seeing that patients were falling through the cracks, and many times the reason was because of communication breakdowns. We take excellent care of patients when they are in the hospital, but when they leave, it would all fall apart without effective communication and follow up systems in place.
To be able to asynchronously follow-up or check-in with patients after they're discharged is critical. Our current process of giving patients a stack of papers and boilerplate follow instructions to see their primary care physician (PCP) is not sufficient. In fact, many patients don't have a PCP, have low health literacy or english proficiency, and may not read through a document that is 15-20 pages long. So with CareLoop, I saw an opportunity to help improve communication with the patient that aligns with how they consume information everyday on their mobile device, be it a text message or through a social network platform.
As Atul Gawande says - when we are able to connect the care team with one another, and the care team with the patient and their family -- the costs, survival and outcomes are all phenomenally better. I fundamentally believe that this is true, and that our healthcare system -- and the way that we've built the technology to support it -- has missed this critical communication piece in how we deliver care.
SH: What needs to happen to improve the often siloed and disparate communications across the healthcare spectrum?
FG: The types of communication that need to happen are centered around the patient with the ability to be able to loop in their PCP and other providers involved in the patient’s care, no matter where care is received. We need to recognize that patients will likely receive their care from multiple other providers, whether it's MDAnderson for their cancer care, the Cleveland Clinic for their cardiac care, or any other primary care or specialty clinician. The best outcome is dependent on effective collaboration and communication among all of these parties, including the patients family. I can't tell you how many times a day I get asked by the patient, “Can you just talk to my doctor (located out of state, uses a different EHR) - I just saw them last week.” Ugh, if only it were that easy.
We really haven’t designed the optimal infrastructure in our healthcare system to actually improve patient outcomes through communication. CareLoop was created to do just that -- we bring them into the loop, with context specific communications and an interoperable data platform, to allow connections to happen around a patient's condition. This approach has been the focus of many federal funding initiatives, recognizing that poorly coordinated care can lead to unsafe, costly and low quality care. Ineffective data sharing and communication has been shown to lead to delayed diagnosis, medication errors or even mortality, not to mention administrative burden to exchange data.
This has been particularly important in nursing homes, where a patient may have dementia, be transferred between different health systems, and being in the loop matters, not only for the care-team but for the family and loved ones.
SH: How has COVID-19 changed the need for this kind of connected communication, especially among vulnerable populations like those in nursing homes and long term care facilities?
FG: There is no question that there have been some fairly significant changes in care delivery since the COVID-19. 43% deaths from COVID-19 in the United States have been in nursing homes. We know this is an area where CareLoop can provide direct value in terms of easing the isolation through improved communication, especially because families can't visit their loved ones in the nursing home due to visitation restrictions.
In addition there have been federal mandates from CMS to notify family members and residents if there have been any COVID outbreaks. CareLoop provides the messaging platform that enables them to do just that, providing asynchronous communication to keep resident and family informed, versus responding to the flurry of incoming calls from each family member, which is not sustainable.
“CareLoop provides the communication and care coordination platform to deliver hospital-level care inside the home.”
Because we’re connected to the electronic health record in the nursing home, if a resident starts a new medication or receives a new diagnosis, all of those things are communicated asynchronously to the specified family members. Since the pandemic, this segment of the market has become increasingly important as family members cannot visit their loved ones in the nursing home but want to be kept informed.
In other market segments, CareLoop is helping support delivery of hospital-level care inside the home, leveraging its communication and care coordination platform. Outside of the home, and in hospitals, CareLoop provides doctors with a way to communicate and conduct virtual visits to communicate with a patient or family, which can reduce exposure to staff or use of PPE.
SH: Platforms can efficiently facilitate communication between different parties or sides of a network. Sometimes the platform winds up being used to communicate different things than founders may have anticipated. Have there been any surprises to date about how CareLoop is used?
FG: That's a great question. One of our partners used the platform as part of a disruptive care model, where the platform essentially handled all the communication exchange: lab results, clinical data sharing, and coordination of disparate care team members, whether it be the doctor, a nurse, a pharmacy or an x-ray tech. By virtue of us being able to loop all of these key players to the care team, our platform was the glue, with the patient at the center of that channel and communication.
I never envisioned that our platform would be used in a way that would replicate many of the functions of an EHR. That’s obviously not the space that we're in; so this was a bit of a surprise, though it actually illustrated the power and purpose of being able to connect people around the care of a patient.
SH: As a practicing physician, you obviously saw a huge opportunity to develop a solution like CareLoop. Are there other opportunities you see in healthcare, where bringing different parties together on a common technology platform to remove information asymmetry and better facilitate information exchange?
FG: There’s definitely an opportunity for different solutions to be able to work together to provide a synergistic solution and improve the efficacy of care. We were just selected as finalists in a contest by the Agency for Healthcare Research and Quality to improve transitions in care from hospital to home. This is an area where there is a critical need to reduce the burden of data exchange and improve communication between care teams, the primary care doctor, the patient, and the family. Being in the loop provides the transparency needed to ensure the safety of patients and shared accountability as patients transition back into their community and resume care by their primary care doctor.
Reflecting on how COVID has fundamentally changed healthcare delivery, technology played a huge role in actually allowing that change to happen. It's been a long time coming. And, really, the COVID pandemic has forced us to make this tectonic shift. We now realized that we can deliver care in the home and that many patients enjoy or prefer virtual care.
I'm really excited for the future role of technology in healthcare and we are really just at the beginning. What we’re learning from this is that by leveraging innovative technologies, we can advance our care delivery system into a more effective, efficient patient centered healthcare system, that focuses on the point of need, rather than the point of care.
Dr. Foster Goss is CareLoop’s founder and Chief Medical Officer.