Innovator Spotlight Q&A Series: Avik Som, MD, PhD
The CIDH Innovator Spotlight is a Q&A series that celebrates innovative ideas, highlights the important work that digital health innovators are doing to advance patient care and outcomes at Mass General Hospital, and shares key learnings about the innovation journey.
Q: Tell us about your innovation and the challenge(s) you were trying to solve.
AS: CareSignal is a technology platform that does deviceless remote patient monitoring for care managers. The platform uses condition-specific text message and phone call algorithms to catch significant events before they happen, such as COPD or congestive heart failure (CHF) exacerbations, in order to reduce hospitalization or to help optimize clinical management of chronic illness, like diabetes, hypertension, or depression. The portfolio allows scaled-up weekly monitoring of patients for care management groups and significantly reduced costs, particularly appealing to value-based health care delivery, such as accountable care organizations. By using a phone and device-agnostic platform, the innovation was particularly designed to reach anyone, including the elderly and lower socio-economic strata.
For digital health projects, our major champions early on were the chief information officers, chief medical officers or chief medical information officers. At my medical school, digital health offered a fascinating in-house way to build solutions to tackle. These department chiefs, along with the HIPAA privacy office, were critical to making sure things were built well.
Q: The innovation process can be long and challenging, but also rewarding. What inspired you to begin this journey?
AS: CareSignal started during my medical school training at Washington University in St. Louis when my patients as a medical student inspired me. In nearly every clinical rotation, there were always situations where, if only we had known a few weeks before or touched base sooner, there would be a better outcome. For example, I had a patient on my psychiatry rotation who, because he ran out of medication and no way for his care manager to contact him (he had a cell phone, but no minutes), committed suicide. In response to this, we built a way to use toll-free texting so that there was always a way for a patient to reach their provider. Another example that inspired me was patients with diabetes whose blood sugar diaries were never in check, which impacted our ability to best control their diabetes medications. Having patients text their blood sugar to be reviewed biweekly with a diabetes educator significantly sped up time to control.
A nurse practitioner in our resident clinic gave her cell phone number to her patients with COPD and CHF. She would call them regularly, and more than once she could catch a COPD exacerbation before it happened and manage it in her outpatient clinic. She was a prototype care manager (something that we did not have at the time) but realized that there was simply not enough bandwidth for her to manage all of the patients she needed to care for. Building that touchpoint to be automatic, by phone or text, was enormously motivating. Overall, innovating gave me an outlet for my patient care experiences, particularly when I saw health outcomes that could be better.
Q: Please tell us about your overall experience and some of the major milestones you’ve achieved so far? What are the next steps?
AS: Building a digital health product that has made it out into the commercial world has been incredibly rewarding. Over 50,000 patients across 10 states have been touched by the innovation to date. Growing from a research project into a fully-formed, aligned clinical product with over $4 million in annual recurring revenue was a challenge with an incredible number of real-world learnings on the finances of healthcare, particularly as we switch from fee-for-service to value-based care.
Most recently, CareSignal was acquired by Lightbeam, a healthcare data analytics company. The synergy between the two companies was particularly invigorating. Lightbeam analyzes data across the system and identifies the patients who need care. Together with CareSignal, we can enable healthcare systems, like accountable care organizations (ACOs) to go from analysis to intervention in one go.
Q: What resources have been most helpful to you, and that you think other MGH innovators would benefit from?
AS: For digital health projects, our major champions early on were the chief information officers, chief medical officers, or chief medical information officers. At my medical school, digital health offered a fascinating in-house way to build solutions to tackle. These department chiefs, along with the HIPAA privacy office, were critical to making sure things were built well.
Working with the technology transfer office was also very helpful initially, particularly because intellectual property (IP) is not as clear-cut in digital health as it is in devices or pharmaceuticals.
Incubators gave us a home from which to work and build in the early settings.
Another incredible resource was the local medical society. Implementing the solution outside of research initially was very difficult. In our case, the St. Louis Metropolitan Medical Society (the local branch of the AMA near my medical school) provided local support for innovative new research projects by physicians who were often looking for new ways to solve problems.
Q: What advice would you give to other innovators at MGH that you wish you had been given early in your innovation journey?
AS: Many! I’m always happy to chat more closely with folks to help their own projects get started. A few pearls:
Do not expect clinicians to alter their workflow for your software. Very few early adopters will do so.
- Early on we were fascinated with the concept of prescribing a digital health mobile application. We realized quickly that downloads are nearly impossible to accrue and asking physicians to use valuable practice time to try to get a patient to do that was a non-starter. We rapidly realized we would need a device and app agnostic system and focused on text messages and phone calls to reach our population. We learned it’s important to align your patient population with the app to get better penetrance. Relatively low-tech solutions that are widely available can be more effective than high tech ones even if they seem less “sexy”.
- Implementing digital health is actually very different from implementing pharmaceuticals or devices that have complete infrastructure, distribution networks, etc. On the other hand, digital health is often very centralized in organizations due to EMR implementations and requires top-down installation and setup. This means you’re looking at longer institutional contracts, and that having an individual physician advocate can be nice but unlikely sufficient to take off.
- Grants are very useful for early innovators to use to collect validated data. However, they make for a poor high-risk business model. Align incentives. In our case, value-based care and ACOs risk share enough that cost savings from CareSignal equals increasing profits and is worth purchasing outright.
- Research was a great way to get initial credibility, but because digital health doesn’t require completed trials to be implemented, the gold standard has been large ‘n’ implementations and case studies from clients, which tend to be more predictive of financial and real-world clinical outcomes than randomized controlled trials. This means that if you had to choose where to invest your time or a relationship, it is far better to get a commercial implementation started than a research trial. Ideally, you do both, of course! In head-to-head battles, the trials we did for CareSignal pushed us over the edge because we had that data and rigor early on, but the reason to purchase and implement rapidly came from our existing customer’s results.
- Do not expect clinicians to alter their workflow for your software. Very few early adopters will do so. Using CareSignal, for example, requires consenting to text messages for healthcare. Identifying the patients and attempting to get consent during the clinical workflow was a tremendous undertaking for already overstretched staff. To tackle this, we built our own in-house group of virtual assistants who cost-effectively could enroll large lists of patients. In the COVID-era, this has become even more important.
- Find the actual clinical group that will use your products. For CareSignal, we rapidly realized that it was care managers who were benefiting from using the product. This realization pushed a rebrand from our original pharma-sounding Epharmix brand to the care manager-focused CareSignal.