How tech startups are bringing the digital revolution to hospitals

A new wave of Canadian technology companies are pushing the health care system to adapt to the digital present. Note: This post originally appeared in Canadian Business. Story by Peter Nowak.

Cancelling a surgery is stressful, for everyone involved. For patients, it can prolong months of anxiety. For surgeons, it disrupts a highly regimented schedule.

Carmine Simone, chief of surgery at Toronto East General Hospital, had six procedures cancelled over a three-month period in 2013 because the patients had failed to stop taking their medication beforehand. His unit was also fielding waves of calls from discharged patients asking panicky questions after the fact.

Simone found a solution with Seamless MD, a mobile app he and his team prescribed to patients during an 11-month pilot program. Seamless MD guides people through surgery prep and recovery: Before the operation, it provides educational material and videos on patients’ upcoming procedures and sends reminders to stop medication at the right time. After surgery, the app allows patients to track any issues they experience and communicate those electronically to hospital staff. They also get full access to their records. The results of Simone’s test? Zero procedure cancellations and a dramatic reduction in the number of distressed patient calls.

“Seamless allows patients to access reliable information when they want, tailored to their specific needs,” Simone says. “It makes an already stressful situation more bearable for patients.”

Seamless MD is a Toronto-based startup co-founded by three recent university graduates. It’s part of a wave of Canadian companies aiming to transform health care and bring the country’s hospitals into the digital age—a massive opportunity to modernize the country’s aging health-care system, and to meet the expectations of a clientele increasingly used to managing every aspect of their lives through a screen.

Canada is home to between 800 and 1,000 health-related technology startups, with nearly half of those in Ontario, according to an estimate from business accelerator MaRS.

Some startups—such as Toronto-based Shift Health and its tablet-based multi-language admission forms—are aiming to improve hospital workflow through software. Others, such as Limestone Labs in Kingston, Ont., and its ultraviolet sterilization systems for tablets, create practical hardware. Either way, they’re all pushing hospitals to smarten up.

“There’s a lot more urgency for new solutions,” says Joshua Liu, co-founder of Seamless MD and a University of Toronto medical school graduate. His description of how his company is changing surgery prep and recovery might as well apply to what’s happening with Canada’s health-care system in general: “We’re turning it on its head.”

One of the thorniest problems facing hospitals today is patient readmission: patients who are discharged from the hospital only to boomerang back within days or weeks because of complications. In Canada, 8% to 10% of patients are readmitted within 30 days; in the U.S., the rate for Medicare recipients was 18% in 2013, at a total cost of US$26 billion.

In both countries, many readmissions are caused by preventable clerical issues: poor record keeping, lack of patient education or unclear lines of communication—exactly the sorts of problems that startups like Seamless MD are trying to address. Patients are often sent home with instructions printed on paper, which can be lost or misinterpreted. The patient then has little recourse but to contact or visit the hospital again. This isn’t just inconvenient; increasingly, hospitals face fines or funding clawbacks if their readmission rates climb too high.

So it’s no wonder facilities are turning to technological solutions. “It’s driving massive innovation in hospitals to figure out how technology can be leveraged to get more efficient and effective,” says Zayna Khayat, health lead at MaRS. “A smart hospital will allow a shift from episodic care on the doctor’s terms to continuous care, where really the patient is in charge.”

Some institutions are starting from the ground up. The $85-million Upper River Valley Hospital opened in Waterville, N.B., in 2007 as a fully paperless operation. The much bigger Humber River Hospital, opening in north Toronto in October, bills itself as North America’s “first fully digital hospital.” The $1.75-billion, 656-bed facility will have completely digitized and automated health records, video links in rooms, and robots delivering supplies throughout the building.

But most hospitals are retrofitting when and where they can. Mackenzie Health in Richmond Hill, Ont., set up a 34-bed Innovation Unit last year to test novel technologies. The ones that work can be rolled out to the rest of the hospital and may be integrated into a new facility in nearby Vaughan, opening in 2019.

Mackenzie Health started with an upgrade to its wired and wireless networks, done in conjunction with BlackBerry and Cisco Systems. The faster connections allowed for the installation of video communication stations in the rooms. Smart beds, provided by Hill-Rom in Mississauga, Ont., allow nurses to monitor how patients are sleeping. The incremental approach means the hospital can try out technologies and figure out how—or if—they work, without making big upfront expenditures.

“We don’t have to build a new hospital to do this. You really can retrofit legacy hospitals as long as you have infrastructure capable of it,” says Aviv Gladman, Mackenzie’s chief medical information officer. “We’re not rushing to do too many things at once.”

Among the fastest-growing startups servicing both new and older hospitals in their efforts to become smarter is ThoughtWire. The 42-person Toronto-based company, funded by angel investors, makes a platform called Ambiant. It’s a sort of operating system for hospitals, that knits together various systems, from video conferencing to sensors to lighting. Both Humber River and Mackenzie Health have adopted Ambiant as their figurative brains and central nervous systems; new customers in British Columbia and Alberta are also about to come on board, according to ThoughtWire co-founder and chief executive Mike Monteith.

Monteith, an IT strategy veteran, started ThoughtWire in 2009 because he saw hospitals adopting new technologies. They weren’t, however, thinking much about how to integrate them with one another, which limited their effectiveness.

Smart beds that send out notifications, for example, can quickly become annoying without context. Nurses don’t want to receive an alert every time a patient reclines below 45 degrees—but they definitely want one if that particular patient also has a feeding tube, because then they’re facing a potential choking hazard. ThoughtWire’s system tracks both situations and issues a notification only when necessary.

“The power is in the combination of these things…or to signal to the humans that there’s an opportunity to improve an outcome,” Monteith says. “It closes the gap between the people and the systems so that something better happens.”

It’s not just smaller companies that are looking to help Canadian hospitals modernize. Smartphone pioneer BlackBerry is also aiming at health care as a key sector in its transformation from a consumer hardware vendor to an enterprise-focused software and services provider.

The Waterloo, Ont.-based company cites several vital statistics as the rationale for its interest in health care:

• Seventy per cent of treatment delays and “sentinel events,” or unexpected situations resulting in death or serious injury, are the result of communication breakdowns.
• Two-thirds of nurses and about 80 per cent of doctors use personal smartphones in the course of their work.
• The value of an individual’s health-care dossier is about $500 (U.S.) on the black market, far surpassing that of credit card information.
• More than half of health-care organizations surveyed by the company say the number of mobile device data breaches had increased over the past 12 months.

BlackBerry thus believes security—the core of its brand—will be a selling point to hospitals as they modernize. “We’re enabling that to happen, but in a very secure way,” says Mark Wilson, vice-president of marketing and health-care lead at the company.

The company is also selling a range of communications functionality, from its BES12 server software that allows for multiple types of smartphones to work together, to virtual private network authentication. Many of its services are provided in conjunction with smaller startups such as ThoughtWire.

The company recently tested a patient flow system at the Chatham-Kent Health Alliance hospital in Chatman, Ont. in conjunction with Oculys Health Informatics, which tracked occupants in emergency rooms and the intensive care unit. The Kitchener, Ont.-based startup’s BlackBerry 10 app also allowed housekeeping staff to report in when rooms were clean and ready for the admitting department. The hospital reports that better visibility on room availability and readiness, as well as knowing exactly how many people were in a specific room, has cut admission times in half.

Transforming hospitals into smart hospitals, Wilson says, isn’t just about improving services for patients. It’s also about raising staff morale by making their work easier. “Giving them mobile devices empowered them by making them feel like they were more a part of the team. It eliminated the bottleneck in terms of doing their job.”

Back in Toronto, Seamless MD is also gearing up for growth. The startup is tiny right now, with only seven employees, but the founders have attracted a number of institutional and angel investors to help fund expansion in the face of demand from new customers.

The Scarborough Hospital in Toronto and the McGill University Health Centre in Montreal are both testing the company’s surgery preparation and recovery app. The app, available for iOS and Android devices and on the web, is free for patients to use, but the hospitals pay an undisclosed amount for it.

Liu and his partners, like most Canadian companies operating in the health-care space, see their home country as a big opportunity, but they also have eyes on the broader U.S. market, where the pressure for hospitals to smarten up is even greater.

But Liu is also a doctor, so he’s pleased that governments are finally taking action to modernize hospitals and thereby improve the quality of care.

“Until you try to fix the policy and get health-care providers to care more about quality and cost, people aren’t going to move as quickly about it,” he says.