MphRx This Week in Health IT
April 23, 2020

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April 23, 2020: Here, at This Week in Health IT, we are strong proponents of platforms, and the COVID-19 crisis has brought to light just how important they are in achieving rapid solutions. Today’s guests Varun Anand and Tiago Frigini are here to share with us their experience of the Minerva platform during this time. Varun is the co-founder of MphRx, the company which developed the platform, and Tiago, a doctor in Brazil, working with UnitedHealth Group, is a Minerva client. In this episode, we talk about the issues that Minerva has looked to solve. When the COVID-19 pandemic reached Brazil, it was clear that there were issues with healthcare delivery capacity. The strain on the system, along with wanting to keep patients safe and out of the ER, prompted Tiago to look for a platform to solve these problems. Varun discusses how the platform works and unpacks some of the specific tools available to optimize both the physician and patient experience. By having an agile, flexible solution, clinical resources can be focused on patients who need it most. We also get some insights into metrics from the platform, what additional features Tiago and his team will be adding to their version of Minerva, and how the patients have received it so far. It’s incredible, once again to see a variety of use cases and platform adoption across the world. Be sure to tune in today!

Key Points From This Episode:

  • Learn more about Tiago’s background as a doctor and how he came to work in health IT.
  • Anand’s background and the MphRx platform that he co-founded.
  • The problems UHG was trying to solve by implementing the Minerva platform in Brazil.
  • Why a vendor-neutral solution was important for Tiago.
  • How the platform MphRx created has been adopted by UHG in Brazil.
  • Platforms can be very easily deployed because they are not hard-coded.
  • Why an agile approach is so helpful when dealing with ever-evolving situations.
  • Learn more about how the Minerva platform stores and moves data around.
  • Find out the patients’ reactions to the new platform and what they enjoy about it.
  • Some of the platform building blocks that UHG managed to take advantage of.
  • What’s on the horizon with the Minerva platform for Tiago and his team.

Scaling Solutions by Platform a Discussion with MphRx

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Scaling Solutions by Platform a Discussion with MphRx

Episode 232: Transcript – April 23, 2020

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

[0:00:04.5] BR: Welcome to This Week in Health IT news where we look at the news which will impact health IT. This is another field report where we talk to leaders in health systems on the front lines. My name is Bill Russell, healthcare CIO coach and creator of This Week in Health IT, a set of podcasts, videos and collaboration events dedicated to developing the next generation of health leaders.

 

Are you ready for this? We’re going to do something a little different for our Tuesday news day show next week. We’re going to go live at noon Eastern, 9AM pacific, we will be live on our YouTube channel with myself, Drex DeFord, Sue Schade and David Muntz with StarBridge advisors to discuss the new normal for health IT. With you supplying the questions with live chat. Also, you can send in your questions ahead of time at [email protected] I’m so excited to do this and I hope you will join us. 

 

Mark your calendar. Noon Eastern, 9AM pacific on April 28th. If you want to send the questions, feel free to do that and you can get to the show by going to thisweekhealth.com/live. This episode and every episode since we started the COVID-19 series have been sponsored by Sirius Healthcare.

 

They reached out to me to see how we might partner during this time and that is how we’ve been able to support producing daily shows. Special thanks to Sirius for supporting the show’s efforts during the crisis. 

 

Now, on to today’s show.

 

[INTERVIEW]

 

[0:01:24.9] BR: Today’s conversation is with Tiago Frigini, the telemedicine medical manager for America’s medical service and Varun Anand, healthcare entrepreneur and co-founder for MphRx, which is the company that has created this platform called Minerva and I’m really excited to talk to you guys about this. 

 

But before we go. Good morning. Welcome to the show.

 

[0:01:49.8] TF: Good morning. Thanks, Bill for the invitation.

 

[0:01:54.3] BR: Yeah, I’m looking forward to this. We are cross continent here so I’m looking forward to this. You know, we’re a big proponent of platforms on this show so I’m really looking forward to discussing the use case around this and what you guys have been able to do.

 

Before we do that, Tiago, Varun, if you guys could introduce yourselves, give a little background for the audience, that would be great.

 

[0:02:20.3] TF: Okay. I’ll start. My name is Tiago. I’m a Brazilian doctor and I work with health IT for about nine years now. And my – I work now for as a telemedicine manager from a medical service which is part of UHC Brazil. So, [inaudible 0:02:48] UnitedHealthcare and global. Then I started working with this health IT thing about nine years ago when I started to implement some decisions support tools for the physicians into the EMR.

 

The physicians was and they wanted to know that the treatments and the diagnosis for the patients and we had some algorithms to help them to do that.

 

[0:03:22.8] BR: Fantastic. Varun, you want to introduce yourself real quick?

 

[0:03:27.2] VA: Sure. Thanks, Bill. Varun Anand, one of the cofounders at MphRx. We’ve actually had a pretty interesting journey. We started back in 2010. Actually, did a lot of work as a mobility platform in healthcare. And around 2016, ended up pivoting and building a new platform called Minerva. Had a high level, you know, it’s an open interoperability and digital transformation platform. Deployed in over 20 countries, serving over 300 million patients live overall.

 

And you know, the way I kind of try to explain it is we were kind of like a Lego box or a collection of Lego blocks of tools that can be very quickly stitched together in a vendor-neutral manner to drive engaging digital transformation projects and talking about here and what we’ve done with UHG and with the COVID-19 crisis.

 

[0:04:30.3] BR: Yeah.  The reason I’m looking forward to talking about this, we talk about platforms a lot and people are like, “Well, why do you push platforms so much?” Well, it’s really the speed and the agility that people can work with because the security’s already baked in and as you say, it’s Lego blocks, right? It all just sort of pieces together.

 

And so, when it came across this, I thought, this would be a great conversation so America’s Medical Services, part of the UHG Brazil deployed the COVID-19 triaging monitoring and teleconsultation workflow on the Minerva platform in a vendor neutral format across multiple EHR’s.

 

There’s a lot in that statement, let’s just start with – Tiago, if you could talk a little bit about the problem you were trying to solve as you were approaching this?

 

[0:05:12.7] TF: Sure, as you can see from my background here. We are sheltered, working from home. And then we have as a UHG Brazil, you have more than 35 hospitals and a lot of urgent clinics. And as you can tell, COVID-19 is becoming a big issue here in Brazil as well. And we needed to talk to our patients and to get them safely discharged from the hospitals so they can go home and does not stay in the hospital and get more infection and more other diseases.

 

We have both workflows that implemented so before the patient come to the ER, we have this trial systems so the patients is not unnecessarily going to the ER. And the post discharge flow that when the patient is discharged from the hospital or the ER, we start to monitor the stations for 14 days, so they can access this questionnaire online questionnaire for their symptoms and then tasks are automatically created to the physicians so we can track these patients.

 

But my bigger problem is – was actually that I do not have much physicians or nurses available for this. Since they are on the front of the battles with the COVID-19. I was looking for a platform that could scale up the physicians I have and can put automatically triage this patient, so I don’t lose any time looking for the patients that are perfectly fine.

 

[0:07:19.2] BR: Yeah, that’s fantastic. We’ve seen the telehealth, telehealth, the triaging, the monitoring. Anything where we can really reduce the number of touch points and exposure to potential COVID-19 is in protecting the clinicians has been a phenomenal solution in this – at this point. But why a vendor-neutral solution? Why is a vendor neutral solution important?

 

[0:07:48.6] TF: Because actually, we as a hospital group, as Americas Medical Service, we wanted to provide the service for our patents so they can understand that this was a system that was provided by us. And then again, we are not charging the patients from that. The patients had already gone to one of our hospitals and we are giving this platform this access for them for free so we can improve their health and that’s why we look for a vendor-neutral solution.

 

[0:08:30.4] BR: Fantastic. Varun, give us some idea of what are some of the benefits of working with a platform in this scenario. Walk us through the engagement and what you’ve been able to do?

 

[0:08:41.8] VA: Sure. You know I mean, just to kind of walk you through the story, right? As we guys started talking to Tiago and actually a few other customers, we started really learning about what the ground realities were around COVID-19. Specifically, in Europe and what we were seeing in Brazil, Asia and the US. And what we actually figured out was one of the biggest challenges right now with this virus was that you know, was the overall healthcare delivery capacity, right?

 

Anyone that came in with any kind vulnerable symptoms, you know, thought that they had COVID-19. Even patients that had mild symptoms, at the end of the day, the way they were taking care of was by asking them to go back home, be in self-isolation. 

 

And where we were seeing health systems get overwhelmed was when everyone would actually end up coming to the ER. Everyone would end up you know, having to come to see their doctors to get diagnosed only to be actually told to go back and be in quarantine.

 

As we noticed this, we actually realized that there were a lot of building blocks that we already had in the past, right? The ability to create a public link which patients quickly open up, put in their information, put in their symptoms, you know, automatically register on the patient app. The ability to create the quarantine care plan which essentially meant that you know, Tiago and his customers were able to define and say when a patient is in self-quarantine, “Every day I want to send them a check in questionnaire, right? Asking them if their symptoms have changed. Every day I wanted to send them some educational material.”

 

These capabilities were already configurable to user interface where in fact, what’s really been interesting is you know, our customers are actually defining a lot of those workflows on our home. The teleconsultation piece, the ability for patients that are identified as high-risk or medium-risk for them to be automatically triaged for logic, put in to a work list where you know, the clinical teams could essentially start focusing patients that are high-risk or medium-risk symptoms. Set teleconsultations around that and keep them basically engaged remotely. 

 

The overall objective here was to basically, you know, have our clinical resources focused on patients and on essentially part of the public that really needed to be seen an emergency room or needed to be seen in the hospitals rather than having to monitor a much larger – it’s really a scale problem, right? That’s basically what the pandemic really show. 

 

Now, just to give you some numbers. I mean, we deploy this particular use case within 72 hours, right? We actually set up a new platform and new instance for UHG, branded it actually translated it to Portuguese which was quite a fun exercise. Translated it into Portuguese put it out there. And you know, they started using it on the fourth day.

 

In terms of what we also realized was that because we’re actually deploying something, we’re also learning from these patient experiences and what’s really happening on the ground. It’s also important to be agile in terms of making modifications, making changes, adapting to new workflows on the fly. 

 

Now, if it wasn’t a platform, if it was something that was hardcoded or you know, kind of custom-tailored to building this, every time you had to make any of those modifications would have been a development cycle and I don’t think that could have been up and running in 72 hours. So that’s really the power of how having these platforms in place can really help you know, employ, go to market with these kinds of solutions really quickly.

 

[0:12:33.5] BR: Yeah, I mean, that is the benefit. It’s configurable versus programmable, right? You’re essentially just going into an interface, configurating some things. Those components already built for deployment within the communities that UHG serves that there.

 

[0:12:55.4] VA: That’s correct. You know, I mean, if you really think about doing this in 72 hours – And the other piece also what we’re seeing is, as the virus and as the pandemic is progressing, the actual needs are also changing on the ground, right? The same triaging logic which was earlier being used by – for patients outside the hospital or patients coming into the emergency room, now, the bigger concern is, the health workers, right? The doctors and the nurses. They’re actually contracting COVID-19 as well. 

 

The same workflow with a little modification needs to start working for tracking health workers on the other end, right? This agile approach of being able to really respond to these situations that really comes in handy especially when we’re dealing with something like this.

 

[0:13:42.6] BR: Tiago, did you have to feed the information back into other systems once it goes through this workflow?

 

[0:13:51.5] TF: Yes, we actually are working on one integration that we record this information that we register into the Minerva system and it goes back to the hospital’s EMRs. The patient EMR where the patient has gone in the past.

 

[0:14:16.1] BR: Yeah, Varun, I mean, that’s always one of the questions it’s like, “Okay, vendor-neutral, we’re going to pop this thing in.” And then people will sort of get stuck, they go, “But you know, how are we going to get this information moving around?” Your platform actually is pretty elegant in terms of how it stores and move that data around. Can you talk a little bit about that?

 

[0:14:36.8] VA: Sure, so one of the things that we guys did when we built the platform back in 2016, we were lucky that there was a new healthcare standard coming about right, which was FHIR. And when we looked at FHIR one of the first realizations was A, if you’re building a platform that is pulling in data together from these different systems, it doesn’t make sense for us to create another proprietary data model. 

 

So, we latched onto FHIR. In fact, our data model is completely based on FHIR which means as even these workflows that are being deployed, the data that is actually even captured is being captured in an open standard. And you know as integrations basically open up with the EMR’s with the different core systems there is not a whole lot of translation work or it is not in an proprietary format that it is very difficult to integrate.

 

Plus, interoperability was essentially our main stay, right? We did so many healthcare data integrations across the course of the company in different healthcare environments. We realized the reality of healthcare data, which is like I like say is that healthcare standards sometimes is like a oxymoron, right? I mean everyone ends up having their own version of it. And so, we’ve built an ability within the platform to quickly integrate, whether it is the healthcare standards like [inaudible 0:15:58].

 

Or as you see with a lot of implementations across the world, a lot of IT systems don’t speak these standards. So, you are still down to doing CSV integrations or down are doing web services and APIs. And the key to digital transformation is the cost of doing those integrations, right? How quickly and how cost effectively you can integrate it with your core systems really makes a big difference on how effective a solution or an engagement would be. 

 

[0:16:32.8] BR: Yeah. Varun, I am going to come back to you because I want you to talk some of those building blocks, you know chat bot, payment gateway and those kinds of things. But before we get there Tiago, I’d love to hear how the consumers or the patients are responding to the solutions that you put out there or are out there at this point? 

 

[0:16:56.9] TF: So, we just actually achieved the two-week implementation just yesterday. So, we are getting some spontaneous feedback from the patients during their tele-consultations and they are phenomenal. The patients are really excited. The patients are glad that we are taking care of them. But we do not have a measured system like any guest or something that we are starting to send these questionnaires for the patients like today because we didn’t want to bother the patients. 

 

So, they can answer this NPS on every single tele-consultation and we just assumed that would be better for us to have a whole program NPS at the end of the care plan. So, that is why I don’t have this at now. But the patients are spontaneously giving this back for the doctors from the platform and the care that we are providing to them. 

 

[0:18:05.1] BR: That was great. Varun, give us a couple of the building blocks and then we’ll close out by talking about where this could go once this is in place. I know it is two weeks into it but one of the magic things that are at a platform is it is only limited by your imagination. But with that being said, what are some of the building blocks that UHG took advantage or just some of the other building blocks that are in this platform? 

 

[0:18:33.8] VA: Sure. So, you know some of the building blocks that really come in places number one, the ability to really quickly deploy white-labelled rapid mobile apps for patients and clinicians, right? So, what we are deploying here is not something which is MphRx branded. It actually looks like an Americas app. They are actually we are releasing and IOS and an Android app to these patients as well. So, there is that front end layer which is flexible and you can configure that. 

 

And then the other piece is that the building blocks that really come in is around the patient identity, the constant management, how you could sign them up to email and phone number and that is always a complex thing to do, right? When you are going out and you are engaging with patients that are not already part of your ecosystem. We already had a workflow engine where for UI you could very quickly set up care pathways where you could say that, “Hey, if somebody has put on a self-quarantine plan this is what needs to happen daily. I want them to record their temperature. I want them to record their Sp02.” So, all of those things were that was a framework already built in. 

 

Similarly, the ability to do alerts and notifications which we are doing right now so you are actually sending out alerts and notifications to patients as well as to the providers saying that, “Okay, you know these are four things you need to do today.” Or follow ups around that and so on so forth. 

 

The tele-consultation piece is interesting. So, we actually within the platform had integrated a framework, which is based on WebRTC. This is a very interesting standard where you essentially don’t need to install anything on web and mobile devices. And if you think about it from a – you know we guys only get on conference calls and it is always – you know every conference call is interesting. If somebody is downloading an app or somebody is downloading a plugin, right? 

 

And the moment you start opening that up to sick patients that becomes a bigger challenge. So, you know the tele-consultation work for zero install whether it is on the iPhone, Android or on the tablet or computer that really reduces the friction for patients and the providers who really use it.

 

And then more importantly I think underneath the ability to store all of this information in an open standard making it something that can be crossed-leveraged in the future as well. 

 

Also, because we have been doing – A lot of our projects have been patient-facing, we also start looking at your overall engagement metrics, right? Which I think every time you are doing some, any kind of remote modern thing, the digital transformation piece, that becomes important. So just as an example in the last 10 days or so I think we’re roughly tracking about 1,500 patients. 

 

I think Tiago and I were talking about this where they – Of those 1,500 patients that are being tracked daily. They have done 400 tele-consultations, right? Off those 400 tele-consultations of those patients only 10 have actually been asked to come back to the emergency room. And of those people that have been asked to come back to the emergency room, zero has been hospitalized. So those are the kinds of metrics you really need to track to drive really good to really understand what ROI or what impact you’re really making in this situation. 

 

[0:22:01.5] BR: Absolutely and plus you have – I mean you guys have a ton of stuff in here like online payment gateway, fraud prevention. I mean just chat bot capabilities, eligibility checking. I was looking at the list of this stuff and I am sitting there going, “Yeah that is the building blocks.” I just sit back and I don’t have to build that. I just go, “Yeah, I need a payment gateway. Yes, I need this,” and that is the beauty of the platform. It is configurable as opposed to building it out. 

 

And having been a CIO who built all of that stuff out, I am glad there is now platforms that you can just configure because that represents a lot of work. So where do you go from here? This is the last question. So where do you go from here, where can you go from here? 

 

[0:22:48.5] TF: Actually, I think I can start with that. As you can, you work out and we are implementing some other blocks that we need here. So, one of them is including I don’t know if you have this demand in the US, but here, we have a virtual urgent care queue line here as a demand. So, the patients wants to see a doctor right now so they can click on the button and stay online in a virtual queue and so the doctor will pick this patient up and talk to the patient without having to schedule the appointment. And this is one of the things that we are implementing by the next week and one of the things that I ask Varun to develop.

 

But for us to have this, we needed to get the online payments and the eligibility too. So, the insurance can pay us for this visits because the patients wants it. And have pass through one of my hospitals and then one of the things we are trying to prevent here is the fraud because the payers will ask us to do that. So, we are implementing the facial recognition in the moment before the tele-consultation as well. 

 

Another thing is this chat box to ease the interactions from the patients through the platform instead of the questionnaire. So, it is more natural for them to answer to the bots than to just answer the questionnaire and another thing that I need the Minerva platform to solve is the doctor to doctor discussions. We already have this ran right now. This project goes back to 2011. And we have discussed more than 60,000 patients within these nine years.

 

And as we are a group of hospitals, we have some centers that are systems of excellence that are dedicated to a specialty or some cardiology cases or neurology. And then we transfer patients between our hospitals and this is one of their bigger problems I have right now because I have different hospitals with different EMR basis. And the patient’s of EMR does not – is not accessible from one hospital to the other. 

 

So we have a lot of paper been translated with the patient and a lot of time that the physician wastes in getting the information from the other hospital and this can be automated by interoperability tool. That is what our last result. 

 

[0:25:50.7] BR: That is fantastic. Gentleman thanks for your time. Varun, if people wanted more information on this where could they go to get some more information? 

 

[0:25:58.4] VA: So, they can go to our website at mphrx.com and we’ll actually pass you a link that you can make part of your podcast as well. So we actually have been talking a lot about this particular workflow, as well as how health systems can use this going forward as well because I think one of the things that I guess is the way I look at it is that COVID-19 is becoming definitely a catalyst for a lot of these tools to be deployed and very quickly used. 

 

But once in the next few months as the crisis unravels itself, the general behavioral rules will change right? So, the capabilities that we’ve used to take care of COVID-19 patients remotely can also be transferred to oncology, cardiovascular, imuno-diseases and so on and so forth. So other specialties as well. So, we’ve got some content on our website about that and I will share the link about it as well. 

 

[0:26:56.6] BR: mphrx.com. 

 

[0:26:58.9] TF: Yes. 

 

[0:27:00.3] BR: Great. I am going to put you on the spot one last time, which is how does an entrepreneur come up with the name and how did you come up with that name? 

 

[0:27:08.2] VA: Well it actually goes back about 10 years. Mahesh is our CEO. You know the early idea behind the company – We were three tech guys who into healthcare, right? And our biggest question is, “Why is it so difficult to get patient records from point A to point B and why don’t patients don’t have access to their own records?” We jumped into the industry thinking that is a problem that needs to be solved. And initially we thought we’d be PHR, the patient health record system. 

 

And we thank our stars that we didn’t do that back in 2010. And we didn’t go down that path. But the name of the company came from that it was ‘my personal health record express’ and you know I actually have a few customers and you start basically going out in the market. I think we were attached to the name and the history that I did. 

 

[0:28:01.6] BR: Yeah, I am making fun of you but it is a pretty easy to remember name, MphRx so gentleman again, thank you for your time. I really appreciate it. 

 

[0:28:11.5] VA: Thanks Bill, thank you Tiago. 

 

[END OF INTERVIEW]

 

[0:28:13.6] BR: That is all for this show. Special thanks to our sponsors, VMware, StarBridge Advisors, Galen Healthcare, Health Lyrics and Pro Talent Advisors for choosing to invest in developing the next generation of health leaders. If you want to support the fastest growing podcast in the health IT space, the best way to do that is to share with a peer. Send an email, DM whatever you do. You could also follow us on social media, subscribe to our YouTube channel. 

 

There is a lot of different ways you can support us but sharing it with a peer is the best. Please check back often as we would be dropping many more shows until we’ve flattened the curve across the country. Thanks for listening. That is all for now.

 

[END]

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