Innovation drives business - all business, regardless of SIC code. If your company is complacent or content, you will suffer, and possibly lose to those who are finding ways to perform better, faster and more affordably. The Atlanta business community is no stranger to innovation. A 24-hour cable news network. Branding and growing a home-style restaurant with a sweet focus on inviting, fluffy waffles. A start-up Internet provider with a mind of its own . . .

As the rising cost of health care becomes a significant issue in 2009 - both politically and it's effects on already-suffering balance sheets - innovation will take hold once again. Tough times breed innovation. So here's a preview of the people, products and services that are committed to changing the way the health care game is played, saving money, saving lives and creating solutions for today's problems in health care. All are based in metro Atlanta, and all are poised to make a difference. You've officially been warned. Innovation - it's a beautiful thing.

[Streamlining Solution]
Rick Jackson
Nearly 60 percent of U.S. healthcare executives who responded to a recent survey say their facilities lack the ability to track patients continuously. According to the 2007 National Survey on Patient Throughput and Capacity Challenges, more than half of those same executives rated their facilities' "bed-turn process" as poor or fair.

What if hospital wait times could be reduced, more people could be seen and it would take less people to do so? That's what Rick Jackson, founder and CEO, Jackson Healthcare, believes his StatCom software will help accomplish. By providing patient flow logistics and tracking across departments, StatCom will help health care organizations anticipate demand and manage potential bottlenecks.

While some health care facilities have implemented patient throughput and logistics management (PTL) systems, a recent Gartner Report estimates the market penetration of such products as less than 1 percent. If that's the case, what are hospitals using to track patient throughput? Nearly 70 percent use phone calls and voice mail to track patients as they move through a hospital, according to a Patient Throughput survey. It's not unheard of for dozens or upwards of 100 phone calls to be made to schedule or cancel a complex procedure.

Charles Frame, executive director at the Emory Center for Healthcare Leadership at Emory University School of Medicine, explains that the historical infrastructure of hospitals led to a silo mentality and a hierarchal organizational structure. "In the olden days, the physician came to the patient a lot more," he says. These days, patients undergo various tests and, as a result, are transferred throughout the hospital. "Many hospitals aren't built for that," he adds.

This silo mentality is exacerbated by the fact that hospitals aren't producing a product, they're dealing with human beings. "The sheer human element makes it so much more complex," Frame notes. It's more difficult than streamlining manufacturing processes with Six Sigma, he says, "That sounds great, but it's a lot tougher to achieve."

According to Jackson, StatCom goes a long way towards increasing efficiencies by tracking a patient's whereabouts in real time, alerting different departments and functions with the click of a button. Jackson likens StatCom to the Federal Aviation Administration (FAA) and air traffic control. Aircraft are tracked from takeoff to landing, and shuffled if some run late or there is inclement weather.

As the FAA is to aircraft, StatCom is to patient flow - from admissions through X-ray, bed assignment, transportation, equipment personnel, housekeeping and so forth - a patient's every movement up through discharge. Jackson believes that delivering patient flow information in this way "will significantly improve operational efficiency," he says. "[StatCom will track] patients, equipment, roving C-Arms, MRIs. There will be increased utility of every asset. That all equals profit." Additionally, nurses will be able to reduce the time they spend on non-clinical duties and devote more time to patient care.

To date, Jackson has invested $20 million in its development and considers the software "truly transformational." And transforming health care is what Jackson is interested in these days.

In 1978, Jackson formed his first health care-related company, Jackson & Coker, a physician staffing company.

Since then, he's conceptualized and/or developed more than two-dozen companies in the health care sector. In 2007 and 2008, Jackson Healthcare made the Inc. 5000, list of fastest growing private companies in the U.S. (having grown from $92.4 million in revenue in 2004 to $372.6 million in 2008).

Recently, Jackson took aim at health care's bigger picture. "A while back, insurance companies came along and solved a problem. But now they're an unnecessary link in the chain," he says. Jackson has developed a plan to revamp health care that is based largely on removing insurance companies from the process. "They're not bad people, but we've come so far," he explains.

While Jackson understands an insurance company's wish to keep health care costs down, the overall effect, he says, is that health care is no longer distributed by doctors, but by insurance companies. "You have non-doctors telling doctors how to practice medicine," he says, adding that it's inefficient as well. "Thirty to 40 cents of every dollar [spent on health care] is not going to health care." He suggests taking insurance companies out of the decision-making procedure and automating the process. The fact that decisions will be made by policy makers in Washington, D.C. distresses Jackson. "Government doesn't know health care," Jackson says. "Everybody is trying to protect his turf."

"By most people's standards, I've been successful. Now I want to move from success to significance - to create a legacy in health care," he says. "I'd like to say I had a hand in how health care is done." - AS

[Consenting Adults]
Dialog Medical
In 2005, a 20-year old woman underwent surgery at Harbor-UCLA Medical Center in Los Angeles to stabilize two fractured vertebrae sustained in a car accident. After the surgery left her paralyzed, the woman, Shanay Bridges, sued Los Angeles County. Bridges claimed that the risks of the procedure - specifically the possibility of paralysis - had not been explained to her.

Physicians at the hospital may have told Bridges paralysis was a possibility, but she had no recollection of being told. And while paralysis is an obvious risk of such surgery, that fact was omitted from the consent form Bridges signed. Many organizations rely on operating physicians to draw up consent forms, and this was  such the case at Harbor-UCLA Medical Center at the time of Bridges' accident. The result? At the end of last year, the county agreed to settle the lawsuit and pay Bridges $1.6 million.

Stories like this are not uncommon. An Archives of Surgery study analyzed consent forms from 157 hospitals and found that only 26 percent of those forms contained the four major elements of informed consent: description of the procedure, risks, benefits and alternatives.

"It's purely an informed consent issue," says James E. "Jim" Gottesman, M.D., when asked why Los Angeles County settled with Bridges. He should know. Gottesman is a Seattle-based urologist who created one of the first standardized informed consent forms for his own practice more than 20 years ago. Now a member of Atlanta-based Dialog Medical's Medical Advisory Board, he has helped the company create consent forms for its iMedConsent application, a software program that allows health care organizations to standardize medical consent forms. Providers use the application not only to educate patients about conditions and procedures, but to document the patient's consent. "Doctors do a pretty good job of giving informed consent but an absolutely terrible job of documenting it," he adds.

Gottesman sold himself on standardized consent forms when he was sued in the late 1980s. One of his patients insisted that Gottesman had misinformed him; however, Gottesman produced two signed standardized informed consent forms clearly indicating that Gottesman had not misinformed the patient, but quite the opposite. Although Gottesman won the lawsuit, he became a self-described zealot for informed consent. "Not only is it an educational tool, but it made me comfortable," he says, adding that informed consent not only protects physicians, but it empowers patients.  


Years ago, Gottesman shared his idea for standardized consent forms with others, and his idea ultimately found its way into the hands of Mike Burke, founder and president of Dialog Medical. Based on Gottesman's initial idea, Burke created the company's signature software, iMedConsent, which offers physicians and medical facilities a comprehensive, standardized approach to the informed consent process. "It's all designed to fundamentally support the relationship between the physician and the patient," says Burke, who founded Dialog Medical in 1997.

Last year, the company, which also creates content for the consent forms (such as drawings and description of conditions and procedures to better help the patient understand) collected $5 million in revenue, and more than 15,000 physicians in 179 medical centers nationwide use its application.

One of the first organizations Burke approached was the Veterans' Administration (VA) Hospital in Atlanta. He felt that iMedConsent was a perfect fit for the organization, which had been given a mandate to enhance patient safety. Initially, Dialog Medical sold its product to a dozen or so VA Hospitals in various markets before the organization decided to conduct a study on whether or not to implement the product system wide. It took the VA a year and a half to decide, but in 2004, Dialog Medical signed a 10-year contract with the organization and is now up and running in over 160 VA Hospitals. According to Aaron Fink, M.D., manager of the Surgical and Perioperative Care unit at Atlanta VA Medical Center, approximately four million informed consent forms are collected each year from VA patients.

"They provide a nice vehicle for patient education," notes Fink. The organization recently completed a study highlighting the effectiveness of standardized consent forms. "The comprehension rate with standardized forms was significantly better than rates for non-standardized informed consent discussions," Fink says.

The program also interfaces with the VAs electronic medical records, so that if a patient visits another VA facility, his forms are accessible with the click of a button. In fact, if there's a need to consult the form during surgery to see what a patient has or has not consented to, physicians can call up the iMedConsent forms while in the operating room.

The forms can be tailored for any number of procedures, complete with diagrams and descriptions of the procedure, creating an opportunity for physician-patient dialogue that over-arching informed consent forms do not. Such forms enhance a patient's education regarding the procedure and post-procedural care, and they document that the risks, benefits and treatment alternatives have been discussed with, and understood by, the patient, thereby legally protecting physicians and medical centers. The content contained in the forms is reviewed regularly to ensure that it reflects current clinical practices.

While the VA is Dialog Medical's biggest customer, the company is exploring other uses for its software - such as streamlining administrative forms and providing consent for medical research - and is working on capturing more private sector business. Last July, the County of Los Angeles purchased Dialog Medical's iMedConsent application for use in its LAC+USC Medical Center and is in discussions with the Atlanta-based company to expand the use of the application into other Los Angeles county hospitals. According to Daily News Wire Services, the program could be implemented by all Los Angeles County hospitals by the end of 2009.

"The more people that use the same consent form, the more you're protecting everybody who uses it," says Gottesman. "It's not just about protecting physicians legally, patients have a right to know these things." - AS

[Improving Process For Profit]
Navicure
In 2009, the political and business community buzzword is transparency, and Navicure appears to be on the front lines. The Duluth-based company sells productivity tools to doctors for streamlining the mind numbing and cost-prohibitive paperwork of insurance claims reimbursement. "One of the fundamental issues [of health care] is getting claims to the insurance companies and into the insurance companies adjudication systems for processing," says Jim Denny, CEO of the eight-year old company. "One of the key components is adding transparency and accountability to process. You can tell where the claim is in every stage along the way. You know there is no question about whether or not the insurance company got the claim, what they did with the claim, and how they process the claim. We make all that very easy to see and understand."

Think of Navicure as the FedEx for processing insurance claims, complete with a way to track each claim online. The company was founded in 2001 by Denny, Ken Bradley and Craig Bridge, and has clearly filled a much-needed void between insurance companies and physician practices swamped with paperwork. "I was in this industry for about five years before [we] started the company ... and saw a lot of the problems that plagued practices," he says, noting the end results often directly affected the patient. "The transmission of insurance claims was really a messy, unreliable, sloppy process and because it was so opaque, it was difficult for people to understand where the problems were originating."

When starting Navicure, he and his founders wanted to emphasize simplicity. "If we could uncover the mystery of why claims processing is so complicated, that there will be a place for us," he recalls. "And I think you know by making a very complicated problem, the dealing of claims easy and open and transparent, we've made it a lot easier for people to get claims paid without a lot of work."
He was right. From 2003 to 2007, his business experienced a 1,329 percent revenue growth rate, garnering a 149th ranking in the country from Deloitte's Technology Fast 500, and was named the top tech company in Georgia. "We've grown quite nicely over the last eight years, but you know there are 550,000 physicians in the United States who could use our service," he says. "Today, we've got about 15,000 physicians on the service. There's just a huge amount of green space to cover in terms of serving the 550,000 physician market."    - DE

[Investing in Innovation]
WellStar Kennestone and the Jetstream
New and innovative treatments can be helpful to both the patient's welfare and the health of the bottom line. Like when Dr. Steven Oweida started treating patients at WellStar Kennestone Hospital with the Jetstream, a newly FDA-approved artery-clearing device.


The Jetstream is an innovative device that removes artery-clogging plaque in the legs of patients suffering from peripheral artery disease (PAD), a chronic condition that occurs when plaque accumulates inside blood vessels, restricting blood flow to the extremities. Typically causing debilitating pain, the condition can ultimately lead to amputation.

The product had been on the market for just one week when Oweida and his team at WellStar Kennestone began using it, making him the first physician in Georgia and one of the first in the U.S. to do so. Months later, physicians from around the country are coming to Georgia to learn more about it.

Economics was certainly among the reasons that WellStar's product selection committee decided to purchase it. "We look to see how many devices are needed to get a successful result," says Roderick Cheney, a member of the selection committee and lead technologist at Kennestone's Vascular Institute. Some equipment results in further expense because it does not achieve satisfactory results on its own, he explains. "With some of these other ones, you then have to do additional stenting. That's more cost to us as a health system and more cost to the patient." In performing a value analysis, the product selection committee considers "what is on the market and what we have in the system, what we can bring in and what we can phase out."

The cutting edge device consists of a catheter that breaks up arterial plaque and then removes it. "That's the quantum leap," says Oweida. "Other devices break up the plaque, but then it just goes downstream, which can cause embolisms or worse. It's almost like robbing Peter to pay Paul."

The Jetstream is the first device on the market capable of treating an entire spectrum of disease found in the PAD patient. Not only does this simplify treatment, but it obviates the need for additional pieces of expensive equipment.

Being a frontrunner with new technology has definite advantages, Cheney says.  In addition to the back-and-forth exchange between early users and the manufacturer, having something like the Jetstream to offer "helps us keep our patients in the neighborhood." - LD

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3 Cool Products In The Pipeline
The biomedical pipeline is chock full of ideas and innovation in Atlanta. Here are three local companies with promising future products:

[Altea Therapeutics]
For everyone who hates getting shots, the PassPort Patch may be the answer to your prayers. Altea Therapeutics is working to replace needles with a system that delivers medication via an electric impulse and a patch. Best of all - it's pain-free.

Although transdermal patches themselves have been around for years, the PassPort Patch is a radical departure from conventional patches. The system uses a hand-held applicator to send a small pulse of heat through its patch, creating tiny channels in the skin through which medicine can travel. Because of the millions of dead skin cells that often form a protective barrier, transdermal patches can be used with just 10 percent of medicines, according to Altea co-founder Eric Tomlinson. That fraction alone represents a $9 billion market, and Altea hopes to capitalize on the remaining 90 percent. The company is well funded with at least eight investment partners, and human trials are under way and commercialization is set for 2012, where a non-injectable insulin patch could make life easier for those battling diabetes.
alteatherapeutics.com

[CardioMEMS]
Wake up. Have breakfast.  Prevent heart disease. 

That may soon be the morning agenda for the more than five million Americans diagnosed with congestive heart failure. A breakthrough sensor system being developed by Atlanta-based CardioMEMS would make monitoring heart pressure changes a fast and easy part of daily routine - one with potentially life-saving ramifications. 

Here's how it works: In a 30-minute procedure, a tiny, wireless sensor is placed in a patient's pulmonary artery. Once in place, the sensor sends information to an electronic system hooked to the patient's phone, which in turn transmits data to a Web site that can be viewed by their physician. Adjustments to medication can then be made without the need for hospitalization. In addition to simplifying care, eliminating hospital stays produces huge savings.  "They are actually the biggest line item on the annual Medicare budget - amounting to tens of billions of dollars," said CardioMEMS Senior Vice President of Scientific Affairs David Stern.

The heart failure system, set to hit the market in 2010, is CardioMEMS' second foray into wireless monitoring. The company's EndoSure sensor has been commercially available in the U.S. since 2006. Successfully implanted in more than 5,000 patients, it monitors pressure changes in aortic aneurisms. 
cardiomems.com

[SoloHealth]
According to the National Eye Institute, 50 percent of Americans 20 and older may have a vision problem. Yet getting an eye exam is not on most people's radar screens. That's something Atlanta-based SoloHeath is out to change. The CIBA VISION spinout is putting self-service "EyeSite" kiosks in high-traffic retail environments to encourage users to take preventive, proactive eye-care measures. Providing free vision analysis, EyeSite kiosks derive revenue from participating referral physicians and advertising.

Since the kiosks' debut in June 2008, more than 65,000 consumers have used them, including a deal to test market inside select Wal-Mart's, the largest retailer in the country.  - LD
solo-health.com