When English-educated doctor and software engineer Gautam Sivakumar founded Medisas, he set out to solve a problem he faced in the workforce. Frustrated by the lack of usable software at his hospital, he built a solution to his biggest pain point, doctor to doctor patient care communication. The result was a cloud-based tool that allowed doctors and nurses to safely transfer patient care between shifts, a process known as the ‘handoff’.
In most hospitals, the handoff is a haphazard process in which doctors, often using scraps of paper or Word documents, write down critical information about the patients they have just been looking after. They then communicate these to their replacements, hoping that the receiver can take good notes. Important tasks to be done, vital signs, lab work that doesn’t look quite right, it is all up for discussion; or it should be.
According to the Joint Commission, poor handoffs are the root cause of as much as 80% of all serious medical errors. Sivakumar says that it kills more than 60,000 Americans each year, and is harming many more.
His solution is a cloud-based tool which works across desktop, tablet, and mobile, giving doctors secure access to this critical information, like a real-time, connected piece of paper. Medisas is also organizing the information in the optimal way, geared towards speed and relevance of information. It even tries to prioritize tasks by their urgency, making sure the important things are seen first.
Medisas deployed its software at a hospital in San Francisco, and immediately studied its effect on patient care. Sivakumar calls this ‘Evidence-Based Software,’ a play on the term Evidence-Based Medicine, which is a hot topic in the medical industry. The practice of using scientific evidence to make decisions about the care of individual patients has been around for a long time, but it has only recently entered the medical mainstream.
Based on the data they have collected from their live pilots, Sivakumar says that he predicts that the usage of Medisas will reduce a hospital’s medical error rate by at least 30%. I had a chance to connect with Sivakumar to find out more about Medisas and hear about their plans for 2014.
Alexander Taub: What made you decide that "the handoff" was the piece of the system you wanted to fix? Did you have a personal experience of "the handoff" going bad?
Gautam Sivakumar: Initially all I wanted to do was build really nice, beautiful software, which could improve patient care, because I was really tired and frustrated with the lack of good technology in hospitals. It is either non-existent, or unusable. That's very difficult for a programmer to deal with, but it's not specific enough to take any action. Then the question became: what is the biggest pain point that I can solve, and what is my biggest frustration? The answer was pretty clear: carrying around a piece of paper with my patient list from the handoff. It had all the important information about my patients scribbled on it, and my colleagues had these pieces of paper too. Why couldn't we all be on the same page? Then when I looked at the studies, I saw that the problem was far worse than I had imagined from my own personal frustration. Most serious medical errors are caused by a poor handoff.
In terms of personal experience with handoffs going bad, there are plenty of examples, but I'll tell you about something that I've seen happen a few times. Somebody forgets to relay that a patient needs to have her blood thinner dose reviewed in the evening, which leads to the patient having a serious internal bleed overnight. All because it wasn't handed over properly. Nuts.
Taub: Can you estimate how many lives Medisas has saved so far?
Sivakumar: It's difficult to estimate the number of lives we've saved so far. At the moment we're still collecting hard data which will hopefully be published by some of our doctors. However, we've heard many anecdotes about the impact on care, or catching out mistakes. For example, soon after we launched, one of the senior doctors looked at four different information sources (including paper, and printed Word documents) that four different doctors had been using for one patient. He found that each was missing key bits of information, and some information was even contradictory, including the code status! (whether the patient should be resuscitated or not). Medisas replaced that and put everyone on the same page, on iPads and the web; he discovered that Medisas was the most accurate source of immediate information they had.
Or from today, one of our ICU doctors just told me the story of a patient who came in this morning with a massive heart attack and then started exsanguinating from the mouth. He had been on a special type of blood thinner, which means he can't be given the usual agents to reverse the bleeding. Because this information was in Medisas, the night team knew exactly what was happening with their patient before they even spoke to the day team, and knew what to give him should he start bleeding again overnight. Or the fact that the day attending had met with his family and his code status had been changed. Patients like him are always at high risk, and little bits of relevant information can have a huge impact on care.
Taub: If Medisas reaches its potential, how many lives do think you'll save?
Sivakumar: This is difficult to predict because the impact we have extends beyond lives saved in an emergency, and is often about allowing doctors to optimise treatment, the results of which may not be seen for weeks or months. We think that we can probably reduce more than half the number of errors that happen each year because of poor handoffs, which would mean saving more than 30,000 people each year in the US, if we were in every hospital. But we're doing interesting things with checklists for example, which extends beyond just pure handoff. That is more about making sure that important tasks don't get overlooked for certain conditions or situations. This moves us beyond just saving people from errors, and to proactively improving care. The impact could be staggering.
Taub: Medisas’s mission as a company is to improve patient care using technology, what else do you have in mind besides improving "the handoff"?
Sivakumar: There are many areas of hospital life which could use great technology. At the moment we have our hands full with the handoff, so we're pretty laser-focused on that. It's a big hairy problem to solve, with huge challenges. However, we are big on the power of checklists to help improve and streamline patient care, and we have started working with our doctors on some interesting ways to use them.
Taub: What are Medisas's goals for 2014?
Sivakumar: We don't have a specific 'end of 2014' goal. Now that we've seen some amazing things from our pilots, we just want to get this into as many hospitals as possible. Medisas's goal for the end of the year is just to have as big an impact on patient care as we can. I would also love to continue to fill our team with awesome, smart people, who are passionate about doing the same!
