As health care becomes increasingly data-driven, skilled nursing facilities have to find ways of gathering data on their patients — while working with tight budgets and dealing a workforce crunch.
Technology providers, with services ranging from electronic medical records (EMR) to telehealth to remote monitoring, have stepped up to try to address the need. But for the post-acute space, and the skilled nursing sector in particular, razor-thin margins have made widespread adoption of technology in SNFs difficult.
But one company, the Ramat Gan, Israel-based EarlySense, is seeing growth in post-acute clients, particularly in recent months. The company, which offers contact-free, continuous monitoring for hospitals and post-acute providers, recently completed a $39 million financing round — backed by medical equipment manufacturer Hill-Rom (NYSE: HRC) and Wells Fargo Strategic Capital — and has carved out a presence in multiple networks.
Skilled Nursing News covered the use of EarlySense tech in Allure Group’s six New York nursing homes in February 2018, and more recently caught up with EarlySense CEO Avner Halperin to talk about the changing role of technology in the post-acute sector.
For those who may not be familiar with your technology, can you talk about what EarlySense is and what it does?
We are a sensing and analytics company. We developed a non-contact, very accurate sensor for monitoring vital signs, cardiac respiratory perimeters, [and] motion, and run analytics on that data. So for patients who previously were not continuously monitored in hospitals and post-acute, instead of them being only manually spot-checked once every four, six, or eight hours, we take 100 readings every minute. With that data we run smart algorithms, and we provide early warning on change in condition clinically, or on risks such as falls or pressure ulcers.
The idea is that once our system is installed — without any burden on the clinician because there’s no setup on the body, with very few false alarms — there’s real-time monitoring of patients and alerting whenever something requires intervention. Hospitals started using this system a few years ago, and have seen very positive results, including shortening of length of stay, fewer falls [and] pressure ulcers, and fewer cardiac arrests.
Then over the last 18 months, we’ve seen this technology very rapidly adopted by post-acute sites, who are dealing with more and more complex patients, with a relatively low nurse-to-patient ratio. So they find this is a tool that allows them to handle more complex patients safely and efficiently. That’s why we’ve seen that fast growth.
Can you talk about how the technology is typically used in a SNF, and the logistics of getting the system set up?
The setup is quite simple. There is a sensor that is placed in the bed under the mattress, and then it’s invisible. Afterwards, there is a small communicating device that is plugged next to the sensor at the bedside. All the information is communicated to a central display and to mobile devices that the nurses can carry — either a pager, an iPad, a phone or whatever is used by the facility. And the idea is that the data is collected automatically; it’s shown on the central display. Whenever there’s an alert on fall risk, pressure ulcer risk, or cardiac or respiratory deterioration, that’s sent directly to the relevant clinician and they can respond to it.
A key part of the design of the system is that there are relatively quite few alerts. We’ve put a lot of a lot of work into preventing what is usually the biggest challenge of continuous monitoring, which is alarm fatigue … The nurses on average get two or so alerts per shift, so a relatively small number of alerts.
You’ve mentioned that you’ve seen recent growth in post-acute care for EarlySense. Can you talk about the chronology of that interest from such providers, and why they’re interested?
When you look at the trends in post-acute, the level of acuity of residents or patients in post-acute is growing rapidly, without growth in the number of clinicians. There are now penalties associated with issues like readmissions and others that are also a key point. And there is the motivation for each post-acute site to make sure patients are discharged to their sites, versus others. So that level of competition is also an important point.
After seeing very nice success in the hospitals … we realized the same technology can bring a lot of value in post-acute care. We devised and developed and launched about 18 months ago, a new product that we call the InSight — the device I mentioned earlier, kind of a smaller plug that connects with a sensor so it does not require a full monitor at the bedside.
With that, we realized that fits very well in post-acute care sites that don’t necessarily want a monitor at every bedside. They just want the data collected and the alerts shown at a central station or on mobile devices. Once we came out with this solution, we started seeing very quick adoption by the post-acute sites.
Most importantly, customers in SNFs that have used our system have seen achievements in terms of improving their clinical outcomes — so fewer readmissions to hospital, more effective care of complex patients, and fewer falls and pressure ulcers have been kind of key points that they’ve seen achieved. That has driven expanded growth both within these post-acute networks, and within these newer networks as well.
When we spoke last year, we actually spoke about Allure’s use of EarlySense. When you and I spoke last year, EarlySense had the goal of covering “practically the whole continental USA” by the end of 2018. How many facilities are you in now, and did you end up meeting this projection?
What I can say is that we have grown very quickly. Our systems are now installed in hundreds of institutions, and we see continued and accelerated growth, that’s also why we did this funding round for us to allow us to continue to grow even more quickly. Because of the very strong outcomes that customers are seeing, and the value that they see for the patients and for the facilities, this growth is continuing and even accelerating.
When it comes to the post-acute care setting, do you have any numbers on how many patients you are monitoring specifically in that setting?
The overall number is a million patients, but what I think we can say is that the number of patients that we cover in post-acute is growing very quickly. I can even say it’s growing more quickly than the growth we see in hospitals, because of this really critical need we see now in post-acute for technologies that enable effective care for more complex patients —s and still are very simple and straightforward to use without burdening the clinical teams.
I’ll say one more thing: I think when we look into the future of care in hospitals and certainly in post-acute, care based on real-time data and smart analytics is critical. There is no other way to deal with the fact that patients are growing more complex and aging than data-based, analytics-based care, and that’s really why we see this fast growth in the use of our systems.
That’s a good segue into my next question, which is about the state of technology in post-acute care. How would you assess the use of technology in this sector and how do you see it changing now and over the next several years?
Historically, post-acute care was lagging in technology after hospitals, but right now, the trend we are seeing is that that is rapidly changing. We’ve seen, of course, sensors like ours going in and being very quickly adopted and based on that, much more data-driven care being provided — and that is because it is associated directly and immediately with improved outcomes, clinically and economically.
That’s maybe a point I didn’t highlight before, but the fact that there is both clinical value and economic value is something that’s really driving quicker implementation of advanced technologies in the post-acute sites like smart sensors.
You also see the EMR companies that are doing very well and growing in the post-acute segment, and once you have both the data collection and analytics with solutions like ours, and the EMR platform to document the data and support all the other processes, we see that really improves the efficiency of management of post-acute sites.
There is still much room to grow, for additional technologies to come in. I think what we will see if we look into the next decade is that this gap that existed between post-acute and hospitals will close. And maybe even in some places we will see technologies going first into post-acute sites, because what has always driven technology usage is shortage of clinician resources. This shortage of resources in post-acute is driving rapid adoption of technology now in SNFs, and I think that’s going to drive that continued acceleration — again, closing that gap and potentially even taking a leadership role in bringing new technologies in post-acute, over hospitals.
That’s interesting. What kinds of technology might end up going into post-acute care first?
I think technologies like ours are a great example, but other kinds of technology that promote safer care and safer living, I think are very likely to be adopted. Technologies around the living of elderly people that need to be safe while they are mobile and as independent as possible, are things I think we are likely to see, and we may well see those adopted faster in post-acute than in hospitals.
Another example is things related to voice activation and voice usage — Alexa-type technologies that allow effective care, real-time communication, and allowing calling for help and analyzing if help is needed. All those technologies are very likely to be adopted in the next few years, and I would not be surprised if they go, again, faster into post-acute than hospitals.
Many SNFs are operating on very thin margins, and with that as the backdrop, what are some of the common obstacles and blind spots in SNFs adopting technology more widely? How can they be overcome?
That’s a great point, and clearly the concern is maintaining and improving the margins of these sites. What we have seen in our work is that what was critical for the adoption of new technology is that there is a proven return on investment on putting the systems in — in terms of reducing costs, enabling the care for more patients, preventing the penalties that are coming up, and sometimes even getting to higher scores on quality that drive higher reimbursement rates, and of course most importantly attracting more patients into these institutions.
One thing we have found is the ability of sites to work with us in a different business model than in the past, and that is a business model where it’s not a capital purchase, but a more of a [software as a service] type model. When it’s a payment per day when there is a patient in the bed, it makes this more attractive to the institutions and really makes this into a win-win, because when there is a patient, the facility gets an income and makes a profit and does that more effectively and efficiently because they have our solution installed. When there is no patient in the bed, and no income, they also don’t have to pay us.
That kind of aligns the incentives. and makes the system — from their perspective — cash-flow positive from the first day. And I believe that is a model that we will see more and more of in the post-acute market.
This interview has been condensed and edited.