Reducing Wait Times in Canadian Healthcare with Intelligent Referral Technology

MOBIA_Solving_for_Change_Episode_10

Rob Lane: [00:00:00] Within a period of 18 months from that first conversation, we had a complete product built, provincially deployed across the province of Newfoundland and Labrador, and live with all the patients going through our electronic intelligent referral platform that we built, which allowed you to measure the acuity in somewhat real time as well.

So, if you did another test and a person's acuity changed, it would automatically present in a different manner.  

We've increased efficiency by 25% in the province in cardiology. We've improved appropriateness by 35%. So, we've already been able to divert people from the cath lab to other places that are first of all, far less invasive and dangerous to the patient but also far less expensive for the province.

We're looking at other pathways that have some similar challenges that cardiology was facing [00:01:00] around acuity, waitlists, and who do we see next, and is it appropriate. So right now we are going live in the province of Newfoundland--within the next two months--we'll be going live with ophthalmology and orthopedic surgery.  

Marc LeBlanc: This is Solving for Change, the podcast where you'll hear stories from business leaders and technology industry experts about how they executed bold business transformations in response to shifts in the market or advances in technology. I'm your host this month, Marc.  

In this episode, we're going to talk about some of the challenges that healthcare is facing as an industry.

There's new things that are emerging, there's new technologies that are able to respond. We're going to talk with the CEO of MOBIA, Rob Lane, about Mobia Health and one of the products that they've developed and how it's helping address some of those challenges. Rob, thanks so much for being a guest on the podcast this month.

Rob Lane: Thanks, Marc. Thanks for having me.  

Marc LeBlanc: So, I was wondering, just in order to kick off the conversation, could you just maybe explain to our listeners what Mobia [00:02:00] Health is up to?  

Rob Lane: Yeah, I'd be happy to do that. So maybe I can talk a little bit about the history. Would that be a good place to start?  

Marc LeBlanc: Sure, please.

Rob Lane: Okay. So, back in 2017, we were approached by a cardiologist in the province of Newfoundland. His name is Sean Connors. And Dr. Sean Connors is the head of cardiology, interventional cardiology, for the province. And I met him at a hacking health conference over a weekend, of all things. And we sat down together and coincidentally, I had just been on the cardiology journey the previous fall. I'd had a stent put in my heart, so I went on the waitlist and went through a series of tests to determine if I might have something wrong with my heart and ended up at the cath lab and ended up having a stent put in my heart. So I had a firsthand vision of the journey a cardiology patient takes from, "Hey, there could be something wrong with you." That's your meeting with a cardiologist, a diagnostic [00:03:00] cardiologist, to being transferred to the cath lab and then having another test done, which is invasive, by the way. It involves putting a catheterization into your artery and then going into your heart to diagnose issues with valves, plumbing, i. e. blockages, etc.  

So, I sat down with Sean over the weekend and he knew we had an IT company and he's a very bright guy and he said to me, "Rob, I have a couple of problems." He said, "You know, one of them is we can't... We don't have proper workflow right now because the referrals come to me in paper forms and they're static. So I just get literally hundreds of these."  

They had 800 people on the waitlist, if you can imagine. And he said, "Of the 800 people, I don't know who the most at risk patient is. We just have no way to quantify it and stratify all these referrals."  

And I thought, "Wow, that's kind of mind boggling." But I've been through it myself, so I [00:04:00] knew it to be true in a different province, in Nova Scotia. So Sean asked me, could we help? And I said, "I really don't know. But you know, we build software and we have business analysts." And I said, "The first step would really be for you and your team to sit down with one of our business analysts and talk about your business challenges, and then they'll frame it up to say: Hey, is there a technology solution that can be built for this?"

And to fast forward that whole thing a little bit, within a period of about six months, we had a minimum viable product built to address the situation. And within a period of 18 months from that first conversation, we had a complete product built, provincially deployed across the province of Newfoundland and Labrador and live with all the patients going through our electronic intelligent referral platform that we built, which allowed you to measure the acuity in somewhat real time as well. So, if you if you [00:05:00] did another test and a person's acuity changed, it would automatically present in a different manner. So, that was our journey into into health care. That's that's how it got started.

Marc LeBlanc: I'm interested because building the product is one thing. But for a product like this, getting that adopted at the province level or even at a clinical level, what were some of the hurdles that you had to overcome with that?  

Rob Lane: That's a great, a really great one, Marc. So, it's interesting, I think that in any company in general, your IT organization is mostly set up to run your day-to-day large enterprise applications, and not necessarily tooled up to embrace innovation and allow new things to come in quickly. And it's not a criticism of IT organizations. It's just how they're built and how they're funded to operate in many cases. It's not that the people can't do it. It's [00:06:00] just that the system doesn't really even allow them to do it very easily.

So, that was certainly a bit of a challenge. We had to come in and we had to address all the things you'd expect to: patient record privacy because we are accessing patient data. Securing it, making sure that it's integrated into your enterprise applications because that's very important. Your client registry, your provider registry, your patient records, all these things have to tie into this application.  

So, I would say that building a lot of those plumbing pieces and then working through internal IT was a big mountain to climb for our team.  

Marc LeBlanc: I would say so. How critical, in your opinion, when you were starting out with this path was having a business analyst involved?

How did that help transform that IT journey?  

Rob Lane: I'm going to summarize it this way: full stop, I don't think it happens without [00:07:00] that BA. It doesn't even start.  

Marc LeBlanc: Right, and I agree. I think it's very important to get those requirements, understanding that process flow up front, and not getting into the paint yourself in a corner situation.

So, I think they really alleviate that. What are some of the wins you've had with the product as it's developed? Like you mentioned the MVP, what are the notable moments?  

Rob Lane: Yeah. Well, this is really fascinating, Marc, because we actually solved a problem and created a problem as the application rolled out and became effective.

So, after they had gotten about two years into the deployment, Sean approached us again and he said, "You know guys, the product has been so effective our waitlist has almost gone to nothing. We've whittled the 800 down to there's hardly any wait time. But," he said, "I have a new problem [00:08:00] now."

He said, "People are starting to show up at the cath lab that I'm really saying they shouldn't be here. They should be at the chest pain clinic. They should be somewhere else, not in the cath lab." So, he then presented a new series of challenges to us, which actually has allowed us to build a new version of the product and enhance the feature set. And it was around the appropriateness.  

So we started to ingest other data and build new algorithms in the application that looked at a whole variety of, in some cases, fairly simple health data to determine is there possibly a better place for this person to be referred to than the cath lab?

And so that's been version two for us, which we have put into service and we have early data from it. But it's too soon to say, this data has been clinically randomized trials and, you know, several. [00:09:00] healthcare authorities, different regions...  

So we've got more to learn, but the early look at it says that we've increased efficiency by 25% in the province in cardiology. We've improved appropriateness by 35%. So, we've already been able to divert people from the cath lab to other places that are first of all, far less invasive and dangerous to the patient, but also far less expensive for the province.  

So, there is some early data indicating that this looks good.

Marc LeBlanc: Looks good. Looks good.  

I'm wondering as well, there's a lot of talk in this podcast around AI and some of the transformation. We often talk about telemetry data, which is essentially what you're talking about with people's health telemetry data. Do you see an opportunity to inject an AI process in with this data?

Rob Lane: I'm excited to think about it. We're not there yet. We've had talks [00:10:00] with GE Healthcare as an example, because GE's a big provider of imaging equipment that's used in diagnostics and cardiology. And, we've often said, "Gosh, it would sure be interesting to intake data from all of this diagnostic equipment and overlay it into the diagnosis and the outcome and close the loop and start to build that learning model around we saw, we recommended, we did, we had an outcome."

And that sounds like a simple thing to get at, but I don't think too many healthcare providers are quite closing that loop yet.  

Marc LeBlanc: It's very early days for AI. I think there's a lot of these interesting "what if" kind of conversations going on? And I absolutely think that it's going to be injected into healthcare. It's just a matter of time for us to figure it out.  

I sure hope so.  

[00:11:00] Tell me a little bit about the people on the project. We often talk about people and culture as part of this journey. How important was it to have the right team behind this product?  

Rob Lane: Wow, I can relay the answer through the eyes of the client because Sean always asks me about our BA, Chris Hankelman. Every time he sees me, the first thing he asks me is, "Chris is still working for you, right?"  

I always thought it really interesting. He doesn't ask about our leadership or anybody else. It's like, his world revolves around how Chris rolled in, interviewed him and his team and then translated those business requirements iteratively. Because of course you don't just go away and build a product and it's like, "Hey, we came back with something." In building the MVP, there was so much iteration through that process of like, "Okay, here's what we've got so far."

"Okay, I like that, but [00:12:00] I'd also like this." So it was a very iterative process throughout. So, you can sort of imagine how that really endears the customer to an individual in the company because we had a number of people as we rolled this out, a number of doctors say, "No one ever asked me what I thought before." Which is fascinating.

Marc LeBlanc: Yeah, absolutely. That skill that the BAs have to ask the right questions. To get the voice of the customer, I think I've heard it referred to. Make sure that you have that perspective is so important to get those requirements right.  

As far as the culture on that team, is there anything that you felt you as a leader were doing to make sure that the team had the right culture, the right approach.

Rob Lane: I'd like to take some credit for that, but I don't think I did. I mean, I think that where the credit, if it went somewhere, it would be from a leadership perspective to Nevin Pick, who was, you know, leading the team at that [00:13:00] time. And I really think Nevin built a team of fabulous people around him and, I think that's where the credit lies. And I guess sort of maybe try to answer your question, because I'd have to be answering it on behalf of Nevin. I think he's done a wonderful job of empowering the people. Of allowing them to reach their full potential.

Marc LeBlanc: That's a great, that's a great viewpoint, I appreciate that. Thinking about what's next on this healthcare journey, it really sounds like we're answering a real need and we're making some impact. What do you foresee is next?  

Rob Lane: I think there's a lot more to do in cardiology and part of what we're debating right now is do we longitudinally start to look at more within cardiology so that we can get at a... Because we've looked at a piece of cardiology, from diagnostic to intervention. There's other areas of cardiology outside of that that could [00:14:00] potentially be impacted and built into the application.

But currently, we're building a solution which is built on the foundation of this technology, all the code, and it's for central intake. So, we're looking at other pathways that have some similar challenges that cardiology was facing around acuity, waitlists, and who do we see next, and is it appropriate.

So, right now we are going live in the province of Newfoundland within the next two months. We'll be going live with ophthalmology and orthopedic surgery. So, we've got two other pathways.  

We've got other ones on the horizon. So, diagnostic imaging is on the horizon, breast cancer surgery is on the horizon, and endoscopy is on the horizon. So, we're looking at those three as next potential areas. But, that's where we're at right now.  

Marc LeBlanc: Excellent. Well, I just want to sort of recap kind [00:15:00] of some of our touchpoints today. We touched on how you got started with Mobia Health as a personal journey, answering a need around how to prioritize a huge waitlist that cardiologists were faced with.

How that evolved into being able to better triangulate where they should go, whether they should actually be at the cath lab or somewhere else. And looking at how people are so important on this journey.  

Rob, thanks so much for joining us on the podcast today. It's been a great episode. It's great to have you here.

Rob Lane: Thanks Marc, I really enjoyed it. Thank you for the opportunity.  

Marc LeBlanc: Thank you for listening to Solving for Change. If you enjoyed this episode, leave us a rating and review on your favourite podcast service and join us for our next episode.

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