The first presentation was related to a solution that's
going to go to market in 2012 very innovative certainly. The
second presentation was a $48 billion entity applying its
process and capabilities to healthcare in a form and now
here is a Awarepoint myself. And so we are in between and so
this is our 3rd year of launch we are a venture backed
company. Full disclosure two of the folks that were up here
if you sat through the VC session or actually either on my
board or their firms are on my board so probably how I ended
up being invited to this I would imagine and the business
that Awarepoint (excuse me)
[Audience]
Completely independent, okay I appreciate that. An
Awarepoint is in the business of enterprise awareness within
hospitals and we use a ZigBee-based technology platform with
a software layer to create that. That technology platform is
an active RFID technology. With a set of software solutions
that are all focused on the premise or service of taking
cost out of the system making it highly more efficient and
allowing for better throughput through the healthcare system
- principally the acute care environment. From a standpoint
of enterprise awareness talking about that definition we
talk about tracking, managing and alerting based on those
assets and locations and interactions of caregivers,
patients and high-value assets.
The problem that where the solution two starts here first at
the macro level that you have heard a lot about today
whether it's the reduction and reimbursement it's some type
of health reform that's going to go through. It's the
accountable care organization initiative. It is the
reduction of reimbursement associated with hospital acquired
conditions or the newer events, ultimately what that points
to is today in healthcare principally US based, which I will
come back to I am marketing sizing in a second and talk
about since 90% of the US market is not penetrated that's
where we are focused principally right now. But we do have
the NHS as a client I must add so we are over in the UK as
well. You know essentially you have to do more with less
because your patient volumes are going to increase, you will
not be able to get additional skilled staff and you will not
be able to get additional money for resources to take care
of those increased patient volumes.
And that's the thesis of where we come in. If you look at
the market drivers we drive a very hard ROI. We have a
monthly service price for our technology software and
service. And our average install time to get going on our
base level asset management in tracking is less than a month
based on the type of technology we use versus some of our
competitors. Since we are only asking people to pay us on a
monthly basis the average client that we have is in a
positive cash flow standpoint within three to five months.
Of what is an average of a three to five-year contract. And
the way we do that is to look at these mobile assets that
clients have such as smart pumps, wheelchairs, vents, other
high value assets that typically the average US hospital
owns a 100% more on average than what is required to take
care of that patient populations.
On top of that 100% more they rent even more and in one case
when we acquired a client University of California at San
Diego what they found was actually one of their assets had
been stolen and was being rented back to them because they
found it as a rental product in their own hospital. CFO
really did not care for that very much. So during the sales
process we go after their hard rental charges, we actually
go through their major asset counts and design the ROI not
with industry averages, not even with our client averages
but with the real information straight from that very
specific institution. And yes at same point and in three or
four cases we have been willing to go at risk associated
with that ROI sharing in the benefit, particularly we did
that with Kaiser. Now after we proved to the regional
controller of the southern region of California of Kaiser
that the technology would work and they would get the ROI
she did the math and determined that she was going to pay
four and a half times based on the sharing of the benefits
of what she could have bought the system from us originally.
Requested a renegotiation, we did that, they ended up paying
us two and a half times what they could have bought the
system originally for us. She is our biggest advocate within
Kaiser today. We are up to 14 hospitals in Kaiser
negotiating for the 19 and extending across the US to the
Mid-Atlantic as well so that's the relationship that turned
out quite well. Besides the hard ROI associated with right
sizing the mobile assets and the appropriate utilization of
those assets which has a lot of variability it starts to
impact clinical and patient care. The average nurse spends
at least an hour a day looking for believe it or not the
patient or equipment in assets and our technology can
massively reduce that time period. That is a contributing
factor in the US to 30% of all scheduled surgeries not
starting on time. Reimbursement today is driving everything
out of the hospital and appropriately so in many cases to a
higher client satisfaction or patient satisfaction area in a
lower cost setting of care. But what that's resulting in is
the average acuity of the patient in the hospital for their
level of sickness or severity is increasing as the hospital
is becoming more appropriately an escalated area for more
sophisticated care settings or diseases.
Which means that the throughput related to the operating
room is much more vital than ever before as well as the ED
because 60% to 70% of everyone who is admitted to the
hospital today on average in the US comes through the
emergency department. Bottlenecks and clogs are those two
areas cause extreme problems with patient satisfaction which
as you heard today now is going to impact reimbursement. And
it's also causing big ROI issues associated with hospitals
as well. So how does our technology work, we use a ZigBee-
based technology for those of you that has a residence here
in California. Pacific Gas & Electric is deploying ZigBee
smart meters which they use the TI chipset just like we do
we love that because our cost keeps coming down very month
of the sourcing of that product. We have 14 patterns that
allow us to use ZigBee as a location based algorithm
solution that no one else can use and those are global
patterns.
Johnson Controls and others are using ZigBee technology for
purposes of measuring water electricity another types of
usage. And essentially what you have is a series of form
factors that we can tag and those form factors can be in
tags can be sterilizable we can do temp tags for
refrigerators then you have variable tags for different
types of form factors for patients for staff members etc.
They are battery powered and emit every 8 to 12 seconds
their location. They are picked up by to the next ride a
sensor that sensor is plugged into an outlet that's why we
are do installs in less than 30 days when most of our
competitors who are using either Wi-Fi or you know
ultrasound technologies as well as couple of others they are
taking 6 to 8 months to do implementations because they are
tripling their current Wi-Fi gear. They are pulling
repeaters. They are doing construction. They are rippling
through walls, they are going through ceilings. We plug
stuff into an outlet it's a lot simpler.
They connect to a bridge. The bridge goes to an appliance.
The appliance goes over the internet to our network
operating center or a NOC where we manage actively this
entire infrastructure down to the individual asset level
remotely. And it also is if they lose the internet
connection the entire system can run locally without relying
on having to go back to that backend system. So automated
workflow and documentation, so I spent 21-22 years in the
electronic medical records industry and most people assume
that if you get to Physician Order Entry where they are
deploying ordering the best practice of care with real time
clinical decision support and then you have a series of
documented tasks that are the best practice of how to take
care of that patient that magically this entire throughput
and workflow situation will just automatically happen and in
fact it doesn't.
And it doesn't because just because you are ordering the
right thing and then you are going to it administer or
perform tasks of the right nature the location of that
patient having the right equipment and having the right
skilled care givers in order to execute on all those tasks
are assumed by those systems to be all in place and in fact
in any hospital in the world that is not the case. So what
we have is a series of workflow and content software
solutions that leverage that underlying knowledge of both
location and interaction of caregiver patient in high value
assets and harness that to make you know workflow far more
efficient.
We also can attack helping to reduce hospital acquired
conditions. I realize this is after lunch but nevertheless
so 20 to 25% of those assets that are shared they are mobile
which means they are shared between patients, are not
appropriately cleaned or sterilized between patients
including vents that people breathe into smart pumps and
other assets that is a big, big issue and we can track that
because with our ZigBee technology we can track the location
of that asset down to two and a half square feet and the
interaction of that asset with the patient and with the
caregiver. So somebody takes that asset out of a patient
room, does not put it through the cleaning process, it is
stored or hidden just the normal practice in a closet to be
made available for when that next patient comes in and they
grab it and bring it into a new patient room. We can shoot
and alert real time either to that caregiver or to that
floor notifying that that is a non cleaned item that's about
to go into a new patient. That's how we can start to attack
clinical workflow. The way it should work is they take it
out of that patient room they put it into where the dirty
equipment is supposed to go, which by the way it's a day
central service walks around just kind of checking and it's
a big medical system like Stanford. There is probably you
know a few hundred places that they are just going to do
rounds and check to see if there happens to be any dirty
equipment there.
What we can do is par level so that area knows that after it
gets above three dirty items send a notification
automatically to central service come up and get them,
instead of just walking around the hospital looking to see
if there is some dirty stuff somewhere. And then on the same
standpoint if a new patient comes in the nurse goes to get a
clean smart pump from that location, let's say there is
normally 8 or 10 of them and now suddenly there is three
automatically sense the note to central service bring me up
five more because we are down to a par level of three. That
caregiver starts to have confidence that the system is going
to work that the items they need to take care of the patient
are actually there. And as you heard about today evidently
this morning and I missed it but a psychologist kind of
talked but if you want to change behavior and you want
people to do the right thing you have to make it easier.
So today for that caregiver is easier for them to take that
asset and hide it in a closet or somewhere else so it's
available to them because they don't have confidence that
where they are supposed to go and do the right thing but
there is going to be anything there when they need it for
the next patient. When they start to get the confidence that
the system works they change their behavior because now it's
easier for them to do the right thing than to hide the stuff
and do the wrong thing. So it's one of the first things we
see in terms of that reaction. So why now, right people talk
to me if you have these reference accounts and if you are
getting this type of adoption if there is a hard ROI, why
doesn't everybody have one of these. Well five years ago or
so some technology companies mainly Wi-Fi folks that are no
longer in the industry got a bit over their skies, they
started to really promise capabilities that we are not
executed on and in general the entire global market took a
step back and said look this seems to have a lot of promise
but if you are only tracking 10 to 15 feet you can kind of
find something sort of in some place in the hospital but you
can't get to room level, you can't attract the interactions
of the caregivers and the patients and that type of thing.
So the whole system sort of took a little bit of a wait-and-
see attitude of can this technology ever meet the real
capabilities of what the promise holds. And the reality is
both ourselves being at Awarepoint as well as others in the
marketplace and we have technology and software competitors.
On the technology side there are companies like AeroScout
and CenTrak that are technology competitors on the software
side. There is this little company called GE that I have
competed against for 17 years and done just fine. But they
have bought a company called Agility and so they are one of
my top software competitors. So from that standpoint we are
starting to get awareness both domestically and globally
that the technology is matured to a point that the outcomes
that can be expected absolutely can be achieved. And so to
talk about a few of them these are US based outcomes but I
won't go through all of them but you will look at some of
the results and the ROIs and the throughput at the end of
the day if you deploy these solutions in the OR and the ED
and you can for instance in the OR on average get anywhere
from you know 19 to 40 more cases and it all depends on how
your quality of throughput is today as to what the
improvement opportunity is but if you are getting 19 to 40
more cases through that OR on a monthly basis that is a
substantial impact to the efficiency in bottom line of the
hospital. If you are taking emergency care environments and
you are making them 20% to 35% more efficient that again has
amazing throughput in ROI capabilities.
If you are driving hard ROI associated with just an
operating cost model versus an upfront capital model which
is not a good way for those of you who are thinking of you
know particularly focusing on any type of US acute care base
solution whether it's medical device IT, it doesn't matter.
Some of the advice that Bryan Roberts from Venrock gave in
an earlier session which is you better make sure you are not
competing for upfront capital. I could not reinforce that
any stronger up here as advice. Going after an operating
cost model and taking out cost in the system to drive the
value for your solution is absolutely a requirement to gain
market share. Awarepoint is gone from 0 to we will do 25
million of revenue this year 35 million in bookings and our
goal is to be up over a 100 million of revenue over the next
three years. The market size and I have had global
responsibility as an executive of publicly traded companies
in the medical imaging and in the HIT you know environments
pretty similar to what those environments are.
Typically the rest of the global market equals the US
market. And the rest of the global market is trailing by 47
years the adoption of this technology. We do have clients in
Melbourne, Australia, the NHS for two trust just invested in
the asset capability. We have a couple of sites in the
Middle East and I am in negotiations with SingHealth right
now who is a client of mine in my last company as well. So
we will be doing global expansion. There is a global market
there but again somewhat of medical imaging and HIT that
global market based on an acute care market segment is about
equal to the US market. From the enterprise you know kind of
value cycle to understand the adoption curve is you just
start with tagging the assets and driving the ROI. First off
the assets don't argue much when you stick a tag on them so
it's not really very political and absolutely you cut out
the rentals and that's you know phase one which we call
TRUST Tracking, Rentals, Utilization, Shrinkage and
Temperature. That infrastructure of technology then can be
used for improved clinical efficiencies in the departmental
areas of the OR, the ED and then heading upstream into
effecting enterprise workflows like discharge management.
And frankly if you think about it items that we haven't even
come up with yet. So we are going to start to you know
enable our clients and others to actually create content and
workflows and publish into a public library you know what
other options might be when you think about the interactions
and knowledge and location of assets, patients and
caregivers. There is a lot of workflows that certainly we
haven't thought of yet that can drive some high value from
that standpoint. For purposes of you know timing I will move
this pretty fast essentially we have a .NET SQL architecture
with embedded workflow engines and we run on a native
Microsoft stack, which you know allows us you know put
honestly and in particularly in US healthcare market to have
great success. And then relative to clients who are adopting
this so kind of a frankly who is who in healthcare
domestically clients that are starting to scale this across
their enterprise that we have agreements with and for the
past couple of years so the UC system San Diego and San
Francisco are live, UCLA is in the process of going live
right now. I have talked about Kaiser you know Ascension
Health, Walter Reed we have DoD and VA sites as well.
And really starting to get wider adoption and frankly one of
our next steps that we need to do is to start to focus,
similar to the electronic medical record market did on what
is the packaging and the pricing and the adoption model for
the average community hospital where many of these folks
already have their meaningful use, EMR system set, they are
very comfortable with it. And they are looking for
additional technologies like ours that can make them more
efficient, increase their throughput, help them address some
of the challenges the macro level that we talked about
relative to cost containment and reimbursement. And today
from Awarepoint standpoint we are up to in just you know
less than three years of having commercialized this solution
on both the technology and the software side. 85 healthcare
organizations representing a 133 hospital sites and we have
a 158,000 assets that we are actually monitoring today and
under contract is about 250,000 which will be by the end of
this year driving you know some meaningful return on
investment in making the healthcare system more efficient.
Thank you.