INTRO: Thank you for joining us. I'm John Farrell, Editor of MobileHealthWatch.com. With us today is Blaine Warkentine, MD…Dr. Warkentine, who is trained in orthopaedic surgery and sports related knee injuries, flourished in his role as health educator and clinical director for Brainlab, Inc…For the past 18 months, he has focused his energies on mobile health solutions through development, partnerships, and innovation. He serves as CEO of InnovationThrives, OrthoThinkTank, and RidRX, as well as medical advisor in his partnerships…We caught up with Dr. Warkentine for a better sense of how he sees innovation evolving at the mobile point of care…Welcome, doctor… 1. Dr. Warkentine, we hear a lot about what smartphones can offer healthcare with regard to cost savings and increased efficiencies, but there's always that caveat thrown in regarding how dirty the devices are at the mobile point of care, and the risks associated with spreading germs. Your efforts began with a focus on hygiene, so why don't you start by telling our listeners about what you've been doing with anti-microbial technologies as they relate to mobile devices? Cheers, and Happy New Year, excited to have the opportunity to speak with you and MobileHealthWatch.com's listeners. First let me say that ALL of my efforts are focused on forming solutions for the healthcare professional. From there I have perfect confidence that the patient will benefit greatly. With that in mind. As a developer of applications and as a doctor I was aptly cognizant of the hippocratic oath "first, do no harm". The issue is well reported that Personal devices and articles of clothing on caregivers are perfect breeding grounds for cross contamination of pathologic organisms that might be causative of nosocomial infection. It is also reported that as many as 5% of all visits to the hospital are fraught with a healthcare associated infection. Such events as surgical site infections or other catheter related events now represent more than 31 Billion dollars in healthcare expenditure annually, and to some extent, it can be avoided. The incentives are aligned for change as these expenditures are not reimbursable under medicare guidelines. Now it comes to finding the right solutions to adopt and create change. This concern lead to me to seek inexpensive, safe, and effective antimicrobial solutions for these surfaces for healthcare providers and so I went to market with these solutions at RidRx.com. The mobile device is of particular concern because 60-70% of all caregivers already use a smartphone for decision support, and heavy users will use them between each and every patient interaction on average reportedly 2.7 hours a day. Also, they can be particularly hard to clean. They run at a higher than ambient temperature and grow contaminants easily. And, ultimately they have been proven at least in one study, of 200 phones in the ICU with the annals of clinical microbiology in March of 09', to harbor pathologic organisms 95% of the time. To me, this is a valid concern, but more important than the antimicrobial coverings of which I do have testing and confidence, particularly in our treated cationic Silver solution, is that soon every caregiver will be walking around with these devices at the point of care. I am excited to report that most of these devices will have RFID integrated into them perhaps as early as 4Gen iPhone this coming year and I am looking forward to evolving our available free Germaphone app for the iPhone to include hand hygiene compliance and surveillance to help administrators understand and comply with these issues of healthcare associated infection and best practices both of which if done successfully significantly reduce healthcare costs and could decrease the incidence of what now represents one of the top five reasons for death in the U.S.
2. Now, after developing anti-microbial coverings for mobile devices and coming up with the hand hygiene app--Germaphone--you unveiled a pretty unique product that's received some press coverage, the iStethoscope. Tell us about that; what is it and how did it come about? Sure. I am not the first to think that a version 2.0 stethoscope would go digital. In fact, a patent dates back to 1984. I just didn't want to pay the current asking price of 769$ for it from Littman. It occurred to me that bisecting my current cardiology II stethoscope just below at the bifurcation and then attaching the tube to an adapter would create a sound proof channel to the microphone of the mobile device and allow me to convert the analog signal into a digital one. I could then use the computing power of the device to process the signal in effective ways as well as store the audio file for later reference and/or send to someone else for interpretation. That is simply what we have done, we have the ability to alter what frequencies we amplify and allow the user to shake the device to visualize the wave form and then email the file. This application will evolve in unique and interesting ways for the near future and our patented adapter is being shipped to early adopters this next week. I think most of your listeners will start to think of how this could be useful. I predict less than 10% of all stethoscopes being used in the field are in the hands of a professional that could pick up the varied murmurs and potentially this application could begin to help the professionals that do know interpret more of these audio files without actually being at the bedside. The scalability of a 60$ adapter and the real time nature of the solution with the ability to export to your Personal health record for later reference I think represents a fascinating way to evolve the concept. Currently I must report that this is not considered a medical device as the FDA has no formal process for dealing with mobile phones or apps as you know.
3. Okay, so hand hygiene awareness led to your focus on antimicrobial coverings for devices, and by focusing on the devices themselves you saw an opportunity to leverage the built-in microphone and computer functionalities. Your latest offering--called TheraProfessional--adapts smartphone technology to actually evolve how physical therapists and physicians interact with their patients when it comes to executing physical therapy work-outs. How did TheraProfessional come about? Oh yes, the exciting stuff. I formed a partnership with a company that has been developing apple products and fitness related content for over 6 years, called PumpOne. I worked very hard with them over the last few years to convert their content and business model into a healthcare professional tool instead of a consumer based one. This allows the healthcare professional to maintain the lead as the most important reference to how to use the app in order to achieve the desired personal, and customized results that the professional is attempting to deliver to the patient. It is simply a better tool for the healthcare professional, thereby benefitting the patient. Informational therapy as I would call it, for us starts with fitness, but now includes physical therapy, and soon will include such topics as nutrition, diabetes education, medication adherence, personal health records and more. As well as a simple Ask button in which we will refer patients to location based healthcare providers from users in need of answers to their healthcare issues. Today the app is known as Fitness Builder for the iphone/ipod touch and sells for 9.99 on the app store. This basic offering is perfect for nearly all patients in my opinion. With a subscription for 34.99 a year it includes unlimited numbers of customized routines and 4400 exercises with 530 high quality routines designed by an accomplished exercise physiologist. Later this month for 29$/month for healthcare professionals and physical therapists we are releasing the TheraProfessional solution with another 700 physical therapy exercises growing to 1600 all with video and audio to support each file on the server. The important aspect of this application is that it allows for full customization by the caregiver. This app is made for the healthcare professional not purely for the consumer. As a subscriber you can modify any of the content and drag and drop into customized routines. You can create your own content from scratch as well. Ultimately the way you will use this app is up to you. But I use it to create specific routines for particular health needs like recovery after total knee replacement therapy, as I see the patient I drag and drop the content on my phone and label with their email as the routine. I then share with them by typing in their email. The patient then will immediately receive an instructional email, if they have an iPhone or iPod Touch device and the 9.99 app they will simply sign in and walk themselves through your customized education with image, text and video/audio support for each exercise and or educational task. All of the execution of which you as the caregiver will see the results of when they push the complete button at the end of the routine including time, reps, sets, comments, etc‌ This allows compliance to be monitored, and allows incentives and motivation to be created with them. This then allows me to extend care quickly and effectively and optimize my time with the patient to the core education topics that I cannot replicate with the tool. In other words, I push all the repetitive and quickly lost information to the tool and keep my time with the patient focused on forming the relationship with the patient, answering specific questions and targeted other advice that is more easily understand with face to face and does not need to be repeated and or tracked. interestingly the portfolio of items I use with the tool continues to expand daily. Of Interest to the market of listeners is that we are actively skinning this application up as a enterprise solution for larger insurance groups, healthcare systems and the like, the only requirement is one made by apple and that is you must have over 500 employees for the enterprise app profile. I would like to speak with any interested parties at www.innovationthrives.com please.
4. What if the patient does not have a smartphone? If the patient does not have the device they will get the instructional email previously mentioned, and it will jump them to a customized pdf that they can then print and or read online with the required links to the videos with audio support that fit the image, there is no difference for the provider in doing this only a slight loss of transparency as to the compliance from the user.
5. So what sets TheraProfessional apart from other mobile apps on the market? Our application keeps the healthcare professional involved. In fact, more so than ever. Other applications for fitness and therapy simply have content that is a set of predefined solutions created by the developer. As a patient and or consumer you are supposed to download the right one for your needs. For instance a patient with shoulder pain would download the app and follow the instructions and then somehow magically become better. To me that is not only nonsense but dangerous. First, every patient is slightly different with different medical conditions and different objectives. Second the healthcare professional is not directing the activity. Third the value is in proper education, execution, and compliance of the routines and the data of it being performed sets up an opportunity for the healthcare professional to deliver customized care at 100X less cost to anywhere on the planet real time allowing extension of care past the allotted 6-7 visits given by the insurance provider. As a patient if I would pay significantly out of pocket if I could have my therapist give me care for 12 months
with those same allotted visits spread throughout the entire recovery period. Soon it will be tied to EMR and practice management software that will make billing and coding a breeze for these monitoring events, and ultimately it allows professionals to communicate highly replicable content with ease onto a platform that people know and enjoy using improving compliance, incentives, and monitoring of highly valuable interactive information for and to the end consumer. Everybody wins with our application.
6. Maybe as a way to wrap things up, you could tell us a little more about one or two of the partnerships you're involved in. Who are you trying to bring together in the industry and what are you hoping to achieve down the road? I still have a vision of the perfect world for these things, and I see it coming faster than expected. With reform, cost reductions and outcomes will be the standard by which all healthcare issues are measured. Telemedicine used in legacy condition of having a professional on the other side of skype does not work for me. I want scalable delivery of health information that allows me as a healthcare professional to scale my business and be more successful as a healthcare provider meanwhile have access to the data to prove it. Personally I am anxious for partnerships of all kinds. Recently one of my more exciting partnerships is with Health Education group, a group creating professional content for big pharma for nearly 20 years, I am working with them with a soon to release product called health ed on demand HEOD. This is a drag and drop content builder for healthcare professionals with a equally sophisticated patient interface for digesting that information. It proposes to be the place where healthcare professionals can create their own CRM or relationship management portal for their patients and to me proves to be a very effective cost reduction trend for the future not unlike CRM's for business or other purposes. I could really use a larger institution to pilot my solutions as a proving ground that wants to apply my principles and solutions as a partner allowing me to achieve scalability and quicker success and i must thank you for the opportunity to discuss my ambitions.
Dr. Warkentine, thanks for your time‌ OUTRO: You've been listening to an interview with Dr. Blaine Warkentine, CEO of InnovationThrives, OrthoThinkTank, and RidRX. Log-in to MobileHealthWatch.com each week for perspectives on the latest developments at the mobile point of care.