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“The primary benefits for mobile care units are the fact that they decrease patient travel times by arriving at their residences and ensuring that appointments are never missed. It also relieves the stress of finding transportation for dialysis patients, outright eliminating the need for the CMS to find alternative transport methods for patients.
By utilizing mobile care units alongside health IT solutions for preventive care services, the CMS can finally do the impossible and establish a basic health care standard for rural citizens.”
Thanh Tran is a health IT executive.
He shares his story and discusses the KevinMD article, “Will U.S. health care match Native Americans’ treatment of chronic kidney disease?”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Thanh Tran. He is the CEO of Zoeticx, and he co-wrote the KevinMD article “Will U.S. health care match Native Americans’ treatment of chronic kidney disease?” He co-wrote that article with Donald Voltz and Eric Tran. Thanh, welcome to the show.
Thanh Tran: Thank you very much. Thank you for having me.
Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?
Thanh Tran: What attracted me to health care was, you know, the first thing is Dr. Don Voltz and two other medical advisors, who pointed out the fact that there is a lot of preventable medical error in health care, leading to between 100 and 400,000, depending on the thing that you’re looking at, preventable medical errors leading to death. The first thing I looked into in health care is: Where are all the applications? Health care has a recording system in the electronic record, but then there is a whole set of collaboration, cost efficiency, and communication, and all the preventable medical errors coming from miscommunication, from dragging and dropping things between the cracks. So where are those applications?
And then, going back to my IT, I looked at it and said, “Well, because you have so many different EHR systems, it’s hard to build an application running on all these things.” So my middleware infrastructure skill got in. We built the middleware infrastructure, and we built the first application, which is on the intensive care unit. There is a need, but it was hard to justify the need at that time. Remember, 2011 to 2014, it was all EHR that occupied all the CIOs. So that is a little bit of a quick journey of how we got there.
In 2014-15, we leveraged our platform to create a set of solutions in preventive care. The reason that we went into preventive care is because I learned that unless you have the revenue side of the equation in health care, you cannot get the attention of the executives to adopt it. We leveraged chronic care management and remote patient monitoring from CMS to create a better business model, not a cost-saving justification but revenue generation on top of it, creating value-add for both the patients and the payers. So we are trying to create that business solution and then have the impact back in health care. So that is a little bit of the journey of where we are.
Kevin Pho: With your background in IT, what were some of the unique challenges in health care that you had to learn along the way?
Thanh Tran: It’s not totally different from the early days of IT. I usually use this example. You know, back in the early days of the teller machine, right? Say you are a customer of Bank of America, and you need $40 cash. You stand in front of an ATM machine from Wells Fargo, you can plug the thing in, and then you can get the money out from your bank account at Bank of America, right? So step back and think about it. Think about the bank teller machine as an application, taking the money, but the database and the account are coming from two different things. So it doesn’t matter who the front-end application belongs to; you should be able to access the back end.
So the one thing I found out is, if you’re using a certain system in the hospital, and then your primary care provider is using athenahealth, good luck changing that, interchanging that, right? But at the end of the day, the truth is, frankly, your vital, your heart rate, is a number. It should be shared. It just happens to be different, right? So now this is the stage of health care where we talk about interoperability, but the integrity part of the equation was, you know, it’s not about exchanging, sharing information; it’s about the ability to access information, so that you can create solutions to reduce the burden on doctors in interacting.
So let’s take another example. A patient who has cancer goes to the hospital for chemotherapy. Your primary doctor needs to access that information so that they collaborate and say, “The next time you do the chemotherapy, here, this is the result I found.” How’s that collaboration? It’s hard, isn’t it, right? You need an application to create that collaboration, but that application needs to be able to access the information anywhere, anytime. But you cannot just do it the HIE way, because the information exchange requires duplication of data, so you have a massive centralized database.
So here’s my background in IT. When I was with BEA, I happened to manage a business group named Data Service Platform. The CEO at that time was Mr. Alfred Chuang. He had this model of kung fu. You know, data for him is like water, and water is very powerful in the kung fu movement because it’s fluid. So the data service platform, or information as a service, is pretty simple. It’s saying, instead of duplicating the data, you have an access point to get the data where it belongs. So the truth of the data stays in the database, but then the application is able to extract the information when it’s needed and rely back on the back end to do that.
So in health care, you have the EHR, which is already hit by compliance, protection of data, and other things. Why do you have to replicate the data into the HIE and go through the headache to service the application? It’s not very convenient to find the thing, too. But if you have an application with a platform that is able to have an engine to point it to where the patient record is, it’s just like a direct service, isn’t it? Then you are able to extract the data, and when you’re done with the session, the data goes back to the source. And that’s the dream of everything that we’re doing.
Kevin Pho: All right, so let’s talk about that KevinMD article you wrote with Donald Voltz and Eric Tran. It’s titled “Will U.S. health care match Native Americans’ treatment of chronic kidney disease?” Now, for those who didn’t get a chance to read the article, can you just walk my audience through it and share the story of why you decided to write it?
Thanh Tran: We have solutions in chronic care management, but when we started the research to implement the solution, Dr. Don Voltz, Eric Tran, and I were developing a kind of a map. They called it the chronic care disease interrelationship. So what it means by that is this, and I quote Dr. Don Voltz’s comment on this. He’s saying, “You know, in medicine, we all know this, but nobody put it on paper in this way.” If you have blood disease, kind of related, you have hypertension and diabetes, but then when you have blood-related things, then you’re forcing your kidney to work overtime. So eventually there is a relationship, when you have hypertension and diabetes, leading into kidney disease, OK?
The one thing about kidney disease also is, if you don’t test it early, you don’t even have the symptoms. But when you have the symptoms, guess what? It’s stage four, and you need dialysis, where your quality of life is going to be dropping like a rock. Our solution in preventive care, both in remote patient monitoring and chronic care management, what we are focused on is the early detection of something that happened. If you have diabetes, we know that diabetes can show a symptom that may be developing into another chronic condition. And then if you monitor on a monthly basis, if you look into the physiology monitoring on a monthly basis, on a weekly basis, you can notify early and say, “Hey, this person may have some other condition. Let’s test him,” OK?
What we’re doing is a little bit different than the article, with the Indian health system. The Indian health system has done this, and it’s very good. If you have diabetes, “I’m going to test you for kidney disease every month,” OK? The whole idea is to test it every month so that they can detect early indications of kidney disease, so that they can treat it and slow down the progression toward stage four, right? And that saved their money. They saved lives, too, and saved a better quality of life.
But the difference between the Indian health system approach and our approach is, we’re saying, “That’s right, but if you test it every month, it will cost a lot, too,” right? So why don’t we leverage chronic care management and remote patient monitoring from CMS, and then put them on remote nurses and remote monitoring via devices like this, so that you can collect the data and monitor it and then intervene when it’s necessary? So it improves the burden on the patient and the burden on the health care system, and it’s improving the cost efficiency. That’s the whole idea of the article. And we’re using the article to point out one thing: There’s a proof point that if you intervene early on detection of chronic kidney disease, then you’re improving the numbers; you reduce the number of kidney patients over the years. And that’s the whole thing it’s about.
Kevin Pho: We’re talking to Thanh Tran. He is the CEO of Zoeticx, and he co-wrote the KevinMD article “Will U.S. health care match Native Americans’ treatment of chronic kidney disease?” Thanh, so what are some of the barriers and obstacles that are preventing you from realizing the vision that you just articulated?
Thanh Tran: It sounds funny, but it’s about old people. I always anticipate, you know, I can say I’m 62, so I can say it about myself, too. But the issue is this. I always anticipated some issues with rolling out such a solution to the population, the elder population, right? So here are a couple of things I want to highlight with you. Take an example of remote physiology monitoring, OK? There are a lot of solutions out there, but one of the things that I’m saying is they fail to understand this. If you burden the patient with reporting the data, by pulling out the iPad and entering the data, then you fail to roll out to the population, because old people, most of them don’t do that every day. And sometimes you need to do it four times a day. How are you going to do that? It’s called patient burden. You have to come up with something that reduces that burden to the minimum, right? So you have to have the ability to collect the data without them doing anything.
So here’s an example of what our solution is. You wear the device. The device is pluggable. You can plug in a device like this, or you can have a scale or anything, and then sync up the data remotely via your phone application to the center. That’s one way to do it. That’s one.
But I tell you, recently I ran into cases in the doctor’s office in Arizona, registering elders in a program like that. It required a lot of effort from the doctor. Doctors need to talk to the patient. The patient needs to be comfortable with that service, you know, to be put in chronic care management. So in the beginning, we didn’t think about that as an issue, because we were focused on solving the back end and the patient burden and everything, to make it easy. But we found out that, first of all, doctors have to call in the patient to offer them that service. So it’s one burden. You have to find which patients have two kinds of conditions to qualify. Even when we scan the database, we tell them, “Here’s a list of patients that qualify,” but you have to call them in, and all these things. The logistics of old people coming into the office to sign up for that is also a burden, and that burden is really slowing down the registration for such preventative services.
What we’re doing lately is creating a concept for, I call it, the integrated care and preventive care platform. What it means is this. If you look at the population of elders, where are they really living, right? They have a set of people who go to a nursing home. There is home assisting living, there is senior community, and then a number of them stay at home, right? So if you think about it, what we are working on with other partners is saying there is a partner who is providing a mobile cabin, right? That’s a partner who is willing to hire nurse practitioners to staff that.
So if you step back and think about what we’re trying to do, it’s to say, “Hey, what if I have a mobile cabin that will park at your door, that will offer the primary care right there?” It will be helping service the community, right? And then we’ll focus on preventive care, so that it improves the quality and everything. It will improve medical access for the seniors, and then we’re going to be at your doorstep, so you don’t have to really call a cab to go to the doctor to sign up and everything. What we are going to be is at your door. We create convenience for you. And then also, when we monitor, if something’s going wrong, we act at your door to help you with the next step. And that, for me, is something that is going to be innovative in health care. Now, especially during the COVID time, you combine telehealth, mobile, preventive care, and remote monitoring. All these things will be something that I would see would change as part of post-COVID, and this is one of the things that we’re working on.
Kevin Pho: And my final question is a short take-home message for the KevinMD audience.
Thanh Tran: Health care right now is, from my point of view, still siloed, right? The medical side doesn’t talk to the behavioral side, but they interact, right? Depression is a chronic condition. Depression leads to hypertension and diabetes. So that interconnection is missing. That’s number one. Number two, just to touch on the mobile and daily health, you need to interconnect those things to offer an effective solution. And it is time to do that. It is time that health care needs to be moving beyond the recording capability offered by EHR systems. We’re not just talking about interoperability. We need to talk about solutions designed to effectively address this and help care providers focus on their profession instead of worrying about everything. And that’s my simple message.
Kevin Pho: Thank you so much for sharing your time and insight, and thanks again for being on the show.
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