Electronic Health Reporter

Joanne Rohde is the chief executive officer and co-founder of Axial Exchange. She brings 30 years of experience to her role and has grown companies using “disruptive business models.” Prior to Axial Exchange, she served as the COO and director of health IT strategy at Red Hat, as well as was the CIO of UBS Investment Banking IT. She’s passionate about healthcare because it’s personal; healthcare is a personal business and with the advent of patient engagement, healthcare is even more so personal than its ever been.

Here she discusses the reasoning for her venturing into to healthcare and Axial’s creation, the company’s mission, what “patient engagement” is to her, how “patient engagement” is changing healthcare and Axial’s solution set. Finally, she addresses what she feels are the most pressing issues facing the healthcare as a whole. Her perspectives are deeply insightful; the following is well worth the read.

Can you tell us about yourself and your background prior to starting Axial Exchange? Why healthcare?

I spent most of my career in finance and technology. If I had a personal tagline, it would be that I like to build disruptive businesses in old industries. I did this in finance, with a company called O’Connor and Associates, which brought derivatives and computers to the financial industry when derivatives were still used to hedge real transactions. Then at Red Hat, we brought the benefits of open source to the enterprise, revolutionizing the software industry. Healthcare is one of the most inefficient industries in our country, and it affects every one of us. It is ripe for disruption.

What was your motivation in starting Axial Exchange? Perhaps you can tell me more about your entrepreneurial spirit and journey. Do you have other plans for new business lines in the works presently?

I was COO of a rapidly growing global technology company, Red Hat, when I became ill. Over the course of two years I became too sick to walk up a flight of stairs. I was in constant pain, and couldn’t speak properly. It took two years and 10 doctors to properly diagnose me. As I went from doctor to doctor, it became clear that I was starting over with each doctor — they couldn’t share information, and that lack of information sharing made it difficult for them and for me. It was also apparent that when I would go into their offices, they’d take tests and check symptoms, but they were point-in-time analysis — if I had a bad situation a week prior, it wouldn’t be captured. It occurred to me that my story was in part every American’s story and the current system frustrated both doctors and patients alike.

We are just at the beginning of what we can do to improve the patient-doctor experience. The rapid advances of wearable devices is our current area of focus. We want patients to understand their own health patterns, and to securely share that key biometric information with their physicians so each appointment can be fact-based, not “recall” based. Our next area of focus is real-time case management. What if you could get in touch with a recently released cardiac patient precisely when they were at the most risk instead of waiting for a crisis that lands them back in the hospital? These kind of timely, specific interventions can be a reality with the integration of our application back to the care managers.

Can you tell us about Axial Exchange, its mission and why patient engagement is important – beyond the bumper sticker response?

We are a nation of chronic disease. Our health system today is geared around trauma and acute problems. If you break a bunch of bones, the system works well. If you have diabetes, heart disease, and COPD, which many Americans have, then no amount of office visits are going to change your prognosis without you becoming a smarter patient and more invested in your own care. In the 15 to 20 minutes you see a doctor, every minute counts. If you know your illness, your patterns and work toward shared goals (keeping on your insulin, for example), then those 20 minutes can be used to discuss next steps, not rehash the past based on unspecific information like “I’ve been feeling really bad lately.”

If we are to bend the cost/value curve in this country, it will be because patients and their families and caregivers have more information and data to act on so they can better control their own health, and the time spent with physicians is focused on meaningful data. Fortunately, with the rapid changes in technology of mobile devices, this is now becoming a reality.

Can you define patient engagement? There’s seems to be a fairly flexible interpretation of the term throughout healthcare.

To Axial, an engaged patient is one that takes a more active role in self-care. The three areas we address today are: education, medication management and symptom/biometric tracking. We’ve chosen these because there are multiple clinical studies to show that patients who understand their disease, adhere to their medications, and are aware of their symptoms and vitals and the impact their behavior has on them, have better outcomes than those who don’t. It’s not realistic to assume that a physician can impact these three subjects fully during their visits with the patients.

Where do you see patient engagement going and how are we actually going to get there? What are some of its biggest impediments? How did it exist prior to meaningful use?

Long term we are fully supportive of the Office of the National Coordinator of Health IT (ONC) and the National eHealth Collaborative Patient Engagement Framework designed to help health systems design and roll out patient engagement programs. The framework, which was vetted by more than 150 healthcare stakeholders, is also aligned with meaningful use through Stage 4.  (For more details on the framework, check our Patient Engagement School on our website and download “A Patient Engagement Primer for Health Systems”).

This is going to be a huge transition for healthcare organizations, and it is primarily driven by the change from fee-based to value-based compensation. In business terms, for 50 years, the incentives were to fill beds and run machines around the clock. Now, the goal is to improve outcomes by reducing costs. This changes practically everything about our health system. The role of primary care specialists is front and center. Care managers and disease educators become increasingly important. So while our software helps organizations make this shift a workable reality there are many fundamental jobs and roles that need to change first.

While meaningful use is important, it’s not nearly as important as the overall shift in how hospitals and physicians get paid. Across the country, most organizations understand where we are headed, but they are at various stages at making this massive transition of care.

From your experience, what have been patient engagement’s most surprising issues, or what surprises you most about patient engagement? 

I continue to be surprised by the disconnect between what patients are willing to do and what the physicians believe they will do. Many doctors will speak about how poorly patients comply on issues like diet and medication. However, we find that most patients want to make changes but they don’t know how. They don’t fully understand their illnesses or what their medications do. They can’t always draw the connection between what they eat or what medications they take and how they feel. But if you give patients and their families the tools to do so, a large number of them will become better managers of their diseases — it may not be everyone, but a meaningful slice of the population.

Who are Axial’s customers and how do they use the company’s patient engagement mobile application? 

We sell primarily to integrated delivery networks, both hospital systems and groups of community doctors. All of our clients make the application available to all their patients and families through the Apple App and Droid stores. Some of our clients, particularly those who have a large part of their client base under some form of capitation, link this patient-generated data back to the physicians as part of the work flow around the office visit (done through integration back to the EMR). We have a couple of very forward-thinking clients that are moving toward proactive case management as I described earlier.

How do patient engagement apps, like Axial’s, improve care outcomes and reduce readmission rates? Specifically.

If you or someone in your family have been diagnosed with congestive heart failure, you’re not alone. Heart failure affects nearly 6 million Americans. Roughly 670,000 people are diagnosed with heart failure each year. It is the leading cause of hospitalization in people older than 65. Worse still, 25 percent of those patients will end up back in the hospital within 90 days. That’s why this is a major priority for U.S. hospitals. The Center for Medicare and Medicaid, in an effort to lower re-admissions, is penalizing hospitals that have the highest quartile of re-admission rates. But how can re-admissions be avoided? It turns out that the single most accurate predictive factor for heart failure is rapid weight gain because of fluid retention. Leading health systems are planning on using wireless scales to proactively identify at-risk patients, and make sure they have the appropriate medical treatment before another heart failure occurs. How? Axial allows you to link patient data from wireless scales and other devices to the hospital information systems and case management tools so that medical professionals can see what’s happening in real time. A nurse or physician’s assistant can reach out to the patient whose weight has rapidly increased and intervene, having the patient come in for a physician visit before the condition escalates. The evidence? We’re working with major health systems now to put these kind of capabilities in place.

How is Axial Exchange different from other patient engagement tools available today and where is the company headed, and how is it likely to evolve past patient engagement?

Axial links two worlds — the consumer wellness/mobile world and the institutional health system world.  Most organizations that call themselves patient engagement companies are either consumer companies that make point solutions that aren’t part of the care cycle. Conversely, most hospitals have invested hundreds of millions in big moat-like systems organized around the hospital and care process. They are not consumer-friendly (or doctor-friendly for that matter). We believe that by linking these two worlds, you can build smarter patients and doctors that can be more effective in the limited time they have. Our patient-facing software is elegant, intuitive and easy to use. That data is transmitted and sent to the hospital’s EHR and population health systems so they have timelier, richer information within their existing workflow. We have seen very few companies that can be part of both worlds.

I’m not sure we want to evolve past patient engagement because healthcare is at the beginning of a change to become more consumer-centric. Instead, we see sharing more and more information — price transparency, information about approved support groups, disease registries, etc. This is just the beginning of a tidal change of how healthcare will be delivered.

In your opinion, what are the most pressing issues facing the healthcare industry today? How does your company help address these?

Healthcare institutions need help understanding how their institutions must change in this new world.  All of a sudden, they must do things they haven’t done before — like become payers or work closely with payers. They need to recruit populations like local employers, and different skills like clinically schooled case managers. This is a huge amount of change in a short period of time.

Axial helps by working with their existing workflow and systems to bring information to providers as they are ready to use it. We have clients in all stages of this transition, from those who are still buying practices and other hospitals but are primarily fee-based, to full ACOs. In any care model, getting closer to the patient is a key part of the organization’s success. We grow with provider organizations as they move toward full risk, while letting them maximize the investments they have already made in core operational systems. Getting a full resolution picture of patients helps all health systems and their patients.