Electronic Health Reporter

At Electronic Health Reporter, we take innovations from healthcare companies very seriously. For nearly a decade, we’ve featured their work, products, news and thought leaders in an effort to bring our readers the best, most in-depth insight about the organizations powering healthcare. That mission lies at the heart of all we do, for the benefit of our audience.

For the first time, we are officially naming some of the most progressive companies in healthcare technology, in our inaugural class of the best, most innovative brands serving health systems and medical groups. Our call for nominations for this “award” series received hundreds of submissions. From these, we selected the best companies from that class. The work these organizations are doing is forward-thinking; award-worthy, we think. We think you’ll agree with all of our choices.

In each of the profiles to come in this series, we’re share their stories — from their own perspective, through their own responses to our questions about what makes them remarkable. Some of the names featured here you’ll recognize, some you won’t. But we believe you’ll agree – all those profiled are doing innovative, groundbreaking work! That said, here’s a member of our inaugural class:

Copeland Clinical AI (C2-Ai)

What is the single-most innovative technology you are currently delivering to health systems or medical groups? 

We use AI-backed systems to help hospitals resolve avoidable variation, harm, and mortality with typical monitoring and reporting systems that currently are only able to detect 10% of what our systems can detect. Meaning, through our systems, we can see substantially more information then what current hospital systems are providing executives. Using the world’s largest patient dataset (140 million records from 46 countries) and built around the work of the developer of the world’s most commonly used patient safety system, POSSUM, we have built predictive applications that save lives, prevent harm and help hospital systems improve margins.

How is your product or service innovating the work being done in these organizations to provide care or make systems run smoother? 

Hospitals cannot resolve avoidable variation, harm and mortality that they cannot detect. By triangulating from existing billing and procedure codes, we can highlight issues and how to fix them. The hospital team can, therefore, save between $5 million and $10 million annually while demonstrably improving safety and avoiding potential stakeholder value-destroying scandals.

This helps reduce staff time fixing harm done to patients and so improves time utilization. It also helps direct improvement teams to where problems exist, rather than being oblivious to the 90% of avoidable variation and harm (or trying to chase improvements without evidence).

What is the primary need fulfilled by the product or service? 

Hospital-acquired acute kidney injury (HA-AKI) and hospital-acquired pneumonia (HAP) are serious avoidable conditions (acquired in hospital as their name suggests) that can increase a patient’s stay in a hospital by six and eight days, respectively, on average and lead to 700,000 deaths in the U.S. annually with a direct cost of $25 billion.

More than one in five patients in an ICU may have HA-AKI and reports suggest 36% of COVID-19 patients have HA-AKI (Northwell, NY). This means 10% of COVID-19 patients may die from HA-AKI.

Our AI-backed app enables front-line doctors and nurses to assess patients at the point of admission (and change of condition) for their respective risk of developing HA-AKI and/or HAP, and take appropriate action accordingly to prevent these serious conditions manifesting themselves.

The resulting 50% reduction in overall AKI and HAP cases (typical) reduces the workload for clinicians/nurses, saves money, reduces harm and mortality, frees bed capacity for other patients, and avoids long term conditions suffered by a third of those with AKI (ex: potential to need dialysis/transplantation).

What is the ROI of said product or service? Provide real examples of verifiable ROI of the product or service when used in or by a health system or medial group. 

Potential across the U.S., extrapolated from actual results in hospitals, to save 350,000 lives, free more than 11 million bed-days, and save more $12.5 billion annually (indirect operating expenditure only). The ROI of this product is 50x. In the U.S., the cost per patient assessment for one condition (acute kidney injury) is a few dollars compared to the cost per patient who contracts the condition of $10,000 (from a Nashville-based system).

Note, the bed-days freed could potentially be the difference between a patient living or dying if facilities are stretched. COVID-19 patients typically stay 15 days in the hospital and so during a surge, 11m beds is a huge capacity to deal with COVID or other patients.

By the end of February 2020, the number of cases of HAP had fallen from 100 in December 2019 to 53. The number of cases of AKI (comprising both community-acquired and hospital-acquired) had fallen from 338 in December 2019 to 215 at the end of February. In this one hospital, 500 lives saved per annum.

These results are consistent with C2-Ai improvements with hospitals in NZ, Sweden and England where we have seen overall AKI and HAP reduce by more than 50% (and a published study where AKI dropped to almost zero). Using a conservative direct cost per case of £4,000 for AKI and £1,800 for HAP, the reductions equate to an annualized hospital saving of $8.4 million. Across the whole of the NHS in England, the equivalent performance would lead to around 70,000 lives saved annually, direct operating expenditure savings of $8(AKI), and £230m (HAP) – using conservative cost assumptions. Longer-term cost savings relating to the life-changing conditions are ignored.

“It took two years and a very costly investigation to deal with a competence issue in our organisation some time ago. We set C2-Ai the blind challenge of seeing if they could have found the problem in our historical data. They did so in 20 minutes. Needless to say, we have invested in the system,” said Dr. Michael Roberts, chief medical officer, Northland District Health Board, New Zealand.

Improving patient safety and hence official hospital ratings 

“Accurate benchmarking of outcomes was a real challenge […] however our work with [C2-Ai] has provided invaluable quality assurance. The risk adjusted reporting has provided confidence that our outcomes are better than comparable organisations and the level of detail enables us to focus on improvements in specific areas.. It was particularly useful during our regulatory inspection and follow up meetings with the CQC [the hospital regulator in the UK] to show how this strengthens our clinical governance…”

• Dr. Jenny Davidson, Director of Governance, King Edward VII’s Hospital

Who are some of the clients and organizations served by the company? Name them.

• Imperial College Healthcare NHS Trust, London
• King Edwards VII, London (used by the UK Royal Family)
• Northlands DHB, New Zealand
• Karolinska University Hospital, Sweden
• Confidential U.S. Health System 1 – use of our systems for due diligence on the quality of potential acquisition targets
• Confidential U.S. Health System 2 – identification of variation, harm and mortality to support improvement efforts

How has the innovation advanced the field of healthcare or the practice of care?  

The ability to recognize avoidable harm is critical to the future of U.S. healthcare. As much as 25% of healthcare spending is believed to be because of waste (including avoidable variation, harm, and mortality). That’s $750 billion annually. We support cost reduction, demonstrably avoidance of harm/mortality but also help reduce clinical negligence (a $55bn cost to U.S. health systems). The ability to address this waste means hospital systems, and particularly rural hospitals may survive that otherwise would go into administration.

How is the innovation changing lives — specifically? 

The lives saved are typically above the number of lives lost on the roads while saving considerable sums for the health systems.

• People are alive who would be dead
• People are healthy who would otherwise have chronic conditions
• People went home from the hospital more quickly because they were not treated for harm that occurred during their stay
• Insurance premiums could be lowered
• Hospitals will not need to close (because their margins will improve)
• People needing risky operations will be more likely to get them. In 2016, the Daily Telegraph suggested one in three heart surgeons was avoiding high-risk patients because this might screw up their statistics (mortality as a percentage of operations). Our systems risk adjust for the patient’s health and operative severity to provide a fair, objective measurement. Surgeons no longer need to fear ‘unfair’ measurements and so more ‘higher risk’ patients will get a chance at life.

What is the company’s go-forward strategy? What’s next, which problem is the organization working on now, and in the future?

We are looking to apply our AI-backed approach to the ER, to understand and support decision making about patients that are admitted to the hospital and those that are sent home.

We are also supporting the triage of the elective surgical list (now) to provide the ‘objective priority scoring’ that the CDC says is necessary to restart surgeries. Our system risk assesses individuals based on their physiological condition (e..g blood pressure, sodium levels) and the proposed operation. The system outputs the risk of mortality and complications (by probability and type) to prioritize the list in an evidence-based fashion.

What are the most significant lesson learned by delivering the innovation, product or service to health systems or medical group? 

Healthcare is very slow and some health systems (outside the U.S.) are fundamentally broken. Although the U.S. health system is far from perfect, the drive for value does lead to behaviors that are logical but which other systems (including the NHS) do not follow.

Feel free to provide actual testimony from a user regarding the product and how it has solved a problem, created efficiency or improved processes at the point of care.

“I’ve been trialing the new C2-Ai App for AKI & HAP, both of which are phenomenal and work incredibly fast … delighted and excited as to how this tool can help us identify these patients early and put in place simple measures, which all have a significant impact.”

• Sunjay Kanwar, consultant general surgeon, St Helen’s & Knowsley Teaching Hospitals NHS Trust, UK

“C2-Ai have the most robust software approach to comparing safety and quality across hospitals, systems, and physicians that I have ever seen. The algorithms are backed up by years of published international research. I believe their approach could be most useful as a solution for providers across any network.”

• James Bonnette, MD (USA) executive vice president, the Advisory Board

Website: https://c2-ai.net/

LinkedIn: https://www.linkedin.com/company/c2-ai/

Congratulations, Copeland Clinical AI (C2-Ai)!

For the record, none of the recipients of this award paid for the honor of being named one of healthcare’s most innovative companies.