ATU411 – StationMD with Dr. Matthew Kaufman MD

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Your weekly dose of information that keeps you up to date on the latest developments in the field of technology designed to assist people with disabilities and special needs.

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Dr. Matthew Kaufman MD, FACEP – CEO Station MD www.stationmd.com Dating App Story: http://bit.ly/2G4U1Fl
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DR. MATTHEW KAUFMAN: Hi, this is Matthew Kaufman, and I am the CEO of StationMD, and this is your Assistive Technology Update.

JOSH ANDERSON:  Hello and welcome to your Assistive Technology Update, a weekly dose of information that keeps you up-to-date on the latest developments in the field of technology designed to assist individuals with disabilities and special needs.  I’m your host, Josh Anderson, with the INDATA Project at Easter Seals Crossroads in beautiful Indianapolis, Indiana.  Welcome to episode 411 of Assistive Technology Update.  It’s scheduled to be released on April 12, 2019.

On today’s show, we are very excited to have Dr. Matthew Kaufman on to talk about StationMD.  We also have a story about a dating app, specifically made for individuals with disabilities.  If you like the show, don’t forget to check out our sister programs, ATFAQ and accessibility minute, wherever you your podcasts.  Now let’s get on with the show.

A lot of times when we are talking about assistive technology, we really get focused on devices and things that really help individuals with disabilities with work, school, learning, and all these other things.  And we can put on the back burner the other things that are really important, which are just living life like everyone else wants to do.  So I found a story by Susie Hunter over on WTNH.com. It’s entitled, “Special education teacher creates dating app for people with disabilities.”  It talks about an app called Blue Crush.  It was created by Angela Rinaldi.  She was a special education teacher and worked with assistive technology for a long time, but she really saw the need in the disability community for a safe dating app.  It’s not just an app for dating, for meeting people, but for also making friends. What’s nice about this is not only is it a safe place, where you might be able to feel more accepted by other individuals with disabilities, but also employs type to text technology.  You can simply speak your message and have it read back to you if you have a print disability or something like that.  That it can really just help individuals to be able to reach out to others and meet people more like them or who have the same needs or the same kinds of wants.

As I said at the beginning, so many times we get so focused on assistive technology to help with ADL’s or work or school or things of that sort that we kind of lose that people need entertainment, people need companionship, people need all of these things that really make life great and with living.  A very cool app.  It looks like there is a cost involved.  The first few weeks are free.  After that there is a monthly fee.  It does say that some of the proceeds from that go to other charities that help individuals with disabilities.  I’ll put a link to the story in our show notes.  Blue Crush is the name of the app, and again, that’s a dating app specifically made for individuals with disabilities.

Listeners, I personally hate going to the doctor.  I’m not sure why.  I avoid it as much as possible, much to the dismay of my wife.  But while not going to the doctor is really due to personal phobias of my own, many individuals with disabilities have other barriers to getting medical treatment: transportation, funding, long wait times, and a lot of other factors can really impede an individual in getting the medical assistance that they require.  But what if they could get that medical treatment without ever leaving their it’s home? Our guest today is Dr. Matthew Kaufman, CEO of StationMD, and he’s here to tell us about a program for individuals with developmental disabilities that can do just that.  Matt, thanks for coming on the show.

DR. MATTHEW KAUFMAN: Thanks so much for having me.

JOSH ANDERSON:  I am really excited to hear about StationMD and all it has to offer.  Before we get into the technology, can you tell our listeners a little bit about yourself and your background?

DR. MATTHEW KAUFMAN: I’m happy to do that.  I have a little bit of an atypical medical training path, but I’m proud of all of it.  I initially went to medical school in the New York area at SUNY Downstate, and I initially trained in internal medicine and hematology oncology, and I practiced specializing in leukemia for a few years.  I had the privilege of working under a very well-known professor. I had always been interested in problems with care delivery and issues with improving access to care.  I had sort of been itching for a different direction and a way to get involved in a different way in medicine.  I ended up doing another training, three years in emergency medicine, and the program director was kind enough to accept me into his program and allowed me to train again.  I became an emergency medicine doctor.  In emergency medicine, there’s a lot about access to care.  It’s really the interface with the community, and you see issues with the care delivery from the ground up.  It was a great chain for me and I got very involved with questions of care delivery in different populations within the system that we neglected or treated suboptimally.  I currently still practice emergency medicine in a New Jersey ER, and I still love it. I’ve gotten involved in other things as well, but I use that skill and knowledge.

JOSH ANDERSON:  I think you alluded to it there on how the idea for StationMD came along.  Can you tell me what is StationMD?

DR. MATTHEW KAUFMAN:  StationMD is a group of ER docs that are developed a telemedicine solution that is focused on serving people with IDD and other disabilities, really the most vulnerable populations we see in the ER. The ideas we use telemedicine to treat people, evaluate, many times tree people upstream in their homes, in their community setting so they don’t have to go to the ER.  That’s our basic delivery system, is we are treating the same issues, the same problems that come up, but instead of someone having to experience the transportation and the tactic craziness of NER, we are able to do that and perform that job in the community.

JOSH ANDERSON:  I can see how that can be helpful.  When did StationMD start?

DR. MATTHEW KAUFMAN: It started as a classic back of the envelope kind of thing about five years ago.  I had always had this interest since being a doctor and questioning access, question issues that come up.  In the ER, we really have a first-hand view, a very close up view of where those problems lie.  The main issue that came up again and again is populations that really were constantly chipped in and out, where they were elderly or people with IDD or other disabilities, that ended up coming to the ER again and again and many times not needing to be there.  I said to some friends who I worked with, some colleagues, it would be so much better for these folks if we could intervene on the issues upstream in their communities.  Many times, the issues themselves, the medical issues themselves, even the complex ones, were not something that a person had to be in the emergency department for. They weren’t something that required a major intervention or suturing or both setting.  They were issues that required medical expertise, but not the presence in an emergency department.

One of the things I’m really proud of in our company is we have special training of our doctors for people with IDD.  There really is a lack of training of this sort in medical schools, so doctors just don’t get this type of training.  We developed a program with some specialist to do that.  I think that’s one of the things I want to emphasize, is it’s not just access, but it’s really specialized access for this population.

We got the idea, how could we get this started, and it came along right around the time that there was a program called DSRIP, which is still around in some states, which is a Medicaid block grant program that has been developed for healthcare innovation, basically delivery systems of healthcare that are unique and innovative that could improve access.  It’s really right along the lines of what we are thinking about.  So we applied for a grant, and we were lucky enough to get it. At the same time around that time, we saw a lot of telemedicine technology become simpler and less expensive, and we were able to employ some pretty simple, inexpensive solutions to our process.  It allowed us to serve a couple of residential facilities at very low cost, and we made some big changes there and had a big impact.  Based on the impact we had in those facilities, we get more interest and ended up going from there.  We are now in about 120 group homes in the New York area.  In this next year, we are expecting to be in many hundreds more, maybe even a thousand more.

JOSH ANDERSON:  Now is it just in the New York area, or are you guys nationwide?

DR. MATTHEW KAUFMAN: We are nationwide.  Right now, we are in New York, New Jersey, Ohio, but right now I would say there are about five or six other states that have shown a great deal of interest.  We are sort of in the process of rolling out to multiple other states.  The timelines of those things are variable.

JOSH ANDERSON:  What kind of technology is utilized?  Let’s say I have someone in my group home that needs medical attention, and I’m going to you StationMD.  What kind of technology do I utilize so the doctor gets all the information they need?

DR. MATTHEW KAUFMAN: We are deliberately using simple technology because we really want access.  You can go to a big medical Center, and in the ICU they use robots and things that are $85,000 or more.  We have deliberately said what’s going to give us the biggest value and allow you to intervene successfully on the most people and not limit the sort of access to the stuff.  The technology is quite simple.  It is run off basically an ordinary laptop or tablet, it’s just a software program.  We have it tailored to our process — of course, it’s HIPAA compliant with all the regulatory issues.  It’s quite a simple program built on top of the zoom platform, and we have additional technology such as a stethoscope, which runs via Bluetooth and transmits a lung sounds, breath sounds back to the doctor on the other end.  We use a high definition camera that allows us to evaluate skin and other issues a little more closely than you might with a regular computer camera.  Again, the cost of that set up is deliberately as low as possible so that that is not an optical or barriers to care for folks. It works in a dramatic majority of patients and cases we see.  This is what you need.  The addition of a very expensive, high-tech feature would, in the vast majority of cases, not add a whole lot to our medical evaluation.

JOSH ANDERSON:  I’m glad you guys thought of that.  So many times a great idea comes along, but it’s so cost prohibitive that no one who actually needs it can afford to use it. I like that.  I really like the use of the stethoscope, so you can still get the information.  If you say so and so is wheezing, I’m kind of worried about them, you can actually probably tell the caregiver where to put it so you can get the information and see what’s going on.  That’s very cool.

DR. MATTHEW KAUFMAN: That’s right.  That’s part of our process, is to partner with the caregiver or the patient.  I say patient, and forgive me for saying that.  When I see them, they are my patients, but the individual, him or her, sometimes able to assist us with that stuff.  But often times there is some person acting as a conduit, and we work with that person, whether it’s a family member, a direct care staff at the facility, a residential facility.  They serve as our team member and they are key to the process.  One of the really cool things that we saw with the development of this process is the enthusiasm with the staff.  This is an outgrowth of their participation and care for someone that is taking on a new dimension.  That is not something I had anticipated.  But we see that instead of just calling 911 and sending someone to the emergency department, they are able to really participate in a very sophisticated process of medical care and help us to be a crucial part of the doctor’s decision-making, not only giving us information that we need but actually serving as our hands.  It’s really a great dimension of work.

JOSH ANDERSON:  What happens if you are meeting with someone kind of remotely and you decide that and ER visit is needed?

DR. MATTHEW KAUFMAN: That’s a great question.  It does happen.  There are cases where we say I’m evaluating this person, and I don’t want to put off an x-ray, or I am concerned that they may need immediate IV fluids or some intervention.  We go ahead and say this person does need to go to the emergency department.  What we do in those situations is, with our partners in – and I can talk about how we build the relationship with our partners in this — we have the information of what emergency department they will go to, what’s the typical emergency department that that individual tends to go to, and recall ahead of time and give them the information, kind of ER docs to ER doc. Hey, this is what I’m concerned about with this young man, please focus on this issue.  I can’t dictate what they do, but it goes a long way – we call it a warm handoff in the medical world – to get a warm handoff from me saying, hey, these are my specific conditions, these are the baseline situation, so don’t worry about that, but this part is new and concerning.  That is a huge amount of information that the doctor in the ER is getting, and that will do two things.  One, it will focus the workup so the cost is kept down.  More importantly, it will streamline the work so that the time spent in the ER is often limited because they are not doing 500 tests.  Instead, they’re only doing two tests.  Finally, we are able to provide insight and reassurance to that doctor on the other end that if they have an issue and they say, hey, I would be willing to send this person back home if I can be assured that he or she will be evaluated in this amount of time.  Or if I can be assured that these medicines will be picked up today and be administered appropriately.  That’s the kind of reassurance that we can give.  

A lot of times what happens is that ER doctor will say, hey, Matt, I saw your patient.  I think you are right, that they might be able to go home. Can you reassure me that this guy will be seen tomorrow by you and you can assure me that the blood pressure is going to be stable or he’s not going be vomiting anymore and not get dehydrated? I can provide that assurance.  I or my teammate will do that.  It really keeps those folks from an unnecessary hospital admission.  As you know, even an ER visit can be incredibly disruptive and destabilizing for someone, anyone, but someone with IDD, to face and ER which is crazy for anyone, but terrifying in a magnified way for many, but even in addition to that scariness, there is a destabilization of the medications, of their food, meals, sleeping.  That can cost a lot of time and hardship on the other end, even when their discharge. If someone is admitted to the hospital, that time of recovery after their discharge can take weeks.  Problems can cascade that worked there before and manifest in behavioral issues, other health issues, just because of that dramatic destabilizing force of an ER visit and hospitalization.  If we can prevent any of those steps, it’s a huge win for the person.

I’ll mention a story that I saw myself with an ER patient while I was working in an ER department. This is a story I sometimes tell because it just broke my heart and just showed how broken the system can be for someone who doesn’t need to be in the your who has a lot of medical comorbidities and vulnerabilities.  There was a young man who was brought in with essentially an upper respiratory tract infection, a cough and a low grade fever.  His mother showed up.  It was late at night, and I evaluated him.  I thought he was doing okay.  We gave him some respiratory treatments.  The mother said to me, well he’s due for his seizure medications.  Can you give him a dose of this medication?  It was a very common medication, not something exotic. I said sure, let me order that in our computer system.  The way that a hospital system emergency department works is they have some medications right available couple others they have to get from a pharmacy in the basement, a different area of the hospital, and they have to ship that medicine. It takes time.  A courier or tube system has to get that medication.  The mother, a very nice woman, exhausted, the middle of the night, she’s with her son in the hallway, says to me, still having given him this medication.  I know that I told you this, you were going to give it to him, but I’m concerned because he get seizures when he doesn’t get it.  I said, okay, let me check on it.  Just while I went back to see where the medication was in the system, he had a generalized seizure.  Literally this man could have exacerbation of a problem that was under control when he was safe and sound in his home, but now is worse because he got to the ER. Now he’s got one of the problem, another issue that was created by him just waiting.  That was heartbreaking for me.  The entire ordeal could have been taken care of where he lived, and he wouldn’t have missed his seizure medicine and the whole cascade of events wouldn’t have happened.  The young man ended up getting admitted and required a few days of hospital stay.  All this could have been handled with telemedicine and seeing him as a patient outside.

JOSH ANDERSON:  I could see, like you said, the stress of being in there, everything else, the normal medicines, eating schedule, all those things, how much they get disrupted.  I like how you talk about being able to talk doctor to doctor, that warm handoff.  For anyone, but especially for individuals with disabilities, it gets really hard to explain every thing that’s going on and explain everything else that’s been going on.  Not just that, but being able to give that Dr. information I’m sure really helps not just with treatment but will probably take some of the stress of the individual and the caregiver to get the information correctly to them.

DR. MATTHEW KAUFMAN: That’s right.  One of the things you learn when you become a doctor, especially an emergency doctor, is finding the relevant stuff.  One of the things that happens in the status quo is when someone from a residential facility or usually from home, the parents, they know a ton of information, but they may not know exactly what the relevant issues are at that moment.  Often times they do.  But when a person comes from a residential facility, they typically come with a big book that is the history of this person, and there’s tons of information in it, but there are papers jammed in.  But for a doctor to see this in a busy yard, sift through the information and try to sort through what the active issues are, what the relevant issues are, it just doesn’t typically happen.  The typical response is I’m just going to test for everything and we will see what we find.  Usually they find something and the person gets admitted.  If there is a doctor on the other end, like you mentioned, who knows the case, who has spoken with the caregiver, direct staff member, the parents directly and can identify the issues more concisely, sift through, a really does a tremendous amount toward getting the correct treatment plan underway for the ER doctor.  A really is very impactful.

JOSH ANDERSON:  What does the future hold for StationMD?

DR. MATTHEW KAUFMAN: We are extremely excited about this. We have had very good data that has shown a decrease in emergency department use by about 85 percent in most people with IDD.  This is one of those rare things.  I’ve got a few things I’m proud of in my career, nothing I’m more proud of than this. This is one of those rare things that it actually medically and ethically, we are doing something I think wonderful, but happens to also make sense in terms of spreadsheets and money. That is a very fortunate issue for us, because we are able to expand our services to more places, more people who need the service.  Every time I go somewhere and I go to different conferences and so forth, we hear how this would work wonderfully in a facility, in a state, so we are planning on growing and delivering this type of service where we can.  One of the beauties of having a simple, inexpensive process as we can do this, and the impact is felt.  We are going straight ahead, going forward as fast as we can to deliver this care and this improvement in quality care to everyone who needs it.

JOSH ANDERSON:  If our listeners want to find out more about StationMD, how can they do that?

DR. MATTHEW KAUFMAN: To find out more, anyone can go to www.stationmd.com.

JOSH ANDERSON:  We will put a link to that in the show notes so our listeners can take it out and find it more.  But especially now with healthcare being such a big issue because you can’t turn on the news without hearing about it and cost change again going up, and as you talk about all of the barriers to individuals with disabilities, I could see how this would be a huge help to anyone, but especially the population that you guys are reaching out to.

DR. MATTHEW KAUFMAN: Depending on what the resident facility is responsible for – and this varies by state – they end up saving a lot of money on staff issues by avoiding these ER visits, and they save money on loss of revenue from their bed.  Even if they end up paying for the service, it ends up saving the money.  The biggest saver is the payer itself, the insurance company, Medicaid, Medicare, whoever the private insurance might be.  Those groups are saving huge amounts of money by avoiding these ER visits.  All of this pressure on cost savings, we are supposed to have value based savings in healthcare at this point.  This is a perfect example of how this would work.

JOSH ANDERSON:  Dr. Matthew Kaufman, thank you so much for coming out today to talk about StationMD.  As you guys expand and grow, maybe we will have you on the show and talk to you again.

DR. MATTHEW KAUFMAN: I would love that.  Thank you so much.

BRIAN ANDERSON:  Do you have a question about assistive technology? Do you have a suggestion for someone we should interview on Assistive Technology Update? If you do, call our listener line at 317-721-7124, shoot us a note on Twitter @INDATAProject, or check us out on Facebook. Are you looking for a transcript or show notes? Head on over to our website at www.EasterSealsTech.com. Assistive Technology Update is a proud member of the Accessibility Channel. For more shows like this, plus so much more, head over to AccessibilityChannel.com. The opinions expressed by our guests are their own and may or may not reflect those of the INDATA Project, Easter Seals Crossroads, or any of our supporting partners. That was your Assistance Technology Update. I’m Josh Anderson with the INDATA Project at Easter Seals Crossroads in Indiana. Thank you for listening, and we’ll see you next time.

***Transcript provided by TJ Cortopassi.  For requests and inquiries, contact tjcortopassi@gmail.com***