Telemedicine

How Curavi uses hardware, software to tackle unnecessary hospitalizations

Curavi Health’s telemedicine product was built by taking into clinician feedback including workflows at nursing homes.

 (Photo by Theo Heimann/Getty Images)

A Pittsburgh telemedicine startup is working on slashing unnecessary transfers of nursing home residents to hospitals. These contribute to factors that lead to higher healthcare costs and are being scrutinized by payers such as the Centers for Medicare and Medicaid Services. 

Backed by the University of Pittsburgh Medical Center’s UPMC Enterprises, and located there, Curavi Health is the brainchild of Dr. Steven Handler, a UPMC geriatrician who holds a PhD in biomedical informatics.

About 80% of transfers from nursing home to hospital stem from five conditions: pneumonia, heart failure, COPD/asthma, urinary tract infections, and skin ulcers, according to Handler.  Many transfers occur at night and on weekends when it’s less likely that a physician or nurse practitioner will be present in the nursing home to decide whether the transfer is necessary.

These transfers can be harmful to residents as well as expensive for payers. Of the $14.3 billion spent by Medicare in 2011 on inpatient admissions from nursing homes, an estimated $8 billion was spent unnecessarily, according to data recently released by CMS.

Curavi’s product consists of a cart equipped with a pan/tilt/zoom camera, Bluetooth stethoscope, digital otoscope, document scanner, and 12-lead EKG system. The system comes with proprietary software, which enables a remote physician or nurse practitioner to interact with the patient and nursing staff. Notably, the software is tailored to each nursing home’s workflow and allows the remote provider to see and hear the patient before making a diagnosis, according to Curavi CEO Nicholas Kuhn.

Handler and Kuhn believe that taking that workflow into account makes Curavi different from other telemedicine companies entering the nursing home arena.

That focus on the workflow was the result from clinical feedback that Handler insisted on obtaining throughout the product’s development. 

The biggest challenge in the development phase was a lack of Internet connectivity at rural nursing homes, Handler said. So Curavi’s 10 developers designed its software with the lowest bandwidth that can operate in extreme conditions, such as in helicopters and ambulances, and still provide high-definition audio and video.

The company is in “very high-level talks” with a large Internet carrier that could work with major cellular providers to integrate a wireless gateway system for the company and prioritize Curavi’s packet on the network at one step below that of 911 calls, he added.

The software and cart were born from an initiative to improve the quality of care for nursing home residents by reducing avoidable hospitalizations. UPMC won a CMS Innovation 2012 Award for the program, which included a number of interventions at 17 non-UPMC facilities. The initiative then spread to UPMC’s own six nursing homes.

The combined experience resulted in training more than 1,000 nurses and healthcare professionals in telemedicine, 212 real-time video consults, and avoidance of 108 unnecessary transfers of patients to hospitals over the last two years, according to a statement from UPMC.

Over the next eight weeks, Curavi will launch in a dozen Pittsburgh-area nursing homes that will begin implementing its service, Kuhn said. The company will initially offer the service 6 p.m. to midnight on Saturdays and Sundays, with plans to expand into overnight and 24-hour cycles.

Nursing homes will initially use UPMC geriatricians for telemedicine consults, but the company also plans to offer the service to facilities that want to use their own medical staff.

Curavi’s long-term goal is to develop other tools to reduce hospitalizations among post-acute care patients, including those living at home, according to Kuhn, a serial medtech entrepreneur.

“We chose to pursue this market initially because we felt that we have a unique solution that could meet this market and it’s an underserved market,” Kuhn said. “The skilled nursing arena is a very segmented market. We felt we could bring something quite unique to that customer base.”

Photo: Theo Heimann, Getty Images