Health IT, Startups

Health IT in the Hoosier State is taking off

The Midwest isn't usually considered a hub for health IT innovation. But a closer look at a few organizations in Indiana shows there's a plethora of healthcare-related activity brewing in Indiana.

“Welcome to Indiana, Crossroads of America” sign with a forest in the background.

The Midwest isn’t exactly the heart of healthcare technology innovation. Silicon Valley and East Coast claim much of the limelight in that regard, while states like Indiana are dismissed as flyover country.

But the Hoosier State has more to offer than the Indy 500. Upon closer inspection, you find facts that are surprising. For instance, did anyone know that based in Indianapolis, the Indiana Health Information Exchange just happens to be the nation’s largest health information exchange? It connects 117 hospitals, more than 14,000 practices and over 42,000 providers.

During the first half of 2017, Indiana was one of 25 states to win digital health investments from investors, according to Rock Health. Comparatively, the state wasn’t even among the 23 states that were home to startups that garnered funding during the first half of 2015.

The BioEnterprise Midwest Healthcare Growth Capital Report found Indiana attracted $41.46 million in healthcare investments in 2015. A year later, that number hit $88.84 million. So Indiana is slowly but surely becoming a hotbed of healthcare activity.

The year-over-year amount increased for the state’s capital as well. Indianapolis raked in $26.9 million in healthcare venture investments in 2015, compared to $74.3 million in 2016.

Unlike other parts of the country, where entrepreneurs more readily tout their achievements, in places like Indiana, the default is cautiousness. And that’s not a bad thing, said one startup executive.

“The mentality of the Midwest is good for health tech innovation,” Tammy Dugan, CTO of Digital Health Solutions LLC, an Indianapolis-based startup, said in a phone interview. “When people’s lives are on the line, you have to be a little cautious. Midwesterners tend to be cautious.”

Dugan and Dr. Stephen Downs, president of the startup, founded the company in collaboration with the Indiana University School of Medicine. Its core product is dubbed Child Health Improvement through Computer Automation — or CHICA for short.

It works like this: When a patient arrives for an appointment, the EHR system alerts CHICA, which then selects 20 questions tailored to the patient and family based on the information known about them from previous visits. While in the waiting room, the family answers the queries using a tablet. The questions are largely based on requirements from the American Academy of Pediatrics. They can span a range of topics, including substance use, depression, domestic violence, food insecurity, developmental issues and sleep habits.

Later, during the appointment, the physician can click a link in the EHR, which lets them visit CHICA and see the family’s answers. Based on the family’s responses, CHICA selects a few key issues for the physician to focus on during the appointment.

Though the software is intended for use in outpatient pediatric care settings, it could be altered to fit other needs.

Digital Health Solutions currently counts IU Health and Eskenazi Hospital as its clients. The CHICA software is integrated with Cerner (at IU Health) and Epic (at Eskenazi), but Downs noted its interface strategy is fairly standard and could theoretically be applied to other EHRs.

“IU has been a good environment for doing this work,” Downs said in a phone interview. “That’s in part because our work started with the Department of Pediatrics here, which has been pretty visionary in this field and supportive of the work we’ve done to develop CHICA.”

Another Indianapolis startup is also leveraging health IT to provide a deeper level of insight from a cost perspective.

Springbuk’s health analytics platform is aimed at assisting employers, brokers, wellness vendors, and clinics so they can view data on the health of their population, track changes and see the cost risk.

For example, Springbuk’s solution permits on-site clinics and wellness vendors to narrow in on specific patient populations.

“You may not want to focus on somebody who’s extremely motivated,” Jeremy Leventhal, the company’s vice president of product, said in a phone interview. “But if somebody who is unmotivated is predicted to have a lot of cost, those are the kind of folks that our software allows us to target, measure and engage with.”

Leventhal added that there are slightly more than 1,300 employers currently using the platform.

Last week, the startup announced a $20 million Series B financing round led by HealthQuest Capital and Echo Health Ventures. Lewis & Clark Ventures and Elevate Ventures participated as well.

With the funding, Springbuk hopes to pinpoint $4 billion in potential health cost savings by the end of 2020. It also revealed plans to add 100 tech jobs to Indianapolis by the same year.

“For us, this $20 million … [is] huge from a health IT perspective, it’s huge from a tech perspective in Indiana and puts Indiana on the map,” Leventhal declared. “This is a place where there are a lot of bright people doing amazing things.”

While companies like Digital Health Solutions LLC and Springbuk are new to the scene, the aforementioned Indiana Health Information Exchange has been around for years.

Although it was founded in 2004 by the Regenstrief Institute, BioCrossroads, health departments, private hospitals and other organizations in the state, its earliest roots date back 30 years.

Today, IHIE’s solutions include the OneCare and PopCare suites.

“The OneCare piece helps providers care for individual patients, while PopCare helps take care of patients’ lives around payment models,” Chuck Christian, IHIE’s vice president of technology and engagement, said in a phone interview.

OneCare encompasses the CareWeb and DOCS4DOCS solutions. Through CareWeb, an IHIE physician can view patient information from other IHIE participant providers. DOCS4DOCS enables the delivery of clinical data to other IHIE customers.

PopCare is all about population health, giving IHIE clients access to analytics tools and clinical output products. It also includes alerts that notify a provider when a patient got care at another facility.

When healthcare organizations are interested in joining IHIE, Christian said the process starts with determining which services they want. Annual subscription fees are based on the size of the organization. They then go through an onboarding process.

IHIE is also one of the founding members of the Strategic Health Information Exchange Collaborative, also known as SHIEC. Based in Colorado, the group is a national coalition of more than 50 HIEs across the nation.

“We’re always more than welcome to share what we know with the other HIEs in the country,” Christian said. “We’re not shy about it.”

Startups and health IT only scratch the surface of the healthcare activities going on in Indiana. In addition to research organizations such as Regenstrief Institute, the state has a rich life sciences landscape, with BioCrossroads, Eli Lilly and Roche Diagnostics’ USA headquarters nestled in the state capital. One of the country’s top payers, Anthem, is based in Indianapolis as well.

“The state is blessed with high-quality healthcare,” Christian concluded. “There is an absolute wealth of healthcare-related business and expertise.”

Photo: Davel5957, Getty Images

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