Stories and graphics by Camila Cernawsky Nakandakari for the USF Center for Entrepreneurship in the Muma College of Business
Ten teams of innovative students from five Florida universities have new ideas on how to solve a $25 billion national problem: How to reduce costly hospital readmissions that put a drain on the U.S. healthcare system. The annual Florida Blue Health Innovation Pitch Competition on Sept. 16 will give them a chance to test their ideas in a virtual event.
This year, USF is represented by students on six of those cross-institutional teams.
The competition asks Florida university students to take on a significant issue in the health care system using either a new invention or an innovative use of existing technology. Hospital readmissions occur when patients are discharged from an acute-care hospital but are readmitted within 30 days for the same condition or problems related to it. Most often, patients find themselves back in the hospital due to a lack of follow-up care, an adverse drug event or issues like infections. In addition to having a heavy toll on the health and emotions of patients and their families, readmissions are costly to the healthcare system. Twenty percent of Medicare patients are readmitted within 30 days after hospital discharge.
The finalist teams will focus on improving discharge planning, patient compliance with medication and care instructions, care coordination, engagement with case management, home health care, and financial and business plans to incentivize reduction. The teams will present their final pitch to health care and business experts after spending more than two months refining their ideas with the help of mentors from the GuideWell Innovation Team and the USF Center for Entrepreneurship at the Muma College of Business.
The teams are vying for prizes that will help support advancing their ideas: First place winners will be awarded $15,000. Second and third place winners will take home $8,500 and $5,000, respectively.
High School Friends Turned Health Innovators Propose New Data-Driven System for Diabetics
When a Gator meets a Bull, anything can be possible. Oyindamola Teniola from the University of South Florida and Rebecca Oyetoro from the University of Florida have teamed up to pitch their innovation, LiveEDU.
LiveEDU is a data-driven, learning technique designed to enhance care delivery, and aid patients and their families in hospital discharge training and exit programs. The innovation includes training while the patient is the hospital and a follow up virtual call. Before a patient is discharged from the hospital, an initial pass or fail will be conducted to assess the patient’s or caregiver’s ability to sustain their health.
“Often times, patients are simply unaware of what they are dealing with or how to deal with it,” said Teniola, who is pursing a bachelor's degree in chemical engineering. “Uninteresting and highly technical resources present information in a manner that is unappealing to the patient, and usually of little benefit. There is also a lack of monitorization and assessment, which LiveEDU aims to rectify.”
Teniola, a first-generation Nigerian-American and an advocate for the underrepresented minority communities, spent the summer as an engineering intern at Medtronic. But his motivation is also personal: Since learning his grandmother has Type 2 diabetes, Teniola's interest in learning and diagnosing health care issues grew and led him to the Florida Blue Health Innovation Challenge.
Teniola also believes that the impact of COVID-19 has amplified the need to address the disparity in healthcare, especially within minority communities.
“African Americans are twice as likely to be diagnosed with diabetes,” said Teniola. “I hope to one day lessen the prevalence of diabetes and other chronic conditions through the creation of sustainable solutions to social exclusion and the implementation of education for healthier lifestyle choices.”
He didn't need to look far for the right partner in the challenge. This dynamic duo met while attending Atlantic Technical College Magnet High School.
Rebecca Oyetoro, a second-year medical student at UF, has been part of a clinical research team at the University of Florida Department of Pediatrics Division of Pediatric Endocrinology. Oyetoro’s research involves the integration of technologies, such as the continuous glucose monitor, and education to improve glycemic outcomes for patients with Type 1 diabetes. Her team has successfully integrated a validated knowledge assessment in pediatric T1D (KAT-1) into their clinic’s electronic health record (EHR).
“When patients have an adequate amount of knowledge about their conditions, they are well equipped to taking proper care of themselves,” she said. “As a medical student, I recognize the importance of empowering patients to become active about their own care.”
Oyetoro jumped into the competition to help educate patients and to help close the inequity gap that exists in healthcare. Just like her teammate, Oyetoro acknowledges the impact COVID-19 has had in intensifying these systemic inequities in the American economy and healthcare system.
“With proper management, most individuals with chronic conditions can achieve good symptom control, improved quality of life, and reduced risk of other associated conditions,” she said. “LiveEDU is a software aimed at reducing hospital readmissions for individuals managing chronic conditions. Our innovation helps patients recognize life-threatening signs and symptoms and provides sustenance for self-management through education.”
USF-FAU Duo Pitch "ONCE" - A System to Keep Hospital Admissions to Just One
Great minds think alike, especially when they bring years of business experience to the table. USF PhD student James Wallace and recent Florida Atlantic University dual master's degree graduate Cory Feldman had similar ideas of how hospitals could use a high-tech scoring system to reduce patient readmissions. So rather than competing against each other, they joined forces.
The team was paired by USF’s Center for Entrepreneurship after mentors considered their project’s similar focus and approach. Together, the team created Once, a readmission reduction program that employs risk scoring to inform and engage patients for better health outcomes.
The innovation assembles data on 21 elements from patients’ electronic health records and compares it against national benchmarks to determine the likelihood of hospital readmission and intervention steps. Through a novel survey tool, Once also measures patients’ locus of control and recommends actions for engagement in the course of care.
This innovation establishes a protocol of identification, assessment, and engagement for clinicians, nurses, and healthcare providers to move a patient to a more effective locus of control. The application can be downloaded by patients who can complete a self-assessment or connect available electronic medical records to determine their readmission risk assessment score.
“Allowing patients to determine their score before admission can lead to better health outcomes and disease management and prevention,” Feldman said. “Scores can be discussed with a primary care physician or treating physician to develop a plan should a patient need to be admitted into the hospital.”
Feldman and Wallace bring an extensive background experience working with business and health care systems. Wallace is currently enrolled in the doctoral program at USF's Muma College of Business. He has worked as vice president of business development for SpaceX and senior researcher at Harvard Business School. Currently, Wallace is the president of AmeriPlus Select Services, a profitable alternative to standard Medicare supplement insurance plans.
His teammate, Feldman, works at MedStar Georgetown University Hospital (MGUH), where he serves as the regional administrator for the MedStar Medical Group Pathology Southern Practice and Department of Pathology and Laboratory Medicine at MGUH. He recently completed dual master’s degree in both business administration and healthcare administration from FAU.
“Time and time again, I hear first-hand accounts of patients and their family members who were hospitalized and how overwhelming the experience can be,” said Feldman. “Through the process of identifying high-risk patients for readmissions, we can make sure that patients get the resources they need so they do not have to come back to the hospital.”
Together, they want to ensure patients and families have a sense of control of what and how much they possess.
“Evidence suggests that patients’ sense of control has a meaningful effect on these outcomes,” said Wallace. “This innovation establishes a protocol of identification, assessment, and engagement for clinicians, nurses and healthcare providers to move a patient to a more effective locus of control.”
Grad Student's Innovation Looks at Social Determinants of Health
Kayla Wilson, who is pursuing master's degree in public health, has created Connecting Care, an app-enabled system which aims to reduce hospital readmissions by looking at social determinants of health and ensuring that patients can recover in a safe and healthy environment after being discharged from the hospital.
The proposed solution of the innovation is to reduce the 30-day readmission rate, specifically on patients recovering from heart attacks and heart surgery, by assigning a social worker to a patient based on the results of a needs assessment.
Social determinants of health have been found to have a big impact on a patient’s health and the needs assessments will cover factors such as housing, food, transportation, utilities, childcare, employment, education, finances and personal safety.
To maintain communication between the social workers and patients, an app will be created that will allow patients to view their social worker’s contact information, their medical information, including instructions for their treatment, and websites to organizations that offer assistance to community members.
The social workers will be able to monitor their patients, look at their patient’s notes and treatment, view the needs assessments, view and edit forms for special requests, and will be able to edit the calendar for their patients for any future appointments. After the appointments are added to the calendar, the patient will receive reminders.
“The social worker will contact their patient at least once a week up to one month after the patient has been discharged,” Wilson said. “Social workers are expected to attend any clinical appointment the patient has at that time if they can. They will check up on patients to ensure that patients do not have questions about their condition or recovery plan and that the patient’s social needs are being met.
“In Philadelphia, it was found that of the patients that had high hospitalization rates, more than half were food insecure,” she continued. “This example shows that social determinants of health greatly impact a patient's overall health and should be addressed in health care settings.”
During the Fall of 2019, Wilson was awarded the More Opportunities to Learn Advocacy Award from the USF College of Public Health activist lab and was able to work with the Guardian ad Litem organization to help educate their employees on the warnings signs and symptoms of Human Trafficking. she currently is working with WellCare and Centene to learn more about the corporate and administrative side of the health care system.
USF-UF Team Devises Specialty Transitional Care Program to Improve Patient Services
USF's Gisela Kennedy, a 10-year veteran of nursing now working on a MBA, and UF's Shayna Rabess would improve the care transition from hospital to home to the healthcare provider by implementing transitional care management services to bridge the gap and improve the coordination of care for high-risk populations.
The innovation is aiming to decrease the time from hospital discharge to healthcare provider visits. The team proposes the implementation of a Specialty Transitional Care Program for patients transitioning from hospital to home who have conditions that are high risk for readmissions, such as congestive heart failure, myocardial infarction, chronic obstructive pulmonary disease, pneumonia or sepsis, for example.
The team’s research found that when patients are discharged from a hospital stay, regardless of risk for readmission, they could experience delays of seven to 14 days before being seen by a primary care provider. The delays are even longer when it comes to seeing a specialist.
“For a hospital to impact readmission rates and subsequent associated non-billable costs, it will need to implement care coordination from discharge to healthcare provider visit for high risk of readmission patient populations,” said Rabess.
The team wants to improve access to care, since access is the main challenge that patients face when they end up visiting an emergency department and ultimately being readmitted either for a previous concern or a different concern.
“Primary Care is invested in this model with dedicated follow-up and communication, but specialty care lacks the collaboration from other entities, like a social worker, nurse, scheduling staff, etc.,” Kennedy said.
Kennedy’s biggest motivation comes from veterans and specialty healthcare providers. She works at the Bay Pines VA Healthcare System’s Department of Medicine as an administrative officer, where she provides supervision of 11 direct reports and leads operations for over 175 clinical providers in 12 specialties. From 2003 to 2007, Kennedy served in various roles as a United States Army Logistics Officer in Virginia, Hawaii, and Kandahar, Afghanistan.
Rabess has been a nurse for 10 years, working primarily in cardiology. She is currently working on her doctor of nursing practice degree, where her research has focused on improving care transition from hospital to home to the healthcare provider in the heart failure population by implementing services which include 72-hour post-discharge telephone contact, and a follow-up visit within seven to 14 days of discharge.
“I listen to my providers every day telling me how grateful they are to work in a hospital where they are confident their patient will get the medication they are prescribing because the pharmacy automatically sends it to them or how they can contact the scheduling team to facilitate an appointment for a patient just to make sure they are OK,” Kennedy said. “This spirit of the good that we can do is what inspired this project.”
USF Pharmacy PhD Students Land Finalist Spot with Telemedicine and Telehealth Innovations
More than a quarter of hospital readmissions are due to a lack of appropriate follow-up, and that's a circumstance which can be prevented, says a team of four Doctors of Pharmacy students in their final year at USF Health's Taneja College of Pharmacy. Caitlyn Smith, Amanda Giggy, Shana Indawala and Indigo Moss seek to reduce the rate of hospital readmission by creating, Simply TOC, a transition of care management program for hospitals and healthcare institutions.
The Simply TOC program will allow for patient concerns and health status to be assessed via telemedicine at predetermined times to maximize patient contact and reduce the possibility of patient readmission. The program will consist of certified pharmacy technicians, who are well trained on the protocols and guidelines set by the service.
“We hope through our program, patients’ acute and overall health conditions will be monitored, and patients who are at high risk for deconditioning will be addressed and referred using appropriate care coordination,” Smith said.“We aim to maintain patient-provider relationships, encourage patient follow-up, and reduce hospital readmission.”
Their model will function as a streamlined integration of insurance data, electronic health record data, and hospital reimbursement through the Center of Medicare and Medicaid Services. The innovation will track the prescriptions that patients are discharged with, along with the prescriptions filled to assess for clinical inertia.
The clinical data will be analyzed to provide follow up appointments through telemedicine and telehealth at three days, seven days, 14 days, and one-month post-hospital discharge. These appointments will assess for medication compliance, appropriateness, and disease state management
“Lack of medication adherence due to lack of education upon discharge or preconceived notions can contribute to hospital readmission,” said Smith.
Smith, Giggy and Indawala participated in the Florida Blue Health Innovation Challenge in 2019 with MedFlag, a system which addressed issues of patient non-compliance in prescription use. After learning the theme for this year’s challenge, they decided it was the perfect time to bring their pharmacy background into play.
“We decided to participate again this year and include an additional classmate to bring forth how pharmacy intervention can aid in hospital readmission rates,” Indawala said. “We felt that the pharmacy could play a big role in reducing the readmission rate.”
Smith has worked in multiple community pharmacies, a hospital pharmacy, and an emergency department medication reconciliation program for six years. Indawala has been a technician at a retail pharmacy and had exposure to inpatient pharmacy practices throughout her rotations.
“I was able to witness patients that were admitted to the emergency department due to various underlying causes such as medication non-compliance,” Indawala said. “I believe that this experience allows me to assess how pharmacy can play a bigger role in reducing readmission rates.”
Giggy is interested in pursuing a career in hospital administration. She has experience working in an independent community pharmacy on standard operating procedure development and compounding workflow. She also brings a background in programming and technical support to help link the capabilities of IT with their innovation.
“I’ve interacted with many patients in the community setting who were confused about what to do after leaving the hospital and I’ve conducted medication histories for many patients coming back to the hospital who weren’t taking medications the way their doctors thought they should,” said Giggy. “This project is intended to help close that gap by helping health systems follow up with their patients.”
“Pharmacists are in a unique position to provide medication management services post-discharge that can help improve readmission rates and general compliance with regimens,” Moss said. “We are the foremost experts in medications and are best suited to help patients manage them.”
USF Student Works to Close the Communication Gap with Innovative Analytics
Srikrishna Krishnarao Srinivasan is dedicated to working to solve one of the most prominent issues facing health care systems in America - the communications gap between patients and providers that lead to many readmissions.
Srinivasan’s innovation, DoctorGenie Healthcare Analytics, aims to reduce hospital readmissions by using a chatbot to engage patients in their treatments and discharge procedures.
The solution will address the case management automation using artificial intelligence integrated with a chatbot. Machine learning will provide a predictive decision on whether to discharge a patient. In Srinivasan's research, he said he has seen evidence that insufficient patient engagement during and after discharge is one of the major reasons for readmission.
“The inspiration for my project is to use artificial intelligence, machine learning, and chatbot technology to benefit the citizens as well as business in a significant manner,” Srinivasan said.
Srinivasan is currently pursuing his master’s degree in Business Analytics and Information Systems at the USF Muma College of Business. He has experience in product development, analytics, and machine learning.
Srinivasan has also worked for over 20 years in software development, ERP implementation, IT consulting, and analytics. He worked for six years in Dubai as a senior IT innovation and customer experience manager in a large group company with operations in seven countries directly and 15 countries through partners. His project won the Retail Technology Award in the Middle East.
Camila Cernawsky Nakandakari is a USF undergraduate studying political science and mass communications with a concentration in journalism news editorial.