Adam Schlifke, Founder & CEO, COVIDvent, Stanford School of Medicine

Host: David Cao, F50 F50 Global Insights

Adam Schlifke, MD, MBA is a board certified anesthesiologist with more than 15 years of experience in digital health. Dr. Schlifke is faculty at Stanford University where in addition to a clinical practice has a digital health appointment.

On March 14, 2020, Dr. Schlifke wrote a two page call to action and operational plan that called for creating more critical care space by repurposing unused space, such as surgery centers.

Since then, a grassroots movement has led to the creation of a operational plan for doing these conversions and to the formation of a company which is creating a digital health platform which will fully support the care of COVID+ patients at home – thereby decompressing the hospitals and emergency departments. Founder & CEO, http://www.covidvent.com Founder & CEO, http://www.expandcare.com #moreVentsNOW #RaisetheBar F50 Global Insights Youtube channel https://www.youtube.com/channel/UCC5Q…

Full interview on youtube

The full transcript

David: Welcome to F50, this is David and I am your host today. We have a very special guest, Dr.Adam. He is faculty from Stanford and he runs two startups. He has a very interesting initiative, just launched very recently to help COVID19 patient. 

Dr.Adam: Good morning everybody. It is a pleasure to be here. Thank you very much for having me. My name is Adam Schlifke, I am faculty at Stanford University, where I’m a clinical assistant professor. In addition, I do have a digital health appointment within the Department of Anesthesia. I’ve been in practice since 2007. I trained at UCSF, I moved to Stanford about a year ago to get more involved in the digital health initiatives going on at Stanford and about a month ago when this sort of the pandemic really started in this country, I saw an opportunity to really raise awareness around the critical care shortage, we were going be facing in this country very very soon.

David: Okay great, so I hear you have a great presentation and you can share to our audience there right now. So for the audience, we are recording this event as well as the live broadcasting on YouTube and ask some questions at the end.

Dr.Adam: Great, before I go into the actual business, I want to take an opportunity to speak about where this all started. On March 14th, I wrote a two-page paper which was an action plan and a call to action around converting space in hospitals and surgery centers into critical care areas and in fact I’ll go a step further not just critical care areas but using the promise of digital health to do virtual critical care. 

So we’ve spent the next two weeks operationalizing the plan. You can’t just move an anesthesia machine and expect to have a virtual ICU. It’s actually extremely complicated and we spent night and day with a team of about 10 people thinking through all the operational plans it would take to convert all these spaces and in fact we are talking to states like New York and other States at every levels of government about how to do this. 

Governor Cuomo said yesterday that there are five days left in New York to have vents if we converted every single operating room and surgery center to a virtual critical care area we could have a hundred thousand more vents tomorrow. Okay, there are only a hundred and fifty thousand vents in this country we can add a hundred thousand tomorrow if we operationalize that plan. But we haven’t stopped there we have created a full offering around remote patient monitoring, because the truth is that  we can bring care to the home. Why are patients going to the emergency room if they can be treated at home? The promise of digital health in my mind has not been recognized. I’ve been in digital health for 20 years and to be honest I’ve seen a lot of money go into the sector and very little come out in terms of treating patients with chronic disease. I come at this as a provider I am an anesthesiologist but I also see the writing on the wall that we have to move tear outside of the four walls of the hospital. This is our opportunity to redo the system. We don’t need big hospitals anymore, we don’t need perverse incentives. We don’t need all the for-profit systems being on the sidelines not helping fight this fight which is really trying to save lives in New York and the rest of the States in this country. So that’s where all this comes from. 

We started with the idea that we could take very lightweight technology and bring it to the home and then what we do is we take that lightweight technology and the weak connected with emergency rooms where providers are not working. Now you might ask me what do you mean, I thought the ears are overwhelmed that’s only true in pockets of the country certainly in the ERs in New York they’re overwhelmed but there are people sitting on the sidelines in other States. The beauty of the telehealth regulations now is that all the regulations have been relaxed so now if you’re a provider in Seattle or in LA or in San Francisco and you’re not that busy why not offer virtual services to another emergency room or virtual critical care services to another ICU whether it’s in the surgery center or somewhere else that’s where the real opportunity is. 

So we’ve thought about remote monitoring in a very complex way and the way I see I’m sorry there’s some typos on the slide I have not seen these slides before we’ve been we’ve been working 24 hours a day to get this all these pieces together. But the problem with remote monitoring in general is that it’s very piecemeal even Teladoc and AM, well they have great offerings but they can’t complete the last mile problem which is how do you get to patients at home and how do you connect them not to just providers in their network but how do you connect them to their facilities. So our plan is actually to connect all the dots in digital health. We bring patients care at home, we send them a package which is a full offering of monitoring solutions right and our partners are some of the best partners in the world. Massimo is one of the best medical device companies in the world and by the way Massimo is super interested in being engaged with us because they see us as thought leaders. We have grown a grassroots movement, we’ve been involved with a petition on change.org which has involved 1.3 million signatures, so I’m not saying that all those people are behind us in this business initiative, but what we’ve done is we brought all the technology to bear that’s already been developed and we’re taking digital health to the next level. Digital health you know for many years has been on the cusp of doing something very meaningful, but it’s been more about treating sore throats and UTIs than it has been about treating real chronic care patients. What if you had a home offering where you’ve had everything wrapped up together where you could basically do 90% of what you’re offering in hospitals at home. So the future I see in healthcare is that eventually patients will be getting 90% of their care at home, the hospitals will be ICUs,  ERs but the rest of it is unnecessary you’ll have some areas in for dialysis but like you don’t need patients sitting in beds not doing anything. In fact you want them walking around you know. May be you do physical therapy virtually, maybe you provide very low cost technology enable services at home so that 90% of this stuff that’s happening in a hospital is actually happening in a home. 

Oh and by the way there’s a group of physicians who are actually advocating trip treating COVID patients at hotels. So why would you do that, well you don’t want them standing in line in an emergency room there’s that’s a way for them to get make other patients sick. So it you know this is a complex system it’s a complex process we have worked out all the details and I encourage you to get involved. We have town hall meetings every day where we have industry people, technology people talking about how to move mountains to save lives in New York. We’re actually having those conversations every day and honestly I’m in this and the people that are in this are in it for the right reasons and the right reasons in my mind are to bring technology to bear that already exists. Why are all these companies reinventing the wheel we need to bring all the tech that’s possible today together to change lives in New York. Today we only have five days left it might be too late in New York but may be it’s not and so. I’m gonna keep pushing in New York, I’m gonna keep talking to the Legislators and the Governor you know. The Governor’s office and CMS and all these people it will take to move mountains but with your help and your or I’m confident that we can do that.

This is our opportunity to redesign the system. I’m just gonna reiterate that like I’ve spent 20 years in clinical practice. I know what the providers are feeling on the front lines. The reason why there is 50% physician burnout. It’s very clear there’s no autonomy, the administrators are sitting in offices they’re not supporting the providers. Providers are getting sued as a result of speaking out about the problems for those of you who have who don’t know ZDoggMD. You should look at his video that he published yesterday ZDogg basically was calling out every single administrator in this country because it’s time that leave the physicians and the providers and the clinicians and the nurses take back health care right there’s too much money in the system that doesn’t go to patients and providers there’s too much money in too much as at stake here with patients lives to continue operating business as usual.

Thanks, I’ll get off my soapbox now but if you want to join us come to our website be a part of the conversation we don’t have any time to waste.

David: Thanks Adam, looks like you have a great initiative. I have a couple questions first start is that so what do you need to move forward with your initiative? Especially with F50 Global Insight we have a global investor network as well as lots of entrepreneurs in Silicon Valley we’ll be watching this video. What do you need them to help you?

Adam: Are you asking today or next week or next month?

David: Now and next few weeks.

Adam: So today we need some money, we have no money today. Today what I had is about 10, what I always say that I built a team that money can’t buy because the people on my team are some of the best people in the industry, which I haven’t announced yet but the reason they’re at the table and the reason they’re making these slides and talking to executives is because they believe in in their heart of the mission and these are people that I’ve known for 20 years. So one of the things I’ve done over the last 20 years is built a great network of people and these people I brought to the table to affect change. So if you’re asking me what I need to do today I need people to help with the initiatives I’m happy to involve as many people but one of them be involved that have expertise to offer and I need a little bit on money to get things off the ground but I’ll tell you in the next week I expect to have some very big contracts and when those contracts happen I’ll need as many people as humanly possible to operationalize all these ideas as quickly as possible.

David:  Okay. Can you be little bit specific a little bit, other than money, what type of people you need to operate and how they can help.

Adam:  So our remote patient monitoring , so if you think about it so Massimo is a good there this is a good example of so Massimo makes a lot of monitors they have they have a network throughout 50 states they could be selling their monitors in all 50 states the one thing I’m not aware that they have is really a date a way to manage all that data think of all the data that will come from their probes that will need to be managed in the cloud and you can’t just have it does it’s that all the people on this call know technology that’s not that is not a problem that can be solved with a workforce that is technology scale at its core and Massimo and I believe we can help. Massimo help design a system that will enable the monitoring of millions of people simultaneously and so to build that we need about 10 and engineers and we need about a million dollars of revenue or a million dollars of money and we can probably build that in about two weeks. So we need people on the ground that are talking to executives, we need technology people that are actually building the system that we’re putting together and then we need a little money to make those operations happen.

David: So how far are you from your plan, so sounds like one million investment is a pretty big commitment where are you right now?

Adam:  We are ready to go so I’m in the final stages of negotiating at a deal with Massimo as I said we are approaching big hospital systems right now we don’t have a signed contract yet but it’s sort of the chicken and the egg problem. I have been talking to the highest levels of government both at the White House and states within this country. I think with just one contract and a little bit of money we will be off to the races. 

David: Specific question, what type of patient because COVID19 Corona Virus actually is the infection symptoms are very different between different people. There are people with no symptoms at all and there are very highly ill people, so what is your target group of patients.

Adam: It is a fantastic question. Something we spent a lot of time thinking about and my answer to you will be the following. That’s up to the hospital system that we work with, if you think about it what we do is we bring all these technology resources to bear and we help the hospital or ER manage a very lightweight technology enable system with big data. They can decide for themselves what the criteria are for which patients they manage or we can tell them. We know which patients should be managed at home with this technology but we don’t want to be prescriptive because at the end of the day it’s the clinicians that providers at the hospital systems that need to take ownership of this process. We can help them with those decisions but we’re not going to tell them what to do.

David: Okay, so I understand the challenge ER system but to take care of the patient at home it is not the ER Department’s issue right?

Adam:  It’s both, so what we’re doing is we are repurposing the emergency rooms to take care of these patients and if the ER doesn’t have enough staff and will involve primary care providers as well. So I’ve been in discussions with Teladoc and with AM Well we have the potential to have access to five thousand physicians tomorrow if we want it. But ideally my job is to repurpose the non-working physicians that are already in the system because I’m a provider like I understand what it means to be an emergency room physician and not to be working. One of my best friends works at the Vituity CEP America there are a billion dollar revenue professional services organization that contracts with hospitals for emergency medicine services. I know firsthand that some of their emergency rooms are overwhelmed and some of their emergency rooms aren’t working at all I can fix that disparate resources through this technology platform.

David: So right now we are in California, what is the process to deploy your services to somebody in New York or Washington?

Adam: So it depends if you’re asking me about that we have two separate businesses here so it depends if you’re asking me about the Surgery Center conversions or if you’re asking about the remote patient Monitoring. To be honest it is all connected because the vision that we have is you’re treating patients at home and then they go to the surgery center where it becomes a mini-hospital. Remember surgery centers typically only operate they don’t take care of patients for chronic diseases but if you repurpose the surgery centers in New York, then you can treat patients that are hospitalized but now you are not in a hospital you’re in the surgery center and then if they get very sick you provide critical care services right so we’ve connected all the dots and then on top of that you implement a low-cost technology solution that follows them from home to hospital to surgery center to critical care. Now you have ground truth now you have data at every part in the process. We are not epic, we are not creating a silo ecosystem of data. We are freeing the data which is what everybody talks about but which is very hard to do. We are sending the data to the cloud, we are sharing it with our partners, we are making it relevant so that in real-time data you can predict surge, you can relocate people, you can reallocate resources. In our minds this is the way to use technology and bring it to bear so that we can create a more efficient system. I am not on this call to sell anything to anybody. The reason why we’re in this is for the right reasons. It is to save lives. It is to save lives in New York, is to save lives in Florida, it’s to save lives in California. The way we do that is, we decompress the ERs We stop spreading infection in lines, when patients are in lines on the emergency rooms. We repurpose surgery centers so they are being used and not sitting on the sidelines. We put providers back to work. We put nurses back to work. This is what is driving us, not trying to make a buck in a system that is like is failing, you know significantly.

David: Okay great. Kaiser actually published a article few days ago stating that there are 5,000 outpatient surgery centers and nationwide. We re-purpose them definitely is one of the great solutions, but how? I understand you probably are one story, but what are the alternatives and how do you compare with different solutions?

Adam: We were the ones calling for repurposing surgery centers that Kaiser helped news. If you notice, I was actually speaking about this. So there are 5,000 surgery centers in this country the problem with surgery centers is that they’re independently owned and operated. So surgery centers are a perfect example of everything that is wrong in this country, okay. If surgery centers are owned and run by administrators then they’re controlled by administrators and administrators honestly are concerned about the bottom line. They are pure economic actors. I have I read you know I wrote a USA Today op-ed about three days ago you’re free to go look at it I call out HCA and that op-ed, okay. I used to work in an HCA hospital I know innately intimately what it means to run an HCA hospital. I was the medical director of an anesthesia group at a HCA Hospital. The reason I call out HCA is because they are one of the worst actors in all of this. They are a huge for-profit health system who is doing the wrong thing and they know it. They have a hundred and thirty surgery centers throughout the country and I in a cut at least a couple of days ago it was business it usual at these surgery centers. The surgery centers are working and there’s doing things that they shouldn’t be doing. Why would you be doing elective surgery when there’s this COVIDt problem. You should be diverting all your resources to being taken care of COVIT positive patients and to answer your question it’s very clear why this is happening it’s because of the perverse incentives. If the hospital system is making all their money doing elective surgery and surgery centers then of course they’re not going to re-purpose their surgery centers. So to answer your question, we had a proposal in front of CMS in front of Seema Varma to create a carrot and stick for the system. The surgery centers that are the good actors should be paid, the surgery centers that are the bad actors should not get reimbursement. It should be a very black-and-white conversation. Nobody should be doing cataracts today in this country.  I think I’m pretty confident that most anesthesiologist would support me when they say like why are we repurposing, why are we committing resources to taking care of unbelievably elective cases what in New York they don’t even have enough masks to protect themselves for COVID. It is just in my mind insane and honestly it’s where I come from with all of this because it’s so disheartening for providers who are on the front lines. 

I mean, have you seen any of the interviews with like nurses and physicians crying about having to inhabit patients around the clock and having to have these conversations with families and not having the masks and the supplies and the equipment that they need. So to get back to your question, two days ago CMS came out with change reimbursement, I can’t tell you for sure that we were responsible for it, but I can tell you for sure that we were involved in that conversation and in that conversation they decided to change reimbursement. So if you’re a surgery center and you’re a good actor you will get paid from a buck for providing critical care services, but guess what it’s still business as usual. So that’s not enough because they created the carrot but there’s no stick. If they’re a bad actor they can still be a bad actor and in fact what HCA, their response is well there are no COVID positive patients and where we’re working. Is that the answer? If you’re not testing patients, does that even matter? You don’t know who’s asymptomatic? You are putting providers lives at risk, you are putting patients lives at risk. If you’re operating on a cataract patient and they are COVID positive, even if you don’t know it, they may die because when you have surgery your body is stressed, your immune system is compromised. Why would you put patients lives at risk for this, for surgery that is unnecessary, when you have people dying in New York. So until you change the reimbursement, until you change you make carrots and sticks, until you have very black-and-white guidelines about what should be done and what should not be done, providers are going to be in the middle and honestly this is the problem today and it’s still why we fight.

David: Okay, got it. So very honestly, policy part is much less what we can do. We do have a big group of entrepreneurs will be listening to your audio. So how can other startup founders help you?

Adam: Listen I am happy to talk to anybody. Text me, call me, email me, get on the town halls. We have   calls every single day at 9:00 a.m. Pacific. I do those calls every day for a while. We were doing them two times a day. The more people we have at the table today the more we can move mountains. 

I’m not doing this alone, I’m not on a soapbox here. I’m doing it with my friends, I’m doing with my partners, I’m doing with my colleagues,  I’m doing it for the right reasons, not to make a couple bucks.

David: Okay got it. Can you tell us a bit more about to how other people can participate? You said, we have townhall meeting, how can people find out your townhall, you talked about?

Adam: If you go to our website, right now that there’s a problem with the website. So I need to figure out what’s going on with the website but  essentially we have a zoom meeting every day and I can give you that information offline. You’re welcome to publish the zoom invitation, it’s 9:00 a.m. Pacific Pacific everyday.

David: Okay, sure you send me the link and I will publish with this video. So the last questions,  there are lots of people on the help the fight with COVID19. Do you have any other ideas or solutions which is not  related to your startup but other startup you think should implement?

Adam:  Yeah, that’s a great question. Listen, I feel very strongly that we have a new world here that we’re going to have a better system. A system that actually works for patients and providers and everybody that’s actually on the front lines and that not for that the people on the sidelines just pulling money out of the system. So it’s an opportunity to really think big, think outside the box. I am an entrepreneur at heart, I’ve been doing this for 15 years. I don’t have all the answers, but I may know people that do so like reach out. You know, let’s talk about what we can do together. I’m not in here to compete with other startups. I want all the startups engaged and I want everybody to be successful, who’s trying to solve these problems.

David: Okay great thank you.

Adam:  Thank You.

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