Cinapsis SmartReferrals
- Startup, TWIDH

Connecting Caregivers Digitally for Advice & Guidance

We sat down with Dr. Owain Rhys Hughes, Chief Executive Officer. Owain is the founder and CEO of Cinapsis. Over his 13 years of experience working as a doctor, Owain has found a need in the healthcare system to eliminate unnecessary patient referrals and founded Cinapsis to accomplish this.

Cinapsis SmartReferrals is a clinical communications platform that gives GPs, paramedics, NHS 111 call handlers, and optometrists access to specialist Advice & Guidance immediately when they need it.

Good afternoon and welcome to This Week in Digital Health. We are speaking with Owain Hughes of Cinapsis. Can you tell us a bit of what you’re working on?

Yes, thanks, Mike. We have built a digital platform that connects clinicians, making it easy for clinicians to communicate with each other, share information securely, and support each other to make more informed decisions about treatment plans patients should have. a typical example is with clinicians in the community – a general practitioner or a pharmacist or a pediatrician or a paramedic seeing a patient, and they’re thinking, “What do I do?”

They would use Cinapsis to connect with a specialist in the hospital to get advice and plan about what to do next.

Why did you pursue this? What was the gap in the market that led you to this?

I’m an ear, nose, and throat surgeon, and in my work, I saw many patients waiting a long time to see me. When they arrive, they’re often very anxious, so some of them would be referred, you know, with a suspected cancer diagnosis, for example. Within, you know, 30 seconds of reading their notes or starting talking to them, I knew the chance of their having cancer was minuscule, and they’d been referred inappropriately.

I also knew from my experience working with junior doctors supporting them, answering their queries that can upskill somebody if they’re seeing a patient and don’t know what to do. They had direct access to me. I could upskill them. They could describe the problem, and it would make sense to me.

I could ask them a few questions and then give them a management plan. It just surprised me that when those same doctors finished their training and now we’re working out in the community, how isolated they were, how this isolation was not serving anybody. In addition, it is causing patients to unnecessarily wait to start treatment or have to travel to access specialist advice.

Those clinicians isolated in the community were very anxious. They were worried about doing the wrong thing or anxious about missing something. That anxiety was causing them sometimes to refer patients where just a bit of advice would have given them the right treatment plan.

This indicates a more significant problem within healthcare in that we’ve seen the data silos that exist and how difficult it is to share information. We were working with a hospital, a relatively large training hospital, in a digital transformation project, and they had 46 data centers that didn’t talk to each other. The only way to communicate was to send a paper file physically. That’s very time-consuming, and it’s prone to human error.

Connecting Caregivers Digitally for Advice & Guidance

Connecting Caregivers Digitally for Advice & Guidance

Why is there so much difficulty in this day and age with communication in healthcare?

Exactly. Why is it like that? The most critical sector where communication is vital. Why is it so archaic?

I think one of the reasons is that clinicians are very pragmatic. Clinicians will get the job done regardless, even if you give them no tools. They will care for their patients, and they will make do. And often not complain and get on with it.

I think there are so many workarounds in the system that the clinicians on the front line have just learned to make do. But healthcare is getting more complicated, and maybe these workarounds were acceptable a few years ago. But the system is creaking now because you can’t keep all the information in your head.

If you’re a specialist, it takes all your time for your small specialty within the breadth of medicine to keep yourself updated. If you’re a generalist working in the community, there’s absolutely no way you can be on top of everything that’s happening.

To be up-to-date, I read a study that a physician would need to dedicate about 75 hours a week to research with all the latest studies. That’s practically impossible and still see patients. We need a better way and a better tool to access what’s current, what’s advisable, and I’m assuming that’s where Cinapsis comes in.

We connect humans. The experiential experience – the experience of having done the job, having seen thousands of patients with these conditions – a specialist with that level of knowledge is extremely valuable and takes years to train. The problem now is that they are stuck within buildings. They are stuck in the hospital.

The way healthcare is changing is that a lot of this knowledge has to be disseminated. it must be much more accessible than there is today, so it’s no longer acceptable to say, “I’m the neurologist; you have to come to me to access my knowledge and experience.”

It’s now all about population health. The only way we can meet the increasing needs of the population is to disseminate this knowledge.

Cinapsis appWe need to adopt a holistic approach rather than a specialist approach.

Precisely, the old-fashioned, prevalent medicine model is you’re going to see a neurologist who deals with that problem. You’re going to see a cardiologist they deal with another problem. a better approach and the direction of travel is that you have a  family practitioner or a general practitioner, we call it in the UK, whose job is to support you through your treatments or maybe for your whole life. They know you. They’re your advocates.

We call them specialist consultants in the UK. They access consultancy on your behalf. This be a neurology problem; let’s check with the neurologist. Let’s ask them some questions. “why is there shortness of breath? Is it a cardiology problem? Is it a respiratory problem? is there a combination of two?”

Let’s get specialists to give their opinion on your condition right now.

One of the challenges that we’ve seen in the past, especially when there’s comorbidity, is there’s no one looking at the big picture. They specialize. If you go to an oncologist, they will focus on cancer without looking at what else is going on. What the impact of what they’re proposing is on some of the other sorts of existing conditions that may you know be a factor in the patient’s prolonged care or extended care.

All these things overlap. One thing impacts another, as you say. Typically from a patient’s point of view, these conversations are spread out weeks apart, often miles apart if they’re happening in different hospitals. It’s just such a crazy way of

doing it. You wouldn’t design the health system as it is. It needs to be much more patient-focused.

The patient has much more information. Often a patient will benefit from an advocate, somebody who’s medically trained who can help.

Ask the right questions.

Ask the right questions exactly, and help guide them. This is the direction we are traveling – more patient-focused, closer to home,  advocacy, accessing the right advice, and bringing all of that together. That’s what Cinapsis is helping with. Change from a specialist-focused health system to a more patient-focused health system.

Is the product live and in the market at this point?

We are live in several areas in the UK. Whole Health Systems across many specialties are using our system. We are now serving you know about 25 different specialties from pediatrics, palliative care, orthopedics, throat surgery, respiratory, cardiology – so across the board, and it’s empowering the clinicians in the community to get that specialist advice in real-time.

“What’s wrong with this rash? What do I do with this child who’s got abdominal pain?” It is dramatically changing the relationship between specialists and clinicians in the communities. It’s a more collaborative approach, a more supportive approach, changing the way patients are managed. Patients have to travel less to the hospital. And that has such a dramatic effect on the working lives of clinicians in the hospital.

One of the questions that we had was why the specialist would want to do this? The reality now is that hospitals are overwhelmed. There’s so much work coming their way. We need to think differently about selecting out the patient who needs to be in the hospital and providing support outside of the hospital environment for all the other patients.

Cinapsis dashboard

How are both the primary and the specialists like this? Do they find this is helpful, or do they feel threatened by it? What is their response?

They love it. From the primary care clinician, you can see why – before they were isolated in the community. Now with one click, they can launch the system, say what the problem is, and they’re talking to somebody who’s very experienced in that problem—sharing information, answering their questions.

They see the benefit from the primary care point of view. From the secondary care specialist’s point of view, it’s helping them manage demand, rather than seeing a large proportion of the patients that don’t need face-to-face time with a specialist.

Often, there are several steps in this patient’s care before we’re going to even think about an operation. The ability to say, okay, you know this is the treatment plan. We’ll see them once we know that we can add value. The specialists know the value of that. They know their time pressures, and they want to focus on the patients on whom they can have the most impact.

It’s taken us a long time to tailor the software to serve these competing needs – seeking advice and providing advice. They’re complementary but very different, and we’ve had to understand what it is what is the pain point in each clinician’s working day that Cinapsis synapses can help with. It’s those insights that make the product sticky and liked by our users.

Do you have a pool of specialists available, or is somebody on call? How do I connect with a specialist using Cinapis?

We have two models. The first one and the predominant one is we support existing relationships. We provide just the software in the middle that connects primary care clinicians to specialists. They will have a hospital where they send their patients and where health organizations have access to Cinapsis.

It’s deployed everywhere across the healthcare system. So, there is an existing relationship between clinicians in the local hospital and the people who refer to them. That’s the predominant model supporting existing clinicians with existing staff.

The other model that we have where we work with organizations has organizations who have their staff working remotely. We don’t employ staff ourselves. We are super focused on the software – getting the platform right and working with partners. There are many partners whose core job is to recruit and validate staff. We work with them, and we say to them our job is to make you look good. When people use Cinapsis to access your advice, it’s a great experience, and we’re working with many partners like that.

How do the payers perceive this – the health insurance companies?

We have a single-payer system in the UK, and they act as an accountable care organization. They’re divided into regions in the UK. their problem is managing demand. They have a fixed budget, and demand is going up.

One of the things that Cinapsis gives them is the visibility of where their money is going. Money is spent by a payer when patients move from primary care to specialist care. That’s when they pay the bills now. We can give them data on what conversations are happening, who they are about, what clinicians are involved in that conversation, the outcome of that conversation, and what ultimately happens to the patient.

So where before, if you’re a hospital, you only get patient data when they walk through your door. Still, now we can give them data before you know several steps before that – what led to this patient coming to this clinic or coming to the accident emergency department?

Payers like giving a great experience to their clinical workforce, but what they get is that data. And not only that data but the ability to change outcomes in real-time to build new pathways offering different care outcomes available to the specialist. They can then change the flow of patients pretty quickly.

Have you been able to demonstrate the value-based care model where by using this tool, fewer patients have to go to the hospital, or there are fewer readmissions? The typical metrics that we use to understand whether or not you know we’re effective and cost-efficient?

Absolutely, for example, for phone technology, about 70 percent of patients in the community.

That represents considerable cost savings to the payers.

Oh yeah, it’s huge. It represents several million pounds per year. It’s a huge savings. And for unplanned care urgent care, we know that using Cinapsis changes behavior about 83 percent of the time – 30 percent of the time the patient stays in community care but 53 percent of the time they still go to specialist care but somewhere else, so they don’t go to emergency care. They go to a more planned part of the specialist care, which is cheaper to deliver, easier to deliver. It has a significant impact across a health economy, which typically also results in a better patient experience.

Right, because nobody wants to go to the ER.

The emergency room is not an excellent environment for non-acute care. You sit around, you wait. Whereas in the appointment-based care scenario,  you have an appointment, you can meet with the specialist for better care for the patients – quicker treatments, less anxiety, better for the environment – less traveling.

Yes, it has a huge impact. I’m assuming, based on how far along you are, that you launched this pre-COVID.

We did. We launched in January 2019, but COVID accelerated our growth. Before COVID, people recognized telehealth as the future of healthcare – this is how healthcare will be delivered in the future.

COVID made it imperative to keep patients out of the hospital. It’s dangerous for a patient to come into the hospital unnecessarily. And hazardous for the staff. That fueled the deployment of Cinapsis because it became inevitable that moving online to consult and see patients as needed accelerated our growth.

Does this also speed up the care process? Because typically, if I was referring to a specialist, we had to wait to get on their calendar, and you had to travel to see them.

If it’s just a consult, hopefully, that happens within 24 or 48 hours. You get feedback faster, so that would seem to move the process along.

The benefit is that not only are patients going to get better treatment, but they’re getting that faster. They’re getting the appropriate treatment closer to home quicker and in a way that saves money to the health system. It’s compelling.

Who ultimately pays for your product? Is it the payer? Is it the provider? Who pays for the product?

That’s a very interesting question. So it’s been the payer that pays us, but a lot of the benefit is realized by the provider. There is a realization of where the benefits are. It depends on how they are reimbursed.

Some providers have a block contract – this is the amount of money you have to care for this population. Where others are paid by results, regardless of the reimbursement model, what it means is they can keep low tariff work outside of the hospital to deal with advice that is cheaper and more convenient to deliver. Inject and focus on high tariff work. Our customers have almost invariably been the payers.

Cinapsis SmartReferrals

One would think you’re changing the care outcomes and reducing the care costs by keeping people out of you know acute situations. Or situations where they didn’t necessarily need to go to a specialist. They just needed some advice or some feedback. That’s considerably cheaper in the long run.

This has a significant impact on the working life of clinicians, so this is huge. For some providers and some specialties, retention of staff is a huge issue. For example, pediatricians are few and far between. So if they, you know, are overburdened by just the amount of patients they see, retention becomes a problem.

Keeping a large number of patients outside of the hospital, supporting them to be managed within the community means that the daily work is more manageable. It’s more predictable, you know, and it happens in a calmer, more structured environment which helps with retention.

Typically most of the digital products that we see are most often utilized by the support staff. A lot of what we see facilitates and helps the nurses with scheduling and administration. How much of this is being used by the support staff versus the care provider?

Our primary users are the clinicians, but we found that there are many tasks to do. After you give the advice – we need to see this patient in a scheduled clinic next week. Well, that needs to be booked. Somebody needs to be informed that these patients are on their way. And there are a lot of adjacent tasks that Cinapsis is growing to support.

But our core users are the clinicians. Our product has to give an excellent experience for our core users, that’s the focus for us. If they use it, then there are lots of things that Cinapsis can do. Those are the added benefits, and that’s why we become very sticky because we do the communication bit well, but also we help with not just giving the advice but actually how do you deliver that care. What needs to happen next, and we focus a lot on integration and moving data around, and informing people.

You are dealing with a lot of sensitive personal information – how do you deal with security?

That you know, that is a core competence of ours. We deal with it by complying with the standards. There is a process in the UK called the data security and protection toolkits, which is an ongoing process. It has many mandatory requirements around how you handle data, where you store it, your encryption, and that penetration testing is conducted. There are lots of things, so we are fully engaged with that process. It’s a core requirement of what we do.

That’s one thing. The other element of it is the patient safety of the technology. In the UK, every health tech company has to have a clinical safety officer. That’s me; it has to be a clinician.

Your job is to document all the hazards that could be associated with your software, how it’s implemented, how that can impact patients, and what mitigations are there. There are two elements: data protection/cybersecurity, and the other aspect is clinical safety. these two things are essential to what we do.

I would also imagine an education component with the clinicians to make sure they’re using it properly. We’ve had know providers that do things that put their data in jeopardy with all good intent. They’ll text something or something like that. We have to explain to them, “No, you can’t do that. But the patients love it. we get that, but that’s not a secure channel so stop doing that immediately.”

I would assume you have to help educate the clinicians to make sure that you can continue compliance.

Sure, that is important for every healthcare organization. For every healthcare organization in the UK, all staff must do data protection training annually. We ensure that our users comply with that to understand and understand their personal and professional responsibility to protect data.

There are safeguards built into our technology that help them with that. For example, they can use our app, but nothing is stored on their device. Nothing is stored on their cloud. Every image that has consented or is taken in the patient’s best interest if consent cannot be accepted.

All these things support our users to comply with their responsibilities and their obligations under the law. There’s a big education piece around that and user training. We focus a lot on that kind of education, onboarding, training, and compliance.

Now that you’re in the market, you have stickiness, and the clinicians like it – what’s next for you? What’s on your growth plan?

What’s next for us is to keep doing a good job. that is what I’ve learned is the most important thing. Keep focused on our users. Keep giving them a good experience, supporting them in telling our story, getting our clinicians to tell their story about how Cinapsis helping them help their patients.

That’s driven our growth, so our focus is to keep doing that. Excellent technology used by clinicians is few and far between. We need to keep doing a good job, and growth will look after itself.

Is your intent to grow within the UK or to grow into other markets?

Certainly within the UK. The UK is a big market. We’re one of the um companies recognized by the government. Expanding within the UK – that’s our focus, you know certainly for the next 12 months. We’re one of the companies recognized for digital health for exports by the UK government, and exports are a big part of the government strategy. We’re engaging with that, and we’re open to opportunities abroad, but our main focus currently is in the UK.

How have you accomplished this? Are you bootstrapped? Are you funded? What has been your startup path?

We self-funded; that’s how we started and is funded by contracts. We flirted with VCs and so on, but I realized that many of our issues weren’t money issues; they weren’t because of lack of money. It was time and allowing the product the opportunity to generate results and for us to collect those user stories.

I’m glad that we’ve taken that route because it’s made us focus on what’s valued by our customers and understand how to go to market. What messages work with customers and what they’re looking for how can we add value.

Sometimes getting external money and the push to grow very quickly can distract you from that. We’ve learned an awful lot from the process that we followed.

As things begin to open up, what do you think will change for you?

I think things will continue and accelerate along the path that we’ve seen during COVID. In healthcare, people have recognized that we should help our patients avoid unnecessary travel to a hospital wherever possible. We realize that it’s been spoken about for a long time, but now people viscerally understand it – that the best care is closer to home.

I believe our growth will accelerate. COVID has caused a massive pent-up demand. There’s a considerable waiting list now of patients waiting for specialists. that needs to be sorted, and Cinapsis is one of the solutions. Cinapsis allows providers to manage demand. There’s a need to increase capacity, which means recruiting new staff.

Cinapsis allows them to manage demand, and that is an incredible thing. It’s imperative to do that as we open up.

We’ve seen and believe that once the horse is out of the barn, there’s no going back. This digital experience has greatly enhanced how we can provide care. Why would we go backward at this point? Digital health telemedicine, e-health – all those things that we have pushed along due to the pandemic – people will continue to want them and still be cautious about having to go places physically in person if they don’t need to.

Exactly, most people have lived their whole lives for months, you know remotely. People have realized that they don’t need to travel as much.

We very much appreciate you joining us. We look forward to some exciting things in the future from you guys.

Thank you very much, Mike.

Connecting Caregivers Digitally for Advice & Guidance

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