Maine Med ER doctor launches startup to improve the ER patient experience

Dr. Samir Haydar had his lightbulb moment while waiting for breakfast at a medical convention.

Haydar, an ER doctor at Maine Medical Center in Portland, was waiting in line with a group of colleagues. When they reached the hostess, she informed them it’d be a 45-minute wait for a table, but that if they provided a cell phone number, the restaurant would keep them updated on the status of their table.

That sort of notification system is pretty typical these days at busy restaurants, but to date has been mostly absent in a healthcare setting.

“Why don’t I have that in the ER?” Haydar remembers asking himself.

It wasn’t an odd question for Haydar to ask. In addition to being an attending physician, he’s also the ER’s director of quality and performance improvement, which means he has for the better part of 10 years been focused on finding ways to improve the patient experience within the ER.

“I don’t know if you’ve been to the ER before, but the experience is sometimes not wonderful,” Haydar admits.

Patients, often in the midst of a traumatic situation, are checked in and then usually required to wait as they’re added to the queue and put through a triage process where the physicians determine what patients get seen next based on the seriousness of their situation. Then, once the patient is finally brought into an examination room and seen, the physician disappears again, leaving the patient waiting and wondering if they’ve been forgotten.

“It’s not because we’re off doing other things,” Haydar tells Maine Startups Insider. “We’re doing a ton of things and a lot of what we’re doing is within the patient’s electronic medical records. We’re placing consults, ordering labs, looking at lab results, writing notes—all for that patient, but the patient doesn’t have any idea that’s going on.”

So, while Haydar was waiting for that restaurant table, he was thinking about how a similar system could be implemented within Maine Med’s ER that would push real-time notifications to a patient’s smartphone about their care and what steps are being taken by physicians behind the scenes so they don’t feel so in the dark.

That was four years ago. Fast forward to today and Haydar’s new startup, called NavigatER, is just months away from launching a pilot project—hopefully at Maine Medical Center—that would incorporate a real-time notification system into a hospital’s emergency department.

Haydar and a technical co-founder have developed a mobile software application that an emergency department could use to keep patients updated on their status while in the ER, as well as offer access to educational resources. Eventually, it could even be expanded to provide two-way communication so a patient could make requests via the app.

The app would be tied into the patient’s electronic medical record (EMR) and is designed to push updates related to certain pre-determined events (the doctor ordered a test, for example) to the patient’s mobile app. The company recently received $10,000 for winning the Emerging Ideas award at Gorham Savings Bank’s Launchpad business-pitch competition.

“NavigatER is designed to add an extra layer of communication to make the experience more transparent,” Haydar says. “If our patients knew and were more engaged with events, we anticipate their experience will be much better.”

Hospitals have interest in improving patient experience for two reasons: The federal government uses patient-satisfaction surveys to determine a small percentage of a hospital’s rate of Medicare reimbursement; there’s also a direct link between patient engagement and health outcomes.

“One of the focuses of NavigatER is keep the patient focused on their healthcare or emergency department experience, which we believe will have a positive impact not just on their experience, but the overall outcome,” Haydar says.

The company recently filed a provisional patent with the U.S. Patent and Trademark Office (the $10,000 from the Launchpad competition will help with the legal fees).

Idea to execution

After that medical-convention breakfast, Haydar briefly looked into what it might take to build a mobile app and notification system for the ER. But it looked daunting. Being an ER doctor coupled with his additional administrative roles (he’s also the emergency department’s associate director for research and the medical director for hospital flow), left him little time to launch a startup and, as a non-technical founder, navigate the process of creating software.

But then a serendipitous meeting occurred during the summer of 2017. Mehmet Kazgan, CEO of a Denver-based healthcare startup called Cliexa, had traveled to Portland for Venture Hall’s summer accelerator program for healthcare companies, which was partly sponsored by Maine Health, Maine Med’s parent company. (Kazgan and Cliexa ended up receiving $25,000 from Venture Hall.)

During the accelerator, Kazgan was introduced to Haydar. Kazgan was looking for a clinical advisor for his company, which offers a patient-reported healthcare outcomes platform, and ended up asking Haydar if he’d be willing to help.

Kazgan remembers the moment. “’I am happy to help you,'” he remembers Haydar saying, “‘but I have an idea.'”

Haydar shared his idea with Kazgan for an app that would provide patients in the ER with real-time updates on the status of their care.

“My initial reaction was, ‘great idea, but I am 100% sure that somebody has already done it,'” Kazgan tells Maine Startups Insider.

Given his position at the hospital, Haydar said he’d know if someone was doing this. Some services make it easy to capture feedback from patients after they’ve left the hospital, Haydar says, “but no one has built anything that provides feedback, intervention, and education throughout the hospital stay.”

Kazgan said he’d do a little of his own research and get back to him.

“The next day, I texted him,” Kazgan remembers. “I was shocked that it didn’t exist and I told him I’d build him an app.”

Haydar, who’d done some research on app development, thought it would take a while, but Kazgan pushed a beta version of an app to Haydar’s phone within weeks.

Haydar had his mobile app. He’d also found his co-founder.

Product-market fit

There are 137 million ER visits each year in the United States, and more than 5,000 ERs, according to the Centers for Disease Control and Prevention.

That’s effectively NaviagatER’s total addressable market in this country. But there are hurdles Haydar and Kazgan will need to get past to reach all those ERs. Because NavigatER is tied into the patient’s EMR, NavigatER’s app has to interact with the specific EMR software the hospital already uses. Haydar and Kazgan’s plan is to first launch on top of the EMR software developed by Epic, which has roughly 53% of the market share in the country.

“That will give us quick access to more than 50% of the market,” Haydar says, “There’s no reason we can’t go outside Epic, but right now that’s the focus.”

The first step, though, is launching a pilot project. Because of his role within Maine Med’s emergency department, Haydar’s first and obvious choice is to pilot NavigatER there so he can oversee its implementation and be hands-on throughout the pilot. He’s had preliminary conversations with those at Maine Med who could approve such a pilot, but there are still details to work out. He’s also had preliminary conversations about a pilot with another hospital in Maine, one in Florida, and one in Massachusetts.

“Right now we’re in negotiations with Maine Health and they’ve been super supportive,” Haydar says. “The reality is we’re in uncharted waters right now, both for NavigatER and the potential partner institutions.”

Kazgan echoed that sentiment, noting that the biggest challenge NavigatER faces is finding partners that are ready to embrace innovation and give this technological solution a shot.

“Because of the regulatory space, privacy and security around patient data, unfortunately it’s a great threat to any healthcare startup if they cannot partner with a strategic institution to either pilot or validate,” Kazgan says. “Decision making and procurement is another challenge as health institutions are highly regulated and creating a clinical case, validating it with real-time practice and building an ROI for the businesses takes a lot of time, resources and money.”

If agreements can be reached, Haydar expects the pilot projects will run for six to 12 weeks. After incorporating the feedback, Haydar expects it will be another four to six months before the team will be ready to take the product to market.

Assuming the pilot delivers the results he expects, Haydar believes signing up hospitals will be a matter of addressing logistical challenges more than convincing them of a need for the investment.

That’s because improving the patient experience isn’t just a feel-good initiative for hospitals—it impacts a hospital’s bottom line. The Centers for Medicare & Medicaid Services releases a small portion of a hospital’s federal reimbursement dollars based on the results of healthcare outcomes, known as value-based purchasing. This system, established by the Affordable Care Act, implements a pay-for-performance approach. Of that withheld amount, 25% is attributed to patient-experience metrics. That means that if patient surveys come back negative, the hospital doesn’t receive as much money.

For a 600-bed hospital like Maine Med that could mean roughly $500,000 is at risk, Haydar says. So there’s a true business case for investing in technology that could improve the patient experience and boost the scores on those patient-satisfaction surveys.

As previously mentioned, there’s also a direct link between how engaged a patient is in their care and health outcomes.

“If you look at it from the ROI for a hospital, they’re at risk of losing significant money and this is one solution that could help,” Haydar said.

Haydar’s revenue projections as of now assume a pricing model that would charge hospitals $2 for every ER visit. He estimates the average hospital has 50,000 ER visits a year, so would be required to pay a $100,000 annual fee. Maine Med has an average of 75,000 ER visits each year, while larger hospitals have twice as many annual ER visits.

“If every hospital in the country were to use it, there’s huge potential from a business standpoint,” Haydar says. “How huge it gets? I have no idea.”