© CEOCFO Magazine -
Lynn Fosse, Senior Editor
Steve Alexander, Associate Editor
Bud Wayne, Editorial Executive
Christy Rivers -
Valerie Austin -
Founder & CEO
Interview conducted by:
Lynn Fosse, Senior Editor
Published – February 24, 2020
CEOCFO: Mr. Carlson, what is the idea behind Azuba Corporation?
Mr. Carlson: The basic idea behind Azuba is to initially collect all of the patient’s current and historical clinical data from their doctors, emergency rooms and/or hospitals visits, and then to continually keep the data updated based on health visits going forward. In addition, Azuba automatically keeps all the patient’s doctors’ computers updated based on the patient’s instructions. By maintaining a master Lifetime Clinical Record for the patient, the system can provide the patient’s data to a list of the patient’s doctors, hospitals and/or emergency rooms. The goal is to reduce the number of unnecessary deaths and unnecessary trips to the doctor, emergency room or hospital by providing all of the patient’s health information to all of the patient’s health providers that the patient chooses in advance of any appointment and/or within minutes of an unplanned trip to the emergency room.
CEOCFO: How do you do that?
Mr. Carlson: We have built a national clinical records network that connects to over seventeen hundred hospitals, forty thousand clinics and over six hundred thousand doctors throughout the country. We are electronically connected to all of them. So, when a patient requests their records from a particular doctor, we then send a request to that doctor’s computer and the doctor’s computer sends the patient’s records back to our system. And, as we receive the patient’s clinical data back from each of their health providers, we then convert them into a standard data format. The reason we do this is because many, if not all, of the patient’s doctors and hospitals have different electronic records systems which save the patient’s clinical data in different formats. Once we receive their records back, we then convert the data into a standard format, and make it available to the patient via their smartphone.
CEOCFO: Many companies seem to be trying to do something similar. How have you been able to put it together with such a large number of stakeholders?
Mr. Carlson: The major difference between the Azuba solution and other similar mobile “app-
This is a much different approach than using an app-
And, if you happen to be sixty-
What we at Azuba are trying to do is take all of that “pain and suffering” out of the equation. The patient connects to our secure enterprise back-
CEOCFO: Where were the technology challenges in making this happen?
Mr. Carlson: As you might suspect there have been and continue to be many technology and non-
The second issue is that only approximately half of the data is in a standardized structured form and the other half of the data is the doctor’s notes that they either transcribed into the system or typed into the system. Therefore, we now have to go look at those notes and extract the important data and put that into a digital form that makes sense for computers and makes sense for more accurate processing.
CEOCFO: Would a patient set up something where every time they press this button sources will receive the information?
Mr. Carlson: Yes, the patient initially either tells the system who their health providers are and/or confirms the preloaded list downloaded from their health insurance company. And, when they want to either retrieve their clinical data or send their clinical data to their one and/or all of their health providers, then they simply click on the appropriate button to instruct the system to do so.
CEOCFO: How would a new doctor be entered into the system? Would the patient do that? Would a doctor do it from their side? Day to day; how does it work?
Mr. Carlson: Let me back up a little bit here and say how you get started. We know that most of us, who are using smartphones, do not like to enter lots of data. We like to get lots of data, but we do not like to enter it. Therefore, when you initially sign up with your health insurance provider that you want to use and download the system to your smartphone, the health insurance company pre-
If I go to a new doctor, then at this time my health insurance company will probably not know that I have a new relationship with this doctor because they have not previously received a claim from this doctor on my behalf. However, because we maintain a data base of all the doctors and hospitals that are licensed to practice in the United States, the patient can add this new doctor to their personal list of health providers by simply typing the provider’s name in the Azuba-
CEOCFO: What is your business model?
Mr. Carlson: We provide these services to the health insurance industry and they provide it free to all of their “members” or what most of us would think of as patients and family members. And, they pay us a small fee each month for as long as you are one of their customers.
CEOCFO: Are insurance companies proactive in getting the information to their patients and explaining what is going on?
Mr. Carlson: That is what we are trying to change. Historically, insurance companies have focused on providing their members with claims data or what some may call the billing data. Our goal is to help insurance companies provide their members with their clinical data so the member can share it with their doctors to reduce both diagnostic and treatment errors. In addition, there is another whole aspect of the system. For example, if for some unfortunate reason a member is in a car accident and ends up unconscious in an emergency room without a family member or friend to help, then currently the emergency room doctors have to proceed with their diagnosis and treatment procedures without the benefit of knowing what medicines the patient is currently taking or the patient’s health history. This puts both the patient and the doctors at a distinct disadvantage. What Azuba does is provide a safety net so ER doctors can reach out to Azuba and obtain the patients clinical history in an emergency. Of course, this assumes the patient has previously authorized us to do so.
In addition, the emergency room doctors may conclude that the patient needs further treatment such as surgery and they are then admitted to the hospital. And once the patient is admitted into the hospital they could be there for two days or five days or more. And, depending on the patient’s condition, the hospital doctors might send the patient to a rehab facility for a week or two or more.
What happens now in the system is that the insurance company sometimes does not find out about these events until two, three or four weeks after the events occurred. As a result, the insurance company is not able to proactively help the patient understand the importance of going to rehab and/or assisting with transportation to help the patient get to rehab. So, one of the benefits Azuba provides to the insurance industry is that we tell them that you have just been checked out from the hospital. Once the insurance company has been notified, then they can follow up with the patient and say, “Do you need transportation to get to rehab?” Or, what other things are needed in addition to the clinical data, but are very important in being able to understand the comprehensive needs of patients.
CEOCFO: Do you anticipate Azuba being the standard in the industry, where it will just be what everybody expects to have at some point? How do you go from here to there?
Mr. Carlson: That is a great question. Azuba is a startup and we have no customers at this point in time. We are just coming to market. We are just starting to have those conversations with the leaders of the insurance industry. Most of the large ones have known that we’ve been working on it, but they have not seen it in action. And, so we are now starting to schedule our initial meetings with them to review the system, explain what it is doing, and demonstrate how it works in real-
The reason we believe we can accomplish this is by “pushing” the patient’s data out to the doctor’s office before the patient actually arrives at the doctor’s office for their appointment. Specifically, we can help the doctor get a better understanding of where the patient’s clinical journey has been before the patient arrives in their office. Currently, most doctors in the United States have, on average, about seventeen percent of the patient’s clinical data when they are trying to make a diagnosis or a treatment decision. What we do is we provide that other missing patient data to the doctor. And, going forward, we believe new technologies like artificial intelligence and machine learning can be made available to help the doctor ask the right questions to get to the correct diagnosis and correct treatment decision based on the patient’s symptoms, health history, and other data about the patient on the first visit. So, yes we are very optimistic about the future of our health system going forward!
We have also been working with a number of researchers who are working on future solutions. And, based on what we have learned so far is that the more we can aggregate, normalize and present the data in a usable and concise manner, then the more value it will have to helping doctors improve the accuracy of their diagnosis and treatment decisions. For example, I recall reading one study that estimated something like three hundred and ninety-
CEOCFO: Let us say that I make an appointment with a doctor; maybe a new doctor or a doctor already used. Is the doctor requesting information or is it me saying, “I have a new appointment, send stuff over there?” How does it come together?
Mr. Carlson: Currently, the patient or the patient’s caregiver initiates the request. For example, if you are a proactive patient and you are a user of the system, and you know you have an appointment for tomorrow morning at ten o’clock, then you add that doctor to your list of health providers on your smartphone. And, you say to yourself, “I’m not sure if this doctor is going to be good fit for me or not, so the patient just instructs the system to send all their data to their new doctor one time before they arrive at the doctor’s office.” If after the initial appointment the patient decides that they like the doctor and want to continue with further appointments as necessary, then the patient can change that request to, “Keep my doctor automatically informed going forward. Or, do it once a month or once a quarter. Or, just do it on demand.”
CEOCFO: Will the doctor know when the records have come in? Is there anything that they need to do or is it seamless?
Mr. Carlson: Each situation is a little bit different because, remember I said there are over five hundred manufacturers of what are called electronic health records systems, and each one operates a little differently. Some just send a little notice. Maybe the doctor does not get the notice, originally, but it is one of the nurses or the staff at the front desk. Then based on what that doctor has told them to do with the patient’s data, the respective doctors system either adds your records to their system and/or makes it an augmented record adjoining your records. In all cases, the process is going to be different for each individual health provider.
CEOCFO: There are many different EHR systems. As records change, as individual health records from different doctors change, how does that get updated so it is indeed the most comprehensive and up to date?
Mr. Carlson: It depends on where the realization has been made, either by the patient or one of their health providers or doctors or hospitals. If it is the respective doctor that they are seeing and it is their system, then that doctor or the nurse can go in and fix it. That data will then replicate up through our systems and notify all of the other parties. Let us say that that doctor does not notice it, but the patient notices it. Currently, they can contact the doctor where the error originated. In the near future they will be able to put a note in the system that this was in error. However, the system does not let them change the actual clinical record of the patient.
CEOCFO: Where does the government come in terms of Medicare or Medicaid?
Mr. Carlson: About seven or eight years ago, the government invited me to serve on a committee called the Blue Button Committee. One of the primary purposes of the committee was to figure out a way to empower patients by providing them access to their claims data from all of their health providers. However, the number one thing to remember, when you start talking about patient health data is that patient “claims data” is not the same as patient “clinical data.” Specifically, claims data is produced by the doctor and sent to the insurance company so the doctor gets paid for their services. The claims data is typically at a much higher almost summary level compared to the clinical data.
For example, if there is a problem with your knee, then the claims data might indicate a code pointing to the area affected, but not get very specific. To the contrary, clinical data is all about the specific clinical and scientific data the doctor needs to know about the whole patient to be able to fix their knee. Bottomline, providing doctors with access to a patient’s lifetime clinical records helps them improve their diagnosis and treatment decision accuracy rates.
What we know is that the Federal government is one of the largest health insurers in the United States. I believe they currently have something like seventy-
CEOCFO: Are you seeking funding, investments or partnerships?
Mr. Carlson: Yes, we are currently seeking funding. We have been self-
I might be dating myself here, but a number of years ago I recall hearing about a “brown out” up in the Northeast whereby electricity service was either not available or available in very limited amounts. And, as I recall, it really shut down operations in the Northeast. So, when we were designing the Azuba solution, I did not want someone in a life and death situation located in an emergency room whereby the doctors were not able to retrieve the patient’s lifetime clinical records to help save the patient’s life. Therefore, we purposely designed the system to grow to multiple locations in different regions of the country to store all of the patient’s data. So, if you shut down one state the system can automatically switch to the next state and still get the data. And, neither the patient, the emergency room doctor and/or the care manager at the insurance company will even know the system has automatically switched to a backup system in another state.
We believe that this is something that has to be part of a national health network solution. And while it is slightly more expensive to build and operate with this level of redundancy, we believe it is a modest additional cost to help a doctor make an accurate diagnosis and/or treatment decision sooner for a patient and/or to save a patient’s life in an emergency room. Just imagine a patient is driving alone who gets into a serious car accident and ends up unconscious in a nearby emergency room. And, further imagine that to save the patient’s life the doctor needs immediate access to the patient’s health records. Therefore, we felt we had to build a system that allows for that emergency room team of health providers to contact us and through a series of checks and balances, be able to transmit that patient’s records in real-
“Azuba automatically keeps all the patient’s doctors’ computers updated based on the patient’s instructions. By maintaining a master Lifetime Clinical Record for the patient, the system can provide the patient’s data to a list of the patient’s doctors, hospitals and/or emergency rooms. The goal is to reduce the number of unnecessary deaths and unnecessary trips to the doctor, emergency room or hospital by providing all of the patient’s health information to all of the patient’s health providers that the patient chooses in advance of any appointment and/or within minutes of an unplanned trip to the emergency room.”-