Hello friends 👋
In our latest Tech Tuesday episode, Daphna and I spoke with Nancy Addison from Locus Health about their remote patient monitoring (RPM) platform. We learned how Locus Health bridges the gap between hospital and home for medically complex pediatric patients, including NICU babies, substance-exposed newborns, and infants on oxygen.
We discussed the potential benefits of RPM, such as empowering families, reducing length of stay, and preventing readmissions. Nancy emphasized the importance of maintaining close family-provider relationships during the transition to home.
We also explored the technical aspects of the platform, like data entry, EHR integration, and alert systems. While limitations exist in wireless home monitoring for infants, the potential for real-time data streaming is intriguing.
Finally, we touched on the research implications of capturing post-discharge data through RPM. Tools like Locus Health could accelerate research and quality improvement efforts to help medically complex infants thrive at home. This thought-provoking discussion left us excited about the future of RPM in pediatrics
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Find out more about Locus Health here: https://www.locushealth.com/
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The transcript of today's episode can be found below 👇
Ben Courchia MD (00:00.788)
Hello everybody. Welcome back to the incubator podcast. It is a Wednesday. We are back with a new, uh, I guess tech Wednesday. Now we call them right. Daphna. I think we moved it up.
Daphna Yasova Barbeau, MD (00:10.577)
That's right. It's not as catchy, but it is a tech episode on Wednesday.
Ben Courchia MD (00:15.524)
It's tech ones. That's exactly right. And, um, you're doing good, Daphna today. So far, so good. We have the pleasure today of being joined by Nancy Addison, who is the VP of clinical services and customer success at Locust health. Nancy, thank you for being on with us today.
Daphna Yasova Barbeau, MD (00:20.77)
So far so good, yeah.
Nancy Addison (00:35.06)
Oh, thanks so much. So happy to be here.
Ben Courchia MD (00:38.496)
You reached out to us a few months back to see if we could discuss the progress that Locus Health has made and the services you guys offer to patients and providers. For people who have never heard of Locus Health before, can you give us a brief overview of who you are and what you do?
Nancy Addison (00:54.427)
Sure. So, excuse me, Locus Health is a remote patient monitoring platform, and we really connect our patients and families with their providers. So, upon being discharged from the health system, we really fill that gap for highly complex, vulnerable pediatric patients to be cared for at home in a safe manner, and for the providers to be able to see the data that is inputted and act on that data. So, we got our start.
within single ventricle programs, which was a very easy thing because they had the system in place. Most health systems understood the benefit of RPM and what it could do for their patients. And we really just digitized their workflow. So that's where we got our start. And then we organically grew from there within other populations, other practitioners would hear about us and say, wait a minute, we wanna do this for our patient population. So we've really grown.
into our RPM services and NICU and babies within the NICU have been a really big area of focus for us.
Ben Courchia MD (02:05.756)
Yeah, I think we just lost you at the end there. I'm sorry, that's okay. We'll get that fixed in editing. No, no, that's okay. No, but don't worry about it. Don't worry about it. The whole point of this platform is that it gets recorded, so you don't have to redo anything. So Nancy, my next question to you is, I think it's interesting that you're bringing up the point that you initially started with cardiac patients. At what point do you guys have this epiphany and you say neonates? We could do this with neonates.
Nancy Addison (02:11.044)
Oh, shoot. Okay.
Ben Courchia MD (02:34.74)
How did you guys come up with this and what was the need that you guys were able to identify to say Locust Health can actually help this population?
Nancy Addison (02:44.663)
Yeah, that's a really great question. So we got our start at the University of Virginia. We're based in Charlottesville. And that was our very first interstage single ventricle program. And the neonatologist there heard about us and heard about what we were doing. And they had started to think about sending home their patients with NG tubes. And they were a little uncomfortable with that and without being able to monitor the progress at home.
So she reached out to us and we said, sure, we can try it. And that's really how we got our start within the NICU population.
Ben Courchia MD (03:21.788)
Yeah, I think this led, if I'm not mistaken, to a very nice publication in the Journal of Perinatology that came out in July 2023 called, Remote Monitoring for Neonates Requiring Continued Nasogastric Tube Feedings, Implementation, Patient Characteristics, and Early Outcomes. The first author is Christina Fisher. We'll put that paper in the show notes. And so how does the...
Nancy Addison (03:27.652)
Yes.
Ben Courchia MD (03:49.456)
How does Locus Health work? Is it something that is it, is it, is there, is this hardware, is this software? And if it's software only, like, do I just download it on my iPad and iPhone and, or is there something more sophisticated to it?
Nancy Addison (04:02.452)
I lost you. I heard, is it something? And then that was it.
Ben Courchia MD (04:04.116)
That's okay. No, no problem. I'm gonna start again. And so can you tell us a little bit about what is local health from the standpoint of hardware versus software? Do you guys have, is this simply an application or is there some hardware that comes with it? And if it's only an application, can I just download it on my phone or on my iPad or is there certain specifications or requirements for the app to work?
Nancy Addison (04:08.686)
Okay.
Nancy Addison (04:29.559)
Yes, so we're both actually. So we have our Locust application. It's an iOS and an Android app. So families can download that once being invited to the platform from their providers. So you could download it on your device, but you wouldn't be able to log in and add any data. We also then have certain devices that are integrated. So we have an infant Bluetooth scale. So the data that the families record at home gets uploaded into the application.
and goes directly to the providers. We started with iPads and we found that really met those needs of folks who didn't have Wi-Fi at home. These iPads are cellular data equipped and also for families that maybe don't have a smart device or are sharing one smart device. So that's how we got our start. We managed that entire experience of the iPad and the iPads are cellular data equipped. We still use that model because we...
We think that there will always be those folks and we just wanna make sure that we're meeting those needs. But now we're really onto our iOS and Android applications. So I would say most of our patients utilize that.
Ben Courchia MD (05:41.192)
Very cool. My, yeah.
Daphna Yasova Barbeau, MD (05:42.974)
And you were talking about, sorry, some of the other hardware associated. So I know you have the scale. What other kind of patient contact devices are there?
Nancy Addison (05:53.659)
Sure, we have a whole slew of eye health devices that are Bluetooth integrated. They are not pediatric or infant specific. The only FDA approved device for within that is for the thermometer. And that's in pediatrics, I should say. So we have the infant scale and that's currently our only integrated device. As you know, probably there is a lack of pediatric approved.
Bluetooth available devices. So that's something that we are always searching for and in the hopes of trying to be able to integrate with those, but our infant scale is our first pediatric device.
Nancy Addison (06:39.34)
Uh oh, did you lose me?
Daphna Yasova Barbeau, MD (06:41.875)
Yeah, briefly.
Ben Courchia MD (06:43.952)
Let me try something before. Let me just pause the recording for one second. I'll be right back. I want to see if it's maybe on my end. I'll be right back.
Nancy Addison (06:55.855)
Yeah, I...
Daphna Yasova Barbeau, MD (06:56.29)
We'll figure it out. Usually what happens is the platform records all of our tracks separately, independently, so he's able to splice things together pretty seamlessly. It makes this more complicated, but we'll figure it out. We may have to all log out and log back in.
Nancy Addison (07:08.559)
The end.
Nancy Addison (07:12.891)
Okay, no problem. Sometimes I've found that it can be helpful to turn off the camera if you're experiencing things, but I have a really strong signal, but I'm always happy to do that.
Daphna Yasova Barbeau, MD (07:25.814)
Yeah, can you see up in the top there? It's in purple. Can you see if it says your percent uploaded? Yeah, that's pretty good. But you froze for me just now too, so I wonder if...
Nancy Addison (07:28.023)
We do have smell here though.
Nancy Addison (07:35.523)
Yes, I have 99. Okay.
Nancy Addison (07:41.921)
Yeah
Ugh.
Ben Courchia MD (07:45.651)
Okay.
Daphna Yasova Barbeau, MD (07:46.902)
Ben, we had freezing even while you were away. So I don't think it's, yeah, I don't think it's you. Should we all log out and log back in? No.
Ben Courchia MD (07:51.123)
feel better.
Ben Courchia MD (07:55.383)
No, that's okay. I'm gonna... No.
Ben Courchia MD (08:01.575)
Um, all right. Can you all hear me? All right. So we have this look. Yeah, that's great. So we have this, that's fine. We just have this low data mode where basically the video gets cut and we prioritize the audio so that, um, there's no issues there.
Daphna Yasova Barbeau, MD (08:06.261)
Yes.
Nancy Addison (08:07.259)
I can hear you, but I can't.
Ben Courchia MD (08:20.031)
Where did we leave off? You were telling us about the different devices that you were looking for, and you were talking to us about the scale and so on. Is that right, Dafna? Okay, cool. My next question for you, Nancy, is you mentioned this iOS and Android app. What is the entry cost for providers who are saying, hey, maybe this is something that would be quite nice?
Daphna Yasova Barbeau, MD (08:28.214)
Mm-hmm.
Ben Courchia MD (08:46.743)
How does it work for a unit? Is this a subscription that then gets added on a premium, depending on the number of patients you add, or what kind of membership plans do you guys have for providers who may be interested in bringing this tool to their NICU?
Nancy Addison (09:00.763)
Sure, so we contract with the health system. There is no charge to the families. We work within the health system. There is an implementation fee because we build a program based on the specific patient population needs. So we work with the care team that will be doing the monitoring. We assist them in their workflow because that is sometimes that we found in the NICU really needs to be fine tuned a bit for these patients going home. And then we implement their program.
Once that is done, it is a software as a service fee, which is the way that it's done is it's up to a certain amount of concurrently monitored patients. And the bill is based on that. So it's a monthly software as a service fee once the implementation has been completed. We also do integrate with EHRs. So we do have an implementation fee for that. And that can be a monthly fee as well to maintain that integration. But we have quite a few programs that start
outside of the integration, which is totally acceptable. Our platform works just the same. It's just sometimes getting in that queue of integration work can be very long. So we wanna make sure that we can get started prior to that integration.
Ben Courchia MD (10:12.879)
Yeah, and you've been successful in partnering with a number of very prominent healthcare system, including Johns Hopkins Bay State Health, HCA Healthcare, Indiana University, and the Ann and Robert Lurie Children's Hospital of Chicago, among others. So kudos for that.
Nancy Addison (10:31.855)
guests. Thank you.
Ben Courchia MD (10:36.195)
I wanted to ask you a little bit about getting into the techie part of the discussion. Because we mentioned, obviously, this group that wanted to follow babies after going home on these oogastric feeds, we mentioned tracking weight. But can you give us a little bit of the details regarding what Locust Health can do if we wanted the app to sort of flex its muscles?
Nancy Addison (11:01.699)
Sure. So with this patient population, weight is important, but we also track their intake. That's a manual entry for families. However, when they enter that data, we ask the kilocalories and the oral versus tube feeding. That way on the backend where the providers look at the data, they can see the percentage of PO versus tube. They also have those calculations done for them through LOCUS. So it's a kilocalories per kilo, the MLs per kilo.
And that way they can really track that transition from tube to full oral feeds. The families can also see that data, which is super helpful for them. And they see it in a trended view. So, when I was at the bedside, families loved to see their baby's weight trending up. And so they can see that data, they can see those calculations. If that's something that they wanna really dig into, they can look at that data. So the NICU...
program is one of our simpler programs, which is great because it's not a ton of data that is needed to monitor these kids. It's really weight, intake. Some programs do ask for output. Some ask about nursing so that moms, they can really support the mom with breastfeeding at home. And so it's really, we just adjust it based on their needs, but it's a great, a great program.
for these patients and it makes it easy for them to enter this data.
Daphna Yasova Barbeau, MD (12:30.834)
And it makes sense that that's kind of the data you're collecting because that's what was asked of you guys. But I wonder what is your vision for other neonatal applications, what types of patients we can follow, and what other types of data you'd like to collect for healthcare professionals.
Nancy Addison (12:49.251)
Yes, so we do have a couple of other NICU care pathways. We have one for substance exposed newborns and that's out of Bay State Health. That doctor there was able to see, utilize Locust so he could send his babies home a whole day earlier with the care of their families. And in that program, they looked at, it was more symptom management. So it was, is your baby, you know,
eating, are they consolable, are they sleeping? So it's those three kind of metrics that are so important for that population. And then we are having a few groups now that are working with kids going home on oxygen from the NICU. Typically, it's a BPD kid, but it can be other diagnoses. We really don't discriminate. It's really any baby that's going home with oxygen. So we do also monitor oxygen saturations, heart rate, you know, anything that
the provider needs in order to care for that patient safely at home. So we have quite a few measurements. We can just adjust it based on the needs of the care team.
Daphna Yasova Barbeau, MD (13:56.59)
And can you tell us a little bit about what that looks like in particular? I think these higher acuity babies, like going home on the oxygen saturation heart rate monitoring, is that still input by the families or does that integrate with your system?
Nancy Addison (14:11.707)
So currently it is manually input, inputted by the family, the oxygen saturation and the heart rate. The health systems have that process set up so they can send their babies home with the equipment when they go home on oxygen. So it is manually inputted. However, we are looking into an infant Bluetooth pulse oximeter so it can integrate with our program. But currently it is all manual entry.
And so it has been very successful. We do this in the kind of older populations. We have some asthma, we have CF. So transitioning it into the neonatal world, it has been successful, but it is manual at this point.
Daphna Yasova Barbeau, MD (14:54.478)
I'd say that's still an improvement over what we currently have, right? Where they meet with the follow-up clinic or the pulmonologist every month, every two months, and then we look at the saturation. So certainly more information. I wonder if you can talk a little bit about, you know, what is the patient experience like? I actually think, I mean, it seems like even by virtue of needing to do the manual input of data that it gives families a...
Nancy Addison (14:55.291)
Thank you.
Daphna Yasova Barbeau, MD (15:24.05)
a big sense of empowerment and control.
Nancy Addison (15:27.835)
Absolutely. And, you know, one of the things that I really looked up to within the NICU is the relationships that the attendings and really the whole staff develop with these families. So that reassurance from the program is so beneficial for the families going home. We really want them to know that it's their care team that's providing the care for them still. So we do have in-app messaging so they can.
message with their care teams. We also have video visits. So our NICU programs, the lactation specialists utilize that feature quite a bit, as well as, you know, just being able to check in if if, you know, the attending see something that they might want to just look at and, and talk with the families. So, you know, all of these aspects, the, the safety and the comfort that it locust provides really is
invaluable for the families going home. And it just empowers them, as you said, to take care of their baby at home.
Daphna Yasova Barbeau, MD (16:31.318)
Can you tell us a little bit about what the experience has been like for health care professionals? What kind of feedback have you guys been getting?
Nancy Addison (16:38.427)
Sure. So as I said, we started with the pediatric cardiology group and they had that process down. So when we have remote patient monitoring at home for these kids. However, when we transitioned to the NICU, we received a lot of input from the folks we were talking to saying, hey, we love this idea, but we don't monitor patients when we discharge them for the NICU. So how can, how does this work? So our
We really had to get the workflow down or an idea of what we thought the workflow could be for care teams to utilize. So a lot of our NICUs have a virtual round. So they look at our Locus dashboard after they're done rounding and they review the data. They can see very easily on our dashboard if there are any alerts. So if a family member does enter a wait that has, you know,
gone outside the parameters of what the care team thinks is safe at home as far as weight gain, then it will pop up an alert for the care team to see. So they can look at the data of all the patients that are monitoring and then they distribute that through there. Typically it's NNPs that do monitor these patients. So we have inpatient workflow. However, what we've been seeing lately through the years as we've been doing this is we have a lot of follow-up clinics, NICU follow-up clinics that really want to increase.
that follow-up from when these patients go home. So they're the ones who are doing the monitoring now. So they're able to review that data after the patient goes home and maintain that follow-up and increase follow-up appointments so that families do come in for those appointments and stay connected to the care team there. So we have a couple different ways of suggesting the workflow, but providers are so...
resourceful and they're always coming up with new ideas and trying to make sure their patients go home safely.
Ben Courchia MD (18:36.811)
This is very exciting, Nancy. And as you're mentioning, you're trying to understand the needs of your customers and the needs of the families. What are you guys thinking of for the future that you're excited about? Anything in the works that you're planning on releasing soon? Any upgrades or any new services?
Nancy Addison (18:55.711)
Yeah, absolutely. We're always fine tuning our program. The way that we got our start that was so organic. We have found that our app has continued to improve from input from our providers. So, in-app messages, like I said, video visits, we now have clinician notifications. So if a family does enter a new message, the clinicians get notified. And
patient notifications is coming next to really increase that engagement for families at home, text reminding them, hey, it's time to enter your data or telling them that there's a new message. So that is very exciting. And then just our integration of devices. We know how valuable that is. We wanna look at data more, having it be more readily available as far as more than once or twice a day that the family enters.
pull that data from a device, let's say every hour. And so that's something that we're really looking into and we're very excited about. And then our integration with EHRs is really just getting better and better so that we know health systems put so much into their systems and we want the providers to feel as if they're working within that system. So our integrations have just really just gotten better. And so.
really just utilizing the system they already have.
Ben Courchia MD (20:23.999)
My last question for you today has to do with the potential for locus health beyond clinical care. And I wonder if you think this could also play a role in clinical research in the future where we do want to follow up, especially in neonatology. I'm going to only speak for neonatology, but we like to follow up our babies after they go home. And we know that collecting data from these families is very...
Nancy Addison (20:43.739)
Hehehe
Ben Courchia MD (20:51.475)
taxing both from an emotional standpoint, from a resource standpoint, they have to come back to the office to get those measurements in. Do you see a potential to facilitate the advances of neonatology and medicine in general by allowing families to contribute, obviously with consent and voluntarily, to clinical projects using Locust Health?
Nancy Addison (21:14.843)
Absolutely. And yes, and to clarify, providers can see the data without families having to come in. It's automatic input. We have research and we have shown a decrease in length of stay, which everyone loves. But what I love, especially as a clinician, is that, you know, families are feeling supported at home. But, you know, not only are they going home, but they're also showing their
Ben Courchia MD (21:22.35)
Uh-huh.
Nancy Addison (21:43.427)
their percentage of oral feeds increased significantly outside of the home, which is something I feel like everyone always suspected that would happen, but it was never really able to prove. So these, you know, these parents are going home and they're feeding their babies, they're gaining the same weight, and they can go home without, you know, they can go home with an NG tube safely. There's been no unplanned re-emissions around the NG tube. So...
The research with that is just getting better and better. And as we continue to get the data, I just feel like multi-site research study, we're just primed for that. We know, yeah, I just think, we're really at the cusp of pediatric remote patient monitoring as far as it taking off. And so we're here to collect that data and we really support our care teams and evaluating that data and everything we can do to support that.
Ben Courchia MD (22:24.144)
That's awesome.
Ben Courchia MD (22:41.519)
Yeah, that's really exciting. Nancy, thank you so much for making the time to be on with us today. This is really a very interesting and very exciting time for remote patient monitoring. We will link all the resources we talked about on the episode show notes. You can find out more about Locus Health at www.locushealth.com. And we will leave also some contact information for some of your team members so that if you
Some of our listeners are interested in finding out more about Locust Health or how they could participate, they have a point of contact to get in touch with. Nancy, thank you so much for being on the incubator with us.
Nancy Addison (23:18.607)
Thank you.