Telepharmacy: Service-Enabled Technology

In this episode of 4x4 Health, we talk with Brian Roberts, co-founder and CEO of PipelineRx. Brian explains that PipelineRx is a “service-enabled technology company” devoted to providing a comprehensive medication management technology platform supported by remote pharmacy services to help hospital pharmacies achieve 24/7 coverage and deliver more clinical initiatives. Their vision is for every provider and every patient to have access to high-quality pharmacy services anytime, anywhere. It’s a great example of how telemedicine is virtualizing care delivery. Throughout the conversation Dr. Dave and Brian touch on a variety of topics including, how PipelineRx combines people and technology to best provide their solution, the potential of artificial intelligence to improve outcomes, and the importance of culture in an organization. Whether you are interested in this cutting-edge field of tele-medicine, or the leadership style of a successful Health IT CEO, we hope you find this episode as engaging and informative as we did.

Dr. Dave Levin: Welcome to 4 x 4 Health, sponsored by Sansoro Health. Sansoro Health, integration at the speed of innovation. Check them out at www.sansorohealth.com. I’m your host Dr. Dave Levin. Today I am talking with Brian Roberts, Co-founder and CEO of PipelineRX. Brian has an extensive background in healthcare services with an emphasis on Tech Enabled staffing solutions. He previously served as President of Canopy Healthcare, a leading allied healthcare staffing firm and as Executive Vice President of Business Development at CHG Healthcare Services, a leader and diversified healthcare staffing which supplied physicians, pharmacists, nurses and allied healthcare professionals to hospitals nationwide. He’s also an experienced investor having been a general partner at Acacia Venture Partners. These days Brian devotes his energy to the role of CEO of PipelineRX which since 2009 has been delivering remote pharmacy services. Their aim is to transfer operations by optimizing pharmacy resources and improving pharmacy workflow. Ultimately amplifying the impact of pharmacy on patient care. It’s a great example of a tech enabled service. PipelineRX’s telepharmacy solution offers a combination of virtual pharmacist services and clinical pharmacy software that allows hospitals of all sizes to optimize pharmacy staffing and workflow and reduce labor cost by improving patient care. This also frees up pharmacists to address high value clinical services such as patient discharge management, antimicrobial stewardship and patient care rounds. It works! PipelineRX currently provides medication management technology and virtual clinical pharmacy services to more than six hundred hospitals across the US and Canada. Virtualizing care, removing time and space as barriers is a key strategy for reinventing the US healthcare system and PipelineRX stands as a real world example of the impact this approach can have. Welcome to 4 x 4 Health, Brian.

Brian Roberts: Thanks Dave, appreciate it.

Dave: Let’s get started! I’m gonna ask you a series of four questions today and we’ll take about four minutes to discuss each one. The first question is pretty straightforward. Tell us about yourself and you organization.

Brian: So, my whole career has been based on building service enabled technology companies, having a background in labor markets in the US Healthcare System. We’ve built several staffing companies throughout our career. However as I started building out my latest venture, we figured out that we could use technology to actually provide remote staffing services and that was the beginning of PipelineRX. We figured out that we could use pharmacists remotely to more effectively process orders across a variety of healthcare institutions and from there the business has really grown. We now provide a SaaS platform for hospitals to process their own orders in the telepharmacy fashion and we also offer a hybrid that combines both the labor components of pharmacy as well as our software components but at the end of the day our business model is based on delivering world class pharmacists anytime anywhere across the US healthcare system and now Canada. We really wanna be the connecting point between pharmacy and others that are involved in the delivery of medications be it nurses, doctors and patients and today we are processing over two million prescriptions per month on our software and that is utilized by over one thousand pharmacists on the system. So, this is just some of the highlights on how we got into this business and what we’re doing today.

Dave: Let’s drill a little deeper into this. So, there’s a couple of things you said that jumped out at me. I really like your phrase, ‘Anytime, Anywhere’. You know, and as I said in the intro, part of what I find so fascinating about virtualizing care is it really can remove time and space, physical location if you will as barriers to delivering the service and I think that what you describe the way you are doing, it fits that really nicely. You said something else really interesting too and I don’t know if it was a turn of phrase or intentional but we’re gonna find out. So, I usually refer to these as Tech Enabled Services and you said Service Enabled Tech. Is there a difference between those in your mind or is it just, is it a different way of thinking about it or is it just the turn of phrase?

Brian: Well, I think it depends on the focus of the company. You know, what’s really interesting about Pipeline is I think we’ve made a conversion there Dave, from a Tech Enabled Service company to a Service Enabled Technology. So, the technology for PipelineRX is actually the faster growing part of our business and that’s because we can actually deploy and reach more facilities by allowing organizations to use our software. So, you are starting to see more of a trend of people identifying themselves as Service Enabled Technologies. Ultimately, we believe that only about 20% of our business will be delivered via the service. Today it’s about 60% as delivered via services. So, real interesting I think certainly in the telehealth realm, whether you are providing radiology services or you’re providing a behavioral health services, the technologies become such an important part of delivering that platform.

Dave: Going beyond the specific use case we’re talking about here. There’s a really important principle here and it’s one that I’ve come to appreciate more just in the last few years and it’s this idea of when you’re starting something new, the balance between the tech component and the service part or the people part if you will is one thing. It often changes over time and the typical pattern is that it starts with less technology and more people if you will behind the scenes but…

Brian: Right.

Dave: …, that it’s gradually industrialized and it requires less of the people because the technology is becoming more sophisticated. I think that’s what I heard you say but if I’m misunderstanding this, please correct me.

Brian: No, I think you’re right and I also think that the connection points and specifically when you drill down into pharmacy there’s transitions that happen, there’s transitions of care between different settings whether you’re going from the hospital to the home or you’re going from the nursing home to home care, there’s transitions that happened and so to be the connectivity point between those transitions of care, so that the medicines that were delivered in one setting can be reconciled to the next setting are real critical points and so we deploy technology there so that those medicines can be delivered and can be reviewed across those settings of care. So, I think that’s just one use case of why the technology, why that record kind of follows that, that individual and then thereby enables better transitions of care, better care and more cost-effective care, so you don’t have to recreate those records.

Dave: For our listeners it may not be quite as familiar with some of these workflows and requirements. Let me just share from my time as Vice President of Medical Affairs in a community hospital, that was part of a large integrated health system and we encountered this issue very directly because you know, the large quaternary care hospital could afford and could justify staffing pharmacy 24/7. The smaller and more remote community hospitals really struggle to make the business case for that and solutions like yours really filled that gap and allowed us to provide better care, more consistent care and frankly more efficient care to just keep the process moving forward. So, it really does provide this kind of both end and a kind of extender that can be very powerful in these settings and of course you’re talking about extending this beyond the Acute Care setting as well, correct?

Brian: Yes, correct. So, we provide now our technology and our platform and our service to nursing homes, retail outlets, ambulatory surgery centers, all places where medicines are delivered, our platform helps with the approval process and the reach to all those various settings.

Dave: So, one last question about this and then we’ll move on. The other thing that I’ve seen in my experience is that when you’re delivering a, either a Service Enabled Technology or Tech Enabled Service, ensuring the quality of the service part, the quality of the staff, the individuals can be an issue and obviously in the situation we’re talking about high risk and high knowledge activities like pharmacy, this is particularly important. How have you approached these issues of quality control if you will on the human side of the work?

Brian: Yeah, on the human side of the equation at PipelineRX we set up very straight hiring standards so that you’re hiring the right type of pharmacists. We are enabling that pharmacists with a whole variety of tools and both developed in-house and also outside of PipelineRX to deliver the right care, notifications and other things and then we have a very systemized way of tracking any kind of variances or other items that may occur in the delivery of care. Knock on wood Dave, you know, we process two million prescriptions of month, we have a very good track record of delivering the highest quality of care and improving the quality of care. So, we actually can measure the types of interventions that pharmacists are making and we can deliver those results back to our organizations. One interesting fact about Pipeline and Telepharmacy is that we do intervene on 5% of all orders that are written by a doctor and so we intervene on those medications either in terms of an interaction that might occur or a potential allergy and we report that back to the physician and 85% of the time that suggestion is accepted by the physician. So, it just goes to show that there are lots of meds that are written and you do need a pharmacist reviewing it and our model helps get that accomplished.

Dave: Well, and I think it also reflects the emerging team care approach and the clinical pharmacist is a critical member of that team and you’ve given just I think one of what are probably many examples of how they can contribute to that.

Brian: Everybody deserves that same standard of care. You know, across the United States whether you’re in a twenty bed critical access hospital or in the middle of an inner city or you’re sitting there at three o’clock in the morning and you have a question about your medication. So, telemedicine, telepharmacy in particular can help you know, deliver on better care.

Dave: Well, I think that’s an extremely important point. This is where virtualization really shines is the ability to spread those resources over a much wider domain in a much more cost-effective manner. So, I personally think we’re at the beginning of what’s gonna be a lot more of this kind of virtual care. With all of that in mind, what’s the most important or interesting thing that you’re working on right now?

Brian: I think as far as is what we are working on at PipelineRX, I think one of the most interesting areas of healthcare and in particular for our model is around artificial intelligence or AI. Some may call it business intelligence and analytics but the fact of taking the data that’s running through your servers and utilizing that data to make better decisions and we’ve made some very significant investments in this area, we will continue to make investments in this area because this is where again we can enhance the delivery of care. We specifically around artificial intelligence, we want to identify high-risk patients, we want to identify high-risk patients before they leave the hospital, before they leave the pharmacy and figure out, what is this patient at risk for in terms of a drug interaction or what is this patient at risk for in terms of an opiate addiction and let’s put those tools to work so that we can identify those patients both for the patient’s sake, you know, and for the provider’s sake. So, we’re really excited about that kind of personalization of medication management.

Dave: Give us a real specific example of where, either that’s in play now or where you anticipate deploying it.

Brian: Yeah, sure. So, a specific case that I could point to is around the discharge process in a hospital and so the typical discharge process of someone leaving the hospital really doesn’t involve pharmacy today and it’s a matter of resources for hospitals and so as a part of our software platform, we’ve kind of written in a module or a process, a business process, so that when a person is leaving the hospital that they can be reviewed by a pharmacist and typically that will be a remote pharmacist and you’ll use an iPad to communicate with the patient and review their drugs with them and make sure that they have means to go and pick up their medications either from the outpatient pharmacy they’re in the hospital or from another pharmacy down the street but we’re actually using methodologies to understand what that patient record looks like, what medications have they been on, what medications are they going on and we’re actually collating that data and then being able to come up with a formula if you will about what medications they’re gonna be leaving the hospital with. So, we really embrace those types of technologies that take the time to crunch the data and provide a better outcome for those patients.

Dave: So, I wanna repeat that back to make sure I understood it. What I heard you say was you’re using the technology to essentially look a little bit into the future, look at the current state of the patient and predict what the likely regimen will be upon discharge, what medications will they go home with. Did I get that correct?

Brian: That’s correct, that’s correct and so the system can actually learn what high-risk patients may come back into the hospital. Whether they are heart patients or whether they are diabetics but by understanding that the patterns of medications that are written and understanding the patterns of which these folks have been readmitted to the hospital, some really fascinating ways to kind of personalize and understand, you know, the potential risk for that patient as well as the cost for, you know, our healthcare system. So, we’re really excited about those things.

Dave: Yeah, and I agree with you. I think this is an area that’s starting to mature and bear some real fruit in healthcare and it’s that predictive proscriptive part of this that seems to be catching on and so I had a couple of other examples I’ve seen and that you’re probably familiar with as well and in the world of medication management there’s some really compelling new predictors that can look at a patient and predict the risk of on opioid abuse and overdose. Obviously, something important to consider in this day and age and if that’s the predictive part, the proscriptive part can provide advice about how to modify that risk or offer an alternative therapy and I think likewise his can be extended to a whole series of therapeutic situations. Which antibiotic would be the best antibiotic to choose in this situation or most likely to choose in this situation, which cholesterol-lowering drug is likely to be the best fit for this particular patient and so I get, I always give my guests the opportunity to call BS on me and reel me in if you need to but, is this what you’re seeing as well?

Brian: Yeah, and you know, let’s humanize it. We’re all in this situation whether it’s our kids, ourselves or our parents that maybe going into a nursing home, we as individuals want to understand those risks and we want the best care to be delivered and so I agree with you on, you know, what you just stated.

Dave: If you’ve just joined us, you’re listening to 4 x 4 Health and we’re talking with Brian Roberts, Co-founder and CEO of PipelineRX. Alright Brian, now for question three, I always remind my guests that this show is PG-13, so please keep this, keep this family-friendly but, what’s your favorite pet peeve or rant these days?

Brian: Ah, my favorite rant, that’s a great question. You know, I think as CEO, you’re always trying to bring out the best in people and motivate folks, you know, I think one of the things that I’ll always come back to, you know, whether someone is presenting a project or we’re looking at an acquisition or we’re looking at an investment into a different area of technology or services, it’s really what does the data tell you and as CEO I can be the biggest cheerleader, I can be out there, speaking on behalf of the company but when it comes down to people making decisions and when it comes down to folks making decisions for the company and the folks that are making the decisions, I’ll always challenge people to dive deeper into the data to support their decisions and so if you’re on my internal conference calls, if you’re on, you know, even in my family, it’s you know, what does the data tell you and so it’s probably the latest thing that I’ve been focusing on. So, that probably what I would say.

Dave: Well, you sound a lot like my CEO as well and you know, there is that old truism about you know, what gets measured, gets managed and my personal experiences, there’s a lot of truth in that. For most activities, I need to know who’s gonna do what by when and how we’re gonna manage and measure success, otherwise I think there’s a low probability that anything really good or productive is gonna happen. Is that kind of square with what you’re saying through us here?

Brian: Yeah, it helps balance out the emotion sometimes in a decision and emotion is good, emotion, you know, helps react from kind of a gut decision but I think if you have the data to back it up, if you’re measuring against the data, that’s gonna get you 75%, 80% of the way. So, we at Pipeline, you know, definitely practice measuring the data and making decisions around that.

Dave: Yeah, I’m a big believer to that. It’s the combination of data and stories that help us make progress, that communicate most effectively and I’ve always believed that the data kind of speaks to your head and the story speak to your heart and…

Brian: Right.

Dave: …, and that you know, to lead change and do some of the hard things we have to do in life and in healthcare, that combination can be really powerful and I hear that running through this part of the discussion as well. Let’s wrap up now and I’d like you to share with us your most sage advice.

Brian: Well, that’s a loaded question. It’s a good question, it’s always interesting to hear what drives individuals and CEOs and others. Part of the message that I deliver to our team is always be evolving, always be learning and I don’t care what your market position is or what your job position is or your title, challenge yourself to always be evolving and again, you’d hear this in our management meetings, in our one-on-one, this is a clear piece of advice that I give our management team members and we actually take it to another level at PipelineRX. Every two years we run a project DNA which helps us look deep into our own DNA as a company and how are we continuing to push ourselves to evolve and it involves the cross-sectional of our company from our telepharmacists through our technology folks and integration folks, through our management team and it really is a great way to look underneath the hood and figure out where do you wanna head as an organization. So, that’s the advice that I typically give folks.

Dave: Alright, you’ve hit one of my hot-button issues, so I’m not letting you off that easy. I’m a big believer in culture and the power of culture.

Brian: Yes.

Dave: Kind of see it as the foundation of everything else. So, take us a little deeper on this. Why did you elect to do this and tell us a little bit more about the actual process and the results that you’ve seen?

Brian: Well, I think, hundred percent agree with you Dave. Culture is why folks work as hard as they do, why they come to work and really what makes an organization thrive and have a heartbeat. We do this on a biannual basis. Again, as you grow as an organization to bring everybody on the same page and come back to those mission vision and values. I think also as a telehealth company, as a virtualized company, we have employees in forty different states that work from you know, every corner of the Unites States and so there have to be ways to bring that culture together and to make sure that you’re eliminating any kind of silos or silo decision-making and to basically you know, rally the team and huddle the team. So, agree with you but that was you know, that’s some of the reasons why we put on project DNA, you know, every couple years.

Dave: And, what have you seen as a result of this, how do you justify the investment of the time and the expense of doing this as the CEO sitting across the table from your CFO, how does that discussion go?

Brian: Right. Well, I think it pays for itself in spades through, you know, retention and the happy employees. The time commitment is actually not entirely significant. You can run two hour conference calls, we can break it up into subgroups for an hour but you give folks an outline and at the end of the day the way that we do it is we build out five teams and each of those teams gives a presentation and then we bring the whole presentation together as we agree on what our key points are but I could sit here for a couple of hours and definitely talk about the benefits across how it improves communication across the organization, how it eliminates silos, how it drives our marketing messages and it reverberates through the whole organization, even if you’re not on project DNA, you’re hearing about it from your manager and so it really reverberates across the organization and drives productivity and happy employees. So, it’s been a very worthwhile exercise for PipelineRX.

Dave: Well, you know, obviously I’m standing up and cheering for all of this because I agree with everything that you have to say there and you know, just will note that at Sansoro Health, we too have taken this very seriously. We have a culture team, we actually work with an outside consulting firm that’s, that has validated tools to help you measure culture and manage it and put some real meat on the bones. So, like you I take this very seriously and I think it has profound benefits. There’s a little salty in here too that I just can’t quite let go of. It’s just interesting how this is connected back to virtualization because as you mentioned your workforce is virtualized to a large degree as well and that poses opportunities but challenges also. My own experience has been that it’s important for people to gather together periodically in the same space that the use of not just audio conferencing but video conferencing. The ability actually see the other person to some degree at least to read body language that those things all actually make a big difference and that you need to be intentional about it. Not that you don’t need to be when everybody’s working in the same building but it brings some interesting twist to that. There’s a beautiful little symmetry here and that we’ve been taking about virtualizing pharmacy services and we’ve kind of ended up here as well.

Brian: Yeah, hundred percent agree. It definitely is a challenge as you’re grown an organization that’s virtualized but it’s happening more and more as you see business models arise in the gig economy. It really is a challenge but you have to use the tools, you have to use communication tools, video tools as you said and then good old-fashioned get-togethers whenever when we can, whether that’s around an industry event or a local get-together in a region, there are people here that have worked together five, six years that have never been face-to-face and they are best friends and so when they finally do get the chance to see each other face-to-face, it’s really quite remarkable.

Dave: Well Brian, that’s a real tribute to you and your team and the leadership and the kind of culture and the types of people you’ve attracted. So, congratulations to you, that’s, it’s quite an accomplishment.

Brian: Well, I appreciate you having us on the show here.

Dave: We’ve been talking with Brian Roberts, Co-founder and CEO of PipelineRX. Brian, thanks again for joining us today.

Brian: Thanks Dave, we appreciate it.

Dave: You’ve been listening to 4 x 4 Health, sponsored by Sansoro Health. Sansoro Health, integration at the speed of innovation. Check them out at www.sansorohealth.com. I hope you’ll join us next time for another 4 x 4 discussion with healthcare innovators. Until then, I’m your host Dr. Dave Levin, thanks for listening.