Session 8-4: i-Consent, L.L.C, Interactive Informed Consent System

M. D. Anderson Cancer Center
Date: April 2008
Duration: 0 / 09:35

Chris M. Hymel, i-Consent L.L.C.

I represent in i-Consent and a little background. Basically everyone in these politically charged, seasons heard politicians talking about the need to control and how to control health care cost and they are actually trying to hide who is paying the healthcare costs. In the immediate medical environment, here especially controlling health care really means exactly that retarding the growth or actually reducing the overall cost of health care for the community. One of the ever rising health care costs has nothing to do with health and too often very little to do with care is the cost of malpractice litigation, its impact on malpractice insurance premiums, which are paid by physicians and institutions alike. In recent years, many states have applied a tourniquet called total reform to this basically financial arterial bleed having to do with malpractice claims, but the financial blood-letting is continuing from a hundreds of small wounds. Let me give you a story, one example, a true story. Neurosurgeon in Dallas performs carpal tunnel syndrome and is sued. The individual has numbness after the surgery, one of the risk factors that were known and signed on the informed consent form. Lawyer is ready to fight, the lawyer is for the insurance company will walk in and say, 'You know we can get rid of this guy for fifteen thousand dollars, but I'm not wrong, I didn't do anything wrong, it was one of the risk factors, he agreed to it.' Patient's response about the informed consent is, 'Well I read it, but I didn't understand it, but I had to sign it to get the surgery, I needed the surgery.' Basically he was not defensible. Essentially instead of spending a thirty thousand dollars in two weeks to fight the case he chose to have a black mark in his record because he couldn't defend against improper informed consent. Review of articles and subjects on [inaudible] laws reports, have suggested some interesting insights on claims. Most of the claims are small, tens of thousands of dollars, not the huge awards. Forty percent of them don't actually involve any errors at all. Most claims, however, most claims do allege a lack of informed consent and many practitioners are not actually getting an effective informed consent. Significant portion of the cost of malpractice protection results from difficulty in proving in court of law you have an invalid informed consent. Typical form [inaudible] are still somewhat redolent with med speak and are often incomprehensible to a number of the patients. Medical technology much was initiated here and is advancing at a very fast rate. Medical communications [inaudible] at the patients is not. The solutions and interactive informed consent system, one which provides a defensible cogent, you know, consent from the patient. Let's talk about the market segment and market needs. There's four major segments. The patients would be the better informed recipients of healthcare. Nurse practitioners and physicians, independents, the hospitals, institutions like this place and the insurers and reinsurers. The patients or the recipients really need to understand health care services that are being provided. They need to understand the terminology, underlying conditions and this is nothing new to any of you folks. You have to become better consumers of health care. The practitioners really need to provide a cost effective efficient convenient way to deliver and legally coach an informed consent that's the industry recognize. They also want to mitigate the owner's effects of the process thereby not contributing to the cause of malpractice, not losing practice time defending themselves and not abandoning practices to other arenas because of the skyrocketing health care cost. Institutional law providers very similarly overlap to their practitioners. They have to deliver a consistent high quality of legally cogent informed consent. They also have to be able to assess his performance as it is delivered not years later when you are trying to defend yourself. The reinsurers, they effect, their need is to be able to effect the delivery of an informed consent system, in this case via economic incentives. However, the informed consent delivery is controlled by health care providers. They need access to performance to proactively manage the risks, not basically make decisions based on premiums or decision to insure or not insure. They also want to be able to demonstrate IC, informed consent comprehension evidence to defend themselves against claims. Summary of the market value of patients to be better educated consumers, practitioners can devote more time to delivering health care, health care management will improve their operations reducing costs and insurers will reduce their liability. The product itself. I'm talking about informed consent product, which is delivered via the internet using interactive multimedia. It should be able to deliver more effective informed consent information to the patients and their families and assess piecewise user comprehension of the content. For instance, you may describe terminology as the first thing. Here's the term and here's the anatomy. Let's ask you about the terms in the anatomy. You get through that, you make sure that they have the answers to your questions right, go back over until they get them right, go to the next thing the procedure. Let's go over the procedure, but ask multiple choice questions, keep going over until they get it right. Then you go to risks, going down the line. The idea is to make sure you can prove comprehension, something that's lacking in many of the current informed consents. The ability to archive the results of comprehension can accelerate the evolution of the content. You can prove point. You can allow for assessment of the delivery process and reduce some of the fairly and ill founded malpractice claims. It also provides strong measures to product development for the company producing a product based on performance. Use of multimedia, they have certain advantages to these products. The use of multimedia can circumvent some of the literacy and social and cultural impacts to comprehension. In our activity list, computers control delivery. They are basically getting ready for surgery and signing a document, they really can read and they all have to sign it because you don't get the surgery without signing the document. It gives them the opportunity to really spend time learning in an ideal learning situation for themselves. Online access gives you flexibility and convenience. You can get it to either the clinic or from the home. It also mitigates some of the, as I mentioned earlier, some of the detrimental effects on delivery. The use of an uniform IC content developed under folks like yourself recognize medical experts from a central source should raise the bar of healthcare IC standards. Integral models that assess understanding, allow realtime detection of gaps. The doctor will get a report that he understood everything, but Rh positive, Rh negative, please explain that to him, yet he went through the question over and over and did not understand that piece, so the doctor will know what the patient understood and didn't understand and of course our cognitive result is useful for review by colleagues, by industry, obviously evidence to defend yourself against litigation and in fact providing an interim vacation if indeed the informed consent that you have used, you have license for a company is found to be lacking, where we identify the ascertained level of losses, it's part of the benefits of the package. Why should we be doing it? What do we have that anyone else doesn't have? I actually started the company as Biodyne in 1992 doing medicolegal litigation. I was in the dark side, 70% or so of the patients were plaintiffs attorneys. Total reforms have knocked the feet out from under that. They did a pretty good job because they were all these big cases. You didn't do fifty to sixty thousand animations for hundred thousand heart cases. However, we did gain a lot of experience in doing medically related animations litigation support. We had a team that learned to integrate biomedical medicolegal design, education psychology, we are trying to educate eighth grade target jurors. The education level to target that low. We have mastered a lot of techniques mostly the 3D modeling animations. You have been seeing the graphics all along. Those are actually from real cases. Those are excerpted from some of the work we have done and we actually learned to standardized and modularize most of the development. The resources we already have include the animation software, third party animation packages. We have extensive media altering web development software. We have got some multimedia interfaces that we've developed over a period of time. We have done children animations again skills that took a long time to develop. We have a pretty extensive library of biomedical anatomical models and several complete stand-alone animation pieces on various biomedical subjects because of the litigation nightmare we went through I guess. We actually made good money, but it was working with lawyers more than doctors. Our hardware includes sort of the technical things. You wouldn't be surprised, you would be surprised not to hear that we have multiple servers, high speed networks, multi-session rendering capabilities, so multiple computers rendered the animations and get them out quickly and of course the requirement for professional broadcast quality audio and video editing. The plan, complete the development of the web accessible dimension of prototype, in this case we chose obstetrics and the first procedure is actually going to be a genetic amniocentesis. It will be a multimedia presentation using a procedure. It will be a demonstration of the online testing and of course the depiction of the reports the doctor would receive or an attorney could receive. Course we are pursuing it, we've already thought of pursuing a large property protection, which demonstrates the prototyping should parties, obviously investors, more importantly probably hospitals and doctors determine their interest level refine their product pricing and specifications and of course talk to the med malpracticing insurers. What we want to do is get them to offer a discount. If you can give them 5% off their insurance premium of 5000 a year, it probably pays for itself. Complete the product for a single medical specialty, I have mentioned obstetrics previously. We marketed the product to doctors in that specialty, use revenues from the first specialty to develop the next two or three specialties, then you market it. You know it's kind of obvious market. The additional specialties as the content is completed. Pricing, the annual license fee of five thousand dollars about 5% of obstetrics policy per year and a market penetration of 5% in one specialty generates about over five million a year. Capital needs two million dollars, type of funding is obvious, it's to develop and market the initialize IC product, which actually represents about half of that fund amount and the rest is to market the product. Funding should cover through 2009 until we can generate positive cash flow and I have a great picture for safe harbor. I thought it was cute. That's it. Thank you for your attention.

[Applause]