Heart Pathway app helps doctors decide need for cardiac treatment Heart Pathway app aids doctors in addressing necessity of cardiac treatment

There are few situations in life more terrifying than experiencing a potential cardiac issue.

More than 8 million Americans face that scenario every year.

The emergency department protocol for decades has been to conduct several tests, whether blood, heart or stress, to determine if the individual is having a heart attack. At the least, an overnight stay for observation was recommended, if not required.

Yet, several studies have shown that in 90 percent of such cases, the patient was determined not to have been experiencing an acute coronary syndrome. Patients often are discharged with a hospital bill in the thousands of dollars.

Impathiq Inc., a Winston-Salem-based health-care technology company, is marketing what it believes is a viable alternative that could save diagnosis time in the emergency department, resources for hospitals and money for patients.

Impathiq, founded by professors at Wake Forest School of Medicine, has rolled out an application - the Heart Pathway - that's designed to help doctors quickly determine the patient's risk for a cardiac episode now and for up to 30 days later.

The application guides doctors through a series of questions that, by using a proprietary algorithm, calculates the level of cardiac risk. That information can help doctors in determining whether a patient can be discharged, needs to be kept for observation or should be admitted to the hospital for more tests.

The application has been used to evaluate more than 15,000 patients to date, primarily at Wake Forest Baptist Medical Center and its hospitals in Bermuda Run and Lexington.

"Doctors simply won't take a risk of discharging patients unless there's a less than 1 percent chance that the patient will develop cardiac problems after leaving the hospital," said Dr. Simon Mahler, chief medical officer for Impathiq and an associate professor of emergency medicine.

"The Heart Pathway identifies that lower risk."

'Safety net'

Impathiq represents an example of how the costly - and at times controversial - introduction of patient electronic medical records (EMR) over the past decade is advancing patient care.

Heart Pathway, and companion platform IQ Engine, are part of a trend known as the Fast Healthcare Interoperability Resources (FHIR) protocol, which links to electronic medical records to track patient outcomes in real time.

The IQ Engine technology enables hospitals and clinicians to perform quality assurance and auditing on patient care.

Mahler said Heart Pathway is a technological offspring of the Heart Score, a diagnostic tool developed in the Netherlands.

Mahler said several clinical trials and studies involving the Heart Pathway application since 2015 - including one published in the American Heart Association's Circulation journal - have determined it doubled the number of patients discharged from the emergency department without stress testing.

The clinical trials and studies also determined that none of those individuals experienced any adverse event in the 30 days following their trip to the emergency department.

As a result, patients determined to be at low or no risk stayed in the emergency department an average of 12 fewer hours than previously.

Impathiq officials said another valuable application of Heart Pathway is that between 2 percent and 5 percent of patients experiencing a heart attack or myocardial infarction are discharged inappropriately or prematurely from the emergency department every year.

Missed diagnosis can be a top cause of malpractice claims, Mahler said.

"Our tool can serve as a safety net for those individuals who are having an active cardiac issue but not showing classic symptoms," Mahler said.

Cost savings

Wake Forest Innovations, the commercialization arm of Wake Forest Baptist, licensed the proprietary technology rights to the company. The group provided Impathiq with $18,000 during the application development stage.

In return, Wake Forest Baptist said it has gained more than $2 million in cost savings from its use of Heart Pathway.

Impathiq recently entered the commercialization licensing stage with Heart Pathway, with Cambridge Health Alliance of Cambridge, Mass., being among the first adopters.

Wake Forest Baptist and Cambridge both use the Epic EMR system.

The Heart Pathway app is available at the Apple app store, with buying licensing rights required for full access. Impathiq is also marketing Heart Pathway to health-care systems and providers through specialized FHIR app stores.

"We are finishing a build for (Cambridge Health Alliance), while concurrently discussing partnerships with other hospitals across the country that use Cerner, EPIC and other EMRs," said Dr. Iltifat Husain, an assistant professor of emergency medicine who serves as Impathiq's chief executive.

Husain's primary role with Impathiq is his background and knowledge of applications. Assisting in the application's development was Scott Gilmore, a medical student who wrote the code.

"Oftentimes, it can take several years for published scientific studies to make their way into widespread adoption in medicine," Husain said.

"We showed with Heart Pathway that you can shorten this time tremendously by having intelligent integration into the electronic medical records for physician and clinical teams."

Collaboration

Impathiq has secured more than $1 million in grants and other funding from various sources, including N.C. Idea and National Institutes of Health. The commercialization step has been assisted via seed funding from Cary-based venture capital group CoFounders Capital.

"You can do a study that's fantastic and publish it, but just because you develop something awesome, doesn't mean that people are going to use it," Husain said.

While acknowledging the commercial potential of the app, Mahler said the company is "motivated to improve patient health, and we can do that by putting effective tools into the hands of the doctors who need it."

"The development of the Heart Pathway app - and its licensing to Impathiq - is a further example of the increasing emphasis that Wake Forest Baptist Medical Center is placing on collaborating with industry to develop new technologies that can improve health," said Eric Tomlinson, the medical center's chief innovation officer.

Tomlinson said that in recent months Wake Forest Innovations has invested in eight novel technologies through its Catalyst fund. It is evaluating, developing or licensing almost 100 new technologies.

"All of these are derived from the ideas, discoveries and inventions of Wake Forest Baptist staff and faculty and cover a wide spectrum of sectors, including medical devices, diagnostics, chemotherapeutic agents, digital health tools and regenerative medicine," Tomlinson said.

David Gardner, managing partner of CoFounders, said the Impathiq officials "are an ideal representation of the health-care entrepreneurs and business-to-business companies we believe are worthy of nurturing and investing in."

"We've got to make better use of the statistical data we already have if we are going to improve medical outcome and control soaring health care cost."

Gardner said due diligence determined Impathiq "met our criteria for being smart, tenaciousness, coachable, having identified a need in the health-care marketplace, and with a demonstrable way to meet it with a demonstrable return on investment potential."

Next step

Husain said Impathiq's technology has predictive capabilities beyond cardiac issues, such as sepsis.

"Basically, we're enabling hospitals to significantly increase the functionality of their EMRs with our plug-and-play platform, and allowing them to do it in a scalable, cost-effective manner," Husain said.

The next step for Impathiq is a presentation at the CED Tech Venture Conference in Raleigh on Sept. 19-20.

The CED conference typically attracts a diverse group of attendees from across the country, including entrepreneurs leading high-growth companies, investors, corporate leaders, nationally-recognized industry leaders and tech enthusiasts.

"To be selected as a showcase company at the CED Tech Venture Conference is an incredible opportunity to share our story and grow our professional network," said Vinay Tannan, Impathiq's chief operating officer.

Impathiq will be one of 13 participants, along with another Wake Forest Innovations-assisted company Compass-CP, which also uses an application with EMR information to generate patient-centered care plans based on their health.

Compass-CP was developed by lead inventor Pamela Duncan and a team of Wake Forest Baptist neurology researchers.

"These two technologies licensed by Wake Forest Innovations are perfect representations of our mission to improve health through collaborative innovation," said Jeff Brennan, vice president, technology innovation and commercialization at Wake Forest Innovations.

"Showcasing these technologies at the conference is a vital step in getting them closer to the market where they can ultimately improve patient outcomes."

Husain said that having active physicians and medical school professors working with Impathiq "gives us a perspective that other health informatics companies lack."

"We know what works and what doesn't because we're in the trenches with our fellow clinicians.

"Clinical decision-support platforms aren't new - but the technology ours is built on certainly is.""

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