Voxello, which began as Iowa Adaptive Technologies Inc., provides devices and services to help caregivers improve their standard of care through better communication with impaired or disabled patients. By enhancing patient- provider communication, Voxello’s solutions will help hospitals and nursing facilities reduce the rate of adverse medical events, improve evaluation metrics such as medical outcomes and patient satisfaction, and more easily meet hospital accreditation standards.
Voxello is an outgrowth of work done at the University of Iowa’s Assistive Devices Laboratory, headed by Dr. Richard Hurtig and was formed in 2013 from a project within the Iowa Medical Innovation Group program. The program brings together students from the Colleges of Business, Law, Medicine, and Engineering to commercialize solutions to medical problems identified by clinical staff and faculty. Iowa Adaptive Technologies was incorporated in 2014 and subsequently began doing business as Voxello. Dr. Hurtig and the rest of the Voxello team members bring over 30 years of combined experience in addressing the communication barriers of patients and launching medical devices in emerging hospital markets.
Being hospitalized can be a stressful experience for patients and their family members. Patients are often dependent on their healthcare providers not only for treatment interventions but also for assistance with many activities of daily living. Many patients require assistance from their nurses for everything from getting up to feeding and toileting. Being able to summon caregivers and effectively communicate is an essential part of best practices in the care of hospitalized patients. The inability to summon help and communicate contribute to poor patient-provider communication that has been associated with increases in the risk of the patient experiencing a preventable adverse medical event (AE). Estimates of the annual costs associated with the AEs that can result from poor patient-provider communication (e.g. Adverse Drug Reactions, Falls, Pressure Ulcers and Ventilator Associated Pneumonia) have been estimated to exceed $29 Billion. In the U.S. the costs associated with such preventable adverse events (AE) must be borne by hospitals.
Furthermore, barriers to communication with caregivers have also been associated with increased patient stress and decreased patients’ satisfaction with their care. Patients who cannot independently summon help require increased nurse vigilance and more frequent checks. When these patients are also not able to express their needs and respond to questions, nurses must spend additional time and effort to provide the necessary care. Supporting patient communication and engagement with care is essential to maximizing nurse efficiency and improving outcomes. Caring for patients who face communication barriers is not only stressful, but also takes considerably more time that then limits the time available to care for the other patients in the nurse’s caseload.
Numerous studies have described the positive relationship between patient-provider communication and health outcomes. Specifically, studies have found that effective patient–provider communication is essential to healthcare access, participation in decision making, and the quality of care received. For example, patients need to communicate with their providers about new or changing symptoms in order to prevent adverse medical events. Patients also have a right to be involved in critical decision-making about highly personal choices related to life sustaining measures and end-of-life decisions.
There are ethical and financial reasons why health care institutions must address the significant number of AEs associated with communicate barriers (Hurtig, Alper & Berkowitz, 2018). These numbers are alarming for both ethical and financial reasons. A patient’s right to effective communication is laid out in the Joint Commission’s hospital accreditation standards (2010). In the U.S. alone, there are 3.9 million hospitalized patients each year who cannot effectively communicate due to injury or illness. These patients are at a 3 times greater risk of experiencing preventable adverse medical events. An estimated $6.8 Billion dollars could be saved by reducing the added risk associated with communication barriers.
Voxello developed the noddle® smart switch and the noddle-chat communication tool to provide patients access to the nurse call system and to communicate with caregivers when their medical condition precludes their use of oral and written modes of communication. The noddle uses patented technology to allow patients to use a voluntary gesture such as a tongue click or a minimal movement such as a head nod or shoulder shrug to access the nurse call system and utilize a speech generation device such as the noddle-chat tablet to communicate. The noddle was designed to be a plug-n-play device that could be deployed at the bedside and would be intuitive, easily setup by nurses and easily used by patients. Voxello has developed a family of sensors for the noddle in order to make it possible for patients to get help and communicate, regardless of what voluntary gesture they are able to produce. The noddle has been cleared as a Class II Medical Device (Powered Communication Device) by the FDA and is now being used at 12 medical centers around the country.
Utilizing feedback from hundreds of patients, their caregivers and family members, Voxello created a set of communication templates for the noddle-chat communication tool. This tool was designed to allow patients who are unable to speak to make their needs known and to more effectively interact with caregivers and family members. It also includes message templates to support participation in medical decision making. While initially developed for English-speaking patients, Voxello has recently developed a bilingual version of noddle-chat to support bedside interactions between patients who have limited English proficiency and their nurses. Patients who have use of their hands can access messages using the noddle-chat’s touchscreen, while more physically limited patients can navigate through the message options using the noddle switch. The noddle-touch has been designed to include communication rate enhancing features like row-column scanning to allow patients to more quickly get to the desired message.
Currently there is no simple, integrated (access and communication) solution in either the hospital or the long-term care market. The current assistive technology out-patient market size is in excess of $3 Billion. We have estimated that the in-patient hospital US market is $600 million based on there being 103,000 acute-care hospitals beds – through which 3.9 million patients who need assistive technology will pass through annually.
The bilingual version of noddle-chat software to address the needs of patients with limited English proficiency would open up a large hospital market as hospitals will also want to reduce the higher risk of adverse events in this population. The existing market for medical translation services in the US is $35B and is expected to grow to $47B by 2021. The bilingual noddle-chat would not supplant translation services but would enhance the traditional bedside care interactions for which it would be impractical to use either live on tele-interpreter services.
Sales & Distribution:
Voxello will market the noddle to acute and long-term care facilities and home- care patients. Revenue will come from a core device (noddle and noddle-chat tablet) and recurring revenue will come through the sale of the disposable noddle sensors in the hospital market. Based on estimates of patients who faces access and communication barriers, the average 280-bed hospital will need approximately 31 noddle kits and will use approximately 1300 sensors in one year. We have calculated that if the targeted preventable adverse events are reduced from 3x to 2x, the ROI for the hospital is 300% in the first year alone.
Sales into the hospital and long-term care facility markets will be indirect through dealers that sell products such as nurse call systems. Voxello has signed distributor agreements with five of the largest nurse call system distributors in the US. These distributors are strategically placed to give us penetration in key markets. Since the noddle works with the same nurse call systems that the distributors are providing to their local hospitals, Voxello’s products represent a high-margin, strategic add-on sale for distributors.
Sales into the home-care market will be through Saltillo/PRC, one of the largest Augmentative and Alternative Communication companies in the US and International markets.
Non-dilutive: Between grants and awards Voxello has raised $2 million in non-dilutive funds. Voxello has received grant support from the NIH through its SBIR program to support the development of the noddle and noddle-chat and clinical testing at sites across the country. Additional grant support for the development and testing of pediatric versions has been provided by the NSF funded Pennsylvania Pediatric Device Consortium.
Dilutive: Voxello has raised $1 Million in a private equity raise and an additional $1 Million in convertible notes. Voxello is initiating a second equity raise with a target of an additional $3 million to support a full product launch through channel distribution in the US.