David Emanuel is founder and CEO of VectorCare.
Tell me about yourself and the company.
VectorCare is a patient logistics platform that manages services such as air ambulance, ground ambulance, and Uber and Lyft rides for patients, either inpatient or outpatient. Our core business is that we have no-code workflow to help move fast and get deep inside EHRs.
What are the major elements of patient logistics and what problems can you solve?
Think about discharge for a patient, where a nurse or a case manager is doing scheduling or coordinating that ride home for the patient. Historically, it’s done via phone and fax. Everything is pretty manual. EHRs aren’t designed for managing logistics the way that you would use Uber and Lyft today, so they are quite antiquated in that regard.
The problem that we solve is that at discharge, we make it easy for that case manager to schedule the transfer from inside the EHR and connect with their network of contracted vendors. Decision trees drive the right care at the right time. Not everybody needs a BLS transport. It might be a gurney. They can schedule that transport for the patient seamlessly.
What’s great is that it’s not just the scheduling part. We pre-populate data from Epic or any EHR, and once it is scheduled, you can see real-time updates of vehicle location. You can message directly with the crews through our messaging tools. We then capture all these relevant data points that help measure success and hold vendors accountable for how they perform.
We believe that the future is multi-event scheduling, so it’s not just scheduling the transport. A discharged patient may need to have a home health visit scheduled within 24 hours to reduce readmissions. Our platform automates that whole process. It finds the care team that will do the home visit as well as schedules the oxygen to be at the patient’s house when they get there. Those three major services help the patient’s care journey.
What benefits are customers seeking and realizing?
We have a large client in California that operates across eight states. It was taking them an average of 31 minutes to manually schedule an ambulance transport. We took it down to three minutes. There’s a huge ROI from keeping the workflow inside the EHR.
The second value proposition is getting the right care at the right time. Skilled nursing facilities shut down at 3:00. If you delay completing the discharge or scheduling the transport just by a few hours, they won’t accept a patient. That means that the patient has to stay over an extra night. That’s a cost to the healthcare system.
We reduce length of stay, improve time on task, and connect with a network of contracted vendors instead of non-contracted vendors that have different rates.
How much benefit do hospitals see from freeing up a bed earlier in the day when they might be in short supply?
Having access to a network of contracted vendors via a workflow that is embedded in the EHR, the patient record, provides a trickle-down effect. Quicker scheduling of that transport to take the patient to the right facility or home makes that bed available.
It also improves internal communication. Our platform allows for notifying the cleaning team that the bed is available so they can clean the room for the next patient. This is a huge value for hospital CFOs. They can track success. When did the patient arrive, when did they leave, and were they readmitted? We’re capturing all of these relevant data points to create an end-to-end view from a financial perspective for the healthcare system.
Are patients aware when the logistics process is inefficient? Does patient satisfaction improve when it goes better than expected?
It makes a huge difference in patient satisfaction. Recovery at home is far better than a recovery in a hospital. Getting them out quicker improves their quality of recovery. No one loves staying an extra night in a hospital unnecessarily. It’s a huge benefit for the patient.
How does your credential management system work?
It’s a key part of the vendor network that you have when you build out a marketplace on our platform. You are inviting all these vendors, which requires documenting that they have the right license and the right insurance to perform services for the hospital. Credentialing is a module within our onboarding process to make sure that the vendor is compliant and is credentialed correctly.
How do hospitals decide whether to establish a formal relationship with vendors, and if they do, which vendors to choose?
Big markets like California have a lot of saturation and lots of vendors competing, so you may have a large network of vendors that you’re working with. In smaller markets, you’ll have a one-to-one relationship. It varies from market to market.
What percentage of patients need some form of transport other than just a ride home?
From an inpatient perspective, a hospital with 300 beds is probably doing 30 transports a day where the patient goes home or is moved between facilities. Roughly 10% of their bed size. The logistic requirements are varied from high-acuity transport, so critical care transport all the way through a gurney van. In some cases, air ambulance, either rotary wing or fixed wing.
Outpatient is where the question becomes more relevant. Is the patient going to dialysis on a regular basis? Three trips a week involves six rides to be scheduled via a gurney, a Lyft or Uber, or some sort of sedan car service to get them there. That would be classified as an outpatient service. Or getting to your doctor’s appointment.
Even at discharge, you’re scheduling the patient’s ride to go home or to a skilled nursing center, but you also can schedule the outpatient rides to get them to that follow-up, such as a doctor’s appointment, chemotherapy, or to get their medication.
The benefit of our platform is that you can do both inpatient and outpatient, handling all of these nuances around the transportation needs as well as home health and DME needs as well.
Who typically pays for the logistics services that patients need?
If it’s not covered by insurance, the hospital or the patient will pay for the ride. We’ve built our platform where you determine medical necessity. That is customizable through our no-code workflow, because every state and every county is different. Once you know that it meets medical necessity and the insurance covers it, great. The ambulance provider, as an example, will bill the insurance. If it is not covered and it doesn’t meet medical necessity, someone has to bear that cost. In that scenario, it’s the healthcare system or the patient.
Hospitals are moving more towards covering the cost of the ride if it doesn’t meet medical necessity or isn’t covered by insurance. Freeing up that bed with the small cost of moving the patient out and getting them to a skilled nursing facility is cheaper than them staying for an extra night.
What level of EHR and workflow integration do providers expect when evaluating applications?
This is a layered question. I say that because healthcare systems, particularly CIOs and CTOs, have been given a mandate to move away from managing siloed systems that don’t talk to the EHR. They are managing many vulnerabilities in terms of different authentication approaches. That isn’t scaling very well for healthcare systems. Our objective is to bring all of these services inside the EHR and into the workflows. This is a lot for healthcare system IT teams to manage.
For vendors who are looking to get inside healthcare systems, win RFPs, and build a moat around their business, the beautiful part of our application is that you can build your own SMART on FHIR app, white label it with your branding, build your custom workflows with our no-code workflow, and put that inside the EHR. That’s a huge win for their customers, in terms of not having to move to a different system, log into a different application, or pick up the phone.
How do you position that capability within your overall business?
It’s still part of our core business. We offer our no-code workflow tools for web and mobile workflows and scheduling services already, so this is just another channel for us.
We’ve been building out these tools for over a decade. The next phase of our business was that we were building our own SMART on FHIR app and the tools that are needed to make it successful and do it really quickly. It’s an extension of our no-code workflow. We are building infrastructure. We’re not just an application. We’re building out the systems for everybody else to be successful.
What is your perception of the experience of using SMART on FHIR to integrate with Epic?
It’s complex. FHIR as a protocol has been slow to adopt, and SMART on FHIR allows you to have the right tooling to get inside the EHR. If you don’t understand the complexities of that process and dealing with Epic, it can cost a lot of money. You have to maintain it and do security reviews. We have automated these things and baked that into our platform.
We saw the pain point in developing our own application. For our customers, this was a problem that needed solving. Once you are working with us, you’ll see how quick it is to build your own workflows and deploy into Epic. It’s remarkably quick because we’ve done all the heavy lifting, in terms of making sure that the infrastructure is there.
How do you expect to use AI?
We’ve thought long and hard about this, going back to before AI was even a thing. We were building out an agent, which we call ADI, automated dispatching intelligence. It is policy driven. It is primarily focused around automation and removing these manual processes that human beings were still doing on our application, like negotiating best times or prices. We’ve built a framework that will have agents handling different parts of the workflow. We’ve got good data in terms of what the future looks like and how this agent will be more embedded in our workflows.
We have deployed ADI over the last three years. Last year, we hit a record of saving over 100,000 hours just on using ADI for several of our large customers. The framework is there.
The huge win for us is that the way we build the SMART on FHIR application makes it agentic ready. In the future, you’ll be able to use the agents that we have inside the SMART on FHIR app to automate discharge for the patient, coordinate with the vendors, negotiate price, negotiate time, all while the nurse or the case manager carries on taking care of the patient.
Do hospitals still use discharge centers that give patients a place to wait for their ride instead of tying up a bed?
That’s still a thing in some hospitals. We work closely with some of our larger clients that have command centers or patient logistics centers. It’s like an air traffic tower, with patients coming in and patients going out being coordinated in one place. Our platform is so uniquely designed for solving that particular problem, because you can handle both inbound and outbound, or inpatient and outpatient, in one place and get full visibility across all these different services.
What elements will be important to the company’s strategy over the next few years?
SMART on FHIR will be key in a world of agentic workflows and having a framework for us to be able to make a difference in healthcare. We need to make sure that we do it really well. We are the go-to platform for vendors to build SMART on FHIR apps that get deeper inside the EHR. Speed, protecting your business, and winning hearts and minds are important. Being able to do that will be key for vendors.
"A simple search on the named authors (when presented) reveals another carefully concealed attempt at Epic influence..." The site is…