Specialists On Call, Inc., (SOC) uses remote connectivity technologies to provide specialist physicians to patients suffering medical emergencies that need to be immediately addressed by a specialist physician, but where a specialist physician is unavailable.   By providing emergency departments and intensive care units with immediate access to our on-call specialists, SOC is improving patient outcomes, literally saving lives, improving the financial performance of local hospitals and, in doing all of these, reducing the overall cost of care of these patients.
The shortage of specialist physicians available to support emergency departments has worsened to now crisis levels, and this is a nationwide crisis that affects hospitals in urban and suburban settings as well as in rural locations.  Neurology is a particularly critical specialty where stroke constitutes the majority of emergencies, causes many patients severe and permanent disability and, if treated within three hours by a specialty neurologist, frequently can be reversed.  For these reasons SOC began its business by providing specially trained neurologists to hospitals 24/7/365, with our specialty neurologists responding calls for help within 15 minutes. Stroke is the third leading cause of death among adults in the U.S., affecting more than 700,000 Americans each year, and is the leading cause of permanent disability with more than 1.1 million Americans living with significant disability due to stroke, and 20% of those suffering disability severe enough to require long-term care in nursing homes.
Since the founding of SOC more than three years ago the Company has performed more than 6,000 emergency neurology consultations; in 2008 alone the Companys specialist physicians performed more than 4,000 consultations and will perform more than 7,000 in 2009.  For comparisons sake the large grant-funded telemedicine programs  prior to SOC the only form of telemedicine exchange between hospitals  will each perform several hundred consultations only.  SOC has become the fastest growing telemedicine provider in the US and is the largest virtual practice.
SOC has posted this unprecedented growth and continues to double in size annually for two primary reasons: one, we offer a combination of physicians to perform consultations bundled with a low cost, easy to use, very elegant technology solution and two, because our cost-efficient solution provides obvious health and financial benefits to all members of the healthcare delivery system.  In short, our technology solution allows SOC to take advantage of efficiencies in the healthcare system and, for the very first time, create a self-sustaining telemedicine model that is treating new patients by the thousands without dependency on grant or government funding.
SOCs uniquely effective model for the expansion of tele-neurology has captured the attention of the best University neurologists and private stroke specialists across the country  today more than 35 of them constitute our physician corps, and we derive staff through formal agreements with five of the most prestigious University medical centers in the US.  With this access to an expanded inventory, of physicians, SOC will begin offering similar specialist coverage in other medical specialties which are experiencing the same shortage in specialists available for emergencies, including psychiatry and nursing.
SOC is a company founded by a physician, and lead by a physician and executive team that is achieving its goal of providing patients with excellent specialty medical care no matter what time of day they seek treatment or where they seek treatment.  This disruption of the traditional limitation of excellent specialty medical care to the geography immediately surrounding University medical centers is a passionate goal of every member of the SOC team.  

Our technology choices have been and continue to be critical to the success of SOC.  Essentially, SOC is using technology to consolidate efficiencies within the healthcare system and redistribute those efficiencies to settings and patients who need those specialty resources to be delivered in a very time-sensitive fashion.   

Our technology solution has to consolidate the reserve time of physicians when that time is available regardless of their location - their offices, hospitals, and when they are home  and needs to be accessible to them in a uniform means of access from these multiple points.  In order to accomplish this we needed to present these essential users with a simple, widely accessible, reliable interface to our system so that these non-technologists are comfortable employing our technology in their commitment to treat life-threatening medical emergencies.  In order to accomplish this we use SIP compliant, dedicated, industry standard videoconferencing technology because of its reliability and essentially one-button operation, and all other technologies at the physicians hands are web-accessible and so not location-specific.

Our solution is unique and so is unknown to new end-users (staff of our clients) who are busy nurse and physician practitioners in emergency settings.  Their adoption of SOCs technology platform has been essential to the success of SOC, and has been driven by the simplicity of the system and its ultimate reliability  in this demanding environment where users are personally responsible for the health and lives of others, turning to a new technology and in doing so turning away from less effective but known practices, 100% reliability has been key.  Further, our technology must be able to be centrally supported 24/7 so that in those rare circumstances when there is a user support issue our response can be swift and effective  for this reason our client-side technology is custom-built into a wireless framework and always on, accessible and updatable centrally.

Our technology has to be the best end-user profile of everything  simple, effective, reliable  and also inexpensive: our clients are hospitals the vast majority of whom are under tough financial pressures.  In order to deliver against this tall order our technology team had to determine those specific features that were essential to our solution and specifically avoid those expensive bells and whistles that were, well, just bells and whistles.  In doing so we have become the fastest growing platform in hospital-based telemedicine while also being the least expensive platform.

Yes

Yes

Our solution was designed and is delivering upon the promise to distribute state-of-the-art specialist physician intervention to patients who need it, regardless of what ED they find themselves in and what time of day they need help.  In accomplishing this mission for thousands of new patients each year, we are demonstrating that our solution provides benefits for all members of the healthcare delivery process, a true win-win offering; more specifically:

patients get the immediate attention of a specialty neurologist within the minutes-up-to-three hours time window where a specialty neurologist can make a difference  we have saved lives, and reversed disabilities as severe as dense one-sided paralysis that, in the absence of a specialty neurologist, would have been permanent.  This is a life-changing impact for not only these patients but their families and children.
Local emergency physicians who dont have support from local specialist neurologists (this describes most EDs) get that support from us, improving the care that they can deliver and reducing their liability with these critical patients
Our University partners, their specialty neurologists and community practice specialty neurologists have the opportunity to actually deliver upon the promise that telemedicine has long held because our model is scaling without the extreme limitations of grant funding that only can be used for purchases of equipment  our for-profit solution is providing the first scalable telemedicine distribution of their medical missions by being able to actually pay these specialists for their service
Our local hospitals are benefiting not only as their physicians do but also because our service increases their local revenues and their marketplace competitiveness, critical benefits in a time when virtually all hospitals face severe economic pressures
Our non-medical team members  executives, technology staff, sales and marketing teams  are getting a very rare opportunity to apply their commercial skills towards the delivery of critical, very human services within a context of a for-profit business leading its industry.

SOC has crafted a solution that previously has not existed  a model by which telemedicine and its great promise to affect the lives of patients  can begin to scale towards a large, national impact.  

This in itself is exceptional, because over the past decade there has been deployed literally hundreds of millions of dollars of state and federal grant monies for the purchase of equipment for hospitals to be able to videoconference nurses and doctors with their facility, but these dollars have gone largely wasted in terms of measurable patient care because the simple purchase of equipment  without the necessary resources for the adoption and integration of new technology and services, has resulted in many closeted equipment purchases lacking the staff to provide a new dimension of patient care.  SOC has combined the imperative to care for all patients without compromise, with commercial lessons in building scalable financial & operational models, into a hybrid solution that is scaling more than 100% per year and without a single dollar of grant or charitable funding.  Instead, the SOC team has used venture capital to fuel the creation of a self-sustaining financial engine that drives forward a vehicle for extending excellent care to patients regardless of their location or the time of day. 

In building this success, SOC has also achieved a very rare and exceptional melding of normally separated talents and backgrounds into a single highly functional team  this is a fundamental of SOCs success.  Our CEO is a former academic physician with 18 years of experience as a CEO of non-medical businesses.  Our founder and CMO is a former Harvard neuro-intensivist.  Our operational leaders combine experiences running call centers and University medical practices.  Our head of sales and each of our sales team have established success with hospital sales in traditional businesses.  Our Board members include industry leaders in the IT and finance industries.  By bringing together a unique team focused upon a common mission SOC has been able to craft a unique and uniquely effective solution.

Our greatest challenge was and continues to be overcoming entrenched but unsuccessful ways of thinking about telemedicine in many, nearly all dimensions, from being product driven, to being client driven.  For example, a prevailing technology trend in videoconferencing in general, and adopted by many telemedicine concepts, is the use of laptop applications for portable videoconferencing; however, the success of our service is much more based upon video quality (which means commercial grade equipment on broadband connections), reliability (which means dedicated equipment not multi-use PCs) and professionalism  which means professional and appropriate backgrounds and appearances when our doctors are communicating with patients.  So we had to get our technology focus away from the portability so currently in favor in the telemedicine grant program space, and design our videoconferencing solution according to what our clients defined as a good solution.  Similarly, telemedicine trends parallel and include trends in electronic medical records  many efforts today are pushing for both multiple HL7 EMR interfaces, or waiting for a universal solution.  Our clients, however, by and large dont want EMR integration with our systems, their EMR solutions are currently unstable and usually not fully satisfactory, so we put in a web-based and fax-based interface instead, driven not but the cutting edge of equipment vendors but by the ease of use, definition originating from our clients.
We discovered that we had to re-formulate many traditionally held telemedicine practices into practices that were based upon customer-defined success, including billing practices, physician compensation, public-private University partnerships and interestingly, what patients defined as a successful long-distance clinical interaction.

SOC, in consolidating the services of physicians in multiple states into one practicing group crossing state lines and time zones, encountered the most resistance in establishing the administrative foundations of the business.  We were told that it was impossible to secure affordable malpractice insurance for this type of collection of physicians.  We searched hard and found that we in fact could.  We were told that we would never be able to overcome the formalities of hospitals providing service without collecting insurance in the process; in fact our model demonstrates that our business model services the financial interests of hospitals.  We were told that academic and community physicians could not be addressed with a single compensation scheme  we worked hard with each group and have created one that satifies all participants.

Exceeded

Of course when we begin to consider broader impact we run into the edge of our own arrogance!  We have already had a broader impact that we originally expected, and so we are humbled by that success. If we could demonstrate our success as a lesson to other groups affecting our industry, wed do that with these groups and with these intended outcomes:
1) Wed like the success of our model to demonstrate simultaneously to medical practitioners and business people  typically an oil and water combination  that the combination of their talents can build  scalable financial models that underwrite the distribution of care to new groups far faster than grant funding, which is more appropriately the focus of proofs of concept.
2) Wed like the success of our model to demonstrate to government agencies that today will only write telemedicine grants for the purchase of equipment, that they must address a fact that we all know from real world experience  that IT projects that solely install equipment without adoption and training strategies, without motivating the necessary adopters, and without models to demonstrate ROI for the involved customers, will ultimately have very little impact and fail by any reasonable measure of success.  Instead, grants for telemedicine must focus upon those resources, investments, purchases and payments  that drive outcome and not just equipment.
3. Wed like the success of our model to be carried internationally where the concept can be readily applied to moving excess medical capacities from markets with an available surplus of physician time to markets that are underserved  not just moving American physician resources overseas.  German neurologists to Turkish ERs.  English cardiologists to remote Irish hospitals.  Thai hospital physician resources to EDs in Cambodia and Laos.  

SOC sells it services into a very high-intensity industry  clinical healthcare  that is remarkably resistant to change, that is under great financial pressure, which further exaggerates risk aversion, and in the emergency setting we serve is laced with liability considerations which in health providers produces the greatest resistance to change and innovation.  Despite this, we are able to engage and close hospital clients far faster than most medical services businesses  this is the truest, money-where-ones-mouth-is, measure of the embrace of our model and our project.  Measured against selling benchmarks long established by other hospital services companies, SOC gets client attention to direct mail at 100 times the normal rate; gets client meetings at about 20 times the normal rate; closes clients in about 50% of the time normally required; and lead by new client enthusiasm, implements new programs in about 25% of the time normally required for a multi-disciplinary effort like the adoption of a telemedicine solution.  We have grown faster than anyone believed possible in telemedicine, treated more patients than we or anyone ever thought we would have the opportunity to treat (a measurement of the adoption by client physician and nurses users of the service), and we continue to grow at 100% per year.  In the very beginning our clients we tentative users of our services; today, we deal with more than 60 hospital clients and their physicians on a first-name basis because were collaborating with them on the treatment of about 7,000 new patients in 2009.  Adoption allows us to have impact, and we are thrilled with the growth in each of these areas of our relationships with our hospital clients and their industry.