merger talks. “What we see when we talk to hospitals,” Rohde says, “is this desire to own as much of the paying market as possible, as Step One, and then to try to figure out how to keep them well and happy, as Step Two.”
Part of the idea for Axial Exchange came from Rohde’s own travails as a patient.
As chief operating officer at Red Hat, the enterprise open-source software giant, Rohde was assigned in 2006 to investigate vertical industries such as healthcare where the company might expand. “I very quickly learned that open source wasn’t going to cure healthcare, but I became very intrigued with the problems of interoperability in healthcare,” Rohde recounts. “We decided that the path for the company was to buy JBoss [a maker of open-source middleware] and the rest is history. That would have been the end of it, if I had not gotten quite ill and been plunged into the healthcare abyss.”
At first, Rohde’s doctors thought she had a textbook case of fibromyalgia, in which joint and muscle pain spreads throughout the body. Then she got so weak she couldn’t walk up the stairs—which was strange, since fibromyalgia isn’t a deteriorating illness. Eventually, after shuffling from doctor to doctor—10 in all—without much improvement, Rohde discovered that she had a House-like combination of problems: a fungal infection that was keeping her from absorbing vitamins and minerals, plus Lyme disease.
“In the end, it was a couple of simple tests that diagnosed me, and I wondered what was wrong with the system,” Rohde says. “I spent a year getting intravenous vitamins and minerals, three hours a day, three times a week, so I had lots of time to think. I decided I wanted to do something about the problem. I decided that the only way we are going to change the healthcare system is for consumers to become more involved in their own care.”
This was the late 2000s, way before the current revolution in consumer health apps got started. At first, Rohde thought the biggest problem holding back progress toward better patient engagement was the inability to share clinical information cheaply between patients, doctors’ offices, and hospitals. So the startup’s first product was what she calls an “open source interoperability engine,” designed to connect the back offices of various providers and payers.
After a few sales calls, “It became pretty obvious that from a business perspective the model was dead on arrival,” Rohde says. “The interests-that-be very much wanted to keep their walled gardens up.” (There’s still a perception at the top levels of healthcare organizations, Rohde says, that power in the industry comes from controlling patient records inside siloed systems. But just as in financial services or e-commerce, she predicts, there will come a time when everyone OK? recognizes the value of open standards and data sharing.)
Rohde and her three co-founders—Matt Mattox from Red Hat, John Casey from UBS, and Mark Ragusa—realized that it would be easier to bring about change in the healthcare system by focusing on patients, and piggybacking on their own power as consumers. “This is usually how change happens,” Rohde says. “The payers are worried about the hospitals and the hospitals are worried about the payers, and meanwhile you have the Fitbits and the Apples and the Googles starting what we believe will be a major wave of disruption.”
These days, Rohde says, Axial is staking out a role connecting two worlds: that of “classic corporate integration,” meaning hospitals’ internal IT systems and digital health records, and the world of “consumer integration,” including smartphones, health information, fitness apps, and personal monitoring devices. “We believe the power comes when you link those streams of information.”
There are three basic parts to Axial’s mobile application, which it licenses to its hospital customers under a “white-label” arrangement (patients see the hospital’s brand on the app, not Axial’s).
First, there’s a layer of information from the hospital: physician directories, appointment scheduling, maps and directions, personal health records, and the like.
Second, there’s the educational component. In 2012 Axial Exchange bought a Mayo Clinic spinoff called mRemedy, bringing full access to Mayo’s full library of consumer content, including reference information on nearly 1,000 conditions and diseases. The company also pulls journal articles from 500 peer-reviewed sources, Rohde says.
As users browse the reference section, the app learns what they’re interested in—say, cancer or heart disease—and guides them to deeper content. Hospitals can also program the app to show targeted health information to users based on their age and gender.
Finally, there’s a section of the app that connects to self-tracking technologies such as wireless blood pressure monitors, Fitbit exercise trackers, or Withings scales. The app can connect to 50 consumer devices overall, and help users track and interpret the data so that they can ask smarter questions the next time they see a doctor.
“Your physician doesn’t want to read all your Fitbit data, but they do want to know if your blood pressure was wildly out of range, and what you tried and what else was happening,” Rohde says. “We prompt you for that.” The self-care portion of the app also includes
