Innovation Profile: Col. John Holcomb, M.D.
Col. John Holcomb, M.D. is vice chair, professor and chief of the Division of Acute Care Surgery at The University of Texas Health Science Center at Houston (UTHealth) Medical School and director of the Memorial Hermann Texas Trauma Institute.
Q | What would you consider to be your most successful innovation?
A | I was in the army for 23 years and as a military physician was trained in tactical combat casualty care. People don’t usually talk about innovation and tactical combat training, but we created a comprehensive trauma system for the Department of Defense (DOD), which didn’t exist at the start of the war. The trauma system involved integration across hospital systems, helicopters and ground ambulances, big tents and little tents, across continents. Now, if you get injured, you go to the right place at the right time to get taken care of by the right people.
On the commercial side, we spun a small startup company called Decisio Health out of The University of Texas Health Science Center at Houston (UTHealth). Decisio tapped into the angst clinicians have with electronic medical records (EMR). Lots of data goes into the EMR, but not much really ever comes out, so much of the information is hidden from patients and families. The data is hidden from the doctors and nurses as well because you can’t see the information unless you look it up in the computer. The whole military runs on a red/yellow/green dashboard, so we took the small amount of data that is needed for actionable information and situational awareness and put it on an individual dashboard above every patient. Now the actionable data is up on the screen, on your phone and on your tablet. It’s a pretty simple idea and people like it.
Q | What spurred your innovation?
A | In 2003, the Surgeon General sent me to Iraq and asked me to figure out what was wrong and fix it. Turns out, his clinical systems were all disconnected. Helicopters weren’t talking to the ground, this tent wasn’t talking to that tent—there was a lack of coordination. We connected them into one Joint Trauma System that is now integrated. Linking clinical outcome data formed the backbone of our effort. It was a lot of work by a lot of people and we are pretty proud of it.
What spurred Decisio Health was really the angst of the electronic medical record (EMR). I wrote my first order on an EMR as a doctor in 1985. EMRs are good, but they slow things down. There is so much data generated, but we don’t need all of it all of the time. EMRs aren’t going away, so instead of whining about it, let’s do something about it. Decisio Health displays the actionable information on a 42-inch plasma screen above every patient. It becomes a good communication tool for the families to talk to the nurses and doctors and look up there and say, ‘It’s okay to be red; you were red yesterday. But, if it changes from green to red, then we want to know about that right away.’
Q | What are the unique benefits of your innovation that make it a valuable solution?
With the trauma system, you are in a deployed environment. Now the patients who get taken care of by a medic get handed off to a doctor, from a small tent, to a big tent, to a cargo plane, to Germany, to the United States. We have a system of care that is connected, more efficient and now you can track what the medic did in one place and what the doctor did in another. When you have a system in place and a way to process the data, you can see what happens in near-real time. Outcomes have improved in every year of the war.
We don’t know the benefits of Decisio Health for sure yet, because we are waiting to hear back from the FDA—but it has been up and running in Memorial Hermann-Texas Medical Center for over a year now. Every two weeks, we get feedback from everybody including nurses and families, and we have been able to iteratively improve the product. The product has gone through many iterations.
There are bundles of care on the Decisio dashboard screen and multiple publications suggest if you follow the bundles of care, outcomes will improve. Instead of looking at all of the thousands of data elements in all the bundles, you can look at the ones that are red. Green lets you know that you have taken care of all elements. If it is red, you say, ‘Okay, what portion of that bundle do I need to fix?’ All these data are already in the computer, it’s just not easy to see the elements.
Q | What resources were helpful to you when you were first starting out?
Money. You have to have a confluence of money, the right people and the institution that gives you the opportunity to do this. When I left the Army and was recruited to Houston, I was given startup funds through ETF, UTHealth and Memorial Hermann. That coalesced to me coming to start the Center for Translational Injury Research, and part of that was commercialization. Money can be achieved in many ways, but you also have to have a creative environment that allows innovation and fosters innovation, and you have to have a lot of patients.
I am a physician, not a businessman. I struggled because I had a good idea, money and patients, but I didn’t have the business part of that equation. You have to have guys like Bryan Haardt and Gray Hancock, the folks at the Houston Area Translational Research Consortium (HATRC) and the support of the TMC. You can’t do things in isolation.
Q | What advice would you give to other aspiring entrepreneurs or innovators?
A | For physician entrepreneurs, work on something that irritates you. If it irritates you as a clinician, then it’s going to irritate other clinicians as well, and that means they will likely want to use it. Solve a problem, whether it is a clinical problem, a process problem or a device problem. Most of the time you are going to improve clinical outcomes as well.
This is where the non-clinician people are at a bit of a disadvantage. They have other skills, but they might invent something that doesn’t solve a problem. A solution looking for a problem—that happens all the time. You bring in this shiny brochure for your company that you spent a lot of time working on, but you haven’t clearly defined the clinical problem it solves. The best businesses combine both clinical and non-clinical teams.
One of the things that I think is really important is to have a good combination of science and business. Don’t just bring the brochure that says, ‘Buy my device!’ Make sure you put high-quality clinical outcome data next to your device. The companies that have both good science and good clinical data really show their benefit. If you roll out a shiny brochure that has good science, business and clinical outcomes, instead of capturing 10 percent of the market, you might capture 80.