Cleveland Clinic: Alliance of Innovators in Digital Health Submits IPO Prospectus

Not long ago, VCBeat published an article on Mayo Clinic’s internet strategy (Mayo Clinic: Why Am I So Outstanding?) article. A thorough review reveals a rather domineering approach to internet-based strategies, seemingly aiming to dominate the entire landscape. Of course, this presupposes the acquiescence of other benchmark institutions, such as the Cleveland Clinic.

When it comes to Cleveland, there are not as many unofficial legends or anecdotes surrounding it as there are for Mayo; those that do exist almost exclusively concern its familial origins.

On February 28, 1921, the Cleveland Clinic was founded in Cleveland, Ohio. In the aftermath of World War I, the hospital was jointly established by four physicians who had served as military surgeons: George Washington Crile, Frank Bunts, William Lower, and John Phillips. Compared with the Mayo Clinic (founded in 1864), the Cleveland Clinic is half a century younger.

Although there appears to be a “generation gap,” it is no coincidence that they share a common strength—innovation. In Cleveland, innovation has always taken center stage.

For instance, it has developed and refined coronary artery bypass grafting (CABG), pioneered leading-edge arterial valvuloplasty, and performed cardiopulmonary transplantation using total artificial hearts, among other procedures. Moreover, since 1995, Cleveland Clinic has consistently ranked first in the cardiology and heart surgery rankings by U.S. News & World Report.

Likewise, today we will discuss its online strategies. Will it, like Mayo Clinic, have “informants” everywhere, or does it have other “schemes”?

Cleveland Clinic Innovations

On the internet front, nothing better exemplifies its agile strategy than the establishment of Cleveland Clinic Innovations.

Cleveland Clinic Innovations, the commercialization arm of Cleveland Clinic established in 2000 in partnership with the Global Healthcare Innovations Alliance, is responsible for the commercial development of medical technologies developed by the hospital’s physicians and researchers.

Since its establishment, 66 U.S. companies have adopted Cleveland Clinic’s technology, with nearly three-quarters of them securing $750 million in equity investment. Nearly 450 licenses have been executed, 2,200 patent applications filed, and 525 patents granted.

Among them, the most distinctive internet product launched is none other than ADEO. “ADEO” comes from Latin, meaning “move forward,” and it is essentially an e-commerce platform.

Launched in October 2014, ADEO currently offers a total of 13 products. Its portfolio is primarily concentrated in seven segments: medical devices, mobile applications, consulting services, toolkits, e-books, hosting solutions, and installed applications. Both healthcare professionals and patients can purchase medical tools through this platform.

In addition to commercializing medical technologies, it also engages in investment. According to information available on its website, its primary investment areas include medical devices, diagnostics and therapeutics, system software, and biopharmaceuticals. Among these, twelve companies are involved in software systems.

Not only that, it also develops its own apps and incubates new companies.

For example, applications developed by Cleveland Clinic, Cleveland Clinic Innovations, and Cleveland Clinic Wellness Enterprise.

For example, Explorys, a big data company founded in 2009, leverages big data to enhance healthcare standards and service quality. By integrating data from various systems through its powerful healthcare computing platform, it provides comprehensive solutions for clinical integration, high-risk population management, medical cost calculation, and performance-based compensation. Explorys has become one of the world’s largest healthcare databases; however, it was acquired by IBM this April, as IBM firmly believes it holds significant potential in the big data sector.

In 2011, the interactive visual medical records company iVHR was established. It aims to develop a user-friendly, intelligent comprehensive interface for electronic health records using interactive graphics, transforming patient data into actionable information. The current key focus is selecting a group of users to pilot and test the beta version of the system. To date, iVHR has completed four rounds of financing, raising a total of $7.3 million.

Furthermore, like Mayo Clinic, Cleveland Clinic Innovations has also chosen to partner with StartUp Health, extending its reach into the incubator space.

Of course, beyond its most proudly touted deployment—the Cleveland Clinic Innovation Department—what is particularly impressive is its extensive collaborations in areas such as software, personalized medicine, big data, and electronic health records.

Cooperation and Investment

●Electronic Medical Records
According to publicly available information, Dr. Toby Cosgrove, the current President and CEO of Cleveland Clinic, was among the earliest adopters of electronic medical records (EMRs). This system allows physicians’ orders to be entered electronically; its “clinical decision support” feature can alert doctors to potential adverse drug reactions and provide medication recommendations tailored to specific clinical conditions.

Its electronic medical record (EMR) information system, however, was developed by Epic. The system used by physicians is called “My Practice,” while the system used by patients is called “My Chart.”

On the "My Practice" interface, physicians can access patient records from the main hospital and its branch campuses by logging in on any terminal. These records include preoperative medical history, imaging data, test results, surgical details, and postoperative follow-up information.

Within the MyChart system, once patients log in, they can not only view all their medical records from visits to CCF but also see each physician’s schedule and book appointments directly. As the information system continues to evolve, MyChart services are becoming increasingly comprehensive. Whenever a physician updates patient information, the MyChart system automatically sends an email notification to the patient.

Furthermore, in February 2008, in collaboration with Google, thousands of patients at Cleveland Clinic gained access to their online medical records through Google, encompassing all information from prescriptions to diagnoses. Although this initiative raised privacy concerns among some individuals, its fundamental nature was positive.

In addition, Hyland is also a collaborative partner in this area. Specifically, Cleveland Clinic has partnered with Hyland Software for electronic document management solutions, adopting its integrated suite of enterprise content management (ECM) software solutions, OnBase. Its core functionalities include document imaging, electronic document management, workflow automation, COLD/ERM, and records management.

● Hardware
A project called “My Records” was conducted in collaboration with Microsoft. It provides home monitoring devices to outpatients with chronic conditions such as diabetes and congestive heart failure (CHF), and nearly 200,000 patients have participated in the program to date. The hardware measures weight, blood pressure, or glucose levels, while the software inputs this information into patient records and automatically alerts physicians via email when adverse results are detected.

In addition, it partnered with the Boston-based healthcare startup American Well to launch the Telemed Tablet. The Telemed Tablet can be mounted on a stand for easy viewing, bringing specialists “to” the patient’s bedside, nursing station, or operating room.

● Software and Data Platform
In 2011, the Center for Personalized Healthcare was launched. Starting from the patient’s perspective, an evidence-based system for personalized medicine was established, incorporating patient characteristics including but not limited to genetic information and family health history. This system was integrated into the standard medical decision-making process.

Using MyFamily, a web-based tool that integrates electronic health records, patients' family health histories are utilized as proxy indicators for genetic, environmental, and behavioral risks to identify diseases with elevated likelihood. Implementing MyFamily involves creating personalized medication programs to determine gene-drug relationships, thereby integrating pharmacogenomics into clinical practice and clinical workflows.

In May 2013, it partnered with Doximity, a physician community known as the “LinkedIn for Doctors,” to enter the field of internet-based medical education and develop a Continuing Medical Education (CME) system. QuantiaMD provides free continuing medical education services, enabling users to earn American Medical Association (AMA) PRA Category 1 Credits™ by learning anytime, anywhere, and at their own pace.

In May 2014, a joint venture was established in partnership with HealthSpot, a mainstream telehealth service provider based in Dublin, Ohio, USA, that connects doctors and patients via video conferencing, with the aim of reaching more patients through telemedicine technology.

Notably, in early 2013, HealthSpot developed a remote-presence capsule-style kiosk called the HealthSpot Station. The primary role of the HealthSpot Station is to serve as an alternative to urgent care centers and emergency rooms, enabling physicians to utilize their time more efficiently. Inside the capsule, a suite of digital tools facilitates remote diagnosis, including pulse oximeters, blood pressure cuffs, touchscreens, video conferencing systems, otoscopes, and stethoscopes. Additionally, the kiosk is staffed by a care attendant to provide assistance.

On October 31, 2014, a partnership with IBM was established to evaluate the Watson supercomputer system for personalized oncology applications. Through this collaboration, researchers integrated the Watson system with cognitive services, deep computational biology models, and IBM’s SoftLayer public cloud infrastructure to jointly conduct data analysis and research.

In February 2015, a strategic alliance named “Vivre Health” was established in partnership with the U.S. telecommunications giant Cox Communications to develop digital home healthcare services. The system features a local kiosk where patients are received by a physician or physician assistant, while remote video connectivity enables hospital-based doctors to conduct simple physical examinations or consultations for minor ailments. A key advantage is that it is recognized and reimbursed by the majority of U.S. commercial insurance plans, with reimbursement rates equivalent to those for traditional in-person visits. However, the cost is relatively lower, suggesting promising commercial prospects.

On March 9, 2015, a long-term strategic alliance was established with the blood-testing company Theranos to improve patient treatment through innovative testing and reduce healthcare expenditures.

On March 26, 2015, Cleveland Clinic’s subsidiary, Cleveland Clinic Wellness Enterprise, entered into a partnership with the health company SoloHealth® (which was renamed Pursuant Health during the same period).

On April 23, 2015, a collaborative research initiative was launched with HealthXL and HealthBeacon to transform the way patients self-administer injectable medications at home.

In June 2015, Cleveland Clinic launched “MyCare,” an emergency video consultation app for Ohio residents, providing patients with access to a professional physician for urgent care services 24 hours a day.

In partnership with MinuteClinic (a U.S. chain of medical clinics), the two organizations have integrated their databases to share patient information through electronic health records. If a MinuteClinic patient requires emergency care and no qualified physician is available on site, the patient will be advised to seek treatment at Cleveland Clinic, although other facilities are also available as alternatives. Conversely, when Cleveland Clinic receives an emergency call, if the patient’s symptoms are mild, the operator may recommend visiting a nearby MinuteClinic.

Of course, there is also the tech giant Apple, collaborating to develop new approaches for data analytics and health management applications.

Cleveland in China

Cleveland Clinic’s presence in China is slightly less extensive than that of Mayo Clinic (although Mayo Clinic has only three facilities). According to publicly available information,
The sole provider is Beijing Shengnuo Yijia Hospital Management Co., Ltd. Chinese patients can be referred to the United States for further diagnosis and treatment with its assistance. It also offers comprehensive services required for seeking medical care abroad, including appointments with overseas specialists, collection of medical records, medical translation, and overseas accompaniment.

Based on the aforementioned internet initiatives, there appears to be little difference from Mayo Clinic in terms of primary focus areas. However, regarding their respective projects, distinctions do exist: while Mayo Clinic casts a wide net, this entity places greater emphasis on developing long-term strategies and conducting in-depth exploration. This approach evokes the concepts of lean production and continuous cycle improvement inherent in the Toyota Way. Indeed, is such a strategy not an effort to realize the dream of a hospital modeled after the Toyota factory?

In light of this, who says one mountain cannot hold two tigers?!