C3N: Advancing Entrepreneurs' Ideas Through Clinical Connections

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Christina Hernandez Sherwood, eMed Editor, MedCity News

The team at Ginger.io, a Cambridge, Mass.-based health data company, had a great product: a behavior analytics platform using smartphone data to create health insights. But they needed a clinical partner to help get access to patients and physicians. That’s where C3N came in.

Physicians at Cincinnati Children’s Hospital Medical Center have created a collaborative chronic care network that links entrepreneurs with doctors, patients, families, researchers, and other stakeholders. C3N, funded by grants from the National Institutes of Health and the Agency for Healthcare Research and Quality, is meant to improve health outcomes for large populations, accelerate the pace of learning, and increase the speed of innovation – all while reducing healthcare costs, said Dr. Peter Margolis, co-principal investigator at C3N and director of research at Cincinnati Children’s.

The organization is a perfect example of how major research institutions are incorporating innovative thinking - and their approach is instructive for entrepreneurs looking for ways to better work with organizations that can validate and improve a startup company's product.

Though entrepreneurs are just one part of the collaboration at C3N, Margolis said they play an integral role in advancing knowledge and improving outcomes for patients with Crohn’s disease and ulcerative colitis, the conditions at the center of the project’s work. “We like [working with entrepreneurs] because we get access to new ideas and innovations outside of our field,” he said. In turn, entrepreneurs working with C3N gain access to a provider partner that can help the company build evidence around their product and measure success, said Karan Singh, Ginger.io co-founder. “It’s critical to be working with a provider partner,” he said. “We wanted a clinical partner that understood the patients.”

C3N grew out of ImproveCareNow, a network of physicians who collect and share data and use quality improvement methods to improve outcomes for patients with Crohn’s disease and ulcerative colitis, Margolis said. The network began to see improvements in outcomes after its 2007 launch, but something was missing. Several key stakeholders, such as entrepreneurs, patients, families, and researchers, didn’t have seats at the table. Rather than maintaining a clinician-centered approach, a new project was imagined: a collaborative chronic care network that accelerated progress by enabling a varied group of stakeholders.

C3N was born in 2009 and has since grown to encompass 51 care sites, 450 physicians, 1,000 staff members, and 15,000 patients. About a dozen entrepreneur-developed interventions are being designed and piloted at C3N sites across the country. Various structural and procedural mechanisms allow such a large group to work together effectively, Margolis said. Stakeholders communicate virtually through email exchanges, webinars, and document and data sharing. All C3N participants measure the same outcomes. Data from dozens of centers is collected by a network registry and analyzed each month to track progress. “We use processes that were developed in the clinical trials world to manage the data,” Margolis said. “By focusing on the outcomes and data about the way care is delivered, it ends up being a pretty small set of data elements that researchers can use to improve their care.”

Entrepreneurs come up with some of the innovative ideas that fuel learning at C3N, but they need the network to connect them with data, patients, physicians, and others, said Dr. Michael Seid, co-principal investigator at C3N and director of health outcomes and quality of care research in the Division of Pulmonary Medicine at Cincinnati Children’s. “We think of ImproveCareNow and C3N as potential labs for entrepreneurs to get to that last mile,” he said. C3N entrepreneurs work with researchers, project staff members, faculty, and patients to prototype their interventions. Rolling out the product might start with a run-through of the analog version of the intervention with a single patient. Once they understand enough about the intervention and how it will be implemented, they’ll pilot it. “Entrepreneurs can help us design the pilot, help us collect data,” Seid said. If the intervention is ready for implementation, ImproveCareNow and C3N provide a distribution channel from the entrepreneurs to thousands of doctors and patients.

The company Ginger.io is using its core platform -- which culls smartphone data like movement patterns and screen time to develop health insights -- to create a model specifically for Crohn’s disease and ulcerative colitis patients, said co-founder Singh. When patients begin to exhibit early symptoms of their disease, he said, they often change behavior, sometimes entering “hibernation mode.” That means data from their smartphone that shows more missed calls than usual or a quiet night at home rather than on the town could mean the patient is suffering a flare-up, Singh said. That data would help healthcare providers track patients and get them the care they need. “We’ve been describing this as a check engine light for your health,” Singh said.

Patients appreciate the chance to bring their perspectives to new interventions focused on their diseases, said Jill Plevinsky, who became involved with C3N as an inflammatory bowel disease patient and now leads the collaborative’s patient advisory council. She guides a group of young Crohn’s disease and ulcerative colitis patients as they work with entrepreneurs, developers, and researchers on C3N projects. “It was meaningful to feel like the intervention leads and researchers were really listening,” said Plevinsky, who works as a clinical research coordinator at Boston Children’s Hospital. “It’s important for children and adolescents because a lot of the anxiety and depression about having chronic illness at a young age is from not feeling in control.”

It’s important for entrepreneurs to remember that an idea is just a starting point, Seid said. “Ideas are cheap,” he said. “It’s the implementation of the ideas that’s important.” Working with patients, physicians, and researchers could mean all the difference between an idea that goes nowhere and one that develops into an implemented intervention. As C3N adds more networks over the next few years, Margolis said, entrepreneurs would have more opportunities to partner with the collaborative. It’s possible that C3N could expand to other disease groups, he said, especially other serious chronic illnesses in pediatrics. Interested entrepreneurs can visit the C3N website or email the project.

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