This Durham Startup’s ELXR Could Reform Health Data Exchanges

Because of the sensitive nature of your condition, your medical data cannot be shared through the standard digital systems—Health Information Exchanges (HIEs)—that doctors and medical facilities use to transfer and store patient data. Instead, you have to fill out a paper form consenting to share your data with each provider who needs the information about your condition. 

That paper form is then mailed, scanned and emailed, or most likely faxed to your new doctor. The process isn’t only inefficient and costly, it could compromise the confidentiality of your personal and sensitive data which breaches the legal requirement to protect and keep the data confidential the system was set up to abide by in the first place.  

ELXR Health—a Durham-based startup, member of the current Startup Factory class, and one of the eight companies selected to pitch at the Rise of the Rest Showcase on May 5th—has developed a solution to this very big problem. And the founders will soon advise Congress on behavioral privacy and exchange matters too. 

The name ELXR is an homage to the passion of co-founders Paul Emanuel and Clinton Racine for playing role-play video games. In the games they most frequently played, elixirs are featured prominently as a cure-all and help the player win the game or beat opponents. The former gamers didn’t create a magical potion, but the technology they designed is its own elixir of sorts for a population of people who aren’t receiving the same standard of care from health care providers solely because of the sensitive nature of their conditions. 

The technology trashes the paper and moves the consent process online into a digital, customizable, and secure format that lets patients choose who can view their personal records. 

Emanuel and Racine are born and bred North Carolinians from Lumberton and Fayetteville respectively. They met while working as computer engineers for the Cumberland County School System. Racine is an artist at heart, but picked up front-end development and digital design skills at the Art Institute of Fort Lauderdale and has since taught himself back-end web programming.

He wasn’t without work long. A family member running a federally qualified health center (FQHC) asked for his help managing the IT systems handling the electronic medical records (EMRs). He quickly became fascinated by the health sector, and health data specifically, learned as much as he could about it and began contracting with health providers in South Carolina and Georgia to streamline and integrate EMR software into their existing technology infrastructure.

After years of working with EMR data, the pair are now focusing on the systems that contain and transmit the EMR data from one health care provider to another— the Health Information Exchanges (HIEs). Not to be confused with the health care exchanges mandated by the Affordable Care Act, HIEs are owned, operated and managed differently throughout the country and each transmit different records and forms. Despite the differences, they all have a similar flaw—an inability to transfer data for mental health, behavioral health, and substance abuse patients. 

The legal requirements intended to protect these types of patient’s confidentiality has instead created an inefficient system filled with reams of paper and lost time.

Inspired by the federal government’s efforts to break down barriers in mental and behavioral health care (with an open source Standards and Interoperability (S&I) framework through HealthIT.gov), Emanuel and Racine decided to tackle the gap in the market. They used the open source framework, practices and standards released by the federal government and the Substance Abuse and Mental Health Services Administration (SAMHSA), to develop a solution of their own. That eventually became ELXR. 

The solution works like this: A patient that falls into the sensitive information category—meaning he or she has mental health, substance abuse, or behavioral health (including STD’s) issues—logs into a portal in ELXR Health’s system. Once inside the portal, the patient creates and signs a consent form and specifies the specific data to share with healthcare providers. 

On the backend, the computer generates a technical policy from a list of permissions (like who can have the data, what type of data can be shared, and how long ELXR can store it) based on the consent form the client created and sends it to the appropriate HIE. Then, the doctor chosen by the patient (and only that doctor) can view the consent form and corresponding data in the ELXR portal. Though it seems complicated on the backend, the user experience—for both doctors and patients—is seamless from start to finish, the founders say.

Once the technology was complete last year, Emanuel and Racine conducted a six-month pilot with previous clients in Maryland, using the software to facilitate the exchange of information on 7,000 patients between the local health department and hospitals in the community. The results were astounding. ELXR’s portal empowers the doctors to better coordinate care for patients, limiting redundancy in processing their health data and helps ensure they see the right doctor or specialist—instead of constantly landing in the emergency room—when they require care. For every patient under the age of 17, the technology saved the insurer $26 a year. And for patients 18 and older, ELXR saved $135 per patient a year.  

That might not sound like much, but when multiplied by thousands of patients, the savings quickly add up for health care providers and insurers. But the group realizing the most savings is the taxpayer since tax-funded Medicaid is the “single largest payer for mental health services in the United States.” 

In North Carolina alone, more than 1.8 million people were enrolled in Medicaid or the Child Health Improvement Program (CHIP) as of January 2015. Emanuel says 50 percent of these Medicaid beneficiaries fall into the population ELXR serves. So using some quick back-of-the-napkin math—if North Carolina realized the same savings as Maryland, North Carolina could save between $24 and $124 million annually. 

But before ELXR can save anyone millions of dollars the men have to further prove their technology and business model. With help from The Startup Factory accelerator in Durham, they’re in the process of doing just that. 

Emanuel and Racine discovered The Startup Factory when they were searching for a coding school to learn some new skills. They found The Iron Yard, then discovered the American Underground, which led them to The Startup Factory. They applied and were accepted as part of the class that began in March.

They credit The Startup Factory with helping them think through customer service and acquisition. Prior to the program, they didn’t know how best to interact with or listen to customers, and frequently spoke in too technical of terms, Racine says. 

The biggest value of The Startup Factory has been help positioning ELXR to adapt to customers’ needs by customizing offerings and evolving with those customers over time. The Startup Factory team also helped them to better understand and navigate the startup environment. 

Racine says, “Before this, we didn’t know a place like this ever existed, especially in North Carolina. We thought it was all in California and New York City.”

ELXR is about to begin pilots with two new paying clients. The founders will use those pilots to determine their commercial pricing models and how to best adapt their technology to the varying state and federal laws surrounding privacy and confidentiality. With more fee-based pilots in the works, they don’t plan to raise any additional funds in the near future. That is unless Steve Case wants to fund the business on May 5.

They’re perfecting a pitch for the Rise of the Rest Pitch Competition next week. Since they’ve not yet pitched their business in public, The Startup Factory’s Chris Heivly, Dave Neal, and Lizzy Hazeltine are helping with pitch prep. 

If they win, Emanuel says they will use the funding to hire more people and “really let the community know who we are.”