While driving home to Raleigh after meeting with a client in Greenville in late April, North Carolina, Tommy Bohrmann, co-founder of Roundtable Analytics, did what many people do at the end of their day—he called his mom. But this time it was more than a simple check-in.
Bohrmann wanted to relay the news that a plan his company helped Vidant Medical Center discover and implement months prior was actually working. Roundtable Analytics’ software hired 17 new nurses to cut costs, streamline care and increase efficiencies for Vidant’s emergency department.
Bohrmann’s mother wasn’t just proud of her son’s work, she was thankful. As a career-long nurse, she interacted with many consultants tasked with cutting costs and increasing efficiencies over the years. She said their strategy rarely included hiring more nurses. Rather, they often recommended firing, cutting back hours, or reducing the number of nurses on duty at a given time.
It’s this novelty that has attracted roughly $1 million in private equity, and another $1 million in federal and state grant dollars, landing the startup with contracts with both Vidant and UNC-Chapel Hill, and helping the team win the “Best Emerging Startup” award at the WRAL TechWire awards last month.
Bohrmann and his colleagues didn’t come up with the idea on their own though. Instead, the strategy was developed by the cloud-based software they created called, the Emergency Department Strategy Lab (EDSL), devised after analyzing the emergency department’s data and a host of other factors the Vidant team input into the software. The lab then simulated hundreds of scenarios and strategies to increase the department’s efficiency.
One simulation from EDSL predicted adding nursing staff would be an extra cost up front, but would help Vidant save a lot of money and improve their care significantly in the long run. Despite being halfway through their budget year, the hospital implemented the plan. So far, the software’s predictions have held true.
The product of years of research, the technology is the first-of-it’s kind for healthcare institutions, accomplishing in an hour or less what previously took months or years, and it’s fully customizable.
For Bohrmann and the rest of the team, the recent successes are a validation of what they’ve long known to be true—that the massive amounts of data produced daily by emergency departments can be leveraged to improve their operations if compiled and analyzed correctly. And they predict these early successes are just the start to what they envision their company can contribute to improving the healthcare system.
Building Roundtable
Bohrmann met his cofounders, Kenny Lopiano and Tate Holt, during graduate school at the University of Florida. While training to become statisticians, he shared office space at the university with Lopiano and Nate Holt who introduced Lopiano and Bohrmann to his father, Tate, a serial entrepreneur with multiple acquisitions under his belt. But it wasn’t until years later when Lopiano and Bohrmann both ended up working in North Carolina that they reconnected and decided to go into business together.
(From left): The Roundtable Analytics team is made up of Kenny Lopiano, Tate Holt and Tommy Bohrmann.
Bohrmann was at the environmental and infrastructure services company, Cardno ENTRIX, when Lopiano, who was completing his postdoctoral fellowship at the Durban-based Statistical and Applied Mathematical Sciences Institute (SAMSI), came to him with an idea inspired by his work with SAMSI.
Most of Lopiano’s work at the institute focused on improving data-driven decision making for healthcare organizations. As he modeled new applications for emergency departments, he discovered that they were not effectively using the troves of data collected on patients and management practices to inform decisions or strategies. His interest piqued and he enlisted Bohrmann to help design a new tool to help emergency departments use their existing unused data to better allocate resources.
Their working theory was that the millions of bits of data produced by the now mandatory EHRs and internal sources like employee’s schedules and patient volume were at best underutilized and at worst not consulted by decision-makers in emergency departments. They saw this as a missed opportunity and set out to solve it.
If they could help emergency departments leverage data to make more informed, strategic management decisions—like how to best staff their ERs or how to best arrange the beds—then he could help the roughly 5,000 hospitals in the United States increase efficiencies, reduce financial losses, reduce wait times for patients and ultimately improve their quality of care.
Soon Bohrmann and Lopiano were developing statistical models in their spare time that would later become the backbone of their software. And in early 2014, after a few months of work, they convinced Tate Holt to join them as the company’s CEO.
In 2015, Bohrmann and Lopiano secured joint appointments at the University of Florida and East Carolina University to partner with research institutions to research their simulation modeling solution. They also received $225,000 in grant funds from the National Science Foundation (NSF) and a matching grant of $50,000 from the One NC Small Business Program from the NC Office of Science, Technology and Innovation to fund their research.
Their research was successful and a year later they were awarded another $750,000 from the NSF and began partnering with UNC-Chapel Hill’s emergency department.
The funding and opportunity to partner with academic research institutions allowed Bohrmann and Lopiano to transform their thesis into a product, the EDSL. They launched the product commercially in September 2016.
Discovering solutions with data
Bohrmann likens EDSL to Turbotax because it is user friendly. person of any technical skill level can use the software,and it guides the user through the process in a stepwise fashion, prompting the user to make selections based on their needs and desired outcomes.
But unlike Turbotax, Bohrmann and his team spend a lot of time learning about the partner’s existing practices, procedures and structure so they can accurately customize EDSL for them. Likewise, the client invests a lot of time into tailoring the software. As such, Roundtable refers to clients as “partners” since it requires an equal amount of work from each side. Before a partner ever touches EDSL, Roundtable Analytics inputs the number of patient beds found in the ER, how many nurses are scheduled for each shift, patient volume and all the other minute details differentiating one emergency department from the other.
Once the software is tailored, Roundtable’s team teaches the partner how to use the system to generate their own solutions. Bohrmann says when you account for every small decision made daily by staff and managers, there are literally millions of different combinations of inputs the partner could include while completing the simulation. But the software walks the partner through each step. And Roundtable also is on call to consult with their partners on any questions they might have throughout the process.
The results are a list of simulation models that help emergency department staff determine which combinations result in the best decisions. Each projecting what to expect in terms of meeting predetermined metrics or goals, expenditures and revenue, how well the patients will be cared for and many other things.
Traditionally, models like these are built by teams of experts and require months to prepare. But Roundtable’s SaaS product can deliver hundreds of models in just hours thanks to it’s reliance on the cloud, from which the software obtains most of its computational muscle. Bohrmann says the cloud is what enables EDSL to operate so quickly. Without it, EDSL could not have been built.
Once the simulations are finalized and management decisions are made based on the simulations, Roundtable sticks around to help the partner implement the plan and any subsequent plans they make based on the software’s simulations.
Scaling in the future
Bohrmann and his team are excited about the progress and partnerships they’ve struck so far, but they believe they’re at the very beginning of their startup journey.
They anticipate that their software is highly scalable, to both academic hospitals and community hospitals. And once they expand to those facilities, they may consider a broader expansion to different departments within the hospitals like pediatrics or geriatric departments.
But for now they’re laser focused on emergency departments, which they see as areas where their software can have the biggest impact in increasing efficiencies.
As Roundtable grows, the founders believe being based in the Triangle will aid in their expansion in finding the best talent to supplement their team. Bohrmann notes, “[There are] a lot of clinical, technology and data-minded people here.” But for now he says the team plans to stay “as lean as we can for as long as we can.”
And they believe they’re offering a better service at a cheaper rate than what is currently available to emergency departments. Bohrmann explains that once the software is tailored to the organization, each new simulation is “pennies on the dollar” compared to the alternative offered from standard consulting firms.
They also don’t believe partners will outgrow their software and services once they implement the plans derived from the simulations. As Bohrmann describes it, a simulation may recommend one or many changes to management structure or procedures, but it also prioritizes the changes to help users decide which to conquer first.
Each change could take months to years to implement though, and additional changes may not be undertaken until after the original changes are completed. Essentially, there’s always ways to improve a department’s operations and services, and Roundtable believes their software, coupled with the expertise they offer in implementing solutions, will ensure their partnerships remain intact for long periods of time.
