EApp BUSINESS PLAN
Putting environmental health assessment in the palm of your hand Founder, EApp Erin Johnson MPH, MSN, RN, Assistant Clinical Professor Drexel University, College of Nursing & Health Professions
[email protected] 215.694.5006
INTRODUCTION
The EApp is a software application available for download on a mobile device, developed to facilitate environmental health assessment in home environments by healthcare providers. The EApp enables home healthcare providers to utilize local, geographically specific, publicly available, environmental health data to guide conversations with patients using queries, prompts, and suggested patient interview topics. The EApp additionally supports healthcare providers through the provision of a resource database for local environmental health services to which patients can be referred. The 2010 American Nursing Association (ANA) Scope & Standards of Practice includes an Environmental Health Standard of Practice. The EApp enables home healthcare agencies to incorporate environmental assessment as part of their prevention strategies, and as a standard of care. Based on previously developed environmental health assessment tools such as those developed by the National Center for Healthy Housing, the Physicians for Social Responsibility Pediatric Environmental Health Toolkit, the HUD Healthy Homes Initiative, and including data sources such as Environmental Score Card, National Environmental Public Health Tracking Network, and TOXNET, EApp brings together all of the data and education tools that home healthcare providers need to provide meaningful environmental health interventions for patients in their homes. Imagine you have been a home healthcare nurse for over 15 years. Your role is fairly autonomous, and you enjoy getting to know your patients. During the course of your work, you have noted that there are many environmental challenges to health in your patients’ homes and neighborhoods. You have noticed mold, moisture in walls, deteriorating building materials, second hand smoke, cockroach droppings, heavily polluted air from industry nearby, and questionable water coming out of the tap. Recent torrential rains have flooded several of your patients’ basements again. Last summer, you lost two elderly patients with respiratory disease due to extreme heat incidents. You also wonder about the psychosocial and mental effects of chronic exposure to all of these stressors. The documentation tools used by your employer do not incorporate a way for you to document your observations and findings. You also do not have time to research local resources that could help your patients address these environmental challenges. A growing number of community-based and home health programs are compelled to focus more effort and resources on preventing disease, yet programs continue to be challenged to find affordable and effective solutions. As climate change and issues like the Flint Water crisis become more pressing, the need to address environmentally mediated health concerns continues to rise.
MARKET NEED
Poor environmental quality is estimated to be directly responsible for approximately 25% of all preventable ill health in the world. Medical and nursing education programs lack the environmental health content needed to properly prepare healthcare professionals to prevent, recognize, manage, and treat environmental exposure-related diseases. On average, 75% of all medical schools require 7 hours of environmental health training over the course of 4 years. Fewer than half of all pediatric medical programs routinely include environmental health issues in their curriculum, other than asthma exacerbation and lead poisoning. Statistics for the number of hours of environmental health curriculum for nurses are lacking. One survey of undergraduate pediatric nursing faculty revealed that 59% of
EApp Business Plan Erin Johnson MPH, MSN, RN
Page 1
programs reported 2 hours or less in pediatric genetics, environmental health or nutrition content. The general lack of comprehensive environmental health and environmental health assessment training in the health sciences, contributes to lost opportunities for home healthcare providers to intervene and prevent disease early. Preventing exposures at an early-stage can lead to lifelong benefits as well as healthcare cost-saving. Exposure to environmental hazards may directly affect an individual’s health, and indirectly increase healthcare costs. In 2008, the U.S. spent $76.6 billion on diseases of environmental origin in children, or about 3.5 percent of U.S. healthcare costs. The EApp addresses social and environmental justice. Low income populations are disproportionally affected by environmental exposures, and ultimately, the economic costs are disproportionately borne by these same sections of society. Yet, many of the individuals residing in low income communities are not actively assessed for, educated about, or protected from potential environmental exposures. By conducting a patient interview with environmental factors in mind, home healthcare providers can enable families in polluted communities to take positive steps, to incrementally enhance the health of their most immediate surroundings, the home environment. Aside from addressing the needs of the most vulnerable populations, the EApp can also be used to optimize health and well-being of individuals who are already healthy. By assessing for environmental risks, those individuals are enabled to further enhance and protect their health. Optimizing the health of healthy individuals can contribute to our knowledge about what factors keep populations healthy.
VALUE PROPOSITION: PHASE 1, YEARS 1-3
EApp supports home healthcare providers and delivers value by • gathering regional, publicly available environmental health data from a wide variety of sources, directly pertaining to health risks for the patient population that is being assessed. • quickly centralizing publicly available environmental health data. • simplifying and creating one access point. • supporting providers through the provision of patient interview questions and communication prompts related to the data available for the local population. • supporting home healthcare providers through the provision of locally available resources and referrals able to address environmental health assessment outcomes. • providing an online forum where providers can communicate and ask each other questions about how to resolve and troubleshoot environmental health-related issues facing patients.
VALUE PROPOSITION: PHASE 2, YEARS 3-6
EApp manages data and further delivers value by • facilitating healthcare provider collection of data. • facilitating storage of useful environmental public-health data. • generating reports about the location, abundance and type of symptoms experienced by patients and within specific geographic parameters. • providing public and home healthcare agencies with reports that they can use to develop preventive strategies related to environmental exposures.
EApp Business Plan Erin Johnson MPH, MSN, RN
Page 2
•
sharing collected data with other systems, for example EApp could potentially feed in to the Environmental Protection Agency’s “EJSCREEN, a web-based mapping tool which seeks to address the lack of a consistent, accessible, and rigorous approach for identifying areas where there may be environmental justice concerns.”
THE BUSINESS MODEL
EApp’s primary revenue will come from annual platform subscription fees. EApp is being designed to be used as a DIY product; however, training on environmental health assessment is currently planned as a parallel product offering. REVENUE PROJECTIONS, Years 0-4 Year 1 Year 2 Year 3 Year 4 Demand 0 125 900 2,500 Assumptions $9/month Subscription Revenue Growth $0 $ 10,800 $ 81,000 $216,000 Number of Single 0 0 1,350 4,500 Users Total Revenue $0 $10,800 $82,350 $220,500 EXPENSE PROJECTIONS, Years 0-4 Director $45,000 $45,000 $45,000 $90,000 Trainer $0 $0 $10,000 $25,000 Customer Service $0 $10,000 $45,000 $45,000 App Programmers $0 $45,000 $75,000 $75,000 Total Expenses $45,000 $100,000 $175,000 $235,000 Loss/Profit ($45,000) ($89,200) ($92,650) ($14,500)
TARGET MARKET SIZE AND SEGMENTATION
The primary target market for EApp is U.S. based public and home healthcare agencies. The app will work best for an agency which builds longer-term relationships with patients. During the first phase of development, the EApp will specifically focus on RNs within these agencies. Phase 2 of app development and environmental health assessment training would extend the reach and utility of EApp to a variety of other professionals, including social workers, midwives, and nursing assistants. Larger agencies, or those with a national reach enable the aggregation of more (and therefore more robust) patient data, allowing agency management to incorporate environmental health preventive interventions with greater confidence and with greater impact.
EApp Business Plan Erin Johnson MPH, MSN, RN
Page 3
COMPETITION
Based on research conducted, it appears that there are no other similar mobile technology tools for home healthcare providers. There are; however, several platforms or tools that are somewhat related. These are potential competitors or collaborators. •
Green RN iphone App “The GreenRN app provides tips for nurses three times a week to educate and inspire nurse professionals and students about environmental health factors and ways to positively affect their patients and themselves. With our app nurses will receive quick snippets of useful environmental health information such as ways to green your nursing practice, environmental chemicals of concern and how they impact human health, and ways to reduce exposures.”
•
National Environmental Public Health Tracking Network – CDC “The National Environmental Public Health Tracking Network (Tracking Network) is a system of integrated health, exposure, and hazard information and data from a variety of national, state, and city sources. On the Tracking Network, you can view maps, tables, and charts with data about: a) chemicals and other substances found in the environment, b) some chronic diseases and conditions, c) the area where you live.”
•
EJSCREEN, U.S. Environmental Protection Agency: “EJSCREEN is an environmental justice mapping and screening tool that provides EPA with a nationally consistent dataset and approach for combining environmental and demographic indicators. EJSCREEN users choose a geographic area; the tool then provides demographic and environmental information for that area. All of the EJSCREEN indicators are publicly-available data. EJSCREEN simply provides a way to display this information and includes a method for combining environmental and demographic indicators into EJ indexes.”
•
DETOXME, “This free smartphone app walks you through simple, research based tips on how to reduce your exposure to potentially harmful chemicals where you live and work – and it keeps track of your progress.”
BARRIERS TO ENTRY
App and mobile platform development is currently taking place in healthcare at a very fast pace. Some considerations include: • Of the “Best Apps for Nurses: Our Top 10 for 2016,1” the majority used both iOS and Android software platforms. It will cost more to develop the EApp for both platforms initially, but will then be more ubiquitously accessible to nurses. • Robert Wood Johnson Foundation “predicts that the number of mobile health apps will increase by a rate of 25 % a year for the foreseeable future.2” • While many healthcare agencies are switching from paper assessment and documentation formats to electronic, mobile format, the switch is not happening uniformly. The Affordable Care Act incorporates provisions and incentives to encourage the adoption of Electronic Medical Records. It will be necessary to research which public and home healthcare agencies use mobile devices, what types of devices and platforms are utilized in order to further target the market segment and utility of EApp.
1
http://www.nursezone.com/Nursing-News-Events/devices-and-technology/The-Best-Apps-for-Nurses-Our-Top10-for-2016_42638.aspx 2 http://healthcare.dmagazine.com/2014/07/01/mobile-apps-the-new-era-in-home-healthcare/
EApp Business Plan Erin Johnson MPH, MSN, RN
Page 4
MANAGEMENT TEAM • • • • • •
Erin Johnson MPH, MSN, RN: Founder, EApp; Assistant Clinical Professor of Community Public Health, Drexel University, College of Nursing & Health Professions Ethan McCutchen: Executive Director, Grass Commons; Leader in open source software Laurie Colborn RN, MSN: Preventive Health and Wellness Nurse, Independence Blue Cross Marilyn Howarth, MD, FACOEM: Director, Community Outreach and Engagement Core (COEC), University of Pennsylvania, Center for Excellence in Environmental Toxicology Mary Green RN,BSN, MSN: Assistant Clinical Professor of Community Public Health, Drexel University, College of Nursing & Health Professions Dr. Poune Saberi, MD: Section Chief for Occupational and Environmental Medicine, Philadelphia Veteran Administration Medical Center
FUNDING AND EXIT STRATEGY 1. 2. 3. 4.
Seed funding for pilot app development Market testing/user interface testing Subscription service - market development Sell business or partner with government (CDC or EPA)
SUMMARY
The EApp mobile environmental health assessment software application effectively bridges the divide between healthcare and environmental determinants of health, by helping providers to gain easy, quick access to locally specific data that is relevant to the patient they are caring for. Not only does the EApp provide access to data, but it also supplies guiding questions and prompts to help the healthcare professional conduct an effective environmental health assessment, based on the symptoms, needs and priorities of the patient. EApp addresses the relative lack of environmental health assessment training across the spectrum of healthcare providers. Once a provider has located a potential concern (such as lead contamination), the EApp additionally provides a searchable database of local organizations and resources pertaining to that health risk (e.g.: lead abatement programs). During Phase 2, the EApp seeks to compound the benefits of the data collected by the healthcare providers by making it accessible to public and home healthcare agencies, for the purposes of reviewing symptoms and disease clusters in the targeted patient population. Home healthcare agencies will be better equipped to develop more comprehensive, meaningful disease prevention strategies based on the availability of the information that the EApp provides. Further, the extensive use of the EApp would raise awareness about the prevalence of environmental determinants of health among an entire generation of healthcare providers. Lastly, by raising awareness about the extent of environmental determinants of health in patient populations through the use of data collection, the EApp has the potential to influence decision makers and policy. EApp uses and contributes to already existing data, and is therefore a cost-effective way to benefit large numbers of people and agencies working to address environmental, social determinants of health.
EApp Business Plan Erin Johnson MPH, MSN, RN
Page 5
