BIG IDEAThe Algorithm Is InWhy smart software means better diagnoses.
When aches and pains keep you up at night, Google is not your friend. According to a 2008 study, about 50 percent of people who diagnose their ailments online believe that the higher the search-engine ranking, the more likely it is that they have the disease. Guess what? "That's completely false," says Craig Monsen, a computer engineer and Johns Hopkins medical student who co-founded Baltimore-based Symcat, a new kind of online symptom checker. "When you type a symptom into Google, the problem is you're not getting content sorted by likelihood. For back pain, your top results might be malaria or tuberculosis; for muscle twitching, you'll get Lou Gehrig's disease. The fact is, these are actually quite uncommon. That causes undue concern or is at best unhelpful."
Apart from the bad-diagnosis problem, says Monsen, online sources like WebMD are more like encyclopedias than diagnostic tools; they're really just textbooks put on the Web. "That works well for search-engine optimization," says Monsen. "But it doesn't provide an answer to what you have or tell you what you can do about it." Symcat's focus is to answer these questions as quickly as possible, using a data-driven approach similar to that used by companies such as Netflix or Pandora to suggest movies or music.
The software's simple interface lets users type symptoms into a search box, prompts them with follow-up questions, and then compares the responses against patient data from the Centers for Disease Control and other public sources. Using the same kind of triage algorithm as physicians, Symcat presents a list of possible causes and their percentage of likelihood, and recommends next steps that could include self-care, calling a nurse practitioner, or visiting an urgent-care center.
Why not just call the doctor? "That's great if you have access," says Monsen. "But that's the problem--so many people turn to the Internet because the health care system is not optimized for access. Your average wait time to get an appointment is about three weeks, and your appointment is 12 minutes long. The ER is convenient, but that creates another problem.
"There's a growing recognition that we need to do a better job getting people to the right level of care, or else they will take advantage of the most expensive option, which is the ER," Monsen says. "It's not Symcat's intention to be a substitute for a doctor, but to empower people with actionable information and be a guide to the universe of health care options--a first step to figuring out where you belong in the system."
BIG IDEAYour Doctor Is Watching YouHow a simple text message can make you healthier.
In health care-speak, compliance means doing what your doctor tells you to do. In other words, after you leave the office or hospital, do you actually get the lab tests and take the medication as directed? It's a crucial question: Studies have shown that noncompliance causes 125,000 deaths a year in the United States and leads to as many as 25 percent of hospital and nursing-home admissions.
New York City-based Medivo, which raised $7 million in Series A funding in 2011, is trying to help. Launched in 2010, the company aims to close the loop between doctors and patients. CEO and co-founder Sundeep Bhan envisions it as a sort of customer-relationship-management system for doctors, helping them refer patients to labs, collect the results, and send follow-up reminders. The service is free to doctors and patients; Medivo aims to make money via advertising on its platform. "Health care in general is very reactive," says Bhan, who sold his previous company, Medsite, to WebMD in 2006. "You see a doctor when something is wrong, but there's no follow-up care between visits. And doctors have no real platform, resources, or incentives to proactively manage their patients. There's no mechanism to remind a diabetic patient to get his hemoglobin tested every three months."
The same goes for medications. It is estimated that 70 percent of all prescriptions are never consumed, and 20 percent of all new drug prescriptions are never filled. The problem is especially acute among patients with chronic illnesses with complex drug regimens. The result often is high-cost complications.
New York City-based CareSpeak Communications, meanwhile, uses simple mobile technology to encourage better compliance: a two-way text-messaging platform that sends reminders to patients and people who assist in their care. CEO Serge Loncar founded the company in 2006 and based it on three core beliefs: that the mobile phone would play an increasingly important role in health care; that a patient's entire "circle of care" should be involved in managing one's health; and that text messages would be the most nondiscriminatory way of staying in touch. Customers, including pharmaceutical companies and health insurers, pay a monthly per-user fee.
CareSpeak has already demonstrated better outcomes through the platform: A 2009 study published in the journal Pediatrics found that for a group of high-risk pediatric patients getting liver transplants, using the CareSpeak system resulted in a significantly lower rejection rate. Half a dozen studies currently under way are looking at the system's impact on wellness and chronic and acute diseases. CareSpeak last year signed an agreement with United Health Group, which hopes the platform can help lower the cost of care for the 26 million patients in its coverage network.
Loncar is excited by the wave of innovation in health care, though he acknowledges that any real changes will be driven less by entrepreneurs than by demand from consumers. "The systems that win will be those that get consumers to engage the most," he says. "If we can come up with apps that the consumer will embrace, then the system will have to change."
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Adam Bluestein is a frequent contributor to Inc., writing about health care, innovation, and new technology. He lives with his wife and two children in Burlington, Vermont. @AdamBluestein