I am frequently asked about the “A-ha” moment that led to the creation of Symcat. This is frustrating because I usually have to make something up about an apple falling on my head or a dream about a snake. People generally think of ideas as spontaneous, as not existing one moment and existing the next. But Symcat has taught me that they are wrong.
I applaud the New York Times for elucidating the incentives that underlie adoption of EMR systems in large medical centers . Bob Wachter wrote a critical piece arguing that Meaningful Use incentives were necessary—that the adoption curve for EMRs is the absolute measure of improving patient care . I want to give the perspective, as a student of medicine and technology (and a daily user of hospital EMRs), that the five major EMRs that now hold control of 50% of our major medical centers and a similar amount of our patient data are unlikely to deliver on promises to improve the quality of patient care . This is due, in part, because Meaningful Use has failed to emphasize the importance of design and open data in health information systems.
Much ink has already been spilled about the impending primary care crisis. Fifty years ago, 50% of physicians practiced primary care. Now, it is only 30% of them and many of those primary care physicians (PCPs) are approaching retirement. According to a recent Senate report we are short roughly 16,000 PCPs already and this number is expected to grow. Wait times have been steadily increasing and it is becoming harder and harder to access the quality PCP that we all need. It would seem that physician-provided primary care is dying.
In truth, the PCP is already dead. Step inside any PCP office for a moment and reflect on how many substantive interactions there are throughout the day. The average PCP spends less than 15 minutes with each patient, leaving 5 minutes for your history, 5 (generous) minutes for your physical, and 5 minutes for assessment / wrap-up. Somehow, these brief interactions are expected to do some of the most challenging work a physician faces: educating the patient and promoting healthy behaviors. A pediatrician I spent time with during medical school often joked that he needed roller skates to keep up with the patient volume. Something like these babies might’ve helped.
c/o MDG Advertising
If you’re like me, you’re extremely excited about the potential for design to reshape health care. I’m not talking health care system redesign (ACOs and such—though that’s great too), I’m talking about the type of design you see on Dribbble: the focus of a recent (awesome) HHS-sponsored competition.
One of the promising upstarts of health care re-design was a 2-year-old-or-so startup called Massive Health founded by ex-Mozillite Aza Raskin. Though I tend towards the skeptical, there was a part of me that thought that not only were they on to something, but they clearly had managed to aggregate real design talent. And in health care, no less! Apparently, I was not the only one as they convinced a number of investors to throw $2.25 million in to test out what they could do.
And what did they do? The Eatery. A quote-unquote “App Experiment” (because apparently Beta is out of vogue). Definitely addressing a real need. Definitely well-designed. But ultimately flawed. Crowd-sourced food rating should work, but there may have been an accountability problem. I, for one, did not know whom to blame when I was told that a picture of my sneaker scored 8/10 for healthy eating. Still, I was optimistic that a few iterations, a handful of pivots, and a dash of some refocused clinical perspective were a recipe for a successful Experiment #2.
Unfortunately, Experiment #2 never came. At least not to my knowledge. Instead, the next I hear of them they are being acquired by Jawbone. Amount: undisclosed. There was some speculation of “tens of millions,” but those quickly fizzled under scrutiny. Instead, it seemed to be another acqui-hire along the lines of Pipette (ie not really market validation, but a clap on the back and a “you’ll get them next time”).
If there is a lesson here, it is that there is more to empowering people to take control of their health than just making a well-designed app. Massive Health represented a movement whereby technology and design could cure health care’s woes from the outside-in. Today, it remains an open question whether or not consumers outside of the niche can be engaged in their health care through apps alone. I remain optimistic, but I may feel a little like “been there, done that” the next time a seasoned Silicon Valley vet says they know how to fix health care.
As far as valence, I’m honestly of mixed opinions as to whether this is a good or bad thing for the greater consumer health space. My bias would be to prefer a greater quantity of the small, agile players in the space, but I suppose having a few new juggernauts offer more contour to the Castlight, ZocDoc, Practice Fusion first-wave health IT gallery wouldn’t hurt. Regardless, I feel that this is a sign of things to come with a good bit of consolidation happening over the next 18 months in the wake of the record year of investments for “health IT” in 2012.
I’m curious, what lesson do you take out of Massive Health’s story?
I was recently asked “what are 4 things you measure where you work?”
Being part of a startup means there’s little room for error. It’s important to figure out what works vs. what doesn’t work early on. The key to doing this is to spend time coming up with various campaigns geared at user-acquisition as well as user-retention, spend time exploring each channel and start to focus more on those that seem more productive while phasing out those that haven’t been effective.
Some things will work well for some startups but won’t for others, so it’s never a waste to spend time figuring out which is which. It takes time to grow companies, the overnight success stories you hear or read about aren’t really “overnight”, in fact it took years. Before Pinterest became a household name, there was the 2 year phase of iterating and figuring out what worked. Sometimes it’s a completely different product (would Instagram be as popular if it kept the original project name, Burbn?)
Here are some things you need to start keeping tracking to help your company grow.
1. Monthly Recurring Revenue. Especially for SaaS businesses, it’s important to keep track of the revenue coming in - a great indicator of the product you’re building in the first place. Do people need it? Is this a problem that needs solving? If people vote with their wallets, then this is the Gallup polling for new companies.
More important than just revenue coming in however is the “recurring” part of it. Are people happy to keep paying month-in, month-out or do they use your product for a month or two and drop out from premium to free? This leads us neatly into a related topic, churn.
2. Churn. How many people are leaving your product per month? Steady growth in distribution can quickly be eaten away if you don’t keep this attrition low. When people have something that fascinates them and keeps them wanting more, they tend to keep the channel open. I’ll give an example, I just did a mass un-subscribe from a bunch of e-mails coming to my GMail account and left only about 10. The reason I left those 10 is that once in a while they actually send me e-mails I want (eg discounts, free trips, free downloads, pro-tips etc). In my mind, I’m hoping that they send those things again sometime soon, so I left them open. That’s how they’ve engaged me. Find a way to add engaging features to your product and churn will reduce drastically.
Pro-tip: The way to reduce churn in the long run is by getting feedback from users who left and addressing their reasons.
For more on churn check out a free chapter from Patrick McKenzie’s book Sell More Software.
3. Cost Per Acquisition. (CPA) How much does it cost you to bring in a new user? Without a doubt, the quickest and most pro-active ways to get users in are Advertisements and Partnerships. The latter sometimes could be unpaid but more often than not, getting your first few hundred thousand users means spending some money for a distribution channel.
As your company grows, you need to add more channels. I recently read an article that summed up how leads work for SaaS companies, “…they usually start with a couple of lead generation programs such as Pay Per Click Google Ad-words, radio ads, etc. What we have found is that each of these lead sources tends to saturate over time, and produce less leads for more dollars invested. As a result, SaaS companies will need to be constantly evaluating new lead sources that they can layer in on top of the old to keep growing.”
But CPA is only one part of an important equation. The other is…
4. Revenue Per User. (RPU) This represents the value of each user. How much does each user bring you in revenue. This is also sometimes called Lifetime Value. If RPU is low, you may be experiencing trouble with your churn (losing paying customers) or in reaching your target market. As far as paid solutions, I prefer adRoll for reaching my target. They place your ads in front of people who have searched for something similar to what you have. Not a bad place to begin if you are doing PPC.
So how should you get started with this metrics?
i. Do a business health test. Sum up all marketing spend and divide by total users acquired. This represents CPA, also average out Revenue per user (RPU). If CPA > RPU, your business is not healthy! You may need to reduce CPA to match RPU. If RPU > CPA, then you’re in good shape. Ratchet up the marketing budget but watch out for evidence of diminishing marginal returns!
ii. For each individual marketing campaign, calculate CPA, double down on the ones with low CPA relative to RPU. Not all marketing ideas are good ones and you should take advantage of the ones that seem to be working!
Now that you know what we like to measure, we would love to hear about what YOU are measuring.
It’s ironic how Health IT works, people are constantly building to make it easier for you to understand your health, make better medical decisions so you end up becoming so self-sufficient that you eventually have no need for these tools anymore. Are we at that point yet? Definitely not. Are we closer to it? Certainly making progress with every year that passes. In 2013, there will be several new innovations that will spring up in the space, but there will also be growth on the work done previously. Here are a few things we think will really take shape in 2013.
1. Personal Health Records will see some change. In the past, there has always been the health records that are not necessarily available to the average patient. Until very recently, very few consumers have signed on standalone PHRs but we imagine things will most likely start to really change in 2013. With tools like Symcat, people are able to keep a digital health record for themselves where they can keep track of their symptoms, medication, allergies, family health history, health plans etc. We believe there will be a lot interaction between PHRs and digital health records like what Symcat provides.
Large companies like Microsoft seem to be betting on this as well, they have recently launched a pilot with Greenway Medical Technologies that will add clinical data to their own Microsoft’s Health platform. By marrying both sides, users now have information available that was never the case in previous years.
2. Mobile Health. We think there will be a lot of progress in mobile health generally. We already know of a lot of services offering users the chance to set up appointments, get diagnosis or Doctor recommendation over mobile devices, but we think there will be even more progress in this sector in 2013. A big contributing factor has been the ease with which people can access EHRs - information that used to only be accessible in hospitals.
In line with all of these, we’ve also seen a surge in number of fitness and health apps people are downloading to their mobile devices. Patients with chronic diseases are also taking advantage of iPhone and Android hardware attachments that let them measure blood pressure, sugar level etc and report them back to their physicians. There will be a lot more of this in 2013. For entrepreneurs looking to build Health IT startups, this is one area you may want to look at, as there won’t be any slowing down there in the next 5 or so years. At Symcat, we are always working to improve and evolve the digital health record part of the app to make tracking and reporting even easier than it is now.
According to a recent PricewaterhouseCoopers survey of consumers and physicians, more than 50% of consumers predict that within the next three years, mobile health will improve the convenience (46%), cost (52%) and quality (48%) of their healthcare. Time will tell.
3. Growth in Telemedicine. Telemedicine has been around for a while but there is bound to be movement in this space with all the technology that is being developed everyday. A few weeks ago, Symcat was at the mHealth summit in Washington DC and right in front of our booth was Intermountain Healthcare, promoting some of the new telemedicine innovations they’ve made available. Their consumers are now able to track and send their health reports to their healthcare provider and when the need arises, they can easily jump on a video call with a Doctor who has all the information he needs to give you a diagnosis and offer a treatment. There will be a surge in this space as well in 2013.
4. Big Data Analysis. With all the data available in healthcare these days, there will be several attempts to use all of that to provide -amongst others- preventive information for consumers. People will very easily and very quickly get a heads up when there’s an outbreak of illness brewing and measures on how to avoid it. There will be innovations that personalize health-related advice for users based on health history and conditions like never before.
The festive period is usually packed full with reasons to over-eat, stay out late, enjoy a lot to drink and neglect your usual fitness schedule. The good thing however is the New Year also presents new opportunities to jump back into the previous cycle or create new ones. For those of you who are bored and tired of the same old - go to the gym and work out routine, we’ve got some great fitness trends for you. Start 2013 with fun fitness plans, here are a few:
1. Trail Running. While this has been a pastime for a long time now, there’s recently been a particular surge in the number of people using it as part of a fitness regimen and we think it will kick on even more in the New Year. Find a safe trail, grab a friend, some trail-friendly shoes and get running! The best thing about trail running is the serenity around it, you get to focus on your workout without distractions and get your cardio in on a regular basis.
2. Group Fitness Sessions. One of the biggest reasons why most people fail to consistently follow their fitness routine is the lack of motivation. There will be days when you don’t just feel up for it, you feel tired or even just feel “well it’s just one session, I’ll make it up next time”. This is why group fitness sessions are going to keep getting the hype they’ve been getting lately. It involves getting a group of work out buddies together (not too many, 3-6 will do), motivating each other and working out together. There are several gyms and personal trainers who offer their services to groups at discounted prices these days, should be easy and fun to do. The best thing about group fitness is that you will be accountable to your mates and vice-versa. It never feels good when you know you’re the one who let down a group of people, does it?
3. CrossFit. This was all the rage last year and we think even more people will discover and join in on the craze. These are super fast and intense work out that combine a whole lot of activities in one session. You’ll end up running (in sprints, in short jogs), lift weights, do some gymnastics amongst other things. These sessions are built on the premise that by forcing yourself to do so many various activities so intensely, you are able to build strength, power and endurance at the same time. To learn more about Crossfit, check out their site.
4. Get your dance on! Most people don’t know how much a good dance session does for the body fitness-wise. Besides dancing at a party, there are several dance clubs and gym-organized dance classes geared to help you keep in shape. They involve high energy routines and non stop movement for several minutes which mean they are great for cardio. The best part? They are so much fun. Most people like to dance anyway, so dancing to pre-selected music that lets you break a sweat should be motivation enough. Research has also shown that an average ‘Zumba’ class burns more than 300 calories and they also engage your entire body, hitting muscles traditional workouts may miss.
Most gyms have dance classes, so if you belong to one, be sure to ask and find out where and when the classes are. If not, just find a local dance class in your area.
5. Zombie Runs. Ever since the Hunger games movie, the Zombie runs have gained popularity and rightly so. They are so much fun that it could even count as a 2nd or 3rd date idea. The idea behind these? Participants each start out with “health flags” indicating you are one of the ‘alive’ people, and you get chased by a number of people dressed as Zombies. In the big picture, participants end up running through a 5k obstacle course sometimes (distance varies - you could find shorter courses around you). This is perfect for people who don’t usually have the motivation to just ‘up and run’ by themselves, zombie runs give you motivation as you are being chased along with hordes of others.
6. Can’t make the gym often enough? Go digital. For those who aren’t too keen on going to the gym 3 times a week or just don’t have the time for it, you could try getting your hands on the workout videos that have been getting a lot of buzz lately. Popular video workout series like Insanity and P90X have been the mainstays, they help users follow a few weeks of pre-planned work outs and help you get in tip top physical shape. They are a bit expensive but almost as much as you pay for your gym membership anyway.
7. Bootcamp style workouts. One big trend we predict for 2013 will be the rise in popularity of the US Army’s basic training program amongst us civilians. They are a set of calisthenics (push-ups, squat thrusts, punches, kick, crawling, jumps & skips) used to kick new recruits into shape. Research has shown that they help participants burn up to 600 calories an hour! Just like Crossfit, these are high intensity workouts that push you hard and test strength as well as endurance.
What other Fitness ideas do you have or want to try in the new year?
It’s about that time of the year again when all the party invites start rolling in, all your old friends from high school are back in town and Christmas is in full swing. This is also the time of the year most people ‘forget’ their exercise routine and just indulge in all the fun activities around them. It’s important to remember however that keeping healthy is much easier than working your way back to health. We’ve come up with some tips to help you lead a healthy lifestyle over the next few weeks.
1. Watch what you eat. Try to make better decisions with what you put in your stomach. It’s easy to get carried away in the moment and overindulge. If you do want to try different dishes, try to limit how much of each you eat. The worst possible way to end Christmas day is with indigestion. Slow down on the fatty and high calorie foods but ramp up on the fruits and vegetables.
2. If you will be drinking, keep it light. There are bound to be lots of holiday parties which means many opportunities to indulge in some drinking. Generally, many alcoholic beverages are packed full of calories so do your best to keep it light. Hangovers are also not great to wake up with, they often lead to you wanting to remain in bed, cancel the pre-planned morning jogs and stuff your face. Tip: If you do drink, for every glass of alcoholic beverage you have, balance it up with one or two glasses of water.
3. Exercise. Don’t forego your exercise routine this holiday period. Infact, if there’s ever a time to step it up, it’s now. Most people are bound to eat and not do a lot of moving about over the next few weeks, so it’s important to try to sweat out those toxins and burn any calories you’ve taken in. If you’ll rather stay in and spend time with family earlier in the day, that’s ok, in fact study shows that exercising may actually be best in the afternoon. Either way, try to do something active every day.
4. Relaxation. Try to spend time kicking back and relaxing every so often. While Christmas is the perfect opportunity to catch up with friends and family, it’s also important to get as much sleep as possible over this few weeks. It not only make you feel refreshed and in better spirits, it also helps you fight flu - the most popular illness suffered this time of the year.
5. Hydrate. Putting as much as two litres of water in your body daily is another great way to stay healthy this holiday period. Water accounts for over 60% of the body weight and just about every system in your body needs water. Not only does it play a part in flushing out toxins from vital organs, it also carries nutrients to your cells. The body easily loses water through perspiration, urine and other physical activities so it’s important to always stay hydrated.
How do you plan on staying healthy this Christmas?
For most startups, the most difficult part of your user-acquisition phase is finding money to buy ads and getting the interest of press/media. A lot of focus these days is on growth hacking, viral marketing and so forth but when you actually live through the humble beginnings of any startup, one thing becomes clear: You always need a core group of early users who become your “foundation” on which you build a brand. These are always the most difficult to find.
Depending on what industry your company is in, you may have to spend longer hours and work a lot harder to get the numbers you want. The next step involves organically growing out those numbers using the already existing user base as a vehicle – this is where viral marketing, referrals, promotions etc come into play.
Some startups will naturally be able to enjoy more success from viral marketing than others, and for companies like that, generic methods of growing a user base become ever so important i.e. Partnerships, Advertisement and Press. Unlike what we all stumble across on TechCrunch daily, more than 80% of startups aren’t funded enough to consistently include advertisements in their marketing plan, and when you’re a new company, getting partnerships is often extremely difficult - you’re not credible enough just yet. This leaves you with press.
I read this article by one of my favorite founders Rahul Vohra of Rapportive a few weeks back about how the company went viral and if you follow their model, you’ll see how heavily they focused on getting the “initial core group of users”. However, Rapportive is well funded as well as a Y-Combinator company, and as such when they launched, they did so to a fanfare in front of many journalists, covered by many blogs and retweeted by thousands. This is not the case for the average startup, in fact no one knows when you’ve launched until you tell them in person. In his story, he mentioned how “you may get 70k users” from press when you launch. The bad news is that this is rarely ever true for most people.
Over the past few months since Symcat launched, we’ve focused a lot of our early strategy on creating great content, not only for search engine purposes but also educational purposes for entrepreneurs and just about anyone curious about their health. We have also focused on Press and media coverage quite seriously. I’ll share some things that have worked well for us.
1. Be creative. The best way to get anyone’s attention is by telling a compelling story, writers aren’t different. Also find out places where people in your industry hang out. A few months after launching Symcat, we created an infographic showing how different people used the app to check their symptoms. We explained some of our findings and shared it on HackerNews – we know most startup-minded people tend to spend some time browsing it. The story did well and got a good number of comments. A few months afterward we did a blog post and referenced this infographic, again, it was well received. A few days afterward, a reporter reached out and wanted to do this story.
2. Build Relationships as you pitch. I don’t imagine there’s anything more annoying as a reporter than receiving the same pitch over and over again, perhaps because the sender thinks you “must not have received” the last 4 or 5 they sent over. As someone on the other side however, I do see the need to keep my pitch fresh on the mind of the reporter. Depending on the size of the publication, most reporters get hundreds of pitches per day, it’s extremely difficult to get their attention, and so things do get lost in the process but the best way you can go about getting a reply is by standing out. Your title needs to stand out and grab attention, your pitch needs to be short and concise, and your follow-up emails need to be creative. When we got covered on Mashable, it took a number of tries. After sending out a few e-mails and not hearing back, we got creative and decided to update the writer on every big change we made. At one point, we had started letting people create a digital health record that could be printed out for your Doctor’s appointment, and this must have been the turning point. We got a reply minutes later and a story the next day.
3. Create interesting content. One thing we do very well at symcat is educate. We like helping people understand their health, ways to stay healthy, how to keep a good medical record and so forth. Besides the stories we write on our blog, and articles we share on our Facebook, we create content for article hubs and try to push a few every other week. Keep in mind that there is a difference between creating random content for SEO purposes and creating articles to educate people. We focus heavily on the later. Symcat helps people keep track of their personal health and so it’s most likely not going to “go viral” with people sharing things they’ll rather keep private. We understand this and so we’ve given them other things they can share - well written articles anyone can learn from. We got covered by a popular international publication because of these stories. Besides article sites, consider pushing stories to Slideshare - again, they must have an educational purpose. Remember to add your e-mail and contact information, you never know who would like one of your presentations and reach out for a story.
4. Take advantage of Social Media. Make a list of your favorite writers, not just people you want to eventually pitch, and start to interact with them. If you like a recent story they wrote, tell them why and make a comment or ask a question about it. Eventually they know who you are and are more inclined to read a pitch from you than if they have no clue who you are. Even if they don’t plan on a story at that point in time, somewhere down they line they may be looking to do a piece relating to your industry and reach out to you. That’s exactly how we got into this article.
While ads and big launches are usually the best/quickest way to get you to your first several thousand users, nothing beats the brand awareness and credibility you could get from a great media coverage. People often get carried away by the allure of sites reaching 100k users in their first year and what not, in reality, very few get to that point. Retention is even harder. Take a look at this graph:
Depending of what industry you are in, growth is subjective. Some ads are worth buying (if you have the money), and sometimes, steady but assured growth could be almost as helpful. How do you define growth?
Symcat was recently invited to the mHealth Summit in Washington DC where we were able to show off the product to industry leaders and connect with several tech companies making big moves in the Health space. It was brilliant getting to see how others were innovating. For example, the guys next to our table were building a tiny patch you could place on your chest records several data points about your current state of health including your heart rate then wirelessly transmits that information to your Doctor. Pretty cool stuff.
In addition to showing off Symcat, we also entered and won the 1st ever Cigna Health Innovation challenge. Cigna who had a big presence at the summit opened up their API and challenged startups to build a product that will significantly impact how people make health choices, using data from Cigna. Challenge accepted!
What we did:
When people fall ill and start taking medications, they often experience new or worsening symptoms that may or may not be related to the illness. Sometimes they are normal side effects and other times they are the scary “serious adverse events” related to medication. How is the average patient to know? “We’ve thought hard about solving this problem from the patient perspective” said Craig Monsen, Co-founder and CEO of AHEAD Research. “In response to the Cigna challenge, we built a web and mobile tool that helps people sort out if these new symptoms are related to their initial illness or are caused by the medication they are taking.”
We came up with a module of Symcat called “MedAssure” that lets users enter the symptoms they are experiencing, add (or auto-populate from Cigna’s data) the medication they are on, and informs them if their medication is a known cause of their symptoms. They also have the opportunity to share this information with their physician, who wants to know if his or her patients are experiencing potentially debilitating, drug-related side effects. The seamless integration of MedAssure into Symcat’s interface allows users to add that information to their existing health timeline and continue tracking their symptoms.
Winning the challenge meant we went home with great recognition for Symcat, cash award and and exciting opportunity to work with Cigna. This is the second challenge we’ve won this year after the Robert Wood Johnson Foundation grant 5 months ago. If anything, it’s great motivation to keep working hard and innovating on how patients find health information.
Early in medical school, I was involved in the care of Ted, who could have been my grandfather. At 76 he was as spry as any of the patients on the ward and always welcomed me with a “morning, Doc!” He was admitted because he was having concerning chest pain several times a week. Opening and closing 2.8 billion times throughout his life, his heart valves had gradually become hard and inflexible preventing blood from leaving at its usual rate. Now, it was risking his life. He had several treatment options available to him: valve replacement through open-heart surgery, a new minimally-invasive procedure where they snaked a new valve through the body’s blood vessels and into the heart, or just taking medications to help with his symptoms. It was my job to help Ted figure out which option was best for him.
Medicine is a highly cognitive discipline, demanding deliberate analysis and careful attention. Moreover, the body of evidence-based practices and medical knowledge continues to grow. Indeed, it has far outstripped physicians ability to stay up-to-date on the latest research. As a result, researchers and businesses have since the 1960s been working to codify medical practice and knowledge so as to offer cognitive support to health care providers trying to advise patients like Ted. These software-based tools usually place textbook knowledge at a doctor’s fingertips. Many of them such as INTERNIST and DXPlain became highly complex diagnostic tools.
However, despite the tens of thousands of person hours that went into developing them they failed to see widespread adoption. This seems strange, maybe even a tragedy, when one considers that as many as 15% of diagnoses made in the US are wrong. That number approaches 50% when considering physician’s management decisions. So why haven’t these tools been more widely adopted?
In general, getting physicians to use decision support tools has significant barriers. For one, there is a perception of a highly-optimized workflow being very sensitive to disruption of change. However, this is not the main obstacle. Physicians are amenable to tools that genuinely save time. However, many decision support tools require a substantial investment of time.
Take, for example, the STS calculator assessing Ted’s risk during cardiac surgery. Insofar as it can predict morbidity and mortality, it is a very useful tool. As you can see, though, there are a number of variables to contend with. Over 40 once you start answering questions and getting into the decision tree logic. Unfortunately, in this example it is hard for a physician to really weigh the different probabilities of death and injury that it presents. Would you prefer a 5% risk of dying from a procedure with a 90% chance of improving symptoms or a 2% risk of dying with a 70% chance of improving symptoms? “How much risk of death am I willing to tolerate for a shot at a cure?”
To answer that question you would need to know about your life expectancy, your quality of life with and without your symptoms, and critically, your own preferences about the type of life you want to lead. Everyone wants to live a healthy and happy life for as long as possible, but when you have to make trade-offs, the decision becomes a deeply personal one.
Of course, there are cases when the trade-offs seem very small. Prescribing a well-studied medication with few risks can dramatically increase a person’s years of healthy life. In these cases, though, no calculator is needed. A physician’s intuition and expertise alone are usually enough to guide a patient in their care.
But when it comes to the decisions at the margins, when even a physician is ambivalent about the right course of action, there can be no other way than to have a frank conversation about a patient’s values. In other words, borderline numbers quoting risk will not appreciably change the final decision. And a decision support tool that cannot change someone’s decision is useless. So, it’s really up to the patient. In these cases, it’s easier and more valid to ask a patient about their values and avoid exposing them to risk calculators derived from special study populations with extensive caveats.
Of course, this may not be true of all physician decision support, just a lot of it. Yet, the story goes a little differently for patient decision support. While there is generally good agreement between a physician’s intuition and actuarial risk, there is a huge gap between patient’s intuition and said risk. That means patients stand to gain much more from the tools that physicians have for the most part rejected. Patients can derive benefit from risks and recommendations quoted by these tools not just when the difference among choices is marginal, but potentially every time.
It’s encouraging to witness a burgeoning of apps designed to effectively communicate to patients the risk of medications and procedures. There are a great deal of new usability and vocabulary challenges to address in these efforts, however.
At Symcat, we’re trying to combine our medical expertise with sophisticated user-interface design to improve patient decision support, but there are others trying to do this as well. What attempts to communicate medical information to patients have impressed you the most?
I happen to fall into a large group of people who take ill once the weather starts to change and it gets cold outside. It has happened for as long as I can remember, and generally my symptoms are: coughing, head cold, runny nose etc. It’s very similar to what the average person experiences when they have a flu. Over the past few years as I’ve grown and understood myself better however, I’ve found that while I haven’t completely knocked this seasonal illness, I’ve managed to cut the bouts down and shorten the duration whenever I do have them. I’ve learned to do things a bit differently when that time of the year (usually between October and March) approaches and it’s been very effective for me. Here are some things I do and encourage you to try:
1. Drink a lot of water. Believe it or not, your Doctor was right when she told you to try drinking 2L of water daily. It’s good for your body. Water makes up 60% of your body weight and every system in your body depends on it. It flushes out toxins from vital organs, carries nutrients to your cells and provides a moist environment for ear, nose and throat tissues. The body loses water easily through breath, perspiration, urine and physical activities. Lack of it leads to dehydration and even a mild case of it knocks your energy levels leaving you more susceptible to taking ill.
2. Eat well. A balanced diet goes a long way in keeping your body functioning at its best level. Research has found positive links between immune function and certain foods, so eating a lot of those immune-building foods could be helpful. For example, Garlic has been shown to boost immunity and increase resistance to infection and stress, cheese and other dairy products contain conjugated linoleic acid, a natural component of dairy fat which has boosted immune response in several trials, Yogurt contains probiotics, beneficial bacterial with immune boosting benefits etc.
3. Exercise well and Keep in good physical shape. It’s general knowledge that exercise often prevents oncoming illness, one study has shown that exercise is linked with nearly 30% reduction in upper respiratory tract infections. During a routine exercise session, endorphins are released into your body, causing relief from certain illnesses and several psychological conditions like depression and anxiety. I advise to join an indoor sports league to help you stay active at least 2 times a week. I personally play soccer 3 times a week, I prefer team sports and encourage it for you as well, it lets other people hold you accountable.
4. Don’t smoke. This must have popped up on your screen several times and for good reason, it is bad for you. Smoking causes your immune systems to weaken and leave you more susceptible to viruses.
5. Wash your hands regularly. This is a no-brainer, viruses are easy to transfer and so when you lead a life that involves a lot of human interaction, your chance of contracting a cold or flu remains high. Just have a look at some of these stats from a recent survey:
- Only 85 percent of respondents said they washed their hands after going to the bathroom, down from 92 percent in 2006.
- 46 percent said they wash their hands 15 seconds or less. Fifteen to 20 seconds of hand washing with soap is recommended by the U.S. Centers for Disease Control and Prevention and the SDA.
- 39 percent of respondents said they seldom or never wash their hands after coughing or sneezing, compared to 36 percent in 2006.
- 35 percent said they don’t wash their hands before eating lunch, compared to 31 percent in 2006.
- 37 percent wash their hands fewer than seven times on an average day.
- Only 56 percent of respondents knew that hand washing is the most effective way to prevent colds.
Imagine how quickly the bacteria and viruses can be passed on from one person to the next. Buy hand soap and keep a hand sanitizer close by.
6. Sleep well. Getting a good night sleep has been shown to prevent common cold. In a recent study published in the Archives of Internal Medicine, researchers studied a number of participant’s sleep pattern. Each person kept track of their sleeping habit for 14 days noting how long and how well they slept the previous night as well as whether they felt rested. After 14 days, the participants were quarantined, given nasal drops containing a cold-causing virus (rhinovirus), and monitored for five days for signs of a common cold. The results showed that those who slept an average of less than seven hours per night were nearly three times more likely to develop a common cold than those who reported eight or more hours per night in the weeks leading up to the experiment.
Have any other tips you personally follow to keep cold and flu away? Share with us below.
Over the last couple of days you may have noticed a few shiny, new features on the site, we are constantly trying to make Symcat easier to use and your number 1 health channel online. We are evolving beyond just a ‘symptom checker’, our goal is to help you keep track of your health and make better decisions.
We want to introduce you to some of the changes we’ve made:
Have a private profile, on us.
You now have a health profile. You can manually add and keep track of all your medical conditions. You will also find personalized health tips in your profile.
View your health timeline.
Your health timelines shows you the symptoms you’ve had most often, how often you’ve had them, and over what period of time.
Print your profile. Your doctor will love it.
We’ve added a new ‘print’ feature. You can now print your health history for your doctor so that you can both work to better manage your health.
Can’t wait to check it out? We can’t wait to show you either! Sign in now.
We love getting feedback from you all, if there’s anything you think we could do better, don’t hesitate to let us know. We also have a few questions we want your thoughts on. Help us answer them here.
It is no secret that research relies critically on data collection. Whether you’re talking about pharmaceutical research, market research, or outcomes research, successful analysis can only be done with robust data that captures the metrics most relevant to the question at hand. Unfortunately, that degree of data collection can be an expensive proposition, especially when it comes to health care.
Large drug trials, costing on the order of $1B, require hiring multiple research centers to recruit patients that meet very specific inclusion criteria and then adhering as closely as possible to the study protocol. Identifying and recruiting centers itself contributes a great deal to the overall cost of the study, but there are challenges at just about every level.
Even when no drug is involved, no intervention being tested, collecting data from the the medical centers that produce it can be extremely laborious. Frequently, experts will analyze reams of paper charts in order to extract meaningful information: patient demographics, symptoms experienced, lab values, and outcome measures like duration of the hospital visit. With so much overhead required even just to look back at what happened during someone’s hospital stay, it is no wonder that individual “case reports” or “case series” were for a long time the lingua franca of medical research.
Thankfully, the costs associated with recording data have shrunk dramatically paving the way for big data to reach health care. Though privacy issues still loom, it is now possible to transfer all information about a patient onto a single jumpdrive or, more relevantly, transfer that data to the cloud for remote access. Instead of being stored in large warehouses like below (source: The Next Frontier in Health Care Reform), medical records are being transferred to virtual data warehouses.
While today most hospitals have their own warehouses, Health Information Exchanges are being created to encourage the consolidation of health record data across hospitals and health networks. New solutions will need to arise to promote data translation and virtualization (perhaps a topic for a future post.
One upside to all of this is that it will become easier to transfer your records from one health provider to the next. No longer will you have to “start over” each time you see a new doctor or carry around your entire paper chart (if you’re a particularly conscientious patient).
But perhaps the most exciting consequence of the virtualization and aggregation of health data is that it will allow us to very naturally track what happens to each person as they go through the health care system. The month-long process of digging through paper charts can be replaced by fast queries of health record databases that take literally less than a second. Instead of the prohibitive task of searching through every single chart for males over 65 who have been prescribed dabigatran, one need only incorporate that logic into a query. Maybe I decide I want to perform a similar analysis for women. Seconds later, I have my data.
There is still a ways to go, but there is no doubt that the big data trend reaching health care will improve our ability to do research quickly and cost-effectively. Having a faster turnaround on research can offer us great insights about the natural history of poorly understood diseases, what treatments are most effective, or how we can better deliver the health care we already know works. With the trend we are seeing in access to health care data, it may only be a matter of time before getting these answers is as simple as figuring out what question you’d like to ask.
What do you think? What questions would you like to ask if you had millions of medical records at your disposal? Do you have any reservations about your health data being used for medical research?
Though it sometimes drives us to cyberchondria, the Internet undeniably offers a wealth of resources that can meaningfully impact the decisions we make when faced with illness. In addition to Symcat, there are a great many companies helping improve the quality of information available. Our friends at FoundHealth share with us one story of a young women’s experience using the Internet to help her better manage her depression and move on with her life.
Delilah, a thirty year old woman living in San Francisco, had been feeling sad, moody, and anxious all at once for the better part of few months. After endless deliberation, she finally decided to call the doctor. After enduring the arduous process of convincing the advice nurse to book an appointment, she trekked her way over, and plopped herself on the exam bed. The nurse measured her weight, recorded her vitals, and politely told her that the ‘doctor will be with you shortly.’
Over the past few years, there’s been a wild soar in number of social apps on the web. It is now ridiculously easy to find out what your friend you haven’t talked to in 20 years is doing, why he’s in the sunny outskirts of Malaga, or learn of his newfound love for Liverpool Football Club. In fact, it can be done in seconds. On the other hand, it’s incredibly difficult to find out what the health trends are in your city are and why all of a sudden your local news channel is reporting 6 cases of meningitis in your nearest hospital. Health information has not always been “at the tip of your finger,” but all that is starting to change.
The trend of big data has significantly picked up lately and there’s been a lot of talk about it. No surprises there.
But what exactly is Big Data? Literally, as the name implies, it means a large amount of data. According to a recent article on O’Reilly Radar, it is “…data that exceeds the processing capacity of conventional database systems. The data is too big, moves to fast, or doesn’t fit the structures of your database architecture. To gain value from this data, you must choose an alternate way to process it.” The amount of data available on medicine and health is significant. A number of health focused startups have taken advantage of that data to build products that not only educate patients but also finds help for them. However, it’s not that easy…
Great excerpt from the Inc story about innovation in HealthCare by Adam Bluestein
The Algorithm Is In
Why 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.”
Read the full article here: http://www.inc.com/magazine/201210/adam-bluestein/the-coming-revolution-in-health-care.html
As exciting as the digital health space is right now, there is still little guidance or validated path to getting off the ground. As part of an effort to help aspiring health care entrepreneurs, I’ll be writing a series of posts explaining some of the decisions we made for Symcat. It hasn’t been a year since we’ve started, but my hope is that our few months of experience can help those who are just getting started themselves.
One of the questions I’m most frequently asked is if our time at Blueprint Health, a health start-up accelerator, was worth it. To participate, the program requires 3 months of relocation to the NYC offices in SoHo and the forfeiture of a nearly 6% equity stake in the company. The program basically offers $20k, mentorship from its network, and office space. A few other health start-up accelerators (ie Rock Health, Healthbox) have some variations but basically the same theme. They are all very selective accepting 3-5% of applicants. While it’s nice to be accepted, there’s still the important matter of deciding if it is right for you.
Heads up: we’ll to be presenting at Health 2.0 San Francisco in a few weeks. October 9th to be precise.
Originally we were slated for The Future of Personalized Medicine, but we will now be presenting as part of Payment Reform and Transparency: Tools for Financial Management and Decision-making. Honestly, it seems like Symcat can fit in most of the talks, but despite the session’s lackluster title this one should be good. The session includes Castlight Health (notable for a recent $100M round), as well as Cake Health and Simplee.
We are also going to be presenting at a second talk with title to be determined.
We should be there for the entire conference (Oct 7-10). If you’ll be at the conference and want to meet up, shoot me an email.
Also, if you’re going to MedicineX next weekend, I’d love to hear about it. We were supposed to present but wound up having a conflict that weekend. C’est la vie.
If you check Symcat on a regular basis, you know how often we’re trying out new features and tweaks to the site. We introduced a big one yesterday that we’re pretty excited about.
The “Ask the SymCommunity” feature allows you to attach a question to your visit profile. This doesn’t affect the probabilities that appear for likely conditions…yet…but it does allow you to ask other Symcat users for help.
It’s widely recognized that health care must change. Paper charts are still commonly used, providers communicate via fax, and patients wait weeks for an appointment. Given the recent excitement around health information technology and the unusual political will, it may seem not only that health care is ripe for disruption, but that it may even happen.
Or will it? Disruption is one of those “know it when you see it” kind of things. By lowering the costs of distribution for content providers, the Internet, for example, has unmistakably changed, and continues to change, the media industry. Or, if you don’t like that, you can try wikipedia’s take. There is a lot about health care that feels like pre-Internet media: insular, capital-intensive, multiple stakeholders (read: middlemen). And so, it feels as though health care will be disrupted, but where and how can that reasonably happen?
This news is long overdue, but in case you haven’t been following our tweets, we were recognized early last month as the winners of the Robert Wood Johnson Aligning Forces 4 Quality Developer Challenge.
I just read the article Half of Healthcare Providers Are Looking to Buy Business Intelligence and it compelled me to post some of my recent reflections on the topic.
There is a growing excitement about the vast stores of data coming from EMR adoption. Policymakers, executives, and entrepreneurs alike are alluding to the great potential for this newly-discovered source of data to transform health care through what is often called “Business Intelligence.”
Check us out in the Health section of the Atlantic.
We’ve been working hard in preparation for our demo day, but expect some new posts coming soon.
Thanks for your support!
We’ve just put together an infographic explaining some of the motivation behind Symcat! See the full version at http://symcat.com/infographics/cyberchondria.png.
Summary: Cyberchondria refers to the tendency to be concerned about symptoms as a result of searching them online. 4 out of 5 people search online for health information, many of them for common symptoms such as headache and chest pain. Unfortunately, web search tends to rank highly more concerning conditions, even though they’re far less likely. This often causes unnecessary concern among web searchers and even influences their decision to seek medical care. Symcat can help solve that by letting people know what they’re likely to have and what they should do about it by asking others what worked for them. It’s crowd-sourcing at it’s best. Try it out at symcat.com.
Medgadget just published an article about Symcat. In it Craig talks about the conception of Symcat and the direction it’s going. Check it out.
Craig just wrote an article for popular health blog iMedicalApps. Reposted below.
You’ve got this great idea for a medical app that will transform health care (or at least a chunk of it).
There is no one path to executing your idea. Particularly for those of us in medicine where the course is clearly delineated (pre-med, med school, residency, etc), acknowledging this fact can be disorienting. My goal here is to suggest one path that has helped me personally get beyond the ideation phase.
We’re excited to learn that Symcat has been accepted from over 50 entries to be among 5 semi-finalists for the Robert Wood Johnson Foundation’s Aligning Forces Challenge. The objective was to use their provider quality data to help patients decide how to find care. The top three finalists will receive $100,000, $25,000, and $5,000, respectively.
You can read more of the details from Health 2.0.
Congratulations to the other semi-finalists!
A few days ago, we posted Symcat, our next-gen symptom checker, to Hacker News to get some early feedback on the tool and evaluate some basic user behavior. We were only on the first page of HN for a short time, but nonetheless, about 4000 users tried out Symcat and gave us some great feedback. As a thank you, we thought we would share with the HN community a little aggregate info about what people were searching. Below are the top 10 symptoms searched during our HN post.
A recent TechCrunch article instigated some debate as to who will win the title of “Medical Expert:” physicians or algorithms. As a medical student with a background in engineering and machine learning, my perspective has led to a somewhat conflicted opinion. I have, on the one hand, seen how powerful algorithms can be, even in the medical domain, and on the other, watched and learned from master clinicians in medical school.
The arguments against algorithms tend to fall into two camps. Either algorithms can never be accurate enough to replace docs or there is more we want out of a doctor than a diagnosis. The latter point goes that the comfort, empathy, and human understanding a physician provides can never be replaced by a computer. That argument may be easily dismissed. As algorithms improve, physicians will need to demonstrate that they cannot be replaced by a good combination of algorithms and a nice nurse (who are often much better at the empathy part than their physician counterparts).
After a few months of development, we’re getting serious about putting Symcat into user’s hands. To help us through the mechanics and meet some great mentors in health technology we’ve joined Blueprint Health. For the next 3 months we’re working with 8 other health tech teams to refine our vision and accelerate our development.
You can read about us, Blueprint Health, and the teams we’ll be working with here on TechCrunch.