Saturday, March 17, 2007

Clinicial innovations - Doctor-Led Search Engine Innovations

Attempt the end, and never stand to doubt,
Nothing’s so hard but search will find it out.

Robert Herrick 1591-1674
Seek and Find

When we speak of Internet influence on modern society and culture, we speak of ubiquity, instantaneity, and availability of information anywhere, everywhere, anytime. We speak of shrinking and irrelevancy of distance. We speak of universal transparency. We speak of individuality run amuck. We speak of universal expression of deeply felt emotions. We speak of blogging, media’s new frontier. We speak of a world powered by cyber-based search engines.

We speak of chaos, confusion, and complexity. In health care, physicians are pivotal in developing relevant, useful, and impactful clinical search engines. These new engines bring order to bear on seemingly intractable problems and put critical information at the fingertips at those responsible for cost and effectiveness of care when that information is most needed, when the patient is in the room and when the receptionist announced, “The doctor will see you now.”

Several years back a friend served as CEO of a doctor-founded search engine company. The company developed software for collecting and downloading clinical research from around the globe, and then, for a fee, within 24 hours of the research’s publication, bringing it topracticing doctors' fingertips at the click of a mouse.

This start-up failed, as most start-ups do, from multiple reasons, including inability to raise money, assemble a harmonious management team, lack of physician enthusiasm on the receiving end, and bad timing.

As every start-up entrepreneur knows, timing is everything. Now, for my friend, the timing might be right. It is never too late to innovate. It seems everybody is rushing into the search engine field – Kaiser Permanente, MedAI, Aetna, health plans of every ilk, WebMD, Revolution Health, Healthline, and now Microsoft – using and deploying such tools as data mining, predictive modeling, consumer monitoring, episode data aggregation, and customer relationship handling.

On February 27, Microsoft announced it was buying Medstory, Inc, a small startup founded by Alain Rappoport, MD, PhD, in 2000 in Foster City, California. The Medstory acquisition follows Microsoft’s purchase last year of Azyxii, Inc., a clinic software company displaying information form scanned documents, x-rays, MRI and CT scans, and ultrasound images. As an aside, I believe image transfer may monumentally transform medical practices. It is much easier to scan a document or image than to enter it digitally.

Medstory applies artificial intelligence techniques to medical and health information gleaned from medical journals, government documents, and the Internet.

Microsoft says it bought the company to improve the consumer experience in health care. The biggest story here is that Microsoft has decided to become a dominant player in the health care search engine field.

The two Microsoft acquisition were preceded by Aetna’s 2005 acquisition of ActiveHealth Management, Inc, founded by Lonny Reisman, MD, a New York City internist. Founded in 1998, ActiveHealth Management provides clinical decision support to physicians and members on an individualized basis and health care data analytics tools that enable customers to analyze the health care of their entire covered membership.

Clearly big innovations are afoot in the search engine and medical intelligence field. Kaiser believes, for example, that it is possible to use its Archimedes Project technologies to run clinical trials for patients without use of human subjects. In Kaiser’s case, the genius behind the scene is a doctor named Doctor David Eddy, who also has at PhD in mathematics.

Many search engine company founders are MDs. This should come as no surprise, since physicians know what other physicians need and what patients want.

Alain Rappaport, MD, founded Medstory. Medstory, he says, increases the efficiency of health care industry processes, from drug development to personalized medicine. Rappaport was previously (1985-1996) co-founder, President, and Chief Scientist of Neuron Data, Inc., a world leading company in artificial intelligence and other business-critical software components. He is currently Adjunct Faculty in the School of Computer Science and Robotics Institute, Carnegie Mellon University. From 1997-1999, he held an appointment as Senior Advisor, Office of the Director, Center of Excellence for Information Technology, National Aeronautics and Space Administration. He is a founding member of the Innovative Applications of Artificial Intelligence (IAAI) Conference.

Another physician leader who founded a search engine firm is Lonny Reisman, MD, who founded ActiveHealth Management in 1998, and which Aetna acquired in 2005. ActiveHealth Management’ products and services are designed to improve clinical care and outcomes and reduce medical costs. The system continually compares this patient data to the latest evidence-based medicine and standards of care, to identify treatment opportunities for those most at risk. These opportunities or suggestions - called Care Considerations - are then communicated to the treating physician and/or patient with the goal of improving the patient’s health.

Search Engine Drivers

One driver here is consumer-focused health care. The notion is that with shifts in demographics, economics, technology, and policy, more individuals will desire, or be forced to make decisions on treatment and provider-selection on their own. Aging baby boomers, used to having things their way, will want personal choice, and a strong say in how they’re treated. Besides, according to a study last year by the Pew Internet and American Project, eight million people every day search for health care information.

There’s another driving-factor as well: competition for the health engine dollar. Microsoft is going head-to-head with WebMD which has just announced a quarterly profit of $8.9 million on $80.6 million of revenue. Steve Case, who founded AOL, is said to have put up $500 million of his own money, though Case disputes this figure and puts it closer to $100 million, to back Revolution Health, hoping to use its website to empower consumers to take charge of their health care and its costs.

The Internet search engine frenzy reminds me of the child's verse about the Merry-Go-Round, “Faster and faster she goes, Where she stops, no one knows.”


Shyam said...

It is very interesting to read this article, another example is company called Greatech Software Solutions, Inc. ( The CEO of this company is Dr Manish Gupta, an Orthopedic Surgeon. This company has worked in the area of Search Engine Optimization (SEO) for several medical projects.

The company is also helping in organizing the HealthCare and Medical Tourism Outsourcing Confernece that has details on this Blog:


Richard L. Reece, MD said...

I was unaware of Greatech Software Solutions, Inc. But I was aware the medical tourism industry is booming. As Thomas Friedman reminds us in The Earth is Flat, the Internet is flattening everything, including medical care. India is a primary medical tourism destination, and software experts from India, including physicians, are among the finest in the world

Richard L. Reece, MD

Mark Miller said...

"Steve Case, who founded AOL, is said to have put up $500 million of his own money, though Case disputes this figure and puts it closer to $100 million, to back Revolution Health"
This statement is a bit misleading, and the figure has been misreported throughout the media. When he announced his plans, Case said he would invest up to $500 million. So it's possible that he has spent $100 million and will continue to invest more.

Jon Brassey said...

Another example is the TRIP Database ( which hails from the UK. This search engine is aimed at clinicians who have an interest in evidence-based practice.

The company is headed by a doctor (a General Practitioner) and me (an information specialist). It has been around for 9 years but much of the recent history has seen it as a subscription service. In September 2006 we reverted to free-access and have seen usage increase dramatically (now over 100,000 per week).

EvidenceGuy said...

Evidence Matters is another EBM system founded by a clinician out of McGill University. It's an evidence-based clinical research search engine, sitting on top of about 30 databases including PubMed, and abstracted info from about 450 journals. It allows users to build questions and rank treatments by effectiveness and safety in a purely objective manner, according to trial data. Results can be narrowed to very specific patient types and levels of evidence. Objective article summaries are available for all references. It is available in three languages, and is used in academic, clinical and corporate settings.

Jon Brassey said...

What would be nice, for the sake of the users, is a trial pitching these various products head-to-head.

I imagine those with a more commercial focus (e.g. paid for products) will have more to lose. I'd welcome it (from the TRIP Database's perspective) as it's a great way of seeing where the weaknesses are. We had our site reviewed by Prof Paul Glasziou at the Centre for Evidence-Based Medicine, Oxford University around 2 years ago - we dramatically improved. I'm acutely aware we could improve - as could all services.

I'm exceptionally proud that we are free!

Danelyn from search engine company said...

Very informative post.
I am so glad I stumbled upon your post.

Thanks for the good read.