In addition to being the co-founder and Chief Medical Officer of Healthagen, Wayne Guerra, MD and MBA, is still a practicing emergency physician in the Denver metro area and currently directs a medical board that reviews over 500,000 emergency department visits a year. In a recent interview with MedHealthWorld, Dr. Guerra discussed how his multi-faceted background has contributed to the design and widespread adoption of iTriage, Healthagen’s mobile and online health resource. iTriage provides consumers with an integrated approach for determining their care needs based on checking symptoms, locating a care provider based on the type of services and location, GPS powered directions to find the provider’s office or clinic, and even a provider quality database to check on quality of care issues.
MedHealthWorld: How did your medical and professional background inspire you to found Healthagen and to design iTriage as an integrated connected health resource?
Wayne Guerra: My co-founder at Healthagen and I have been emergency physicians for many years, and have taken care of over 60,000 patients in the emergency department setting. I and other ER physicians frequently see patients and their families struggle to take in all the details that they hear in that setting, and to make immediate decisions about care. So much is happening during the emergency or urgent care visit. The actual time with the doctor can be very short and the treatment is often complicated so we know that patients may only hear and absorb a few words of the explanation. It’s distracting and hard to ask questions at that point and it’s hard for patients and their families to absorb all the details that they hear.
Thinking about emergency care from the patient’s point of view, as well as from the hospital and care provider perspective, we say a major gap in mobile health information resources and we developed iTriage to address that gap. iTriage puts detailed information about symptoms, when to seek emergency care, and where to find the most appropriate care directly into the patient’s hand. Because iTriage is on the mobile phone, it can travel with patients to the care provider – in fact it gives them directions to get there, and then it gives them enough detail about potential treatments in advance to organize their thoughts and questions for the doctor.
There’s also an important value for the hospital and urgent care center. Hospitals invest millions of dollars in facilities, staffing and specialist training to be a designated stroke center or a trauma center, for example. But it’s a challenge for hospitals with these specialized centers to let potential emergency patients – especially patients who don’t live in the community – to know that they have the specialty that is most relevant to a particular healthcare need. By providing a directory of nearby care providers, iTriage lets hospitals and physicians reach out to mobile patient populations.
MHW: Do you think that mobile health applications like iTriage will become a mainstream component of the healthcare and care provider decisions made by consumers?
WG: I think mobile health will be adopted in certain segments of the population first, and then expand over time as the mobile devices themselves become more advanced. In 2008, when we were planning iTriage features we couldn’t implement everything we envisioned because the early iPhones didn’t have certain capabilities. Now we are seeing things like video conferencing on the latest models. As more consumers reach for their mobile phone as an overall health information resource, they will be routinely using iTriage or another symptom checker application to decide whether they need to seek immediate care. I don’t think we are ever going to go backwards in the amount of online and mobile health information that’s available to consumers - and so it’s just a matter of time before the majority of consumers expect to use more integrated mobile healthcare resources
Another driver is more consumer consciousness about cost of care. This is becoming very important to consumers as so many of them have HSAs and high deductible plans where they are paying out of pocket for treatment. Most people don’t know much about urgent care services – what they can handle, what type of care is available compared to a hospital emergency room, but they know that it’s probably less expensive. In fact, for some treatments an urgent care clinic can be 8 times or even 10 times less expensive than going to an emergency room. On the other hand, patients need help understanding when clinics and urgent care centers cannot handle – when it comes to heart attacks or pneumonia, going to the urgent care center will just lead to transfer to an ER with the added cost and delay for that transfer. So there are multiple reasons that consumers will want the type of information provided by iTriage.
MHW: How are consumers and care providers using iTriage today?
WG: The most common consumer use is looking up symptoms. People feel sick or have a mishap, then they look for information about what’s wrong and what to do about it, and then they may go on to search for the most appropriate care that is close by. We also see that a fair number of users go straight to the “find a care provider” feature of iTriage.
Some of our user testimonials are compelling; for example we heard from parents who noticed their child getting a sudden rash. They checked her symptoms on iTriage and found out that this could be an anaphylactic reaction - - with the advice that this could be a really serious reaction that needed ER treatment. So they headed right to the hospital instead of waiting. The doctor in the ER told them that their daughter could have died without that prompt treatment.
iTriage has also been very well received by physicians. In the planning stages, we had some concern that doctors might push back because our information includes quality ratings for care providers as well as locations and specialties. But that hasn’t been the case. We hear that emergency doctors and nurses are actually showing iTriage on their own phones to patients who are receiving treatment, and recommending that the patient take time to read the iTriage description of their problem and the treatment. The care providers appreciate that if patients get to absorb more information by reading about their condition, it elevates the level of discussion and helps them to ask more relevant questions.
MHW: iTriage is free to consumers. What is the Healthagen business model, and how are you measuring its success in business terms?
WG: Our primary business model is to provide free directory listings in our national care provider data base (over a million listings) and to charge the hospitals, care centers or clinicians an annual fee for a premium listing. With a premium listing, the provider can include more details such as specialties, or the names of individual providers. We also work with directly with health systems and have found that the system typically wants all of its providers to be listed. Many systems have adopted iTriage and then launched their own local marketing and PR campaigns to let their population know it is available.
We are always looking at ways to add new features that will be valuable to the patient and to the providers. We’re doing a pilot right now for premier listings to let patients inform the ER or provider that they are on the way and even to pre-register and get advice before arriving. The patient selects a specific care provider and a form opens up for them to input their name, phone number and symptoms and send this information directly to the care provider. This helps the provider to organize the reception for that specific patient and condition and to get the chart started. It will improve the flow of care by connecting patient and provider in a way that hasn’t been really feasible before.
Dr. Cronin is a Professor of Management in the Information Systems Department at Boston College. To read more of her articles, please visit her columnist page.Edited by
Erin Monda