The Associated Pressreleased that Papa Johns has just crossed the threshold of over a billion dollars in orders from their online ordering system (including text message orders). Last year, their online sales topped $400 million, and they project the annual revenue from online orders to skyrocket over the next couple of years, as more people become more comfortable with the process. An interesting part in the press release was the mention of a Papa Johns franchise location that was extremely busy, yet very quiet, because they were receiving very little phone calls, and a majority of their orders were processed online.
As I mentioned in a post about some of the similarities between SavvyDoc and Potbelly’s, the Internet is really making it easier for us to process regular tasks. The benefis is the ability to operate at your own pace, and ultimately make more informed decisions because of the transparency. Is it that painful to order a pizza over the phone? Most likely not, but the added convenience online provided to the customer is important, especially if it will cut down on errors. We at SavvyDoc are trying to make doctors appointment scheduling as easy as ordering that pizza online. Imagine if you have five children, who have tons of activities, programs, and schedules, and instead of calling the dermatologist, orthodontist, and pediatrician, you could manage all of that from the comfort of your home, 24 hours a day, 7 days a week. If it works for pizza, it will work for an industry where 1 out of 3 people have an inability to make a timely appointment.
It would be disingenuous of us at SavvyDoc, to champion the need for further adoption of health care IT and not understand that with any new technology there will be unscrupulous providers of bad technology. I recently came across a great resource for doctors who are having issues with their electronic medical record systems or are looking to implement a system. Doctors in peril is a non-profit organization that is looking to help protect doctors from bad IT investments. There is some useful information on current companies the organization is fighting legal battles against, but there is also a brief breakdown on how to protect your IT investment, which is VERY good. For those of us looking to implement IT solutions into health care these bad technologies or bad companies only slow the progress of a blossoming field. Especially with SavvyDoc where we have created a solution particularly useful for smaller practices, which are at greater risk of these predatory selling practices, we want the buyer to make informed and smart decisions on IT solutions for their practice.
For those looking for faster adoption of IT in health care, Aetna is taking a nice step forward with their new plan to electronically alert doctors to patient care needs. Using Aetna’s claims information on patients the health insurer will be able to inform a doctor if a patient is allergic to a medication recently prescribed or if a patient is due for special tests. For example a patient with diabetes needs an annual exam with an ophthalmologist, when the Aetna system realizes an annual exam has been missed it will alert the patients PCP so that an appointment can be arranged. This is a great system, and its good to see the insurance companies leading the way with regards to implementing health care IT. Admittedly the system is not perfect, alerts will be made through a special physician website but physicians will also need to be notified via phone, fax or e-mail but even as currently constructed this is helping physicians to run a more efficient practice.
One of the issues that has come up recently with implementing technology into health care is the unrealistic desire that systems like the one Aetna has created, electronic medical records, Google Health, or SavvyDoc need to be perfect technologies. This can range from questions of integrating into other systems or questioning the usefulness of technologies simply from each specialists perspective. Each of these issues and others need to be covered by new technologies but this will happen in time and will require a period of trial and error. As the medical field is one of perfectionism, and rightly so, there tends to be resistance or a wait and see attitude for new technology. But even the most dangerous drugs, have to be tested on humans at some point and I believe we have reached this threshold with health care IT. Waiting for the perfect technology is a lot like waiting for the proverbial magic bullet cancer drug. Additions to the framework of already useful technology will make for an awesomely powerful IT solution but they are the icing on the cake and should not be viewed as barriers to implementation. When IT is able to adapt seamlessly to various specialties or patient situations and fully integrate across electronic medical records, billing software, appointment software, personal patient records etc. then the health care IT space will truly be mature and we at SavvyDoc will need to find another cause in health care to champion.
The Association of American Medical Colleges (AAMC) recently released a report on Industry Funding of Medical Education which was reported on by the New York Times this weekend. Unexpectedly, this was a very strong report seeking to ban all medical giveaways to medical school faculty, staff and students. Though this report is not a mandate, it is very likely that most if not all of the 129 U.S. medical schools will adopt the task force’s recommendations on how to proceed with medical school and private industry interactions. The report does a good job of realizing the role private industry plays in medical education and they are obviously not looking to prevent pharmaceutical or medical device companies from presenting to the medical school community (though its hard to believe these recommendations would not stifle these interactions). Rather the AAMC is concerned with the perceived conflict of interest when private industry presentations involve paying faculty to present information or presentations are attached to gifts such as free food and/or pens.
It is not a secret that the pharmaceutical and medical device companies spend billions of dollars marketing to doctors. However, unlike traditional marketing (TV and print adds for example) doctors receive free meals, pens (and other office products) as well as some more extravagant gifts. Considering there are slightly less than a million U.S. physicians but billions spent on marketing to them it’s not hard to imagine that some of these giveaways have been, lets just say, a little over-the-top. However, my initial reaction to the AAMC task force report is that it took the easy route by attempting to deal solely with the conflict of interest issues and missed an opportunity to create guidelines that would impact the real crux of the issue which is how private industry should market their products. We have all noted the influx of direct to consumer advertising by drug companies and my concern is that the position of the AAMC will only lead to more drug advertising through mainstream media. I point to the controversy surrounding this common Lipitor commercial featuring Dr. Robert Jarvik:
Pfizer was forced to pull these adds over controversy that they imply that Dr. Robert Jarvik treats patients, where he is actually an inventor and entrepreneur who has developed an artificial heart. This is an example of blurring reality to create effective direct to consumer advertising, and this is not the only example. Viagra adds were pulled in 2004 for implying that Viagra increased libido. When the AAMC limits the marketing of drug products or medical devices to physicians the alternative is to market these products to patients. The Viagra and Lipitor examples may be extreme and in all fairness both are Pfizer drugs. But the impact of 30 and 60 second drug adds that have potentially devastating side effects that are rattled off and barely audible in these commercials seems like something that should be factored into any discussion of how physicians involve themselves in the marketing process. Taking positions that will lead to big pharma diverting marketing budgets from educating physicians about new drugs to creating slick commercials created by Madison Avenue firms will not help the ultimate goal of doctors, helping patients. A more useful report would have laid out guidelines for how private industry and medical schools interact and placed reasonable limits on giveaways to medical faculty, staff and students. I am just concerned that the tone of the report and it’s strong stance makes any and all private industry-physician interactions seem tawdry when in fact they are necessary. Physicians need easy access to new information on drugs and medical devices and private industry need an opportunity to create name recognition for their products. The drug and medical device companies can develop revolutionary products but if no one knows about them they are useless. Private industry understands this and will market their products regardless of reports by the AAMC. As a document to prevent all perceived conflicts of interest the AAMC report hits the mark. But it’s necessary to view these issues with a global focus and the ultimate goal of creating a better health care system, which I’m not convinced this report will do.
With the SavvyDocblog, we not only want to highlight what we’re doing as a company, we also want to highlight other business, mainly start-ups that have disruptive business models aiming to make the health space better for ordinary people. Today, it was announced that Health Plan One raised $6.5 million Series A funding to build out their health insurance comparison site, led by Pequot Ventures.
Health Plan One is aiming to be the Orbitz or Travelocity of health insurance, that aims to bring transparency to the entire process, as well as ease of use. I think this idea has a great deal of merit because instead of pricing out the three companies that come to your mind when you think of health insurance, their service can streamline that search and compare sites side by side with one search. These comparison sites have really transformed the airline industry, and I expect a couple of sites similar to Health Plan One to pop up furthering innovation and disruption in this space.
How does this relate to SavvyDoc? What we aim to do is provide transparency within the health space, by enabling the consumer to have more choice and make more informed health care decisions. Although I cannot vouch for the accuracy of Health Plan One, from a mission statement and from a thirty thousand foot view, I like the idea.
Recovering from a little Spring flu but of course we have still been keeping up with some of the most interesting stories regarding the intersection of health care and technology. I want to briefly recap some previous posts with updated information.
We discussed the primary care crisis and the interesting solution of creating a doctor of nursing practice degree to fill the void of primary care physicians. I still think this is a reasonable idea if managed in the correct way so that medical doctors are still readily available for consultation when more complicated patients require care. My biggest issue with the DNP was that as a M.D. doctor it would be ideal if there were a better title for the DNP so as not to cause patient confusion. To update there was an interesting blog on pharmacists increasing their role in primary care. Having worked with an excellent pharmD in the past, I think this is a great idea. A pharmacist can be a great resource for patients when it comes to questions about medications and I argue could manage small medication adjustments just as well as physicians. The additional advantage comes in that actively involved pharmacists would be better equipped to help prevent medication errors.
There was a recent breach at the NIH where patient records were stolen from a doctor’s laptop. I argued that though these crimes of health care related information are serious they tend to be used as an excuse for not implementing electronic medical records (EMR) or other web based health care tools. My argument against limiting implementation of EMR’s is based on my experiences of paper based records being the least secure method conceivable for maintaining patient privacy. Having worked in a hospital with EMR’s and one without, the loose paper trail and privacy breaches when EMR’s are not implemented are atrocious. A colleague of mine brought up a great point one time, when a patient is hospitalized no less than 50 people are aware. This includes the doctors, nurses, phlebotomists, radiology techs, transporters, cleaning staff etc. To think a hospitalization is a private experience is a expectation based purely in fantasy. Using EMR’s will at least create a way for hospitals to monitor who is viewing records and make sure those records are only being viewed when necessary. This is how UCLA has been able to track down the staff members involved in the recent breeches of celebrity patients. Another point I made in this post was that medical information has little to no street value, this is compared to social security numbers and bank account information. Well, here is the evidence for that position. A patient admissions rep at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York sold 2,000 patient records for a whopping $1350. That’s less than 68 cents per record. Again, these security issues are important but considering a large percentage of us just recently e-filed are taxes and are awaiting our refunds to be direct deposited, which required providing our government a social security number and bank account number, these security issues should not continue to be used to prevent the progress in web based health care technology that will lead to more efficient and improved patient outcomes.
This was simply an introduction to what we are looking to accomplish with SavvyDoc. Through my experiences I have seen how difficult it can be for patients to obtain access to a quality physician or dentist. We are also aware that it is expensive and difficult for doctors to create a strong presence on the Internet. SavvyDoc is looking to be a simple and inexpensive alternative for both doctors and patients. This recent NY Times article on plastic surgeons and examining the expense of marketing cosmetic practices illustrates a lot of the pain we are alleviating with SavvyDoc. This article touches on the expense of obtaining and maintaining a website that is search engine optimized as well as the expense of being listed in a doctor search engine. Many doctors cannot justify these expenses but understand that they should have virtual access to their patients. SavvyDoc will provide an easy to use tool that puts doctor’s in control of how they are marketed and how patients find their doctor’s information on the web.
Here at SavvyDoc, and on our blog, we not only want to highlight and further the discussion of pertinent research in the health space, but we also will highlight other Web 2.0 or Health 2.0 companies, aiming to solve significant problems to make patients and physicians better off. We are not necessarily endorsing every company we review, but we want to showcase the innovation. The services we cover may not be the perfect solution, but by furthering the discussion, we hope to become a destination to get all of your latest news of innovation within this space.
One service that I learned about on one of my favorite tech blogs, ReadWriteWeb, is CureHunter. CureHunter is essentially a search engine for disease information mining tons of data to automate the process of trying to determine cures for various diseases. Very ambitious. Essentially, they aim to become the Google of disease information, and using their algorithm, they determine which cure is most effective and list it, in the same way Google uses their patented PageRank to determine the best search results.
Although I am somewhat skeptical at first blush about the ability for a web application to determine disease information and treatment, going to your physician seems to be the best choice rather than self-diagnosing or treating yourself through the site. At least for now. I did quite a bit of searches on the site, and it’s overwhelming for the non-physician, but maybe, it can be helpful for the doctor. The important take away for me is that there are tons of information on the web going from Google searches to your favorite health destination site such as WebMD. With over 117 million US adults searching for health information online, there has to be quite a bit of self-diagnosis that can be misleading to the medically untrained individual. The problem is that we need a way to sift through all of this information and that’s the power of Web 2.0 and why SavvyDoc is an advocate of utilizing web based technology and progressive web strategies to make patients and doctors better long-term. If we’re able to utilize weighted crowdsourcing, perhaps those 117 million people that search for health information online, can get a trusted resource to make more informed health decisions using the Internet, and hopefully because of the ease of use and transparency that SavvyDoc provides, they’ll seek out that physician at the first signs of needing treatment.
In my previous post on health care costs, I argued for further adoption of technology to help alleviate the long term cost issues that are plaguing Medicare. I briefly mentioned the impact the transparent appointment system we are creating at SavvyDoc will help to alleviate the over-crowding in emergency rooms. I was prompted to spend today relating the trickle down effect of web based doctors appointments on the ER because of this Wall Street Journal Health blog post describing recent research showing that the uninsured are NOT to blame for ER overcrowding. This is a common misconception that I am glad the WSJ picked up on. The uninsured unfortunately avoid health care all together. The cost of an ER visit is significantly more expensive than an office visit, so to think that uninsured patients are going to the ER for a bad cold is a false premise. The question then becomes why are insured patients visiting ER’s with such frequency? Thanks to the work being done at the Institute for Health Care Improvement a lot of the reasons for this phenomenon have been illucidated.
Before I go further, the primary source for the statistics in this post come from this JAMA article by Dr. Mark Murray (the link is to the abstract, you will need to visit your local library or have a JAMA account for access to the full paper).
In his paper Dr. Murray argues that issues with health care access are actually due to delays in obtaining care. For instance, in 2001 it was found that 40% of ER visits are not urgent and could in fact be seen in a primary care office setting. I have not seen recent research on this, but as the population ages I would imagine this percentage is increasing. Imagine for a moment the improved wait times in an ER if half of these patients were able to easily obtain a last minute office appointment rather than going to the ER. Realizing that the median ER visit is four to five times more costly than an office visit, think of the economic implications of patients easily finding an open office appointment rather than going to the ER. There are billions of dollars to be saved just by fixing this one problem in our health care system!
The follow-up question: why do patients see it as easier to sit in an ER for hours rather than going to a doctor’s office? Well, at least patients know they can be seen in a somewhat timely fashion in the ER. In 2001 1 in 3 patients reported an inability to find a timely appointment this increased from approximately 1 in 4 patients in 1997. Again, this number is likely rising as our population ages. It does not take a stretch of the imagination to realize patients who cannot find a timely office appointment are deciding to go to the ER for care.
Solution. A transparent wed based appointment system would allow patients to look for any last-minute appointment openings. Patients who desire last-minute care would prefer to see the doctor they are familiar with. Searching for that doctor on SavvyDoc, will allow patients to see if there is availability within the next 24 hours. If that doctor does not happen to be available then further searching will allow patients to find a doctor within their area that is available. The alternative is to walk into a crowded ER waiting room where the patient has no information on who their doctor will be. Our market research to this point has shown that patients overwhelmingly see the value of making on-line appointments with their doctor. Patients are becoming more savvy about how to use the internet for researching information on doctors as well as information on their health. Providing the opportunity for patients to have more control over the appointment making process has wide ranging benefits, this impact on reducing unnecessary ER spending is one of the most significant.
For those of you in downtown Chicago or have spent time there, there are many Potbelly Sandwich Works located every couple of blocks. For those of you not familiar with this restaurant, it’s a combination of Subway meets Starbucks. For many people, it’s a daily routine for their lunch hour. You can get a toasted sandwich and a pretty good vibe, all for about $5. Amateur musicians play in the background, and the cafe/restaurant is always filled with upbeat, high energy people.
While offering such a unique environment for a reasonable price, they have to have quite a bit of volume to stay in business. Sales per square foot are the name of the game, and Potbelly wins just about every day. Lines can be seen being formed outside of the restaurant, seemingly a huge bottleneck. Potbelly’s has done quite a bit to ensure that the throughput of the restaurant is reasonable, so that everyone keeps coming back during that vital lunch hour, which can make or break a downtown fast-food restaurant in Chicago.
Lately, I have noticed that they have really been promoting their website, where you can place orders, and pick up your food without the wait. Your sandwich will be prepared, so you can eat and run, or take your food back to your office. In promoting this website, they have inserted postcards with orders and have made it highly visible through every step of the order process when you’re in the store, that there is a viable alternative, not aimed at replacing the current way most people grab lunch. They are aiming to target those individuals that value convenience and speed, over long lines. From a business perspective, they improve their throughput and can better anticipate demand through a transparent system.
With SavvyDoc, we aim to do the exact same thing. We don’t aim to replace using the telephone to make doctors appointments, we want to make it easier for those individuals that highly value efficiency and transparency. For us to be successful as a company, we do not need to have 98% of the doctor’s patients utilizing the online tool, it’s a system that can alleviate the bottlenecks so the physician can better anticipate demand. As an industry, by most studies, far less than 10% of the carryout orders are done online, yet it translates into a multi-billion dollar space. For tech savvy individuals, ordering online is a huge plus, which GrubHub capitalizes on.
Their are inherent bottlenecks in making appointments, which is why in our market research, 20-30% of the office staff’s time is spent on patient scheduling. Imagine the impact if 40% of the the appointments were done online. Imagine this power, coupled with decreasing the no-show rate, filling last minute cancellations, and the ability to recruit additional patients to the practice. That’s the goal of SavvyDoc. Some patients will enjoy utilizing SavvyDoc because of the real-time scheduling, but there are still others that may not see the value, but as with online banking, over time, I believe that it will be just as common, at least we at SavvyDoc think so.
The robust business of cosmetic surgery is apparently feeling the economic downturn just like everyone else. According to an article in yesterday’s Chicago Tribune the multi-billion dollar business of plastic surgery will have a difficult 2008. This revelation is not surprising considering plastic surgery falls under discretionary spending, but it is interesting in that for many the practice of medicine is appealing because it’s a recession proof career. Despite the desire for a steady career many doctors have resorted to providing cosmetic services to patients due to decreasing Medicare reimbursement. It will be fascinating to follow how the economy affects not only cosmetic surgery but other discretionary procedures such as LASIK surgery, or cosmetic dentistry. For any practicing doctors out there, are you noticing any affects on your practices with regards to discretionary care? Let us know in the comment section.
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