There is a huge movement to empower patients to make better decision regarding their care. Hopes are that more informed choices will lead to increased satisfaction as well as better follow-up and compliance rates. In addition, there is also a more fundamental underlying issue – whether healthcare is a human right or a market service. In order for the latter to be possible, it requires a well informed consumer with access to the same information as the service provider. And there are certainly a plethora of services that are aiming to fill the void of patient resources.
iTriage brings many of these services as well as symptom/disease based medical information to the iPhone and iPad. It allows patients to find healthcare providers as well as reports on those providers from HealthGrades, a popular vendor of physician and hospital quality reports. It also provides access to healthcare advice lines staffed by healthcare providers, and aims to incorporate cost information for a wide range of procedures and tests in the near future.
We’ve talked previously about some of the major issues surrounding these kinds of apps. While the aim of empowering patients is certainly a noble and necessary one, that doesn’t guarantee that these resources do the job. For example, current quality indicators used by groups like HealthGrades are fraught with complications. Also, there are issues about conflict of interest that complicate the supposedly “objective” information as well as the risk of delays in treatment.
Here we review iTriage which, despite the issues outlined in our previous job, certainly has some great features for patients in need of medical care.
The home screen of the app (shown above) gives away its intent – to help patients experiencing relatively acute symptoms figure out what to do. Hopefully, if you need to call 911, you didn’t open this app. The next option is to find medical treatment (see below). Here’s the first big “consumer empowering” feature of this app. Lets say I am a bright-eyed, bushy tailed new resident of Baltimore a.k.a Charm City (yeup that’s really the nickname) and I develop a sharp right lower quadrant pain. I need a physician – but woe is me, who to pick?? In iTriage, you can not only find physicians in your area (via GPS) but you can also access HealthGrades reports one them – portions of which are free (including patient reviews), but the bulk of the reports require a fee.
Now as it turns out, the cardiologist doesn’t know how to handle appendicitis so he says that I need to go to an emergency room or urgent care center for more work-up. Back on iTriage I go, looking for the closest facility. Once I find it, I also get turn-by-turn directions, built-in to the app, to get there asap.
After being evaluated by the fine physicians and medical students (the latter group I hear particularly good things about) at Johns Hopkins, I am told I have appendicitis. iTriage also provides resources for patients to learn more about specific symptoms (basically a list of causes) as well as about specific diagnosis.
The the “Disease” window, we are provided with resources including more information about the disease, potential evaluation, and treatment. This portion of the app I found lacking. The descriptions are generally simple yet use rather complex medical terminology. This also occurs in the tests section, where terms like CBC, ANA, etc are used without definitions. The images and videos are basically searches for the disease name on YouTube and Google Image. Similarly, the “medical websites” accessible for each disease are the same for every disease rather than, say, a patient-support site for that disease. All in all, I found the disease specific resources to be a bit weak. I suspect this is because the app just tries to do too much – rather than distilling the masses of information available into a resource that patient’s can use in an acute setting (for example, just description/tests/treatment), it brings the pain of searching the internet for medical information to the palm of your hand.
There are a few other features of iTriage that are worth noting. First is the ability to access physician and nurse advice lines, with the latter sorted by insurance provider (shown below). The physician line is provided by a service called TelaDoc, essentially a physician call service which charges up to $40 for a phone consultation and is available 24/7. I found this to be a particularly interesting feature to embed, but it is inconveniently located in the app – within a specific disease window. It would be far more intuitive to put it on the home screen.
Pricing: The app itself is free though many of the embedded features (TelaDoc, HealthGrades) charge additional fees for usage.
- Embeds a number of resources useful to patients seeking acute care – TelaDoc, nurse advice lines, physician/urgent care/ER locators
- While i have mixed feelings about services like HealthGrades, some sort of publicly-available quality rating system (hopefully better than HealthGrades) is on the horizon. This app uses the available service in a way that helps patients become more informed consumers of healthcare. Dislikes/Future Updates I’d Love to See:
- The symptom/disease information frankly needs work. I’d suggest streamlining this section to focus on more acute-care issues. This could include eliminating image/video searching (which often returns extraneous and sometimes misleading information). Also, reducing the conditions described in the app, focusing just on the acute conditions, may reduce the “information overload” that often plagues patients.
- Cost information that takes into account the patient’s insurance plan i.e. what will my copay be with this provider, what are my additional out-of-pocket bills for a heart cath, etc.
Conclusion: Like I said in my previous post, I think apps like these – geared towards empowering the patient as a healthcare consumer – are the wave of the future. Healthcare providers have done a poor job of that on our own and frankly could use the help. This app has an intuitive, useful platform to access a number of healthcare resources – advice lines if you’re trying to decide whether you need to see your physician (I’m making a big assumption here that these advice lines actually give good advice), provider locators with embedded quality reports, and even cost information. The fact that its free means that its a nice tool to have, especially for people who travel or are pretty mobile within a big environment (e.g. NYC). However, the symptom/disease parts of the app need some work and there are better resources out there for patients that want to learn more about a new diagnosis. And aside from the app functionality itself, there are clearly ethical issues relating to the business model here that need to be addressed further as well as systematic issues in how we “grade” healthcare providers. But whatever faults exist, this app is definitely an interesting evolution of the patient-centered healthcare of the future.