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Medical Collaborative Expert (Presentation)


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  • 1. Medical Collaborative Expert™ working name Arbitrated Health Decisions for consumers and professionals Gil Ronen © 2010 Founder/Demo Developer
  • 2. SynopsisOur goalsMedical Collaborative Expert was a startup founded in April 2009 by Gil Ronen and Miki Kolko. Our goals were to (1)promote participatory and shared decision-making between providers and patients by providing concise analysis ofmedical information, (2) alleviate expertise bottlenecks by bridging the divide between lay users, prosumers and medicalprofessionals, (3) provide rigorous medical reputation & trust mechanisms that help discern quality and locate expertise.The startup was called variously MyPulse and SecondOpinion.What we were building?A service providing personalized step-by-step instructions relating to medical and preventive-health decisions toconsumers, patients and medical professionals; what to do next with regards to treatments, self-tests and labprocedures, monitoring and follow-up and how to go about them. The service utilizes a new collaboration platform thataddresses quality issues by incorporating proven social arbitration mechanisms and proprietary reputation and trustalgorithms and processes. As a by-product of the service a comprehensive evaluation network is created for contentcreators providing help in locating expertise in specific topics and opportunities for professional recognition.Progressively, the service would have supported multiple delivery methods and cater to varying levels of medicalknowledge with a focus on exploiting the continuum of knowledge from lay users, to prosumers, and to various degreesof medical specialization.Where is it now?Between December 2009 and May 2010 Gil Ronen designed and developed a demo system (see separate slide deck)using Python, Django and MySQL. The startup was terminated in August 2010 having failed to secure funding alongsidewell-funded competition. Gil Ronen © 2010
  • 3. Pain How to reach health decision? Example: What to do about blurry vision?• Consumer Pain • HC Providers & Corporate Pain – 80% of medical decisions – Costs involve online research/ Incurred by unnecessary office Overload & confusion visits, treatments, and Search engines and portals medication – practice of provide exponentially- ‘defensive medicine’ increasing quantity and – Ineffective collaboration complexity of information: Patients often subject to online anecdotal, biased, inconclusive misinformation, terminology – Lack of expertise differences and approach Each decision requires learning mismatch terminology and structure of a – State of medical knowledge new domain Huge investments to keep track – Impersonalized with rapidly changing, Impossible to align information contradictory, biased and with personal medical history, inconclusive research and personal approach and needs anecdotal evidence – Trustworthy – Medical networking Not clear where the best quality Not clear with whom around the information resides world best knowledge resides Gil Ronen © 2010
  • 4. Vision: Social Arbitration for Consumers and Professionals Content Arbitrated KnowledgeWhy knowledge and not content? How do we create it?Current analysis process: search the web , Mass collaboration, a proven technique,look for similar conditions, analyze articles , utilized to generate Q&A sessions ongeneralize from anecdotal cases on blogs, medical topics. Proprietary accreditationfilter biased content, find inconclusive and and reputation algorithms and other socialcontradictory conclusions, get confused, structures arbitrate between conflictingbring stack of printouts to physician office elements for state-of-the-art conclusions.visit, request various tests and medications, Knowledge authors share ad revenueexperience side-effects, start over based on their effectiveness in high-quality content productionStatus Quo Solutions Our SolutionDomain-specific searches identify more Envisions personalized step-by-stepmaterials, portals provide more instructions relating to medical andinformation, tools targeting professionals preventive-health decisions for consumers,identify articles and ongoing clinical trials patients and medical professionals. Ourand provide less than cutting-edge solution helps create quality knowledgediagnosis, and identify expertise lay Gil Ronen © 2010
  • 5. Vision: Social Arbitration Produces Quality Knowledge From ContentPresent Future Locus of expertise What-to-do-next instruction Content Online deliberation Automated check-up/follow-up Latest arbitrated knowledge Voice & indigenous languagesProblem Solution Gil Ronen © 2010
  • 6. How It Works: Member Reputation Just like in real life ! Medical Professional Medical Prosumer 75% 75% Education Dr Stevenson Institutional & Training Member of Amy Chow, Affiliation American Heart Teacher, mom of 3, Association. author of 12 topics. Expertise: Atrial Expertise: Jaundice Fibrillation Prosumers Medical have 2 ways Publications Who’s to gain Who SO Topic SO Topic reputation Author Author 1 Authored highly-rated Verified by content 3 Professionals 100% have 3 ways 2 Dr Holsenstein to gain Expertise: Vouched by reputableProprietary reputation infectious members ***accreditation, diseases Reputation is context- *** Either medical professionalsreputation & trust or medical prosumers sensitive and time- sensitive: expertise &algorithms. Proprietary experience in topic oversocial structures time Gil Ronen © 2010
  • 7. How It Works: Topic Reputation Just like in real life ! Contributed to Topics Utilized & Rated Topics Recently joined SecondOpinion; reputation is established over time 50% 75% Tom Renback Dr Stevenson Intern/John Hopkins Created topic Malaria 75% 90% Treatment Amy Chow Contributed Dr Mebuto Author of 12 topics to topic Experience: 20 years treating Malaria in Zimbabwe 100% Dr Holsenstein Anonymous Affiliation: CDC 1125 – No Gives topic a reputation Seal of Topics gain Approval reputation from Member has no reputation on …and from the their authors’ so rating is counted as reputation ofProprietary reputations… less significant than other reputation sources their raters.accreditation,reputation & trustalgorithms. Proprietarysocial structures Gil Ronen © 2010
  • 8. How It Works: Incorporating Latest Findings 75%Question Add Mode: Chronic Fatigue Syndrome Authors: Ann Aaronson 100% Dr. Xio L MonCurrent editor (since Oct 12, 2009 9:40pm EST): Dr Judy Mikovits Last modified: Sep 22, 2008 by Dr Xio L Mon (minor edit)Q #398: Was patient tested for XMRV? Q New see full edit history 12,285 views / 563 ratingsPrevious Next Similar Questions Question Author Edit History Dependencies see full statsImportance Explanation: Chronic Fatigue linked yesterday to HIV-like virus (Science October 8, 2009). XMRV Test is quicker and cheaper than alternative of sleep-studies on individual patients. 100% Alan Burke: I added the question following reading in the NY Alan Burke Times about an article published online in the journal Science: Chat email 68 of 101 patients with the syndrome (67%), were infected with an infectious virus, xenotropic murine leukemia virus-related virus, or XMRV. By contrast, only 3.7 percent of 218 healthy people were infected. Continuing work after the paper was published has found the virus in nearly 98 percent of about 300 patients with the syndrome. 100% Dr Judy Mikovits Comment: I authored the referenced Dr Judy Mikovits article. XMRV test should be performed in order to rule out Chat email more subjective methods (e.g. self-reporting or sleep studies)Latest tests incorporated nearlysimultaneously with publication, providingopportunity for open debate by proponentsand opponents and swift adoption of newtreatments whenRonen © 2010 Gil and where appropriate.
  • 9. Technical: How Its Done? / Collaborative Authoring 100%Topic Edit Mode: Blurred Vision Authors: Mr Yuan 100% Dr Broad Current editor (since Sep 22, 2009 5:40am EST): Dr Broad Last modified: Sep 28, 2009Topic questions by Dr Broad (major edit) see full edit history1. Blurring of distant/nearby objects? Expand 785 views / 112 ratings2. Blurred vision associated with Diabetes? Expand see full stats3. Blurred vision onset? Collapse Response options: Immediate, Gradual, Comes and goes, Don’t know modify Description: Onset trend can rule out or suggest several directions for ...more Topic Ad Keywords edit Author Talk page 1. Vision Problems4. Use Predinson medication? Expand 2. Glaucoma5. Suffer from Glaucoma? Expand 3. ArthritisTopic cases Compare Conditions Blurred object Blurred Diagnosis eMedical Profile Citation Options Author distance vision onset Glaucoma Crp > 10 Nearby Gradual Article Modify Feedback Dr. Globinsky Glaucoma Medication=preinson Prof. Distance Experience Modify Feedback OR Arthritis Diagnosis=Glaucoma Blumental Glaucoma Crp > 10 Nearby Gradual Article Modify Feedback Dr. Globinsky Glaucoma Nearby Always Article Modify Feedback Dr. Globinsky Gil Ronen © 2010
  • 10. Technical: How Its Done? / Structured Deliberation 75%Question Edit Mode: Adolescent Depression Treatment Authors: Dr. Globinsky 100% Dr StevensonCurrent editor (since Sep 22, 2009 5:40am EST): Dr Stevenson Last modified: Sep 22, 2009 by Dr Stevenson (minor edit)Q #324: Does Adolescent take Psychostimulants (e.g. Ritalin)? Q Suspended see full edit history 1,285 views / 128 ratingsPrevious Next Similar Questions Question Author Edit History Dependencies see full statsImportance Explanation: Proven interactions between Buprion and Ritalin (Citation *) 75% Amy Chow: Interaction cited is an anecdotal case. Often Amy Chow ADHD accompanies adolescent depression (Citation **) and Chat email Buprion is a common add-on for depression medication (Citation needed). Removing Ritalin from the arsenal in these cases is unsubstantiated and may do more harm than good 75% Dr Stevenson Comment: I concur with the above Dr Stevenson Chat email* Case Study: Acute Myocardial Infarction in a Young Male on The combined reputation of bothMethylphenidate, Buprion and Erythromycin reviewers disputing the rationale for** ADHD in Children: Rationale for its Integrative Management question #324 is sufficient for the question to be suspended. Gil Ronen © 2010 authors Notifications are sent to
  • 11. Technical: How Its Done? / Algorithms Member Reputation Opinion Diversity Heuristic Longevity of content edits Heuristic Heuristic impacts a member’s Member groupings based reputation; Lasting edits on topic interactions: A C imply quality A C “Dokdo” nodes attract Group A: Korean point-of-view: use of each other B D terminology such as ‘East Sea’ not ‘Sea of B D Japan’; claims of Korean heritage (affiliation) on user pages; supporting edges (content edit reverts) repulse nodes Korean claims on users’ talk pages Schools of thought Group B: mostly Japanese content edit history flow by Time (X axis), point of Content Segment (Y) and Agent (Color) view Group C: Agent A mixed A’s Reputation Profile: Trust & [Education Item 1,…] Reputation […,Experience Item 5,…] contribution of trust to Content Trust […,Author Item 3,…] Agent E Agent E is function of Agent D Algorithms Agent D’s reputation Trust of new version of content is atwo experience items are almost identical (1) function of trustworthiness of previous [Education Item 1,…] [Education Item 1,…] version, reputation of agent affecting the […,Experience Item 3,…] Agent B […,Experience Item 3,…] changes and the changes themselves. […,Reviewer Item 2,…] content trust […,Author Item 2,…] (1)Credit Assignment: The rAi rAi+1 contribution of Experience Item Agent Reputation propagation is a fn. of the reputation ii Agent C #3 on agent B’s reputation is of supporting agents the predictive value of the determined from its contribution. Incremental and approximate models are di contribution to other agents’ used so models are not recreated from scratch when tVi tVi+1 Xi reputation (such as Agent A) events occur (such as Hierarchical Bayesian models) Gil Ronen © 2010
  • 12. Function Summary: Non-professional Consumers on SecondOpinion.comProfessional members: 120,000 Non-professional members: 21,231,331 Health topics: 317,899 Link to favorite medical record service Allows SecondOpinion to apply its knowledge 1 of medicine to 3rd-party infrastructure (e.g. Google Health). Updates to 3rd-party eMedical record trigger an automated check-up Get personalized medical suggestions 2 Application of SO knowledge results in notifications on drug interactions, suggestions on next steps on medical conditions and provides other personalized medical information 8Let SO help with Share with trusted contactsa second opinion 3 Share your medical records with trusted doctors and family members and let them contribute to your well-being through follow-up, corrective suggestions and support 7 4 Connect with experts Connect with similar people in topics of Find people with similar symptoms interest 5 who’ve possibly been successful 6 with different treatment Earn money for your contributions Whether you’re a medical professional or Contribute to medical knowledge knowledgeable individual, you earn money from By starting your own health topic or updating advertising the more trusted your contributions existing ones with sound and supported knowledge Gil Ronen © 2010
  • 13. Function: My eMedical Profile Function: My Community Medical standards change slowly so new information will need a SecondOpinion Health Profile Trusted contacts (add) home. SO will also Healthcare provider notes overlay information from your medical Dr. Globinsky (Ophthalmologist) Community notes providers and trusted 100% Chat Poke Profile Allowed to edit profile contacts so it is visible Click to add additional information in context when profile is viewed Dr. Shteinlauf (General Practitioner) Google Health Profile 50% Chat Poke Profile Allowed to edit profile Age, Sex, Height, … 79, Female, 165cm Conditions Glaucoma, Arthritis, Heart attack Miki (Son) Medications Diamox Sequels, By mouth … Chat Poke Profile Allowed to view profile Allergies Procedures Consulting contacts (find) (add) Test results Dr. Noam Harass (Rheumatologist) Immunizations Flu 75% Chat Poke Profile Files & Images Symptoms Blurred vision Ilana Korman (herbalist) Diagnosis 75% Chat Poke Profile Insurance company Kupat Holim Me’uchedet Linked to Members with similar profile (find) Enable Google health  MonitorMe™ Anonymous 1013 Automated Microsoft health Chat Poke Profile Checkup Gil Ronen © 2010
  • 14. Function: My Communication CenterIncoming messages Click to see results of MonitorMe™ checkup triggered by new blood testArchive Type Date/Time From Flag Message Dr. Shtienlauf 9/18 7:15am I’ve seen your blood test results – please give me a call Chat Poke Profile test 9/18 4:05am Test result alert Abnormal blood test detected by topic Blood Test Diagnosis Ilana Korman 9/17 11:03pm Hi, tried new medication for my arthritis . Let’s talk. Chat Poke Profile Mat John 9/17 5:15pm We have the same symptoms. Can you share your course of treatment? Chat Poke Profile 9/18 7:15am SecondOponion Detected member with same symptoms but different treatment Gil Ronen © 2010
  • 15. Function: MonitorMe™ Automated Check-upsWhy A New Checkup? Topic Details: What to do about abnormal LDL/HDL 9/18/2009 Blood test: High HDL What to do about abnormal LDL/HDL? 12 updated topics since last checkup 8/23/2009 Last update: 8/22/2009 (version history) Topic rating (122 raters) 75% Average author reputation (5 authors)Checkup Result Topics (see all 23) (see all new)x Topic: What to do about abnormal LDL/HDL? Actions for What to do about abnormal LDL/HDL Topic rating (122 raters) Start this topic now 75% Average author reputation Subscribe to topic Show subscribed users / online Topic: What to do about Azidone & Plebirite interactions? Bookmark topic Topic rating (81 raters) Find similar topics Average author reputation 50% Find specialist Provide feedback Notify my community Contribute to this topic ! Resources: What to do about abnormal LDL/HDL Show info from medlineplus Gil Ronen © 2010
  • 16. Function: Personalized Consultation Authors share revenue from ads Search/NavigateType topic / free-form-question here placed on content Ask Your Network they’ve authored. The AuthorTop-rated Result: Blurred vision Content RevenueAuthored by Dr. Globinsky 75% , Prof. Blumenthal 100% model takes into account theContribute to Topic! portion and quality of each author’sBlurring of distant/nearby objects? Nearby contribution Deduced No (modify)Blurred vision associated with Diabetes? from profile Google Ads Deduced Gradual (modify)Blurred vision onset? from profile Buy magnifiers from Deduced Yes (modify)Use Predinson medication? from profile Why this is important?Suffer from Glaucoma? Deduced from profile Yes (modify) Why this is important?Blurred vision might occur due to side-effect of Explain why?Predinson on Glaucoma (68% confidence) See more diagnosis Gil Ronen © 2010
  • 17. Function Summary: Medical Professionals on SecondOpinion.comProfessional members: 120,000 Non-professional members: 21,231,331 Health topics: 317,899 Author or validate medical knowledge 1 Find peers with similar interests 2 Also, find doctors with a specific expertise for a patient referral 8 Conference on hot topics 3 Impact public health in an Earn prestige for immediate way significant contributions Apply knowledge- 4 base to a patient 7 Earn money for contributing 5 Find and compare similar cases 6 Consult anonymously with peers Gil Ronen © 2010
  • 18. Function: Case Consulting MedChat Mode share MedChat Dr Blumenthal onlineHello Dr. Globinsky ! verified Conversation Contacts Call View Tools HelpPatient ID Alisa KoshlovskyNotes: Prof. Blumenthal: Hi Dr Blumenthal: Any experience with Arthritis causing blurred vision? Dr. Shteinluf: Yes – read this Trusted to Modify eMedical Profile (citation) and we can discussPatient Alisa Koshlovsky – Symptom Blurred vision – Application of topic Blurred Vision (version 3) Blurred object Blurred vision eMedical Profile Citation Diagnosis Author distance onset Crp > 10 Nearby Gradual Article Glaucoma Dr. Globinsky Medication=preinson Glaucoma OR Distance Experience Prof. Blumental Diagnosis=Glaucoma Arthritis Crp > 10 Nearby Gradual Article Glaucoma Dr. Globinsky Nearby Always Article Glaucoma Dr. Globinsky Gil Ronen © 2010
  • 19. Opportunity: Why Now? Wikipedia, Picasa, Hunch and many others have shown that complex tasks can be done byComplex Simplicity lay users via simple user interfaces The US government and companies in every field (IBM, Google, Healthizen) are spendingeMedical Records billions of dollars on creating an infrastructure for medical analysis with structured and web- available content The medical domain is at the crux of 10% of world GDP (includes treatment, products andMedical Market services) and growing as populations age Companies recognize that generic search alone is inadequate and are starting to address it by adding semantics and vertical domain knowledge (e.g. Microsoft Bing, Wolfram Alpha,Problem Recognition Google), using social computing to tackle analysis (e.g. Yahoo! Answers, Hunch, Vark, eCommerce sites such as Amazon), and by summarizing content (About, Wikipedia, AskDrWiki, Knol). New ideas are flourishing Digg, Amazon and others have shown that social metrics can significantly augment genericSocial Metrics Work search resultsSocial Deliberation Wikipedia and others have shown that by providing experts, prosumers and lay people withWorks deliberation tools, complex knowledge convergence can emerge Significant evidence that people conduct a growing portion of their analysis online, ahead ofAcceptance making most decisions (66% specifically in the medical and health-care domain) People expect information on most topics on the internet and have raised the bar onRaised Bar themselves in terms of optimality of decision choices that they makeComplexity, Volume, The amount of information and its rapid pace of change are increasing the complexity ofChange analysis exponentially Gil Ronen © 2010
  • 20. Competitive Landscape• Medical-specific: Portals, communities & forums, vertical search, messaging, eMR  WebMD  Healthline  Omnimedicalsearch  Imedix  Careplace   Mednets  Healthcentral  Ehealthforum  Medhelp  Healthatoz  Revolutionhealth     Keas  Medstory  Mwsearch   YourDiagnosis  AskDrWiki  SymptomChecker   Healthizen Limitations: Portals and search engines offer content not knowledge, Knowledge aggregators suffer from expertise bottle-necks aggravated by simplistic reputation and quality-control mechanisms, lack comprehensive personalization and create a gulf between lay consumers and medical experts that is being gradually erased in other domains.• Domain-independent: Search, analysis, Q&A, question propagation  Google & Bing  Vark  Hunch  Knol Limitations: Generalized solutions lack domain-specific quality measures and do not offer domain- relevant tools. In general, existing and proposed approaches do not sufficiently address quality in a domain for which it is essential. Gil Ronen © 2010
  • 21. Differentiators (1) Status Quo Solutions * No; current sites do not offer personalized analysis and suffer from the “expertise bottleneck” problem (aside from Hunch**). Existing sites provide opinions Yes; analysis is created by mass provided by medical experts from their own specific collaboration of reputable sources. perspective (often not able to keep up with the latest Incorporates information from a vast pool of Personalized findings), summaries written by “experts” (e.g. medical professionals as well as a much Conclusions to are usually not written by medical larger pool of medical prosumers Medical Analysis professionals with a reliable (and transparent) (experienced analysts that are not medical Problems affiliation and reputation, article links require professionals but are accredited through a command of complex medical terminology and often reputation system that emphasizes the rating only serve to highlight contradictions in research by medical professionals) findings; anecdotal evidence such as found in thousands upon thousands of blogs needs to be manually assimilated by the reader. Yes; Automated check-ups based on ever- Everyday Health evolving medical knowledge: triggered by Monitoring user events (e.g. new blood test results) or No (MonitorMe™) updates to rules (e.g. new drug interaction warning) Complex No; large amounts of text across sites makes Analysis on Yes; Q&A format is easy and compact information hard to assimilate *** Mobile Devices* Competitors analyzed include: WebMD, AskDrWiki, Hunch, Vark, AskSimon, Knol, Amazon** is a new personalized analysis site. It is not a medical vertical site, has no medical-specific features, nor a rigorous reputation system.*** Hunch is the exception that proves the rule. It shares a single but significant aspect of SecondOpinion and serves as an encouraging prototype formass collaboration generated analysis! Gil Ronen © 2010
  • 22. Differentiators (2) Status Quo Solutions Yes; Case simulation, facilitates analysis Tools for Medical collaboration with immediate public-health Limited; Wiki-like functionality Professionals impact Author Incentives – why Comprehensive; Authored Content Revenue should (ACR) model, do-good satisfaction, community Limited; Do-good satisfaction, community professionals recognition, “accreditation” by and for recognition and others professionals contribute? Status quo; Social networking functionality is Next generation; Professional to prosumer to added as a feature – no distinction between Social Network lay person interaction is mediated by rigorous professionals and non-professionals (no Synergies social structures (e.g. accreditation, reputation, accreditation), reputation is simplistic and lacks trust, access balancing) qualitative features. Yes; Allows for better utilization of question- Question propagation and other forms of direct No * Propagation communication between persons of varying degrees of expertise Openness to No; Translating large amounts of content is not Non-English Yes; structure makes translation easier practical Speakers* Vark is a new question propagation service that does not target any vertical. It is not integrated with any other analysis functions. Gil Ronen © 2010
  • 23. Opportunity and Revenue Model: Flexible Multi-pronged Approach Total online ad revenues are projected to be $147 billion dollars by 2012 with the health-care slice platform can be private-labeled or garden-Hunch currently claims 3.2% and growing 4 times as fast walled where appropriate. Healthcare ITthat 40% of its topics are as all other categories) expenditures are projected to reach $54 billionmonetizable by 2014 Transaction Fee Advertising Premium Services Topics cover soup-to-nuts Context-specific ads around Hospitals and other fee-for-service including products and services services (e.g. question providers pay for specialized propagation) services or private-labeling MedChat Mode share MedChat Dr Blumenthal online Conversation Contacts Call View Tools Help type question for your network ask Prof. Blumenthal: Hi Dr Blumenthal: Any experience with Arthritis causing blurred vision? Buy at $29.98 Dr. Shteinluf: Yes – read this (citation) and we can discuss Buy at $31.24 Buy at $19.99 HC IT Market E-commerce market License model Referral fees Online Ad market Private Labeling Gil Ronen © 2010
  • 24. Team Gil Ronen – Co Founder Published and patented technologist, speaker and award-winning practitioner for 20 years in the area of knowledge systems employing applied artificial intelligence; rule-based and case-based reasoning paradigms as-well-as analytical models. Theoretical and practical experience with knowledge editors for lay users. Former VP at MindBox. BSc in Computer-Science and Cognitive Psychology from Bar-Ilan University in Israel, an interdisciplinary MSc in Intelligent Systems from the University of Pittsburgh and an MA in Studio Art focusing on Digital Art from NYU. Alumni of IDF MAMRAM center for computing. Miki Kolko – Co Founder Entrepreneur and technologist: Founded Aspear, a real time collaboration platform in 2000. Founded PicaBook in 2005, providing photo book publishing services to consumers. Experienced in funding, management, business development and alliances, and marketing of new companies. 23 years experience in software development and technology management. BSc from the University of Bar-Ilan University and MSc from Tel-Aviv University in Mathematics and Computer Science. Alumni of IDF MAMRAM center for computing.Gil Ronen © 2010