Podcast interview with iTriage co-founder Dr. Wayne Guerra (transcript)

This is the transcript of my recent podcast interview with Dr. Wayne Guerra, co-founder and chief medical officer of Healthagen, the maker of iTriage.

David Williams: This is David Williams, co-founder of MedPharma Partners and author of the Health Business Blog. I'm speaking today with Wayne Guerra. He's co-founder and chief medical officer of Healthagen, which makes the iTriage app for the iPhone. Wayne, thanks for your time today.

Dr. Wayne Guerra: Thanks for having me, David.

David: Wayne, what is iTriage?

Wayne: I'll just give you a quick background. Our chief executive officer, Dr. Peter Hudson and I are both practicing emergency physicians. We've witnessed patients struggling to make difficult medical decisions with very limited information. Collectively, we've seen over 50,000 patients. We both have done other business ventures, started companies and sold them. We've known each other for 20 years. We got together in August and decided to figure out a way to give patients the information they need to make better healthcare decisions.As you know, more and more responsibility for the healthcare decisions that people are making has been put on themselves, not only financially, but also with less access to their primary care physicians. They can't get them on the line.So, we really wanted to make iTriage healthcare in your hand. How did we do that? It came around about the same time that the iPhone was developed --a mobile hardware and software tool that allowed us to do many of the things that we had been talking about over the last couple years.It's a vertical search engine with what we call actionable data. It gives users medical information on over 300 symptoms, 1000 diseases, and 350 procedures. It integrates and interprets what they're searching, helps them find appropriate healthcare facilities, and then gives them information, what we call transparency, around cost and quality.When people have a medical problem, David, a decision's going to be made. They may decide to do nothing. They may decide that they need more information, which they can get on iTriage with our content, which is very focused.Sometimes you can do searches on the current online medical content sites. It's almost information overload. You look down and there's seven pages to go, and it's just too much information. We've focused our content to be enough to give you a good general idea of what the disease is that you're searching, and then to make the next decision.If that decision is to get more information, we allow you to do that through the application. You can do very focused Google searches on symptoms, prognosis, and latest research. You can even see videos or images right on the application, and then get right back to where you left off in the application. It doesn't close the application.Let's say you're searching something and you think you have disease X. Then we help you find the appropriate facility for disease X. I can't tell you how many patients I've seen after their workup, and they're doing this mental calculation in their brain. They know that this is going to be quite an expensive bill.More of us are at risk for at least a pretty good portion of that. After I'm done taking care of them they'll say, "Doctor, could I have gone to the urgent care for this?"That's a really valid question. We try to help direct people to the appropriate level of care. So, if it's something you're searching that could go to an urgent care clinic or retail clinic, we'll help direct you in that direction.But, if it's not, if it's something that you think is more serious, then the opposite is true. You shouldn't try to go to an urgent care clinic if you think you have appendicitis, because you're going to end up not only delaying treatment, but they're going to charge you for that visit. Then, there's sometimes even an ambulance visit or ambulance transport from the urgent care to the ED.So, we're trying to help people make better decisions. Once they choose a facility, or once we give them the appropriate facilities to find, then we can actually geolocate those facilities, the ones closest to them, and help them either call them or actually get a map directly to them.

David: Wayne, I guess the concept of iTriage is pretty broad, so I'm sure you're dealing with all sorts of scenarios. Can you, perhaps, give me an idealized type of scenario about a particular situation, particular type of person, particular condition that they might have, and take me through what they would do with iTriage, how it would help them?

Wayne: Sure, that's a great idea. Let's say you're on a business trip. So, you're out of your normal environment. You're out of your normal resources. You start having abdominal pain on the plane. You land; you get to your hotel room. The pain is getting worse and worse, and it starts to move down to the right lower side. I'm really concerned about this. It's just not going way. It's not something I ate.So, you would open iTriage and search "lower abdominal pain." You've heard of appendicitis, but you don't really know what it is. You click on "appendicitis" and you'll get a description of it. You'll get symptoms and then you start to decide, "Well, what do I need to do? That sounds like what I might have."You can get common workups or standard workups. If you decide to go to a facility, you can figure out if you think what you have, and your doctor thinks what you have - are they doing the tests that are generally done to figure that out?Let's say, you decide, "I need to seek care, because this really sounds like what I'm having from that description." So, you choose "Find a facility," and again, like I stated earlier, the only appropriate facility would be an emergency department. You click "Emergency department," and then you can filter that search by 10, 20, or 50 miles. If you're in an urban area, 10 miles is going to be sufficient.You find an emergency department that can take care of you and get a map to it. You decide to go there. Now, you're in the emergency department. The emergency doctor comes in and starts to see you. You tell him or her, "I think my pain's in the right side. I think I might have appendicitis."I always appreciate that, as a caretaker myself, because I may or may not have been considering that. But, having a patient that's educated, knows what the process is, and what they might have makes it much easier for me to interact with them and to deliver their care.Let's say, appropriately, on iTriage it says you should have a CAT scan and a white blood cell count, both of which your ER doctor does. Three hours later, after the whole workup, the ER physician walks in and says, "David, I'm sorry, but you have appendicitis. You're going to have to have an operation."That makes sense to you because you looked and it said "Standard treatment," so you know that the standard treatment for appendicitis is that your appendix has to come out. You just can't give antibiotics.Then he says, or she says, "Doctor X is on call today for us. They'll be taking you to the operating room."How do you make a decision, whether Doctor X is a good provider or not? That's something people struggle with. I actually had a neighbor of mine wake me up at two in the morning once, when their kid jumped off a balcony and broke his femur. They had to take him rather urgently to the operating room. It wasn't something that could wait two or three hours.She was frantic. She woke me up and said, "Is Doctor X a good doctor? Is he a good orthopedic doctor? Would you let him operate on your family?"I said, "Absolutely," kind of groggily because I wasn't quite 100 percent awake, but awake enough to know what her question was. I could just feel all of this anxiety coming off her shoulders.Similarly, let's say you have no idea. You've never met the ER physician. You've never been in this hospital. You don't know who Doctor X is. Well, right on the phone, with our partnership with HealthGrades you can obtain a quality report, not only on the hospital but also on the physician.Delivered right to your phone, it takes maybe five to seven minutes. Then you can compare that to their peers. If the report is good, then sooner or later, you're going to have decreased anxiety.People have a need for this kind of service. They're getting more involved in their care. They're not just trusting what the health environment or what the health czars are telling them. They want to prove that for themselves. They want to vet that themselves.So, they get the quality report. It's a good quality report. You feel much better about your hospital, about your surgeon, and you have your care. That would be one scenario of many where this is effective.

David: You've already answered this question in a way, since I know that iTriage is available on the iPhone, and you gave the business person away on a trip as an example, but are there particular target consumer segments that you had in mind in thinking about how to develop this app?

Wayne: Yes. Certainly the business traveler you just stated is a big one. If you're traveling and your ear hurts you know you don't need an ER, you just have to go to an urgent care or a retail clinic because your ear hurts. You've had an ear infection multiple times; you know exactly what it is, you just have to get care. So business travelers, the tech-savvy 20- to 35-year-olds... It's interesting, when you look at iPhone adoption, one of the fastest growing segments is a population that makes between $25,000 and $50,000 a year. That's an interesting phenomenon because the phone itself, and the data plan, is kind of expensive. What some analysts think is happening is that they're giving up their home Internet connection and they're only using the iPhone for their email and whatnot. If you don't have to print something off that you're reading, it's fairly easy. You can get photos and transfer them over and print them off that way.So, that's the fastest growing segment. These tech-savvy early adopters, they embrace technology, they love to use all capabilities of the iPhone. That group is really important for us. That group also, unfortunately, happens to be either uninsured or underinsured, so we give them a product and a tool to make the best decision, not only cost efficiently but also medically.Worried moms. We get lots of phone calls from, you know, "My kid just fell, playing basketball, and hit his head. He's vomited once and still has a headache. Do you think I need to go to the emergency department?" For our friends that have that ability to call a physician, either Pete or I, that's great, but most people don't have that resource. So, here's a medical resource that helps them to make better decisions.Then, this whole idea about consumer-driven healthcare. Pete and I started a billing company and a physician management contract company and a physician service company. So, we sort of stand between the consumer/patient and also the facilities, and know what both of those needs are, and we try to position iTriage to help both of those needs.What we hear from third-party administrators and large payers, and patients as well, is, we're pushing more and more responsibility financially on the patient, but then haven't given them any tools to make decisions. So, how do we reconcile that? iTriage does do that; it is a consumer-driven healthcare tool. Some of those people with consumer-driven healthcare plans that don't have any other tools, especially in a mobile environment, on the go, 24x7.

David: Tell me about the relationship with TelaDoc.

Wayne: We partnered before launch with three partners, the first being TelaDoc, a nationally recognized telephonic physician advice and treatment service. Many times, if you call TelaDoc with the appropriate symptoms - it's bronchitis or an ear infection or a sore throat or urinary tract infection - after a telephone history and they review your health record, they can call in a prescription for you. So, we thought, here's a busy business traveler, doesn't have time to get to a clinic; he can call a physician and get a prescription called in and get treatment for what they know they have, with all that's appropriate. That's why it was very important for us to set up that partnership. The same with Coalition America. The way people are charged currently, if you don't have insurance and you go into an emergency department, you will many times be billed the full uncontracted rate, so you'll pay 100 percent of billed charges. We know this because we run a billing company ourselves and know what happens. What that does is it doubly dings people that don't have any insurance. Not only are you paying for your whole treatment, but you're not getting any discounts and you're not getting any of the contracted rates.The agreement and the partnership with Coalition America, someone can go right to the phone, email Coalition America, they contact you and they'll do retrospective bill negotiation for the user. Not just the hospital, but with all the physicians and the lab and radiology and get their users and our users a better rate.

David: It sounds like really exciting functionality and great partnerships. Give me a sense of how things are going and how many downloads you have had and what's the business model. Do you expect this to be a successful, profitable venture?

Wayne: The actual number of downloads is proprietary, but I can tell you that we have a thousand facilities being searched across the nation currently. People are looking up diseases and symptoms. When you present a new product and a new way of doing something that saves time --when people do get it in their hands, they just love it. They say, "you know, I would never not have this." But, you have to get that adoption. We are also kind of excited about being a new app 2.0 company in the sense that it's not just based on application download, which is a one-time event. The only reason we charge $0.99 is because we want our users to not delete it if they have some difficulties with it, but to contact us. (We haven't had very many of those by the way.) We send them an email, "please do these things to learn how to use iTriage, to make it more effective for you.If people even spend $0.99 on something, they value it more than if it's just free. We know there will be a little less downloads than if it was free, but we really want people to use it. That's not really a revenue model for us that is significant.The platform is transactional, so we have the partnerships agreements. We also sell advertisements, so banner ads and very specific ones, obviously this is something you'd be very interested in. As you know, if someone is searching for rheumatoid arthritis, there is such a limited landscape on the iPhone. We think a banner ad for Remicade or for another disease-modifying drug is going to be very valuable, because it's the only ad that's going to show on that page.We also sell listing services. We'll never delist an emergency department for not listing with us. We will always list and we've painstakingly gone through our list to ensure it's the most accurate possible. Not only is it an emergency department, but is it also 24x7 and does it provide the services that it does, that they say they do?So, we will never turn off an emergency department, but we do give hospitals and providers, urgent care clinics, retail clinics and pharmacies and soon physicians, as well, the opportunity to have a premiere listing so they get a different color font, they get to have their logo, they get links to their own website. We build them their own web page on iTriage that allows them to highlight the specialties of their facilities.We know from talking to hospital CEOs that they spend millions of dollars a year to have doctors on call and have the available hardware, such as CT scans and special Angio suites to be a trauma center, to be a stroke center, to be an acute cardiac center, but they have limited ways to tell patients and their community that they have these capabilities. That really differentiates them from the other facilities around them.We give them a web page to be able to do that. They can show videos, they can give us videos or we can make them videos that we can play right on the iPhone. Also, in a multimedia format, highlight those capabilities. That's a whole company built around the app and the download, and we are really only using the iPhone and iTunes as a software delivery model.

David: I've been speaking today with Wayne Guerra, who is the co founder and chief medical officer of Healthagen, which makes the iTriage app for the iPhone. Wayne, thank you for speaking with me today.

Wayne: Thanks David, it was a pleasure.