Podcast interview with MedExpert's Mary Hiller (transcript)

This is the transcript of my recent podcast interview with Mary Hiller of MedExpert International.David Williams:            This is David E. Williams, co-founder of MedPharma Partners and author of the Health Business Blog.  I’m speaking today with Mary Hiller.  She is Executive Director of Knowledge Engineering and Health Systems at MedExpert International.  Mary, thanks for being with me today.Mary Hiller:            It’s a pleasure to be with you.Williams:            What is MedExpert?Hiller:            MedExpert is a medical information company that is rooted in medical informatics and artificial intelligence. Our information goals are to provide patients with current advice and accurate information so they can make the best decisions possible and keep pace with the time that they need to make those decisions.Williams:            I understand that you have something called IMDS.  What is that and how does it fit in with your approach?Hiller:            IMDS is something that we started about ten years ago.  It stands for Individual Medical Decision System and in generic terms it’s a shared decision model.Williams:            It’s interesting what you said about “keeping pace” with patients.  Can you say a little bit more about that?Hiller:            I certainly will.  Part of the genesis of MedExpert is that I was a bench scientist at Stanford in leukemia research. If you came to our lab or one other lab in the world you had a chance to live. At that point in time, wherever else you went, the protocol was such that you were not going to get into first remission, which was the standard of care at that time.It left an indelible mark that there was a protocol and a procedure and a best evidence play available that the bulk of the world didn’t get to tap into.  So we got together during the 80’s and tried to figure out how to deliver care.To truly sift through all the peer reviewed medical information, which has been growing exponentially, required about 400 to 800 hours.  No patient can afford that kind of time.  No physician can afford that kind of time.We conducted a study from  1993 to 1997 where we tracked 200,000 patients for five years. The goal was to understand the informational needs at the different stages of diseases and divide them up. What do patients want from information? How do they use information?  We were astonished to find that patients make up their mind in 24 to 48 hours, especially when faced with a severe health issue.So to keep pace with the patient we realized we were going to have to automate the knowledge and so that is what we embarked on in the late 90’s.  We set up the expert system  rules base and we had a dozen MD’s and PhD’s work through it. The real challenge was how to condense the 400 to 800 hours to come up with best evidence in a matter of minutes.At that point there wasn’t a company called MedExpert.  We were really trying to solve an issue. Through the combination of supercomputing and artificial intelligence, we were able to automate the process.That is how you keep pace with the patient.Williams:            It sounds like the patient and perhaps his or her family and friends would be the users of the service, but who are the customers?  Who are the people that pay the bills for it?Hiller:            The end user is the patient and whoever --we call them a communicator-- is working with that patient.  The customers of MedExpert are the purchasers of health care so it would be corporations, cities, Taft-Hartley groups.Williams:            What do you foresee in terms of health reform and what impact if any that will have on your services?Hiller:            When we first started this organization we looked at the possibility of how information would play in a managed care or universal coverage system. We carved out the space on knowledge so we’re agnostic to what the structure is.  Our assumption is that there will always be discovery, there will always be research, there will always be patients who need help.The rules of the game are something that we can adjust to but patients will always need current knowledge.  They will always strive to make the most appropriate medical decision possible. It good be from the preventive aspect like, “How do I avoid this?” so we have the whole genetic aspect at play. Also if you’re trying to avoid going up the curve of disease. Also if you have been diagnosed and now you’re trying to find the best treatment options.In terms of reform, our focus is to install any rules at play. We have very elaborate systems on how to install whatever the rules are at play but by focusing just on the knowledge we know that we can always help patients regardless of the rules that the patient has to live by.Williams:            A lot of what you’ve described here sounds to me like it is improved on focusing quality and responsiveness for the patient.  But your marketing materials also emphasize cost savings.  Can you tell me how those two things come together?Hiller:            We always focus on quality of care.  When we’re discussing options with patients we never ever say this is less or more expensive. One of the premises that we based our work on is that if a patient is treated with current, unbiased, accurate information they will become less costly because they will make better decisions.That’s just a hypothesis.  We assume that if you get it right the first time you’re going to avoid a second time.  We always said everyone would want to have one surgery if that was all that was necessary. They wouldn’t want to be on ten drugs if they could find a good solution with three drugs.  So by focusing on what’s most appropriate, we made the assumption that cost would come out.  That was a gamble and that was a risk but it was something that in the last ten years has been borne out. We’ve taken huge swipes at cost.We also don’t make decisions for the patient.  That was another gamble.  We find that if you put up a series of stop signs the patient starts focusing on the stop signs, but if you remove all the stop signs and stop lights and just ask, “What is the road you want to travel?” and let them know they can travel down any of those roads, then they start off with questions.  They ask about the pro’s and con’s of going down each path.We’ve found that patients are really good at choosing a path that meets their needs the best.Williams:            What should we expect to see from MedExpert over the next two or three years either in terms of advances in your technology or from your market position?Hiller:            In terms of market position, we have some pretty good results that have been beaten up and validated. So from a market standpoint you will see us in some larger populations.In terms of business lines and services, there is a lot that can be done on timing and a lot that can be done in delivering information more swiftly to a patient at their point of need, more instant coordination with the health delivery system.  Those are services that can improve.  We are also keeping pace with potential shifts for primary coverage from a physician-based office to the inclusion of retail as primary care.  So we will be working in those areas.Williams:            Final question, just to change the topic a little bit.  How does working for MedExpert compare with being in a James Bond film? (See clip from Diamonds Are Forever)Hiller:            It’s a lot more meaningful!That role was only the result of the fact that I was a gymnast and our national team was training down in Southern California. In that era they were pulling a lot of gymnasts into spots.It was fun but MedExpert is a lifetime effort.  There is a fundamental need in what we’re trying to solve and it’s intellectually more stimulating.Williams:            I’ve been speaking today with Mary Hiller, she is Executive Director of Knowledge Engineering and Health Systems at MedExpert International.  Mary thanks very much.Hiller:            Thank you for having me today.