Technology
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Most of the technology I review, whether it’s a new stethoscope or an electronic pocket reference, tries to improve upon the way we as EPs take care of our patients. Healthagen’s iTriage is a different sort of product, one that actually helps our patients help themselves. Which in turn should actually help us too. Sound complicated? Let’s get you up to speed.

iTriage is a medical application for smart phones and the web that helps patients understand the symptoms they are experiencing and guides them to an appropriate medical provider using GPS technology. Along the way, this one-stop shop provides a range of information from text to video to web links. At least, that’s how it’s supposed to work. We put it through its paces to see if it’s worth the price tag.

altWhen you open the mobile app the first screen allows a quick 911 call if needed. If you decline the emergency call, you are brought to a page where you can search by symptoms, diseases, procedures, and providers. Clicking on the symptoms tab brings up an alphabetical list of symptoms that, when tapped, displays multiple potential causes for that symptom. The list of symptoms and possible causes is not as extensive as WebMD.com but offers up a reasonable number of possibilities. While no differential diagnosis tool is perfect, iTriage does a nice job of showing the most likely (less concerning) causes of your complaint while still providing the user with the less likely but more concerning illnesses such as cancer. What iTriage doesn’t do – nor any other altpatient diagnosis tool – is risk-stratify the likelihood of any given diagnosis. I guess they won’t be replacing us with robots quite yet. Tapping a disease brings up a table, allowing the user access to multiple areas of information. The end result of this decision tree is that the patient can get a good sense of what to expect if they seek care for this problem including tests, procedures, treatment, etc.  There is also a web link that allows the user to access the infinite wisdom of the Internet, accessing non-iTriage information, including photos and video.  If you need a little more information there are links for both nurse and physician help lines (both are partners with Healthagen).

altOnce you’ve decided to bite the bullet and seek treatment, iTriage really gets to flex its muscles. By tapping the “Find a Provider” link you are taken to a page showing several categories of care. In the mobile version, iTriage places a red X in front of providers that are unlikely to be able to help you with your suspected issues (i.e. pharmacies are not listed for suspected appendicitis) while displaying others with a green check mark. The mobile app then allows you to search for an appropriate provider by zip code or GPS (nice for travelers). The list is organized by distance from your current location or zip.  Tapping on a provider expands to show an address and phone number. The web app includes a map as well as a link to Healthagen’s altpartner sites HealthGrades (for report cards on the provider) and Coalition America (for help “negotiating” your bill).

This is the time for those ED Admin folks out there to pay particular attention. The information listed for a given provider can be further enhanced if you pay an annual fee and become a “Premier” provider. While Healthagen would not quote a price, they claim that the annual cost is roughly equivalent to reimbursement for two moderately ill patients. “Premier” members can add a multitude of additional information to their profiles, from the availability of specialty services to real-time estimated ED wait times. This service is central to Healthagen’s mission of empowering both physicians and patients with the information necessary to make more informed decisions. Their hope is that utilization of iTriage will decrease medical costs, increase patient satisfaction by directing patients to appropriate levels of care in a realistic time frame, and finally improve physician satisfaction through enhanced communication with and timely care of their patients. It is important to note that non-premier members are not excluded from, or given poor placement on, the search lists. Current “Premier” members include such heavy hitters as the Hospital Corporation of America (HCA), Centura, Exempla and HealthONE, as well as multiple urgent care organizations. Not bad for a company that has been out for less than a year.

According to Healthagen, by becoming a “Premier” member and including the hospital’s web site, a provider can increase the click-through to that site by approximately ten-fold. The assumption here hinges on knowledge sharing. If the hospital system can give their consumers more knowledge, they will make more knowledgeable decisions and be happier with the provider’s health-care product.

An informed consumer is a preferred costumer, right? Now I know what you’re thinking and I agree that this adage is not always true in medicine. Many of our “informed” patients know just enough to be worried but they don’t know what they need to really worry about or what is really an appropriate work-up for their complaint.  So, you may be asking yourself why you’d want to empower potential patients with iTriage. Keep in mind is that individuals who use smart phones tend to be in higher income brackets, more informed, more compliant, and more often than not, insured. This is where you as an ED director will have to decide if it’s worth the price of admission to be a premier customer with iTriage. As stated above, if you can attract just a couple more patients the subscription likely pays for itself, and any additional patients attracted to your facility, courtesy of iTriage, will just be icing on the cake.

Future directions for iTriage may include online health records, direct patient-to-physician communication via texts and email, as well as patient monitoring. Current platforms include iPhone, android, blackberry, and the web as well as a widget you can imbed on your own web site.

All in all, iTriage is a well thought-out product with a good layout both on the web and on your smart phone. With its slick GPS mapping, it takes advantage of the best that smart phones have to offer. That said, unless providors and/or insurance companies get on board and start recommending it to their customers, it could definitely suffer the fate of so many apps, that of getting lost in the avalanche of new products.

Jason Wagner, MD, is an assistant professor of emergency medicine at Washington University in St. Louis.
Follow Jason on Twitter @TheTechDoc
 

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