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HealthTap explores how big a community you need to crowdsource health information

A new company named HealthTap has just put together an intriguing combination of crowdsourced health advice and community-building. They rest their business case on the proposition that a battalion of doctors and other health experts–starting at the launch with 580 obstetricians and pediatricians–can provide enough information to help people make intelligent decisions. For me, although the venture is worthy in itself, it offers a model of something that might be even better as a national or international effort.

I had a chance just before the launch to visit the HealthTap office and get a pitch from the boisterous and enthusiastic Ron Gutman. The goal of HealthTap is to help ordinary people–in its first project, pregnant women and new mothers–answer basic questions such as, “What possible conditions match this symptom?” or “What should I do about this problem with a baby?” They don’t actually provide health care online, but they provide information directly from doctors on the health issues that concern individuals.

The basic goals of HealthTap’s “medical expert network” are:

  • To improve the public’s understanding of their own health needs by providing precise, targeted information.

  • To engage patients, making them more interested in taking care of themselves.

  • To allow doctors to share their knowledge with communities, including current and prospective patients, by publicizing answer and tips they often share with patients.

  • To increase the efficiency and effectiveness of healthcare by helping users record personal information while researching their concerns before doctor visits.

  • To promote good doctors and create networks around caring

HealthTap needs to bring two populations online to succeed: health care provides and individuals (which I will try to avoid calling patients, because individuals can use health information without suffering from a specific complaint). I’ll explain how they attract each population and what they offer these populations. Then I’ll explore three challenges suggesting that HealthTap is best seen as a model for a national program: motivation, outreach, and accuracy.

Signing up health care providers

As I mentioned, HealthTap is demonstrating is viability already, boasting of 580 obstetricians and pediatricians. These doctors answer questions from patients, creating a searchable database. (And as we’ll see in the next section, the customization for individuals goes far beyond search results.) Doctors can also write up tips for individuals. If a doctor finds she is handing out the same sheet to dozens of patients, she might as well put it online where she can refer her own patients and others can also benefit.

Doctors can be followed by patients and other doctors, an application of classic social networking. Doctors can also recommend other doctors. As with cheat sheets, doctor recommendations reflect ordinary real-life activities. Each doctor has certain specialists she recommends, and by doing it on HealthTap she can raise the general rating of these specialists.

Signing up individuals

Anyone can get a HealthTap account. Although you don’t need to answer many questions, the power of customization provides an incentive to fill in as much information about you as you can. The pay-off is that when you search for a symptom or other issue–for instance, “moderate fever”–you will get results tailored to your medical condition, your age, the state of your pregnancy, and so on. A demo I saw at the HealthTap office suggested that the information brought up by a search there is impressively relevant, unlike a typical search for symptoms on Google or Bing.

HealthTap then goes on to ask a few relevant questions to help refine the information it provides even further. For a fever, it may ask what your temperature is and whether you feel pain anywhere. As explained earlier, it doesn’t end up giving medical advice, but it does list the percentage match between symptoms reported and a list of possible conditions in its comprehensive database. All these heuristics–the questions, the list of conditions, the probabilities, the other suggestions–derive from the information entered by the providers in the HealthTap network and data published in peer-reviewed medical journals.

Some natural language processing is supported, letting HealthTap interpret questions such as “Should I eat fish?” Gutman ascribed their capabilities to a comprehensive medical knowledgebase built around a medical ontology that is designed especially for use by the lay public, coupled with a Bayesian (probabilistic) reasoning engine driving user interactions that lead to normative value-based choices.

HealthTap lets individuals follow the doctors whose advice they find helpful, and connect to individuals with medical conditions like theirs. Thus, HealthTap incorporates two of the key traits of social networks: forming communities and raising the visibility of doctors who provide useful information.

HealthTap uses easy-to-understand data visualization techniques that distill medical content into simple visual elements that intuitively communicate data that otherwise could seem complex (such as the symptoms, risk factors, tests, and treatments related to a condition).

So now let’s look at the challenges HealthTap faces.

I’ll mention at the outset that HealthTap doesn’t have as much of a problem of trust as most social networks. Doctors have passed a high threshold and start out with the expectation of competence and commitment to their patients. This isn’t always borne out by individual doctors, of course, but if you put 580 of them together you’ll end up with a good representation of the current state of medical knowledge.

The challenge of motivation

Time will tell whether HealthTap can continue to attract physicians. Every posting by a physician is an advertising opportunity, and the chances of winning new patients–which can be done both by offering insights and by having colleagues recommend you–may motivate doctors to join and stay active. But I suspect that the most competent and effective doctors already have more patients banging down the door than they can handle, so they might stay away from HealthTap. I like the HealthTap model but wish it could be implemented on a more universal scale.

The challenge of outreach

Pregnancy and childbirth was a clever choice for HealthTap’s launch. Each trimester–not to mention the arrival of a newborn–feels like a different phase of life, and parents are always checking other people for insights. Still, the people who sign up for HealthTap are the familiar empowered patients, the ones with time and education, those who take the effort to take care of themselves and are likely to be big consumers of information in other formats such as Wikipedia (which has quite high-quality health information), books, courses, and various experts in fields related to birth. HealthTap will have more impact on health if doctors can persuade other people to sign up–those who don’t eat right, who consume dangerous stimulants, etc.

And if HealthTap or something like it were a national program–if everybody was automatically signed up for a HealthTap account–we might have an impact on people who desperately need a stronger connection with their doctor and encouragement to lead healthier lives. The psychiatric patients who go off their meds, the diabetics with bad diets, the people with infections who fail to return for health checks–these could really benefit from the intensive online community HealthTap provides.

The challenge of accuracy

Considering that most people depend on the advice of one or two doctors for each condition treated, the combination of insights from 580 doctors should improve accuracy a lot. Still, clinical decision engines are a complex field. Again, it seems to me that a service like HealthTap would be much more trustworthy if it represented a national crowdsourcing effort. Every doctor could benefit from a clinical decision support system, and the current US health care reform includes the use of such systems. I’d like to see a large one that HealthTap could tap into.

Gutman says that HealthTap has indeed started to work with other institutions and innovators. “We have worked with the U.S. Department of Health and Human Services to help make the public health data they released easy to access and useful for developers, and last year we held the first-ever ‘health hackathon,’ where hundreds gathered to build apps using the newly released health data we organized. We can become a platform for a world of health apps tied to our growing, open data, created by leading physicians and validated research.”

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  • Rebecca Mitchell

    A very exciting concept, and as a soon to be doc I am really pleased that a technology company is finally recognizing the importance of recruiting doctors for collaboration with the tech industry. You wouldn’t believe the number of health start ups in SF that have NOBODY with any health background or experience in the system involved. A huge oversight from my perspective, that causes lots of would be great companies to waste significant time because they have a poor understanding of the problems they are trying to solve.

    However I share a similar concern as the author regarding where the incentives are for physicians to stay involved and spend significant time creating quality content. It reminds me a bit of the Huffington posts troubles with authors questioning why they are not getting rewarded to create the content the entire business rests upon.

    Specialists in private practice are the only ones who are rewarded for attracting new patients in our current screwy system, Andy Oram has it right when he notes that for the rest of us health care providers our patient census is generally already overloaded, especially for generalists who are the ones actually treating the most common conditions people seek health advice on. Also wondering how we attribute new patients to HealthTap? Finally, how do patients feel receiving specialist reccs from docs they have no personal relationship with or any way of vetting beyond the fact that they are tech savvy? This goes for the drugs and treatments they recommend too, lots of docs have relationships with pharma and device companies.

    Great concept, but these issues need some consideration.

  • http://www.healthsouk.com Harry Peer

    I agree with Rebecca. As doctors we can’t just allow patients to be referred randomly because of a blog posting that the doctor made or some arbitrary recommendation (e-version) that they received. We have liability for who we refer to and a responsibility.

    Personally I think HealthTap is a great idea but HealthSouk is going to be the real winner and leader in all of this. . . HEALTHSOUK

    They have built everything HealthTap has and they have a full marketplace that fosters transparency to the patient. . . It is an Internet Marketplace for HealthCare and they allow the patient to have a better “say” in their health process as well as provide the information sources from doctors. . .
    Interesting to see what happens

    -Harry