Author: cmonsen

Reach: Text-Message Appointment Reminder System

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Problem

reach exampleIn aggregate, community health centers account for the care of about 20 million people in the US. Over half of these patients represent racial or ethnic minorities and over a fifth (22%) prefer to speak Spanish rather than English.

Most CHC revenue comes from fee-for-service reimbursement paid by Medicaid (40%), private payers (7%), and Medicare (6%). This has led CHCs to pursue many of the strategies for maintaining solvency as other care centers across the US, including increasing patient visit volume and improving operational efficiency.

One problem all clinic sites face is the incidence of no-shows, patients for which an appointment is scheduled but that do not show up. It is estimated that no-shows account for 5-30% of appointments scheduled across the US and it is typically higher at CHCs. No-shows risk failing to deliver appropriate care to patients for whom they are scheduled in a timely or continuous manner, reduce access to scarce healthcare resources for those waiting for appointments, and represent up to 15% of lost revenue for the clinic.

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Seeking a diagnosis on the Internet: survey results

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Testing design assumptions with users is a critical ingredient in user-centered design. In Symcat’s early stages (ca 2012), we thought, for better or worse, that we would identify some eligible test users through Craigslist NYC. We were surprised by just how many people were willing to participate and collected some pretty interesting data in the process. I just stumbled upon it and I suspect much of it is still relevant, so I thought I would share. Get ready for some graphs.

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On the Evaluation of symptom checkers for self diagnosis and triage: audit study

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I should begin by acknowledging the authors’ important contribution to elucidating the gap between what symptom checkers may hope to provide and the existing state of the art. Semigren et al adopt a pragmatic approach both by identifying which symptom checkers patients may reasonably find and assessing them in the most intuitive way imaginable: making them take the standardized patient tests we all take in medical school.

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When is a Doctor Not a Physician?

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OK, so there are a lot of doctors: PhDs, JDs, DDS. For the sake of argument, I’m talking about MDs here. Let me start by explaining night float.

Night float is an interesting rotation during residency when most people who are working during the day leave their hospital and their patient’s care in your hands. It is alternately some of the quietest times during residency as patients drift off to sleep and some of the most hectic as in when a surge of patients finally arrive from their ambulance- or helicopter-assisted journey across the state. Night float, or “the night shift” arose out of a recognition that sleepy interns having worked 30-hours straight sometimes do not make the best decisions or confuse their lefts and their rights.

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Identification of High Risk Commercial Patients for Population Management (Epic XGM 2015)

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Just got back from Epic XGScreenshot 2015-07-11 18.43.53M 2015 presenting some of the work I have been doing at Atrius Health in predicting high risk patients.

Some of the session details (slides below):

Summary: Atrius Health expects a large proportion of commercially insured patients to shift into accountable care arrangements in the near future. The presenters will describe their work to develop new risk models for commercial patients, using both financial claims and Epic data, and compare these against other risk models.

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Squire: Handheld Hospital Assistant

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Problem

Effective hospital care requires coordination among multiple individuals including therapists, care coordinators, primary teams, consult teams, and nurses. Unfortunately, this coordination is costly to frontline staff often requiring much time and many steps even to identify the appropriate contact. Existing solutions have significant shortcomings without a highly-available best practice.

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The Non-Physician’s Guide to Hacking the Health Care System

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Written with my friend and co-founder of Symcat, David.

We are residents and a software developers. Before starting residency, we spent time as software developers in the startup community. We were witness to tremendous enthusiasm directed at solving problems and engaging people in their health. The number of startups trying to disrupt healthcare using data and technology has grown dramatically and every day established healthcare companies appear eager to feed this frenzy through App and Design Competitions.

Continue reading The Non-Physician’s Guide to Hacking the Health Care System on THCB.

Killer Features of the Next Generation EMR

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I was absent-mindedly playing with my iPhone today and took special notice of a feature I have rarely used before. If you swipe all the way to the left on the home screen, you will get a search bar to search all of your iPhone. This includes contacts, iMessages, and apps. I’ve never needed to use this before–a testament to the iPhone’s ease of use. Just prior to this, I was working on some patient notes using my hospital’s electronic medical record (EMR). In contrast, each task I performed required a highly-regimented, multi-click process to accomplish.

Criticizing EMR interfaces is a well-loved pastime among clinicians. Here, however, I am going to take an oblique approach and reflect instead on what has made good interfaces (all outside of medicine, it turns out) recognized as such.

Continue reading Killer Features of the Next Generation EMR on the THCB.

Magic Numbers for Startups

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Startups are hard. There’s no book. Or are there too many books? If you’re like me, you wind up feeling like you need to learn everything for yourself. That you have to “touch the stove” to know it’s hot.

It can be time consuming to learn Everything There is to Know, so instead we gravitate towards principle, heuristics, or rules of thumb. A set of heuristics are based on specific numbers–Magic Numbers. They can be used as signposts to guide decision-making where uncertainty otherwise prevails.

Several Magic Numbers frequently come up for me: 2, 3, 5, 7, 10, and 10,000. Why are they so magical? I’ll tell you.

Continue reading Magic Numbers for Startups on the Symcat blog.

Starting a Company as a Medical Student: Part 2

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Last week I included my answers to several questions I was asked as part of an interview for The Doctor’s Channel about entrepreneurship as a medical student. You can read that post at Starting a company as a medical student: Part 1.

This week I will finish the 2-part series with answers to the questions:

  1. How did your school admin respond to your request to take a year off for your start-up?
  2. How did you juggle the challenges of running a business with the rigor of being a medical student?
  3. What are some of the skills/lessons you’ve learned while running a business that a typical student would never even think of?
  4. How do you see your decision to launch a business in medical school influencing your future career (residency application, specialty choice, lifestyle, etc.)?

Continue reading Starting a Company as a Medical Student: Part 2 on the Symcat blog.