Medication costs make up over 10% of health care dollars and are the fastest growing source of medical expense. Many state and federal officials have called for action that 
would add cost transparency to the complex, opaque medication supply chain believing that this will lead to lower prices and higher value care. Though this may appeal to our intuition, evidence that medication cost transparency leads to higher value care is scant. In order to add to the evidence base, four other investigators and I embarked on a 9-month investigation designing and evaluating the effect of medication cost transparency decision support built into the electronic health record. Bottom line: it makes a difference. The results were recently published and are available on the JAMIA website: https://academic.oup.com/jamia/advance-article-abstract/doi/10.1093/jamia/ocz025/5445905.
decision support
On the Evaluation of symptom checkers for self diagnosis and triage: audit study
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.
The Non-Physician’s Guide to Hacking the Health Care System
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.
Cardiovascular Risk Calculator
Introduction
The 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk introduced a new risk assessment calculator based on aggregate data from several cohorts. According to these guidelines, a patient’s risk according to this algorithm is critical in determining if a cholesterol-lowering statin should be prescribed. Initially, this calculator was available only through a somewhat onerous Excel spreadsheet. Moreover, this was nearly impossible to access through mobile phones, a preferred modality. Continue reading
The Real Problem with Physician Decision Support
Early in medical school, I was involved in the care of Ted, who could have been my grandfather. At 76 he was as spry as any of the patients on the ward and always welcomed me with a “morning, Doc!” He was admitted because he was having concerning chest pain several times a week. Opening and closing 2.8 billion times throughout his life, his heart valves had gradually become hard and inflexible preventing blood from leaving at its usual rate. Now, it was risking his life. He had several treatment options available to him: valve replacement through open-heart surgery, a new minimally-invasive procedure where they snaked a new valve through the body’s blood vessels and into the heart, or just taking medications to help with his symptoms. It was my job to help Ted figure out which option was best for him.
Continued reading The Real Problem with Physician Decision Support on the Symcat blog.
Symcat: A Consumer-side Expert System for Diagnosis (Johns Hopkins Informatics Grand Rounds)
I am appreciative for the opportunity to share alongside David some of my journeys in conceiving of and building Symcat during the Johns 
Hopkins Informatics Grand Rounds. In it, we talk about some of the history of decision support, the technology behind Symcat, and some additional points about entrepreneurship and web development that excite us.
Symcat: Data-Driven Symptom Checker
Problem
When people get sick, they have several options for obtaining health care. These include going to the emergency room, urgent care center, or calling a doctor or nurse. However, 80% of people experiencing symptoms start with an Internet search. Unfortunately, searching on Google offers spotty results and frequently leads to undue concern. For example, one is 1000x more likely to encounter “brain tumor” in web search results for “headache” than they are to ever have the disease. Undue concern is a contributor to the 40% of emergency room visits and 70% of physician visits that are considered to be inappropriate.
Stroke in AVS App
Introduction
Each year, half a million patients present to emergency departments in the US with acute vestibular syndrome (AVS) characterized by vertigo lasting more than 24 hours. Though this is frequently caused by something benign such as a self-limited viral infection, it may also indicate a more severe condition such as stroke of the posterior circulation. Unfortunately, MRI can miss strokes when obtained early in the disease course meaning half of those with with posterior strokes are inappropriately sent home from the ER. Continue reading
Craig Monsen 