The folks at are on a mission to streamline the PCP office visit. They think patients will appreciate the convenience and PCPs will love the improved efficiency as well as better profit margins. Investors think they are on to something. just closed a $3.5 million Series A funding round. And they were just selected as the “solution of choice” for most of the health systems in AVIA Health Innovation‘s Virtual Access cohort. What is all the excitement about?


What is is an automated healthcare support system. They have developed proprietary software, called SmartExam, that handles a lot of the routine administrative, as well as clinical tasks, that fill up a large part of a doctor’s day. For example, many of the questions primary care doctors ask patients to better characterize what is going on are based on their understanding of the natural history of the disease as expressed in the chief complaint. Most of the time, they know what they are going to ask even before they see the patient.


Virtual physician’s assistant

The company has developed evidence-based algorithms that present those questions to the patient via a process Ray refers to as the virtual physician’s assistant. Once the information is collected, it is sent to the doctor in concise format that allows her to quickly review the case. Algorithmically-generated diagnoses and treatment plans are also suggested, providing guidance, but not substituting for the physician’s clinical judgment.

If the doctor feels like she needs more information, she can reach out to the patient via phone or video conference. Ray says that has not been necessary in 97% of the cases they have handled so far. Once the history taking is complete, the doctor can formulate a diagnosis, arrange for further diagnostics if needed, and create a treatment plan. Prescriptions can be emailed or phoned in to the patient’s pharmacy of choice.


Time saved for everyone

smartexam by bright.mdAn office visit that might have taken a half day of a patient’s time (drive, park, wait, wait, get roomed, wait, wait, see doctor, get prescription, to go pharmacy, wait, wait, drive home) can now take minutes. What’s not to like about that?

SmartExam also generates the chart note and has automated processes for order entry, billing, and follow-up so the physician’s time on the case is limited to reviewing the patient’s information and making clinical decision. As Ray pointed out in our interview, this allows doctors to practice at the top of their licenses.

For simple cases, as many are, it can mean a fraction of the time spent on the virtual visit as compared to a traditional in-office encounter., Ray says, let physicians

“focus on the pieces that they can create unique value around, such as diagnosis and creating the treatment plan. We remove all of the other things that should be automated…and so they [the doctors] can create the most value in each visit.”


Grandma medicine

When retail clinics, like Minute Clinics first started, they limited the cases they saw primarily to self-limited conditions (colds, sore throats, flu, and so forth). They were practicing what I call Grandma medicine—these are conditions that your grandmother used to take care. When I asked Ray if was mainly for Grandma medicine (he called it “Ditzel care”), he said it could also be used for more complex care, such as the management of chronic illnesses.


How good are the algorithms?

Although hasn’t yet subjected its algorithms to rigorous scientific evaluation (e.g., a clinical trial), they do work with the clinical leadership of their delivery system clients to vet the algorithms. In addition, they provide full transparency around the interview process. Clinicians not only receive an easy to digest summary of the patient’s history, they can also access a full verbatim transcript. Presumably, this allows them to determine whether or not the interview was thorough enough or whether they need to contact the patient for more information. As noted above, synchronous doctor-patient interactions have been unnecessary in 97% of the cases so far.


What about FDA approval?

In answer to my question about the need for FDA approval, Ray responded,

“we provide clinical decision support, which from an FDA standpoint is similar to what is provided via nearly every EMR system in mainstream use. We just do it in a higher value way. Providers always have full visibility into all of the information provided by the patient and the provider is always the one to use that information to make any diagnostic and treatment decisions, including whether to treat online or convert a SmartExam into an in-person visit.”


Formal studies of the software

So far, formal studies of the software have been limited to some initial studies around the provider time per visit with what Ray describes as “great results.” They have also performed formalized usability testing as an integral part of their product development process.

We are a very data driven company,” Ray says, “with a passion for improving healthcare and our product. Given that as our DNA, we expect to continue to perform additional studies, with increasing sample size and increasing rigor.”


What about clinical outcomes?

When I asked about clinical outcomes, Ray said,

“So far, the key clinical outcomes we are measuring indicate that our tool helps providers follow evidence-based treatment guidelines nearly 98% of the time. In addition, we are seeing very strong results around specific clinical outcomes, like appropriate use of antibiotics and single visit resolution rates.”

Of course, we have to take all of this with a grain of salt because it is self-reported by the company CEO. That being said, I really hope he follows through and subjects this innovative product to rigorous, peer-reviewed testing because I believe that it is just the type of approach that could finally help usher the practice of primary care into the 21st century.

Featured Photo Credit: Photl



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