From a five-person team in Oslo, Norway back in 2013 to over 2m users and a growing staff of some 30 people, Matteo Berlucchi is, step-by-step leading Your.MD closer to its vision of free healthcare for everyone. We meet him to hear more about their journey in man vs machine in pre-primary care diagnostics.
A free diagnostic app that provides personalised healthcare assistance direct to patients via a chatbot, Your.MD is Berlucchi’s first foray into life sciences. ‘It’s very interesting, but very backward,’ he laughs, speaking of the medical technology space. And looking at his 20+ years of online experience – spanning projects at the digital cutting edge of communication software, online currency, media and lately wine – his perspective is certainly borne of experience.
A serial founder and CEO of disruptive, high growth companies, Berlucchi recalls his decision to join the company: ‘The investors were looking to see if they could take the initial search-led idea to the next stage. But the challenge they faced was how could they create a tool that would provide the right, personalised information to patients. Currently only doctors can do this – Google isn’t equipped. So I started having some ideas around chat, natural language and AI. I got intrigued…and decided to accept the challenge.’
And indeed, Berlucchi has been instrumental in transforming Your.MD from a search-based tool into a fully interactive and conversational environment.
‘If you want to understand what’s going on with anyone, you need to have some form of dialogue to be able to tease out relevant information from a user in a way that a doctor might – information that a user may not otherwise perceive as important. The only way to do that is to have a chat-based environment so you can converse with the user and then have all the intelligence behind it to know what you should ask, and when and how you should respond to the information provided,’ explains Berlucchi.
Your.MD recognises that patients are not created equal – each one is different to the next, with a unique set of variables. Using this basic tenant, it then aims to mimic a real-life experience with a doctor, with the added bonus of a huge backend of data to support it. A backend of data that a human doctor could never hope to retain. There are thousands of conditions and the influencing factors that are needed to give an indication of what an individual’s problem could be are also in the thousands. Only a computer can handle this complexity in a reliable way.
The app itself has three core functionalities:
As a diagnostic tool, Your.MD falls into the category of pre-primary care – or self-assisted care – in allowing people to understand their symptoms and conditions and find the suitable treatment and services.
‘Patients in the developed world are quick to criticise healthcare system failures but not so prompt in correcting their own behaviours that exacerbate the burden on healthcare budgets. In nationalised health economies like the NHS patients see it as their right to use the system they have paid for and in privatised systems consumers see it as a necessity to get their money’s worth. Different systems same behaviours, driven by different perspectives,’ Berlucchi and digital health advisor Jonathon Carr-Brown state in their report: Pre-primary care: an untapped global health opportunity.
‘What if, in the developed world, we enabled citizens to be more responsible and accountable for their own health? What if our doctors told us we all had to take our blood pressure, weight and pulse before coming to see them? What if, in the developing world, we trained one person in every village, armed them with a mobile phone, miniaturised testing equipment and showed them how to appropriately diagnose, treat and triage members of their community?’
Pertinent questions indeed. Particularly when faced with the results of a 2007 study of medical records of 130 general practices in the UK over a two year period, which showed that 51m – 90% of consultations – were for minor ailments and 88% of which were suitable for self-care. In total, the study found that 20% of a GP’s time was being spent on minor ailments that could have been treated by a pharmacist or an individual at home with better information and pre-primary care support. But there are challenges ahead in making “pre-primary care” a reality.
So how can we speed up adoption of pre-primary care in the pathway to diagnosis? For Berlucchi, it’s all about time and trust.
‘You need to build trust and this is one of the biggest challenges for Your.MD. Doctors come with built-in trust. AI software does not. Patients don’t think that they can use an automated system to find out what they need to know. So as an app, we need to be very accurate and do a good job all the time. Eventually people that use Your.MD will find the result that they’re looking for and will realise that it can be even more accurate than visiting a doctor,’ he says.
Whilst Your.MD hit 2 million users in April 2017, expansion of the user base is not currently a top priority – they are more interested in understanding their early adopters, gathering data to understand their needs and how Your.MD can assist. In addition, having focused significant resources into the diagnostics side of the app, the team is now channelling efforts into patient safety: ensuring the technology provides suitable and safe advice.
As for the business model, Berlucchi explains how this has evolved as much as the digital product itself: ‘I liken our journey to that of Google, who didn’t have a clear business model when they launched. But revenue streams became obvious towards the end of 2016 when I understood that if we could deliver the information that users were after, then we would be in a very similar position to Google. We would be able to give people the right information and they would be in the right environment and mindset to be connected to possible vendors of relevant services and products.
There are currently 30 “vendor” partners featured in Your.MD, and the company is starting to work with insurance companies, the NHS, private GP practices and others to try and see how Your.MD could be deployed in these environments.
‘I think that we have a quite unique approach because we have this idea of trying to fill the gap between doctors and Google. I haven’t seen that done by anyone else – solutions like Babylon are creating a vertically integrated healthcare solution. With our model we just want to be a better Google, then we want to connect patients with the best Babylons of this world.’
And will we see a revolution whereby artificial intelligence supersedes medical establishment completely? ‘I predict, in general, that AI will take over diagnostics across the board. I think that’s right because you will take out the human error and human limitations. So if you rely on computers you will have better outcomes, better directions and overall a better healthcare for everyone, but of course diagnostics is only one section of the healthcare continuum,’ Berlucchi concludes.
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