[HN Gopher] Launch HN: InpharmD (YC W21) - curated drug informat...
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Launch HN: InpharmD (YC W21) - curated drug information for doctors
Hi HN- My name is Ashish, and I'm the CEO/ co founder of InpharmD
(https://inpharmd.com). We take questions from doctors and return
curated, evidence - based answers. I was a clinical pharmacist
offering a remote service from a University for 10 years. Ask us
anything, we begged, and our team of pharmacists, residents, and
students would look it up, get through the paywalls, and provide
the answer. I passed out business cards around local hospitals.
They were lost over time. Then I passed out business cards with
magnets. They stuck around, but there aren't that many places in
the hospital with the magnetic surfaces. Eventually, people stored
our number, but we'd ask so many questions when they called, they
couldn't ask theirs: who are you, where are you calling from,
what's your email, spell it, etc, etc, etc. Often, they'd hang up
on us, and I don't blame them. The average doctor now sees five
patients an hour. I realized I wasn't alone, and hundreds of other
academicians, all leading their own teams, had the same problem.
So, we formed a network and interviewed hundreds of our customers
about how they'd ideally interact with us. What we needed to build
was simple: one touch request. My co - founder Tulasee built that
and since, we learned that AI can transcribe PDFs faster (but not
yet better) than our pharmacists. We started with 5,000 of our own
study abstracts, assigned weights for corresponding content in
their respective PDFs, and now we continuously reassign the weights
until the algorithm can completely make our own abstracts. Our
latest test revealed 94% accuracy against a matched human control,
but with medical information, this will need to be 100% before we
can rely on it. We think Watson was a missed opportunity, so we
called our algorithm Sherlock. We're launching a partnership with
the American Society of Health-System Pharmacists(r) (ASHP-
https://ashp.org), using their database of 1,300 vetted drug
monographs, so Sherlock can field questions at the point of care.
We've been fortunate to find early adopter health systems to pay
for our service: WellStar, Ochsner, University of Maryland, Georgia
DPH, and St Francis. We're typically compared to the cost of their
healthcare providers manually searching, and we end up cheaper. We
love this community and we'd welcome your ideas/ experiences/
feedback on what we're building!
Author : aadvani
Score : 53 points
Date : 2021-01-29 14:50 UTC (8 hours ago)
| cj wrote:
| I have hyperhidrosis (a fancy term for excessive sweating).
|
| When I was a teenager (and before all answers to everything were
| online), I went to multiple docs and no one was aware of a
| particular prescription that, once I found out about it,
| completely "cured" the issue (Drysol).
|
| Looking back, it was obvious the doctors just weren't aware of a
| valid treatment for the issue. It'd be great if a service like
| this helps doctors discover treatments for less than common
| conditions.
|
| Side note: I recently discovered iontophoresis for the treatment
| of hyperhydrosis without the use of drugs at all... discovered
| via a Facebook ad for the machine (don't ask me how Facebook knew
| to target me for such a specific product). I bought it a couple
| months ago, and wow - it works. I've been googling the studies
| around it, which date back to 1950's -- not something new, but
| also dumbfounded as to how I wasn't aware of this treatment
| sooner, and why no doctor was aware of it either (or at least
| didn't bother mentioning it as an option).
|
| Best of luck to you! Lots of problems to be solved in the health
| space.
| rubatuga wrote:
| Even asking a pharmacist would have gotten you the answer :P
| tulasichintha wrote:
| Exactly! Back in the day it took three decades for the info to
| get across that smoking was in fact, bad for us.
|
| Now, info travels fast, but there's so much info coming at us,
| we choke on it.
|
| Totally relate to your story, I come from rural India and saw
| many patients misdiagnosed for this same reason. This is
| exactly why we're building InpharmD.
| treis wrote:
| >It'd be great if a service like this helps doctors discover
| treatments for less than common conditions.
|
| Isn't that what Up To Date is?
| aadvani wrote:
| Despite their best efforts, up to date can never truly be up
| to date, can they?
|
| No shade, we love up to date; we just see ourselves as a
| complement.
| sterlinm wrote:
| I mentioned this to my wife (she's a research physician)
| and her first response was also "isn't that what Up to Date
| does?"
|
| How would you characterize the difference between InpharmD
| and UpToDate? Different features? Better execution?
| sterlinm wrote:
| Sorry I see you answered below!
| aadvani wrote:
| Yep, totally. But they have X credible authors so can
| only have X credible info on their site.
|
| This means they focus on the most common questions.
|
| Public data/ our data shows point of care references like
| UTD can only answer ~1/2 of clinical questions.
|
| We're building our tool for the other 1/2.
| HPsquared wrote:
| And people say advertising doesn't add value to the world...
| fudged71 wrote:
| A training client of mine with hyperhidrosis was treated
| through surgery. To be fair he was still sweating a lot more
| than my other clients, but he said it used to be way worse.
|
| I had a fever on a trip in africa where it felt like sweat was
| pouring out of my skin and it was incredibly uncomfortable
| tyingq wrote:
| _" We think Watson was a missed opportunity, so we called our
| algorithm Sherlock."_
|
| Agree with the first part enough that I wouldn't even want the
| near association :)
| aadvani wrote:
| Haha good point
|
| When Sherlock is older we may let him go by his middle name
| feanaro wrote:
| It seems a bit wrong to target this to doctors exclusively. Is it
| just because the cost of your service would be prohibitive for
| someone not using this professionally?
|
| Anyway, I'm not a doctor but one of those types that love looking
| into everything themselves. I'd be interested in having access to
| something like this for my personal research.
| aadvani wrote:
| We started with a for us, by us approach to build our content
| and a brand first.
|
| The reason every patient knows of the Physicians Desk Reference
| is because they believe their doc relies on the PDR.
|
| In just 10 years I've seen the doctor go from being the top of
| the patient care hierarchy to the patient on top (not
| coincidentally DTC ads have blown up). We think there are a lot
| like you, and soon, we'll make our tool publicly available.
|
| If you want to test before that time- reach out! Ashish at
| InpharmD dot com
| faitswulff wrote:
| I'm not in this space, so just out of curiosity what does this
| cover that Up To Date doesn't? And/or What are some examples of
| questions doctors might ask? Thanks!
| aadvani wrote:
| We get this one a bunch; Up to Date is pretty awesome.
|
| Public data + our data shows only ~1/2 of clinical questions
| can be answered by Up to Date (or references like them).
|
| Those online compendia employ a small team of credible authors
| + have massive scale, so they focus on the mainstream
| questions.
|
| Our custom solution is designed around the long tail of
| emerging or complex questions.
|
| For example, if you want to know about dexamethasone 4mg for
| early stage COVID, Up to Date will have it. But if you want to
| know about dexamethasone 20 mg, you're faced with doing this
| literature search on PubMed (which = 2 hours + 4 journals) .
|
| We get this question a lot, and really appreciate you surfacing
| it here. We made this into a FAQ for anyone that prefers to
| visualize it: https://www.inpharmd.com/faq
|
| Maybe this is how any startup takes on any large incumbent?
| IDK. We love your collective wisdom, we learn a ton from you
| all.
| aadvani wrote:
| My bad, typo- meant 6mg here
|
| For anyone curious , we actually did this question:
|
| https://www.inpharmd.com/is-there-any-data-to-support-
| higher...
| refurb wrote:
| This is my question.
|
| And it comes down to liability as well. Basing your treatment
| decisions on UpToDate or NCCS guidelines or Cochrane Reviews is
| pretty defensible. But basing it on the findings of an AI start
| up? How is that being addressed?
|
| But don't get me wrong. I think there is a lot of value in
| physicians having easy access to pharmacists to discuss
| treatment options. Right now that doesn't happen that easily.
| aadvani wrote:
| Totally agree- before we started doing anything we had to
| understand what we could and couldn't say. We probably
| interviewed as many lawyers as potential customers !
|
| The consequences of wording something wrongly are huge.
|
| To be clear, we stop short of making recommendations. Our
| goal is to give the provider all the info she needs to make
| her own evidence informed decision.
| bearjaws wrote:
| Love the idea, I work in specialty pharma and getting concise
| information to the pharmacists has become critical. Physicians
| rely heavily on pharmacists to call the shots on treatment plans
| now more than ever.
|
| We built our own in house solution to this exact problem, but its
| maintained by our own clinical staff, it costs us north of $300k
| a year to maintain it! This only works of course because we have
| over 150 specialty pharmacies in our 'network' so we have volume
| to help keep up with costs.
|
| I could honestly see us leveraging a solution like this at some
| point in the future, and probably anybody running fewer than 10
| specialty pharmacies _needs_ a solution like this.
|
| Good luck to you guys!
| aadvani wrote:
| Thank you and yes! Medical education is mostly diagnostics and
| pharmacy education is mostly therapeutics. The most forward
| thinking health systems are relying on pharmacists to guide
| treatment decisions. And I'm sure you see this with specialty
| meds in particular.
|
| And WOW re: $300k per year. I'm certain we could do this for a
| fraction of that cost. Ashish at InpharmD dot com :-)
| euthymiclabs wrote:
| Love this! I was just trying to search for studies on weight gain
| in a very uncommon medication. I'll have to pester my institution
| about this.
| aadvani wrote:
| Thank you! This is exactly the type of question we're here for.
|
| You can create a free trial account here and ask your question,
| all in 30 sec: https://www.inpharmd.com/provider_signup/new
|
| Then if you like it, pester away!
| mrweasel wrote:
| I'm not really looking to buy, but given both my own job and that
| of my wife, I am curious.
|
| After reading your description, and watching the video on you
| website, I can safely say: I have no idea what service you
| provide.
|
| Adding example question might help.
|
| In Denmark the government office for medicin provide a free
| service where you're able to look up all approved drugs, their
| usage, side effects, treatment plan and so on. It that what you
| provide or does it go further than that?
| aadvani wrote:
| Sorry it didn't land with you. We're constantly torn between
| writing for the one person (a healthcare provider) vs a larger
| population.
|
| An example question is a fantastic idea and will land with both
| audiences :-)
|
| We'll get our top three most recent on the homepage ASAP but in
| the meantime:
|
| If you have a typical late stage COVID patient, a static
| patient resource like you described is perfectly fine to look
| at efficacy of the standard dexamethasone 6mg treatment.
|
| But if you have an atypical patient and considering a 20mg
| dose, you're out of luck. Most patients are atypical and we see
| an unmet need with a long tail of atypical questions.
| Herodotus38 wrote:
| Typical dose of dexamethasone is 6 mg not 4 mg. And only in
| severe cases needing oxygen, not early.
| aadvani wrote:
| Thanks for the correction I actually typed 6 every 24 but
| found it confusing and resulted in error, fixed now
| aadvani wrote:
| Also, we actually did this one, if you're curious:
|
| https://www.inpharmd.com/is-there-any-data-to-support-
| higher...
| Herodotus38 wrote:
| Thanks for the link. Anecdotally in our hospital only one
| patient to my knowledge has survived after a higher dose
| of dexamethasone (this was only used after the patient
| was worsening despite the standard 10 days of 6 mg
| dexamethasone). Whether this helped them or they were
| going to improve despite can't be known.
|
| I would also be careful about how you use the term
| atypical, in fact most patients with COVID are typical
| and improve with the standard treatment. :)
| aadvani wrote:
| Great info, and a shame there's not better real world
| evidence for cases like this. And I hear you, just making
| the point that most shouldn't be considered "typical"; we
| should question everything.
| ahstilde wrote:
| Why do doctors want "curated, evidence - based answers" to their
| questions? Why does a health system want this for their doctors?
| aadvani wrote:
| I can understand this take, many docs don't like to ask
| questions at all.
|
| But there's a new school type of doc that realizes how vast the
| medical literature is (20m studies), how quickly it's changing
| (20,000 just added on COVID), and has tons of questions.
|
| All medical references were essentially converted to SAAS
| products from large books- so they're thousands of pages
| covering the mainstream topics, and they answer only ~1/2 of
| questions.
|
| Health systems employ clinical pharmacists to answer the other
| 1/2 with evidence because it's insanely high ROI for them to do
| so (5M/ pharmacist/ year/ hospital). Health systems outsource
| this to us because we're more efficient.
| ahstilde wrote:
| > Health systems employ clinical pharmacists to answer the
| other 1/2 with evidence because it's insanely high ROI for
| them to do so (5M/ pharmacist/ year/ hospital).
|
| I didn't know this.
|
| In that case, software is probably way more scalable than
| hiring more and more pharmacists.
| aadvani wrote:
| This is our hope :-)
| avrionov wrote:
| 10 days ago someone posted a similar idea and how he failed.
|
| "I wasted $40k on a fantastic startup idea"
| https://news.ycombinator.com/item?id=25825917
|
| I hope your project succeeds.
| aadvani wrote:
| This is gold, thank you.
|
| He went after the same problem, yes, but with a traditional
| SAAS approach.
|
| We feel strongly that the only way to make this work is to have
| humans on our back end, thoughtfully automated with tech (vs
| the other way around).
| Jommi wrote:
| Isnt this like the recent GlacierMD?
| https://news.ycombinator.com/item?id=21947551
| https://news.ycombinator.com/item?id=25921697
| aadvani wrote:
| Same problem, for sure, but we're taking a different approach.
|
| A SAAS tool has a hard time with complex questions because
| healthcare data is messy and results will be imperfect.
|
| Therefore we feel strongly about building a human - lead
| service thats optimized by software.
|
| Every health system employs clinical pharmacists to manually do
| this today, so we use that as our stake in the ground, and so
| far we're finding we're way more efficient.
| Jommi wrote:
| Yes I think you're approaching it from a way better angle.
| FL33TW00D wrote:
| I've just spend the last few months working on a medication
| potency scoring system using ASHP data. Would be interested to
| hear more about your approach.
| lunarFlash wrote:
| ASHP's drug information data is very complex in structure and
| finely tagged. Instead of a traditional algorithmic approach,
| we are leveraging machine learning to build Sherlock.
|
| We are using AWS's machine learning service called Kendra,
| which indexes the clinical content, and provide search based on
| natural language processing. In our testing, it is able to find
| relevant information with pretty good results. Kendra also has
| capability for users to rate results so it can become smarter
| and give better answers over time.
|
| We wrote integration between Kendra and AWS's chat bot service,
| Lex in a lambda based serverless architecture.
| Killakwinn wrote:
| Wow! This is exactly the type of service that academic
| institutions could benefit from.
|
| When I was a medical student and resident on rounds, it was
| really stressful trying to do literature searches on pubmed and
| up-to-date (esp while taking care of active patient problems!) I
| often didn't have the time or bandwidth to comb through the
| papers/lists of care guidelines, and the abstracts often didn't
| give the clear story (or the relevant numbers!)
|
| If I had had access to InpharmD, I could've 1) looked like a
| rockstar to my team, and 2) actually learned and understood the
| info I needed. :)
| aadvani wrote:
| This makes our day :-) Academic MCs are our main target right
| now. Thank you!
| ereinertsen wrote:
| Ashish, I've long been a fan of your work and am excited to see
| you share InpharmD here.
|
| 1. What are your thoughts about partnering or selling to pharma /
| biotech / R&D orgs? Is there a potential value prop?
|
| 2. How does this compete with or complement existing clinical
| informatics and medical librarian capacity at academic medical
| centers? Or are they not the target market because they already
| pay salaries for humans to do these tasks? How do above entities
| relate to what the PharmDs do?
| aadvani wrote:
| Excellent questions and thank you for the kind words :-)
|
| 1. We tested this with Pfizer last year and found there was an
| opportunity to supplement existing med info teams that do the
| same thing.
|
| But it's tough to do two markets well at once, so we decided to
| focus on health systems for now.
|
| We also find that in hospitals, everyone thinks they're asking
| b unique questions, but they aren't. We can be much cheaper vs
| their pharmacists and still make money. Pharma companies
| already have standard responses so it's a totally different
| value prop.
|
| 2. We don't really compete with clinical folks at hospitals,
| most will readily off load this to us, so they can spend more
| time on patient care. There are some that like to own this, and
| I totally get why, but we eventually win them over. As for
| medical librarians, they're great for article requests but for
| complex clinical questions we think a clinical pharmacist is
| the right type of researcher.
| mananatwyndly wrote:
| I'm an ENT surgeon and I've personally used the service.
|
| I asked about the safety of a drug and the product gave me a
| summary and literature to answer complex clinical questions fast.
| This product does a lot of the work that before involved me lots
| of time clicking and searching and trying tons of different
| Google searches. For a busy physician it works great.
|
| It saved me time and helped ensure I was using the most up to
| date research for my decision making. This would've been a game
| changer when I was at an academic hospital doing clinical
| research, but even as a private physician it's great to ensure
| you're always up to date with the current evidence.
| aadvani wrote:
| Thanks so much! Hearing we saved you time is our favorite type
| of feedback!
| Uberphallus wrote:
| What's your take on off-label uses?
|
| e.g. certain antihistamines for sleep aid
|
| Also, hiring?
| aadvani wrote:
| Off label questions (questions outside the FDA approved
| indications of a drug) are fun for us. There are so many great
| ones and this is where the traditional references fall short.
|
| We just have to be fair and balanced about how we present
| (which we are anyway) + be extra vigilant to include all
| relevant prescribing info, and especially the actual
| indications and any boxed warnings.
|
| As for hiring, yes, and for anyone interested, I firmly believe
| interest in what we're building is the most important thing at
| this point, and everything else is secondary. Ashish at
| InpharmD dot com
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