David M. Eddy, MD, PhD is a legend when it comes to Evidence-Based Medicine. He coined the term in 1980s, actually. Being exceptionally skilled in mathematics, it was perhaps natural for him to apply it to medicine. The result is Archimedes Model- a mathematical simulation of the human physiology and how it interacts with healthcare interventions.

A more loaded one-line description of Archimedes (taken from his original paper in 2002): “It’s an object-oriented, continuous-time, full simulation model for addressing a wide range of clinical, procedural, administrative, and financial decisions in health care at a high level of biological, clinical, and administrative detail.” Phew. I’ll confess that I don’t know what exactly is under the hood. But I know enough about the informatics field to believe that this approach is viable and very exciting.

This YouTube video explains how the model can be used to run virtual clinical trials. Kasier has already backed the findings of Archimedes to change their diabetes care delivery.  I think there are fantastic, unlimited opportunities for applying such a fundamental model to medicine- personalized health predictions, public health, health policy, cost-effectiveness and what not.  As a startup, they are doing fine. With an impressive list of partners/clients, and a $15.6M RJWF grant (2007), they have a good runway and momentum. They have all the right ingredients to be a change agent for next-generation Healthcare IT.

TrialX.org is an fantastic example of how the web enables linking specific demand with relevant supply. The services matches users (patients, affected individuals) to ongoing clinical trials using their submitted personal health information.

What a great startup idea. Service demand can be tapped easily since users are searching the web for highly specific keywords (almost all include the keyword “trials”, so bit of SEO and keyword advertising would direct the traffic effectively). Other sources are the rapidly growing PHR platforms like Google Health and Microsoft Healthvault- both encourage developers to write apps that provide such value-added services based on user’s health information. Supply is readily available on ClinicalTrials.gov, a government-sponsored online public registry of clinical trials in US.

TrialX.org is completely free for users (patients). They let investigators create free accounts to post their trial information directly, but charge a fee for providing access to the interested potential trial enrollee. It’s hard for trial investigators to find eligible patients who are motivated to stick around for the complete trial. TrialX solves both the problems for them.

Imagine the possibilities if this service gets integrated into CIS vendor products. A patient coming in for advanced  breast cancer treatment can be flagged right at admission and be given the option to enroll in an experimental drug trial right then, if they so choose. If nothing else, it’ll give the medical research community a much more real-time opportunity to advance the science.

AskDrWiki is an online repository for medial information modeled after Wikipedia. The project was started in early 2007 by four physicians looking for a quick way to share review articles, notes and images in cardiology. The site is a grassroots effort, and geared towards clinical audience- residents, interns etc.

Wiki’s are a good way to organize collective wisdom in any field, so the concept is valid. Problem with wiki’s are that 90% of content is written (and policed) by 10% of the users. When your potential audience is not a big number (only 100K or so residents enrolled in US every year) and nature of material necessitates careful oversight, all that translates into a very slow progress for content. Their homepage was last edited in Dec 07 and last blogpost was in April 08. The site draws a decent number of unique visitors though..in range of 5,000. Hope they gain momentum in future.

SimulConsult is a diagnostic decision support system started by Dr.Michael Segal. It covers 1,800 diseases that have at least one neurological finding in them.

SimulConsult has an interesting logic behind it. Roughly speaking, its knowledge is derived from a ‘computational wiki’ that is restricted to physician users only. So its database is not only open for viewing, but users can submit modifications to the database. The system performs bayesian pattern matching and also considers temporal information like the age of onset and disappearance of each finding for each disease under consideration.

According to Dr.Segal, there are about 33,000 data points (disease findings) in the system and the future expansion plans are to include more of metabolism and genetic diseases. Interestingly, the wiki approach for knowledge gathering in healthcare is becoming more common (AskDrWiki, WikiDoc, wikiMD to note a few- more on them later).

Feb 20, 2009 Update: Got an email today announcing that those who contribute information to SimulConsult database will now get paid for their contributions. As they are adding sponsored links in the software, I guess it makes sense to share the wealth. More info here.

Curbside.MD is a search engine for finding evidence based clinical information. The idea is to type in the search need as a natural language question that a clinician would normally ask his/her colleague, and get relevant answers from the literature (articles, images, guidelines, etc.)

I took it for a test drive with a moderately complex question (‘what is the indication for platelet transfusion in an 80 year old female with dengue fever?’) and got relevant results in terms of review articles and clinical trial outcomes. Pretty cool.

The logic behind Curbside.MD is semantic indexing using a controlled medical terminology (they call it “semantic fingerprinting“) with a bit natural language processing. They provide a bunch of tools (search box, news, spellchecker etc.) for partners and a browser search toolbar for users. The technology is also available as an API service from an alternate website called Fingerprint.MD.

Praxeon is the company that started Curbside.MD and MyDailyApple in 2006. Both websites are currently free for users, but the company admits to a future ad-based business model.