Photo courtesy of Hims & Hers

照片由Hims＆Hers提供

Direct-to-consumer virtual care company Hims & Hers Health announced last week the launch of a new AI-enabled offering, MedMatch, which provides healthcare providers with anonymized data points generated from the company's customer database, aimed at helping mental health professionals identify suitable treatments for patients..

直接面向消费者的虚拟护理公司Hims＆Hers Health上周宣布推出新的AI功能产品MedMatch，为医疗保健提供者提供公司客户数据库生成的匿名数据点，旨在帮助心理健康专业人员确定合适的治疗方法。耐心。。

Dr. Patrick Carroll, chief medical officer at Hims & Hers, sat down with MobiHealthNews to discuss the company's internally built EMR and how its customer datasets power MedMatch.

Hims＆Hers的首席医疗官Patrick Carroll博士坐在MobiHealthNews身边，讨论公司内部构建的EMR及其客户数据集如何为MedMatch提供动力。

MobiHealthNews: Tell me about MedMatch and how it works.

MobiHealthNews：告诉我MedMatch及其工作原理。

Dr. Patrick Carroll: I came to Hims & Hers in June of 2019. I came from somewhat more of a traditional healthcare background. I was the chief medical officer at Walgreens for five years, and then prior to that, a primary care physician for 30 years. I led some health systems. I led a CMO but also some large, multi-specialty groups.

Patrick Carroll博士：我于2019年6月来到Hims＆Hers。我来自更多的传统医疗背景。我是Walgreens的首席医疗官五年，然后在此之前，我是初级保健医生30年。我领导了一些卫生系统。我领导了一个CMO，还有一些大型的多专业小组。

My DNA is primary care. So, I just saw that what Hims & Hers was doing even back in 2019 is really unique, you know, how you leverage technology in a virtual care environment to deliver really high-quality care and not only solve the access issue but really to get down to personalized health care for folks. .

我的DNA是初级保健。所以，我刚刚看到，他和她的工作甚至在2019年都是独一无二的，你知道，你如何在虚拟护理环境中利用技术提供真正高质量的护理，不仅解决了访问问题，而且真正解决了获取问题向下为人们提供个性化的医疗保健。 .

I'll talk about MedMatch. But we should probably spend a few minutes talking about our EMR, which is really innovative and very different from the six different EMRs I was on in my career, including Cerner and Epic, and the tyranny of the million clicks.

我将谈论MedMatch。但是我们可能应该花几分钟来谈论我们的EMR，这与我职业生涯中出现的六种不同的EMR非常不同，包括Cerner和Epic，以及一百万次点击的暴政。

MedMatch is fascinating, and the reason we're able to do this, and the beta test is in mental health, but we're going to be able to do it for each one of my verticals, is that, unlike the world I practiced in, in primary care, I would see a patient as a family physician, they would come in with a complaint or a follow-up for something like a hypertension or diabetes.

MedMatch非常吸引人，我们能够做到这一点的原因，而beta测试是在心理健康方面，但我们将能够为我的每一个眩晕做这一点，那就是，与我实践的世界不同在初级保健中，我会看到病人是一名家庭医生，他们会对高血压或糖尿病等疾病提出投诉或随访。

I would talk to them. I'd look at their past history, you know, review my EMR, which at the time was a version of Epic, and then would make decisions in terms of medication modifications. .

我会和他们交谈。我会看看他们过去的历史，你知道，回顾一下我的EMR，当时它是Epic的一个版本，然后将根据药物修改做出决定。 .

And I would generate a prescription for them, and that prescription would go to a CVS or Walgreens or a local pharmacy, and they'd get it filled. I had no idea whether they were adhering to the medication or not. So it wasn't really a verticalized system ... and then I might see them back in three to six or even 12 months.

我会为他们开处方，该处方将进入CVS或Walgreens或当地药房，他们会得到填补。我不知道他们是否坚持服药。所以它不是一个真正的垂直化系统。。。然后我可能会在三到六个甚至十二个月后看到他们。

So, I didn't know what was going on in the interim. I didn't know whether they were adhering to medication, and I was missing half of the data points around pharmacy, medication, and check-ins. Unless they had a major issue, they didn't follow up with me. .

所以，我不知道过渡期间发生了什么。我不知道他们是否坚持服药，我错过了药房，药物和登记处的一半数据点。除非他们有重大问题，否则他们不会跟进我。

So what we have at Hims & Hers is truly unique in that we're an entirely vertical health system. So, someone actually comes onto our platform with a specific health issue. We provide content. In other words, if they come on and it's mental health, or they come on and they have sexual dysfunction, or they have hair loss, they can read everything about it through a lot of our search engine optimization initiatives and the content we put online..

所以我们在Hims＆Hers拥有的真正独特之处在于我们是一个完全垂直的卫生系统。所以，有人实际上来到我们的平台上有一个特定的健康问题。我们提供内容。换句话说，如果他们出现并且是心理健康，或者他们出现并且他们有性功能障碍，或者他们有脱发，他们可以通过我们的许多搜索引擎优化计划和我们在线提供的内容来阅读关于它的一切。。

And then they come on, and they actually go through a workflow that is very structured, and all of the questions are designed to get the essential information for them. Those workflows and protocols were built not only by our own physicians but by national experts. And so every essential question is asked, and they answer, and then we make decisions based on whether they're appropriate for our platform or not.

然后他们来了，他们实际上经历了一个非常结构化的工作流程，所有问题都是为了获得他们的基本信息而设计的。这些工作流程和协议不仅由我们自己的医生而且由国家专家构建。因此，每个基本问题都会被问到，并回答，然后我们根据它们是否适合我们的平台做出决定。

If they get through that screening, if it looks like they may benefit from those medications, that visit gets put in the queue if it's asynchronous, which most of our visits are, or the video visit gets set up asynchronous..

如果他们通过筛选，如果看起来他们可能从这些药物中受益，那么如果它是异步的，我们大多数访问是异步的，或者视频访问设置为异步的，那么访问就会排队。。

So then this interaction between the customer, the patient and the provider, we have over 600 providers in all 50 states, and then a decision is made through that communication from the customer, the patient and the provider whether they would qualify for the medication and whether it would be beneficial for them and then all the side effects are going through in terms of the medication and then all the information about when to expect improvement, you know, the indication of when to follow-up with us.

因此，客户，患者和提供者之间的这种互动，我们在所有50个州拥有600多个提供商，然后通过客户的沟通做出决定，患者和提供者他们是否有资格获得药物，以及它是否对他们有益，然后所有副作用都在药物方面进行，然后是关于何时期望改善的所有信息，你知道，指示何时跟进我们。

But we just don't leave that to chance. The prescription actually gets sent to, you know, 80% of our scripts now are filled by our proprietary, our own pharmacies. And so we have full visibility on medication adherence, which I never had as a primary care physician..

但我们不要让这个机会。你知道，处方实际上被发送到我们80%的脚本现在由我们专有的，我们自己的药房填写。因此，我们充分了解药物依从性，这是我从未作为初级保健医生的。。

In addition, on a regular basis, depending on the condition, the frequency is determined by the condition, we do regular outreach. For example, on mental health, they get regular check-ins through our program to document GAD-7s [General Anxiety Disorder 7 questionnaires] and PHQ-9s [Patient Health Questionnaires].

此外，根据情况定期进行，频率取决于情况，我们会定期进行外展。例如，在心理健康方面，他们通过我们的计划定期检查GAD-7s[一般焦虑症7问卷]和PHQ-9s[患者健康问卷]。

So they do that initially when they come on the mental health platform, but then we're able to see through their entire journey over the next year, two years, three years whether they're improving or not and that information gets back to the provider and then they can make decisions on medication adjustments or whether a sooner follow-up is needed or any form of escalation that needs to occur. .

所以他们最初在他们进入心理健康平台时就这样做了，但是然后我们能够看到他们在下一年，两年，三年的整个旅程中是否正在改善，这些信息会回到提供者然后他们可以就药物调整做出决定，或者是否需要更快的后续行动或需要发生的任何形式的升级。 .

But basically, what we do is we have millions of data points that come from a fully vertical system. So we have insight into the patient's demographics, past medical history and medications. For example, on mental health, prior experience, and side effects with SSRIs [selective serotonin reuptake inhibitors] or SNRIs [serotonin and norepinephrine reuptake inhibitors] in the past.

但基本上，我们所做的是我们有数百万个来自完全垂直系统的数据点。因此，我们可以深入了解患者的人口统计学，过去的病史和药物治疗。例如，过去的心理健康，既往经验和SSRIs[选择性5-羟色胺再摄取抑制剂]或SNRIs[5-羟色胺和去甲肾上腺素再摄取抑制剂]的副作用。

And then we have the documentation that comes from that, those data points that come from that, the prescription that is generated, and then the follow-up in terms of efficacy through regular structured check-ins. And then we also have the pharmacy adherence since we do the pharmacy fulfillment..

然后我们有来自这些的文档，来自这些数据点，生成的处方，然后通过定期的结构化检查进行功效跟踪。然后我们也有药房坚持，因为我们做药房履行。。

So when you have those millions of data points, you can imagine that's like a treasure trove for someone in machine learning or AI. They can actually take all that information and then identify, for example, in mental health, that's our beta test, which SSRI specifically for folks with the way they answer the questions, with their background, with their demographic, with their past experience in terms of side effects, what worked and what didn't, which SSRI is most likely to work for that specific patient.

因此，当您拥有数百万个数据点时，您可以想象这对机器学习或AI中的某人来说就像一个宝藏。他们实际上可以获取所有这些信息，然后识别，例如，在心理健康方面，这是我们的beta测试，SSRI专门为那些有背景，人口统计数据回答问题的人提供，根据他们过去在副作用，工作和不工作方面的经验，哪种SSRI最有可能适用于该特定患者。

So, it becomes very personalized. And then what we do is we then suggest to that provider, the provider ultimately makes a decision, which medication to choose from, and we just do generic medications. So SSRIs, SNRIs, Wellbutrin. But the provider is given some guidance based on the data that we have this medication is more likely to work in a quicker manner with this patient.

所以，它变得非常个性化。然后我们所做的就是向该提供者建议，提供者最终做出决定，从中选择哪种药物，我们只做通用药物。所以SSRIs，SNRIs，wellutrin。但是根据我们拥有这种药物的数据，提供者得到了一些指导，这些数据更有可能与该患者更快地合作。

So that's essentially what we've created in MedMatch. .

这实质上就是我们在MedMatch中创建的内容。 .

We're in the early days of it, but we're seeing some really positive signals, and then we can actually carry that over to each one of our verticals to really personalize and identify specific medications, specific even dosages of what will work for that patient based on all the data points we have.

我们处于早期阶段，但我们看到了一些非常积极的信号，然后我们实际上可以将这些信号传递给我们的每个眩晕，以真正个性化和识别特定的药物，特定的甚至剂量的适用于该患者基于我们拥有的所有数据点。

MHN: The AI uses data from your existing customers. Exactly what type of data in regard to mental health is going to help care providers make more informed decisions?

MHN:AI使用来自现有客户的数据。究竟哪种类型的心理健康数据将有助于护理人员做出更明智的决定？

Carroll: What we've created is a way to give them visibility in real-time for that specific patient for their background, comparing it to all of our datasets, which medication would be the most likely to work for that patient. And so it surfaces that and makes a suggestion. Again, the provider, for various reasons, can say, 'Well, okay, I get that, but I'm going to do something different,' which is fine.

卡罗尔：我们创建的是一种方式，可以让他们实时了解该特定患者的背景，并将其与我们所有的数据集进行比较，哪种药物最有可能为该患者工作。因此它表面并提出建议。再次，由于各种原因，提供者可以说，“好吧，好吧，我得到了，但我要做一些不同的事情”，这很好。

But I think basically it gives them the partial answer to the test of which medication is going to work based on all of that anonymized data that they're looking at, and we will surface that directly to our providers..

但我认为基本上它为他们提供了基于他们正在查看的所有匿名数据测试哪种药物起作用的部分答案，我们将直接向我们的提供者展示。。

And so we're actually doing this with providers now–testing it. And we've gotten very positive reviews on an iterative model, though, as all these AI models are, they get better with time. The key thing to remember is we don't just say to the provider, 'You must prescribe this medication.' We just give them a clue.

因此，我们现在实际上正在对提供商进行测试-测试它。并且我们在迭代模型上得到了非常积极的评论，但是，正如所有这些AI模型一样，它们随着时间的推移会变得更好。要记住的关键是我们不只是对提供者说，“你必须开这种药。”我们只是给他们一个线索。

It's almost like…not cheating on the test, but at least letting them know that this is more likely to work than the other..

这几乎就像……不作弊测试，但至少让他们知道这比另一个更有可能工作。。

MHN: The company plans to roll out MedMatch across its entire platform at some point beyond mental health, correct? Do you have a scope of when that might happen?

MHN：公司计划在精神健康之外的某个时候在整个平台上推出MedMatch，正确吗？你有什么可能发生的范围吗？

Carroll: I don't have the crystal ball on that. We definitely want to get mental health with MedMatch perfected because we actually look at that as one of all our verticals with the most variation in terms of medication, quite honestly.

卡罗尔：我没有水晶球。我们绝对希望通过MedMatch改善心理健康，因为我们实际上将其视为药物变化最大的所有眩晕之一，非常诚实。

It also is the toughest decision for providers, you know, whether you're using this SSRI versus an SNRI versus a Bupropion, and it's more complicated, as you know than a PDE5 [Phosphodiesterase 5], which, you know, sure, there's generic Cialis, which is longer acting, generic Viagra-type medications that are shorter acting...that's not as complicated.

对于供应商来说，这也是最艰难的决定，你知道，你是否使用这种SSRI而不是SNRI与安非他酮，并且它比PDE5[磷酸二酯酶5]更复杂，你知道，当然，有通用Cialis，这是一种长效，通用的Viagra型药物，作用较短。。。这并不复杂。

So I think what we're looking at is which [vertical] can have the most benefit for our customers the fastest and which one, for our providers, is worth giving them the most guidance on..

所以我认为我们所看到的是哪个[垂直]可以最快地为我们的客户带来最大的利益，哪个对我们的提供商来说值得给予他们最多的指导。。

MHN: Is there anything you want to add that we still need to cover?

MHN：你还有什么要补充的，我们还需要报道吗？

Carroll: I think a corollary to what we're doing on this technology front and is really underappreciated is that we built our proprietary EMR. So when the company started, we had the choice of going to something off-the-shelf versus building our own, but as you can see, what we do is fairly unique. It's not only virtual, but a lot of it is asynchronous, but we also do synchronous, and it's a platform that is specifically designed for that interaction between the customer and the provider.

卡罗尔：我认为我们在这项技术领域所做的事情的必然结果是我们建立了专有的EMR。因此，当公司成立时，我们可以选择去现成的东西而不是自己建造，但正如你所看到的，我们所做的是相当独特的。它不仅是虚拟的，而且很多是异步的，但我们也做同步的，它是一个专门为客户和提供商之间的交互设计的平台。

And we are freed from the chains of just having to do billing and coding because that was essentially what traditionally EMRs do–they're billing and coding machines. And so what we've been able to do is to create this EMR with built-in guidelines that allow us to really deliver a great customer, but also provider experience..

我们摆脱了只需进行计费和编码的链条，因为这基本上是传统的EMR所做的-它们是计费和编码机器。因此，我们所能做的就是通过内置的指导方针创建这个EMR，使我们能够真正为客户提供伟大的客户，同时也为提供商提供体验。。

And the other part of the EMR that people don't realize is when you build something internally like that, we're able to follow quality in a lot more robust manner because what happens is that we're able to identify providers who may not be following guidelines because it's all structured in our EMR, and we actually are able to grade them.

人们没有意识到的EMR的另一部分是当您在内部构建类似的东西时，我们能够以更加稳健的方式跟踪质量，因为发生的情况是我们能够识别可能没有遵循的提供商指南，因为它都是在我们的EMR中构建的，我们实际上能够对它们进行评分。

Last year, we did over 50,000 encounter reviews based on their interaction with patients, but also, are they prescribing the appropriate medication? Are they making a coherent note in that chart? Are they providing appropriate follow-up?.

去年，我们根据与患者的互动进行了超过50000次遭遇评估，但他们是否开了适当的药物？他们是否在该图表中做了连贯的笔记？他们是否提供适当的后续行动？。

When I led large medical groups, I never had an EMR that could actually really embed quality as part of it and then also provide an experience that is well received by both our customers and our providers because they're not spending all their time doing billing and coding documentation. They're spending their time following the guidelines and making sure they hit the quality metrics that we've set up..

当我领导大型医疗集团时，我从来没有一个EMR可以真正将质量作为其中的一部分进行嵌入，然后也提供了我们的客户和我们的提供商都很好的体验，因为他们并没有花时间进行计费和编码文件。他们正在按照指导方针花费时间，并确保他们达到我们制定的质量指标。。

As the company develops, as we add new services, we're able to bucket those on, and we just have great flexibility to do that. We also have to hire a lot of engineers for that, as you can imagine. But other than for us to have to go back to one of the traditional vendors and say, 'Can you adjust this? Can you adjust that?' Quite honestly, I don't think they have set up, to date, an EMR that really works well in the digital, virtual health, asynchronous world.

随着公司的发展，随着我们添加新服务，我们能够将这些服务放在上面，我们只有很大的灵活性来做到这一点。正如您所想象的，我们还必须聘请许多工程师。但除了我们必须回到其中一家传统供应商并说：“你可以调整吗？你能调整一下吗非常诚实地说，我不认为他们迄今为止已经建立了一个在数字，虚拟健康，异步世界中非常有效的EMR。

So that's been some of the exciting work we do just on our EMR. And then MedMatch is just an extension of using our technology chops to collect those data points to deliver better care..

这是我们在EMR上做的一些激动人心的工作。然后MedMatch只是使用我们的技术chops收集这些数据点以提供更好护理的扩展。。

Tags: Hims & Hers, mental health, artificial intelligence

标签：Hims＆Hers，心理健康，人工智能

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