The Doctor of the Future

By: Chuck SalterFri May 1, 2009 at 2:00 PM

Photograph by Jamie Chung | Prop Styling by Bryan Byrn

Cost, access, quality -- the prognosis for American health care may look grim, but innovation is the cure. The medicine of tomorrow is being born today.

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Photograph by Tanit Sakakini

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"This is a $2.4 trillion industry run on handwritten notes," says 33-year-old Dr. Jay Parkinson. "We're using 3,000-year-old tools to deliver health care in the richest country on the planet." His prescription: a Facebook-like platform that uses technology, from IM to video chat, to restore the traditional doctor-patient relationship that has been lost in today's high-pressure, high-volume, eight-minute-appointment practice model, which is often blamed for the shortage of primary-care physicians.

Parkinson, fresh from residencies in pediatrics and preventive medicine and a master's in public health from Johns Hopkins, started a virtual practice in 2007, in Williamsburg, a Brooklyn, New York, neighborhood known for its heavy concentration of artists, bloggers, and bushy beards. He had a Web site and a blog, of course. He made house calls and conducted same-day e-visits. He accepted PayPal, but not insurance. Three hundred patients signed up in the first three months.

And then, he says, sounding more like a perpetually amazed surfer than a medical rebel, "I blew up on Gawker, man." Through some photographer buddies, the gossip site discovered Parkinson and proclaimed, "Williamsburg's Hipster Doctor Will Diagnose You Via IM." In the accompanying photo, he wore a stethoscope draped casually across his shoulders like a scarf, white jeans, and a white shirt with one too many buttons unbuttoned, as snarky commentators observed. Gothamist, Yahoo, and The Washington Post jumped on the story.

The publicity caught the attention of Nathaniel Findlay, the CEO of Canadian software company Myca Health. A veteran of six startups as well as $91 billion Cardinal Health, he was leading a team building a secure portal to do what Parkinson had cobbled together using multiple applications like Google Calendar. The Myca project had begun with Don Jones, who runs the health and life-sciences group at Qualcomm. Jones had worked on one of the first electronic-medical-records efforts in the 1990s and was eager to expand the wireless company's mobile activities into telemedicine. After his team developed the technical requirements for such a platform, he contacted Myca to build it. Findlay then persuaded Parkinson to serve as chief concept officer to ensure a doctor-friendly application.

On a recent morning in Williamsburg, Parkinson demonstrates the latest version of the Myca Platform, which launches this summer. It's part electronic medical record, part practice-management system, and part social-networking site, complete with profiles and photos of doctors and patients, all in a secure environment that complies with federal privacy standards.

If you're a patient, your profile shows your medical team -- a primary-care physician and any specialists you've chosen, perhaps from the experts listed on your primary-care physician's profile. To make an appointment, you look at a doctor's schedule, select a time slot of at least a half hour and the type of appointment (in-person, video, or IM), and fill out a text box describing your ailment so the doctor can start thinking about treatment. Typically, follow-ups are e-visits. A timeline dotted with icons representing previous appointments lets you review the doctor's comments, read the IM thread, watch the video of an earlier electronic house call, or link to test results.

"You can rate a visit, comment on it, share it," Parkinson says. "Is that innovative? Man, I don't know. It's paying attention to what's awesome about Flickr and then doing it."

For the doctor, the platform is an intuitive tool for managing his time -- there are lists of upcoming appointments and prescription-refill requests -- and communicating with patients and other physicians more quickly and directly. One feature provides a health snapshot, the top conditions treated that week locally, statewide, or nationally. Another allows doctors to organize patients by condition and email them as a group about new treatments. "I'm a big fan of Craig Newmark [of Craigslist]," says Parkinson. "Create something useful and get out of the way. I have no idea what people are going to come up with."

The first practice that will employ the portal is Hello Health, a more polished, three-doctor version of Parkinson's early practice. "Think of Hello Health as a Mac and the Myca Platform as Intel, the stuff running inside," says Parkinson, who is never at a loss for a tech analogy. There's no receptionist, so doctors greet patients as they arrive. The clientele skews young. Half have insurance, and it's their responsibility to file for reimbursement. So far, very few insurers cover a wide range of e-visits, but the number is growing.

Insurance is, in fact, both a challenge for Parkinson's vision -- and, perhaps, an industry that could be transformed by the kind of medicine made possible by the Myca Platform. Doctors using the platform set their own fees, and Myca takes a cut of each transaction. At Hello Health, patients pay a $35 monthly subscription fee and $100 to $200 an hour for online or office visits. Brief email queries are free. Doctors at other practices who adopt the Myca Platform may charge less than their usual rates, since online appointments slash overhead. The sweet spot for this business model right now, Parkinson says, is the "invincibles," as health-care types call young, healthy people who forgo high monthly insurance premiums; instead, they pay doctors directly and buy relatively inexpensive high-deductible policies for emergencies.

About 2,000 doctors have inquired about joining, says Myca's Findlay. He maintains there's no shortage of companies looking for health-care options for employees that could eliminate lost productivity through absenteeism or waiting in a doctor's office. "The genie is out of the bottle," he says. "People want it. We just have to figure out how to do it properly."