Praxeon Blog

Praxeon Provides Medical Research for Kosmix RightHealth

New Service Helps Consumers Find Medical Literature In Their Health Search

Boston, MA – August 11, 2008 – Praxeon, Inc. announced today that its consumer health news and search site, MyDailyApple™ (www.mydailyapple.com), will provide advanced reading content for Kosmix™ RightHealth. RightHealth searches the health Web and categorizes it into useful modules for consumers giving them the relevant information they need to explore and learn about any health topic. The “Advanced Reading” module will now feature medical literature served from MyDailyApple. MyDailyApple’s evidence-based material will give RightHealth users access to the latest literature and research breakthroughs relevant to their query.

“Praxeon's patent-pending semantic fingerprinting, natural language query and profile-based filtering technology is what sets Praxeon apart from other health information and search companies,” said Kevin Cronin, CEO of Praxeon. “Now this technology, combined with some of the most authoritative medical content, will be available on one of the most trafficked health online sites.”

“At Kosmix, we are focused on delivering the most relevant content from a variety of sources – basic facts, advanced reading, expert opinions, forums, videos and images – to users searching for health information online,” said Ravi Raj, vice president of products at Kosmix. “Praxeon’s strong technology gives us the ability to offer millions of RightHealth users with advanced reading material and additional information for their health care needs.”

About Kosmix

Kosmix, headquartered in Mountain View, Calif., takes traditional Web search to the next level by organizing content to let consumers explore, discover and learn about any topic, connecting them to information that makes a difference in their lives. Consumers get a 360 degree view of topics that includes videos, images, reviews, discussions and expert opinions. At the core of Kosmix is a powerful content categorization engine which powers its vertical consumer sites, RightHealth, RightAutos and RightTrips, and the recent alpha of its horizontal platform, Kosmix.com.

About Praxeon

Praxeon’s sophisticated technology is revolutionizing the way people get health care information. Praxeon’s products have been extensively tested and validated by healthcare providers and by more than 20 health advocacy groups. In 2007, Praxeon was voted “Best Health Search Company” at the Health 2.0 Conference in San Francisco, CA.

PHRs - Miracle or Mayhem?

You may have caught some of the recent press around personal health records or PHRs.  Both Microsoft and most recently Google have entered the market of providing individuals the ability to enter their personal health information in an on-line medical record.    And in the case of Google, individuals have the ability to import their medical records from pharmacies, labs, hospitals and insurers.  (Full disclosure – MyDailyApple is a Google Health service).

A lot of commentary on Microsoft HealthVault and Google Health has focused on the advantages of accessibility and patient control.  The PHR allows the patient to take their medical records anywhere and provide access to anyone at anytime – since it’s all on line.  The major disadvantage that has been mentioned revolves around issues of privacy and security.  Do you trust Microsoft or Google to safeguard your medical information?

I agree that accessibility and portability are major advantages of PHRs and that security is a major concern.  But I think most commentaries have missed some of the other major advantages associated with an on-line PHR and some of the major pitfalls.

For instance, from a patient perspective, consider some of the following additional advantages beyond portability and accessibility:

1.       Now you can review your records to see how your doctor thinks.   You can see their decision making, how thorough they are and what other diagnostic possibilities they are considering.

2.       You can see if your physician is compliant with the latest guidelines regarding screening, testing and treatment.

In short, as a patient, you can now get some insight into whether or not you are getting high quality care.

But on the flip side, from a physician perspective, there are some serious concerns with opening up medical records so easily:

1.       Does this expose physicians to additional liability?  What if a patient finds something wrong in their medical record or an omission of care?

2.       Can you imagine a HealthVault or Google Health service provided by lawyers – “We’ll see if there is evidence of negligence in your PHR and get the money you’re entitled to!”  Okay – some of you might think I’m being a paranoid doctor.  But seriously – I saw an ad on the TV asking women who had an emergency c-section to get immediate legal counsel.

Bottom line: Are providers really going to rush to provide easy access to medical records to on-line PHRs if it means they might get sued?

On-line PHRs contain the aura of another miracle for what ails the US healthcare system.  And certainly, greater transparency, portability and accessibility or records and patient empowerment are all important goals – furthered to an extent by the PHR.  But there could be problems – and a great deal of reticence beyond issues of patient privacy – before there is widespread adoption. 

Google Health and HealthVault are not going to be enough to fix the problems in US healthcare.  It’s going to take a couple of additional “mini-revolutions” beyond on-line PHRs – like in areas of medical tort reform and malpractice; easily understood and validated quality measures; financial incentives towards prevention and wellness and not just disease treatment – till this patient starts to get better.

Special thanks to my father – whose conversations with him helped shaped much of my thinking for this current blog.

Praxeon launches Google Health integrated service

New Integrated Service Helps Consumers Find Relevant Health News and Blogs Related to Their Medical Information

Boston, MA – May 20, 2008 – Praxeon, Inc. announced today that its consumer health news and search site, MyDailyApple^TM (www.mydailyapple.com), is now available as an integrated service on the Google Health platform. Google Health is a new product that was launched today at a media event in Mountain View, California that allows users to store, organize, and manage their medical records online. The new Praxeon service gives Google Health users access to health news, blogs, and research information from the most trusted sources along with the ability to personalize that information to individuals’ health profiles.

“Google Health is a personal health service that paves the way towards consumer involvement and accountability,” said Kevin Cronin, CEO of Praxeon. “And MyDailyApple provides Google Health’s users with relevant and personalized health information so that users can be fully engaged in managing their own health.”

MyDailyApple uses data from an individual’s Google Health profile, upon their consent, to provide relevant health content that is personalized to their own health conditions or medications. MyDailyApple gives Google Health users pertinent, current health information from sources that are matched by medical relevance and by measures of community popularity. This combination of sophisticated health search technology and active user input leads to a richer, more informed, personalized health experience, driven by the most trustworthy health news and information.

“Praxeon's patent-pending semantic fingerprinting, natural language query and profile-based filtering technology is what sets Praxeon apart from other health information and search companies,” said Dennis Underwood, Chief Scientific Officer of Praxeon. “That technology powers Praxeon's top-rated health news and search products — MyDailyApple^TM for consumers and Curbside.MD^TM for healthcare providers — and delivers intelligent, organized and personalized answers to health questions.”

Praxeon’s sophisticated technology is revolutionizing the way people get health care information. Praxeon’s products have been extensively tested and validated by healthcare providers and by more than 20 health advocacy groups.  In 2007, Praxeon was voted “Best Health Search Company” at the Health 2.0 Conference in San Francisco, CA.

Google Health is available on the web at www.google.com/health

We welcome the Christopher and Dana Reeve Foundation

We are pleased to welcome The Christopher and Dana Reeve Foundation aboard the MyDailyApple.com network of disease advocacy organizations.  The renowned charitable organization was founded to accelerate curative spinal cord injury research and improve quality of life for those living with paralysis.  Named after Christopher Reeve and his wife Dana, the foundation (formerly the American Paralysis Association) lends its name to fund global initiatives in the areas of embryonic stem cells and innovative research.  Feel free to visit our new partner’s website at www.christopherreeve.org.

Financial Incentives in Medicine

A recent article in the New York Times “Many Doctors, Many Tests, No Rhyme or Reason” reminded me of the distorted financial incentives that permeate the practice of medicine in the United States. In the article, the author, a NY cardiologist states, “In our health care system, where doctors are paid piecework for their services, if you have a slew of physicians and a willing patient, almost any sort of terrible excess can occur.” He then goes on to detail the evidence of excess both at a national level and on an anecdotal basis.

Unfortunately, I have to concur with his bottom line conclusion: “Doctors are doing too much testing and too many procedures, often for the sake of business. And patients, unfortunately, are paying the price.”

This article reminded me of my own early experiences in the hospital. I remember as a third year medical student I commented to one of my classmates that my internal medicine hospital rotation was so easy! All we did was call consults every morning based on all the abnormalities we found on the labs and imaging from the day before. Okay – so I’m being a bit glib and over-exaggerating. But I do remember the conversation and sentiment very distinctly. I felt like we spent a lot of time asking for consults when maybe they weren’t necessary. But then again – I was a naïve third year medical student with no experience. What did I know? 

But I have to say, I’ve had those same nagging feelings through the years  – that utilization of consults and testing is driven by financial incentives; maybe even “throwing a bone” to one of your medical colleagues. Where I did my internship, many of the medicine patients I took care of on the wards were either uninsured, underinsured or within an HMO model. In that situation, where there really wasn’t the willing patient (or matching reimbursement) I felt we were a bit judicious and restrained in our testing and consults. But in other environments where I have practiced, where patients were more generously insured, I definitely have felt a trend towards overutilization and unnecessary testing. 

So what is a patient supposed to do in an environment of distorted incentives for testing and work-up? Some solutions will hopefully come from our site, MyDailyApple. Over the next several weeks, we will be introducing a set of content, features and tools on MyDailyApple to assist patients with understanding the world of medicine and to take action with managing their health.  Some of this is already there and I encourage you to check it out.

 
But even with all the great Health 2.0 technology, it is probably unrealistic to expect a patient to look up information and search on the internet while in the hospital. So how can an individual advocate and maybe to a certain extent – protect themselves within this environment? Probably one of the first steps, in addition to all of the technology out there, is an old-fashioned Health 0.0 solution - engage your provider in an honest discussion. Someone has to start the process. And it is always fair to ask, “Do I really need this? What happens if we find something – then what? What if there is a false positive result? What are the alternatives? Is this all necessary?” Physicians probably aren’t used to such pointed questions. But times are changing – and so should the nature of the interaction between physicians and patients. And perhaps this will start the frank dialogue to understand the distorted incentives that operate in the American health care system. 

I think one of the final quotes from a hospital executive in the New York Times article really sums up my feelings on this one.  “The hospital is a great place to be when you are sick. But I don’t want my mother in here five minutes longer than she needs to be.”

Introducing MyDailyApple

Today Praxeon is proud to introduce MyDailyApple, our personalized health information service for patients and health consumers.

MyDailyApple brings together news, blogs, and discussions from around the web and personalizes them to you based on a simple profile that describes your health interests. You can create this profile right on MyDailyApple, or import it from a personalized health record (PHR) system like Google Health or Microsoft Health Vault.

MyDailyApple delivers you a daily or weekly news bulletin through whichever channel you find the most convenient : email, RSS, a widget-based home page like iGoogle or NetVibes, or right on the MyDailyApple web site. We surround each article with

• Explanatory material and related articles to help you interpret its meaning and judge its quality
• Features to conveniently share it with friends and family
• Links to relevant discussions from trusted patient forums and communities

So if you have specific health interests and you want to stay informed, visit www.mydailyapple.com today and sign up using our simple one-page form.

And if you operate a health-related blog, discussion group, or web site, contact us today at info@praxeon.com to find out we can help you grow your audience through our personalized feeds.

Doctors catch errors in own medical records; experts say patients should check too

How much do we trust our physicians to record our medical histories?  It seems that perhaps we should be checking our medical records as closely as we check out credit history.

Errors can creep into medical charts in various ways. Doctors are often under time pressure and may find themselves taking shortcuts or not fully listening to a patient's problems. Others rely on their memory to update their patients' files at the end of the day. Other mistakes can arise from illegible handwriting or coding problems."  Read more here...

Provided by: The Canadian Press
Written by: Alicia Chang, THE ASSOCIATED PRESS, Nov. 21st, 2007

 

Consider the consequences of recording an inaccurate diagnosis or the wrong medication.  In cases of emergency medical response these errors can be life threatening.  Even in cases of impaired diligence during illness or because of age, the repercussions of taking the wrong medication can be dire. 

"McDonald's has a better record of what they've served all their customers than we have of our patients' medical histories," says Isaac Kohane, a Harvard University medical informatics specialist and endocrinologist ("Paperless Medicine", MIT Technology Review, April 2003). When pondering this, remember the following facts:

•  $17-29B spent each year in medical mistakes in hospitals across the US (Institute of Medicine Report, “To Err is Human”, 2000)
• The WHO estimates that 1 in 10 patients receiving hospital care will experience some form of unintended harm  (PRNewswire, May 21^st, 2007 “American Medical Informatics Association Leaders Shaping the Future of Biomedical and Heath Informatics”
•  About 98.000 people die every year in the hospitals in the USA due to medical errors (1997 statistics)

 

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Semantic Fingerprinting is like Geocoding

Geocoding:

"... is the process of assigning geographic identifiers (e.g., codes or geographic coordinates expressed as latitude-longitude) to map features and other data records, such as street addresses."

- Wikipedia

A geocoder accepts a document written in plain language, and identifies geographic features. Each of these features is converted into latitude and longitude, a unique, canonical representation that is perfectly suited to this kind of data.

Once a document has been geocoded, the computed coordinates can be used to display and manipulate the document as if it were a geographic feature. It can be placed on a map; a collection of documents can be searched by location, with clauses such as 'within 25 miles of Brookline Massachussets'. The value is obvious to anyone who has used a map of real estate listings, or searched for a used car within 25 miles. Imagine having to type in the name of every city within 25 miles of your house, and still not being sure that you didn't miss anything.

Yet, without semantic fingerprinting (or maybe we should call it Healthcoding), this is exactly how people are still searching for documents about health and medicine. Medical documents are full of rich terminology : "malaria", "bupropion", "randomized controlled trial". The semantic fingerprinter recognizes each of these concepts, and translates it into a unique code. Of course medical terms don't map into coordinates, but they do have important natural relationships that, once understood, can be exploited to build powerful and intuitive user interfaces. My favorite example is the concept cloud; you can see two of them (Drugs and Diseases) at the bottom of the MyDailyApple news page. Here, current news is collected and fingerprinted. The medical concepts within the news articles are then aggregated according to their hierarchical relationships, and then ranked by importance. The result is a complete overview of current health news that fits into half a browser screen! Only fingerprinting makes this possible.

Like geocoding, and unlike purely text-based methods, semantic fingerprinting is also very robust to synonyms. Just as a geocoder converts multiple representations of the same place to the same coordinates, the fingerprinter replaces medical synonyms like 'bupropion', 'wellbutrin', and 'zyban' with the same unique identifier. And as in geocoding, the algorithms that operate on the coded document deliver the same query results no matter which synonyms are used in the query and the content.

Comparing Semantic Fingerprinting to other search technologies

Today I came across this Venture Beat post about Twine, which provides an enumeration of technologies by which a computer can come closer to true understanding. I'll repeat that list here and include semantic fingerprinting. I'll go from most complex to most feasible.

1. Natural language. This is the Hard AI problem of teach a computer to read and understand written (or spoken) language. The computer may respond in a variety of different ways, but I think the most commonly discussed is 'question answering', in which you ask a question and the computer tells you the answer. The meme for this seems to be a system that can answer 'Who did Dick Cheney shoot?', and also respond to 'Who shot Dick Cheney?' (as of today, nobody has). Systems without 'understanding' tend to give the same answer to both question. Ask Google and you'll see.
2. Semantic search. This is something of a gray area because there aren't many great examples to point to. But it seems to be essentially an offshoot of the Semantic Web idea, in which people associate structured tags with text content. Semantic search technologies are working more with hard facts than the web search engines of today. However they require additional effort from content publishers that may or may not ever happen (my money is on 'not'). Semantic search systems can do question answering without natural language understanding, because the data they are working on has been specially encoded for them by humans. It's really more like database technology.
3. Statistical analysis and keyword search. Documents are treated simply as collections of words. Some attention is paid to word proximity, and a lot of attention is paid to headings and links, but generally speaking the search engine does not try to 'understand' anything. The power of this technique is that no complex modeling is required on the part of the search engine developer, and no burden is placed upon the content author either. Boolean search has proven to be immensely scalable, largely (as far as I can tell) because the system is restricted to accepting very simple input.

So where does that leave semantic fingerprinting? Semantic fingerprinting is like:

• Natural language, in that the user input is accepted in the natural written or spoken form.
• Semantic search, in that the fingerprint contains true concepts rather than opaque words.
• Keyword search, in that it is based on boolean search technology.

It is unlike:

• Natural language or semantic search, because the output of the system is an organized set of documents, rather than a specific answer to a question.
• Keyword search, because the user input is not limited to keywords.
• Semantic search, because it operates on documents rather than facts.
• Statistical techniques, because a domain model is required.
• Statistical techniques, because the search results are organized according to insight gained from the domain model.

As far as I know, semantic fingerprinting is uniquely suited to search-like problems in which the input is one or more complex statements (optionally combined with restrictive keywords), and the output is an organized collection of documents. Some application examples:

• Presenting medical evidence to answer a complex medical question.
• Showing medical content (e.g. guidelines, alerts) that is related to a patient electronic medical record.
• Guiding keyword-based search results using a patient profile. A keyword or two may constrain the hit list, but the profile strongly influences the relevance ranking.
• Delivering health news and alerts to a patient, based on their health profile.
• Making social connections between patients, and between patients and providers, based on their health profiles and areas of expertise.
• Automatically showing related content next to blog and discussion posts.

The Big Idea : Personalized Health Information

We've all seen the searches in television commercials : 'hypertension', 'diabetes', 'ankle sprain'. But if professional health information is a Ferrari, the typical search results from a simple keyword query is more like a shiny tricycle. The novelty quickly wears off; we know there's a bigger world of information out there, but how to access it?

Being a patient is a journey. There's a period of initial diagnosis, learning basic disease information, then achieving a deeper understanding, gaining experience with the personal aspects of the condition, sharing information and gaining support from peers, and eventually giving back to the community through mentoring or active involvement in patient support and disease advocacy. The journey is complex and personal; health information resources on the web should understand this and support it.

Personalization is the key. In order to go beyond the introductory 'What is Hypertension', a health site needs to learn about your personal health history, family health history, medical conditions, and treatments. From this basic, anonymous, health profile, you can realize immediate benefits

• Personalized health news, selected from the best sources to match your profile
• Personalized search results, highlighting important factors such as connections between symptoms and conditions, side effects, drug interactions, and factors in your family history that may influence diagnosis, risk factors, and treatment.
• Personal connections to other patients that share a similar profile.

You are now 'plugged in' to your condition, continuously updated with relevant information, able to delve deeper into background material and research, and connected to peers.

Next, you'll begin to communicate with your health provider. Personal health records are coming into being in many forms, and there are great benefits to integrating the physician's view of the patient with the patient's own health profile. Using the health profile, the patient is seeing information written for patients, with the ability to venture into more advanced material if they desire. From the physician's point of view, the patient health profile becomes more than a bookkeeping system; it's a window into the best, most relevant, most applicable guidelines and research that they can use to make real-time decisions.

Realizing this vision, a personalized health information system that bridges new patients, mentors, and health care providers, is not a simple task. It is not all about technology, although innovative technology is required. It is not all about discussions and social networking, although effective communication is required. The system we describe can only be built by connecting patients, providers, content developers, industry, and medical information systems, using new technology that truly understands the language and structure of medicine.

This complete solution, this 'Big Idea', is what we're working towards.