@jayparkinson

38

Sherpaa’s full-time doctors who work exclusively for us have a very efficient, and innovative, way of solving medical problems. 98% of the time, our doctors communicate with employees via our web or smartphone app. The other 2% is over the phone, for urgent issues. Here’s how Sherpaa works:

  • When an employee creates a Sherpaa profile, they complete a health history. This is essentially like filling out the paper clipboard in a doctor’s office, but they only have to do this once.

  • Via our app, an employee creates a case choosing from “I’m sick,” “I’m hurt,” “I need a refill,” “I need a referral,” “I have a mental health concern,” or “I have a chronic health concern.” They typically write a paragraph or two explaining in their own time and on their own terms their unique situation. They send it off.

  • A Sherpaa doctor reads the employee’s story and then sends back a list of targeted questions. Typically, this is a series of about 20 questions designed to rule out serious things and draw us toward a diagnosis. An employee answers the questions and sends them back to our doctor.

  • 50% of the time, simply asking the right questions leads us toward the diagnosis. We will treat accordingly with a medication and/or things to do at home to get better.

  • 20% of the time, our doctors send the employee to a lab or radiology center to confirm the suspected diagnosis by blood tests or X-rays, ultrasounds, CT scans, or MRIs.

  • Once the results are available, we get the results and treat accordingly. Depending on the test, this is a matter of minutes to hours. The results are accessible to the employee within their Sherpaa profile.

  • 30% of the time, our doctors deem it absolutely necessary to be seen in person. We will recommend a specialist and make the appointment for the employee bypassing the extremely long wait times. After the patient has been seen in person, the specialist will send us a consult, which will then be accessible to the employee within their Sherpaa profile.

  • We follow up with the patient a few days to weeks later to make sure all is well and/or address any further questions the employee may have at any time.

We think this communication is better than an in-person doctor visit. It changes the entire concept of a doctor visit from a transaction within the confines of a doctor’s office to a convenient conversation that evolves over time. And, like every other aspect of life, good things happen with good, efficient communication. Employees can tell their story without interruptions in their own words and on their own time without being in an uncomfortable, intimidating doctor office surrounded by sick people. Doctors can take a very complete, structured, history asking all of the right questions to rule out serious things and give us a clear idea of what’s actually happening. It’s taking an evidence-based history and covering all bases. It doesn’t have the time constraints of the typical 8 to 10 minute office visit. And, let’s face it, with the enormous amount of medical information out there, it’s impossible for a doctor to know everything. In an office visit, doctors have to “wing it” when they see something they don’t fully recall or understand. But with Sherpaa, doctors can do the research and respond to the employee after getting a better scientific grasp on the issue.

Is it safe?

We think the best way to answer this question is based on our malpractice insurer’s actuaries. Our malpractice rates are a third of a traditional office-based doctor. This is due to three reasons. First, we don’t do any procedures (the vast majority of malpractice stems from procedures gone wrong and 6% of doctors account for 60% of malpractice…we absolutely do not hire any doctor with any history of malpractice). Second, we’re very accessible. In fact, we have an open line of communication with employees 24/7. Being accessible to respond to any new problems that arise is extremely safe. Third, every case comes with a list of reasons to reach back out to us or go to the ER. The entire conversation is documented.

100
Sherpaa moved to a beautiful new office in SoHo at Broadway and Prince a few weeks ago. The decor is coming along. We got a whole wall of vintage first aid kits via Etsy, one of Sherpaa’s clients. Lots of plants and a beautiful stretcher from the 60’s, you know, just in case. And on that coffee table is a vintage German knee from West German-knee! We’ve got 24 people now and we cover about 120 companies. So proud of our team. Sherpaa moved to a beautiful new office in SoHo at Broadway and Prince a few weeks ago. The decor is coming along. We got a whole wall of vintage first aid kits via Etsy, one of Sherpaa’s clients. Lots of plants and a beautiful stretcher from the 60’s, you know, just in case. And on that coffee table is a vintage German knee from West German-knee! We’ve got 24 people now and we cover about 120 companies. So proud of our team.

Sherpaa moved to a beautiful new office in SoHo at Broadway and Prince a few weeks ago. The decor is coming along. We got a whole wall of vintage first aid kits via Etsy, one of Sherpaa’s clients. Lots of plants and a beautiful stretcher from the 60’s, you know, just in case. And on that coffee table is a vintage German knee from West German-knee! We’ve got 24 people now and we cover about 120 companies. So proud of our team.

43
This is the only photo I can find of me during my pediatric residency. Seems we were so busy, we forgot to take photos.

This is the only photo I can find of me during my pediatric residency. Seems we were so busy, we forgot to take photos.

62
My watch is the only watch I’m excited about today. Call me a curmudgeon, but we look at too many screens and, already, get too many things vying for our attention. A wearable screen ready to distract us? Does that make us more present, or less? My iPhone has been my wearable since 2007. I wear it in my pocket. Do I really need another screen and another wearable?

My watch is the only watch I’m excited about today. Call me a curmudgeon, but we look at too many screens and, already, get too many things vying for our attention. A wearable screen ready to distract us? Does that make us more present, or less? My iPhone has been my wearable since 2007. I wear it in my pocket. Do I really need another screen and another wearable?

75
Sherpaa moved offices to a new space in SoHo. We’ve got about 25 people now. It feels good to grow.

Sherpaa moved offices to a new space in SoHo. We’ve got about 25 people now. It feels good to grow.

36

What is unique about how Sherpaa doctors practice medicine?

You can think of Sherpaa like a corporate medical practice in the cloud. When an employee health issue arises, employees launch the app, create a case, tell us their story, answer our questions, and see their plan. When an employee has a new message from our doctors, they get an email saying they have a new message and they should go to the app to read it. Ninety-eight percent of all communications our doctors have with our patients is done via asynchronous, private messaging within our app. The other 2% is via the phone. It’s essentially secure email within our app. Needless to say, this type of communication is one everyone in the working age population is far too familiar with.

First, let’s define how this is markedly different from the traditional way of practicing.

Sherpaa is online and asynchronous vs. real-time and in-person. Traditionally, communication between doctors and patients is done in real-time in an exam room with time spent on the case dictated to the patient by the doctor. Patients must think on their feet and answer questions upon command without the luxury of contemplating the question, or looking up terms they don’t understand. Although this is how it’s always been done, it’s highly ineffective and inefficient. Granted, there is some value in in-person body language. But that is relatively rare. The vast majority of patient-physician communication is matter of fact.

Sherpaa leverages checklists when taking a history vs. not. Although most doctors are average history takers, there is risk in not having a standardized process of taking a good history from the patient. When taking a history is unstructured and not part of a formalized, repeatable process, things can get missed or you can go down a rabbit hole. At Sherpaa, when a patient reaches out to us with a chief complaint of, say, abdominal pain, all of our patients are asked the same questions, depending on their gender. We’ve created a standardized way to take an accurate, complete history. For the top 200 chief complaints, we’ve created protocols to ask the right questions— questions that rule out the serious issues but also cover all bases and lead us to the right diagnosis. This ties back in to the issue of real-time and in-person. The only way to do this is with a checklist. Essentially, Sherpaa, at almost every point in the process from history taking to treatments, utilizes the concept of a checklist. A checklist is what enables 45,000 commercial planes to take off and land every day with years in between crashes. The same should be used in healthcare to effectively take a history and treat most appropriately.

Sherpaa doctors can take a time out. Just as patients need to sit back and think about the questions being asked them, doctors sometimes need to do this too. If doctors are in an exam room with a patient trying to ask the right questions and stumble upon a situation that either stumps them or is something they don’t have a ton of experience with, how do they, in real-time, educate themselves about the best way to diagnose and treat? Remember, doctors don’t and can’t know everything. Because Sherpaa is asynchronous, our doctors can also take a time-out and read up on the condition and/or how best to diagnose and treat it. It’s extremely valuable and safe.

Sherpaa leverages all diagnostic tools, including time. Doctors have tools to make an accurate diagnosis— asking the right questions, ordering the right blood or imaging tests, conducting a skillful physical exam, and, finally, leveraging the passing of time as a diagnostic test. For example, diseases often have a relatively predictable course. Doctors sometimes say, “well, I don’t know exactly what this is now, but if we wait 12 hours and see how things develop, we’ll have a much better idea.” The problem with this is how the healthcare system isn’t set up to leverage time as a diagnostic tool. A visit separated by 12 hours is double the cost. It’s an opportunity to bill twice, when it should be simply billed once. With Sherpaa, we always have a direct communication line to the patient at all times. As doctors, if we want, we can say to the patient, “we don’t know exactly what’s going on, but with your permission, we’re going to reach back out to you in 8 hours to check in and see how you’re doing.” And, then, 8 hours later, we send a check-in message to the patient to get an update. The passing of time is a wickedly powerful diagnostic tool that doctors who practice traditional medicine simply can’t employ. If you are discharged from the ER, good luck trying to reach that same doctor 8 hours later to give them an update on your condition. So Sherpaa doctors leverage time and they also have the luxury of ordering the right lab and/or imaging tests. Every day, we send people to Quest or LabCorp to get their blood drawn or to radiology centers to get imaging. Those results are then sent back into Sherpaa’s platform and our doctors diagnose and treat accordingly. Since our doctors never see a patient in-person, we can never do a physical exam. But that’s ok for 70% of our cases. One of the four rules of practicing Sherpaa is, “if you are in any way uncomfortable, get the patient seen in-person fast.” And that happens 30% of the time.

Sherpaa treats in an evidence-based way. In the same way we’ve built 200 protocols for taking an accurate history, we’ve also built about 200 treatment protocols based on the best available evidence. You would be highly surprised to know that 90% of everything a doctor does is essentially hearsay, folklore, wisdom, and faith. There is very little scientific evidence backing up the majority of what doctors do. So we’ve taken what little evidence there is in western medicine and created protocols around them. Essentially, safety checklists again. This standardizes care and allows us to understand its efficacy by tracking outcomes. Was this treatment plan effective? What was the outcome? With an always-on direct communication line with the patient, we have the luxury of gathering outcomes and understanding how effective our treatments are. Traditional doctors don’t. Once you’re out of their office, you’re gone and it’s on you to make another appointment to update them on your outcome. That’s wrong.

Sherpaa leverages data. Since 98% of what we do is online text communication, we have access to massive amounts of analyzable data from which we can learn. Because the rest of healthcare happens verbally in real-time, that is lost data that can never be used to study and improve best practices. Sherpaa is a vast medical practice full of usable data that can be used to help us get better and better. This allows us to understand “If the patient answered yes to this one question, the diagnosis of x is 90% likely. If the patient answers yes to these 5 questions, x diagnosis is 99% likely. If the patient is treated with this treatment plan for x diagnosis, there will be a 96% cure rate.” This data-driven practice of medicine simply can’t happen anywhere else in healthcare. It can only happen because we can analyze online communication and iterate on best practices.

We’re building something that happens nowhere else in healthcare. It’s quite astounding, unique, and powerful. Once you see it in action as a doctor or as a patient, you understand how revolutionary it truly is.

105
See that weird rash caused by a fitbit? That’s the only time a doctor will ever care about your fitbit. They’ll never care about the data generated from these devices, ever. Why?
Because ignorance is bliss. Imagine if a doctor’s typical panel of 2500 patients all had fitbits and were all generating data and sharing all that daily data with doctors. That’s a lot of data for a doctor to digest on a daily basis. Of course the doctor surely wouldn’t be responsible for all of that data. The doctor would only be responsible for the data that sets off some sort of trigger. Let’s say that there’s a miracle device with a miracle algorithm that flags 1% of users as atypical and something the doctor should be analyzing. That means a doctor would then be looking at data from 25 patients a day. Doctors typically see 25 patients a day in their practice, so now they are responsible for 25 more patients, analyzing their data, and then acting on the results. Meanwhile they’re not getting paid for this kind of management. Would this be a co-pay that patients pay? Could doctors open up cases for you that would then give them the freedom to take your co-pay whenever they want?
And what happens when they overlook a blip in someone’s data and don’t act on it? Are they negligent? Will they be sued for malpractice? Will you also be able to sue Apple or Fitbit because of a flawed algorithm that didn’t trigger alarms for life-threatening data it’s collecting about you? 
It’s the same issue with paper records. If you have your paper records and deliver an inch-thick of paper to your new doctor, it’s in the doctor’s best interest to refuse to take them. Because if they do take them, they are assuming responsibility for them and are then expected to know the information in that stack of papers. If they don’t take them, they can always claim ignorance. And, legally, ignorance is much better than negligence.
For doctors, it’s best to ignore these devices and this data. Too much data coming at you. And too many unknowns. With increasing data streams targeted at you and increasing risk of malpractice, it’s probably better to just keep your distance and call them “cute.”

See that weird rash caused by a fitbit? That’s the only time a doctor will ever care about your fitbit. They’ll never care about the data generated from these devices, ever. Why?

Because ignorance is bliss. Imagine if a doctor’s typical panel of 2500 patients all had fitbits and were all generating data and sharing all that daily data with doctors. That’s a lot of data for a doctor to digest on a daily basis. Of course the doctor surely wouldn’t be responsible for all of that data. The doctor would only be responsible for the data that sets off some sort of trigger. Let’s say that there’s a miracle device with a miracle algorithm that flags 1% of users as atypical and something the doctor should be analyzing. That means a doctor would then be looking at data from 25 patients a day. Doctors typically see 25 patients a day in their practice, so now they are responsible for 25 more patients, analyzing their data, and then acting on the results. Meanwhile they’re not getting paid for this kind of management. Would this be a co-pay that patients pay? Could doctors open up cases for you that would then give them the freedom to take your co-pay whenever they want?

And what happens when they overlook a blip in someone’s data and don’t act on it? Are they negligent? Will they be sued for malpractice? Will you also be able to sue Apple or Fitbit because of a flawed algorithm that didn’t trigger alarms for life-threatening data it’s collecting about you? 

It’s the same issue with paper records. If you have your paper records and deliver an inch-thick of paper to your new doctor, it’s in the doctor’s best interest to refuse to take them. Because if they do take them, they are assuming responsibility for them and are then expected to know the information in that stack of papers. If they don’t take them, they can always claim ignorance. And, legally, ignorance is much better than negligence.

For doctors, it’s best to ignore these devices and this data. Too much data coming at you. And too many unknowns. With increasing data streams targeted at you and increasing risk of malpractice, it’s probably better to just keep your distance and call them “cute.”

13

Are you a family practice or internal medicine doctor who wants to work at Sherpaa? Do you think healthcare is broken and you want to be on the team that’s fixing it? Are you ready for an exciting change? If so, please join us. 

What do Sherpaa physicians do all day? They talk with patients via our app or phone, order tests, diagnose, treat, coordinate care, and/or refer to the perfect specialist for the patient. In fact, 70% of the time, we actually diagnose and treat without referring for an in-person visit. You work out of the Sherpaa office in Soho and become part of our growing Sherpaa team. 

It’s creative, refreshingly different than a traditional doctor’s life, and it’s an opportunity to be part of something that works better than traditional, old-fashioned healthcare delivery. You’ll work alongside our tech team and help guide our app’s development as we continually focus on making healthcare delivery as effective and efficient as possible. You’ll become a part of our patients’ lives as you change their lives and health for the better.

It’s doctoring, and also working at one of the most forward-thinking healthcare startups around today. You’ll get a salary that’s more competitive than a traditional doctor, amazing benefits, and we, of course, cover your malpractice. Please send your resumé to jay@sherpaa.com. I’m looking forward to meeting you!

22

I’m been a bit silent lately. Sherpaa is moving to a much larger office in Soho on Friday and we’ve been quite busy. But here’s one of the many things we’ve been working on.

sherpaa:

Sherpaa has an internal team devoted exclusively to building and optimizing a group of specialists our full-time doctors here at Sherpaa refer to when you need to be seen in person. This only happens about 30% of the time, but when you need to be physically examined, our mission is to send you to the highest quality doctor where you’ll have the best experience. Essentially, out of the 880,000 doctors in America, we’re curating doctors so we can send you to the best doctors who will provide you with the best experience. These doctors are rare. We look for the upper echelon of exceptional— the probably less than 5% that meet our definition of a doctor we’d trust with our own lives. So how do we choose our specialists? And how do we define an exceptional doctor? 

Our candidates must meet the standards of a proprietary 30-point weighted system before they’re considered. Next, we look at credentials. Are they board-certified in their specialty? How prestigious was their education? What have they published and do they have a professorship? Are they members and/or leaders of professional organizations? Most of all, we prize clinicians, as we believe that the more time spent with patients, the better.

Credentials are only the beginning. Sherpaa next performs an exhaustive search of  a candidate’s online presence, of how a doctor presents herself and of how patients perceive her. We’re likely to refer to someone with great Yelp reviews, for instance, but that’s only one piece of the puzzle. We then investigate all available quality metrics. For example, we’ll consider outcome rates for procedure-based specialists or preventive care efforts for primary care doctors.

Part of our commitment to a great patient experience is ensuring that the medical treatment as well as financial obligations make sense. Our doctors take patients’ insurance nearly every time. We also ensure our doctors aren’t part of the sliver of doctors receiving a large amount of payouts from insurance companies. We want to avoid, at all costs, doctors who overbill insurance companies and patients.

If a prospective specialist passes this test, we move the conversation offline and into their practice. We choose physicians and practitioners with great personalities; who enjoy their profession and nurture their interests; whose offices are orderly and comforting; and who appreciate timeliness, kindness, and efficacy. 

Our system for assigning potential specialists a weighted score includes the following:

  • Their personal website must be high quality and value beauty and clarity
  • They take more than 5 major health insurance plans
  • Their practice size is less than 10 physicians
  • They graduated from a well-regarded American medical school
  • They have a professorship
  • They’ve published academic journal articles
  • They are members of their respective professional affiliation
  • They’ve been in practice between 5 and 15 years
  • Yelp must have above 4 stars and 20 yearly reviews
  • Healthgrades must have over 4 stars and over 10 yearly reviews
  • ZocDoc must have over 4 stars and over 20 yearly reviews
  • They speak English and Spanish
  • Their bedside manner is top notch
  • Their office is well designed, with exceptional staff, and minimal wait times
  • They are one of the top 10 specialties to which we refer

Our team is constantly researching new doctors, looking for the 5% of doctors that meet our criteria, adding them to our referral network, engaging with them on a regular basis, and ensuring the reviews our patients leave within Sherpaa sustain our decision to include them.

We’re curating doctors to add meaning to the list of 880,000 doctors in America we all have access to on the internet or on our health insurance company’s website. Massive lists are meaningless. We’re doing all the work for you so you have access to a curated group of specialists who meet our definition of an exceptional doctor.

17

Although there is a ton of activity in healthcare right now in terms of new apps, new health data companies, new ways to purchase health insurance, etc…there are very few companies tackling the most profound part of healthcare that’s broken and ripe for disruption— the delivery of healthcare. What does it mean to “go to the doctor?” When do you need to actually see a doctor in person vs. just talk with a doctor?”

Here at Sherpaa, we’re preventing 70% of office visits from happening at all. That is a fundamentally massive change. It’s true healthcare disruption, not incremental change. It’s not an efficiency increase of 5%. It’s an acknowledgement that 70% of doctor office visits simply don’t need to happen.

So, on June 12th, I’m delighted to be on a panel with two of my fellow healthcare delivery innovators:

  • Tom Lee, the CEO of One Medical Group
  • Jason Gorevic, the CEO of TelaDoc

Although Tom, Jason, and I are reimagining the future of healthcare delivery, there are fundamental differences in the strategy and philosophy of our companies. 

Needless to say, it’s going to be a spirited discussion tackling the real issues of healthcare. I’m excited. 

It’s free, located at Softbank’s space in Flatiron on June 12th and 6:30pm, and there will be food and booze. 

Space is limited. RSVP to Saundra (Saundra_parola@softbank.com) to secure your spot. 

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My grandfather turned 94 two weeks ago. He’s been a wealth of influence in my life, but there’s one thing he’s regularly told me:
"If you sit down, you’ll never stand up."
He’s always been moving. He’s been the most active man I’ve ever known and his long life has been his reward. A new groundbreaking study just published in JAMA suggests that:

Regular exercise, including walking, significantly reduces the chance that a frail older person will become physically disabled, according to one of the largest and longest-running studies of its kind to date.
While everyone knows that exercise is a good idea, whatever your age, the hard, scientific evidence about its benefits in the old and infirm has been surprisingly limited.
“For the first time, we have directly shown that exercise can effectively lessen or prevent the development of physical disability in a population of extremely vulnerable elderly people,” said Dr. Marco Pahor, the director of the Institute on Aging at the University of Florida in Gainesville and the lead author of the study.
Countless epidemiological studies have found a strong correlation between physical activity in advanced age and a longer, healthier life. But such studies can’t prove that exercise improves older people’s health, only that healthy older people exercise.

My grandfather has always been ahead of the curve. It’s nice to see science proving his theories. It’s also interesting to note that the studies around such a logical concept are “surprisingly limited.” Actually, it’s not that surprising. In the medical world, if you can’t profit off the findings of a study, there probably isn’t good, well-funded, objective science around it. The question is interesting…who stands to profit off exercise and would they still publish the results if the findings found there was no effect?
Interesting…
 

My grandfather turned 94 two weeks ago. He’s been a wealth of influence in my life, but there’s one thing he’s regularly told me:

"If you sit down, you’ll never stand up."

He’s always been moving. He’s been the most active man I’ve ever known and his long life has been his reward. A new groundbreaking study just published in JAMA suggests that:

Regular exercise, including walking, significantly reduces the chance that a frail older person will become physically disabled, according to one of the largest and longest-running studies of its kind to date.

While everyone knows that exercise is a good idea, whatever your age, the hard, scientific evidence about its benefits in the old and infirm has been surprisingly limited.

“For the first time, we have directly shown that exercise can effectively lessen or prevent the development of physical disability in a population of extremely vulnerable elderly people,” said Dr. Marco Pahor, the director of the Institute on Aging at the University of Florida in Gainesville and the lead author of the study.

Countless epidemiological studies have found a strong correlation between physical activity in advanced age and a longer, healthier life. But such studies can’t prove that exercise improves older people’s health, only that healthy older people exercise.

My grandfather has always been ahead of the curve. It’s nice to see science proving his theories. It’s also interesting to note that the studies around such a logical concept are “surprisingly limited.” Actually, it’s not that surprising. In the medical world, if you can’t profit off the findings of a study, there probably isn’t good, well-funded, objective science around it. The question is interesting…who stands to profit off exercise and would they still publish the results if the findings found there was no effect?

Interesting…

 

10

We’re looking for a dedicated back end developer to help us improve healthcare with technology. Won’t you join us?

Who we need:

We are looking for a back end developer eager to join our small but ambitious development team and grow with us. With just two developers, we’ve built a product that is currently giving thousands of people better healthcare, but as we expand and set up shop outside of NYC, we have a lot more to build.

The core of our technology is a secure, rich, asynchronous messaging system connecting doctors and insurance specialists to our clients to solve their health and insurance problems. Our next challenge is to transition our existing system to a robust and scalable architecture capable of serving orders of magnitude more users, while building powerful new features that enable our doctors and insurance specialists to work more efficiently.

Elegance and ease of use is our priority, and we pride ourselves on bringing that to our clients.

Our next addition to the development team will need a good handle on:

  • Python

  • OO design

  • Security

  • Unix administration/server ops

  • Functional programming concepts

  • Databases (SQL and alternative)

  • Distributed systems

  • Web Architecture

Most importantly, we need a capable, skilled, and thoughtful engineer, who wants to solve large-scale problems, is confident and decisive enough to help us reach our goals, and can add your own experience and vision to our team.

Please send your resume along with a thoughtful cover letter to engineering@sherpaa.com