Sunday, February 5, 2012

On HealthTap, Advice for You and Points for Doctors -

EVERY sphere of life, it seems, can be turned into a game — including the way physicians offer medical advice and build a public reputation. HealthTap, a start-up based in Palo Alto, Calif., has brought the vocabulary and mechanics of games to medicine.

At the company's Web site, users post questions and doctors post brief answers. The service is free, and the doctors aren't paid. Instead, they engage in gamelike competitions, earning points and climbing numbered levels. They can also receive nonmonetary awards — many of them whimsically named, like the "It's Not Brain Surgery" prize, earned for answering 21 questions at the site.

Fellow physicians can show that they concur with the advice offered by clicking "Agree," and users can show their appreciation with a "Thank" button. These clicks bring recognition to the contributors, too. Receiving 25 thanks gives a doctor a "Doogie Howser Award"; for 50, it's a "Dr. Heathcliff Huxtable Award."

Here's an example of a question on HealthTap: "What does it mean when ur right side of ur body goes num?" The top-rated answer last week was as follows: "Stroke is likely. If that occurs at any time, anywhere, immediate emergency room evaluation should be done and the person should get there by ambulance. The earlier the intervention the better the result." Five other doctors agreed.

By participating, doctors who want to attract new patients have a chance to gain visibility. When searching for answers to a particular question, users can add a geographic filter, narrowing the search to doctors who are nearby. But doctors who already have busy practices and can't accept new patients are less likely to be interested in participating on the site.

HealthTap started its Web site last May. It says that it has signed up more than 9,000 physicians and that it is adding 100 a day. The site does not carry advertising, and the company declines to comment about how it plans to generate revenue.

Aside from the badgelike awards, the site offers some social network features. Users can follow particular doctors and topics of interest; new answers related to these are displayed in an "activity feed" shown when users log on to the site.

"Twitter, Facebook, Quora and Zynga have invented social and game mechanics for broad markets," says Tim Chang, a managing director at the Mayfield Fund, one of HealthTap's venture capital backers. "If you can take the best of those mechanics and apply them to a single vertical, that can be very powerful."

The site offers a peer-based reputation system of its own devising. Next to each answer, users see the number of doctors who agree; with a click, they can see who the approving doctors are, as well as something that HealthTap calls a "reputation level," which is built by accumulating HealthTap awards, "Agrees" from fellow physicians and other measurable activities at the site.

Neither the doctors' specialties nor the levels are displayed next to doctors' answers, but by clicking, the curious user can see that one answer was submitted, say, by a psychiatrist listed as "Level 7 Leading" and a dissenting one from an internist who had reached "Level 14 Distinguished."

Ron Gutman, the chief executive of HealthTap, says this of its system: "In academic or big hospitals, a physician's reputation is known only to fellow physicians. At HealthTap, professional reputation is transparent to patients as well as to peers."

But patients have long been able to check on one part of their doctors' background: whether they are board-certified. That certification, administered by physician peers, requires continuing education after one collects a medical degree and license and passes a famously difficult board exam. The American Board of Medical Specialties works with 24 member boards, covering internal medicine, family medicine and specialties. It offers a Web page that makes it easy for patients to learn a particular physician's certification status.

HealthTap requires only that its physicians be licensed in the United States and in good standing — that is, not accused of malfeasance. Lamentably, it does not use board certification to establish a floor for qualifications required for physicians to participate. The company says it does not require board certification because this "is not required in the U.S. to see and care for patients."

Another worrisome aspect is the breeziness of HealthTap's answers, which are limited to 400 characters, a length hardly well-suited for providing nuanced answers to some medical questions.

A disclaimer at the foot of every page says that the site "does not provide medical advice, diagnosis or treatment."

DR. PETER W. CARMEL, president of the American Medical Association, says he is concerned about the use of online medical information, which should "complement, not replace, the communication between a patient and their physician," he wrote in an e-mail.

With online health information sites, "a medical history is not taken, a physical exam does not occur and any suggested treatment is not monitored or assessed," he said. "Using this information in isolation could pose a threat to patients."

In response, Mr. Gutman said, "We respect the A.M.A. and would welcome collaboration with them and any other forward-thinking medical organizations looking to improve the quality of care."

Many doctors just out of medical school, like other people in their 20s, are accustomed to texting as a primary mode of communication, so they may embrace HealthTap's exchange of bare-bones information. But other physicians may find the context-free, short-question, short-answer approach problematic. The Doogie Howser Award will go to others.