One Doc's Prescription For Hassle-Free Healthcare

Dr. Jay Parkinson envisions a future of more efficient, hassle-free healthcare—and it starts online. He says he and his colleagues at the New York City-based healthcare start-up Sherpaa can solve 70 percent of patients' problems via email, eliminating a trip to the doctor's office.

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IRA FLATOW, HOST:

This is SCIENCE FRIDAY. I'm Ira Flatow. Now, picture this. You get sick, and you've got a horrible sore throat so painful you can only drink ice water and eat mango sorbet. Call your doctor to make an appointment. It's after hours, so you're on hold for 10 minutes.

And finally you make it through to a scheduler, but he says it looks like your doctor doesn't accept your new insurance plan. Better check with your insurance company and call back. OK, 20 minutes later, you call back the scheduler, and yes, the doctor takes your insurance, but you're on hold again. Please, make an appointment for tomorrow.

Then, at last you go in. You fill out seven pages of forms. You sit there for half an hour before seeing a nurse. And finally, you get to see the doctor, and now you're off to the pharmacy to wait once again for your antibiotics. Sound familiar? Well, I'm not making this up. This actually happened to one of our producers here on SCIENCE FRIDAY, and it got us wondering: Shouldn't there be an easier way?

I mean, you are sick, after all. Wouldn't a little less hassle be nice? How about health care without the headache? And maybe you can save some money along the way. Well, my next guest, a doctor and perhaps a social engineer, has been thinking about how to do that, and he has a vision for the future of health care, easier for doctors, easier for patients and saves time and money.

Sound too good to be true? Well, what do you think? Our number is 1-800-989-8255, 1-800-989-TALK. You can also tweet us @scifri, @-S-C-I-F-R-I. Dr. Jay Parkinson is the CEO and co-founder of the health care startup Sherpaa, that's S-H-E-R-P-A-A, and he's based here in Brooklyn, New York, in our New York studios. Welcome to SCIENCE FRIDAY.

JAY PARKINSON: Thank you.

FLATOW: Tell us what Sherpaa is and how you got started in all of it.

PARKINSON: Well, Sherpaa is just trying to make health care more affordable and more accessible. So it's 24/7 email and phone access to a group of doctors. And 70 percent of the time, we solve the problem over the phone or the Internet. And the other 30 percent of the time, we have a group of about 100 handpicked specialists here in New York that we think are great. They're mission-driven, they have wonderful personalities. And we'll just connect you with the perfect doctor to solve your problem.

FLATOW: So you have a team of doctors, a what, 100 doctors, of - all different kinds of doctors?

PARKINSON: There's about 100 doctors, yes, here in New York. And they're just doctors...

FLATOW: So I call up, and I call a number, and I say I have - let's go through this case. I have a sore throat. And your doctor says...

PARKINSON: Well, we just gather a history, and, you know, we'll determine: Is this something that's just a viral infection, or is this something that needs further analysis? And if it needs further analysis, we'll refer you to who you need to go see, and we'll make an appointment for you.

FLATOW: And you'll get right in.

PARKINSON: You'll get right in.

FLATOW: And if I need medicine, the doctor will prescribe that?

PARKINSON: If the situation warrants that, absolutely.

FLATOW: Can I - can you take care of me without seeing me, totally over the phone?

PARKINSON: Absolutely. The estimate's about 70 percent of all office visits are unnecessary with - if you just have good communication. But the issue is doctors get paid to see you in the office. They don't get paid to communicate with you.

FLATOW: Do you make house calls?

PARKINSON: We don't make house calls yet, but we would absolutely love to work with a doctor who would be willing to go to the offices and the homes of our clients. Definitely.

FLATOW: Isn't there a danger that by never seeing a patient or doing lab tests, that you might prescribe the wrong antibiotic or misdiagnose the patient?

PARKINSON: We have a pretty low threshold. So if there's any doubt whatsoever, it's absolutely, you know, it's an in-person visit.

FLATOW: Now, share with me, share with our audience the story you told a large group of people about your practice, especially about a case of appendicitis. That was very interesting.

PARKINSON: Sure. The reason why Sherpaa started was because I got an email from a friend of a friend. He described classic appendicitis. And we - and I looked at it, and I fired that email off to our surgeon that we work with. And Dr. Goldstein said: Send him right over.

So I sent the gentleman over. Dr. Goldstein examined him, thought it was appendicitis, too, and sent him on to his outpatient surgical center, where they did a CAT scan and diagnosed appendicitis. And about an hour later, Dr. Goldstein was over there laparoscopically removing this gentleman's appendix, and three hours later, sent him home with oral antibiotics. And all within the space of about six hours, he contacted me and was home minus an appendix.

FLATOW: In six hours.

PARKINSON: Without stepping foot in the ER or the hospital.

FLATOW: How did you do that?

PARKINSON: Well, you just - I have a network. I have connections. I can arrange things very easily. It's doctor-to-doctor communication.

FLATOW: And how much money did you save?

PARKINSON: In this case, we saved about $60,000.

FLATOW: Six-O. How do you break that down? Where would that money savings come from?

PARKINSON: Well, if you get just a basic procedure done like, you know, an appendectomy, in a large institution, the majority of that fee goes toward the overhead of that hospital. If you do it in an outpatient surgical center, where that's what they do all day, every day, and they do these things very routinely, the price is much, much lower.

FLATOW: And did the insurance company - were they involved in this, too?

PARKINSON: They were not, but I'm sure they were extremely happy.

(LAUGHTER)

FLATOW: Did the patient have to pay anything out of his own pocket?

PARKINSON: Not at all. It was covered.

FLATOW: It was all covered?

PARKINSON: Absolutely. They had insurance.

FLATOW: You saved the insurance company $60,000?

PARKINSON: Yeah. Not too bad.

FLATOW: Why aren't they banging your door now, saying why can't you do this with everybody, or more patients?

PARKINSON: Oh, we're just getting started.

FLATOW: Do you think - so you're only now located in New York City.

PARKINSON: Absolutely.

FLATOW: Or is the whole tri-state area, or just New York?

PARKINSON: No, it's just New York, just really concentrated in New York City right now.

FLATOW: Mm-hmm. And don't you have to have regular insurance in addition to your service?

PARKINSON: Absolutely, yes. Typically, it's a high-deductible plan, and we typically - our contracts are actually with employers. So we actually go in and look at their health spend, which is about 10 to $15,000 per employee, per year. And we typically get them plans that cost, you know, 30 to 40 percent less and encourage the company to actually give each employee a debit card full of the deductible. And whatever those employees don't spend at the end of the year goes back into the company.

So at the end of the year, they're saving about 20 percent on health care costs, plus they have a doctor they can call whenever they want.

FLATOW: And can you expand this out? Could something like this go nationally?

PARKINSON: Absolutely. I mean, this is just redesigning the process of how you interact with the health care system. And if 50 to 70 percent of all ER visits are unnecessary, you know, it's just we have to use health care resources more intelligently.

FLATOW: How did you - why and how - why did you decide to do this? You were - you graduate medical school, you came out of Johns Hopkins.

PARKINSON: Yes.

FLATOW: You must have been in debt up to your teeth, right?

PARKINSON: I was about $280,000 in debt from medical school, yes.

(LAUGHTER)

FLATOW: So tell me, take me down the road of how you arrived at doing this.

PARKINSON: Well, you know, I just learned in residency that everything is a process, and if you don't design a process, it's going to design itself. And the most important thing is that the patient, in health care, really doesn't come first. And I thought: Well, what if we could design a process where the patient is first?

And I looked at - I mapped it all out. You know, I created about 100 steps. And then I said, OK. Is this step vital? Can we Internet-ize this step, for example. Can we just get rid of this step? And I just came up with a really elegant process that I think worked. So I started my own practice that mimicked that process.

FLATOW: Can people take cell phone images of what's wrong with them and email them to you?

PARKINSON: Absolutely.

FLATOW: Do they do that sort of thing?

PARKINSON: All the time. I mean, it's wonderful. If you have a new rash, if you have, you know, some weird, you know, mole or something like that, you know, we'll fire that off to our dermatologist that we work with. And that dermatologist will say, yes, I need to examine you for this mole, or no, you're fine.

FLATOW: What about the people who will say, you know, you're missing the human contact with the patients?

PARKINSON: That's interesting. I mean, to me, sometimes human contact is necessary. And sometimes it's just good, old-fashioned communication via the Internet.

FLATOW: What about having annual checkups?

PARKINSON: That's great, too. We definitely encourage that with your primary care doctor.

FLATOW: 1-800-989-8255. A quick call before the break: Steven in Hollister, California. Hi, Steven.

STEVEN: Hi. They have something similar with Veteran Affairs here in California through the San Francisco and Palo Alto VA hospitals.

FLATOW: Are you familiar with that?

PARKINSON: I'm not familiar, but it absolutely makes sense. I think the military health care system in America is one of the only systems in the world that runs as efficiently as can be because, you know, they want to get those people back out working as quickly as possible. So they're going to do whatever they need to do to take care of their covered lives.

FLATOW: And how could you expand this? I mean, are you looking for other doctors in other states to get attention to...

PARKINSON: Absolutely. I mean, I think this works in any major metropolitan area, even rural places. We don't need a ton of doctors in each city to make this work, but we are absolutely looking for doctors probably in the next year in California and Boston, D.C., other major metropolitan areas.

FLATOW: Let me get a quick phone call in here from Sharon in Portland, Oregon. Hi, Sharon.

SHARON: Hi. Thanks for taking the call. I'm an emergency physician practicing in Portland, and I'm president of our state college of emergency physicians here. And I want to commend your guest for a wonderful idea that I hope does thrive as we move forward with all sorts of health care reform.

I did also want to note that there is a myth out there about emergency department utilization. And your guest mentioned that 50 to 70 percent of emergency department visits are unnecessary, and I did want to correct that, because it's a huge misconception that's out there.

There's a recent CDC study that states that only 8 percent of emergency department visits are actually unnecessary, meaning they don't need to be seen, the patients don't need to be seen within the next 24 hours. I think we need to work on our system of preventive medicine so that people don't get to the situation where there are emergencies. But right now, the vast majority of people seen in the emergency rooms, those are necessary visits. So I don't want to - but I just wanted to point that out.

FLATOW: Thank you, Sharon.

PARKINSON: Yeah, I fully agree. But I think accessibility is the best prevention, and if you can just guide people to the proper resources - that might be an emergency room, that might be an urgent care center, that could be, you know, just simple communication via the Internet with a trusted doctor.

FLATOW: Well, good luck to you.

PARKINSON: Thank you.

FLATOW: And we'll be looking forward to see how you work out, and maybe you'll get some attention after - expand this network out.

PARKINSON: Sounds wonderful. Thank you.

FLATOW: Thanks a lot. Jay Parkinson is the CEO and co-founder of the health care startup Sherpaa. That's with two A's, S-H-E-R-P-A-A. That's based in Brooklyn.

We're going to take a break, and after the break, ready for a summer getaway? The author of the new book, "Visit Sunny Chernobyl" - yeah, sunny Chernobyl, not Philadelphia - joins us to talk with - talk about traveling in the world's most polluted - want to visit the world's most polluted places? He's got a whole list of them. You can set your itinerary after this break. Stay with us.

(SOUNDBITE OF MUSIC)

FLATOW: I'm Ira Flatow. This is SCIENCE FRIDAY, from NPR.

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