A conversation with the co-founder of Hello Health.

Question: Describe therngenesis of the idea for Hello Health.

Jay Parkinson: When I finished residency at Hopkins, I really didn't know what I wasrnplanning on doing with my life. rnBut I knew that there were a ton of my friends who were photographers,rnlike myself, who didn't really have any sort of connection to the healthcarernsystem.  So they would always sendrnme an email or an IM chat with some photo of some rash or something like thatrnthey they'd be like, "What's wrong with me?"  And being the nice friend that I was, Irnwould reply with some advice, or you should just see the doctor or hang tightrnyou'll be fine.  But then I justrnthought if I could do that for my friends, I think I could do that for myrnneighborhood.  So, that's whatrnreally gave me the idea.  Justrnknowing that we are all sort of communicating differently as a culture now,rnespecially millennials and Gen Xer's, I just figured why not tailor a practicernin Waynesburg Brooklyn that makes internet communication with house calls andrnPayPal?

Question: How did yournexecute on that idea?

Jay Parkinson: I just designed my own website that had a different promise.  And that promise was I'm a new kind ofrndoctor.  You can communicate withrnme the way you communicate with your friends.  And that to me was just sort of the beginning of everything,rnand it just had a little button that said "Make an Appointment," andrnthat would bring up my Goggle Calendar where you could input your symptoms andrnyour address and that would send an alert to my iPhone and I would go do arnhouse call and they would pay me via PayPal.  But it was great because I could charge anywhere from $100rnto $200 a visit, which is less than most office visits in New York, and do fivernor six a day and make a very comfortable living because my overhead was nothingrnbecause I worked out of my apartment and didn't have an office or staff.  It was really about simplifying things.rn Simplifying my life and that ledrnto simplifying my patient's lives. rnSo, to me, healthcare should be simplified down to its bare essencernbecause 90 percent of us are sort of light users of healthcare in America.  So why can't we just make it simplernagain?

Question: What is HellornHealth?

Jay Parkinson: In the very beginning, you create a profile and you search for a doctorrnin your neighborhood, and you like a doctor, so you add him to your team.  When you add a doctor to your team,rnthey can read and write to your medical records.  They are all encompassed within HelloHouse.com and yourrnprofile.  So, once you add a doctorrnto your team, you can make an appointment with them and it's all sort of likernrenting a zip car, it's a really nice interface to just sort of make anrnappointment with your doctor, and you meet up with that doctor in his or herrnoffice and the doctor's got total freedom to set how much time they spend withrnyou.  So, they may only need a halfrnhour or so, or an hour.  But it'srnreally about just establishing a relationship and maintaining arnrelationship.  Because once you'vernseen the doctor in person that opens up a whole new world of communicationrntools; so you can email or you can video chat, you can IM with yourrndoctor.  But your doctor has to getrnpaid for communications, so he or she charges an hourly rate forrncommunicating.  So, if it takesrnyour doctor 15 minutes to reply to an email, that's a quarter of an hour.  It's up to the doctor to have arnmembership fee if they want.  But Irndon't know if that's the future.  Irnthink it's just pay as you go. 

It just changes the wayrndoctors are paid.  Doctors rightrnnow are paid for office visits and procedures and that encourages them to do asrnmuch as they can.  If you pay themrnan hourly rate that they set, it changes how they practice medicine 

Question: How does thernrelationship evolve between doctor and patient? 

Jay Parkinson: Right now the evidence says that about 50 percent of all doctor visitsrnare unnecessary.  But they only getrnpaid to bring you into the office, so that's what they do.  So, if you don't have that incentive,rnthat means 50 percent of problems can be taken care of without physicallyrnseeing you, but augmented with good communication.  So, it actually depends 100 percent on the doctor and thernpatient.  There are some doctorsrnthat are very, they just want to see you all the time and some doctors are sortrnof, you know, if they know you and know you're a great capable person that canrntake care of themselves; they might tend to do more over the internet than inrntheir office.  So, it's really arndifficult question to answer because we don't know.  It's very patient and doctor dependent. 

Question: Are house callsrnmore effective than office visits?

Jay Parkinson: I think that it depends on the situation, absolutely.  But, yes.  If you can see a person's life and see where they live andrnhow they interact and see what's in their refrigerator, see if there's Twinkiesrnon the counter.  You can say, wellrnhey, I don't know if you're really living the best sort of lifestyle forrnyou.  However, at the same time, itrndoesn't really -- most people know that they aren't living the best lifestylernif they aren't living the best lifestyle. rnDoctor's aren't really trained to encourage you to change your behavior,rnwe're trained from day one to write prescriptions and do procedures.  We're absolutely horrible to get you tornchange your lifestyle.  So, Irnactually think that doctors shouldn't be involved in lifestyle changes. For thernpast hundred years, our training is fully focused on making a profit off ofrnsickness.  Which is wrong.  So, I think a whole new professionrnneeds to come in and start making a profit off wellness and keeping you out ofrnthe sickness industry.  The bestrnway to do that is through most likely just careful listening and carefulrnunderstanding of the client to understand whether or not they can changerncertain aspects of their lifestyle. 

House calls are probably arngood situation for that profession, but for doctors, I mean, their time is justrntoo expensive to be traveling all over a city.  It's probably not the best use of resources. 

Question: Does giving outrnyour cell phone compromise the traditional doctor / patient relationship?

Jay Parkinson: Whenever you give patients a number and there's a real person on thernother end that's they're doctor, they're not going to call you at 2:00 in thernmorning unless there's really something wrong.  If they get a 1-800 number to some faceless person, they'll callrnat 2:00 in the morning because they just don't care.  But yeah, so the deal is, I think that increasingrnaccessibility in the doctor patient relationship actually minimizes poorrncommunication because I think there's a certain respect that people have forrnone another. 

Now, that's not saying thatrnthere are a few patients, every doctor has a few patients in every practicernthat are just sort of over the top in terms of communication.  And yeah, that's when it gets sort ofrndifficult.  But at the same time,rnthere's ways to handle that.

Question: What are some ofrnthe shortcomings of our current health care system? 

Jay Parkinson: I think the main shortcoming is that patients aren't the customers ofrnhealthcare.  Customers are peoplernwho purchase or buy goods or services. rnAnd as patients, we just sort of turned that duty over to insurancerncompanies.  To sign contracts withrnlarge groups of hospitals or doctors and all of a sudden you've sort ofrnrelinquished control of customer status. rnAnd when you do that, you're not really treated like a customer.  You're not really treated like thernApple store treats you whenever they're trying to take care of your computerrnwhen it breaks.  And that's sort ofrnwhat healthcare has become, a sort of faceless institution that really isn'trnfocused on the patient's needs, you know like satisfaction.  

Question: Are there anyrncountries getting it right in terms of health care? 

Jay Parkinson: There's countries like Norway. rnThe deal is, Norway has 4.8 million people and Kaiser in Californiarncovers about 10 million people. rnSo, you can't really say are there any countries doing it correctlyrnbecause that's like apples and oranges. rnAre there systems in the United States that are doing it properly?  Absolutely.  Kaiser, Geisinger, Inter Mountain, Bassett in Up State NewrnYork.   Absolutely.  Those guys are just really, reallyrnnarrowing the proper delivery and payment for healthcare. 

Question: What are yourrnviews on universal health care?

Jay Parkinson: I think it's a bad policy given the current situation of paying forrnsickness because the sicker a population gets the more expensive it's going tornget.  The older a population gets,rnthe more expensive it's going to get. rnSo, in the widget that we sort of live and die by in healthcare isrnsickness, it's designed to skyrocket out of control.  So, the business model of healthcare delivery has to changernbefore we institute everybody -- you know mandating everybody paying into arnsystem that's designed to not do what's best for you, it's designed to do whatrnmaximizes their profitability.

Question: Would a shift tornelectronic medical records help the situation?

Jay Parkinson: Theoretically, a shift to electronic medical records would helprnsignificantly; however, electronic medical records don't solve the problemsrnthat doctors face.  They'rerndesigned for insurance billing as well as protecting them legally fromrnlawsuits.  So, they're designed tornproduce as much information about an interaction as possible and data is oftenrnirrelevant to actual clinical care, to the case at hand, because the lastrnvisit, it might have been a one minute visit, but it's five pages worth ofrnnotes that are just designed to protect your butt. 

So, the interfaces arerndesigned like Windows 95, these things were built 15 years ago, these legacyrnsystems.  They are built in likernthe Windows 95 era.  They're siloedrnpieces of bad technology.  So, I dornnot support current electronic medical records being mandated across the UnitedrnStates because I think the electronic medical record industry needs to berndisrupted with today's technology.  

Obama has appropriated aboutrn$20 billion to get doctors to use electronic medical records.  How much would it cost to Facebook ifrnit were designed to power medicine to sign up all 11 million healthcare workersrnin America?  It surely wouldn'trncost $20 billion.  It wouldrnactually cost significantly less because the building technology today that isrnflexible enough and platform-like, like Facebook for healthcare, wouldrnabsolutely be the proper way to go. rnBut the deal is, as in everything, the money and the corporate interestsrncontrol the welfare of our country, so it's a real problem.

Question: Would Hello Healthrnencourage more doctors to go into primary care?

Jay Parkinson: I think a system like Hello Health could definitely encourage morernpeople to go into primary care, absolutely.  However, for the past at least 10 years, about 5 percent ofrnthe doctors have been going into primary care.  Most high performing healthcare systems in the world havernabout 75 percent primary care doctors and 25 percent specialists.  In America, we're about exactlyrnopposite.  We have 75 percentrnspecialists.  And we're about tworngenerations behind the curve on this one. rnSo, once Boomers retire or die, primary care is sort of dead with them,rnwhich is unfortunate because that's what sort of controls your experience andrnyour health.  That's the person yournshould be able to depend on.  Butrnright now, specialists are making double, triple, quadruple, as much as primaryrncare doctors, and seeing half as many patients.  So, what's the incentive for doctors to go into primaryrncare?  There's not much.  A system like Hello Health thatrnencourages and pays primary care doctors for communication and pays them more onrnpar with specialists would absolutely work. 

But there are other issuesrnwhere the medical institutions devalue the art and talent of primary care inrnexchange for the big bag neurosurgeon and the respect they get. 

Question: What would be thernimplications of the death of primary care in the U.S.?

Jay Parkinson: I don't know, that's going to be really interesting.  I mean, that's the kind of stuff I'mrnsort of thinking about right now. rnWhat I think is most interesting about the death of primary care and thernrise of the Internet as well, when you think about it, the Internet connectingrnme with information and connecting me with patients is actually doing somethingrnreally interesting to the practice of medicine.  You spend about one hour a year with doctors, and aboutrn8,765 without doctors.  So, whatrndoes that mean to your life?  Well,rndoctors aren't the cure all for your health, I mean, you are.  Right.  So, I mean, you’re sort of like the CEO of your body andrnyour doctor is a sort of consultant that you call on every once in a while,rnright? 

So, that basically meansrnthere are a ton of tools that are just now springing up that connect us withrngood information, that relevant to you as well as connect us with otherrnpatients that are having similar problems as you.  So, I hope that the Internet can prevent office visits,rnespecially primary care visits. rnAnd help people take care of themselves better. 

There's tools now, you canrnconnect with doctors via video chat. rnI think those tools have serious issues though because nobody reallyrnuses video chat with strangers. rnAnd who are the doctors who are on video chat?  Why aren't they seeing patients in their office?  You know?  But I think that there are opportunities to build systemsrnlike this. 

The issue is, how do you,rnwhen people need a prescription maybe, for say, antibiotics, that can't reallyrnbe done over the Internet with today's sort of laws and regulations.

Question: Why aren't ourrnmethods of developing drugs more advanced?

Jay Parkinson:  The methods of developingrndrugs are sort of set up so that you try to control for a similar group ofrnpeople and you give them a similar pill. rnBut the deal is, we don't know anything about their genetics.  So, maybe they have these certainrnenzymes in their body that like really turn this drug over and turn it into thernactive metabolite for example that helps you, or maybe you're a bad metabolizerrnand it builds up in your liver and causes problems. 

The deal is, thernpharmaceutical companies would rather have their market not limited by 66rnpercent, they would just like to sort of create a drug for everybody, throw itrnout to the masses, and if it improves symptoms by 5 percent, well it's a drug,rnand it's done it's job.  But inrnactuality, whenever you look at it across the population, there's a significantrnamount of people that are harmed by that drug.  The FDA tries to eliminate that as much as possible, but itrndoesn't always work. 

Question: Should we still berntaking drugs?

Jay Parkinson: I think that there are certain drugs that we should not be taking,rnabsolutely.  In 2009, the FDArnapproved only 26 drugs.  Seventyrnpercent of those were the Me2 drugs, drugs that were going off patent, andrnneeded to be remarketed as the next "Purple Pill" for example.  In order to create a $400 a monthrnblockbuster drug in exchange for a $4.00 a month generic.  I think that is a very, very, veryrnshady practice and it's harming our health in exchange for creating a wholernindustry of profitability of selling snake oil and marketing gimmicks.

Recorded on March 9, 2010