Tonic Health Looks to ‘Gamify’ Dull Doctor Office Forms
Fun isn’t the first thing that pops to mind when you’re asking thousands of people about their last mammogram. But Sterling Lanier is wagering that one of the dullest parts of modern healthcare, the standard patient questionnaire on a clipboard, can be made fun. It’s the organizing principle behind the startup he co-founded, Tonic Health.
“Imagine you go to a doctor’s office and instead of a clipboard, you are handed this,” says Lanier, pulling out an iPad with an open game application that looks a little like Fruit Ninja. “It says things like, ‘Welcome,’ ‘Rest Easy,’ and ‘Have Fun.’ When’s the last time someone had fun in the healthcare system?”
Tonic Health, based in Menlo Park, CA, has been testing this concept of whether healthcare can be fun for about the past 18 months. It’s borrowing principles of video gaming and consumer marketing to help healthcare organizations collect better data from patients. The idea is to create customizable patient intake forms that a patient can fill out with a few finger swipes on an iPad, instead of the usual pen and paper forms. Tonic has already made some headway by testing its software program with the Athena Breast Health Network, which is using Tonic to help screen 150,000 women in California for breast cancer risk, and follow them for decades.
The Athena Breast Health Network, directed by Laura Esserman at UCSF, is just one of the first early adopters exploring whether fun in the waiting room can translate into more thorough, more accurate patient information. The UCLA Division of Digestive Diseases has also agreed to try the Tonic system, and Lanier says he’s in talks with a number of “large enterprise health systems” on the East Coast and in the Midwest that are interested in jazzing up their data collection capabilities. The company, self-funded at the moment, has a team of 10 employees.
“People sometimes ask, are you a data collection company? No, we’re a patient engagement company,” Lanier says. “When you increase patient engagement, you increase data accuracy, and you increase the hospital’s ability to communicate with that patient.”
Lanier came to this line of work after previously founding Chatter, a market research firm that he says played a role in a number of big-budget consumer marketing campaigns, including the “Talk to Chuck” campaign for Charles Schwab. He got exposed to healthcare through some pro bono marketing work, and became intrigued with ways to spiff up this change-resistant, highly regulated, heavily lawyered industry.
Tonic looked around at the electronic medical record industry and saw plenty of competitors in various niches, and steered clear. It saw opportunity, however, in the mundane patient intake forms.
Here’s how the product is designed to work. A patient comes in, and picks up an iPad loaded with the patient intake form developed by Tonic. In the case of the Athena Breast Health Network, they are attempting to collect some in-depth family history and health information, in the form of a 700-question form that asks things like whether your mother, grandmother, or aunt had breast cancer. The sheer number of questions that Esserman’s team wanted answered—700!—got Lanier’s attention.
The Athena network “had thought a lot about the back end, they had implemented salesforce.com and had a fancy database. But on the front end, they just had a boring paper questionnaire.” That was the part that got Lanier fired up, with an attempt to beat pen and paper.
So the IT challenge was set—create a 700-patient questionnaire that all these women would want to fill out, thoroughly and accurately. Eighteen months later, the company has a system that can toggle easily between English and Spanish, pairs graphics with text, and transmits the patient’s data wirelessly to a secured hard drive at the clinic, Lanier says. The program is compliant with the Health Insurance Portability and Accountability Act (HIPAA) rules, and has passed usability tests among low-education, low-income people who have never used an iPad before, Lanier says. The iPad-based system has shown clear advantages over the iPhone, because for some reason, people appear to get tired after answering just a few questions on the small screen, but they are comfortable going for longer periods of time on the tablet.
The business plan is built on a pretty straightforward software-as-a-service model, Lanier says. Customers have to buy the hardware themselves (and iPads are more expensive than clipboards and paper), and once they do that, they spend at least $5,000 for an annual license to the Tonic system, or much more, based on the volume of patients who use the program. The Tonic system should pay for itself not just by saving on costly data errors, but also by enabling patient satisfaction surveys that people will actually fill out, Lanier says. For example, in keeping with the simple/playful philosophy, Tonic enables patients to rate a doctor’s bedside manner as either like a teddy bear, or a bull.
In Lanier’s world, even the most mundane tasks that nobody thinks much about can be made fun. Tonic sought to do that with the screen at the end of the questionnaire, when it’s time to remind the patient to bring the iPad back to the nurses’ station, as opposed to getting any funny ideas about taking it home with them. “We’ll have people drag the iPad through a maze to bring it back to the nurses’ station. It says the same thing as ‘please return your iPad,’ but puts it in a friendly context. It makes people smile. When was the last time you saw a smile in healthcare?” Lanier says.
There are other electronic medical record (EMR) companies that are seeking to integrate patient-intake forms with database software, like Mountain View, CA-based Drchrono. Tonic insists that the back-end EMR software market is well-served, and it only wants to help collect the data, not manage it with software on the back end. “We’re not trying to be an EMR. Tonic is the pixie dust you sprinkle on your EMR,” Lanier says.
Compatibility with other software is always a challenge in health IT, where hospitals tend to run dozens of different proprietary programs that don’t usually work well together. When I asked if patients could fill out a Tonic form just once, and not have to bother filling out the same information over and over, Lanier said that’s the goal, but it will depend on achieving critical mass. If a patient from San Francisco enters data on the Tonic system at UCSF, and then gets in a car accident in Palo Alto and gets treated at Stanford University Medical Center, the intent is you wouldn’t have to enter the same information twice, “assuming all the hospitals are Tonic-enabled,” Lanier says.
The company is still very much in startup mode, seeking to win over a lot more hospitals than the original five UC campuses it has gotten started with. But Lanier is encouraged by what he’s seen from the early usability tests. Pediatrics departments have shown interest, suggesting that the Tonic programs are easy enough for kids to use, as well as adults. If Tonic can persuade enough hospitals that its program is worth the cost, it could change the way people think about their time in a hospital waiting room. “What we are ultimately trying to do is revolutionize the way data is used in healthcare,” Lanier says.
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