How The Game Of 20 Questions Inspired The Tech To Help Doctors Digitally Triage Patients

Many U.S. parents are working overtime this summer to try to get their kids off the couch and out from behind their video games for fear that spending too much time navigating virtual worlds will come at the expense of learning how to navigate the real one.

But those fears might just end up being misguided. As Infermedica Co-Founder and CEO Piotr Orzechowski told Karen Webster, had it not been for gaming, he never would have founded his firm — or set out on a quest to innovate healthcare using artificial intelligence (AI) and application programming interfaces (APIs) to create a “virtual GP,” or general practitioner.

Prior to his work in medtech entrepreneurship, Orzechowski was a mobile games developer and avid player — including more than a passing fascination with the online version of the game of 20 questions. One evening while playing with a friend, who also happened to be a doctor, it struck him that what made the game unique was the AI integration that made the game better and better after every online interaction with a player.

They wondered if they could use the same basic structure and logic to come up with a competitor for what they jokingly referred to “Dr. Google” — the initial instinct that everyone with any medical symptom has to try to troubleshoot what might be wrong.

“We figured out that maybe we could create something similar, but instead of guessing at random questions, people could input symptoms and answer the game’s questions,” Orzechowski said. “And by the end of the session, they would be able to look at the possible causes of the symptoms bothering them and be directed to where they should go next. Basically, we wanted a much better version of Dr. Google — more personalized, but interactive and engaging.”

Inspired by Google and the mobile game, they built their first prototype back in 2012 and Infermedica was born. The firm has since grown a lot — and expanded its ambitions considerably. Today, Infermedica is a very useful triage tool when it comes to working with patients, Orzechowski said.

“Our vision for the development and evolution of Infermedica is actually pretty broad,” he said. “I would say that what we want to build in the next five to 10 years is a model for a virtual GP.”

But the company isn’t trying to replace doctors. On the contrary, it’s trying to build doctors a “digital best friend” of the future and make better medical care available to more patients worldwide, Orzechowski said.

Recreating Triage Digitally

The Infermedica service was originally designed to be B2C, but the company quickly discovered a problem with that model. While the service was meant for patients, appealing directly to consumers wasn’t a workable financial model because there was no good way to monetize it.

The offering might be more accurate than either Google or WebMD, but consumers weren’t willing to pay for the high level of accuracy, Orzechowski said. Thus, the company made its first big pivot, from B2C and toward B2B — or, more accurately, B2B2C.

What he said he realized over time was that building a B2C service could be monetized by making it a B2B product. Today, Orzechowski said that the company white-labels its technology for various partners at health systems, health insurance companies and hospital systems. Those entities, in turn, integrate into their digital portals to help their patients make better decisions about their symptoms.

The service is delivered via APIs that can be embedded — according to partners’ needs — into their patient portals, into electronic health records, into their mobile apps, etc. The point is to be able to hand partners an API for symptom checking and patient triage so that clients can integrate it with anything they have in a way that will be the most useful.

Infermedica designed the app to recognize more than 680 conditions that tend to come up in primary care contexts: tension headaches, food poisoning, nutrition problems, the common cold, etc. The app can also handle some serious conditions like cancer and heart disease.

“We don’t go into very rare genetic disorders because you simply cannot do that with just a subjective interview over the internet,” Orzechowski said.

But with conditions that are relatively common, the app correctly diagnoses a patient’s condition and routes the person to the right care point 93 percent of the time. That might mean sending a patient to the emergency room, but it also might mean steering a patient away from one in favor of a telemedicine appointment or a regular visit with a human GP.

In any case, the care provider saves time on screening the patient, and the patient has much greater odds of starting his or her medical journey in the right place with the right provider instead of simply defaulting to the ER.

Building Beyond Triage

But triage is only the starting point — literally the entrance area of most treatment processes.

Orzechowski told Webster that there’s a lot more to the medical care process that just triage. He said Infermedica is busily engaged in thinking about what else it can help with — “for example, navigating additional lab work, or writing prescriptions, or verifying sick leave or referring a patient to a specialist. There is a whole range of different capabilities that we need to develop.”

But Orzechowski added that Infermedica needs data to build such applications, which is why it’s so beneficial for the company to work with medical organizations. Not only does that give Infermedica exposure to patients, but the company can also work with physicians who can provide crucial information as well.

He said that’s how Infermedica can start building a feedback loop that will eventually help the company reach its goal of an FDA-approved chatbot. That will help Infermedica collect data from different places and use the information to begin offering automated treatment plans for some basic conditions.

But that will take time. Orzechowski said a virtual physician’s assistant capable of guiding care is more than a decade away.

However, Infermedica sees it coming — as it partners with Microsoft on COVID-19 tracking efforts or builds capabilities into the various voice-AIs on the market. The Microsoft partnership, he noted, is particularly critical to Infermedica’s efforts to grow and scale simply by nature of the incredible access to healthcare organizations round the world they offer.

“It’s not only that we do sales directly,” he said. “It would be very hard, especially being more of a small Polish company, but we have strong partners like Microsoft. Especially in [these] times of COVID-19, they have really created a lot of connections with health organizations because they have this COVID-19 checking module. If you think about different apps and chatbots that a health system can use, we are not building the whole chatbot. If this were a pizza, we’re not making the pie. We’re just providing the best mozzarella, which is our AI.”

Noting that half of the world’s population has never even seen a doctor, Orzechowski said that “something like this is very much what the world needs. But of course, it will not be an easy task.”