Lifecom Successfully Completes First Clinical Trials with OHSU: An Interview with CEO Jim Moon

By Ed Carroll, Agilis Solutions

“Healthcare is at a crossroads. There is currently such an immense volume of knowledge relating to wellness, illness, disease, and clinical management that it is now impossible for any one provider to bring it all to bear in the service of the individual patient. And the gap between what one provider knows and what can be known is growing exponentially. The result is an ever widening knowledge gap that produces less-than-optimal care for many patients. Challenged to keep abreast of this explosive growth in knowledge, physicians have even less time to provide comfort to their patients. The result is professional dissatisfaction and loss of patient confidence in the healthcare system. At the same time, costs are rising as more and more people are unable to afford health coverage. We are also facing grave time and content challenges in training our next generation of physicians. Assaulted on all fronts, we have reached the limits of what our traditional healthcare model can accomplish.” S. Datena, M.D. (http://www.lifecomhealth.com)

The following interview with Jim Moon of Lifecom, Inc., took place in May 2007.

Ed Carroll: What can you tell me about Lifecom that makes it important to the community at large?
Jim Moon: Lifecom emerged from the anxiety of its founder, Dr. Stephen Jay Datena, M.D.. Steve understands that the point of diagnosis is the critical point in patient care; a bad diagnosis can result in the wrong care or worse happening. Steve observed the problem that all doctors have in keeping all of the various symptoms and solutions for any situation in the doctor’s head (see the book “How Doctors Think, by Jerome Groopman”).

Being able to combine the doctor, the typical physician office workflow, and an automatic second opinion in light of a given patient’s history and present condition—that is our goal. The result will be better healthcare, at lower cost and with earlier diagnosis and treatment.

There is published evidence that states that if diabetes cases were diagnosed on average six months earlier, the reduction in complications and resultant cost would save $100 billion annually. Evidence shows that the typical diagnosis could have been made six months earlier. Diagnosis is most often practiced as an art, not a science, and if the doctor is wrong, he or she gets full blame.

EC: What are some of Lifecom’s recent successes?
JM: We have recently completed our first clinical trials with OHSU. This is a major collaboration with OHSU and goes a long way toward proving the value of our software. Click here to learn more about the Lifecom software product.

Trial objectives were to learn the following: One, would the first contact person (usually a medical assistant) with minimal training be able to use our system to enter patient history, allergies, primary complaint and answers to questions generated by the AI technology? Two, at what speed could the necessary data be collected from the patient? Three, would the differential diagnosis (multiple possibilities) list concur with the diagnosis of the attending physician?

The trial results were the following: The user interface was widely viewed as easy and provided a much faster means of collecting patient information than paper transcription methods. In addition, the diagnosis differential was that 91 percent of physician diagnoses matched the top listed item by Lifecom, 8 percent of physician diagnoses matched, but were not the top item, and 1 percent of physician diagnoses were not present in the Lifecom knowledge base.

EC: What have been some struggles that Lifecom has had to overcome?
JM: First of all, the technology we are using is complex. We considered all of the standard AI tools but encountered unacceptable limitations: neural networks get too complex and become slow; Bayesian statistics do not allow for deeper refinement; decision trees have a level of complexity limitation. We needed an AI engine that can provide a reasoning model combining statistical analysis, probability, rules engine, neural networks, genetic algorithms, etc.

Additionally, the system requirements are not simple. We need large data scaling; currently there are more than 12,000 symptoms, conditions, lab values, etc. in the system. The product is designed to provide a complete lifetime medical record of the patient. We need to be able to guide a high-skill user (e.g., a doctor) through a reasoning process while remaining sufficiently intuitive for a lower-skill user (e.g., a medical assistant). We need to deal with multiple concurrent diagnoses, related and unrelated. We need to be able to make updates and modifications without revalidating previous diagnoses.

The medical industry requires a number of stages (proof-of-concepts) that most funding sources will not participate in until late in the game. This means we need to prove the technology by ourselves and bring the company along to the point where the perceived risk becomes a more typical business/investment risk. In the meantime, we are a small group of eight courageous entrepreneurs working in non-paid roles.

EC: Where do you see Lifecom going in the future?
JM: We will soon be starting a second trial with OHSU, to help us move beyond the technical risks. Then we will tackle the customer risks by conducting additional trials beyond OHSU. By the time we launch our product in summer of 2008, we will have reduced the risks to a more normal business/investment level.

EC: What are your growth projections?
JM: Our research reveals that there are more than 430,000 physician practices without electronic medical records. This industry is on the verge of change due to legal constraints, billing complexities, cost of business (rate squeeze), pay-for-performance metrics (Medicare), and the like. It is not unrealistic to see a five-year target (after product launch) exceeding $100 million in revenue. It becomes a clear issue of product differentiation and ensuring that our product truly solves real problems. We also have to execute every aspect of our business to very high standards to win and maintain customer confidence.

EC: What uniqueness does Lifecom bring to the industry?
JM: Steve Datena is both a trauma surgeon and end user of the performance criteria (credibility and need). His/our vision to improve healthcare is an underlying element moving Lifecom in a unique direction. His insights have provided patentable solutions to the appropriate AI technology, as well as deep understanding of the end-user community.

EC: Is there anything unique about your software that contributes to the overall software industry at large?
JM: Our AI model is not medical specific, and was intentionally designed to support general-purpose applications. We are already in conversations that could open other market applications in the future.

EC: What is unique about the healthcare informatics industry?
JM: This is a large market with lots of products targeting many niche solutions. To be successful, one needs to truly rise above the noise and be 10 times better then anyone else. This small core group is only building the pilot product. A large team and investment will be needed to flesh out this product.

EC: Does Lifecom collaborate with other companies, or in any professional associations such as a state-recognized cluster?
JM: There is somewhat of a medical software cluster in the Pacific Northwest that is working toward greater collaboration of electronic medical records. HIMSS is the focal point of those efforts. There is good potential to draw healthcare IT professionals to Oregon through the influence of the university systems: computer science program, grad programs in healthcare informatics (OHSU), that sort of thing.

EC: How does being in Oregon help or hurt?
JM: The proximity to OHSU is a great help, and the lack of local venture capital definitely hurts.

EC: Let’s talk a little about you. You are a serial entrepreneur, so what does Lifecom mean for you?
JM: This is my fourth start-up. Of all four projects, Lifecom represents the greatest potential of any of these endeavors. The team has proven that they are second to none in skill, dedication and entrepreneurial spirit toward getting this concept into the healthcare system. The opportunity to truly build a global enterprise has never been as real as here at Lifecom. The size of the market versus the market need combined with our unique technology to address those needs and the core team’s ability to be successful— all this will make this company successful. The patient-monitoring products at Protocol Systems were a great success, for example, and provide the model for success at Lifecom in terms of how to build, finance and staff the company.

EC: What attracted you to this venture?
JM: I am attracted to great business opportunities that also have a positive influence on society, and this one has a huge potential to give back to shareholders as well as to society.

EC: Other than scars and T-shirts, is there any difference this time around?
JM: The market and business climate has changed. It is much harder to get funding because the level of risk versus the expected return has shifted, that is, the opportunity must be much greater. We are both expected and challenged to create that home run.

EC: What is it like to be an entrepreneur in Oregon?
JM: We are a smaller group because Oregon has not done the things that foster growth that locations like San Francisco, Boston and Austin have done; I’m referring to a lack of capital, people and market. We need a combined effort to move higher education to Portland, improve metro transportation and foster better state-wide community and infrastructure planning. That said, Oregon is still one of the best places to live in the country.

About the author
Ed Carroll has been building software products for more than 20 years, with particular expertise in automating economic analyses, decision support and supply-chain management processes. He has provided strategic technology leadership in roles such as the vice president of engineering for Egghead.com, director of technology at Nike and director of software engineering at Boeing. He can be reached at EdCarroll@AgilisSolutions.com.