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Launch HN: InpharmD (YC W21) – curated drug information for doctors
82 points by aadvani on Jan 29, 2021 | hide | past | favorite | 73 comments
Hi HN-

My name is Ashish, and I’m the CEO/ co founder of InpharmD (https://inpharmd.com). We take questions from doctors and return curated, evidence - based answers.

I was a clinical pharmacist offering a remote service from a University for 10 years. Ask us anything, we begged, and our team of pharmacists, residents, and students would look it up, get through the paywalls, and provide the answer.

I passed out business cards around local hospitals. They were lost over time.

Then I passed out business cards with magnets. They stuck around, but there aren’t that many places in the hospital with the magnetic surfaces.

Eventually, people stored our number, but we’d ask so many questions when they called, they couldn’t ask theirs: who are you, where are you calling from, what’s your email, spell it, etc, etc, etc. Often, they’d hang up on us, and I don’t blame them. The average doctor now sees five patients an hour.

I realized I wasn’t alone, and hundreds of other academicians, all leading their own teams, had the same problem. So, we formed a network and interviewed hundreds of our customers about how they’d ideally interact with us. What we needed to build was simple: one touch request.

My co - founder Tulasee built that and since, we learned that AI can transcribe PDFs faster (but not yet better) than our pharmacists. We started with 5,000 of our own study abstracts, assigned weights for corresponding content in their respective PDFs, and now we continuously reassign the weights until the algorithm can completely make our own abstracts. Our latest test revealed 94% accuracy against a matched human control, but with medical information, this will need to be 100% before we can rely on it.

We think Watson was a missed opportunity, so we called our algorithm Sherlock. We’re launching a partnership with the American Society of Health-System Pharmacists® (ASHP- https://ashp.org), using their database of 1,300 vetted drug monographs, so Sherlock can field questions at the point of care.

We’ve been fortunate to find early adopter health systems to pay for our service: WellStar, Ochsner, University of Maryland, Georgia DPH, and St Francis. We’re typically compared to the cost of their healthcare providers manually searching, and we end up cheaper.

We love this community and we’d welcome your ideas/ experiences/ feedback on what we’re building!




I’m an ENT surgeon and I’ve personally used the service.

I asked about the safety of a drug and the product gave me a summary and literature to answer complex clinical questions fast. This product does a lot of the work that before involved me lots of time clicking and searching and trying tons of different Google searches. For a busy physician it works great.

It saved me time and helped ensure I was using the most up to date research for my decision making. This would’ve been a game changer when I was at an academic hospital doing clinical research, but even as a private physician it’s great to ensure you’re always up to date with the current evidence.


Thanks so much! Hearing we saved you time is our favorite type of feedback!


10 days ago someone posted a similar idea and how he failed.

"I wasted $40k on a fantastic startup idea" https://news.ycombinator.com/item?id=25825917

I hope your project succeeds.


This is gold, thank you.

He went after the same problem, yes, but with a traditional SAAS approach.

We feel strongly that the only way to make this work is to have humans on our back end, thoughtfully automated with tech (vs the other way around).


How did you get around the problem of having the doctors actually care ?


Clinical pharmacists at every hospital have been key. Many docs prefer to still rely on their clinical pharmacist, which is fine because they (the clinical pharmacists) end up relying on us. Over time, it’s become simpler for many docs to just ask us themselves.

Also, a newsfeed with common/ interesting questions has really helped since the experience gets better with more users.


We arrived at the same insight while implementing several digital patient assistance programs across different markets. In PAPs which require doctors to register vs pharmacist registration, the latter outperforms the former in adoption and engagement. Doctors seem to be too damn busy to take time to onboard themselves with the PAP apps even though ultimately they aid the patients in terms of medication cost.


Yes! I think every doc probably has a bit of PTSD from EMR rollouts, so probably much harder to find early adopters for any new tech .


I have hyperhidrosis (a fancy term for excessive sweating).

When I was a teenager (and before all answers to everything were online), I went to multiple docs and no one was aware of a particular prescription that, once I found out about it, completely "cured" the issue (Drysol).

Looking back, it was obvious the doctors just weren't aware of a valid treatment for the issue. It'd be great if a service like this helps doctors discover treatments for less than common conditions.

Side note: I recently discovered iontophoresis for the treatment of hyperhydrosis without the use of drugs at all... discovered via a Facebook ad for the machine (don't ask me how Facebook knew to target me for such a specific product). I bought it a couple months ago, and wow - it works. I've been googling the studies around it, which date back to 1950's -- not something new, but also dumbfounded as to how I wasn't aware of this treatment sooner, and why no doctor was aware of it either (or at least didn't bother mentioning it as an option).

Best of luck to you! Lots of problems to be solved in the health space.


Exactly! Back in the day it took three decades for the info to get across that smoking was in fact, bad for us.

Now, info travels fast, but there’s so much info coming at us, we choke on it.

Totally relate to your story, I come from rural India and saw many patients misdiagnosed for this same reason. This is exactly why we’re building InpharmD.


>It'd be great if a service like this helps doctors discover treatments for less than common conditions.

Isn't that what Up To Date is?


Despite their best efforts, up to date can never truly be up to date, can they?

No shade, we love up to date; we just see ourselves as a complement.


I mentioned this to my wife (she's a research physician) and her first response was also "isn't that what Up to Date does?"

How would you characterize the difference between InpharmD and UpToDate? Different features? Better execution?


Yep, totally. But they have X credible authors so can only have X credible info on their site.

This means they focus on the most common questions.

Public data/ our data shows point of care references like UTD can only answer ~1/2 of clinical questions.

We’re building our tool for the other 1/2.


Sorry I see you answered below!


A training client of mine with hyperhidrosis was treated through surgery. To be fair he was still sweating a lot more than my other clients, but he said it used to be way worse.

I had a fever on a trip in africa where it felt like sweat was pouring out of my skin and it was incredibly uncomfortable


And people say advertising doesn't add value to the world...


Even asking a pharmacist would have gotten you the answer :P


I’m not really looking to buy, but given both my own job and that of my wife, I am curious.

After reading your description, and watching the video on you website, I can safely say: I have no idea what service you provide.

Adding example question might help.

In Denmark the government office for medicin provide a free service where you’re able to look up all approved drugs, their usage, side effects, treatment plan and so on. It that what you provide or does it go further than that?


Sorry it didn’t land with you. We’re constantly torn between writing for the one person (a healthcare provider) vs a larger population.

An example question is a fantastic idea and will land with both audiences :-)

We’ll get our top three most recent on the homepage ASAP but in the meantime:

If you have a typical late stage COVID patient, a static patient resource like you described is perfectly fine to look at efficacy of the standard dexamethasone 6mg treatment.

But if you have an atypical patient and considering a 20mg dose, you’re out of luck. Most patients are atypical and we see an unmet need with a long tail of atypical questions.


Typical dose of dexamethasone is 6 mg not 4 mg. And only in severe cases needing oxygen, not early.


Thanks for the correction I actually typed 6 every 24 but found it confusing and resulted in error, fixed now


Also, we actually did this one, if you’re curious:

https://www.inpharmd.com/is-there-any-data-to-support-higher...


Thanks for the link. Anecdotally in our hospital only one patient to my knowledge has survived after a higher dose of dexamethasone (this was only used after the patient was worsening despite the standard 10 days of 6 mg dexamethasone). Whether this helped them or they were going to improve despite can't be known.

I would also be careful about how you use the term atypical, in fact most patients with COVID are typical and improve with the standard treatment. :)


Great info, and a shame there’s not better real world evidence for cases like this. And I hear you, just making the point that most shouldn't be considered “typical”; we should question everything.


Love the idea, I work in specialty pharma and getting concise information to the pharmacists has become critical. Physicians rely heavily on pharmacists to call the shots on treatment plans now more than ever.

We built our own in house solution to this exact problem, but its maintained by our own clinical staff, it costs us north of $300k a year to maintain it! This only works of course because we have over 150 specialty pharmacies in our 'network' so we have volume to help keep up with costs.

I could honestly see us leveraging a solution like this at some point in the future, and probably anybody running fewer than 10 specialty pharmacies needs a solution like this.

Good luck to you guys!


Thank you and yes! Medical education is mostly diagnostics and pharmacy education is mostly therapeutics. The most forward thinking health systems are relying on pharmacists to guide treatment decisions. And I’m sure you see this with specialty meds in particular.

And WOW re: $300k per year. I’m certain we could do this for a fraction of that cost. Ashish at InpharmD dot com :-)


What's your take on off-label uses?

e.g. certain antihistamines for sleep aid

Also, hiring?


Off label questions (questions outside the FDA approved indications of a drug) are fun for us. There are so many great ones and this is where the traditional references fall short.

We just have to be fair and balanced about how we present (which we are anyway) + be extra vigilant to include all relevant prescribing info, and especially the actual indications and any boxed warnings.

As for hiring, yes, and for anyone interested, I firmly believe interest in what we’re building is the most important thing at this point, and everything else is secondary. Ashish at InpharmD dot com


Wow! This is exactly the type of service that academic institutions could benefit from.

When I was a medical student and resident on rounds, it was really stressful trying to do literature searches on pubmed and up-to-date (esp while taking care of active patient problems!) I often didn't have the time or bandwidth to comb through the papers/lists of care guidelines, and the abstracts often didn't give the clear story (or the relevant numbers!)

If I had had access to InpharmD, I could've 1) looked like a rockstar to my team, and 2) actually learned and understood the info I needed. :)


This makes our day :-) Academic MCs are our main target right now. Thank you!


Ashish, I've long been a fan of your work and am excited to see you share InpharmD here.

1. What are your thoughts about partnering or selling to pharma / biotech / R&D orgs? Is there a potential value prop?

2. How does this compete with or complement existing clinical informatics and medical librarian capacity at academic medical centers? Or are they not the target market because they already pay salaries for humans to do these tasks? How do above entities relate to what the PharmDs do?


Excellent questions and thank you for the kind words :-)

1. We tested this with Pfizer last year and found there was an opportunity to supplement existing med info teams that do the same thing.

But it’s tough to do two markets well at once, so we decided to focus on health systems for now.

We also find that in hospitals, everyone thinks they’re asking b unique questions, but they aren’t. We can be much cheaper vs their pharmacists and still make money. Pharma companies already have standard responses so it’s a totally different value prop.

2. We don’t really compete with clinical folks at hospitals, most will readily off load this to us, so they can spend more time on patient care. There are some that like to own this, and I totally get why, but we eventually win them over. As for medical librarians, they’re great for article requests but for complex clinical questions we think a clinical pharmacist is the right type of researcher.


I’m not in this space, so just out of curiosity what does this cover that Up To Date doesn’t? And/or What are some examples of questions doctors might ask? Thanks!


We get this one a bunch; Up to Date is pretty awesome.

Public data + our data shows only ~1/2 of clinical questions can be answered by Up to Date (or references like them).

Those online compendia employ a small team of credible authors + have massive scale, so they focus on the mainstream questions.

Our custom solution is designed around the long tail of emerging or complex questions.

For example, if you want to know about dexamethasone 4mg for early stage COVID, Up to Date will have it. But if you want to know about dexamethasone 20 mg, you’re faced with doing this literature search on PubMed (which = 2 hours + 4 journals) .

We get this question a lot, and really appreciate you surfacing it here. We made this into a FAQ for anyone that prefers to visualize it: https://www.inpharmd.com/faq

Maybe this is how any startup takes on any large incumbent? IDK. We love your collective wisdom, we learn a ton from you all.


My bad, typo- meant 6mg here

For anyone curious , we actually did this question:

https://www.inpharmd.com/is-there-any-data-to-support-higher...


This is my question.

And it comes down to liability as well. Basing your treatment decisions on UpToDate or NCCS guidelines or Cochrane Reviews is pretty defensible. But basing it on the findings of an AI start up? How is that being addressed?

But don’t get me wrong. I think there is a lot of value in physicians having easy access to pharmacists to discuss treatment options. Right now that doesn’t happen that easily.


Totally agree- before we started doing anything we had to understand what we could and couldn't say. We probably interviewed as many lawyers as potential customers !

The consequences of wording something wrongly are huge.

To be clear, we stop short of making recommendations. Our goal is to give the provider all the info she needs to make her own evidence informed decision.


Love this! I was just trying to search for studies on weight gain in a very uncommon medication. I'll have to pester my institution about this.


Thank you! This is exactly the type of question we’re here for.

You can create a free trial account here and ask your question, all in 30 sec: https://www.inpharmd.com/provider_signup/new

Then if you like it, pester away!


Why do doctors want "curated, evidence - based answers" to their questions? Why does a health system want this for their doctors?


I can understand this take, many docs don’t like to ask questions at all.

But there’s a new school type of doc that realizes how vast the medical literature is (20m studies), how quickly it’s changing (20,000 just added on COVID), and has tons of questions.

All medical references were essentially converted to SAAS products from large books- so they’re thousands of pages covering the mainstream topics, and they answer only ~1/2 of questions.

Health systems employ clinical pharmacists to answer the other 1/2 with evidence because it’s insanely high ROI for them to do so (5M/ pharmacist/ year/ hospital). Health systems outsource this to us because we’re more efficient.


> Health systems employ clinical pharmacists to answer the other 1/2 with evidence because it’s insanely high ROI for them to do so (5M/ pharmacist/ year/ hospital).

I didn't know this.

In that case, software is probably way more scalable than hiring more and more pharmacists.


This is our hope :-)



Same problem, for sure, but we’re taking a different approach.

A SAAS tool has a hard time with complex questions because healthcare data is messy and results will be imperfect.

Therefore we feel strongly about building a human - lead service thats optimized by software.

Every health system employs clinical pharmacists to manually do this today, so we use that as our stake in the ground, and so far we’re finding we’re way more efficient.


Yes I think you're approaching it from a way better angle.


It seems a bit wrong to target this to doctors exclusively. Is it just because the cost of your service would be prohibitive for someone not using this professionally?

Anyway, I'm not a doctor but one of those types that love looking into everything themselves. I'd be interested in having access to something like this for my personal research.


We started with a for us, by us approach to build our content and a brand first.

The reason every patient knows of the Physicians Desk Reference is because they believe their doc relies on the PDR.

In just 10 years I’ve seen the doctor go from being the top of the patient care hierarchy to the patient on top (not coincidentally DTC ads have blown up). We think there are a lot like you, and soon, we’ll make our tool publicly available.

If you want to test before that time- reach out! Ashish at InpharmD dot com


Seems like this centralises the experience answering the questions with the people in your organisation rather than the wider community of clinical pharmacists embedded in hospitals. Have you considered a more distributed approach that avoids this? I'm not really sure how to word this question better, sorry.


Yes! But shouldn’t it be central? There are hundreds of thousands of clinical pharmacists answering similar questions every day. To your point- everyone asks unique questions so still get unique answers that they can then combine with patient- specific preferences to make personal decisions.

Am I answering what you asked ? Sorry if not!


So when a hospital switches from in-house clinical pharmacists to your service, what happens? Do they leave the hospital and you hire them, or are they just fired and have to find a hospital you haven't taken over yet (what happens when there are none in their city)? Is there a way they could remain embedded in their hospital community whilst also providing expertise to your service, potentially you could get a wider variety of questions through your service this way too, to grow the range of things you can handle.


The clinical pharmacist has so much to do, they’re like Swiss Army knives. Systems that take us on don’t fire anyone to do so; this just frees up their clinical folks to do more patient care duties. So, yes, we want to grow through them !


Hmm, so their question answering skills will atrophy then?


Yes, but most don’t seem to mind. There are so many other high ROI things for clinical pharmacists to do instead. Most want to round more or spend more time with patients instead .


Anyone know if InPharmD integrates with EPIC EMR?


Yep we do! We started building custom but just went into app orchard


"We think Watson was a missed opportunity, so we called our algorithm Sherlock."

Agree with the first part enough that I wouldn't even want the near association :)


Haha good point

When Sherlock is older we may let him go by his middle name


I’ve been lucky to work at an institution has clinical pharmacists available on call all day to answer literally any question we have.

This is pretty neat, hope it works out!


That’s great! This is the future.

During vaccines, how have your pharmacists managed to do both? I’m sure it’s a lot on them


I've just spend the last few months working on a medication potency scoring system using ASHP data. Would be interested to hear more about your approach.


ASHP's drug information data is very complex in structure and finely tagged. Instead of a traditional algorithmic approach, we are leveraging machine learning to build Sherlock.

We are using AWS's machine learning service called Kendra, which indexes the clinical content, and provide search based on natural language processing. In our testing, it is able to find relevant information with pretty good results. Kendra also has capability for users to rate results so it can become smarter and give better answers over time.

We wrote integration between Kendra and AWS's chat bot service, Lex in a lambda based serverless architecture.


Sounds very interesting! I think something like this could be applicable: https://yjernite.github.io/lfqa.html

Although with the finely tagged data it may not be necessary.


Just curious, how did you make the links clickable in your submission text? I wasn't able to do that for mine.


Took me a sec too- just replace the www with https://


hm.. It doesn't seem to work. I tried here https://news.ycombinator.com/edit?id=26030392. Perhaps it works for you because yours is a YC startup?


Your website seems horribly broken on mobile. (Brave Browser)


Thanks for letting us know and we will fix it on our upcoming release.


Great idea!


Thank you :-) Now we must execute


Reminds me of chacha, a bit.


Interesting! I think Chacha was kind of general q&a search engine ? If so, yes, we’re building the same but for medical literature.




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