InQuickER: See the ER doc in 15 minutes or less, or your ER visit is free

by tkiley • 17 years ago

102 96 17 years ago

tkiley11• 17 years ago

This is my startup. 100% bootstrapped and ramen profitable. Questions and comments encouraged. Thanks for checking it out!

dschobel• 17 years ago

Love the idea. What are the expansion plans?

tkiley11• 17 years ago

Because this is such an intensely localized service, expanding the network of participating ERs is pretty much the most important thing we need to do. We've made it a turnkey implementation for low- and mid-volume ERs, and there are some fairly compelling customer service and bottom-line benefits for participating hospitals.

prakash• 17 years ago

fantastic idea. The first ER experience I had in the US, I waited for 5 hours -- completely baffled that it was called ER.

aaronblohowiak• 17 years ago

Triage is the new priority queue.

kirse• 17 years ago

Just wait until we get socialized health-care... the wait times are going to be absolutely phenomenal.

mattmaroon• 17 years ago

Well, good luck. I'm rooting for you because your service would be amazing. You're dealing with the most fucked up, slow-moving, ass-backward industry in the history of capitalism though, so it's going to be a really tough battle.

patio11• 17 years ago

I don't know about it being the worst possible industry -- government procurement or public education give it a run for its money some of the time. (I will refrain from playing the "find the common thread here" game.)

Seriously, though, I hope that this startup escapes the regulatory issues and goes Big. It solves a clear problem for both patients and hospitals, will greatly increase societal welfare, and it should attract Big Bucks (TM) because of the amount of money wrapped up in the problem it solves.

This page is one of the best brief sales pitches I've ever seen, by the way:

http://inquicker.com/page/inquicker_benefits

Everything about it is great. It scans great. It directly addresses the customers' needs and makes it explicit what tangible benefits buying in will get them. I have bookmarked it so that when software vendors ask how to improve their website I'll say "Your benefits section should look like this".

Best of luck.

Adrenalist4• 17 years ago

Sounds like a neat idea. You obviously have to get hospital permission/buy-in before this idea could really take off. This is a similar idea to OpenTable, the dining reservation system. Perhaps you could do (or already have done) some research to find out how that company has succeeded/failed and apply those lessons to your efforts. Online based reservation systems are a great idea, but seems like a lot of leg work is required to get it really rolling. Classic chicken/egg problem here with early adopters.

1. Add some auto-suggest features to the 'add a hospital' form.

2. Use an IP address/geolocation service to guess where I'm located and pre-populate the state for the form.

3. I tried to add my local hospital, and received a very ugly error message:

====

Internal Error

There was an error processing your request. The system administrator has been notified of the problem, it will be fixed as soon as possible. Please try again later. TELEPHONE SUPPORT

For telephone assistance, call our on-duty support technician at (770)-597-9185.

====

tkiley11• 17 years ago

Thanks for reporting this, it's been fixed, and we did receive your hospital suggestion. :)

absconditus5• 17 years ago

If you can afford to wait do you actually have an emergency? There are many other options, including clinics in drugstores, which don't burden emergency departments.

Adrenalist4• 17 years ago

I'm a father of 3 and this service would have been useful on several occasions. TRUE emergencies are handled VERY quickly at the ER, but there are a lot of times when the regular doctors office is closed (holidays, weekends, after business hours) but you REALLY need to take your sick child to get medicine or whatever. We've had more middle-of-the-night ear infections than I'd care to remember. :)

absconditus5• 17 years ago

The drugstore clinics can certainly handle ear infections. There are also urgent care facilities in most areas that can be utilized.

tkiley11• 17 years ago

This is a very good question, and a very complicated one. In many markets, retail clinics and urgent care centers are open 60 hours per week at best; nights and weekends, treatment options are scarce.

Additionally, many hospitals operate onsite "fast-track" clinics which are connected to the ED, so low-acuity conditions are essentially treated in something resembling a retail clinic.

Our goal is to make the emergency medical treatment experience as efficient as possible. Parents don't want to be sitting in the waiting room half the night, potentially exposing their children to contagious diseases in the er. Professionals lose valuable time to ER visits that drag on forever. We're trying to recapture that lost time and give the patients more control of the treatment process.

bestes2• 17 years ago

As yet another parent, this looks promising. My ER visits are usually in the 5-7 hour range. I also don't really care what the place is called: if I have an issue, I want to go to the closest place that can help me. If it happens to be the Walgreens three blocks away (it isn't), fine. Urgent Care, ER, trauma center or whatever.

Until recently, I always thought these places would triage, but my experience has been that it is just 'take a number and wait' I've been in with a broken arm, a torn nose (that required stitches) and couldn't believed we were treated exactly like a headache. So, this looks great. Try the Silicon Valley next so we can try it!

wildwood• 17 years ago

In addition to making emergency treatment more efficient, you're also providing valuable decision support to people in some of the most stressful moments of their lives.

Anyone who is scared enough or in enough pain to be considering an ER visit is about as far from a 'rational actor' as possible. Helping them make good decisions not only smooths out the system, it also gives people essential help when they need it most.

Nice job. :)

teej• 17 years ago

InQuicker specifically notes that they aren't for urgent or emergency conditions (http://www.inquicker.com/when_to_call_911). I don't see any reason why this couldn't be extended to non-hospital clinics, they work pretty similarly.

eries3• 17 years ago

Very cool.

zackattack3• 17 years ago

Are you Eric Ries?

matt13• 17 years ago

Look at his submissions. I'm seeing a trend... :)

eries3• 17 years ago

yes

stevenbedrick3• 17 years ago

Great idea! Which EHR/scheduling systems do you currently interoperate with? EmStat, Epic, etc. Alternatively, if you're not directly hooking into the ER's systems:

A) What sort of workflow do you use to exchange scheduling and appointment data between your site and the ER?

and

B) Is it the same for each participating hospital? If not, how are you planning on scaling your operation to include more than four hospitals? I'm genuinely curious, having done some work on ER workflow analysis and modeling. I think this is a great idea, but can envision some pretty significant workflow issues on your horizon depending on how you've got stuff set up currently.

tkiley11• 17 years ago

Right now, we're use a manual workflow; we provide patients' preregistration data to nurses and registration staff through a web interface. Direct EHR integration is my next priority.

We're implementing at relatively low-volume locations (in the neighborhood of 25-35k pts per year), and so far we've used the same manual workflow at all locations without any problems, but I think we need full integration for long-term growth.

I'd love to talk further by email -- can you send me a note at tyler@mystartupdomain?

mildweed• 17 years ago

IIRC, Emory uses Cerner FirstNet.

cadalac2• 17 years ago

Wow I think you have a great idea. We really need something like this in Canada. What are your rates? I couldn't find them on the site.

Oh, and one last question: where you funded by YC?

matt13• 17 years ago

To answer one of your questions... From the registration page: "Your credit card will be charged a fee of $24.99 to complete the registration process."

tkiley11• 17 years ago

Exactly. Originally, we experimented with offering this service to patients for free or for $2.99, but the hospitals were experiencing significant numbers of no-shows and bogus registrations; the $24.99 price point was actually requested by our pilot hospital as a form of data validation.

If we could find another way to keep the signal-to-noise ratio high, I would love to offer this service at a lower price point.

delano3• 17 years ago

Ontario?

cadalac2• 17 years ago

Yes, Ontario.

edw519• 17 years ago

Nice. You may want to consider a Google maps mashup centered on my location. If the hospital(s) I know aren't participating, this would be easier to use than a drop down box.

tkiley11• 17 years ago

Great idea! Right now we have a fairly small network of participating hospitals (3, to be exact), and engaging visitors who aren't in our current service area is a bit of a trick. I'll pass this one along to the designer for our next revision.

thorax• 17 years ago

From what I understand, there are a number of hospitals that can do some measure of call-ahead scheduling for ERs. What would prevent you from asking about each hospital policy and at worst doing a Twilio automated call to the number if they choose that one? At worst your automated message would get hung up on, and you'd tell them that it could not be processed and tell them to go there directly.

At best, you win because the ER staff hits the right keys for your automated message. Or they agree to do a full agreement with you.

matt13• 17 years ago

What an ambitious, innovative idea--nice work.

I don't understand (even after looking at the How it Works page) is how it works. Since you can't predict what types of injuries that are going to come in that are more critical than yours, how can you gaurantee an appointment time?

tkiley11• 17 years ago

The short answer: we can't. Sometimes, we miss the guaranteed appointment time. However, we do everything we can to ensure that our predictions are accurate, and we do everything we can to ensure that the patient experience is still as smooth as possible if we're wrong.

At this point, we have a 99.9% success rate with that guarantee: less than 1 out of every 1,000 patients has requested a write-off of the bill.

JimmyL2• 17 years ago

Can you expand on this a bit - for example, do you come up with the appointment times based on your own models, or does the hospital update your system to say "well, we're having a light day, so most people can get in two hours after they send us their triage info, regardless of what comes up."

I also wonder if you could talk about the incentives you use to get hospitals to sign on to your program - while you're adding value, you're also costing them staff time. Do you pass on a portion of the $25 to them, or is the idea that they will make up the cost by having more people come to them and thus getting more volume?

Lastly, have you considered partnering with insurance companies to offer this service as part of a premium's offering?

All-in, great idea you have - this is the kind of health care innovation we need.

byrneseyeview• 17 years ago

Interesting. Actually, this is a good way to separate two of the crucial functions of health care: actually fixing medical problems, or demonstrating serious concern and sympathy for someone's medical problems.

A person interested in the first can use inquicker; someone more interested in the latter can still bustle off to the ER and pace around, or something.

jacoblyles• 17 years ago

Awesome, meaningful, useful startup. Congratulations. I hope you are successful and expand to my area. My friend spent 4 hours in the ER on his birthday to get some stitches. This would have been a huge help.

danw• 17 years ago

I'm not sure I comprehend this. Isn't it the role of the emergency services to prioritise your visit? If you're critical you'll get seen, otherwise you wait.

If you're capable of shopping around for the best appointment time then shouldn't you be seeing a GP instead?

tptacek8• 17 years ago

This service doesn't bypass triage. It just puts your name and info on the triage list and allows you to wait from home instead of taking up space in the waiting room. The hospitals are (apparently) intensely involved in this process.

tkiley11• 17 years ago

Bingo. Most patients fall into the general "low-acuity" category, which means that they are essentially seen in the order in which they arrive at the ER; this is the default case in our system. However, the ED caregivers do have the ability to change it.

Feynman• 17 years ago

Nifty idea -- I work for a Hospital with California's largest ER, and several ERs in other hospitals owned by the same company. Unfortunately, I'm having a hard time seeing something like this working in our environment (for a variety of reasons). However, I CAN see how this could be killer for small Urgent Care clinics. I can't tell you how many times I'd love to just go on a website and see what the wait times are for all my local urgent cares -- and then reserve/travel to the one I can get in quickest. Nice idea, clean design... really cool. Best of luck with it.

tptacek8• 17 years ago

Real quick: SIFR for typography not a win. I'm not some crazy paranoid, but I block Flash by default because it kills my browser.

invisible2• 17 years ago

Just for a note as to my experience, there should be a "relinquish" or "Cancel" when setting up an appointment. I clicked next step and it booked my time temporarily. Ten minutes later it'll be open, but if you're releasing this you're going to want to allow us curious folks to cancel out.

invisible2• 17 years ago

Also, it looks like it booked the SOONEST appointment rather than the one I requested. In the "When" row I selected 10:30PM and it said on the next page 11:15AM was what I had selected.

tptacek8• 17 years ago

A killer idea. Every friend of mine that has had kids echoes my experience, which is that you end up going to the ER way more than you expect to --- your primary care pediatrician sends you there any time the answer to an "is it serious" phone call is "maybe".

If this scales, it will let me pick which of 4 local ER's I'm going to go to based on wait time. I'd pay $50 a visit for that. I'd subscribe to a service like this simply in anticipation of needing it eventually.

Good luck.

delano3• 17 years ago

This is a great service but it seems unfortunate that it has to exist at all.

The health system in Canada isn't ideal (or the Netherlands where I am now) but having to check emergency room wait times has never even occurred to me.

jdminhbg• 17 years ago

http://www.torontosun.com/news/canada/2009/05/03/9330606-sun...

'Down a hospital hallway, a row of stretchers line the wall near the nurse's station. On one of them is an elderly woman who's in pain.

She has been waiting for four hours to get into a room with a bed, but there isn't one available.

This is happening nearly every day in hospitals across the province and the GTA," said a nurse with 22 years of on-the-job experience.'

delano3• 17 years ago

That's fair. I should have been more accurate since Canada is a gigantic country. My experience is based on living in Vancouver and Montreal (although I went to a hospital in Toronto on one occasion and waited only 30 minutes).

Titanous• 17 years ago

This is extremely common in my area (Ottawa/Gatineau). In fact, people travel the ~40 minutes to my small town where we have a relatively new hospital, and use our ER.

bestes2• 17 years ago

You might be watching too much TV. Nothing happens quickly in a real ER.

calambrac2• 17 years ago

Great idea, but why focus on the ER in your branding? The question that the end user has is "How can I get treatment for this health problem as soon as possible, without having to wait around in a waiting room"? It seems like the way that you're answering this could easily be extended to clinics and urgent care centers, couldn't it?

Also, I echo the calls for a map-based or local-search interface.

tptacek8• 17 years ago

Because from a pure marketing perspective very few people have the problem of having horrendous waits at clinics, but tens of millions of people have had the experience of waiting 3-5 hours in an ER waiting room.

calambrac2• 17 years ago

I've personally had horrendous waits in clinics, urgent care centers, and ERs. I've also had really quick experiences with an ER. I'm not saying I'm typical, I'm just saying that my personal experience is such that your point never would have occurred to me.

But even granting your point, you can still market against that experience without implying that you only schedule people for ERs.

Right now I imagine that this site gets most of its business from people who call the ER directly, and then the participating ER tells them about the site (I could be totally wrong about that, though). Going forward, though, I would think that way that this is going to be used is that a user will know they need treatment, go to the site (find it via a search engine, whatever), look for the treatment facility that satisfies some mix of 'near', 'soon', and 'perceived ability to treat my problem', and put their name down.

If there's a marketing hump to get over, I would think it would be snagging people who are coming from a search engine or via some route other than having the ER send them there directly. It seems like the perception that this is just for ERs is more a problem in this sense - I'd personally be less likely to use it if I thought it wouldn't include nearby clinics in the list of places I could sign up for.

JimmyL2• 17 years ago

What this service does, if I'm reading this right, is bypass the stage where you talk to a triage nurse - you're triaged based on what you report is wrong with you, as opposed to what a nurse sees is wrong with you.

Do you have any mechanisms in place for two-way communication between the hospital and the people booking appointments? Specifically, I'm thinking about situations where a series of individually minor symptoms may collectively indicate something major is going on, but that a layman wouldn't know.

Like let's say that I go on your site and see that I can get an appointment at an ER in three hours, so I book that because I'm feeling slightly off. My symptom description seems innocuous enough - went for a walk in the countryside, right arm is tingling a bit, small red bump on my leg, etc. - but to someone trained in medicine they indicate that I've been poisoned by some sort of tick, and I need treatment ASAP, as opposed to in three hours. Is there a way for the nurse who processes this reservation into the hospital to call me and say "screw the booking, get here now!"?

tkiley11• 17 years ago

Yes, we do have the capacity to reprioritize patients based on symptoms. Patients who reserve a treatment time online are responsible for their own health until they arrive at the ED, but we do give the ED caregivers the capacity to communicate with the patient early on if they deem it prudent; this feature is generally used in the sort of situations you describe, where the patient's condition may be more serious than he or she realizes.

cscott• 17 years ago

Talk about contributing to the public health problem in our ERs.

Emergency medicine in the US is in a horrible state. Overcrowding is one of the primary reasons. See: http://www.ama-assn.org/amednews/2009/01/19/prsb0119.htm

One of the primary reasons for the large influx of patients is the diversion of primary care visits into the ER for non-urgent matters. A booking system that encourages non-urgent care visits to the ER as opposed to other urgent care options does nothing to help this.

As other commenters have mentioned, the problem with overcrowded ERs from a patient perspective where they have a potentially emergent case is NOT in the middle of the night - it's during the day, where other options (including primary care and urgent care facilities) are available.

Emergency medicine should not be treated in the same convenience form-factor as other consumable goods, and applying this approach is socially irresponsible in the big picture.

tptacek8• 17 years ago

Your argument is that on-site ER wait times are an effective deterrant for frivolous ER visits. They aren't: they impose costs on both legitimate and illegitimate visits. That cost is also imposed randomly: currently, your ER wait is luck-of-the-draw.

If you want to solve the ER overcrowding problem, you should do it directly, by adding a surcharge (over and above the one that already exists) for nonessential ER visits. There's no rational reason to force people to sit in a crowded ER waiting room.

Meanwhile, a retail interface to the ER scheduling systems that already exist is more likely to help than hurt overcrowding, because it will route patients to the least crowded ER in their area.

stevenbedrick3• 17 years ago

The problem with the surcharge idea (and lots of other market-oriented solutions to health care problems) is that, under our current system, market forces don't really apply in the same way that they apply to, say, items in the grocery store. Very few people going to an ER are paying out of pocket: many don't have insurance[1], and will either not pay for their visit or will negotiate some sort of payment plan at a reduced rate with the hospital. And, of course, those visitors with insurance don't care what the hospital ends up charging their insurance company- that's the whole point of insurance. This is, of course, especially true during emergency or urgent care situations.

[1] To the extent that emergency room overcrowding is due to people without other health care options (i.e., the un- and under-insured) using ERs as their primary care facilities, surcharges really won't help: by definition, these are people who can't pay for medical care... so adding additional surcharges probably won't have much effect on their ER utilization.

nerdburn• 17 years ago

Awesome :) Glad to see this taking off Tyler. Nice to see my new design on there. PS. Center the layout ;)

rickharrison• 17 years ago

I liked this design. I've been looking for a designer for some work. Could we get in touch? Email is in my profile

iamelgringo• 17 years ago

So, I've been an ER nurse for the last 15 years. I run the Hackers and Founders Silicon Valley meetup, and I love to support startup ideas. It's extremely rare that I don't support a startup idea or give it a fair shake.

This is a spectacularly bad idea. I can unequivocally say without a doubt that if you pursue this service, someone will die.

Why? Because I've seen it happen.

Part of my job as an ER nurse is to triage patients that come in. Triage involves sorting through the dozens of patients that come in every night, and decide who can wait and who cannot because they have a life threatening emergency. People having symptoms of a heart attack move to the front of the line. People who ate a bad taco and have the shits get seen on a space available basis. That's the gig. I sort patients: sort_by_acuity([bad taco, bad taco, bad taco, heart attack, runny nose, cough, gun shot wound, ear infection, headache, headache, headache, stroke, headache]).

I've been doing this job for 15 years, and I have seen plenty of triage mistakes that can change people's lives for ever. I've made a few myself. You care for thousands of patients a year, you're going to drop a ball every now and then. But, I have a lot of experience doing this, and I have a lot of knowledge and very good instincts on when someone is very ill. Patients do not have that knowledge and I would never trust your customers to make that decision when life and death is on the line.

This is why ER's are almost universally abysmal at judging how long it's going to take to be seen by the doctor. The same team that is taking care of your earache at 3am or helping you get stitches after you cut your finger on your computer case, is the same team that can crack your chest open and do open heart massage on you after a thug sticks a knife in your heart. We take care of bladder infections and dying babies, sometimes right next door to each other at the same time. ER's are built for safety, not speed or even convenience. The fact that in the US, they are primarily the only type of physician that can be seen 24/7 without an appointment is an unfortunate effect of our health care system. But, we have to care for the sickest patients first, and you can never predict when the next ambulance is going to roll through the door. So, ER's suck at estimating wait times. But, you will, eventually see a doctor.

Now, I understand that you have a disclaimer that says that people should call 911 for Emergencies, and that they will not use your service for life threatening emergencies. I don't think that's not going to keep you from getting sued when Uncle Bob dies of his massive heart attack that he though was a bad burrito and put his name on your waiting list. That's also not going to help you sleep at night thinking about how you might have prevented Uncle Bob's death.

I'm not trying to flame you. I'm really not trying to be nasty. I'm just trying to communicate what a big, big, huge mistake I believe this application is. Please, shut it down.

mustpax• 17 years ago

The need for such a website also points to a larger problem: a lot of people in the US, including most insured people, do not have access to timely primary care for non-life threatening problems.

Say your daughter has an ear infection, the appointment your HMO primary care physician gives you one week from now, is no good. So you go to the ER. There is no effective in-between option. I don't know if this website fixes that problem or exacerbates it. But that is the real problem.

This whole un- under- insured category people talk about in the US exists because people are actively being put in insurance plans where we know they will not have access to some health care services they will need. Let's not kid ourselves.

csbrooks• 17 years ago

I guess it depends on your doctor, but we usually get an appointment the same day if someone is actually sick. Also, the in-between option is "urgent care", which is open at least 8 hours or so on Saturday and Sunday.

ivankirigin• 17 years ago

Emergency services: there in minutes when seconds matter.

InQuickER: See the ER doc in 15 minutes or less, or your ER visit is free

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