HL20: Blau and Cohn—Understanding the Patient's Need for Understanding

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of Alex Blau, MD, and Brad Cohn, MD.

This profile was published in the December, 2011 issue of HealthLeaders magazine.

 "This was just something we needed and we were surprised that it didn't exist."—Alex Blau, MD

While working the overnight shift at San Francisco General Hospital, Alex Blau, MD, and Brad Cohn, MD, found themselves at the corner of necessity and invention. The two young physicians in training were in their third year of medical school at the University of California San Francisco in 2008, and they were frustrated by their inability to communicate with patients from the Bay Area's diverse racial and ethnic communities.

"In healthcare your greatest diagnostic tool is your ability to communicate, to obtain a decent history and a physical exam from your patients. This is difficult to do with patients you can't easily communicate with," says Cohn, 29, now a resident in anesthesiology at UCSF and San Francisco General Hospital. "Patients who don't speak the same language as their providers sometimes do not have the opportunity to give that vital piece of information they need to in a timely fashion."

So, the pair came up with the idea for MediBabble—an iPhone/iPad app that allows clinicians to better communicate with nonEnglish-speaking patients during the initial exam and history-taking.

 "Understanding a patient’s needs is really critical in developing an app that helps people."—Brad Cohn, MD

"This was just something we needed and we were surprised that it didn't exist," says Blau, 35, an emergency physician who has since left medicine to develop MediBabble. He is also medical director at Doximity Inc., in San Mateo, CA. "We both had iPhones and we thought ‘why isn't there an app that helps us? We can now walk around with computers in our pockets and impressive interface ability. Why don't we have a quick language app that allows us to play some questions for our patients?' Then we realized that we were perfectly situated to do it ourselves."

MediBabble—which is free and does not require Internet access once it is downloaded—focuses on the history-taking process during the initial patient interview.

"We specifically rewrote all of basic medical history taking," Blau says. "It turns out that most of the information we look to get as physicians is fairly predictable, depending upon a patient's complaint. We were able to organize history taking in a standard fashion, the way most physicians will approach it, based on patients' chief complaints and wrote out all of the questions that a physician would want to know the answer to."

Blau and Cohn and their small technical support staff at the company they formed—NiteFloat Inc. —had the questions translated by native speakers into six languages: Russian, Spanish, French, Cantonese, Mandarin, and Haitian Creole—the last of which was rushed into production to help clinicians in the earthquake relief effort on Haiti.

"Say a patient comes in complaining of chest pains," Blau says. "You simply pull up chest pain section and it will have the list of questions organized in the chronology you would normally want to ask as a clinician. You tap on your device and it will play those recordings that have been laid down by these professional interpreters out of the speakers of your device. It would be like they are hearing the interpreter in the room with them."

Blau stresses, however, that MediBabble is no substitute for a flesh-and-blood translator.  "The tricky part obviously is how do you understand their response?" Blau says. "We wrote this history so it is all closed-ended questions that require only ‘yes' or ‘no' responses or gestural responses, such as pointing to a body part or holding up a number of fingers to indicate pain on a scale of 1 to 10."

Cohn says they intentionally limited MediBabble's ability to obtain information from patients. "You can't give information to a patient using MediBabble," he says. "This is for an emergency situation where collecting data quickly will allow you to improve the patients' health or allow you to get critical health information. It boils down patient responses into a format where you don't need to actually speak their language to understand their replies. But in order to give that information back to a patient you need to work with a medical interpreter."

The response to MediBabble has been strong. Since it was launched in February 2011, more than 15,000 clinicians have downloaded it. MediBabble was also voted the No. 3 new app of 2011 for internists and residents by the influential physician-review Web site iMedicalApps.com, which called it a "most superior" translation device.

Blau says NiteFloat wants to expand the breadth of the questions, the languages offered, and the content. "Right now it is focused on broad emergency and primary care complaints. But we have had a lot of specialists request additional content in areas such as OB/GYN and anesthesia," Blau says. Plans are also under way to launch an "internationalization feature" that will allow, for example, Russian speaking physicians to communicate with Spanish speaking patients.

While it's not charging a fee for MediBabble, NiteFloat asks users to donate money. "We have no plans to charge for the service. We continue to pay for MediBabble's development ourselves, but we're looking for foundation support," Cohn says. "We are technically not a non-profit, but we are also technically not profitable."

The growth of medical apps is exploding, with thousands of offerings for medical professionals and patients. For healthcare applications to be effective, Cohn says, there will always be a need for the physician's perspective. "You can build an app for what you know best," he says. "The more you work in the system as a physician, the more you can identify true need. The more time I spend with patients, the more I come to appreciate their struggles and what benefits them. Understanding a patient's needs is really critical in developing an app that helps people."