By Sonia K. González, DrPH, MPH
Dr. Yair Saperstein is a Chief Resident for inpatient medicine at Kings County Hospital as part of the SUNY Downstate Internal Medicine Residency program.
Dr. Saperstein graduated from Yeshiva College as Valedictorian and earned his medical degree from Albert Einstein College of Medicine with distinction in research in global health. He completed a dual track in Internal Medicine residency and a Masters in Public Health at Downstate, and was elected to both the Alpha Omega Alpha (AOA) honor society in medicine and Beta Iota Chapter of Delta Omega honor society in public health. During residency, he was the founding resident chair of the Internal Medicine Wellness Committee, and the founding editor in chief of the Internal Post, the official newsletter of the Internal Medicine program. Dr. Saperstein is the co-founder of three companies, two education-focused non-profit organizations (START Science and Teach4Kids), and AvoMD.
I have long dreamt of contributing to the practice of medicine through technology. As a child of two physicians, if I wasn’t playing “doctor,” or playing games on the computer, I was thinking about how the two might intertwine.
Throughout high school and college, I focused on the sciences. I majored in Chemistry, and competed in numerous science fairs and competitions. I credit the fostering environment of both my family and school life for promoting my blossoming interest in the practical application of the sciences. (Accidentally blowing up science experiments at home just made it more exciting…)
In medical school, I focused on teaching and empowering others as I myself learned. I helped grow two education-focused clubs into internationally operating non-profit organizations. I also did extensive global health work, working in 14 countries during my time in medical school. In Internal Medicine Residency at SUNY Downstate, I continued to look for opportunities to make a positive change. My advisor, Dr. Isabel McFarlane, suggested that I look into the field of Clinical Informatics, a subspecialty in medicine that combines IT and medicine.
I took an elective at Columbia University’s Department of Biomedical Informatics and met the faculty, including one fellow, PJ, who later became my cofounder in avoMD. He told me over dinner how he was building a tool to help doctors make better decisions — the merger of computers and medicine that I had been dreaming about. I got to work on learning how to build a decision pathway and successfully built one for Diabetic Ketoacidosis, a crisis of diabetes. From there, we (and avoMD) grew.
avoMD is a mobile-app based personal assistant to help doctors make better clinical decisions. The app is like “an expert doctor in the palm” that guides clinicians through the process of diagnosis and treatment.
The vast increase in evidence-based literature has made it much harder to bring accurate and relevant information to the patients’ bedside. In the recent COVID-19 pandemic, for example, the changing evidence in preferred treatments took weeks before reaching peer-reviewed journal articles, and further days before reaching many clinicians the point of care, where clinicians are actively caring for patients. avoMD summarizes the relevant evidence in a manner that allows for the information to be personalized for the patient.
The avoMD suite has pathways for an ever-growing set of guidelines: urinary tract infections, skin and soft tissue infections, atrial fibrillation, and many others. These pathways are able to be edited by our team of physician authors, reviewed by our expert clinicians, and kept up to date by our team.
PJ had been building the tool for about 5 years before I came on board, and I had been dreaming about this tool for about 20 years, so…about 25 years?
Seriously, though, it was our passion project, and I built the pathway for DKA in about a week. It took about a month from when we started to see the app live in the app store. Even after that initial lightspeed jump, it took only a few months to incorporate, form a larger team, get accepted to the NYCEDC E-Lab accelerator, and a few more months to raise our initial $100,000. The dream keeps becoming more of a reality.
With the amount of research and available medical knowledge increasing exponentially, it is progressively harder for clinicians to assimilate and apply this knowledge at the point of care. Personalized medical guidelines allow clinicians to get just the relevant part of the guidelines for specific patients or in a broad sense, in a specific institution. For example, Alerts, such as Best Practice Advisories, notify the clinician at the point of care about important events for specific patients with recommendations for next steps. Order Sets give suggestions on what to order for a particular complaint or diagnosis that is in line with the guidelines.
In a broader sense, the personalization of guidelines applies not only for individual patients but to individual institutions. Every medical institution has its own guidelines that help dictate care at their own specific site.
When PJ and I decided to work together to build more, we talked about how to open up our tool to the medical community to be able to solve this universal problem of needing access to medical guidelines at the point of care. We canvassed hundreds of other doctors to understand what they would want out of it, and realized it was important to them to understand not just what to do but also why. Doctors didn’t want to be replaced by robots, nor turned into robots, but wanted to have tools that would augment their ability to care for patients. People were interested in our tool because it allowed them to learn and not just to do.
Thus, the application of personalized guidelines is continuing to shape the field of healthcare, and we are a part of that force!
I have always wanted to understand the multiple different connecting parts that make a system work. After exploring clinical medicine and public health, as well as education, technology, and entrepreneurship, forming and running avoMD gives me the ability to combine all of these aspects.
NYC is the city of opportunity, and my motto is “seize the opportunity.” There is a growing network of healthcare institutions, startups, thinkers, and supporters in New York, and leadership that supports this growing trend. There is no better time nor place than here and now.
As the various currents in healthcare ebb and flow, health-tech needs to respond, and this provides both opportunities and challenges. As examples, the exchange network of health information is at the nexus of privacy vs. improved continuity of care over the health system. The public vs. private sector within healthcare take turns in their respective seats of power, and the needs of these systems change accordingly.
One of the major benefits of standardizing personalized medical guidelines is that it can help bridge the health care disparity gap. It brings access to the updated guidelines across the globe. Health-tech and public health are already working closely, and will surely continue to work together in solving issues in disadvantaged communities.
Learn from everyone.