Giving The World A Diagnostic Tool

August 22, 2003
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GRAND RAPIDS — Sagestone Consulting and Saginaw-based Robertson Research Institute have embarked on a philanthropic mission to save lives worldwide through medical technology.

The partners are developing real-time medical diagnostic software called NxOpinion to aid physicians in the diagnosis of non-chronic illnesses.

"NxOpinion is a very sophisticated diagnostic software package under development that works with a very sophisticated medical database being assembled by a content team," explained Keith Brophy, president and CEO of Sagestone Consulting and chief technology officer on the project. "Together, the application and the database provide handheld diagnostics."

Sagestone and Microsoft, along with HP Digital India and several West Michigan-area subcontractors, are supplying the technical expertise, and the Robertson Research Institute is providing the medical expertise. The Robertson Research Institute is the nonprofit spin-off of 20-year-old, Colorado-based Robertson Institute, a for-profit company.

Pharmacologist Joel C. Robertson founded the nonprofit institute more than a year ago as an educational resource for clinicians. He said the Robertson family donated a lot of intellectual properties to the nonprofit research institute to help feed its initiatives.

The NxOpinion initiative is truly philanthropical in nature, its creators say.

Robertson Research Institute will distribute NxOpinion free to areas of the world where medical facilities and resources are scarce and, domestically, to facilities in disadvantaged areas. It will likely be available to all others at a cost.

"We want to provide this with unlimited access, regardless of ability to pay," Robertson said. "We don't want to keep information that can save lives from anyone just because they don't have the money. We have the support to do this in a nonprofit environment, and that's the only way I would do this."

The initiative has strong, initial-round funding from philanthropic investors, all of whom come from a Christian background and are motivated by a desire to "give back," Robertson said.

As Brophy explained, the vision is to give NxOpinion away free to areas in great need and every six months provide a new flashcard with an updated database. The need is very great in terms of domestic ER rooms and overwhelmingly great in terms of locations where health care is delivered in primitive settings, he pointed out.

"In the U.S., incorrect medical diagnoses in the ER, for example, cause more deaths each year than AIDS, breast cancer and highway deaths combined," he added.

There are about 200 medical diagnostic type tools on the market, but none quite like

NxOpinion in level of sophistication, Brophy said. It's the first software of its kind to use artificial intelligence, and it's multi-level, multi-cultural and multi-language.

The software will be available in English, French, German and Spanish and will take into consideration not only language differences, but cultural differences, the skill level of the medical practitioner and differences in Eastern vs. Western approaches to medicine. The software will run on tablets and pocket PCs using small cards that hold a gigabyte of information.

"In the last couple years, for the first time, the technology has converged to provide the possibility to have a full-scale, medical data-based driven, artificial intelligence inference engine in your hand," Brophy said. "The power of it is really the information-at-your-fingertips concept. Our current understanding is that NxOpinion will be offered as an educational tool that practitioners can use as a resource, not as a sole-source diagnosis."

Robertson said he chose to base the initiative in Grand Rapids because he recognized it as a life sciences-rich community. He opened an office here Saturday in the same building as Sagestone. As the initiative grows, he'll be looking to expand.

"We will look at partnering, whether with a health-care organization or some other organization," Robertson said. "It works for everybody because we can help them and they can help us."

NxOpinion is designed to harness the explosion of medical knowledge. Two teams, one in Saginaw and another in South Africa, will be dedicated to continuously updating NxOpinion's content.

With the amazing amount of medical knowledge available, no doctor can possibly retain all that information and do the correlation, the filtering and the matching of cause and effect relationships, Brophy observed.

Technology is the key to piecing it all together.

"The only way to integrate all the medical specialties into one area is by using computer technology," Robertson said. "But you have to take it one step further. You can't just make it a library of research because those already exist. You have to have a program that can give you exceptions and think for you."

NxOpinion software analyzes information supplied by the physician — such as symptoms, test or imaging results, and patient history — and provides practitioners with feedback by leading them through a series of questions and offering suggestions. The diagnosis is refined with each additional finding.

Some of the basic software framework is already complete and has gone through acceptance tests. Marketing prototypes are also in place. The goal is to have both the database and software ready to go by Oct. 22.

In late October, NxOpinion will be in use at different pilot sites in South Africa, India, Uruguay and the Dominican Republic, Robertson said. Later this year more pilot participants will come on board through an organization that places volunteer doctors in Africa.

Toward the end of the year, the team will collect feedback from physicians at pilot locations and use it to refine the software.

"We see the need for specific content management — meaning physicians constantly feeding us new data," Robertson said. "That will come from South Africa, South America, India, China, Australia and the United States."

Brophy said the early pilot will last about three months and will segue into a second pilot six months later. In 2004 the group will launch the next stage of development, adding refinements and some of the more sophisticated features.

"It's going to be a multi-year effort for the software to mature to its full level of sophistication. With software this potentially far-reaching and sophisticated, we want to make sure we do it in an incremental, very controlled, disciplined manner," Brophy said. "We'll keep refining the approach."

Robertson anticipates that by September 2004 the software will have incorporated 80 percent of the data on all known diseases and will be available for lease in English-speaking markets. He said his nonprofit might just decide to give the software to urban hospitals, too, and only charge them a subscription fee for maintenance.

There are some challenges ahead, including sustained long-term funding, product distribution and evolution of the content database.

"How do you manage so much content? That's the staggering part," Robertson observed. "Writing a program is one thing, but being able to manage the content on time, instantly, around the world, with constant updates and proven research — that's a huge task.

"That's where Grand Rapids comes in. We see the sophistication of technology and medicine that exists in West Michigan that can work globally. There's a global mentality that exists in West Michigan. Those are all things that are very key and why we looked at locating here. There's no question that the vision and the talent lie in West Michigan."

Robertson pointed out that the partners have technology that Microsoft doesn't even have right now. Some of the technology they've developed can be used in many other disciplines, so it could be sold to help support the nonprofit initiative.

"The artificial intelligence inference engine has never been developed at this platform before. We patent and copyright that and it's a great way to support this venture," he added.

Brophy said he was attracted to the partnership because his company's own mission is to change the world through software.

"In the world of Microsoft technology, we have some of the top experts in the nation. We see a lot of opportunity in the whole life sciences sector. It's a natural fit for Sagestone."

Robertson estimates the initiative has already pumped about $4 million into the Grand Rapids economy and about $1 million into the Saginaw economy in software development alone.

He anticipates the project will inject $30 million into the West Michigan economy, predominantly Grand Rapids, over the next five years.

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