Sutter Health's online symptom checker aims to provide care at the right time, place

Health systems are well aware of the plethora of apps that invite users to share their symptoms in return for lists of probable conditions and suggested action plans. In fact, some are worried such tools could draw their patients to rival providers.

Several systems have responded by putting symptom checkers on their websites—which, after taking users through a line of questioning, lead them to a list of the system's facilities. Often that means partnering with the very technology companies whose tools they worry could drive patients to seek care elsewhere.

“The idea being, 'If we can make them aware of the care options we provide, then maybe that will prevent people leaking to another care site,' ” said Dr. Ateev Mehrotra, an associate professor at Harvard Medical School who has studied symptom checkers.

Sutter Health is the latest health system to partner with such a company. By the end of the month, Sutter's website will offer Ada Health's symptom checker tool. Along with a list of potential ailments, users get a list of nearby Sutter facilities where they can get treatment, if that's what the tool suggests.

Dr. Albert Chan, Sacramento, Calif.-based Sutter's chief of digital patient experience, said the goal is to provide care at the right place and the right time.

Milwaukee-based Froedtert & the Medical College of Wisconsin and the Boston Children's Hospital formed similar partnerships last year with the digital health tool Buoy; other such platforms include Babylon, Triage, Symptomate and Mediktor.

Ada co-founder and CEO Daniel Nathrath says his tool, which became available to patients two years ago, differs from the competition since it doesn't rely on a predefined set of questions; instead they change based on users' responses.

When app users get treatment based off Ada's recommendation, they're encouraged to share that with Ada, along with that provider's diagnosis, Nathrath said. That information, which is de-identified from specific users, creates a feedback loop designed to improve the tool over time.

Sutter plans to study its patients' anonymous responses, including the types of questions asked and whether and where patients sought care, Chan said.

Similar to the way telemedicine tends to be disjointed from primary care, tools like this often become a substitute for primary care, said Dr. Steven Waldren, vice president and chief medical informatics officer with the American Academy of Family Physicians. “If they're using these types of tools to go see another specialist about this thing and another specialist about that thing, you have the potential of increasing the cost of care without significantly increasing the quality for these patients,” he said.

Patients can download PDF reports of their Ada assessments and share them with their primary-care providers, but currently the program does not automatically share information on urgent-care or emergency room visits with those providers, Nathrath said.

Harvard's Mehrotra studied 23 symptom checkers (but not Ada) for a 2015 BMJ article and found they provided the correct diagnosis for 34% of patients and appropriate triage advice for 57%. How well they perform is still an open question, he said. “It is a striking thing that as we have this huge plethora of tools that have emerged, they're being used hundreds of millions of times, and yet we don't really know that basic question, 'What does it change?' ” he said.

Ada has gone through some third-party testing, but none of the studies were peer-reviewed. Ada partnered with Waterloo Health in a pilot study involving 300 patients in London who downloaded Ada, completed a symptom assessment and shared the results with their primary-care providers. In 92% of cases, the doctors found Ada's assessment to be useful. In 80% of cases, the doctors agreed with most of Ada's suggested conditions.

Nathrath said his goal is to become to personal health what Google is to a general information search. “That's a pretty big aspiration,” he said, “and we're interested in partnering specifically in the U.S. where there is a lot of room for improvement in the delivery of healthcare.”