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Bad Medicines

Gerardo Pis-Lopes and Eliot Kristan

Photo: Gerardo Pis-Lopez (left) and Eliot Kristan (right)

Two weeks ago, Eliot Kristan, Iora Health’s Devops and Systems Manager, was in the middle of his week-long on-call rotation when he received a support ticket from Stephen Dahmer, a physician in our Manhattan practice. Stephen wanted help querying our electronic prescription service for a list of our patients taking a specific combination of medications due to a report in the NEJM which concluded that the coadministration of trimethoprim-sulfamethoxazole and spironolactone “confers excess risk of sudden death”.

Unfortunately, the two vendors we use for electronic prescriptions do not provide a way to query a patient panel for those who have a specific combination. But the Iora practice team could go through each drug and cross reference the but that would be time consuming and error prone.

Eliot understood that this manual search was going to be a huge burden on the Manhattan team so he consulted with Gerardo Pis-Lopez, a Senior Software Engineer, who had recently been working on integrations with our electronic prescription vendors (and who happens to sit right beside Eliot). After a quick spike (that means a time-boxed experiment), Gerardo was able to download the medication history for each patient at our Manhattan practice. Eliot provisioned an Elasticsearch system and imported the medication data so that he could quickly build a report for any patients with a history of both drugs. The results indicated that, according to our data, there weren’t any patients in Manhattan with the dangerous combination in our system. Eliot informed Stephen and our Chief Medical Officer.

So at Iora, the story wasn’t over. Eliot and Gerardo did not stop with just the Manhattan practice; they decided to do similar work for all our practices. And good thing. They identified 13 patients in total across Iora Health and informed the appropriate teams.

Those teams were then able to very quickly look through 12 patients one at a time (instead of thousands) and determine that only 1 patient was potentially at risk for the interaction. Our care team contacted the patient and confirmed that he was not taking the combination.

An Iora physician reads about a newly published drug interaction, submits a support ticket and our tech team was inspired and empowered enough to spring into action to check on our patients nationwide. Only hours after first becoming aware that this interaction existed, we had a care team on the phone with a patient thousands of miles away to prevent the possibility of sudden death.

One Culture

Iora’s culture is something that is hard to define but I believe it is rooted in a desire to serve others first and foremost. No need to ask permission or beg forgiveness, Eliot and Gerardo felt empowered to just solve the problem. They were not asked to do this but felt that this was the right thing to do so they both dropped everything and got on with it.

At Iora Health, our product development is centered around cross functional teams consisting of clinical, engineering, design and analytical team members. The cross functional team is empowered to build a solution to a given problem and, at the same time, it is one of many components that help maintain one culture across the company. During the team collaboration, we get to hear about what is good, bad or missing in our systems and, as importantly, we get to see our colleagues using them. Those who use the tools we build (patients, health coaches, physicians, etc.) are part of our day to day interaction. Other tech teams don’t often get to have this tight collaboration and because of this, we don’t look at our users like customers but coworkers and patients — people we have an intimate relationships with. This connection is what encourages the behaviour Eliot and Gerardo demonstrated.

I consider myself to lucky to work as an engineer at Iora Health. Not only is the mission of the company noble, I get to create solutions to difficult problems — with people like Eliot and Gerardo — which is rewarding when seeing its impact to ourselves, our colleagues and most importantly, to our patients.