There are over 700 treatment guidelines in Germany alone, and each is up to several hundred pages long. Can doctors still stay on top of things? A start-up company from Mannheim called evid is developing a software that can retrieve relevant therapy recommendations for individual patients from the huge pile of paperwork. In March 2018, the founding trio won first place of the eHealthForum Freiburg start-up competition.
Johann Rink, a junior doctor, is standing in the operating theatre looking perplexed. The patient on the operating table has just undergone surgery and needs to be given an antibiotic to prevent infection. But which one? The patient suffers from various secondary conditions. Rink leaves the operating theatre to download a pdf file of a treatment guideline in which he hopes to find a suitable antibiotic. Thirty minutes pass before Rink returns to the operating theatre with an antibiotic.
Rink is convinced that there must be a faster and simpler way to find a therapy recommended by medical organisations. Immediately after graduating with a doctorate in March 2018, Rink, along with medical informatics specialist Henry Müssemann and psychologist Felix Franz, established the company evid UG. The company’s first software product is called evid.one, which is derived from the term evidence-based medicine.
When Rink opens the software on his smartphone, tablet or computer, a diagnosis search box appears in which he enters the word pneumonia, for example. He selects one of the suggested guidelines for this disease, and clicks ‘slight pneumonia and absence of secondary diseases’ on the menu. A few seconds later, the name of the recommended antibiotic and dosage information pop up on the screen.
The founders have since also updated their software with guidelines for blood poisoning and colorectal cancer. They initially want to focus on internal medicine diseases, and will add others later. “Using software algorithms, we can quickly scan through a lot of knowledge and make it tangible,” says Rink.
Standardising queries was far from easy as guidelines do not have a uniform structure. They vary from ten pages for short recommendations to more than 200 pages for detailed guidelines for complex clinical pictures. The software must be able to filter the essential therapy recommendation from these pages. Although electronic decision-making tools are available for doctors, they are little more than digital reference volumes.
Around 30 doctors from four hospitals in Heidelberg and Mannheim have tested various prototypes of the software. The founders want to have optimised the software by early 2019 so that it can be certified as a medical device. "We have to make sure that the software makes no mistakes when it comes to recommending a therapy, and that the user interface is designed in such a way that the user understands it and uses the software correctly," explains Rink, who is the managing director of the start-up. External doctors, currently two in number, regularly check that the software provides correct and up-to-date guideline information. Rink is convinced that certification will give the company a competitive advantage. Due to new European medical device regulations, many medical software products that currently operate in a grey area will need CE certification as medical devices or have to meet more stringent requirements by 2020.
The foundations for the software were laid by Michael Neugebauer, one of Rink’s peers whom he met when he was studying medicine in Mannheim. Neugebauer has developed his own digital decision aid for antibiotic therapy. When he heard about this software in 2017, Rink was really excited. In the meantime, Neugebauer had founded the start-up MediNet IT UG, which offered IT services for clinics and medical practices. And Rink, at that time a doctoral student who also worked as a website and graphics designer to make a living, came on board as web designer.
Rink already had a good nose for technical solutions back when he was a teenager. He loved computers and had set up an Internet platform where anyone could download or share free graphic interfaces for Internet forums. The platform quickly attracted 30,000 members.
Rink joined Neugebauer's start-up in summer 2017 along with software developer Müssemann, the brother of a former roommate. At the age of 29, Rink became the managing director of the company, which is now called Solve Studios UG. Shortly after, Franz, who is a year younger than Rink, joined the company as a freelancer. He has since become a member of the company's managing board, while Neugebauer has left the company to return to the clinic.
Rink, Müssemann and Franz quickly realised that they complemented and worked together very well. Parallel to the customer projects, the three developed a business plan for the evid.one software and in March 2018 founded the start-up evid, which will be exclusively devoted to the development of the evid.one software. "If we want the software to succeed, we need investors. It will be more attractive for them to invest in a company with a clear focus,” says Rink.
At the same time, the participants of the eHealth Forum in Freiburg – mainly doctors – voted the company best start-up of the three that had been shortlisted. "It was really nice that all the work we put into the development of the software was rewarded," Rink says. Of course, the company founders occasionally doubted whether establishing a company was the right decision. In their energetic pursuit of setting up something new, the young entrepreneurs have encountered some headwind, for example when costs have been higher or programming tougher than expected.
The prize money of 4,000 euros was spent entirely on start-up costs. The evid founders are currently trying to acquire additional funds on a crowdfunding platform and from investors. The aim is to programme the software so that the recommended therapy is printed out as a prescription or the guidelines are automatically integrated into the software. They also hope to expand their team. Ultimately, the company founders hope to have developed a software that benefits both the doctor and the patient who will be treated according to the guidelines the software recommends.