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Breaking News: Emergency Medicine's Own Google

Shaw, Gina

doi: 10.1097/01.EEM.0000446048.66123.58
Breaking News


Timothy Peck, MD, said he felt like he was drinking from a fire hose of multimedia medical information while he was in medical school at New York University School of Medicine. “Especially on my emergency medicine rotation, there was so much out there to learn from, and I didn't know how to consume it,” he said, now in his final year of emergency medicine residency at Beth Israel Deaconess Medical Center in Boston. “There was no one leading the way and showing me what was valued, what was trusted, what was useful, and what wasn't.”

So Dr. Peck created his own “trusted user” library, an ever-growing list of blogs, podcasts, online journals, and other online multimedia resources. He shared it with friends, and together they would vet, critique, and update the lists.

Those curated lists were the inspiration for a new EM-specific search engine, iClickEM, that Dr. Peck launched in beta version in December, releasing 1,000 access codes for early adopters to test the site.

iClickEM, Dr. Peck said in his own blog, Teach, MD, “will host all EM knowledge on the entirety of the Internet that is relevant to the EM provider. This knowledge will be delivered by powerful artificial intelligence, which grows smarter with every use. The more EM physicians who use it, the better the results will become.”

What does that mean? Well, it doesn't mean the original incarnation of iClickEM that Dr. Peck developed during his first year of residency. That version was entirely manual, with no artificial intelligence or machine learning. Users would enter a resource, and Dr. Peck and a team of volunteer emergency physicians would assess and rate the resource.

“That failed completely,” he admitted cheerfully. “It was way too work-intensive, but that failed experiment really energized me. I knew this was a good idea, and it could work, but I needed computer scientists and people from other fields, not just emergency physicians.”

A few months later, Dr. Peck was approached at a Harvard symposium by Lonnie Kurlander, MD, a Boston University medical student with a business background who saw the potential in iClickEM. Drs. Peck and Kurlander soon teamed up with Stanford radiologist Celina Ansari, MD, and Glenn Willen, a former project manager at Google, to create Parzival, a company that creates specialty-specific vertical medical search engines.

iClickEM is Parzival's first baby. “If this works, we feel that it really will change how emergency physicians — all physicians — consume information,” Dr. Peck said.

What makes iClickEM different from other search engines, Dr. Peck explained, is that it has artificial borders around its content. “We have a space in which to experiment where we have control and let only certain things in. Ideally, when iClickEM is fully realized, if you're an emergency physician at the bedside and you have a specific question, you can put it in the search bar and what comes back will be the best resource — the most relevant as well as the most valid — to answer that question.”



And all resources compete on an equal footing at iClickEM. “We're putting blogs, textbooks, journals, podcasts, all the resources available online head-to-head,” he said.

With input from a Content Advisory Board that so far includes half a dozen leading emergency medicine experts (such as Life in the Fast Lane's Mike Cadogan, MD, and EMLyceum's Anand Swaminathan, MD), Dr. Peck and his team started by including certain trusted domains within iClickEM's borders. He ticked off examples: “Life in the Fast Lane, SmartEM, Leon Gussow's Poison Review. Anything that comes from domains like those, newly published or updated, comes in automatically, and we no longer have to go in and review them.”

The artificial intelligence portion of the search engine will assess many aspects of how people use the tool: “There are multiple parts to the algorithm, and we can play with it by putting more or less weight behind specific parts,” said Dr. Peck. “Clicks are one element, of course, but then there are other factors: how long do you spend on the page? Where did you go next? Did you put it in one of your collections? Did you share it? Did that person share it? Or if one trusted source says something good about another trusted source, that flags the system, and says, ‘Hey, this is something important,’ so we can adjust the weight.”

The classic “impact factor” plays a role here but not in the same way that it does in other general medicine searches. “Of course, we're putting in the New England Journal of Medicine, which has an impact factor of something like 50, compared to 1.5 or whatever for the Journal of Emergency Medicine,” Dr. Peck said. “But for us, JEM is more relevant than NEJM except for the NEJM stuff that really affects us as emergency physicians.”

The site isn't ready for prime time yet, Dr. Peck acknowledged, noting that they are now working with another company to investigate how to understand questions better. Right now, it works best when you use single search terms, such as “hyperthyroidism.” The site then returns the best, most relevant resources for emergency medicine and hyperthyroidism. “But it doesn't work as well at interpreting questions, such as, ‘What is the best treatment for fever in a person with hyperthyroidism?’ That's just around the corner, though,” he said.

Tech guru Alex Mohseni, MD, a partner in the DC-area Emergency Medicine Associates who writes EMN's Doc APProvED column, sees great potential in iClickEM. “As clinicians, we're all somewhat overwhelmed with the amount of information out there and the constant changes in that information,” he said. “In emergency medicine, it's even more challenging because we have to deal with every single field of medicine. Anything that helps you curate all that information and identify what's valuable and trusted is great.”

He quickly spotted some favorite elements. “I like that you can see which articles have been looked at the most and linked the most by your peers, not just the Internet. That's really valuable. And the interface looks really nice in terms of color and style.”

But Dr. Mohseni said iClickEM still needs tweaking to be more intuitive. “I clicked on a blog, and then I thought, OK, I like this. What do I do so I can keep it and not search for it later? The workflow isn't immediately obvious, how you manage the stuff that you especially like.” He pointed to the wildly popular “social magazine” app FlipBoard as a potential model, a comparison Dr. Peck called “dead on.”

Dr. Peck and his team have limited their beta users to about 800 physicians, some flight nurses and critical care nurses, and a few physician assistants and fourth-year medical students. “We're getting great feedback, and learning a lot from the analytics,” he said.

When will the mature version of iClickEM go live? A lot of that depends on money. “We're pretty close to closing on our first round of seed funding, which would allow us to get some computer scientists and heavy-duty servers, and go on from there,” Dr. Peck said. He said he is optimistic that will happen soon.

Dr. Mohseni said he hopes it does. “It's a tough problem they're trying to solve,” he said. “You have a limited time to read, and you want information that makes sense and is most valuable to you. But they're on the right track, and the overall concept is absolutely fabulous.”

Keep up with the growth of iClickEM by contacting Dr. Peck at or by following him (@TimothyCPeckMD) or the company (@ParzivalInc) on Twitter.

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