• 7 min read

Triage.me and 10g.io Take Home Top Honors in Twilio’s Developer Contest to Build The Next Great Twilio App on Windows Azure

Twilio just announced the winners of its Developer Contest, where developers built awesome Twilio apps running on Windows Azure.  The contest, which was launched in concert with the “Meet…

Twilio just announced the winners of its Developer Contest, where developers built awesome Twilio apps running on Windows Azure.  The contest, which was launched in concert with the “Meet Windows Azure” event June 7, awarded the winner up to $60,000 of Windows Azure usage over two years through Microsoft BizSpark Plus. Moreover, both the 1st and 2nd place winners received a generous amount of Twilio credits and a full pass to TwilioCon2012, plus unlimited bragging rights.

The Winners!  

Dan Wilson (left) and Mark Olschesky (far left) took top honors with Triage.me, an app that helps people find local medical care by allowing patients to text a local number with their location. The app replies with information about the nearest health care clinic and suggested transportation methods.

A Close Second!

Chris Holloway (right) and Jacob Sherman (far right) came in second place with their stock market app 10g.io, which makes it easier to manage and analyze the stock market.  The app provides SMS notifications that a user can set up for any major market changes, updates or just keeping up-to-date with their favorite stocks. Click here to watch a video about 10g.io.


Interview with The Winner!

I had the opportunity to chat with Mark Olchesky to learn a bit more about their winning solution, Triage.me.  Read on to find out what he had to say.

Himanshu Kumar Singh: Tell me about yourself and how Moxe Health came about.

Mark Olchesky: Moxe Health is a two-person operation based out of Madison, Wisconsin – it’s me (Mark) and Dan. We worked together at Epic, one of the major Healthcare IT and Electronic Medical Record vendors. We met each other while working on the same assignment together at Children’s Medical Center of Dallas. We bonded over troubleshooting enterprise printing errors and routing hospital charges. At the beginning of this year, we decided to begin working together on our own projects.

We were working on a Case Management solution when we went to the Milwaukee Build Health hackathon in March. We didn’t expect much to come out of the event; we went there trying to identify engineers we could recruit. But, the end result of the event was the first prototype for triage.me.

HKS: What problems were you trying to solve with Triage.me?

MO: A representative from one of the hospitals in Milwaukee came to discuss the city’s combined effort from hospitals to help prevent Emergency Department (ED) misuse. ED misuse is one of the largest problems healthcare organizations face today. Nationally, there were 124 million ED visits in 2011, of which the Center for Disease Control & Prevention (CDC) estimates 50% could be handled in a primary care setting. With an average charge for each ED encounter approaching $700 vs. the average physician office charge of $150, every patient redirected away from the ED saves the payer $550. This represents a total potential market savings of $34 billion for facilitating correct use of primary care.

Providing people with the tools they need to find appropriate care everywhere saves everyone, hospitals and patients, money and time. Patients receive a SMS from triage.me post emergency room discharge. By sending a text to triage.me with their problem and current address, we route the person towards the nearest clinic, providing the address and a link to directions (for smartphone users). Many clinics that work with the underinsured also often have variable hours and locations. We’ve made it easy for these clinics to update their hours and location via SMS so that we can better route triage.me users to locations.

HKS: What solution architecture approaches did you consider? 

MO: We knew that text message based communication was central to our design for triage.me. Not everyone owns a smartphone, particularly in the demographics that we aim to serve. I had worked some with Twilio in the past, so it was a great way to quickly provide SMS functionality under the quick dev timelines of a hackathon. Our company was already a BizSpark partner member and I really liked using C#/.NET/MVC 3/SQL Server for healthcare IT applications. Specifically, the integration between MVC3 and SQL Server makes it easy to quickly create forms, scripts and reports customized for our users, both patients and clinical users (nurses, case managers, public health officials)

While at its most basic roots I could have written the base application in Rails or Django, I knew that as with most Healthcare IT applications that triage.me would eventually need to provide more complex reporting or integration with other systems. This is something that is not only supported well by .NET platforms, but it’s something that Hospital CIOs and technical teams are familiar with architecturally. It’s a strong technical solution both architecturally and politically, which is why we ultimately went with our Microsoft stack.           

HKS: What cloud vendors did you consider and why did you choose Windows Azure?

MO: Since the hackathon, we looked at EC2 and Rackspace in addition to Windows Azure. Right now, Windows Azure’s offer of a BAA with companies like ours is the clear differentiator for Healthcare IT. We can trust Windows Azure with sensitive patient information and to stand with us instead of having to bear the entire burden of problems and fines associated with potential data breaches in the cloud. Cloud hosting has always been more affordable, but not always feasible due to that sensitivity for patient data. Now it’s something that we can engage in, which is helpful to us as we’re starting out as a company.

Of course, the added benefit to us to use Windows Azure is the direct integration with Visual Studio tools. Simple Web Deploy to staging and production environments is a major benefit to productivity. 

HKS: Can you provide details of how Triage.me works and how it uses Windows Azure?

MO: The workflow kicks off when a user texts or uses the web form on triage.me to look for care. We ascertain that the person has a low acuity, i.e., they don’t need to go to an emergency room. We then ask the user for their location and their problem (headache, needs a pregnancy test, etc.). This is where the heavier computing happens. We receive the text message inputs back via XML, which we parse and then analyze on a number of attributes that we have stored on Windows Azure SQL Database. At its most basic level, we are analyzing the user’s proximity to the nearest open clinic. At its most complex level, we’re analyzing the person’s problem to route them towards a specific clinic specialty (Pediatrics, psych, OB). This involves a lot of calculations that are occurring in real-time. LINQ to SQL not only makes this easy to code, but also operates blazingly fast. The SMS conversation returns responses back to users within seconds. As a result, within 30 seconds of interaction we’ve provided a specific recommendation of a clinic for a user to go to via SMS, tailored specifically for them.

Triage.me is deployed on a Windows Azure role for staging usage right now. We will be moving our production usage to a Windows Azure role soon.

For clinic staff and professional end users, we use Windows Azure Caching to handle session variables across cloud servers and services. We were initially storing everything on Windows Azure SQL Database so that we could transition our database to a locally hosted SQL Server group, but now that cloud hosting is a more viable option, we’ll look towards using Windows Azure VMs and Windows Azure Tables to handle our database storage as necessary.

HKS: What benefits have you realized with Windows Azure? What are the benefits for your customers and end-users?

MO: There are two major benefits that we’ve found with Windows Azure. The first is the cost. We never want to charge the uninsured for our services, nor do we want to charge community clinics or FQHCs that work with this population. As such, it’s essential to keep our operating costs low. Receiving free hosting from Microsoft as a result of BizSpark and now winning the Twilio-Windows Azure contest has helped us a lot in getting our project off the ground. Into the future, as we expand our services, knowing that we can deploy our solutions through the cloud will keep our costs low. 

The second benefit is the flexibility that we’ve been given for deployment options. Our architecture is not the limiting factor in our ability to deploy a solution for our customers. As such, we can spend more of our time focusing on building new tools to help people in need.

HKS: What are your future plans with this solution, and otherwise? How do you plan to leverage the Windows Azure benefits you just won? 

MO: Right now, we’re working on securing a formal pilot in a city so that we can provide routing solutions that fit within the community’s public health initiatives. While our tools work well independently, we know that we need to engage hospitals and payers to provide more focused recommendations and to facilitate the patient transition to primary care.

As for the Windows Azure benefits, we’ll be expanding our Windows Azure usage into hosting our production deployments. I’m also looking forward to experimenting with the new VM capabilities for data storage options.

HKS: And lastly, why choose a bee for your logo? : )

MO: Our logo and mascot is a bee because at Build Health where we created triage.me, we were sharing space with a beekeeping convention. Beekeepers were regularly walking in and out of our room. We’ve kept the bee around because we like to think of our routing services like a bee: when it knows where it wants to go, it makes a “bee-line” to its destination! : )


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