Ignacio Hernández Medrano

Ashoka Fellow
headshot_ignacio_h._medrano.jpg
Spain
Fellow since 2017
This description of Ignacio Hernández Medrano's work was prepared when Ignacio Hernández Medrano was elected to the Ashoka Fellowship in 2017 .

Introduction

Ignacio “Nacho” Medrano is creating Savana, the first on-line platform of medical knowledge, based on the agglomeration of millions of patient records and the use of sophisticated computational technology, aimed at empowering every medical doctor with the best possible medical insights, no matter where the point of care is.

The New Idea

Founded in 2014, Savana is an online platform of medical knowledge created by doctors for doctors, that collects qualitative information from millions of electronic medical records and, thanks to computational and linguistic intelligence, provides every doctor with the best possible medical information worldwide . Ignacio has created a hugely powerful real time input for the medical community, no matter who or where the doctor is.

Ignacio stresses that the key success factor for diagnosis lies in clinical medical records. “The essence of great medical care is the combination of guidelines and “mindlines”: the qualitative knowledge that a doctor gets from the patient and from observation”. Only a minor fraction of a doctor’s work is “science”, according to Ignacio – himself a practicing neurologist - and the rest is intuition, experience, time, recommendations from other professionals.

With an original statistical and probabilistic approach Savana mines and analyse millions of anonymous patients’ records to create a knowledge base where individual information is no longer relevant. Relevance comes from the trends and conclusions that can be extracted from the sum of millions of different pathologies and treatments.

Ignacio combines this with state-of-the art technology that allows for linguistic recognition (for example, some doctors may use “migraine”, while others may prefer the term “headache” – Savana ensures a comprehensive analysis taking into account linguistic variables).

Whilst much has been done to democratize access to scientific publications (see uptodate.com, ClinicalKey or DynaMed Plus in the US, 3clics in Spain), Ignacio has identified a way to gather, analyze and distribute the cumulative knowledge and experience of case histories to support all doctors in treating their patients. And he has done this with the active collaboration of many different stakeholders in the health sector: doctors, health managers, hospitals, public and private institutions. As the
value to users is immediate, hospitals, health clinics and individual doctors are immediately incentivized to contribute with their own case histories. With a powerful tool like Savana, he has transformed these actors not only into beneficiaries of the platform, but into providers of information and resources, strengthening the virtuous cycle needed to ensure efficiency, high impact and systemic transformation.

In a constantly changing medical world, Savana allows the sector to effectively manage exponential increase in knowledge and research, and use it as an asset, rather than a hindrance. Ignacio has changed the way doctors think and work by helping them swap models: from an individual growth based model to a common knowledge based model. This means going from an "I think" to a "we all know" mindset. This is a social revolution not just a medical one, Savana is dedicated to transforming tons of raw medical information in usable and extremely relevant knowledge, breaking down entry barriers, contributing to level the playing field, reducing the variability between more and less experienced doctors, and granting easy access to knowledge, regardless of location, personal experience or network.

The Problem

Access to accurate and updated medical information ensures better medical treatment. Unfortunately, not all doctors have the time, resources, competences or skills to access the best possible knowledge. Twenty years ago, doctors would attend approximately one conference per year and read ten or twenty papers to be up to date in their area. Nowadays, the amount of information generated is impossible to assimilate.

This challenge is worsening, as medical knowledge grows and “science inflation” (as Ignacio calls it) rises exponentially and faster than professionals can follow. According to an article published in the National Center for Biotechnology Information, it is estimated that in 1950 it took 50 years to double the amount of medical research, reducing drastically to 3 to 5 years in the beginning of 21st century. In 2025, the quantity of knowledge will double each 73 days, as some sources have projected.

For students who graduate in 2020, what is learnt in the first 3 years of medical school will be just 6% of what is known by the end of the decade. Knowledge is expanding faster than our ability to assimilate and apply it effectively; and this is as true in education and patient care as it is in research. For this reason, only one in five medical decisions are rigorously evidence-based. This uncomfortable phenomenon, variability, is undoubtedly one of the worst enemies for patient treatment and care.

The most common sources of information for medical doctors are academic research papers and training. For the former, some innovations have been designed to gather the knowledge collected in research and academic papers, to facilitate access to the latest publications in an organized manner. Nevertheless, these, although effective, do not take into consideration the collective experience, successes or recommendations of doctors across a country or continent. They ignore the millions of clinical records that, until now, due to organizational and technical challenges, were fragmented cells of knowledge.

Regarding training, in Spain, virtually no public budget is destined to training practicing doctors. Learning relies mainly on the professional’s initiative and time, and private companies’ funding of learning experiences.

In Spain, over 80% of doctors are general practitioners or family doctors. Ageing population means that doctors have even more patients under their care while healthcare budgets and the number of doctors employed remain stable. Although the national health system is often considered exemplary and inclusive, it is currently under great pressure, to the extent that doctors´ appointments have been reduced to just 3 minutes per patient.

In smaller cities or rural areas, the access to information, recommendations or a support network in case of doubt is even smaller, with virtually no specialists and only one general practitioner for several small towns.

The Strategy

Ignacio is empowering doctors and healthcare managers converting complex medical information in very relevant and usable knowledge. Savana uses computational intelligence, combined with big data collection, to develop a search engine able to understand complex medical terms and to process complicated medical information.

Savana accumulates millions of clinical records that are then anonymized and aggregated in order to build essential new knowledge, made accessible to health professionals to support them in their daily decision-making process.

As a neurologist and entrepreneur, Ignacio has been the key medical engine to the process. Ignacio knew that access to knowledge was a barrier to patient care, and he was determined to develop a database that would be accessible to all regardless of geographic location.

For this, he has built a core team of three experts; one in business management, one in technological innovation and himself as medical expert, who work alongside computational linguists, programmers and mathematicians. This team’s combined work has resulted in the first software tool able to read and understand human medical language available to healthcare professionals, offering helpful and insightful information to improve efficiency.

Faced with the particularly difficult challenge of innovating in the health sector (due to the scientific rigor required and the strong emotional element linked to the medical profession of “saving lives”), Ignacio has developed an ingenious strategy and designed three different solutions to engage hospitals, doctors and managers:

1. Savana Management: Hospital management teams
Savana Management is the strategic point of access to hospitals and allows the necessary patient record database to be built.

In order to lure hospitals into this transformational movement, Savana Management offers them a very strong added value: Their state-of-the-art platform uses collective knowledge that allows management teams to increase efficiency, to measure best practices and to carry out routine audits on medical services. The module has been designed to generate data on hospital indicators such as average length of stay, re-admittance or pharmaceuticals prescribed so that management teams can make decisions based on hard data. Savana Management was designed for doctors by doctors, and as a result has a very high level of acceptance and appreciation among professionals. The module is licensed to the hospitals for a monthly fee (1.500 – 2000€) and the requisite for use is that all the hospitals’ patient records are included in the platform.

In this context, Ignacio has disrupted the medical system by accelerating a mind-set shift among senior managers in favour of considering the benefits of data sharing. Once hospitals see the impact and benefits of Savana Management, they become very willing to contribute with their own data.

In less than 18 months Savana Management was installed in 25 hospitals in Spain and in one of the most recognized hospitals in Latin America, Las Condes Hospital in Chile. These 26 entities have generated more than 20 million clinical records, essential for the efficiency of the second part of Ignacio’s strategy:

2. Savana Consult: Hospitals, general practitioners, individual doctors
Savana Consult is the platform’s ”raison d’être” and core service, conceived to help rapid, real-time decision making in the consulting room. Savana Consult mines and analyses the information in 20 million medical records across Spain.

The actual interface can be interpreted as a “medical Google”. When faced with a specific medical case, the doctor enters key words in the search engine to identify other cases with shared characteristics. Savana Consult finds the most common and relevant aspects for the case, in terms of medical instructions (for example, most prescribed drugs, referrals to specialists, demographics of patients etc.) and presents them to the user. The platform has different filters so that the consulting doctor can fine-tune the results depending on the needs.

Although Savana Consult is useful for all doctors regardless of the point of care, it is particularly relevant in smaller cities and rural areas, where the number of specialists is limited. Doctors in these areas can use Savana in cases where their medical experience is limited, tapping into the cumulative knowledge of other medical histories, supporting them in the diagnostic process.

Access to this knowledge base will be revolutionary in developing countries, where healthcare is extremely variable and access to specialists is rare. With this in mind, income from Savana Management will allow Savana Consult to be offered to individual doctors at a subsidised price (estimated at around 8 Euros per month).

3. Savana Research: Hospital Research teams, individual doctors
Savana Research is designed to allow doctors to pull data is required for specific research or clinical investigation. Without Savana Research, if a doctor wanted to see, for example, how many +40 year-old males die each year of a heart attack, they would need to go through each patient record one by one as there is currently no automated shared process. Savana research automates this process at high speed, and facilitates complex data to any professional user.

In the near future, a sufficiently large amount of information will be able to mathematically predict disease in patients before they happens, moving medicine from reactive (care when the health problem appears) to proactive (prevention and anticipation).

Examples of Ignacio´s impact range from unifying successful treatment (for example, showcasing the positive result of breast cancer patients with a given drug treatment), highlighting relevant trends in different patient diagnosis to create new protocols (for example, Savana identified that Alzheimer diagnosis is often followed by a traumatology consult, as the patient is more likely to trip or fall) and recruiting specific patients for clinical trials.

As a further example, Savana Consult has been extremely important in helping isolated paediatric doctors in diagnosing and prescribing for whooping cough. This disease, which had been eradicated in Spain, reappeared in recent years and paediatricians were not familiar with symptoms or treatments. Ignacio’s tool connected apparently isolated cases and allowed for effective diagnosis and a reactive protocol to control the outbreak.
Savana is currently set up as a social enterprise: Ignacio markets Savana Management to hospitals (1,500 - 2,000 Euros per month per license, depending on the resources and size of the hospital). He charges 8 Euros on a monthly basis per license (per doctor) for Savana Consult. With this model, Savana Management provides the basis for economic stability, and allows the team to scale Savana Consult for higher social impact.

Savana is growing to expand to more regions in Spain and other Spanish-speaking countries, and is currently developing the technology in English, to guarantee a worldwide revolution in medical treatment.

The Person

From a very young age Ignacio had already shown his motivation to create positive change around him, mainly as a result of his parents, his school education and his Scout membership.

Ignacio’s parents have had a significant influence in his life. Both are doctors, and they were a major influence in his decision to choose medicine as a career path. They also introduced Ignacio to the Scout movement from a very young age, and he has lived by Scout values since then, actively following and often repeating the well-known motto: “Leave this world a little better than you found it”.

Aged 19, he spent a summer working with the Jesuits in rural Mexico, helping in a local health clinic and teaching English to underprivileged children. His near-death experience with cholera convinced him to move back to Spain, and gave him a completely new outlook on how health is managed. Ignacio knew that he wanted to become involved in making medicine more inclusive and accessible. Whilst specialising in neurology, he spent his evenings studying for a Master’s Degree in Health Planning and Health Management.

After completing his specialisation, Ignacio was given the opportunity to coordinate and train over 500 newly qualified doctors. In this period, he was often recognized for his work, winning the prize for the hospital’s “best doctor”, converting the center into the best hospital for medical training. However, it also allowed him to experience first-hand their difficulty to cope with the information overload.

He took a job at the Ministry of Health with the intention of getting into public health management. It was while he was working at the Ministry that he began to work in data mining and discovered its potential, marking his future path. He understood that changing the world is easier through innovation than through public policies, and won a place at the Singularity University, where his idea was considered one of the 20 worldwide projects able to impact 1 billion people in 10 years. He recalls this as a tipping point for Savana, and an opportunity for him to develop entrepreneurial skills, which he had little access to as a doctor.

Ignacio dedicates most of his time to Savana, but maintains a weekly consultation in order not to lose touch with patient care. This contact allows him to continue to understand patient idiosyncrasies and to contribute to software development with practical experience.

Ignacio is currently positioned as an opinion leader in digital health and data analytics applied to healthcare. He has become a reference in the field, participating almost daily in meetings and conferences, influencing professionals to adopt information technologies to improve healthcare.