MedCredits: How it works

Simplicity and reliability are our primary objectives in the design of the MedCredits platform. Below we outline the basic features of our first product release, Hippocrates, which is our teledermatology app.

How will it work?

• Download the app
• Snap a photo of your skin lesion
• Click the buttons choosing your age, sex and brief description of the problem
• Pay in MEDX

What happens next? The case is broadcasted to the MedCredits network of dermatologists. The first doctor to respond with a diagnosis and medical recommendation closes the case making it unavailable to other doctors. In this model, doctors compete for the patient’s business in a free open health market. Motivated to receive payment for the case, doctors will respond as quickly as possible. The result? Fast diagnoses.

After the initial launch of MedCredits, we will build a robust global network of doctors. Taking advantage of time zone differences, doctors will be available at any time to review cases. With our open market model, we suspect that turnaround time on submitted cases could be as fast as minutes. From the time of downloading the app, a patient could have a doctor’s recommendation in minutes. All from the comfort of home.

Verifiable

In a free market system, how do we encourage high quality evaluations? MedCredits will use both a reputation-based system and smart contracts for case validation.

In our reputation system, each patient will rate the doctor after receiving a diagnosis and recommendation. It will be a 1 to 5 star rating system. Third party agencies that verify doctors’ board certification status can then use this reputation system for quality assurance. In turn, these agencies will prosper by charging doctors subscription or one-time certification fees. Over time, these independent agencies will develop reputations for certifying high quality physicians. These agencies will receive their own ratings on the platform, which will be a weighted average of their doctors’ ratings. This weighted average will be based on a variation of the Bayesian Estimator, outlined below.

Weighted Rating (WR) = (d ÷ (d+m)) × R + (m ÷ (d+m)) × C

Where:

* R = average doctor rating for that agency
* d = cumulative number of doctor ratings for each agency
* m = minimum number of doctor ratings (d) required to be a rated agency
* C = the mean doctor rating on the network (only doctors with a minimum of 10 completed cases are included)

In later product releases, patients will be able to elect to only be evaluated by doctors verified by specific agencies. Doctors will be incentivized to have this stamp of certification, as it will include them in the highest paid pool of doctors.

To maintain a good reputation, agencies will decertify any “bad actors” within their doctor network. For example, if a doctor’s average rating falls to 3 stars, the agency may give the doctor a warning. If the doctor continues to receive poor ratings and falls to 2 stars, the agency may decertify the doctor. Once decertified, the doctor will no longer be included in the pool of certified doctors and would therefore be limited to lower evaluation fees.

The Smart Contract

In addition to the above reputation system, good behavior will be financially incentivized through the use of escrow in Ethereum’s smart contracts.

• The patient submits the evaluation fee PLUS 50% to escrow. After a doctor evaluates the case and submits his report, the patient confirms that the doctor’s response was either appropriate or inappropriate. A patient has 24 hours to respond before the smart contract automatically transfers payment to the doctor.
• If the patient is satisfied with the doctor’s evaluation, the additional 50% will be refunded back to the patient’s account.
• If the patient is dissatisfied and challenges the case, the case will go for validation and is re-listed in the pool of cases. From the doctors’ perspectives, initial evaluation cases and validation cases are indistinguishable.
• If the diagnosis by the second doctor matches the diagnosis by the first doctor, the smart contract sends the initial fee to the first doctor and the additional 50% to the second doctor. From the patient’s point of view, this can be seen as a discounted second opinion. From the doctor’s perspective, the second doctor is completing the same amount of work as the first doctor, but is getting paid less. This reduced fee is distributed among the doctors though. For example, assuming only 10% of cases go to validation, the overall average doctor fee is still 95% of the fee for an initial evaluation.
• If the second doctor’s report differs from the first, then the initial fee is refunded to the patient and the additional 50% goes to the second doctor. The initial doctor receives no money in this encounter. Since doctors cannot know which cases are initial evaluations and which are validation cases, doctors will always be incentivized to perform quality evaluations.

In summary, MedCredits is a global platform that utilizes Ethereum smart contracts to govern robust reputation and verification systems allowing patients to obtain expert diagnoses in minutes.