Ray Bradford is convinced technology will change the way we interact with our doctors. And it starts with an iPhone app that lets you get prescription drugs for your acne.
With Spruce, out today, Bradford's taking a fresh approach to the strange emerging phenomenon known as telemedicine. The app doesn't try to pipe appointments over video calls. It doesn't attempt to put a doctor in your pocket. Instead of doing a bunch of things awkwardly, it aims to treat just one condition–acne–very well.
Bradford acknowledges that people might be wary of healthcare that lives on their home screen. "Naturally, there's a lot of anxiety here. Is it safe? Is it high-quality?" he says. "Because it's a new model, it can't feel janky. It's gotta feel like, 'Wow, there's a lot of attention to detail here.'" Thus, the idea with Spruce wasn't to give people an experience as good as a visit to the dermatologist. It was to give them something even better.
An Asynchronous Appointment
Bradford, who left his role as a partner at Kleiner Perkins to start Spruce last year, describes his app as a new way to visit the doctor, though that requires a fairly elastic idea of what constitutes a "visit" with a doctor in the first place. At no point in using the app do you communicate with a dermatologist in real time. Instead, everything happens asynchronously. You create an account. You take a few pictures of your face with your selfie camera. You answer some questions about your skin, and jot down whatever personal questions you might have. Then you send it off.
The whole process takes no more than a few minutes. The app's bright, cheerful design is reassuring in the same way that a bright, cheerful doctor's office might be. "Since it's a new way to see the doctor, you don't want to make it cold or too sci-fi," Bradford says.
Within 24 hours, a certified dermatologist in your state sends you a personalized treatment plan, with the appropriate prescriptions filed digitally to your pharmacy of choice. (To start, Spruce will be available to patients in California, New York, Florida, and Pennsylvania.) By keeping overhead costs for doctors low, Spruce is able to offer a flat rate for the service: $40.
A Better Visit
Bradford says this asynchronous design makes life easier for all parties involved. As a patient, you can start to take care of your skin problem in a few minutes, instead of scheduling an appointment and waiting a few weeks. Currently, Bradford says, only twenty percent or so of people who have acne bother seeing a dermatologist at all. An app like Spruce vastly reduces the activation energy required to get treatment.
For doctors, who use an accompanying app for treatment, Spruce offers the freedom to set their own schedule. They can take care of their new patients from an iPad, anywhere and anytime, with far less administrative tedium than an in-person visit.
Bradford thinks that there are plenty of places where specific, thoughtfully-designed solutions will be able to improve the status quo.
The design process, which lasted a year in all, focused on the doctor's experience as much as patient's. In talking to doctors, Spruce heard again and again that existing electronic medical record software was too cumbersome. "They talk about 'death by a thousand clicks,'" says Megs Fulton, the company's lead designer, who joined from Facebook.
To combat this, Fulton and company consciously tried to minimize the rote input required from doctors, leaving them free to spend their time on the more personalized aspects of the treatment. "We feel like that goes a long ways toward making things personal," Fulton says.
Expediency and flexibility are two benefits of treatment-by-app, but Bradford thinks the approach could offer a more comprehensive experience in a few small but significant ways. For one thing, Spruce becomes a sort of clearinghouse for all things related to your acne treatment. It has information about whatever creams, ointments, or pills you were prescribed, and detailed instructions for using them. It has a sort of FAQ, which Spruce created with the help of dermatologists, where patients can find recommendations for approved moisturizers and sunscreens, and get the straight dope on topics like how diet effects skin.
Spruce also makes it easy to check back in after the initial "visit". In addition to getting assigned a dermatologist, the app links patients with a "care coordinator" who serves as a sort of nurse and front desk person for the whole experience. You can message this skin care concierge in the app—say if you're having trouble getting your insurance sorted out, or if you don't quite remember which order you're supposed to apply your creams. This gets closer to the sort of thing we typically think of as the benefit to telemedicine: instant, lightweight access to a real person who can address small questions and concerns.
Spruce does a remarkable job of taking something that could easily feel weird and making it feel very normal. The app is just as intuitive as Lyft or Yelp, except that instead of getting a ride or a restaurant you end up with a little tub of prescription-strength Benzoyl peroxide. In that sense, it really does seem like some sort of step toward a whizbang health care future.
The question, of course, is if the approach makes sense anywhere else. After all, acne is just about the only thing you can diagnose from a selfie.
Bradford's firm that the vision for Spruce goes beyond pimples. He thinks that there are plenty of places where specific, thoughtfully-designed solutions will be able to improve the status quo. Acne might well be uniquely suited for remote treatment, but future Spruce efforts could ease health care pain points in other ways. "We see technology complementing the doctor, not competing with or replacing the doctor," he says. "It's how you let doctors do what they do best—which is using their judgment, and caring for patients—as opposed to repetitive, rote things, or administrative paperwork."
Bradford won't divulge what other conditions Spruce is thinking about tackling just yet. But he does point out that as gadgets like the Apple Watch, with its sophisticated health-related sensors, flood the mainstream, the opportunities to transform health care will only expand. Technology moves fast, and while health care moves slow, Bradford's convinced that the latter will inevitably catch up with the former.