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When building from scratch makes sense
By Presence Product Group
June 15, 2022

Building a digital product from scratch can be scary. It’s hard to imagine in today’s technologically-advanced world that there isn’t a product that already serves most of your needs! By focusing on patient and doctor needs, Presence’s client, Tono Health discovered that they needed to build a completely new telehealth platform from scratch in order to provide best-in-class care to patients with serious medical conditions. Innovative healthcare required an innovative product.

Delivering expert dermatology

Dr. Mondana Ghias, a dermatology resident and co-founder of Tono, is no stranger to innovative medicine. She helped develop breakthrough treatments for Alzheimer's disease, cancers such as chronic lymphocytic leukemia, and severe skin disorders. While Dr. Ghias was working in leading research and treatment centers, she was inspired to expand access to exceptional care to patients all across the country.

Dr. Ghias and co-founder Bryson Tombridge recognized that a new delivery platform, powered by technology, was needed to meet today’s demand for expert-level care. They founded Tono to set out on the ambitious journey to make first-class specialty care accessible to all patients who need it. 

Patients suffering from debilitating skin conditions struggle to access expert care. For example, over 3.5 million patients suffer from Hidradenitis suppurativa (HS), but only 22% see a dermatologist and even less see a dermatologist that specializes in HS. This leads to troubling statistics like patients on average experiencing 3 misdiagnoses before receiving real answers.

Of the existing telehealth tools, none provided a comprehensive, virtual-first experience for serious skin conditions. In order to deliver truly exceptional specialty care, Tono needed a HIPAA-compliant platform that was designed to augment expert providers’ ability to treat patients at scale.

According to Tombridge: 

“We set out to build a digital clinic that delivers care for complex medical dermatology. To accomplish this ambitious mission, we are building a network of expert doctors, and giving them superpowers to deliver world-class care  through the software we built with Presence.”

Building a product that translates best-in-class care, virtually 

One of Tono’s core values is making patients the focus of the care experience. There is a special feeling that comes from delivering and receiving best-in-class care. Tono gives patients the confidence that comes from partnering with a trusted doctor.

Tono’s founders do not believe in the out-of-date perspective that serious medical care needs to be austere, intimidating, and doctor-driven. They envision Tono empowering patients to feel  enthusiastic about taking control of their health. fuseproject and Presence helped build the Tono platform to reflect this patient-centered philosophy, by streamlining doctors’ workflow, so they can help more patients. 

Built on AWS and React/Node.js using Next.js, the patient portal takes the disconnected in-person and online/on-the-phone patient experience and creates a structured online process that expands and improves patient care. The provider portal mirrors the patient portal, but is aimed at helping the specialists do their work more efficiently. Once the Presence team reviewed the needs and design for Tono’s provider portal, they determined that none of the out-of-the box solutions would provide what was needed. 

When creating something from the ground up, digital product development companies can often best serve their clients by identifying where they can leverage existing best-in-class components. Presence used Material-UI (Mui), tried-and-true React components used in Google’s software, to develop the provider portal, which minimized the additional design and development needed for custom development. Presence was able to take advantage of the time saved using Mui to further enhance the patient portal experience.

Bringing a new experience to an old process

Most doctors agree that teledermatology has the potential to solve key access issues for patients suffering from serious skin conditions. However, the medical field needed a new solution to deliver digital care for these complex conditions. While current EHR solutions provide many features, they are not optimized to deliver a virtual-first experience. Patients spend over 99% of their life outside of their 15-minute visits with doctors, and the existing model does not capture the totality of their experiences. 

Tono’s platform combines the comforting parts of the patient-doctor relationship with features that provide more efficient triage and give patients tools to document their symptoms in order to more effectively manage their disease. For example, to maintain the familiar parts of the experience, Presence integrated the Amazon Chime video conferencing tool into both the patient and provider portals so that patients and providers can still meet face-to-face as needed.

The Tono platform sends patients clinically relevant, validated assessments via email to document quantifiable outcome measures that their doctors can easily interpret. Patients can even take photos of their skin to track progress over time. Traditionally, patient symptoms are only captured during in-person appointments, giving providers a snapshot every few months. Now, doctors can get a better understanding of patients’ day-to-day experiences. 

Tombridge remarked, 

”The clinical assessments capture patient progress in a standardized manner. These assessments are usually not integrated into the patient's care outside of formal research studies. When doctors see this [in our platform], it’s one of those aha moments. We give relevant information that is actionable – and cut out distracting red-herrings. It gives doctors the tools to understand the patient’s progress with continuous snapshots of granular data. It’s like a picture coming into focus based on real data points that actually makes a difference to the patient’s care.” 

Tono’s user experience works for patients because the assessments leverage what they know from other parts of their lives.

According to Presence project lead Jon Karlin: 

“The proven patterns in the mechanism of surveying is already a norm with patients in their day-to-day life [outside of the doctor’s office]. We are approaching them with intuitive UX patterns.”

Not only is the doctor reviewing the patient's symptoms, but the platform is also analyzing patient-reported outcome measures to help doctors visualize the overall response to treatment through graphs and charts. Specialists have called the platform “life-changing”  and “a major advancement,” because it provides everything they need in one place and takes care of the tedious, time consuming aspects of managing cutting-edge treatment plans.

Solving for unique needs

Presence often encounters unique challenges that require creative problem solving. Tono is working to address the unmet need for care to treat serious skin conditions - a problem well known to the patients who experience it, and the doctors who treat it. By creating solutions for these problems, the Presence team engaged deeply with the people who know it best – the patients and doctors themselves. The collaboration between Presence, fuseproject, and Tono’s co-founder, Dr. Ghias and her colleagues served a crucial role in designing and building a product that both delights patients, and advances care delivery. 

Tombridge appreciated Presence’s flexibility and expertise in problem solving, which were critical to successfully creating the platform they envisioned:  

Telehealth provides a unique opportunity for many patients to get access to the medical care they would otherwise not receive. While Presence built a custom product virtually from scratch, the platform has broad applications across medical specialties, and will provide the foundation to better serve patients across a spectrum of medical conditions.

If you are seeking to solve a unique problem with a digital solution and could benefit from Presence’s creative problem solving, reach out to us to learn more.