Dr. Jessica Knox, Medical Director, NurX
Terrence Nelson: Could you briefly describe what Nurx is and the services that you provide?
Dr. Jessica Knox: Nurx is a tele-medicine startup and our main purpose is to put healthcare back in the hands of the people by making healthcare more accessible through our app. Currently, we offer couple of different service lines, one is birth control. We offer pills, patches, rings and emergency contraception. We also offer Truvada which is a daily medication for HIV prevention. What's different about tele-medicine service is we allow patients to access the basic prevention medicines without a doctor's visit. Patients can come to our website, request the medication, complete a health history questionnaire and then that request will be reviewed by one of our doctors. For birth control a patient will get a prescription and the medication is mailed to them and then automatically refills for a year. When it comes to Truvada, we will order their labs and have the patient visit a local lab to have their labs drawn. If all is good they will get their prescription written and it will be automatically refilled for 3 months until they need to repeat the lab process. Nurx’s goal is to use technology to improve patient’s access to preventive medication to make that and to make the easier process for them.
Terrence: What need in the marketplace did you identify to develop the concept of Nurx?
Dr. Knox: One of the co-founders (Dr. Edvard Engesaeth) is a physician and his friends would call him on Friday nights because their girlfriends were running out of birth control and they were hoping he could refill their prescriptions. Which is actually a common situation among physicians in that their friends call them to request prescriptions when they cant make it to their primary doctors. So that's originally where the idea came from and our other co-founder (Hans Gangeskar) who is not a physician, was interested in offering Truvada services and felt like there was no reason it couldn't be offered in a more convenient way. Also, the primary issue with Truvada is that the access to it is very poor and a very small percentage of people who should be on Truvada are actually on it. Due to a of lack of education there is also a stigma associated with going to the doctor and discussing your sexual health risks and asking for medication that will protect you from HIV. Patients have shared a lot of stories with us about going to their doctors and asking for Truvada and have been shamed out of the office and told they need to make better sexual decisions for themselves. Both birth control and Truvada are medications that still have a lot of stigma and judgement involved in the prescription of these medications so Nurx works around those barriers not only making access easier but also enabling patients to connect with healthcare professionals who believe in these medications.
Terrence: How does Nurx use its digital influence to educate along with providing medication?
Dr. Knox: We are in the process of developing educational content so when patients visit Nurx’s website or app for medication they can also poke around and learn a lot. Currently we really focus a lot on consultations when prescribing medications. I spend approximately half of my day responding to our patients questions, we’ve created an environment where patients feel very comfortable messaging Nurx because our patients feel very comfortable communicating with us about their sexual health and medications.
Terrence: How does technology affect the communication between patients and medical professionals?
Dr. Knox: The way we interact with our patients is very different than a more traditional model where you sit face to face with a doctor in their office. Most of our communication happens through our secured messenger through the Nurx platform which enables our patients to log in to our profile and message us directly and they’ll receive a response within 24 hours. Patients have given us feedback that they feel much more comfortable asking us questions than their primary care physicians. Our platform makes it easier to discuss difficult topics and since it's not a live chat people have time to think about and research the questions they want to ask us. Furthermore, they get to think about the information our doctors have provided them with and do research and come back more informed about their health and that really empowers people. The other piece to our communication is that if we aren’t able to fully gain an understanding of a patient's specific issues we can still pick up the phone and talk it through.
Terrence: When it comes to women’s health specifically, how does technology change the privacy landscape?
Dr. Knox: Removing the need for women to physically go to the doctors office and go to the pharmacy is adding an additional layer of privacy. By using Nurx women don’t have to sit in a waiting room with 30 other patients peering at you (laughing) or having that person at the pharmacy looking over your shoulder. Also, many women find it difficult to find a doctor whom they are comfortable having these conversations with. An interesting twist to that, is the fact that we’ve found that most our patients have no problem taking to social media and promoting the fact that they are using the Nurx app. When we ask our new patients how they learned about our service, more often than not it's because a friend posted about us on one of their social media platforms.
Terrence: What kind of response has Nurx gotten from other doctors or healthcare providers who aren’t necessarily as progressive when it comes to tech and health?
Dr. Knox: Overwhelmingly positive surprisingly, but we have had some negativity thrown our way as Nurx has gained more notoriety. There have been doctors who have expressed concern about taking the prescribing of birth control out of the doctors office. Their concerns primarily have been based on the perceived lack of sexual health consultations or services especially when it comes to minors. We’ve done a lot to fight these misconceptions about Nurx because they simply are not true. We often have to remind health providers that CDC guidelines state that there is no physical exam required to prescribe birth control so physically requiring a patient to come in for that service is not necessary. Nurx also does in fact provide sexual health counseling so we’re not leaving patients void of any resources.
Terrence: What is your long term vision for tele-medicine?
Dr. Knox: My grand vision for tele-medicine is to have it fully scaled up and eventually have the tools to make it the norm for preventive and primary care. That technology would enable people who are otherwise healthy and don’t necessarily need to be in a doctors office for something like a sore shoulder to be served by a healthcare provider remotely. That would enable people who need acute care to have more time in the doctor's office or the emergency room. With that said, in my perfect world we would be able to re-allocate patients based on their actual needs so that highest acuity, high cost care in the hospitals, emergency rooms and doctors offices are the people that actually need to be there.
Terrence: What does innovation mean to you?
Dr. Knox: Innovation is the application of tools to a problem to create a solution. You can innovate every and anything it's just a matter of reimagining how a system can work better and using or creating tools to bring that imagining to fruition for the improvement of that system of that experience.