Worried about a coming shortage of physicians?\u00a0 Don\u2019t be, says Cameron Powell, CEO of Physician Cognition.\u00a0 Low-cost providers, such as nurse practitioners, and consumers themselves, he says, will fill in nicely.\nEmpowering them will be what Powell calls \u201cMD-mimicking technology.\u201d Powell\u2019s company is building just such a technology. \u00a0The program, called Xebra Pro, is being groomed to advise healthcare providers and patients about the signs, symptoms, diagnoses and treatment of diseases.\nXebra is being groomed initially for use by healthcare providers.\u00a0 A Web-based \u201cclinician app\u201d has been in testing since April. It can still be accessed online.\nLately the development team has turned its attention to a mobile app, which they hope to make faster and more user-friendly than the current Web-based one.\u00a0 This app is scheduled for release in a few weeks on iOS and Android, according to Powell. \u00a0Apps for the consumer will come out in a few months.\nThe company behind Xebra, Physician Cognition, is Powell\u2019s fifth startup since graduating from Harvard Law School 23 years ago. \u00a0It's his first in healthcare, a company he co-founded with Dr. Vipindas Chengat, a specialist of internal medicine. The others addressed law or business.\n\u201cMy outsider perspective allows me to see clearly what\u2019s wrong with the processes and technology in healthcare,\u201d he says.\u00a0 \u201cAnd I\u2019m not afraid to speak plainly about it.\u201d\nThe medical community is already paying attention to technologies that might empower patients.\u00a0 A peer reviewed paper published in BMJ (formerly called the British Medical Journal) looked into 23 \u201csymptom checkers.\u201d The research team was less than enthusiastic.\n\u201cSymptom checkers had deficits in both triage and diagnosis,\u201d the authors wrote.\u00a0 \u201cTriage advice from symptom checkers is generally risk averse, encouraging users to seek care for conditions where self care is reasonable.\u201d\nBut Physician Cognition\u2019s software is not a symptom checker, which Powell asserts is an obsolete technology.\u00a0 Rather, Xebra Pro employs a cognitive process that Powell describes as being similar to that of a human clinician. Rather than allowing input of one or just a few symptoms, Xebra can handle \u201can unlimited number of symptoms, and all their qualifiers,\u201d he says, \u201cas well as an unlimited number of physical signs, lab results, medications, and patient history inputs.\u201d\nXebra Pro performed well on numerous tests, Powell says, including ones involving the same clinical cases featured in the Harvard study of 23 online symptom checkers in the BMJ.\nThe current Web and the soon-to-be-released mobile apps are primarily intended for providers.\u00a0 These would include nurse practitioners, physician assistants and triage nurses. The cost of these versions would be about a third of the cost that the company plans to charge MDs. \u00a0\nPowell has not yet sought clearance for Xebra Pro from the FDA.\u00a0 A 510(k) clearance \u201cis the most we think we will need even for the lay, or consumer, version coming out later,\u201d he says.\u00a0 \u201cBut the professional version requires that professionals use their own considerable judgment, and it doesn\u2019t provide any final diagnoses or treatment recommendations.\u00a0 Also, our user agreement includes a pretty thorough set of disclaimers, in addition to those we pepper around the site and mobile (version).\u201d\nThe patient-oriented app, which is further from market and has yet to be formally named, will empower patients by documenting symptoms and signs to discuss with their physicians and suggesting \u201cthe most appropriate tests and labs to narrow down the diagnosis quickly and cost-effectively,\u201d Powell says. \u00a0\u201cIf a lab (or imaging exam) suggested by the physician is not on that list, the patient can push back.\u201d\nThe program might even suggest where in the medical hierarchy the patient should go first. \u201cIs this a nurse practitioner issue; is this for a GP [general practitioner]; is this for a certain specialist?\u201d Powell says.\u00a0\nThis is what constitutes real patient engagement \u2013 not just access to records or alerts, he asserts.\u00a0 Xebra, he says, will allow patients to \u201cmeaningfully challenge their clinicians on what symptoms and conditions to consider and what workup investigation to do.\u201d\nPowell describes Xebra as a disruptive technology: \u00a0\u201cImagine medicine without cognitive errors, without implicit bias, without financial conflicts of interest \u2013 and yet with a powerful advocate in every would-be patient\u2019s corner.\u201d\nThe clinician apps, which Powell expects will enter the marketplace first, will generate revenue through subscriptions and upgrades, paid by clinicians and other healthcare providers.\u00a0 Apps designed for the general public may contribute to the company\u2019s top line by any of several means, including advertising and treatment referrals.\nIn the meantime, the software will go through substantial evolution, culminating in the integration of artificial intelligence. \u00a0Currently, its logic is deterministic, Powell says. \u00a0Algorithms dictate suggestions based on collected medical knowledge (e.g., medical texts and publications) that has been and continues to be adjusted by beta users.\n\u201cWe have had almost 1000 users who have been getting on our Web-based app since we opened it up in April in over 50 countries,\u201d he says.\u00a0 \u201cThey have been giving us feedback and improvements in the algorithms since then.\u201d\nWhat drive Powell, he says, are memories of his late mother\u2019s suffering, physically and mentally, following numerous misdiagnoses and late diagnoses.\u00a0 Xebra is intended to reduce those kinds of mistakes. It is an ambitious goal.\n\u00a0\u201cWe will do for clinical intelligence what Google did for information generally \u2013 making it freely available to everyone in the world, regardless of race or religion, income or gender,\u201d he says.