Hugo Stephenson is floored by the growth of iGuard, the consumer-oriented online medical monitoring service he started last year with financial support from Quintiles.

iGuard turns one this month. When it was launched, Stephenson expected to have perhaps 60,000 people signed at this stage. Instead, iGuard now has 750,000 members, and that is expected to surge to 1 million by year’s end.

“We’re sitting where we had hoped to be three years from now,” says Stephenson, a drug safety expert, previously president of strategic research and safety at Quintiles, but now president of iGuard. “We’re overwhelmed, but it’s a good problem to have.”

Fast Growth

iGuard allows users to register for free, type in the prescription drugs they’re taking, and anonymously create a health profile. When the FDA issues advisories about drugs or drug interactions that may affect them, or new research on those drugs emerges, iGuard members get an email or a text message alert.

Upside for consumers: handy, free, personalized drug safety information.

Upside for iGuard: A rapidly growing database that it can deploy for drug companies looking for epidemiological data or subjects for in silico or traditional research. That is, if consumers have given their permission. Approximately 90 percent do, says Stephenson.

Mining the Data

iGuard’s database has already been tapped by several drug developers. Some are hoping to clarify emergent or subtle safety signals—signs that a drug may have a certain side effect—before plowing more resources into a full-blown trial. The classic drug safety problem boils down to a mathematical fraction: a numerator of people having a problem and a denominator of the total population of similar patients. 

“They often don’t have a denominator,” explains Stephenson. “They say something like, ‘Hey, look, can we send this survey out to your members to try to figure out how many have had dental problems over a six-month period? Then we’ll compare it to patients who are on our drug and see if there’s a problem we need to look at.’”

Reimbursement Strategy

Or a drug maker might notice that patients are switching from its asthma inhaler to a competitor’s. iGuard can look up such patients, and then blast an email to ask why. For answering such surveys, patients are paid between $10 to $25.

Other sponsors use iGuard in an epidemiological manner, tracking patients longitudinally, which is easier than establishing a traditional registry.

Instant Registry

iGuard, says Stephenson, can find patients in a variety of therapeutic areas quickly and inexpensively. It might take 12 to 18 months to set up a drug registry the old-fashioned way—finding and hiring investigators, who then need to find and enroll patients. Using iGuard, no investigators are needed. Instead, targeted surveys are emailed out and, due to member loyalty, responses come back quickly.

Cost? It’s priced on the basis of “communication with the patient,” explains Stephenson, who adds that setting up a robust registry of about 500 patients through iGuard can run about $100,000, compared to millions to set up a registry with investigators at various sites. iGuard is clearly capable of driving down cost-per-patient metrics.

Insurance, Too

iGuard has also assisted insurance companies. “They may want to, for example, make an investment in diabetes, but first want to see what do people on insulin think is lacking in disease management today?” explains Stephenson.

Stephenson is particularly excited about genomics and genetic testing. One customer, he says, noticed its drug was working for some patients and not others. They asked iGuard to gather people from both groups, and then request that they do a buccal swab and send it in, allowing the sponsor to test for genetic differences. One such project recently took just 45 days, says Stephenson.

Channel Partners

At times, the results Stephenson gets stun him. One drug maker wanted to find patients with acromegaly, a rare disorder of the pituitary gland. Stephenson surveyed iGuard’s membership and quickly came up with 40 members with the condition. “I was shocked,” he says.

Currently, iGuard is marketed through 28 “channel partners.” Those are websites that run iGuard ads and e-prescribing companies that drive patients to its site. There are also hundreds of pharmacies and doctors that recommend iGuard to patients, even providing a paper registration form. In such cases, iGuard employees can perform the data entry of the patients’ medications.

Patient Patients

Due to the massive numbers, the website is a little slow these days, Stephenson concedes. It generates 30,000 safety checks per day. At times, iGuard has had 1,000 people trying to sign up at once. Sometimes those folks have to wait an hour to get into the system.

iGuard is lean. It has just six full-time employees, six consulting pharmacists and uses a “small server farm,” he says. Stephenson says there are three central lessons to date. d9A2t49mkex

Patients Like Email. Consumers are far more interested in getting email alerts than in going to a website to get personalized news alerts and other health updates.

Give Something Tangible. An online service like iGuard would not succeed if it was exclusively web- and email-based; many consumers prefer to hold something in their hands to trust that nothing improper is going on, says Stephenson. That’s why iGuard equips doctors and pharmacists with paper registration forms.

Offer Immediate Rewards. Stephenson predicts that the projected growth of electronic health records (EHR), with data supplied by patients themselves, will only occur if patients feel they are getting a valuable benefit now. Organizations spending millions to get patients to participate in completing an EHR for the benefit of doctors or insurance companies should take heed.

“Registering with us means creating a mini-health record, but it’s not presented like that,” Stephenson says. “It’s presented as, ‘Do you wish to get safety alerts?’ Seven out of 10 people say yes. There has to be immediate, tangible benefit to the patient or they won’t act.”

Is iGuard turning a profit? No. Not yet. The company is projected to do that in 2009, says Stephenson.

For now, the focus is on continuing to register more members at a rate that won’t overwhelm the system. Once membership has hit one million—likely at the end of 2008—Stephenson says iGuard will pull back on channel-partner advertising in an effort to slow down member recruitment.

From there, he and his team will be able to shift gears. They will focus more vigorously on recruiting patients for trials, which is really iGuard’s primary objective. “Once we hit a million,” says Stephenson, “we can pretty much identify patients for anything.”

by Suz Redfearn 

Editor’s note: This and this are two previous ClinPage articles on iGuard. Since this article was published, iGuard has been renamed MediGuard.