How Cogniciti built a brain health app with cloud services

Jon Reed Profile picture for user jreed August 6, 2014
Cogniciti built its free online brain health assessment entirely with cloud services - and no internal IT staff. CEO Michael Meagher tells us how they got it done.

Three years ago, serial entrepreneur Michael Meagher got one of those phone calls that changes everything. On the line was the board of Cogniciti, who needed his help to forge their brain health research into a public-facing venture. Result: on May 27, Cogniciti launched its free online brain health assessment, a twenty minute offering that has been taken by more than 20,000 respondents to date. The cloud-based system was built without any internal programmers.

Up to now, most of the respondents were from Canada, but as of August 5, Cogniciti is formally extending the test to the U.S. market. Prior to the announcement, I spoke with Meagher about how this joint venture between Baycrest and MaRS came together. Meagher shared the ambitious goals behind the online self-test, and how he built a major web application without a single programmer on his own payroll.

Jon Reed: Michael, take us back three years. You had a massive problem on your hands - or maybe a few?

Michael Meagher: We didn't have to guess whether there was a crisis.  It wasn't our imagination. As the baby boomers continue to age, we find ourselves in the middle of a dementia crisis. Most of the healthcare leaders across the world have identified it as an epidemic.

Reed: And when you started, you had brain health research assets, but not a business model.

Michael Meagher resize
Michael Meagher

Meagher: The Cogniciti board told me: 'We need a clear strategy that makes sense, and then we need to get busy with the job of creating a product and then bringing it to the world. The good news is: you've got lots of smart people around you. The bad news? We only have 60 days of money left (laughs).

Reed: A typical startup scenario then.

Meagher: Right. We managed to take the 60 days' worth of money and stretch it out to 12 months.  In the course of that 12 months, we identified an area we felt was important. That led us to the online health assessment.

The dementia epidemic requires diagnostic tools

Reed: And why is this assessment needed?

Meagher: We have this basic problem of 100 million adults across North America who fit within the key age range of 50 to 79, the time when these memory problems really start to come to bear.  Only about 5,000 doctors are well equipped to perform the diagnostic work on this group.  It isn't a fair fight.

Reed: But an online system can't take the place of a doctor, can it?

Meagher: No. But in that age range, there is a flood of people heading to doctors to get their cognitive health checked out.  Most of them were worried - but well.  That's good news, but it's tying up resources.  Meanwhile, the people who needed help the most are being delayed, sometimes by years, and early treatment is important.

Reed: So how did you seize upon the idea of an online brain health assessment?

Meagher: Based on our research, we knew there was a powerful need in the market to find a way to deal with these 100 million people, most of whom had brain concerns.  We knew that the current healthcare system could not handle the volume of work.  We knew that there was not a product in the market that would go directly to adults and give them a yes/no answer to the question,  'Is my memory normal, or should I see my doctor?'  So we envisioned an unsupervised online solution that would give a clinical result, that would answer the basic question; is my memory normal? And now that solution is publicly available.

Going from idea to public brain health solution

Reed: You went from idea to solution pretty quickly!

Meagher: Well, we knew that Baycrest had the knowledge and experience to get this done. We began the clinical research in the second half of 2011, and started to learn our way through the problems and difficulties of creating that type of an assessment tool. By early 2014, we found that indeed, we could create such a product, and it would be clinically valid. We formally brought it to the marketplace on May 27th of this year.

Reed: The response seems to have justified the effort. 

Meagher: We got a massive response.  It's amazing what you can do with a media release.  Particularly when the story is compelling, and you provide an opportunity to take action. In this case, it's something people desperately want to do, but have never been given a chance. Now, they can take a free, clinically researched brain health assessment.  Based upon that simple media release, we've had extraordinary coverage from coast to coast.  We've had 55,000 site visits from 40,000 unique adults.  We've had 22,000 tests completed - and that's in the course of the past two months.

Reed: You're currently offering the test as a free service. What are the legs of the revenue table going to look like?

Meagher: We've just begun the process of commercialization.  Number one, we need to make sure we've got something that people really want.  The reaction we've had so far helps a great deal towards that. Health care funders is an obvious group, so we're exploring that possibility in Canada and the States.

The pharma industry is the other big one.  If you have an early-stage dementia drug, it's a problem when people only go to their doctors after the symptoms have gone into mid-stage. This has worked very successfully with cardiac care, for people to get to the doctors at the earliest stages of the disease so that they can be treated most efficiently.  If we can get people to their doctors at the earliest stages of a problem, the outcomes are better and the cost is lower.

Building an app without an IT staff

Reed: You're not a developer, nor did you have an IT staff - so how did you build this thing?

Meagher: We did it all through partnerships with cloud services firms. We've utilized the talents of three different groups.  The first was Microsoft Canada, who saw the potential in this at the earliest of stages.  They declared us a global healthcare innovation even before we existed as a product, and offered us help on a couple different fronts as we started the process of creating the product itself.

The second group is a firm called Navantis, which is one of the big healthcare tech partners for Microsoft located in Toronto. Our current provider is another Microsoft partner, Dapasoft - another large healthcare IT firm located in Toronto. Dapasoft  took the handoff from Novantas at the later stages of research and have built us the public solution that we launched on May the 27th.

Reed: Did you have an internal IT manager that coordinated these relationships?

Meagher: The internal person was me. (laughs)

Reed: Cloud can make such collaborations easier, but I imagine you had your challenges.

Meagher: Beyond the IT partners, we had a group of doctors and clinicians at Baycrest who were properly skeptical of business project, because they hadn't seen many of them that did a very good job of sticking true to the science. Equally skeptical were the researchers and the neuroscientists who developed the product. We're quite happy in business with 90 percent solutions, but scientists and neuroscientists and researchers really aren't.  They want to get it right.

Then we had lawyers from a number of different groups.  We had ethics boards to contend with.  We had funding agencies with their criteria.  Finally, we had the executives at Baycrest and on the Cogniciti board.

Reed: So what was the key to getting it done?

Meagher: For a couple of us, the most important job we did was to keep people talking, including the science team and the IT team. Even though the vocabularies were different, we had to stick with it so we could actually find our way through to solutions. From the science team's perspective, we were frightfully fast.  From the business perspective, as days meant money, we were frightfully slow.  I think we ended up with the proper blend, where we actually got the product right.

Reed: And you were able to do much of the 'talking' through online tools, rather than face time.

Meagher: When you've got people lined up on values as well as objectives, then you can use lots of different tools and manage without face-to-face time.  If we didn't have strong champions within the science, executive, and IT teams, we wouldn't have gotten this done.  I'd say that we're a fantastic example of agile development, of actually taking things on, quickly getting them developed, getting them in front of end users or scientists or doctors, get their reaction, and make continued adjustments.

Tackling healthcare data security

Reed: Secure data is a necessity for health care systems - how did you manage that?

Meagher: We made the decision at the beginning to host the reporting on Azure. In 2012, we decided to separate identifiable data from non-identifiable data.  Identifiable data might be an email or a password. The non-identifiable data - that being the results of the brain health assessment - sit on the Azure system.  We built a security apparatus that works with a token. For the briefest moment of time, the token allows the two systems to talk to each other, but effectively always keeps the data bases separate.

Somebody could take all the data from Azure and they'd have lots of really good brain health data, but no privacy intrusions.  Or they could take everything from the other service, and emails would be taken, but nothing else.  We needed a provider that would host the identified data, and we chose CentriLogic.

Reed: It looks like you were able to preserve a good user experience despite the user shifting from two different data locations.

Meagher: The IT team tells me that the time delays to get one from one place to the other is less than a second.  For an end user, it's a seamless experience. A good hosting partner is a lot like a really good sport referee.  You just never want to know they're around, right?  When the referee becomes a story in next day's paper, you know that something went horribly wrong.

You don't really know what you're getting for certain when you sign a hosting commitment, and it's really hard to change hosting providers.  There's a leap of faith. For CentriLogic, we took a leap, and when we put it to the test with a system audit, they worked with us until it came out right. Results from follow-up audits have been immaculate. Without choosing the right partners on the science side, the IT side, and the hosting side, we wouldn't have gotten this done - and we did.

Reed: Sounds like you're ready to take on U.S. traffic capacity.

Meagher: I think we are!

Reed: Good luck - we'll be tracking the progress.

Image credits: Photo of Meagher and brain health assessment screen shot used with permission of Cogniciti. Feature image: head © vege -

Disclosure: Cogniciti has no financial relationship diginomica. CentriLogic PR helped to arrange this interview - CentriLogic has no financial relationship with diginomica.

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