Here is a half-baked idea that adds another data point to my rant about how keeping a record of health-related activities is useful, and how web 2.0 technologies can help enable such a record. Bedpost is a web application (currently in private beta) that helps in keeping track of user’s sex life. I’ve not used the site myself, but they claim simple functionality- log in after the fact and fill in some fields about it. Thankfully, they also claim ‘zero social networking’ functionality to keep things private.

Sure all this can be a simple iPhone app (maybe there is already one out there) or even a one-line cryptic entry in your google calendar. My point is not to critique the utility of an independent website to track one’s sex life. I’m reflecting on the overall trend of niche health and wellness ‘trackers’ (read my previous posts about FitBit, Proactive Sleep, ZeaLog, Qwitter). Given the myriad sexual disorders (e.g. Erectile Dysfunction) and their probable causes, an application like this could provide rich history for clinicians. Overall, it underscores the importance of web 2.0 technologies in enabling consumers to keep granular, accurate health records.

Practice Fusion is a web-based EMR & practice management system that is targeted towards private practices. SaaS-based EMRs are not new, but what sets Practice Fusion apart is its business model and lineage.

Practice Fusion’s is free. Free software, free hosting, free service. It is  supported by ‘non-intrusive’ ads. They have figured out a way to utilize Google Adsense APIs in a way that is compliant with HIPAA, i.e. doesn’t adversely affect patient privacy. Their CEO said in a 2007 interview that Practice Fusion will provide advertisers with basic demographic information about the physicians who view the ads – such as their city and specialty – but will not reveal names. If the users don’t want ads, they have an option to pay $100/month/provider to make them go away. As for the lineage, the company is backed by SalesForce both in terms of investment and advisory board. I guess that is where they inherit the ‘online, real-time, risk-free, on-demand’ marketing message.

I’m an absolute fan of free software, and believe in the utopian dream of free, ubiquitous EMRs. But I scratching my head on how exactly does an EMR work with an ad-supported model. Fact 1 – Doctors (esp. private practice) doing electronic documentation want to minimize distractions and click on as little items as possible. Fact 2 – Google Adsense sends you a check only if the users click on an ad. Those two facts are contradictory. How many doctors in their right mind will take time out in the middle of care delivery to click on an ad? I’ll bet none. Not many will pay $100 either.

There is some evidence that they charge some unpublicized fees ($50/month/provider “support” fee according to this commenter at another blog Note: Updated: See Emily’s comment to this post).  Practice Fusion claims their user base is now up to 18,000 and they are the “fastest growing EMR” but those sound like marketing tactics rather than hard facts. For example- This press release says that they are “fastest growing ” with 1300% growth rate. Well that is perhaps because they are comparing two convenient times – in early 2008 they had about 1000 users, and in early 2009 they had reached 13,000.

I’ll try not to judge them based on unverified complaints and odd press-releases, but I seriously doubt that good, competitive Healthcare IT software and it’s support can be sustained solely on the basis of only an ad-supported model.

Polka’s mission is to make your up-to-date basic health information available to you all the time, on the web or your iPhone. They claim that their ’secure aggregation and collaboration service’ can help users manage their health. Here is what they offer:

• My Health – An application to store your basic health information (allergies, meds, diagnosis, emergency contacts, and a twitter-ish 140 char Health Log). Available as a 99¢ iPhone app or a free online dashboard.
• If Found+ – A 99¢ iPhone app that can display a short message and contact info on the wallpaper of a locked iPhone.
• My Emergency Info – Another 99¢ app that essentially does the same this as If Found+ but instead of a short message, you can show ’summary health info’. (So how is this different if I choose to write health info as the message in If Found+? I’m not sure.)
• Close Call – A free iPhone app that apparently does the same thing as If Found+ and My Emergency Info. It displays important emergency contact info as a part of wallpaper on a locked iPhone. Don’t know how that is different from the other two 99¢ apps.

Polka is the first funded company created at the Lab2Market progam at UCSD Rady School of Management and they started around mid-2008. I think they are certainly on the right track since the fast-growing, 24X7 access mobile platform is ripe for healthcare information storage and communication.  Except that I’m lost at the product differentiation and pricing level. In terms of competition, there are other In-Case-of-Emergency category apps available for the iPhone like Easy I.C.E for 99¢, EMT ICE for $1.99, Health n Me Pro for $2.99. None of them do any better job at it, though.

There are rough edges to what Polka offers today (tried their online dashboard.. not particularly impressive) but that may be understandable given that they are relatively new startup. iPhone apps are fine, but I think online dashboard may be a stretch unless there is a really ground-breaking, never-before feature that they can offer. Why not integrate with Google Health/Healthvault for the online PHR-like functionality right out of the box?

Primary care is a frustrating experience for most patients as well as physicians. Patients find the experience inconvenient, borderline impersonal and hardly get access to any of their resulting information from the visit. Physicians are hard-pressed for time since they are mostly drowned in paperwork. Considering the rise in HSA, high-deductibles, and no-insurance it’s logical that out-of-pocket payments for primary healthcare will keep increasing.

Myca plans to ride that wave. It’s an outpatient EMR and Practice Management system built with a social networking perspective. Its core emphasis is on enhancing the physician-patient communication and provide a shared ‘dashboard’ that both can utilize. As a patient, one can schedule appointments (or cancel) online, pay with credit card, setup email/video consults, access your record, etc. The service is based on a $35 monthly fee with physician charging $100-$200 depending on the complexity of complaint (see breakdown here).

Using Myca platform, any PCP can setup a subscription-based, consumer-oriented primary care practice. The first such practice is called HelloHealth, located in couple of neighborhoods of New York city. HelloHealth is co-founded by Myca’s Chief Concept Officer (what??) Jay Parkinson who attained fame with his unconventional anti-establishment practice approach couple of years back.

I like the concept. It empowers PCPs to get off the hamster wheel of insurance and invest time in patients. Given enough competition and market acceptance, tools like these can make the old ‘Boutique Medicine’ concept more affordable and efficient. If nothing else, its a sign of service innovation in an orthodox industry.

PS: I’ve been running into a lot of these niche medical practices based on Boutique/Concierge Medicine. They dont have a direct relation to Healthcare IT, but point to an important trend that will utilize IT at its core. Here is an ongoing list of such practices: Qliance in Seattle, Crossover Healthcare in Southern California, MD2 (NYC, Chicago, Portland, Bellevue, San Francisco, Seattle),…

TrialX.org is an fantastic example of how the web enables linking specific demand with relevant supply. The services matches users (patients, affected individuals) to ongoing clinical trials using their submitted personal health information.

What a great startup idea. Service demand can be tapped easily since users are searching the web for highly specific keywords (almost all include the keyword “trials”, so bit of SEO and keyword advertising would direct the traffic effectively). Other sources are the rapidly growing PHR platforms like Google Health and Microsoft Healthvault- both encourage developers to write apps that provide such value-added services based on user’s health information. Supply is readily available on ClinicalTrials.gov, a government-sponsored online public registry of clinical trials in US.

TrialX.org is completely free for users (patients). They let investigators create free accounts to post their trial information directly, but charge a fee for providing access to the interested potential trial enrollee. It’s hard for trial investigators to find eligible patients who are motivated to stick around for the complete trial. TrialX solves both the problems for them.

Imagine the possibilities if this service gets integrated into CIS vendor products. A patient coming in for advanced  breast cancer treatment can be flagged right at admission and be given the option to enroll in an experimental drug trial right then, if they so choose. If nothing else, it’ll give the medical research community a much more real-time opportunity to advance the science.

Your doctor may not think of it that way, but some advertisers feel that the time you spend in the waiting room is important. Phreesia offers ‘PhreesiaPad’: a wireless-enabled touch screen device that replaces the traditional forms-on-a-clipboard you get handed when visiting your doctor.

The idea is that patients enter their information (age, insurance, complaint, history etc.) via its touch-screen interface in the waiting room while ‘enjoying’ drug company sponsored educational material related to their situation. PhreesiaPads are provided free of charge to the physician, and tab is picked up by drug companies. The company claims several benefits like legible information, shorter visits, less errors, reduced data entry, reduced staff time etc. Whatever.

Phreesia is a part of inevitable invasion of electronic medical record-keeping, but my personal irk is with the blatant way in which our healthcare system is giving more and more direct patient access to pharma companies. There is a fine line between ‘educating’ patients and taking advantage of their emotional state to promote your product. Direct-to-consumer-advertising (DTCA) adds unnecessary cost to our already overburdened system. No wonder DTCA is illegal in all developed countries except US and New Zealand.

Collecting patient input electronically is a great idea. It would go a long way in complex, long-standing conditions that require regular physician interaction; like chronic pain, palliative care, geriatrics, etc. In all these cases there is a lot to be gained by understanding patient preferences/attitude regarding treatment and how it affects their quality of life. Often patients can’t verbalize everything they feel and physicians run short on time. Having a tool like PhreesiaPad can enable valuable insights without affecting the clinic workflow much. Not to mention how great it’d be to have such data integrated into the EMR that the clinic is using.

SugarStats is a hawaii-based startup inspired by one diabetics’ unfulfilled need to manage his disease data better. Marston Alfred (the site’s creator) found the online diabetes management solutions boring and inaccessible, so he embarked on crating a clean, user-friendly website where diabetes could track their sugar levels and network with other affected individuals.

They have various analytical graphs and trends, messaging, mobile edition and even twitter integration. I think the concept would have been much more powerful if there was a way to eliminate manual data entry by patients. So integration with blood glucose monitors that can sync data to the website would be great- perhaps using platforms like Healthvault?

Side note: Diabetes is perhaps one of the most well-represented diseases online. There are a ton of resources out there- David Mendosa has a good list here.

Pain is a subjective symptom that is often hard to correctly diagnose and treat on long-term basis. It’s the focus of ReliefInsite- an online web diary for patients with chronic pain. The idea is first to provide a simple platform to record and store pain-related data and provide easy-to-interpret analysis to patients. Secondly, this enables a longitudinal insight for providers into the key medical details that can help their on-going pain treatment.

The functionality includes a neat body map (screenshot below), notes and basic reporting. The business model includes a premium service (starting at $6.95 for 1 month) that exapnds the list of features to symptoms, reminders, advanced reports etc.

The concept falls in the realm of ‘disease management‘ solutions and is shows what future Healthcare IT solutions are going to be: specific and customized. An aggregation of tools like ReliefInsite can jumpstart a real PHR trend, one that is sustainable. Better still, this begs to be an application on the upcoming PHR platforms like Google Health and/or Microsoft Healthvault.