Docent Health

Service industries like consulting, hospitality, restaurants or the local car mechanic, are judged on experience. Healthcare folks would like to think that it’s all about outcomes but no one would argue that experience is just as important. And most healthcare experiences suck from a patient’s point of view.

Docent Health caught my attention last year in July when they raised a healthy $15M Series A round from big names like NEA and BVP. Their ‘Docent Program’ is an intriguing service approach, to say the least. They offer docents -people who are familiar with the healthcare system, like ex-nurses- to act as a liaison between the patient and caregivers. These virtual and/or onsite docents integrate with the clinical staff to act as a representative of the patient’s anxieties and preferences.

Fair enough. Can’t argue with the benefits of having a personal concierge throughout hospital journey. Building a personal relationship with the patient allows the hospital to create a better brand impression. That kind of word-of-mouth marketing is priceless and spreads fast. Additionally, the learning from one patient’s preferences may be transferable to the next, creating a patient experience-related ‘best practices knowledge base’ that has never existed in traditional health organizations.

But it’s not a panacea. Revitalizing service experience shouldn’t necessarily be about adding more humans into the mix or creating one more layer of touch points. I understand that the current environment doesn’t allow clinicians to have the ideal 1-on-1 time with patients, but adding a new resource into the mix increases the human interfaces through which information has to travel. A new team member gets added to the physician/nursing rounds and the incumbent care team may not like dealing with someone else on their turf. The overall cost goes up too, since someone is ultimately paying for the added cost of docents. Needless to say this added cost will ultimately be handed-off the patient.

If healthcare service experience sucks, the solution should be to fix the fundamental issues (for example overworked caregivers and unhelpful EHRs). It’s the same argument I make against scribe services: fix the EHR user interfaces rather than adding another minion to the mix.

Criticize someone else’s solution is like shooting fish in a barrel. I realize that the current system is straining while waiting for salvation. Docents may be a good-but-temporary fix but tech-enabled services are here to stay. Omada, Livongo, Virta are good examples of how this trend can transform condition-specific care experience and outcomes.


The service transaction between a patient and physician has always been looked at closely from a billing perspective. Relatively few attempts have been made to enhance the match-making aspect of it: like which physician is best suited for the given patient? Tweaking this may have cascading effects downstream in the service experience and actual outcome.

Years ago, Zocdoc impressed me with their simple solution in this space. It was making it easier to get an appointment with retail physician of your choice. It’s hard to scale the retail small/medium clinics, so they dabbled in employee wellness for a bit and finally settled its focus on hospitals and health system customers.

Amino focuses on figuring out the right physician first and then help with cost-estimation and scheduling. It claims to have analyzed a trove of insurance claims data to figure out the attributes of past interactions of care providers. Using the information that patient’s type in to Amino website (health problem, insurance, zip code, etc.) it can align it with the best physician profile in its database.

The approach has merits since most patients are inherently biased (“my sister says this doctor is great”), lazy (“I’ve always gone to this nearby clinic”) or arbitrary (“I just googled it”, “His name was on the first page of my insurance directory”) in the way they select physicians. Having a good partner in healthcare can make a difference. My curiosity is about their business model – who pays for this ultimately? For now, Amino has enough runway to not worry about it ($20M in three rounds so far).

PS: Kyruus does similar stuff, but for enterprise.



CaretickerLogoI know nothing more about Careticker than what their spartan website says. But the first time I read it, something clicked. Careticker is a sort of personal (health) productivity app that lets users manage their interaction before, during and after hospital stays. I think that is a great niche.

Except for hypochondriacs, no one likes hospital stays. Most of the anxiety related to a hospital stay can be attributed to the fear of unknown. Patients simply dont know enough about what they need do or what is going to be done to them during that stay. It’s like visiting a foreign country with no map or translation tool. That, is where I think niche context-aware companion apps can help. For common inpatient procedures (like hernia, tonsillectomy, etc.) a focused mobile app that gives patients reminders, education, to-do lists like functionality is  a tremendous value proposition.

Note the word ‘focused’. That’s the key. There are plenty of WebMD, MedlinePlus like generic health information apps that have wide variety of conditions covered. But to make the experience worthwhile the app needs to align all interaction vectors and focus on one intervention (or a group of closely-related conditions/procedures). Take a look at the list of most common procedures performed in US: all of them are candidates for an app. An app to remind patients when to stop eating/drinking for surgery, what to expect during stay, read FAQ posted by surgeon, get a copy of handout/discharge summary, etc. etc.

Back to Careticker. It surprises me that with the fundamentals rooted in an interesting niche, why did they pick a generic, already-crowded-with-apps condition of pregnancy as their first product. To be clear, Ob/Gyn is surely the right subdomain since the majority health-related app user skews to female gender. But a sharper focus (like Caesarean section) may have been smarter. The slightly derogatory name ‘Knocked Up’ doesn’t help either.

There is definitely room for growth in the target market. Especially since outpatient surgeries surpassed inpatient a couple of years ago. For a service like CareTicker, the gamut should run all types of procedures, regardless of care setting. Watch out for more entrants in this space.


In the standard healthcare IT media landscape, increasingly all I find are the ruinous signs of bloated, overcomplicated conventional healthcare IT systems struggling to do everything that they claim to do. Alongside that increasingly infertile landscape are green shoots of some startups doing few things, and doing them right.

I’ve harped in the past on scheduling being a ripe area for disruption, perhaps something that we will see being ‘done right’ very soon. Zocdoc is forging ahead, turbo-charged by humungous funding and legendary backers. But it only handles non-emergent situations where both patient and provider have the luxury to find a mutually convenient time.

Nashville, TN based InQuicker takes that value proposition to a new level. Besides facilitating non-urgent outpatient scheduling, it allows patients to ‘hold their place’ online in the urgent care or ER waiting room queues. That way patients with non-life threatening medical conditions can stay at home till it’s their turn to be seen. ER and Urgent Care Centers avoid overcrowding and patient frustration. The operational benefits of having a smooth flow in such round-the-clock care delivery centers is huge from a staffing, customer satisfaction and overall efficiency perspective. Which is why InQuicker has a growing list of participating facilities that underwrite this free service for patients. The conspicuous absence of a mobile InQuicker app is a bit odd though. This is a perfect context for mobile solution.

Enabling just-in-time operational strategy for emergency care operations… it’s a small but important piece of the overall process of delivering healthcare in a efficient and cost-effective manner. If you expect the incumbent EHR, EDI, HIE vendors or payers to get to this, don’t hold your breath. Pragmatic innovation like this will happen faster at the periphery of the perceived center of healthcare IT. InQuicker was founded in 2006, and has never raised a single dollar of venture capital. Their 2012 revenues are expected to be around $4. That, is a sign of a real business.

The need has not gone unnoticed by others. ERExpress, ERTexting are already there as direct competition. iTriage (now a part of Aetna) takes an almost similar approach with their ER wait times and check-in features.  ZocDoc may very well get into it with relative ease. Regardless of the competition, InQuicker is a great example of what laser-sharp focus can do in a nascent, over-regulated industry. Look out for such small and significant success stories in other healthcare IT sub-niches like clinical analytics, consent management, diagnostic decision support, care collaboration, transition of care, PHRs etc.

Sandalbay Life

The personal wearable-sensor devices trickle that started with FitBit around 2008 is now starting to look like a flash flood. For every one offering that has got media love (like Basis), there are perhaps five other being incubated (like Node).

It’s an embryonic market, and one that is tackling complex health problems with commoditized sensor technology. Every smart inventor in a garage seems to be capable of doing something about it. So a few things are bound to start happening now:

  • Event Managers will take notice. Exhibit A: Quantified Self Conference
  • Doubts on where does this lead us or what we learn
  • Hardware and software platforms that unify the myriad devices start sprouting

Sandalbay Life exemplifies the last. It’s is a young startup (started last last year) at LA-based accelerator StartEngine. Not much information out there about details of the offering, but their aim is to provide a single software platform for manufacturers to leverage. Given the device and format proliferation, it makes sense that someone should try to manage the complexities of dealing with application and network security, cross-platform performance and reliability issues, etc.

“Providing the white-labeled consumer software for manufacturers to utilize”, as Sandalbay Life founder Neil Malhotra puts it in an interview, is smart, since so many of these offerings are from small players. But the big guys are noticing it too. Qualcomm’s 2net platform is going to be close competition. It too, is a cloud-based system designed to be universally-interoperable with different medical devices and applications and provide easy access to the aggregated data.

I’m also not sure how to align it with other platform approaches that are already out there. Biggest one being Microsoft Healthvault. Healthvault may not be white-labeled, but does provides a way for device manufacturers to contribute their data to a PHR. They do have API’s that let a developer get to the unified Healthvault data. Plus they have a fast-growing ecosystem of devices and apps that are integrated with it.

There are smaller, but committed players going at the aggregation value proposition from multiple angles: Digifit (cardio), WellDoc (disease management) for example. Open-source grassroots projects (OpenYou, Cosm, LockerProject, are surfacing too.

The play for sensor manufacturers to have a common platform for reducing their development cost is valid. Remaining value propositions (single app for consumers, unifying data from multiple devices, giving providers tools to create workflows and insights, etc.) all come with crushing competition. Plus the whole field of personal wellness tracking is too nascent – we need the devices to take a hold in the mass market before aggregating platforms truly become a viable business themselves.

2017 update: Sometime in the last few years, Sandalbay Life has recalibrated its offering to be more about wellness training programs. More about services than data aggregation.


Among other things in healthcare, the care transition process is also broken. For example, outpatient care usually ends with the provider summarizing for the patient their medical issue, instructions on next steps, etc. Ideally, the key takeaways are given to the patient as printed handouts, prescription instructions. But as most of us who have been a patient would know that printed medical artifacts are cryptic and conversational details fade away rather quickly. So for a recently diagnosed Crohn’s Disease patient, the label on prescription may inform about corticosteroid treatment details but remembering doctor’s talk about it’s cause, lifestyle changes, treatment options etc. is not easy.

Jiff is a company that is focusing on ‘reinventing healthcare communications’ (their own words). They seem to have two offerings to that effect so far- JiffPad, and Circle of Health. JiffPad is an iPad app that allows annotations and notes to be overlaid on educational content and sent back/forth between provider and patient. Circles of Health allows the creation of niche social health networks around an individual so caregivers can educate and collaborate (like CareFlash). The apps are free for patient, but Jiff plans to make money from  providers through app licenses, storage space (!) and possibly sponsored content.

With that background, the ‘reinventing healthcare communication’ mission of Jiff makes sense. It’s a lofty goal though, since there are multiple incumbent players who own the digital workflow that Jiff is intending to lubricate. Exhibit A – EHR offerings. Where do the physician/nurse documentation (like H&P, Progress Note, Discharge Instructions..) live today? EHR is not only the easy answer, it’s the legal answer. So unless provider annotations on JiffPad are integrated into the EHR workflow and considered part of the medico-legal record, they create yet another silo of information. Beautiful, user-friendly, cool iPad app. But on it’s own isolated digital island.

Exhibit B – PHR offerings. Personal Health Record space may not have a clear winner, but it certainly has a growing number of players in the game. Neutral platforms like Microsoft Healthvault and Indivo along with EHR-tethered or insurer-sponsored offerings are all vying to be the patient’s personal health record. Unless Jiff plans to be yet another PHR platform in the fray, integration is needed at this end too.

Exhibit C – HIE, ACO offerings. One of the reasons for creating complex geo-political health information exchanges is to be able to engage patients in their own care. If ACOs are going to make a buck from bundled payment model, they need to make sure patients are involved in their own care. Other drivers like Direct Project based messaging (the ‘how’) and Meaningful Use (the ‘why’) are emerging as well. All of these are rooted in the clinical information/workflow that is generated by EHRs and other point-of-care tools. Again, Jiff platform needs to find it’s footing in real clinical or administrative workflow to be viable long-term.

I rest my case for high barrier to entry. If Jiff can re-state their mission to be about ‘care coordination’ rather than communication, there is scope for a new entrant. Inpatient discharge, palliative care, oncology services… there are numerous care transition points where better communication is key to better outcomes. A compelling offering across care settings that is well integrated with local workflow systems would fly off the shelves.

I admire all startups. Esp. the ones with the cojones to take on established, orthodox players. But as I read this quasi-cheerleading post about Jiff, I feel that the romance between healthcare and tech entrepreneurs has reached a feverish pitch. Yes, conventional healthcare software artifacts are ugly, inefficient and low-tech. But not because healthcare professionals want them that way. There are legal, political, real-world constraints in care delivery because medicine is an art, not a perfect science. Unless the disruption is from or with the players that own the underlying digital workflow (like EHRs), it’s prognosis is not good.