Alliance Health offers services to create health-related social networks. So it’s like Ning (Marc Andreessen‘s online platform for custom social networks) for healthcare, except that users can’t self-service and start a health-related network on Alliance Health.

They currently operate separate networks on over 40 physical and mental health issues (see screenshot below). Each community offers the standard fare expected in a online social networking site- discussion forums, videos, posts, reviews, etc. The star performer in their portfolio is DiabeticConnect, which is reportedly the largest diabetic community online with around a million unique visitors monthly.

If you look at the top most active social networking websites today, there are hardly any entries related to health (DXY.cn, DailyStrength, CaringBridge are the only ones). Yet health information is one of the most commonly sought-after content online. So there is definitely scope and need for leveraging social features of internet for health. Doing so on a combined platform increases viability, since the mainstay of revenue for social networking is still advertising. Cumulative audience across all networks is a better sell to potential advertisers.

I have high hopes for Alliance Health. Once the user base is there (like in DiabeticConnect), there are significant revenue opportunities in data analytics and mining. Beyond niche topic-based networks, I think they can extend services to private organizations like large care delivery organizations, insurers to create white-label social networks.

There are exceptions though, perhaps due to changes like Orphan Drug Act of 1983. Take Genzyme‘s wonder drug cerezyme for example. It’s target population (worldwide) are the roughly 10,000 patients affected with Gaucher’s Disease. For each patient, the drug treatment costs $200,000 annually and is needed for life. No wonder that even with that small target market, cerezyme accounts for about 30% of Genzyme’s revenues, netting close to a billion dollars every year ($1.24B in 2008, for example).

Such exceptional, near-magical stories are not limited to pharma wonderland. Patients with some rare conditions have found exceptional support through dedicated online communities started by inspired individuals who are often patients themselves. PatiensLikeMe was started for ALS, for example. Ben’s Friends was started by Ben Munoz in 2006 for AVM. There are many more niche online destinations for rare conditions, and that fact is hardly surprising.

The really interesting trend, though, is the emergence of companies/organizations that offer something at a higher level; beyond just a focused online destination for an uncommon disease. CureTogether is a good example. By aggregating self-reported data from patients, it aims to create an open-source research database for uncommon conditions. Similarly, Bens’s Friends acts as an incubator and clearinghouse of online communities focused on the long tail of rare medical conditions. They claim to have around 25 networks and over 7,000 patients in their family of ad-supported communities. The sites don’t have huge number of visitors, but that is perhaps due to the implicit rarity of target audience. See the quantcast chart below, for example, where I compare couple of their communities that are supposedly the most popular.

Regardless of visitor numbers, Ben’s Friends points to an interesting evolution phenomenon for healthcare information online. Building communities is now old-school. The new set of ideas are at a higher level of abstraction.

Pharma, Media, Government organizations sometimes find themselves in dire need for a quick survey of licensed physicians. They are happy to pay honorariums for a response, but how does one quickly assemble a large enough group of physicians based on a specific criteria (like specialty, location, etc.)? TruthOnCall aims to serve that need. Physicians, verified through their provider ID (NPI), sign-up on TruthOnCall to receive text questions through SMS. If they respond within 24 hours, they earn $10 per question. Once the amount reaches $100 or above, TruthOnCall mails a check to the physician.

Granted that there is a need here. Big companies often find it hard to get any objective granular data on strategic issues- surprise move by a competitor, drug recall in same class, end-of-the-year justification for a marketing campaign, etc. The usual source are industry analyst firms like Frost or Gartner, but the facts in those reports are often too generalized. So getting feedback from a thousand physicians in a few hours can be worth a lot.

But all that depends on the critical assumption of consistent demand and supply. There needs to be enough supply of physicians (in a given specialty) signed up, and there needs to be a demand from an organization willing to pay. Getting the former is the hardest. Metcalfe’s Law from telecom applies here. It’s clear that the value of such a network grows exponentially with the number of connected users in the network. But niche social networks don’t crystallize by themselves overnight. To reach that critical mass (where networks start having “value”), they need significant money or marketing or both. No good way to tell how TruthOnCall is doing with respect to incoming demand and supply.

Some side-notes: There are a few physician twitter celebrities- (@KevinMD, @DeanOrnishMD, @jhalamka, @tedeytan…). Maybe a viable alternative for rapid physician feedback is getting these guys to tweet the question. Generic networks aside, Epocrates is one good example of a viable physician network. Incidentally, this sort of honorarium service is a good fit for Doximity, which is another physician networking startup by the co-founder of Epocrates.

The free app is currently only available for iPhone platform. It offers a staple of standard social networking functionality- creating profile pages, looking up colleagues based on certain criteria, finding med-school classmates, sharing private contact info, sending messages etc. Being mobile-focused gives it some amount of differentiation from other online physician networking sites, I guess. Users can also look up phone numbers and location maps of healthcare facilities like pharmacies but I dont quite see what is the unique selling point in that. Below is a short video demo of some of the functionality.

On to more important things.

Their about page hints at their possible revenue models – “We have a number of fee-based products in the works, including a service for hospitals and clinics to better manage their scheduling and on-call lists“. In an online interview with iMedicalApps, their CEO gave more details. First, they plan to sell a premium version (base version will always be free) to hospitals as a real-time ‘enhanced communication tool’ for physicians so they can get quick consults, updates etc. from each other. That may work, but only if the hospitals or physician groups foot the complete bill for such an ‘enhancement’ tool. I doubt individuals would pay anything for it- enlightened physicians may already have effective substitutes through enterprise EMR messaging functionality or Linkedin/Twitter.

Second one was honorariums given for occasional survey participation. Hmm…don’t think practicing physicians would find that lucrative enough to join, since the time spent on doing such things is almost never worth the money that can be offered in return.

Third one was mediation fee for physician recruiting. Now that may work, but it depends on how they structure the job-exchange functionality. Because there is a real risk of physician recruiters short-circuiting Doximity and approach the candidate physicians directly if they can identify them for free on the network.

Irrespective of the vague details on the revenue model, I’m a supporter of niche social networks. I think the Facebooks and Linkedins of the world are eventually going to be victims of their own success. Beyond a certain size, generic networks risk imploding under their own weight. Just like MySpace did. Professional networks (especially for highly paid professions like doctors, lawyers) need to serve very specific purpose and be fine-tuned to that. One specific aspect that may be served well by a real-time physician social network is scheduling. Enterprise-wide, rules-based smart scheduling that enables physicians to manage their availability in a group setting is a tough problem to solve. There is some analogy to be found in the nurse scheduling space- a startup called YourNurseIsOn. This page explains what they do. That kind of service, I think, is something that large healthcare establishments can find convincing enough to pay for.

By the way, those who know Joomla (the popular open-source content management system) would notice the uncanny resemblance of Doximity logo to Joomla’s logo. Hopefully they will realize it at some point and get a new logo made.

Dec 2011 Update: Doximity changed their logo..

MeYou Health is a ‘well-being company’, in their own words. Their offerings help users engage in a healthy lifestyle, using their social network support. If you are like me, that doesn’t really tell you what they do. So I decided to find out more.

MeYou Health started in 2009, and is funded by Healthways, Inc. Healthways is a 30-year old, publicly traded health services company based in Franklin, TN. They main business is to provide disease management and wellness programs to managed care companies, self-insured employers, governments, and hospitals. MeYou Health seems to be a good extension to what they do.

The current ‘products’ being offered are all aimed at fostering behavior change and provide social support. The available lineup is:

• Daily Challenge: Released September 2010. Sign up through a Facebook account, and you get daily emails encouraging one small ‘positive’ action like eat an apple, rearrange your desk. Points, badges and levels are achieved as actions are completed. There is added social functionality of peer-to-peer competition, benchmarking etc.
• Community Clash: A web-based game that allows players to discover their communities’ health to other U.S. cities by choosing “cards” that represent health indicators such as obesity, smoking, diabetes, etc. The goal of this poker-like game is to bet on which city is more healthy. Underlying data for it is sourced from several databases that were promoted by the HHS led challenge, the Community Health Data Initiative (CHDI). This page lists those databases, and I found it to be a good bookmark of what open-databases are available around certain health-related topics like diabetes, uninsured etc.
• Change Reaction: Another Facebook app that lets you record a small ‘positive action’ and pass it on to your friends. The idea is to create a growing chain of people who do it, and hopefully create a big trend.
• EveryDRINK: A slick Adobe AIR desktop widget that lets you set a daily goal of drinking water, and then subtly reminds you to get a drink periodically.

They have some other under development, listed here. There is no doubt that behavior is a critical factor for healthy lifestyle. And changing behavior is about influencing the micro-choices we make hundreds of times every day (like taking the stairs instead of elevator or skipping soda for water). So there is a role for services that guide and encourage individuals making the right healthy micro-choice.

But such guidance source needs to be omnipresent in order to be effective. What if I end up ignoring my email or desktop alert after the first few times? Or don’t really care about Facebook? Intelligent mobile platforms, ubiquitous connectivity and sticky networks are promising trends that will eventually pave the way for viable solutions. Ones that consumers may even be willing to pay for.

So consider it as the social network that started before the age of social networking. It now offers blogs, forums, reviews, news, feeds, tweets and other community features to people interested in mental health. Seems like they are making a decent revenue with it too.

Always good to see focused, pragmatic and simple solutions being successful. Proves the point that social networking has more potential when done in a niche way.

The crown jewel offering is the educational content- they have 3D medical animations around a long list of conditions. These are meant to help patients and relatives better understand the medical condition. The content is developed by another company (Blausen Medical) and is high-quality, professional grade. I reviewed some of the videos and found them quite useful.

Its been around since 2007 and gets substantial visitors- around 2K+ per month. The site is completely free, and one of the press releases points to their business model “CareFlash is completely free to our users because select industries value having their advertisements tastefully and unobtrusively displayed in the circumstances on which each unique community is based.” Although I didn’t see any ads next to the videos I saw.

There are plenty of precedents to social networking websites for patients, so nothing new from that perspective. But as I read more about this one, it stood apart. The idea of a patient collective focusing on obscure, lifestyle-affecting, painful, chronic and under-researched diseases  and making their raw data available is pretty cool. This WSJ article talks about trend of ‘Personal Informatics’ emerging- where affected individuals obsessively record everything about their life and share it with others. This may usually sound useless and weird, but given the fact that there is no definitive causal understanding of conditions like migraine (even though it affects millions of Americans each year), I find it novel and exciting.

I like this bottom-up, organic approach to furthering research on obscure conditions. Their call for Open-Source Health Research is also an interesting read.  Bit worried by the fact that CureTogether is self-funded. Hopefully they will stay around long enough to claim a large-scale success for one of the diseases.

Although I’d always like to write about novel ideas, exceptions like these are purely from a record-keeping perspective. I’m trying to get a rough list of how many different takes of social networking for clinical professionals are currently floating around on the web.

September 2010 Update: The website is no longer functional.

The site seemed to be more like an offshoot of a professional organization, and not a startup, so I delved further. Seems like MedTrust Online was formed to leverage genetic-based medical discoveries by a non-profit organization called TGen (Translational Genomics Research Institute). TGen and MedTrust signed licensing and service agreements to bring to market potential drug therapies based on genomics.

Not much else to note about the site since I dont have insider access. Their site tour talks about standard features like sharing cases, ask experts, general forums, news etc. It’d be interesting to find out how many of the 30,000 or so oncology professionals are currently members of the site.

Basic idea is for icyou to be the exchange hub for patients, providers and caregivers to share their stories and experiences with the world. Some social networking add-ons like profile page, blogs are included too. The company seems to be well-funded and seriously engaged, given their onsite studio and mainstream press coverage.

I’m not a big optimist when it comes to online video space, but icyou does point to an important trend: massive information sharing platforms like online videos are prone to be more successful (as businesses) when adapted to a niche.  Healthcare is a great example of such a niche. But I’m not convinced if anyone has mastered a straight forward revenue model. Icyou doesn’t mention how they intend to monetize their content either. They don’t have ads running, but even if they did, advertising can’t really pay the bills for such a bandwidth-heavy service.

Anyone can contribute- physicians/Ph.Ds become directors editors (after approval) and others can give suggestions that queue up for editorial review. The site has modest traction but not enough to differentiate it from other wiki-like approaches in healthcare like Ganfyd.org, wikiDoc.org, WikiMD, AskDrWiki and many others (see David Rothman’s extensive list of medical wiki’s here)

There is potential in the wiki-approach, but I’m not holding my breath. Wikipedia may have reached a size and popularity threshold that it remains useful with the community self-policing content effectively, but it was a long an painful journey to that point. Right now the medical wiki space is too fragmented to have an impact.

MedHelp gives the (now) standard online community features to users looking for better information and support around thier medical problems. It was started around 1994 and now draws more than 2 million unique visitors a month.  Perhaps that is why they have long-standing partnerships with the top medical institutions like Cleveland Clinic and Partners Health. Not sure if advertising is the only source of revenue for them- plenty of companies willing to pay for access to this kind of rich data for patient insights.

Jan 2011 Update: Just read that MedHelp has partnered with GE to create a new mobile mood diary app that helps users keep tabs on their mood to better understand their mental well-being. The app, called MoodyMe, is available as a free download on iTunes for the iPhone and iPod touch.

For a site started in early 2007, their numbers are pretty good. Dataopedia shows around 400,000 unique visitors every month. The site self-reports its major user demographic to be females between 25 -55 years. In Dec 2008, it was acquired by HSW International, the digital content company that owns the China and Brazil flavors of HowStuffWorks.com (which itself is a part of Discovery)

Wiki’s are a good way to organize collective wisdom in any field, so the concept is valid. Problem with wiki’s are that 90% of content is written (and policed) by 10% of the users. When your potential audience is not a big number (only 100K or so residents enrolled in US every year) and nature of material necessitates careful oversight, all that translates into a very slow progress for content. Their homepage was last edited in Dec 07 and last blogpost was in April 08. The site draws a decent number of unique visitors though..in range of 5,000. Hope they gain momentum in future.

They are still in beta so maybe other features are in pipeline, but honestly, FoodFeed seems to be a solution looking for a problem. So here is a wild thought- why not transform it into a service for people with food-related conditions? Diabetes, Bulemia, Celiac disease, IBS… the list is extensive for the number of diseases that force patients to monitor what they eat and seek treatment/help accordingly.

Example- say a $9.99/month service for young diabetics who need to log, analyze and accordingly modify their eating habits. The service could take real-time user tweets via FoodFeed and provide the following: an online diary of food, instant ‘nutritional info’ tweet back, offer expert monitoring, and the usual host of social networking features. This hypothetical ‘service’ would be an interesting extension to huge online diabetes communities like Tu Diabetes, or Lunch Clubs. BTW, startups like SugarStats are already twitter enabled, but pursue it only as a way of data input.

September 2010 Update: FoodFeed seems to have closed shop permanently. Rest in peace.

What sets it apart from the usual networking websites is their business model (plus the fact that its aptly explained on a dedicated page) . Within3 is free to individual professionals, and earns revenue by selling software licenses to health and life science organizations who wish to establish online communities inside the platform. There are some nice examples of communities built on their platform- like med school alumni website, medical associations, etc.

Since its launch in early 2006, SpineConnect has gathered 1174 members from 38 countries with a knowledge base of over 900 cases and 4200 reviews (June 2008 data). I’m not sure about their business model, but it has to do with facilitating partnerships to bring innovative spine surgery ideas to market.

My personal belief is that general social networking websites loose their value with scale- there needs to be a common passion among members for the community to thrive. SpineConnect is a good example of a narrow focus community discussing treatment, challenges, outcomes, research and new technologies for a very specific field. All the more better for targeted advertisements . The future of networking is niche… at least in healthcare.

The business idea is to mine the community generated data and monetize it by letting sponsors directly participate and gain real-time insights into physician attitudes and perceptions. They provide online CME (free), journal articles and news/meetings/conference coverage. The standard WebMD fare of Medscape Drug Reference, expert columns and interviews are included too.

Besides searching for personalized health information in natural prose, MyDailyApple users can get relevant medical news and community opinions for their condition. It utilizes the same technology as Curbside.MD (Praxeon’s website for evidence based clinical search for physician users).

MyDailyApple is a Google Health integrated service, which means Google Health users can share their information between the two services.