Today, clinical professionals have tools (like Ovid, ScienceDirect, UpToDate, Trip) that help answer complex questions and are connected to validated knowledge bases derived off of sources like PubMed. But how does a patient, with no access or expertise in the domain find and leverage this information? Medify tries to solve that.

The value proposition of Medify is not easy to describe. In fact, the ‘What is Medify‘ description on the site was banal enough to be dismissed, just like most other online social health startup marketing. They do a better (albeit prolix) job on the ‘How it works‘ page. Medify will appeal to the well-informed patients who are not afraid to sift through piles of academic articles burdened with medical jargon to understand and manage their own disease. Medify gives them a dashboard of existing literature – with it they can monitor things like which treatments are gaining traction in the provider community, which institutions are on the forefront of relevant research, etc. Affiliated web 2.0 functionality like faceted search, social sharing, tracking, annotating are bundled in to make it more personal.

Under the hood, it is smartly leveraging what public knowledge bases are already out there. The citation and abstract are free from PubMed. Interstitial phrases and terms in the content are further linked to sources like Wikipedia and MeSH. Brief outcomes or summaries are synthetically constructed from the article text.

Medify is not alone. There are other sites that try to help patients navigate the vast sea of research literature. PubMed’s parent NLM runs MedLinePlus,  UpToDate has a patient-oriented version, and niche startups like MyDailyApple, PatientsLikeMe are also tackling this to some extent.

In 2001 Brian Haynes, MD, PhD wrote an article describing the landscape of such ‘pre-appraised’ resources through a hierarchical structure that had four layers (called “4S” Model):

• Original ‘Studies’ (what PubMed provides) at the base
• ‘Syntheses’ (systematic reviews sources like The Chochrane Library) of evidence just above that
• ‘Synopses’ (like EBM, EBN Online) of studies and syntheses next up, and
• the most evolved evidence-based information ‘Decision Support Systems’ at the top.

He later expanded the model to 2 more layers (read about the “6S” paper here), but the basic argument remained same – Information seekers should begin looking at the highest level resource available for the problem that prompted their search. That is a good framework to understand why services like Medify are needed.

The skeptics would argue that offerings like Medify will do little more than empower hypochondriacs. But I believe that well-served health information only makes outcomes better. The lag time between published research being implemented in real-world medical practice can be in the order of decades. As consumers, we are entrusted to make choices about other important topics like money, and the market provides personal finance tools/services to help. Same can apply to healthcare, without diminishing the role of experts.

Healthline was founded in 1999 as YourDoctor.com and was re-launched as Healthline Networks in 2005. It’s got some deep-pocket investors behind it (Aetna, NBCU, Kaiser Permanente, Reed Elsevier, US News & World Report to name a few) so I’m not surprised that they have managed to create (what they call as) ‘Consumer Healthcare Taxonomy’ of >1 million terms and 250K medical concepts. That is what powers their proprietary ability to organize and present contextually-relevant health information to a viewer. Personally I don’t think of it as novel, given that there are plenty of precursors in the medical ontology area (SNOMED, UMLS…) that match this feat.

So Healthline can power health search in multiple ways (symptom, treatment, doctor, drug) and help consumers navigate to the right information. They have also branched out into health-specific ad network, PHR etc. Regardless, I’m interested in mentioning Healthline because of their excellent 3D Body Maps. They have a neat library of 3D animations that lets you partially control and understand body structure and function. Much like CareFlash. Development of these consumer-oriented educational health content repositories is a positive trend, although it’d be much nicer if all these individual attempts were cataloged in one place, giving a complete guide to educational 3D health and wellness content on the web. Like what Clicker does for Internet television.

Ranting aside, I like the user-friendliness of this site- very easy to navigate and see relevant information. They also do a good job of digging up public information from various sources and aggregate it all in a as-comprehensive-as-possible profile. Was also impressed by the fact that they have a healthy growth in traffic (now more than half a million unique’s every month, according to Compete).

Given the fact that potential users perhaps value ratings/recommendations/comments from other patients most, the biggest issue with all such sites is how to validate such information. In my search for multiple doctors, user ratings were almost non-existent. But even if they were as abundant as on Amazon, how does one establish their authenticity? I was able to submit ratings on one doctor without submitting any proof that I was ever treated by him (in full disclosure, the rating didn’t show up right away so its not that simple apparently. For example, their FAQ page says you can only rate your doctor once a month). Not sure about their revenue model either, since its free for users. Regardless, this is a good site to bookmark, just for getting all the public information about your doctor in one place.

Patients get to use the site for free-  looking up physicians that accept their insurance and setting up appointments with them. Apparently, physicians need to pay to join ZocDoc and their enter availability info. Given their recent start, focus on one metropolitan area, the monthly unique visitor count is significant (20K+ according to dataopedia).

Interesting idea overall, kind of OpenTable.com for clinical care. The fact that you can set up a guaranteed appointment with a care provider today is a great feature (hard to execute in all cases though). What blows me away is the backing they have- Khosla, Bezos and Benihoff! That has got to be the most incredible investment partner team I’ve seen so far in any small healthcare IT startup.

September 2010 Update: ZocDoc is now in San Francisco, Chicago and Washington D.C. too.

The service went live in January this year and initially focusing on Hawaii. The basic ‘interactive consultation’ uses two-way video conferencing, audio and secure text chat. It’s a step-up from the usual definition of a ‘e-visit’ which are mostly asynchronous text-based communication. Patients join for a fee, as I understand (what frustrated me was that I couldn’t find how much the fee was. I would have expected that to be extremely obvious!). Physicians sign up and make themselves available in aggregated pools of their respective discipline, which in turn are tapped into by patient demand.

So will the health plans pay for this? Until now they had signed up only two customers- the Blue Cross-Blue Shield plans in Hawaii and Minnesota. Last month, United Health Group, the largest private health insurer in the U.S., said it would begin deploying American Well’s platform across its huge network of more than 70 million members.

The concept has some viability for sure. But like anything else, it remains to be seen how well it can permeate through the tough, unyielding US healthcare system. I’m sure we’ll see many more startups with similar approaches soon.

Their business model is advertising, where interested companies can push their ads on specific WisdomCards that are most relevant to their target audience. With an average 40K visitors per month, I wonder how that model is working out for them.

Medstory is a health information search engine that went into a public beta in mid 2006. In feb 2007, it was acquired by Microsoft. Their interface is pretty minimalistic, with only a search keyword box on the homepage. The results returned with an option to refine it in various categories like conditions, procedures, trials, articles etc. The google-like interaction and navigation reduces the noise that is usually associated with health related information search.

There isn’t much out there that explains the technology behind Medstory (except vague references to machine learning and AI, like in this CNET article). Anyway, it’s yet another addition to Microsoft Health Solution Group‘s product portfolio that includes the enterprise health information system Amalga and the consumer-oriented Healthvault platform.

The navigation is pretty simple and straightforward. MEDgle’s output is a probabilistic list of disease/conditions based on the user input. The content is authored by their 3-physician team and is based on publicly available information available such as the Center for Disease Control and National Institutes of Health. Where probability estimates were not available, they have used their own practice experience to fill in the gaps.

The need for a healthcare vertical search engine is widely realized, and like everything else, it opens up the ability for potential (ab)use with self-diagnosing hypochondriacs. Skepticism aside, I did a search using a common symptom (difficulty in walking, heel pain) and found it easy to navigate to a list of links and information around bone spur and plantar fasciitis. The “Related Local Doctors” section for finding local providers relevant for your symptoms is a neat idea too.

There is an obvious limit to the utility of such tools- Alexia Estabrook’s blogpost talks about MEDgle’s performance for a more complex query. Although that points to the Achilles heel of any diagnostic decision support system today; it’s hard to model the entire spectrum of disease-symptom relationship in an all-inclusive, 100% accurate way. It has more to do with the ever-expanding body of medical knowledge than the lack of technical prowess. That why medicine is a science and an art.

PS: You can read the interviews of some of MEDgle team members here and here.

I took it for a test drive with a moderately complex question (‘what is the indication for platelet transfusion in an 80 year old female with dengue fever?’) and got relevant results in terms of review articles and clinical trial outcomes. Pretty cool.

The logic behind Curbside.MD is semantic indexing using a controlled medical terminology (they call it “semantic fingerprinting“) with a bit natural language processing. They provide a bunch of tools (search box, news, spellchecker etc.) for partners and a browser search toolbar for users. The technology is also available as an API service from an alternate website called Fingerprint.MD.

Praxeon is the company that started Curbside.MD and MyDailyApple in 2006. Both websites are currently free for users, but the company admits to a future ad-based business model.