In an effort to understand what is unique about Zumi Life, I stumbled upon this interview with its CEO. Crunchbase tells me that they started with $700k seed funding in 2007 and got a Series A infusion of $1M in April 2008. With that context, several questions come to mind. Zume Life needs manual input for all the data it needs from the user- and that assumes the user to be reliably putting it in. If Zuri had a sensor to automatically capture the critical vitals (like Zeo, Bodymedia, DirectLife, FitBit, LifeShirt and scores of other devices), that would make it infinitely more useful. But I understand that there is no automatic sensor for your mood or for what you ate, so somethings need to be captured manually. Which is why there are services like RememberItNow, Reqall, Zealog, Polka etc. Still, why not get the medication list for Zuri from PHR platforms like Google Heath? If we assume that the chronically ill and overworked individual remembers to input their care regimen in one place, why wouldn’t they use a simple paper sticky note or a smartphone reminder app? Even a simple Google Calendar or 30Boxes event can be configured to deliver reminder emails that show up as audible, sms alerts on your phone. So is there really a need for a dedicated hardware device in a world that is slowly converging mobile computing platforms? Zuri reminds me of the device that is made to do twitter only.

The price tag was also a bit of surprise. Although there is no official mention of pricing on the Zume Life website, I found a PCmag article from Sept’09 that quotes $35/month or $300/year for the service, and $4.99 for the iPhone app. That sounds way too much money for a basic alerting and journal-keeping service that is 100% manual entry based.

Of course, it’s easy to criticize others idea. I don’t have the complete facts on the service, its utilize and its founder’s vision. The overall trend of using patient-oriented hardware devices integrated with web and mobile dashboard/analytics to manage chronic conditions is for real. I just think sensors are a key aspect of such devices and that pricing can be Achilles heel for adoption.

Zeo system consists of a wearable headband that measure brain’s natural electrical activity. Although their blog has a high-level explanation of how it works, my understanding is that its a single-channel EEG, which seems to be a reasonable way to do sleep analysis in healthy individuals. That data is wirelessly transmitted to a bedside display and stored on an SD card.

Algorithms based on proprietary logic churn out a personal sleep score (called ZQ) to quantify the type of sleep you get. The display unit looks like a bedside alarm clock and shows current and past 2 weeks worth of sleep analysis. Also has some smart alarm clock features like SmartWake alarm that wakes you up at the most suitable time within half-hour of set time. You could upload the data to an online sleep journal through the SD card. The website gives graphs, trends and the ability log other supplementary lifestyle data that can affect your sleep. All that for $249. An additional $100 would get lifetime access to a personal sleep coaching program, which includes regular assessments, goal tracking, email tips etc.

There is no question that Sleep Science is a serious, mature field. Zeo can find its place as a useful adjunct for plenty of sleep-related disorders that affect people who are otherwise healthy. It’s not an FDA approved 11 channel medical grade polysomnogram, and it’d be a mistake to compare it to one. It’s perhaps a closer analog to Actigraphy where a wearable sensor measures overall motor activity during sleep. An actigraph unit is an accelerometer based device like the FitBit, WakeMate or Axbo.

Accurate or not, Zeo is yet another proof that healthcare is slowly being transformed by sensor-based, portable devices that are capable of analyzing data in a consumer-oriented way to enable individual patient to manage their conditions better.

FreeMD is the free online version of the same underlying triage application. It  uses video to conduct the interview, ask questions and then generates a custom web page that contains care instructions and suggested next steps. I tested it with a few hypothetical cases (from benign nose bleed to serious UTI) and it seemed to do fine for basic diagnosis. With vague complaints like diffuse abdominal pain and vomiting, it stayed roughly in the right categories at a high-level (appendicitis, pancreatitis, kidney stones, gallbladder disease, intestinal obstruction).

Is the underlying logic based on hierarchical structured programming or a more sophisticated expert system with forward and backward chaining algorithms? I don’t know. My interest in FreeMD spiked when I saw the 100K+ unique visitors/month statistic. They are consistently generating a lot of traffic, so there’s got to be fairly comprehensive content and at least some utility in the service. My personal impression is that as a patient-oriented triage tool, it does well. Of course, provider-oriented decision support is tougher and I don’t expect it to hold up like Mcyin or DXplain.

I’m also intrigued why DSHI systems chose to make their application available for free, when the revenue model seems to be based on licensing/co-branding with partners. I was half-expecting to see a feedback loop on FreeMD (like “Was this the right diagnosis? Let us know”) since one of the major reasons for open-sourcing anything is to leverage wisdom of crowds. But there isn’t anything like that, so maybe its all about gaining awareness and marketing the application.

Update: Connected with Dr. Steven Schueler after writing this post. He correctly identified that FreeMD is a triage system, so its a bit unfair to compare it with diagnostic decision support systems like Mycin/DXplain.

I was fortunate to see a demo last month. At the core of the offering is a set of remote sensors- a heart rate monitor (worn as a strap around torso) and a stride sensor (clips on to shoes, and measures stride pattern, distance and speed). These communicate wirelessly to a central unit called ‘Pacer’ (MSRP $139.99) which connects with your mp3 player and gives audio feedback about things like calories burned, distance, workout progress etc. Another peripheral that communicates with both sensors is the ‘Zone’ (MSRP $69.99) which is worn on wrist, and gives constant visual feedback (using colors) about your heart rate zone. Pacer connects and syncs to the personalized website, zone doesn’t. Coupled with all that hardware are workout ‘plans’ for your goals like run faster, get fit, loose weight, learn to run or to reduce stress.

My initial impression is that it all sounds too complex and too expensive. But maybe this is legit functionality for people who are serious about running. For the novice consumer who wants to track daily physical activity, I like the simple approach of FitBit. For those who run regularly, the Nike+ Ipod offering is another (much) cheaper competitor. Either way, miCoach is yet another sign that consumer-oriented wellness monitoring solutions are becoming mainstream. Next logical phase would be moving similar technologies and frameworks to tackle real disease management and prevention.

• VISICU (a remote ICU monitoring technology company acquired in 2007)
• Digital Pathology (commercial offering in 2009)
• Motiva (Remote patient management and education delivered through television)
• TeleStation (In-home hub for two-way communication between provider and patients with chronic diseases, integrated with wireless measurement devices)

The list above is not comprehensive by any means, it’s just what I could recall right away. Without making this a post about Philips’ strategy, here is the latest addition to my personal list of innovative Philips Healthcare IT offerings- DirectLife activity monitor. It tracks your physical activity (through a triple axis accelerometer) to calculate calories burned. Results show up on a personal webpage (detailed) and on the device (simple indicator lights).

It’s like FitBit, but with some design differences – DirectLife is waterproof and needs USB-based sync (FitBit is wireless through a hub). Most importantly, DirectLife comes with a coach- a real person to provide inspiration and assistance to meet your target weight or activity level. The device (hardware) is $99, but coaching is a monthly subscription of $12.95 (first four months free).

The entry of Philips in this lifestyle-tracking arena makes the proposition more legit for mass adoption- now the HR departments of large enterprises  can think of offering it as a health benefit, maybe health insurance companies will pay attention too. FitBit is a great device in itself, but what’s needed is a “wellness service”, much like what DirectLife is starting to sound like. My prediction is that we’ll see proliferation of such services in the next few years- maybe even a lower premium option in your medical insurance if you choose an integrated activity tracking service.

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.

The website is not currently recommended for clinical use- mainly because the images have not yet been verified by pill manufacturers. Still, it’s a smart tool that can benefit multiple care settings. Many seniors coming through the emergency room and clinics don’t remember the name of their pills, but can recall its visual characteristics. A tool like this can be a great addition to EMRs and even PHRs.

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.

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 dont think much of it, 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.

In general, I really like the idea of using personal mobile computing devices in treating/preventing chronic conditions. As devices and sensors get smarter and cheaper, it’s logical that they start playing role in helping individuals deal with chronic, lifestyle affecting conditions like migraines, sleep disorders, allergies, dysmenorrhea, depression etc.

Proactive Sleep provides a ’smart alarm clock’ for iPhone/iPod Touch. Some features: customize what music to fall asleep to, and to wake up with, a dynamic ‘vigilance game’ that you need to complete to turn the alarm off, and a sleep diary to note your observations and sleeping habits. Nothing earth-shattering there. The features may be simple, and its not my intention to critique Proactive Sleep per se. What I want to emphasize is that applications like these are a step in the right direction overall.

For a number of chronic disorders with no established cause (like migraines, insomnia), keeping an accurate log (diary) can be extremely useful for prevention and treatment. Integrating such ‘digital diary’ into daily lifestyle can be much more convenient and smart way of keeping track of such conditions. Proactive Sleep is a bit too manual, in my opinion (e.g. you need to document everything in your sleep diary yourself). What would be awesome is to combine it with a smart sensor (like the FitBit) to automatically record your sleep habits. That way its even more Health 2.0.

The site was inspired by a true story, and I agree that we can do better by utilizing web technology for medication adherence. But I’m not sure if there is a need for a devoted web service just around medication reminders. They are currently in beta so all services are free, but looks like they will offer paid accounts once they are out of beta.

Reminder functionality is best served as a part of a bigger PHR platform (like Google Health) and in most cases, there are generic substitutes available. For example, why not use 30Boxes or Reqall or even your Google Calendar instead of paying monthly subscription? All of these are capable of sending reminders at a preset time. Medication reminders is an important issue, but emails/text is not going to be the complete answer imho. Especially given the fact that most of the people having trouble remembering are in an age group where emails/text are not the choice of communication anyway. That is why devices like ePill exist.

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.

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.

Believe it or not, a lot of electronic medical record archives today consists of documents in free text format- no structure or organization, just vanilla narrative text. 360Fresh uses their proprietary data-mining logic to extract meaning from that. Generally speaking, I think there is potential for such offerings; especially when presented in a focused manner. For example, a service that identifies high-risk patients in ED or Labor & Delivery patients could be enormously useful for hospitals. And ‘risk’ can go beyond just clinical perspective, like this vendor that focuses on malpractice risk. And if its near real-time data-mining based on output from existing systems, even better.

Of course, ideally we would want  (and expect) such intelligence to be inherent in the multi-million dollar enterprise Healthcare IT systems that hospitals buy to record the data in the first place. But most of them are either distracted by industry fads (like RHIOs or Comparative Effectiveness) or bogged down by existing product support to innovate in this direction.

There is scope for such services, for sure. There are significant number of people who need care that falls outside the realm of what insurance covers. Second opinions, cosmetic procedures, international travelers are some categories that come to mind. But as always, business model remains the Achilles heel. If you are operating a platform that matches supply with demand, its more straightforward to make money in commercial domains, much like eBay or eLance. But healthcare is different ballgame. Privacy, outcomes, benchmarking, feedback, transparency are some of the confounding issues that need to be taken care of.

Currently HealDeal is a social venture, with no subscription or advertisement model evident. Hopefully they have deep pockets or influential allies to keep themselves above water. It’d be interesting to have it as an app on Google Health though, especially if they can strike partnerships with other related, pro-self-pay businesses like Myca.

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.

A more loaded one-line description of Archimedes (taken from his original paper in 2002): “It’s an object-oriented, continuous-time, full simulation model for addressing a wide range of clinical, procedural, administrative, and financial decisions in health care at a high level of biological, clinical, and administrative detail.” Phew. I’ll confess that I don’t know what exactly is under the hood. But I know enough about the informatics field to believe that this approach is viable and very exciting.

This YouTube video explains how the model can be used to run virtual clinical trials. Kasier has already backed the findings of Archimedes to change their diabetes care delivery.  I think there are fantastic, unlimited opportunities for applying such a fundamental model to medicine- personalized health predictions, public health, health policy, cost-effectiveness and what not.  As a startup, they are doing fine. With an impressive list of partners/clients, and a $15.6M RJWF grant (2007), they have a good runway and momentum. They have all the right ingredients to be a change agent for next-generation Healthcare IT.