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.

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.

Docmein is an online appointment scheduling service focused on private practices. The value proposition is that providers and patients can both use this online service to request and confirm appointments without any software to install. Side benefits are timely email reminders and custom pages for patients and practices.

It’s a bit surprising that healthcare continues to get the onslaught of simple web ideas repackaged from elsewhere. Perhaps its due to the relative ease of executing on internet-based ideas today. More importantly, it underscores how poor is the public perception of healthcare IT. Those who have observed the disruptive force of information technology elsewhere wonder why it hasn’t penetrated healthcare effectively. Hence the constant idea and technology arbitrage.

Most internet users are probably aware that online group scheduling services are free. Choices are plenty (Google Calendar, Tungle, TimeBridge, Jiffle, Doodle to name a few) and they are all very good. So what does healthcare need that can’t be fulfilled by these companies? Consider it from two perspectives: inpatient and outpatient.

Outpatient scheduling is more aligned with the services described above. The need is for patients and providers to coordinate a mutually convenient appointment time. But usually patients already know their provider by the time they are trying to find an appointment (e.g. they’ve called the insurance company or the doctor’s office). So finding an appointment time is just a short conversation away. The real value proposition is when patients are still open to picking a provider. That’s when such consumer-oriented outpatient scheduling services are really worth using. ZocDoc does this.

On the inpatient side the need is for a enterprise-grade, rules-based scalable system that integrates with various existing healthcare information systems. To figure out what is the most suitable appointment time for a patient coming in for knee replacement, the scheduling department needs to know the status of radiology/lab reports, clinical resource availability, OR schedule etc. Even just scheduling in-house clinical staff is often an insurmountable and complicated task. For example, YourNurseIsOn is s start-up specifically focused on the nurse scheduling and communication.

Docmein may not be there yet, but scheduling in healthcare delivery systems is definitely a problem waiting to be solved.

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.

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.

MedWatcher is a mobile application trying to streamline this process, and increase public (patient) participation in pharmacovigilence. FYI- it’s not out yet (some sources projected Aug 2010 release, but I couldn’t find it in iTunes), so all that is known is intended functionality.

The application will serve two major purposes. First, users can receive drug-related alerts through it, based on FDA MedWatch and less-formal sources (news, media etc.). FDA MedWatch may be a treasure-trove of information, but it’s not easy to use. You can subscribe to an RSS feed, get email or text messages about all drug-related warnings. With tens of thousands of drugs on the market, that is like drinking from a fire hose.

If you are a patient worried about your cholesterol-lowering Zocor or a cardiologist who wants to stay informed about statins in general, there needs to be a way to subscribe to only what you care about. I’m hoping that MedWatcher leverages a comprehensive drug-database like FDB, Medi-Span, Red Book etc. to lets users do exactly that.

The second major functionality is for users (both patients and provider) to submit side-effects through a lean process. They mention that serious side-effects will ‘automatically’ be submitted to FDA (rest probably become discussion topics on MedWatcher itself). The current FDA MedWatch online reporting process is cumbersome and a bit disconnected (who remembers to submit voluntary information after they have seen/experienced a side-effect?).  Having a user-friendly mobile application form would solve some of that.

I think the direct patient engagement is very promising in this niche space. The concept may run the risk of becoming yelp for drugs, but even yelp reviews hold useful information once you figure out how to get rid of the noise. By opening direct communication channel with patients, it has the potential to provide the same disintermediation that TrialX provides for clinical trials.

ScanAvert is an interesting paid application of the same functionality. It allows users to scan the usual UPC barcode information on their supermarket items and cross-check the ingredients with their health profile. Consumers register and create their profile with facts like allergies, prescriptions, diagnoses, dietary needs, etc. ScanAvert uses data provided by Gladson (a major CPG product images and information provider) to do real-time checks on the ingredients of the item to detect incompatibilities. Now I know the usual critique would be that why wouldn’t the consumer just read the ingredient list or package label? And the counter would be that an average consumer may not find the information easily readable or understandable.

Those and other evident arguments aside, the service has obvious value for people with serious dietary issues (think gluten allergy, Celiac, Diabetes, Obesity, Prescription drug interactions). But I’m more excited about another aspect of the service- ScanAvert users can specify custom limits on a labels nutritional box values (calories, carbs, fat…) and get instant recommendation. To me, that is pretty useful for the rest of the population that doesn’t deal with any significant dietary restrictions. In fact, most of us end up buying food items without paying much attention to what it means nutritionally. Even those few that give a thought to the nutritional box items, the mental calculation done is only at a high level (“100 Cal drink…sounds low….I’ll try that”) and inconsistent (how many times have you checked the fat vs. saturated fat numbers?). I doubt most of the ‘normal’ population even knows what is their actual average dietary intake in terms of calories, fat, proteins, etc.

So if someone can setup a profile that puts a limit on the daily fat/protein/cal intake and have a real-time summary report given to them while they were grocery shopping, that would be an darn useful service, I think. Seems like currently ScanAvert can also suggest alternatives (if it detects incompatibility) and send alerts about scanned items that have been recalled. That makes the service even more useful.

It’s intriguing to think about expanding this service into a space where it can potentially be the long-term dietary record for an individual. Suppose one could combine that with a personal activity monitor like FitBit.  That would make a great ‘wellness solution’ for an individual to record, analyze, set goals and then get guidance on two important aspects:

1. Energy input (your food intake)
2. Energy output (your daily activity)

I also found some other apps that help manage food allergies (FoodContentAlerts, iCanEat/iEatOut), although they don’t have bar code scanning ability. This space just keeps getting more interesting every day.

At the core is a symptom-checker that lets users do a high-level categorization of what could be wrong with them, and how serious/not can it be. That functionality is nothing special, since there are multiple services that do that both online and mobile. Also included is a nationwide directory of care facilities (including urgent care, retail clinics, pharmacies and physician offices) and nurse advice phonelines (sorted by insurance provider). Your smartphone knows where you are, so the neat service is to be able to find directions to the nearest facility with few clicks. It may not sound like much; but when you are away from home, it’s pretty useful to be able to quickly figure out the nearest urgent care or retail clinic. iTriage is also trying to take this service to another level with the addition of ‘ER wait times‘ functionality in select cities. That way a user can further filter out the facilities based on wait times. Even if this is not really present/reliable in your area today, I think it’s a brilliant extension of a service like iTriage. Because its not a question of if this will be useful, but when. Once there is a critical mass of hospitals in an area submitting their ER-time feed to iTriage, the rest will find it hard not to do the same. There is a need for public to have a near real-time pulse on ER utilization, and services like iTriage provide a good platform for it.

The other interesting aspect is their partner service integration. Healthgrades provides the physician/hospital quality reports within iTriage, although users need to pay to get info beyond minimal basic report. Teladoc provides the 24×7 physician advise service (its phone consultations are for under 40$ mostly). They also partner with a claims adjudication organization (name?) that helps consumers negotiate thier medical bills. One can argue that a lot of the above functionality can be accomplished with a mobile browser or search app. But the value-add of a dedicated app is to provide fast, context-relevant info and be a steady companion as the user traverses the acute healthcare system.

I heard Paul Hudson, MD (co-founder) speak at the Mobile Health 2010 conference last month. He used an intriguing term to describe their technology: “symptom-to-provider technology”. Guess that is one way to think about a IT service that holds your hand from beginning to end of an acute care episode. He placed iTriage in the “multi-billion $ self-referral market”, and gave couple of interesting factoids about it’s current utilization:

• Around 89% iTraige members are commercially insured
• It’s use has gone beyond Emergency care in some cases- people have used the Healthgrades info to switch providers

Both of those underscore the fact that consumers need a trusted guide in handling how they interact with the acute care system. ERs, Urgent Care centers are the way most people experience care delivery most of the time, and having insurance doesn’t really help in making a good choice. With mobile phones getting smarter, the ‘self-referral’ market is ripe for innovative services.

Child Count is an mHealth platform developed by the Millennium Villages Project aimed at empowering communities to improve child survival and maternal health. It facilitates the activities of field-based community health care workers in Africa.  Using any standard phone, these workers are able to use text messages to register patients and report their health status to a central web dashboard that provides a real-time view of the overall community health. This enables an automated system that helps reduce gaps in treatment (sms-based rapid diagnosis, follow-up reminders etc.).

ChildCount is open-source. It’s built with RapidSMS, a  framework that manages data collection, complex workflows, and group coordination using basic mobile phones. This short video does a good job of explaining the overall project and technology.

Public Health interventions are often based on simple logic, but have far-reaching effects. Screening regularly for malnutrition, malaria, diarrhea, etc. requires relatively simple documentation and measurements- making it perfect for sms-based communication. Even keeping a simple registry of births, deaths, immunization status enables local health teams and organizations optimize their efforts. Care delivery organizations in developed countries should also think about integrating the mobile platform into their services- its a great way to interact and keep in touch with patients. Medication adherence is a good example. NCPIE‘s 2007 report states that poor medication adherence is almost a crisis, costing $177B annually. Almost any population care management topic (outreach, screening, compliance, etc) would be a good use case.

Child Count is in good company -there are many interesting mHealth applications out there that deserve mention. The mHealth wikipedia page has a good running list of some applications. I’ll continue to post about what I discover and like.

It’s a public private partnership that provides this educational program. The list  is impressive: CTIA,  HMHB, Johnson & Johnson, WellPoint, Pfizer and CareFirst BCBS, BabyCenter, George Washington University and MTV Networks among others. U.S. government partners include the White House Office of Science and Technology Policy, the Department of Health and Human Services and the Department of Defense Military Health System. The mobile health platform is provided by Voxiva and fifteen U.S. carriers have agreed to carry the program’s text messages at no cost for two full years.

91% of US residents have a cellphone, compared to 22% that have internet connectivity. Educating pregnant women and new moms with information they need to take care of own and baby’s health is a powerful preventive measure. So there is reach and utility in this idea, no doubt.

Note: Found interesting background about Voxiva. They started in 1999 with the idea that mobile phones were going to play an important part in health going forward. They now have a technology platform and provide mobile health solutions in about 14 countries (mostly developing countries like India, Mexico, Rwanda, Peru). They market and sell to public health agencies and government providers usually, but are moving into pharma and provider networks now. An insightful interview with their founder here.

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.

Feb’10 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.

Dec’10 Update: FreeMD has a new look now. The user interface is much better and the interaction is much more easy (handy pain scale, descriptive pictures for example). Some interesting new functionality has been added too:

• Triage results now provide more information: FAQ, video explanations, and images
• Best options for care included in results, like ER, Urgent Care. Especially interesting are newer venues like eVisit and Retail Clinics. Hovering over each option gives some useful information like average charge expected at that venue. Very cool.
• The final ‘Triage Report’ can be printed or copied to clipboard.

These are all steps in the right direction. A more integrated future (like export capability to Google Health Record, or ER wait times from iTriage, or provider rankings from Vitals) would definitely establish FreeMD as a viable online triage destination.

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.

Update: Few weeks after writing this post, I found a number of mobile apps (with integrated online version) that let you count/track anything you want. Few examples: TallyZoo, Dayta, Daytum, TheCarrot. There are also multiple websites that let you track and analyze anything- Graphomatic, Kibotzer, Track-n-Graph, Me-trics, LifeMetric, DailyDiary.

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.

April 12, 2010 update: Got a demo of new functionality from CEO Pam Swingly. Besides medication reminders online and on mobile platform, they now also offer a personal health record and the ability to create care communities.

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.

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.

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.