It’s a brilliant niche. MotherKnows will interact with the healthcare system (your physician, hospital, insurer, etc.) on your behalf to procure a copy of the medical record, store it, analyze it and make the information available to you on-demand. Anyone who has tried getting their child’s immunization record will agree that the conventional interaction is a sub-optimal customer service experience at best. So having someone else do it for you is worth paying for.

Once collected, the information is available in a PHR manner – view meds, problems, allergies, immunizations, growth charts in one place; create emergency cards; get reminders; mobile access, etc. But the key to MotherKnows’ viability, in my view, is being the authorized agent for painful extraction of medical records. As long as the pricing is right (which, at $19-$98/year, is in the right range) it will gain traction.

It’s a prudent strategy to market it initially to parents as a way to keep the records straight for their precious progeny. But I don’t see why it can’t be extended to adult healthcare consumers themselves. I’d like to be able to get my medical data all in one place, hopefully showing me trends found in my quasi-annual physical exams and labs. Today in the patient population, the motivated few try to save copies of records; and the enlightened few go one step further and manually key the data into an online PHR like Healthvault. In either case manual labor and discipline is required. Perhaps having a real-world service (of paper record collection) is what really can make a difference to PHR uptake by consumers. Hopefully, MotherKnows will reach beyond just child medical records in future.

The overall idea of patients paying an agency to wrest to their medical records from providers point to the underlying systemic inefficiencies. Theoretically, there are solutions on the horizon. An enterprise EHR used by care providers could pass the relevant info into a PHR accessible by patients. And if they change providers, a community-wide Health Information Exchange (HIE) could still enable patients to be the custodian of thier own information in another system. But we are not there yet.

The unmet need for electronic systems (like PHRs) to interface with the physical world (i.e. bricks and mortar organizations and paper processes) is very real. Till every end-point in healthcare delivery is digitized and interoperability is no longer a pipe dream, we’ll need services that handle real-world complexities. Take companies like eHGT who are already in this ‘record retrieval services‘ niche. By actually having real account managers who can get imaging records from facilities, they elevate the value proposition of an “Image Exchange” to new level. The phenomenon exists outside of healthcare too. The now defunct Random Acts of Genealogical Kindness (RAOGK) site was a volunteer effort to bridge the gap between virtual demand and physical supply of genealogy records.

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.

Voxiva provides the technology platform, professional services and support needed for designing and deploying a mobile-based health solution for consumers. When you read that, think beyond the now-hip smartphone app market. Less than a fifth of mobile handsets out there are smartphones. So to reach the remainder, the solution has to encompass relatively simpler mechanisms like feature-phone data entry, SMS and IVR.

There are a number of unique design challenges for creating an engaging public health solution that can work across any/most devices and be delivered through multiple channels to a varied set of end-users. It needs to work synchronously across web, mobile, email. It should support data entry across all kinds of user interfaces (feature phones, smartphones, different mobile operating systems, multiple-languages, etc). It needs to deliver real-time alerts (SMS, voice, email, web portal) and provide real-time analysis for decision-makers. And obviously be scalable and dependable with near-100% uptime. What appears to be a simplistic low-end IT solution on the surface is really a huge undertaking to communicate with an end-user population that is as diverse as it can be.

Voxiva’s real impressive achievement is doing a lot of what they do in international market- specially developing countries. They have created a HIV/AIDS mHealth solution for Rwanda Ministry of Health, disease surveillance solution for Peruvian military, diabetes management program in Mexico, and plenty of others. In US, their most famous offering was Text4Baby (see Multiplyd’s previous review on it), an SMS-based maternal health education service launched in early 2010. Since then, they have diversified into Text2Quit (smoking cessation) and Care4Life (diabetes management). Simple interventions, but designed for massive implementation and adoption. Which is why Voxiva continues to stand out.

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.

My interest piqued after I heard David L. Inns (Jitterbug CEO) speak at the Mobile Health 2010 event held in May 2010 at Stanford University. He described a sizable list of Health-related services available to Jitterbug customers. Here is the current list, and pertinent facts (from May 2010 time frame) from the presentation he gave at the event:

• Check-in Calls: Automated calls to check-in on the user or a loved one. $5/month.
• Medication Reminders: Automated calls at the right time to remind taking medication. Neat functionality includes a prescription refill reminders (with option to be connected to the pharmacy), personal dashboard that tracks medication adherence, and the ability to share it with others. In partnership with Meridian Health. $10/month.
• LiveNurse: Unlimited 24-access to a registered nurse for health advice and information. Free on rate plan $29 and up, $4 month otherwise. 12,000 reported users in 6 months post-release and about 4000 calls handled per month. One-fifth of the callers end up seeking medical attention within 24 hours.
• Daily Health Tips: Daily guidance and tips on living a heart-healthy lifestyle. Free. In partnership with the American Heart Association’s Go Red For Women Movement. Reported 4,000 users.
• Wellness Calls: 5-minute per week motivational calls with tips and techniques related to topics like sleeplessness, stress, loneliness etc. Attracted 1,000 users in one month. Free with plans above $29. Content by Brian Alman who runs TruSage.
• 5 Star Emergency Response: Personal emergency response service. Based on the offering by startup MobiWatch that they acquired late 2009. Supposed to be launching around Fall 2010.
• D-Coach: A little-known, yet-to-be-launched diabetes management service in partnership with WellDoc. Incidentally, WellDoc’s Diabetes service recently got FDA clearance in August 2010.

None of these service concepts are unique per se, each has been attempted by other wireless (and non-wireless) companies. But two things make them highly viable within Jitterbug. First is their niche target market. It’s no secret that majority of healthcare costs are due to individuals age 65 and up. And that is Jitterbug’s target user too. A personal mobile device may provide the elusive ‘last-mile‘ access to such individuals. Second is the personalized, high-touch nature of Jitterbug’s service. Jitterbug users are already used to connecting with a human operator with one button-click and use them for pretty much everything – find a contact, dial the number, get weather info, etc.. Adding health-related services to that framework makes undeniable sense.

It’s not hard to imagine other services waiting to materialize- outpatient appointment scheduling and reminders, preventive services (flu shots, etc.) assistance, personal health record information access, to name a few. I bet we’ll see more wireless network operators move into the healthcare services vertical. For now, advantage Jitterbug.

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.

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.

gDitty is targeted towards promoting physical activity in kids. The product combines an activity meter device (on belt or in pocket) with an online rewards program that motivates kids to move more. The program is in a private research trial mode, so details are unavailable. But it seems that data recorded by the device is uploaded to a custom website, and translated into points of some sort. Points can be then redeemed for certain virtual and real-world rewards like avatars, gift cards, etc.

Trends in childhood obesity are alarming, to say the least. Although I’m a bit skeptical about promoting reward-seeking behavior in younger generation. There is a lot of that going on already. Maybe induce loss aversion instead? We are wired to strongly prefer avoiding losses to making gains, Kahneman & Tversky proved that.

Behavioral psychology argument aside, I realize that encouraging movement through rewards is probably more applicable to kids age-group than adults. I recently met someone from Green Goose- it’s a startup in pre-launch beta mode with similar offering for adults. They deploy tiny activity sensors in way that helps track your daily activities (biking, brushing, water bottle, shower-head, key chain etc.). The recorded data is converted into points, and you get the incentive to transfer money into savings or compete with your friends.

October 2010 Update: gDitty is now rebranded as Zamzee. From some of the job postings online, looks like they are getting serious for a commercial launch.

• 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)
• LifeLine (focused on preventing falls and medication errors for seniors)

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.

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.

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 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.

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.

Given the fact that Adverse Drug Effects (ADE) are one of the leading cause of death in the US, there is significant market opportunity in consumer education and support around it. Couple of nifty features that I like:

• Direct meds import from Healthvault
• Community Knowledge Base – an aggregation of information and experiences from people who are on multiple drugs. This feature is currently in private beta, but I think that it can be a great revenue opportunity once it gets some traction in terms of number of users. There are plenty of pharma companies who would pay good money for getting early (even though informal) insight into side-effects, efficacy, interactions, and usage patterns of their drugs.

Seems like they are planning to integrate with DestinationRx and Polka, which is a good idea since the traffic from those sites will already be primed for the services that PharmaSurveyor provides. The advisory board has some significant names, including Barney Pell, Matthew Holt and Mark Musen.

They do have some interesting marketing techniques like analyzing celebrity cocktails, not requiring registrations, etc. Business model seems to be only google ads for now, which is no surprise given their research-oriented background. The site is more a proof-of-concept for the underlying technology (although I’m not sure what it is exactly). It’ll make a lot of sense to integrate this service with commercial CIS offerings, and take it one step beyond just using RxNorm.

Aug’10 Update: PharmaSurveyor service changed its name to SurveyorHealth. Now they also offer mobile apps for iPhone and iPad.

Here is a simple overview of their offering: pay $500 to be tested for 10 common conditions or upgrade to $2,500 for all conditions (28 currently). The upgraded package has perks of genetic counseling, personalized updates and educational content for a year.  Beyond  that you pay $250/year to keep it going. What sets Navigenics apart (as I understand) is that they only tell you your results from the perspective of these 28 (and growing) conditions whereas others (deCODEme, 23andMe) let you ‘explore’ your results for every trait/condition they are continuously covering.

Regardless of what company it is, the question remains that how much can you learn from you genetic profile? If you are at 64% risk for Diabetes type 2 and 47% risk for macular degeneration, what can you do about it?  Well, the advice would mostly include one or more of- exercise,  dont smoke, eat healthy, avoid alcohol, sleep well, vitamins, lookout for warning signs etc. So why get the test; you should be doing all that anyways. I’m not knocking down genetic testing per se, just trying to find utility for it in a DTC model.

The future of healtcare is more personalized, for sure. I’m happy that the commercial foundation for it is being laid down right now. But personally, I wouldnt invest in these services till we firmly and clearly establish an end-to-end causal linkage between genes, diasease, and therapy. We havent even agreed on how important is the role of enviornment and habits (is it only genes that determine a disease outcome?) Heck, who said it’s genes- what about proteomics?

The price they charge includes collection fee for sample draw, ordering physician fee (i.e. lab order approval, result review, consultation) and a Personal Health Record (where you can view and store the results, among other things). Users pay upfront for the tests and have the option to receive a receipt to submit for reimbursement from an insurance company or a health savings account.

There are several other players in this direct-to-consumer lab testing, like DirectLabs, HealthCheckUSA, MedLabUSA. The benefits of these services are tangible- lower cost (specially for the uninsured, who don’t want to pay for the visit to the doctor), convenience, speed and privacy.

But not everything is that straight-forward. Most insurance companies will not reimburse patients for tests that were not ordered by a physician, so the target market is restricted to people who are health-conscious and rich enough to pay for self-initiated disease monitoring. Jury is still out on many aspects- who approves these tests medically? Who carries the legal burden? Is it okay to let patients self-diagnose themselves? what about misinterpretation of results? IMHO, there is a market and advantage for direct-to-consumer lab testing, even if the healthcare system doesnt recognize or reimburse for it yet. Also, these services would look pretty good as applications on PHR platforms like Google Health.

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.

It’s not focused on healthcare issues, but I see potential for something like this in chronic conditions that affect an individual’s lifestyle. A good example is migraines. Those who have these terrible headaches would benefit from knowing exactly how many did they have this month vs. past 6 months and what were they doing when it started. So If one could log the onset/end of a migraine attack and the preceding activity conveniently, it’d be easy to spot a pattern (e.g. higher chance of migraine after cold shower).

Why not keep a simple diary bedside? or spreadsheet? Yeah, you can. But how many people do? And how many diaries can remind you to enter latest information in them and chart/graph your progress? It’d be a good idea to add some social networking features to ZeaLOG- finding comparative stats or just connecting with others in the same state as you are powerful motivators for using such tools (for example- Qwitter). ZeaLOG has twitter integration, but it’d be neat to have a mobile app too, especially one that syncs up intelligently with online data.

There is a paid service idea in this concept somewhere. I’m sure we’ll see one soon in healthcare.

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.