Turns out that Lifescan apparently did nothing with that concept. Anita Mathew (who gave the demo on Lifescan’s behalf in 2009) decided to take it forward on her own and founded Glooko. The company currently sells MeterSync, a cable that connects your iPhone to five popular glucometers in the market. Users can download the ‘LogBook’ app from iTunes store to document, analyze and share their data.

I’m not an investor (yet), but if I was, I’d put my money in Glooko. This is exactly what the future should start to look like for conventional consumer health devices. Instead of being isolated products that store a limit amount of quarantined information, they need to provide a service that enables longitudinal disease management. For a patient with long-standing diabetes, he/she needs to know how much insulin to inject for covering the meal they are about to have, not what their blood glucose number is. It reminds me of Theodore Levitt’s famous MBA quote “People don’t want to buy a quarter-inch drill. They want a quarter-inch hole.”

For Glooko, the long-term sustainability is directly proportional to how useful and sticky it’s users find the logbook iPhone app. The hardware (Metersync) may be critical at first, but end user experience and market differentiation will come from the software. There is competition, of course. Agamatrix  has been in the market with it’s iPhone compatible glucometer, and last year they announced partnership with Sanofi-Aventis that gives them the much-needed commercialization ability. Instead of augmenting diagnosis, another company Cellnovo takes a similar approach with therapeutic insulin pumps. Perhaps we’ll see a synchronized gluocometer-insulin pump offering or an intelligent, symbiotic ecosystem for diabetes devices in future.

I’ve talked about the ‘last-mile’ of remote patient monitoring in the past. Conventional medical devices produce digital manifestations of physiological parameters, but the information collected hardly goes beyond the device itself.  We need consumer-oriented medical devices to become monitoring services that automate/transform the last mile for consumers. The future is arriving piecemeal, and sadly enough, it’s not being delivered by the incumbent behemoths of the medical device industry. Withings BP Monitor (which I can personally validate since I use it) enhances the value proposition of a regular BP Monitor for hypertensives. Zeo does the same for people with sleep disorders. Granted these offerings are perfect yet, but all vectors are aligned in the right direction. As for Glooko, look out J&J.

While reviewing Zeo and aXbo last year, I found myself wondering what was the need for having a bedside clock hardware, since most of that computing could be done in a smartphone. Seems like the crop of solutions  that followed (e.g. WakeMate, Lark, Zeo Mobile) thought of the same. EASYWAKEme follows the pattern: wearable sensor (on wrist) that monitors movement as a proxy for sleep phase, provides intelligent wake-up alarm and longitudinal insight into your sleeping habits. Their ‘how it works‘ page explains it well.

Quick market analysis shows that price is going to be a very important factor since there is a wide range right now and consumers will tend to favor the cheapest. EASYWAKEme (£118), aXbo (starts at €179), SleepTracker ($149) are at the more expensive end compared to competitors like Lark (starts at $99), Zeo (mobile is $99), FitBit ($99), Jawbone Up ($99). WakeMate has already started the downward spiral at $59.

Activity sensors like FitBit, and more recently Jawbone Up are also chomping at the bit to include sleep monitoring as their value proposition. Cheaper solutions that are just smartphone apps are competition too. I actually bought the $0.99 SleepCycle iphone app out of curiosity (it had >20,000 reviews, most were positive) and ended up forgetting about it after a week. I now put it in the same category as placebo: it’ll work only if you already believe it does.

So the real question is whether body movement tracking and analysis is really a dependable way for extrapolating sleep phases. I still believe (based on scientific persuasion like this, and this) that it is. The ultimate hope is that these low-cost innovations can make their way back to help with serious issues like sleep disorders and psychiatric disorders. Current solutions like polysomnography are too cumbersome to be done outside of a clinical setting.

Disclosure: the generous folks at EASYWAKEme offered to send me a review unit, so I’ll be testing that hypothesis over the next few weeks. Look out for an update to this review in near future.

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.

According to the National Association for Home Care, about 12 million people in this country receive care from more than 33,000 home health care providers. The market is made up of few large, publicly traded companies (see LHCG, AFAM, AMED stocks for example) and many small/mid-size players. The challenges faced by these companies are typical of those with field-based employees: scheduling the visits, then figuring out if their employee actually visited the patient, if they did then what was the real time and mileage, ensuring the data collected during visit is archived and accurate, etc.

Which brings me to CellTrak. It was founded in 2006 and delivers mobile-based automation to Home Healthcare agencies. I think it’s a brilliant application of healthcare information technology for alleviating self-reported information issues and paper-processes in a niche market. Given that everyone carries a phone today, using mobile modules to increase compliance and productivity makes a lot of sense for a field-based business. Some examples of the modules available:

• Care Plan Management
• GPS and Directions
• Time and Attendance
• Travel Time and Mileage
• Supply Management
• Alerting and Messaging
• Scheduling
• Nurse Care
• Wound Care

Solving logistical issues like location, time capture, attendance, inventory etc. is pragmatic. But providing modules around clinical care is the more interesting strategy from my perspective. Usually, software solutions that enable care documentation and collaboration are associated with either care-delivery enterprises (e.g. fixed location hospitals using EHRs) or with patients themselves (e.g. PHRs). Neither of those have a particularly critical need to be consumable in a mobile form-factor- that is just a nice-to-have functionality. CellTrak has found a special need where the inherent care delivery workflow necessitates even the clinical Healthcare IT solution to be exclusively mobile. It is a good example of the hidden corners within the complex maze of healthcare system which require thinking outside the traditional bounds.

Other examples of using exclusively mobile-based electronic health records are mostly restricted to public health context in developing countries (see ChildCount for example). That skew is mostly due to the field-based nature of public health and mobile being the primary means of connectivity in emerging economies. With CellTrak, we see the same technology paradigm tackling the problems of a conventional health industry segment in a developed country.

CellTrak partners with some EHR (Cerner, Allscripts) and wireless providers (AT&T, T-Mobile, Sprint, Verizon) currently. I expect that the future iterations of most enterprise EHRs would include incorporating a solution like CellTrak which enables running operations in the field and  seamlessly connects health information to/from a mobile workforce.

I first heard about MyBasis during a talk given by Bharat Vasan (founder?) at Bay Area Quantified Self gathering in June 2010. He referred to it as PulseTracer back then, and described its use for pulse monitoring. Based on the current description on their website, the product concept seems to have matured. Similar to BodyMedia, it now has 4 Sensors: Pulse, Temperature, Accelerometer, Skin Conductance (i.e. moisture). It is USB and bluetooth enabled; and comes with integrated social functionality (gaming, sharing, rewards, etc.). There seem to be smartphone, iPad and online applications that help provide analysis and understanding of the collected data.

MyBasis certainly has the concept nailed: A smart device with multiple sensors and long battery life in a familiar form-factor + Always-on and connected to desktop, mobile and online dashboards that simplify analysis of the aggregated raw data + Integrated social features that help make it sticky and viral. If they play it right, this can be a hit. Mainstream competition from products (like the lackluster Polar offerings) is uninteresting and hardly addictive.

But critics can say that there are always technophile early-adopters (like me) who crave anything that is novel and web-enabled. So before we get over-optimistic about the impending success of such devices, consider two important caveats.

First, it’s not about sophisticated monitoring or granular data. Whether they realize it or not, the key value proposition for an average end-customer is the personalized insight that results from it. Gathering 24X7 data from multiple sensors is great, but it’s all pointless if the user doesn’t understand the ultimate picture that results from all that data. Most users are interested in revelations into their health and lifestyle, not numbers. So the way MyBasis handles analysis is going to be critical. I was disappointed with MyZeo and FitBit for the very same reason. An interesting approach that MyBasis seems to have is the creation of a virtual pet that gives a quick proxy of your overall status. It may sound silly, but abstractions like these have shown promise in encouraging self-monitoring and positive behavior change in users (e.g. see UbiFit project at University of Washington).

Second, the technology and device needs to be so well-integrated with a user’s lifestyle that they essentially ‘disappear’. If someone needs to put a headband one (like for Zeo) or remember to find a USB cable and synchronize every week to prevent data loss, you can be assured that it’s not going to work out long term. As a species, we humans have remarkable lack of discipline even when it comes to things/habits that are good for us. So the offering needs to add minimal extra work and be seamless with your daily life. Neil Versel at MobiHealthNews calls it “passivity”. Example: FitBit gets a better grade than Zeo in this regard. I clip it onto my belt (almost sub-consciously now) every day and plop it on to the USB hub (always connected to my desktop) once in a couple of weeks. That’s it.

MyBasis is still in early beta, so my impression is based on what their website claims and not actual usage. I’ve signed up for preorder and will update this review when I get my hands on one. Seems like the cost is a one-time $199 for now. It would make a lot of sense to have  a subscription-based model of some sort though. Also, it’d be great to see such solutions go beyond just wellness and be tailored for medical-grade serious conditions like diabetes, hypertension, etc. All clues indicate that such applications are not very far in the future.

Established in 1995, the Center for Connected Health is another such example within Partners HealthCare in Boston. They’ve dabbled in a number of remote monitoring pilots- diabetes, dermatology, heart failure, etc. Healthrageous is their first spin-off. It started as a pilot project conducted in 2006 with EMC Corp. to give employees self-management tools for blood pressure. In June 2010, Healthrageous raised $6 million in a Series A funding led by North Bridge Venture Partners of Boston.

Having read enough of them, I think the marketing message around the concept of continuous care through remote monitoring has now been perfected from multiple angles. Read the descriptions from Welldoc, HealthBuddy, Telcare, iMetrikus, Hommed, Cardiocom, Gentag, BL Healthcare for example. Healthrageous also does a good job at describing the high-level value proposition.

But it seems that the transition from online paragraphs to a generally available, well-known and affordable solution has not happened. I searched for what product/service I could buy through Healthrageous to help a close friend manage her hypertension, but couldn’t find anything. There are some encouraging success stories on the website, but no explanation as to where can one sign up for becoming a success like that. I wish these websites were more transparent and lucid, maybe even at the risk of being less enchanting.

PS: Found two candidate consumer-oriented solutions for remotely managing hypertension. One is not available yet (Withings BP Monitor), and other needs an Apple iOS device to work (iHealth Lab’s BP3) and didn’t get great reviews. If anyone knows of other products/services, please share through comments below.

Seems like the new crop of ‘medication management services’ are purely software applications using the increasingly-ubiquitous mobile phone as the hardware companion. The space is getting crowded: PillBoxApp, PillBoxer, RememberItNow, ZumeLife, PharmaSurveyor, MedWatcher and Jitterbug. PillPhone joins the lineup with a few mildly notable differences.

Pillphone is made by Vocel, a mobile messaging platform developer. It’s based on ‘The Pill Book‘: consumer guide to the most prescribed drugs in america. The book has been around for decades; now in it’s 14th edition. The app is available on AT&T, Sprint and Verizon networks and the company claims it can work with most handsets and costs around $4/month. The features are pretty standard: visual/audible alerts and reminders, a mobile MAR, visual identification (i.e pill pictures), and side-effects information. Bit surprisingly, they have managed to get an FDA 510(k) clearance, handful of patents and some big investors.

No doubt that mobile computing platforms (not just phones, maybe dedicated health devices in future) are going to play a crucial role in providing medication adherence services of tomorrow. One of the key gaps though, is in integrating such personal MARs data with institutional EHRs. If we continue to be unable to reliably involve patients in the medication reconciliation process, then such mobile applications are just another isolated island of data – incapable of making the overall healthcare system more efficient. See Joint Commission‘s take on this topic here. Lets hope that in future everyone who checks into ER can hand over their detailed medication history on a dumb (or smart) phone to the staff and providers can use that information right away.

The underlying concept is nothing new in medical device industry, with it’s origins perhaps in holter monitoring fifty years ago. But true at-home remote monitoring began gaining traction in early 1990s; and today some major names are in the race: Honeywell Hommed, Philips, Health Hero, Cardiocom, Corventis. All of these companies have had an actual device as a part of the overall offering-  some piece of electronic hardware that enables capture and transmission of given physiological parameter(s). LifeStream, Motiva, HealthBuddy, Commander, PIIX are the respective names of the hardware from companies mentioned before. Even the recent consumer-oriented solutions like GlowCaps, Zeo, Fitbit etc. have a proprietary piece of electronics central to them.

And that, is what makes Welldoc is interesting. They have a disease management solutions that are entirely mobile and web-based. No proprietary hardware. It’s an interesting approach that points to an underlying need as well as an overall weakness of such models.

The unmet need here is for solutions that help engage patients at home and provide round-the-clock assistance in chronic disease management (e.g. what insulin dose to take, when to see your physician, etc.). That doesn’t require a device hooked to patient necessarily- it can be accomplished by manual data entry, easy-to-use software and intelligent algorithms. The value proposition is across many soft (as in, hard to quantify ROI on) aspects: enabling patient self-management, promoting health education, improving compliance, effecting positive behavior change etc. Of course, all these lead to some hard benefits that can be quantified (like improved Hb A1C values over time), but the cause-effect relationship can never be established beyond doubt.

The weakness in this approach is that all this depends on manual data entry by the patient or caregiver. It assumes that the affected individual is capable and disciplined enough to interact with the software consistently and reliably. Offering mobile applications is one way to start making that assumption partially valid. As a constant companion with computing power and internet connection, mobile phone makes it easier to use such software. But not enough to cover what I call the ‘last mile‘ of remote patient monitoring- from the patient’s body to an electronic data capture device. No matter how sophisticated the software is, it’s no good if there is not enough data to run its logic on. And our fundamental human behavior tends to revert back to lazy, undisciplined ways sooner or later. So yes, there is a role for pure disease management software but its a stretch to assume that it’ll suffice on its own.

WellDoc was founded by endocrinologist Suzanne Sysko Clough, MD in 2005. Their first solution, focused on Diabetes managment, was piloted in Baltimore in early 2006. Digging through their news it seems they have been fortunate enough to find substantial angel and grant funding, starting with $5M in 2007 and totaling nearly $17M to date. Recent years have also brought some big milestones for WellDoc: deal with Jitterbug (April 2009), FDA clearance (August 2010), deal with AT&T (October 2010), and integration with AllScripts EHR (December 2010). WellDoc website is skimpy on the actual details of their product, but there is a high-level demo. They seem to be expanding beyond diabetes into cardiovascular, wellness, medication adherence and clinical trials data management areas. That is a smart move. Also smart is their attempt at a business model. As their CEO explains in this article, they are aiming to get paid by large employers, plans and payers for making chronic disease management programs more effective.

The whole RPM industry has been praying for national direct reimbursement for decades now. Its been a tough journey so far- positive studies keep trickling out, and every year seems to be the one that will finally see payers admitting the cost-savings from RPM and starting reimbursement. WellDoc has also invested heavily in clinical trials to convince the industry. It’ll be worthwhile to see how successful a purely software-based company would be at making a living in the RPM market.

February 2011 Update: WellDoc announced that they have acquired Oncology Care Home Health, LLC, a education and consulting company helping home health providers implement specialized oncology home care programs. Probably the idea is to use that specialized knowledge to augment the logic behind their oncology offering (maybe get that FDA certified?).

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

On to more important things.

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

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

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

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

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

Dec 2011 Update: Doximity changed their logo..

Touch Diagnostics is a small startup that has created four iPhone applications that provide a new way to administer some of the neurologic exams:

1. Nystagmus is a  disorder with periodic rhythmic, involuntary movement of the eyes. One of the ways to test for it is by using a ‘Optokinetic Drum‘, which relies on the response of the eye to continuously moving pattern that has contrasting elements. Now the drum can be expensive and comes with real-world problems (storage, disinfection etc.). OKN+™ is a simple app that replaces the drum for $2.99.
2. In Finger Oscillation Test, individuals are instructed to tap their index finger as quickly as possible for few seconds, keeping the hand and arm stationary. It measures motor speed and helps determine particular areas of the brain that may be damaged. $2.99 DigiTap™ is replacement of older devices for this test.
3. Reaction time is a simple measurement (in milliseconds) between the presentation of a stimulus and the elicited response. The results can be used to assess fatigue, concussion, sobriety, etc. ReAct™ does that for $2.99.
4. Tremors are unintentional movements, and sometime these micro-vibrations are too small to notice with naked eye. For $3.99, TremorTracer™ provides a way to perform some subjective tremor tests (like Archimedes Spirals in which patient tries to trace a line inside a spiral space)

Okay, so these apps are not exactly cut for the top 25 list on iTunes. And they may never gain traction amongst the myriad of health-related apps out there. The clinical value of doing these tests, although foundational, is also no match for a CT scan. A neurologist I spoke with was quick to point out that doing these test the old-fashioned way doesn’t take much time, and the results are not that crucial anyway (for clinical course of action).

Regardless, I like the way these apps cleverly digitize a small subset of real clinical tests even when the hardware (i.e. the iPhone) was never intended for clinical applications. There will be a time in future when these smart computing devices open up to third-party hardware add-ons like scopes or sensors- temperature, pulse oximeter, etc. Then this would be a valid and viable genre of applications. Till then, we need to ‘fit the test to the device’ rather than the other way around.

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.

Seems like there are three components of the overall offering:

1. A hardware device called “Spiroscout” – a small add-on that mounts the inhaler canister. Every time it is pushed, the location and time-stamp data is recorded.
2. Mobile app – a ‘diary’ to keep track of symptoms, triggers, medications, etc. Can also be used to view map of data received from Spiroscout, and to get sms reminders for taking medication.
3. Online website – a ‘dashboard’ of sorts. Can help summarize submitted data to figure out disease patterns and trends.

The hardware device is not out yet (website says it’ll be out this summer), and the mobile app is currently in private beta. So there is not much of real world testing that has happened. But I’m still positive about Asthmapolis, for a number of reasons.

First, it’s the right kind of ‘focused’ monitoring solution that can potentially be transformative for managing a specific disease (kinda like Regina Herzlinger‘s argument about ‘Focused Factories‘ as one of the ways to salvage the entire healthcare system). It’s better than trying to find a solution that can monitor multiple conditions (example 1, example 2). I think the mobile diary and online dashboard would be key engagement tools in this regard. The more focused and customizable, the better.

Second, it helps in medication adherence which is a big issue irrespective of the medical condition. I think that knowing whether you took your medications and getting reminders if you didn’t,  is more powerful than knowing when/where you took it. The mobile app reminders would be a great resource there (automated calls to landlines may be good too…for seniors).

Third, it helps understand the individual triggers and community impact of asthma. For successful asthma management, a patient should know his/her triggers and avoid getting exposed to them. That is not an easy task for a number of reasons. My initial reaction was that GPS may be a bit of an overkill. But with rapidly decreasing cost of location-aware technology, why not? Much better than using it to check-in to nearby McDonalds.

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.

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.

Yes, I’m thinking the same thing. Why would you want to tweet something like that? And who the heck wants to be spammed by other peoples weight info?

Those obvious questions aside, its the trend that I find interesting. As the commodity devices that measure one or more of our vitals become web-enabled, ‘wellness’ goes beyond just being about purchase of a product. It gets transformed into a service. Withings is already compatible with a growing list of partners like DailyBurn, FitOrbit that provide fitness and personal training services. They also integrate with the big PHR platforms – Google Health and Microsoft Healthvault. So in theory, someone struggling with obesity could very well use the regular measurements from Withings device, social support from twitter followers, professional coaching through FitOrbit and health record from Google to try and achieve their ideal weight.

‘Connected Appliances’ are what Withings team envisions. They are not alone. I’ve written about several  analogous monitoring devices with some sort of web-integrated service (Read about Zeo, FitBit, Directlife, BodyMedia…). Although most of these focus on ‘wellness’ currently, they are setting an important precedent for managing ‘health’ conditions in a similar way. Consider the ‘how-does-work’ visual from the Withings website:

Now replace ‘weight’ with ‘Blood Pressure’ or ‘HbA1c‘ and you get the framework for managing health conditions (hypertension or diabetes, respectively). Take J&J’s spinoff, SymCare, for example. They are following the same framework for evolving the traditional glucometer. Lookout for more medical devices to move in the same direction.

January 2011 Update: Not that Withings team is reading Multiplyd for product strategy, but they just announced a Blood Pressure Monitor. I think that takes them one step closer to serious medical condition management tools company. Wellness is not going to be a sustainable product category for long, so this is a smart move.

August 2011 Update: Bought the Withings BP Monitor, using it to keep tabs on someone on the other side of the planet. It’s working very well so far. Very easy to use. The graphs and analysis functionality is not quite mature yet, but it works. I’ll definitely recommend it to others.

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.

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.

• My Health – An application to store your basic health information (allergies, meds, diagnosis, emergency contacts, and a twitter-ish 140 char Health Log). Available as a 99¢ iPhone app or a free online dashboard.
• If Found+ – A 99¢ iPhone app that can display a short message and contact info on the wallpaper of a locked iPhone.
• My Emergency Info – Another 99¢ app that essentially does the same this as If Found+ but instead of a short message, you can show ‘summary health info’. (So how is this different if I choose to write health info as the message in If Found+? I’m not sure.)
• Close Call – A free iPhone app that apparently does the same thing as If Found+ and My Emergency Info. It displays important emergency contact info as a part of wallpaper on a locked iPhone. Don’t know how that is different from the other two 99¢ apps.

Polka is the first funded company created at the Lab2Market progam at UCSD Rady School of Management and they started around mid-2008. I think they are certainly on the right track since the fast-growing, 24X7 access mobile platform is ripe for healthcare information storage and communication.  Except that I’m lost at the product differentiation and pricing level. In terms of competition, there are other In-Case-of-Emergency category apps available for the iPhone like Easy I.C.E for 99¢, EMT ICE for $1.99, Health n Me Pro for $2.99. None of them do any better job at it, though.

There are rough edges to what Polka offers today (tried their online dashboard.. not particularly impressive) but that may be understandable given that they are relatively new startup. iPhone apps are fine, but I think online dashboard may be a stretch unless there is a really ground-breaking, never-before feature that they can offer. Why not integrate with Google Health/Healthvault for the online PHR-like functionality right out of the box?

September 2010 Update: Polka.com doesnt work anymore. Although the applications are still available on iTunes store.