Zume Life is a San Jose start-up that is planning to develop its own dedicated device to allow individuals to keep track of and manage their own care regimen. It’s target users are individuals with complex care requirements- taking a multiple medications, specific diets, frequent measurements, daily exercise etc. So what is offered is a ‘Zumi Life Service’ that helps coordinate the logistics of doing these multiple activities. The service can be accessed via the device, an iPhone app, and a website. The device (designed by Dubberly Design Office, seems still under development) is called “Zuri” and below is a pic and video that, interestingly enough, I found elsewhere on the web.

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

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

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

Around 1989, Steven Schueler started working on a computer program that could perform symptom triage. The intent was to create something that patients could use to safely decide what to do when they were sick. In 1990, his company DSHI Systems released “Home Medical Advisor” on a floppy disk. Later it was issued on CD-ROM’s, and claims to have sold over 2 million copies over the years. A major win for DSHI since 1999 has been its adoption by the Veterans Health Administration (VHA) as the Veterans Health Gateway (VHG). VHG provides over 300 symptom/condition-based triage algorithms and related patient education information and is used by VHA nurses to provide health advice via the telephone.

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

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

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

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

In their own words ‘Psych Central is the Internet’s largest and oldest independent mental health social network’. From what I can find, it seems to be true. They have been online since 1995, and last year got close to half a million unique visitors.

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.

Usually I’m wary of putting time into big-budget health portals, but San Francisco based Healthline deserves a mention. They have a portfolio of healthcare search, navigation and content that is syndicated through a growing network of big web properties like AARP, Health.com, iVillage, AOL etc.

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

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

RememberItNow is an online medication reminder service. Once you enter the pill information (what, when) it can send email/text reminder messages at the right time. Also included are some features around access control , scheduling, charting, journal etc.

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.

CureTogether was started in July 2008 as a way for patients to aggregate their anonymous medical data into an open-source database that can be used by any researcher in the world. They started with three conditions – migraine, endometriosis, and vulvodynia but now count more than 400 on their radar.

There are plenty of precedents to social networking websites for patients, so nothing new from that perspective. But as I read more about this one, it stood apart. The idea of a patient collective focusing on obscure, lifestyle-affecting, painful, chronic and under-researched diseases  and making their raw data available is pretty cool. This WSJ article talks about trend of ‘Personal Informatics’ emerging- where affected individuals obsessively record everything about their life and share it with others. This may usually sound useless and weird, but given the fact that there is no definitive causal understanding of conditions like migraine (even though it affects millions of Americans each year), I find it novel and exciting.

I like this bottom-up, organic approach to furthering research on obscure conditions. Their call for Open-Source Health Research is also an interesting read.  Bit worried by the fact that CureTogether is self-funded. Hopefully they will stay around long enough to claim a large-scale success for one of the diseases.

ZocDoc is a free service that allows patients to book Doctor appointments online in New York City. It started in September 2007 as a service to help people find and make dentist appointments in NYC, and has now includes other specialties too (like primary care, dermatologist, ENT, ortho, OB/GYN, allergist, podiatrist, etc.)

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.

While the conventionalists argue otherwise, there is some truth to the fact that plenty of health conditions can be taken care of without actually seeing the patient in-person. Based on that assumption, AmericanWell offers an interactive service that lets patients talk to a physician in real time, anytime.

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

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

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