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.

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.

GlowCaps fits the standard pill container, and uses short-range wireless communication to talk to a gateway hub at home that is connect to the internet. There is also a reminder light (looks like a night light) that plugs into any standard power outlet. If the bottle isn’t opened at the appointed time, the cap and night light start blinking to remind the owner to take the medication. If after an hour, the pill is still not taken, GlowCap starts start playing jingles as well. After yet another hour, it’ll send a message to Vitality’s system which can then place an automated phone call or send a text message with a reminder. Brilliant.

Beyond having a ‘smart lid’ for bottles, Vitality has integrated functionality that keeps caregivers in loop. There are social support features (shareable weekly email reports), refill facilitation (refill reminder calls) and physician interaction tools (printed monthly reports to you/doctor). So it hits all the major interaction points for a patient’s medication regimen. Last month AT&T put out a press release about GlowCaps running on its wireless network. So the Vitality gateway now has mobile phone technology, and I assume that precludes the need for an ethernet connection.

Every clinician knows that medication adherence is a huge problem ($100B figure has been thrown around as the cost of poor adherence in US). More than a consumer product, this is a fantastic service that can change medication packaging in general. And looking at the Managed Care (enhance the personal/medical record), Research (change patient behavior) and Pharma (reduce brand-switching) focused pages of their website, I think Vitality knows that. It’s definitely the next stage in evolution of the standard pill dispensers (like ePill, Philips).

Their CEO David Rose has an interesting background in creating internet-connected everyday devices at his last company, Ambient Devices. Somewhere in a press release I read his quote about “…providing minute-by-minute adherence data to motivate healthy behavior.” If you take the word ‘adherence’ out, that may be a basis for a lot of future medical solutions and an adage for next-generation of medical device companies.

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 reliable enough to put 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 just 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 utilization 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.

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.

So consider it as the social network that started before the age of social networking. It now offers blogs, forums, reviews, news, feeds, tweets and other community features to people interested in mental health. Seems like they are making a decent revenue with it too.

Always good to see focused, pragmatic and simple solutions being successful. Proves the point that social networking has more potential when done in a niche way.

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

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

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.

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.

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.

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.

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.

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 be impactful.

Myca plans to ride that wave. It’s an outpatient EMR and Practice Management system built with a social networking perspective. Its core emphasis is on enhancing the physician-patient communication and provide a shared ‘dashboard’ that both can utilize. As a patient, one can schedule appointments (or cancel) online, pay with credit card, setup email/video consults, access your record, etc. The service is based on a $35 monthly fee with physician charging $100-$200 depending on the complexity of complaint (see breakdown here).

Using Myca platform, any PCP can setup a subscription-based, consumer-oriented primary care practice. The first such practice is called HelloHealth, located in couple of neighborhoods of New York city. HelloHealth is co-founded by Myca’s Chief Concept Officer (what??) Jay Parkinson who attained fame with his unconventional anti-establishment practice approach couple of years back.

I like the concept. It empowers PCPs to get off the hamster wheel of insurance and invest time in patients. Given enough competition and market acceptance, tools like these can make the old ‘Boutique Medicine’ concept more affordable and efficient. If nothing else, its a sign of service innovation in an orthodox industry.

PS: I’ve been running into a lot of these niche medical practices based on Boutique/Concierge Medicine. They dont have a direct relation to Healthcare IT, but point to an important trend that will utilize IT at its core. Here is an ongoing list of such practices: Qliance in Seattle, Crossover Healthcare in Southern California, MD2 (NYC, Chicago, Portland, Bellevue, San Francisco, Seattle),…

They smartly target three different segments using different pricing/marketing strategies: Consumers (as GoWearFit), fitness clubs (as BodyBugg) and clinical researchers (as SenseWear). The specifications, features and services differ for each offering and a good comparison table can be found here. All that detailed health info does come at its price- their consumer product starts at $199.95 for the hardware and a $12.95/month subscription to the online personal manager tool.

The company has been around for more than a decade and has certainly come a long way. BodyBugg is used by contestants on NBC’s television show The Biggest Loser, you can find GoWearFit in Dick’s Sporting Good Stores, and there are a bunch of peer-reviewed publications and studies done using SenseWear. I’m a fan of products that let consumer manage their own health, and BodyMedia is certainly doing the right things to ride that growing trend.

Tying the mandatory monthly subscription seems like a walled-garden approach, though. Integrating with electronic records would be a fantastic growth opportunity- think of all the apps that can be built on top of such monitoring data if it were available on PHRs (like Healthvault or Google Health) and/or the outpatient Electronic Medical Record with your physician. Perhaps a more affordable pricing strategy would also help, since insurers are still a long way from paying for such devices.

What a great startup idea. Service demand can be tapped easily since users are searching the web for highly specific keywords (almost all include the keyword “trials”, so bit of SEO and keyword advertising would direct the traffic effectively). Other sources are the rapidly growing PHR platforms like Google Health and Microsoft Healthvault- both encourage developers to write apps that provide such value-added services based on user’s health information. Supply is readily available on ClinicalTrials.gov, a government-sponsored online public registry of clinical trials in US.

TrialX.org is completely free for users (patients). They let investigators create free accounts to post their trial information directly, but charge a fee for providing access to the interested potential trial enrollee. It’s hard for trial investigators to find eligible patients who are motivated to stick around for the complete trial. TrialX solves both the problems for them.

Imagine the possibilities if this service gets integrated into CIS vendor products. A patient coming in for advanced  breast cancer treatment can be flagged right at admission and be given the option to enroll in an experimental drug trial right then, if they so choose. If nothing else, it’ll give the medical research community a much more real-time opportunity to advance the science.