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..

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.

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.

Ranting aside, I like the user-friendliness of this site- very easy to navigate and see relevant information. They also do a good job of digging up public information from various sources and aggregate it all in a as-comprehensive-as-possible profile. Was also impressed by the fact that they have a healthy growth in traffic (now more than half a million unique’s every month, according to Compete).

Given the fact that potential users perhaps value ratings/recommendations/comments from other patients most, the biggest issue with all such sites is how to validate such information. In my search for multiple doctors, user ratings were almost non-existent. But even if they were as abundant as on Amazon, how does one establish their authenticity? I was able to submit ratings on one doctor without submitting any proof that I was ever treated by him (in full disclosure, the rating didn’t show up right away so its not that simple apparently. For example, their FAQ page says you can only rate your doctor once a month). Not sure about their revenue model either, since its free for users. Regardless, this is a good site to bookmark, just for getting all the public information about your doctor in one place.

Patients get to use the site for free-  looking up physicians that accept their insurance and setting up appointments with them. Apparently, physicians need to pay to join ZocDoc and their enter availability info. Given their recent start, focus on one metropolitan area, the monthly unique visitor count is significant (20K+ according to dataopedia).

Interesting idea overall, kind of OpenTable.com for clinical care. The fact that you can set up a guaranteed appointment with a care provider today is a great feature (hard to execute in all cases though). What blows me away is the backing they have- Khosla, Bezos and Benihoff! That has got to be the most incredible investment partner team I’ve seen so far in any small healthcare IT startup.

September 2010 Update: ZocDoc is now in San Francisco, Chicago and Washington D.C. too.

There is scope for such services, for sure. There are significant number of people who need care that falls outside the realm of what insurance covers. Second opinions, cosmetic procedures, international travelers are some categories that come to mind. But as always, business model remains the Achilles heel. If you are operating a platform that matches supply with demand, its more straightforward to make money in commercial domains, much like eBay or eLance. But healthcare is different ballgame. Privacy, outcomes, benchmarking, feedback, transparency are some of the confounding issues that need to be taken care of.

Currently HealDeal is a social venture, with no subscription or advertisement model evident. Hopefully they have deep pockets or influential allies to keep themselves above water. It’d be interesting to have it as an app on Google Health though, especially if they can strike partnerships with other related, pro-self-pay businesses like Myca.

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.

Carol.com’s original intent was to be a ‘marketplace for care’- a place where consumers with fat HSA‘s could comparison shop for their healthcare needs. The site attempted to create “care packages” around specific conditions or medical needs (e.g. years-worth of outpatient asthma care, for example) and let consumers choose which provider to go with. Very neat concept, although in my opinion it’s probably more applicable to commoditized parts of care (like LASIK, botox) rather than a cardiac cath or appendectomy.

Turns out that Carol.com didn’t attract enough buyers and sellers to make this a viable marketplace- blame it on the economic downturn, lack of consumer awareness, or just plain bad timing. The statistics show a steady decline since Feb’08 (probably the peak of media coverage for Carol.com): 15K then to less than 5K in Feb’09.  As this article states, in late 2008 they had to make job cuts and re-think their strategy- which is since then to be a consulting and software services provider for healthcare organizations.

I doubt Carol.com will run out of money anytime soon (the website is still up for Seattle and Twin cities) given it’s founder’s previous success. But its unfortunate that good ideas like it go on life support while CDHC remains in its long gestational period. Someone needs to teach consumers how to drive healthcare… soon.

September 2010 Update: Guess I was wrong. Carol.com now has a new name (Carol Corp.) and the website no longer has the marketplace as before. It has some boilerplate info about healthcare consulting and software development services.

Vimo is a consumer portal focused on comparison shopping for healthcare needs. Founded in 2005, Vimo provides a platform for users to research, review, compare and price the following:

• Hospital Procedures
• Individual & Group Health Insurance Plans
• Health Savings Accounts
• Doctors

Compete.com data shows pretty good visitor count (more than 100Kvisitors/month), so they must be doing something right. Their services are free which makes the surgical procedure pricing tool even more impressive. I tried their doctor search tool too, and it worked pretty well for my location (returned more info than usual). Neat interface, fast results.