Nothing new here. Ozmosis is based on the now-old concept of physician networking website, with features like knowledge exchange, journal club, cases, alerts, news etc. Looking at dataopedia, they don’t have much traction either (roughly 1K visitors per month).

Although I’d always like to write about novel ideas, exceptions like these are purely from a record-keeping perspective. I’m trying to get a rough list of how many different takes of social networking for clinical professionals are currently floating around on the web.

Practice Fusion is a web-based EMR & practice management system that is targeted towards private practices. SaaS-based EMRs are not new, but what sets Practice Fusion apart is its business model and lineage.

Practice Fusion’s is free. Free software, free hosting, free service. It is  supported by ‘non-intrusive’ ads. They have figured out a way to utilize Google Adsense APIs in a way that is compliant with HIPAA, i.e. doesn’t adversely affect patient privacy. Their CEO said in a 2007 interview that Practice Fusion will provide advertisers with basic demographic information about the physicians who view the ads – such as their city and specialty – but will not reveal names. If the users don’t want ads, they have an option to pay $100/month/provider to make them go away. As for the lineage, the company is backed by SalesForce both in terms of investment and advisory board. I guess that is where they inherit the ‘online, real-time, risk-free, on-demand’ marketing message.

I’m an absolute fan of free software, and believe in the utopian dream of free, ubiquitous EMRs. But I scratching my head on how exactly does an EMR work with an ad-supported model. Fact 1 – Doctors (esp. private practice) doing electronic documentation want to minimize distractions and click on as little items as possible. Fact 2 – Google Adsense sends you a check only if the users click on an ad. Those two facts are contradictory. How many doctors in their right mind will take time out in the middle of care delivery to click on an ad? I’ll bet none. Not many will pay $100 either.

There is some evidence that they charge some unpublicized fees ($50/month/provider “support” fee according to this commenter at another blog Note: Updated: See Emily’s comment to this post).  Practice Fusion claims their user base is now up to 18,000 and they are the “fastest growing EMR” but those sound like marketing tactics rather than hard facts. For example- This press release says that they are “fastest growing ” with 1300% growth rate. Well that is perhaps because they are comparing two convenient times – in early 2008 they had about 1000 users, and in early 2009 they had reached 13,000.

I’ll try not to judge them based on unverified complaints and odd press-releases, but I seriously doubt that good, competitive Healthcare IT software and it’s support can be sustained solely on the basis of only an ad-supported model.

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.

Online communities are nothing new to healthcare. What seems to be the trend is increasing vertical focus. Oncocentric (also called MedTrust Online) was launched in January 2009 as an online community for oncologists. Their aim is to help find, manage and share information by connecting oncologists with each other. They have other features like twitter updates, ‘OncoAssist’ panel of experts, search engine, etc.

The site seemed to be more like an offshoot of a professional organization, and not a startup, so I delved further. Seems like MedTrust Online was formed to leverage genetic-based medical discoveries by a non-profit organization called TGen (Translational Genomics Research Institute). TGen and MedTrust signed licensing and service agreements to bring to market potential drug therapies based on genomics.

Not much else to note about the site since I dont have insider access. Their site tour talks about standard features like sharing cases, ask experts, general forums, news etc. It’d be interesting to find out how many of the 30,000 or so oncology professionals are currently members of the site.

Medpedia is an attempt to apply crowdsourcing concept to medical knowledge, just like Wikipedia. It launched in beta mid-February this year, with some big names backing it (Harvard, Stanford, NHS, AHA, ACP to name a few). The idea is to create a collaborative body of knowledge using physicians and Ph.Ds as gatekeepers.

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.

Primary care is a frustrating experience for most patients as well as physicians. Patients find the experience inconvenient, borderline impersonal and hardly get access to any of their resulting information from the visit. Physicians are hard-pressed for time since they are mostly drowned in paperwork. Considering the rise in HSA, high-deductibles, and no-insurance it’s logical that out-of-pocket payments for primary healthcare will keep increasing.

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),…

Your doctor may not think of it that way, but some advertisers feel that the time you spend in the waiting room is important. Phreesia offers ‘PhreesiaPad’: a wireless-enabled touch screen device that replaces the traditional forms-on-a-clipboard you get handed when visiting your doctor.

The idea is that patients enter their information (age, insurance, complaint, history etc.) via its touch-screen interface in the waiting room while ‘enjoying’ drug company sponsored educational material related to their situation. PhreesiaPads are provided free of charge to the physician, and tab is picked up by drug companies. The company claims several benefits like legible information, shorter visits, less errors, reduced data entry, reduced staff time etc. Whatever.

Phreesia is a part of inevitable invasion of electronic medical record-keeping, but my personal irk is with the blatant way in which our healthcare system is giving more and more direct patient access to pharma companies. There is a fine line between ‘educating’ patients and taking advantage of their emotional state to promote your product. Direct-to-consumer-advertising (DTCA) adds unnecessary cost to our already overburdened system. No wonder DTCA is illegal in all developed countries except US and New Zealand.

Collecting patient input electronically is a great idea. It would go a long way in complex, long-standing conditions that require regular physician interaction; like chronic pain, palliative care, geriatrics, etc. In all these cases there is a lot to be gained by understanding patient preferences/attitude regarding treatment and how it affects their quality of life. Often patients can’t verbalize everything they feel and physicians run short on time. Having a tool like PhreesiaPad can enable valuable insights without affecting the clinic workflow much. Not to mention how great it’d be to have such data integrated into the EMR that the clinic is using.

AskDrWiki is an online repository for medial information modeled after Wikipedia. The project was started in early 2007 by four physicians looking for a quick way to share review articles, notes and images in cardiology. The site is a grassroots effort, and geared towards clinical audience- residents, interns etc.

Wiki’s are a good way to organize collective wisdom in any field, so the concept is valid. Problem with wiki’s are that 90% of content is written (and policed) by 10% of the users. When your potential audience is not a big number (only 100K or so residents enrolled in US every year) and nature of material necessitates careful oversight, all that translates into a very slow progress for content. Their homepage was last edited in Dec 07 and last blogpost was in April 08. The site draws a decent number of unique visitors though..in range of 5,000. Hope they gain momentum in future.