Rochester, NY based Logical Images is the company behind VisualDx. Understandably enough, it was founded by two dermatologists from University of Rochester in 1999. At its core lies a pretty big repository of clinical images (they claim > 60K) that are tagged with clinical metadata like symptoms, location, history etc. A user can browse through diagnosis domains or input findings to reach a relevant set of images.

There is a 15-day trial for non-enterprise users, and individual subscription pricing ranges from $49.99 (Pediatric) to $99.99 (Adult) for a year. Student discounts brings it down to a very reasonable level ($29.99 and $49.99 respectively) in my view. The company has leveraged their content to create an online consumer health resource called Skinsight. Besides the clever name, I really liked their slick ‘Skin Condition Finder‘ tool. Overall, it’s a smart approach for gaining market recognition and expanding services.

The concept of Diagnostic Decision Support (DDS) often comes with the implicit notion of text-based query, so I really like the ‘visual’ DDS approach. Dermatology, Pathology are obvious choices to implement such an approach and situations like ER, bioterrorism, infectious diseases are prime contexts since there is not enough time to engage a pure text-based knowledge base. Also, some conditions are rare enough that most practicing physicians and non-specialists haven’t actually seen one in real life. Other factors like dark skin, atypical presentation can be confounding. It’s handy to have a this as a medical education tool and as a care delivery aid in facilities where specialists are not available all the time.

I’m bit surprised why it’s not a widely subscribed resource in hospitals, public health entities, medical education and general EMR vendor products. Anyway, it’d be interesting to see this visual content embedded in other consumer tools (like iTriage, FreeMD) and enterprise offerings (Isabel Healthcare, SimulConsult, Curbside.MD etc.). Wonder which firms are competitors for VisualDx today…

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’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.

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.

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.

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),…

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.

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.

What sets it apart from the usual networking websites is their business model (plus the fact that its aptly explained on a dedicated page) . Within3 is free to individual professionals, and earns revenue by selling software licenses to health and life science organizations who wish to establish online communities inside the platform. There are some nice examples of communities built on their platform- like med school alumni website, medical associations, etc.

SimulConsult has an interesting logic behind it. Roughly speaking, its knowledge is derived from a ‘computational wiki’ that is restricted to physician users only. So its database is not only open for viewing, but users can submit modifications to the database. The system performs bayesian pattern matching and also considers temporal information like the age of onset and disappearance of each finding for each disease under consideration.

According to Dr.Segal, there are about 33,000 data points (disease findings) in the system and the future expansion plans are to include more of metabolism and genetic diseases. Interestingly, the wiki approach for knowledge gathering in healthcare is becoming more common (AskDrWiki, WikiDoc, wikiMD to note a few- more on them later).

Feb 20, 2009 Update: Got an email today announcing that those who contribute information to SimulConsult database will now get paid for their contributions. As they are adding sponsored links in the software, I guess it makes sense to share the wealth. More info here.

Since its launch in early 2006, SpineConnect has gathered 1174 members from 38 countries with a knowledge base of over 900 cases and 4200 reviews (June 2008 data). I’m not sure about their business model, but it has to do with facilitating partnerships to bring innovative spine surgery ideas to market.

My personal belief is that general social networking websites loose their value with scale- there needs to be a common passion among members for the community to thrive. SpineConnect is a good example of a narrow focus community discussing treatment, challenges, outcomes, research and new technologies for a very specific field. All the more better for targeted advertisements . The future of networking is niche… at least in healthcare.

The business idea is to mine the community generated data and monetize it by letting sponsors directly participate and gain real-time insights into physician attitudes and perceptions. They provide online CME (free), journal articles and news/meetings/conference coverage. The standard WebMD fare of Medscape Drug Reference, expert columns and interviews are included too.

Curbside.MD is a search engine for finding evidence based clinical information. The idea is to type in the search need as a natural language question that a clinician would normally ask his/her colleague, and get relevant answers from the literature (articles, images, guidelines, etc.)

I took it for a test drive with a moderately complex question (‘what is the indication for platelet transfusion in an 80 year old female with dengue fever?’) and got relevant results in terms of review articles and clinical trial outcomes. Pretty cool.

The logic behind Curbside.MD is semantic indexing using a controlled medical terminology (they call it “semantic fingerprinting“) with a bit natural language processing. They provide a bunch of tools (search box, news, spellchecker etc.) for partners and a browser search toolbar for users. The technology is also available as an API service from an alternate website called Fingerprint.MD.

Praxeon is the company that started Curbside.MD and MyDailyApple in 2006. Both websites are currently free for users, but the company admits to a future ad-based business model.

So what is special about Sermo? For one, it has been forming all the right partnerships. Take its alliance with the country’s largest physician organization (AMA), collaboration with pharmaceutical giant Pfizer and the agreement with main regulatory authority FDA. Second, it’s been successful in getting traction from a very fickle and tech-resistant group of prefessionals- physicians. Their compete.com report is pretty impressive:

The site claims 65,000 users and generates revenue by charging outsiders for access to the community. The data generated by physician interactions around medical events, treatments, observations, opinions provide valuable insights to commercial organizations. The ‘information arbitrage’ model, as Sermo calls it, is shown below:

Sermo is not alone in trying to aggregate and monetize the lucrative US physician community. Docsboard, SocialMD, DoctorNetworking are others in the game. There is competition in adjacent spaces too: NurseGroups, NurseLinkup are focusing on the registered nursing professionals, StudentDoctor.net focuses on medical students. Even finer niches like women in medicine are online (MomMD).