Turns out that Lifescan apparently did nothing with that concept. Anita Mathew (who gave the demo on Lifescan’s behalf in 2009) decided to take it forward on her own and founded Glooko. The company currently sells MeterSync, a cable that connects your iPhone to five popular glucometers in the market. Users can download the ‘LogBook’ app from iTunes store to document, analyze and share their data.

I’m not an investor (yet), but if I was, I’d put my money in Glooko. This is exactly what the future should start to look like for conventional consumer health devices. Instead of being isolated products that store a limit amount of quarantined information, they need to provide a service that enables longitudinal disease management. For a patient with long-standing diabetes, he/she needs to know how much insulin to inject for covering the meal they are about to have, not what their blood glucose number is. It reminds me of Theodore Levitt’s famous MBA quote “People don’t want to buy a quarter-inch drill. They want a quarter-inch hole.”

For Glooko, the long-term sustainability is directly proportional to how useful and sticky it’s users find the logbook iPhone app. The hardware (Metersync) may be critical at first, but end user experience and market differentiation will come from the software. There is competition, of course. Agamatrix  has been in the market with it’s iPhone compatible glucometer, and last year they announced partnership with Sanofi-Aventis that gives them the much-needed commercialization ability. Instead of augmenting diagnosis, another company Cellnovo takes a similar approach with therapeutic insulin pumps. Perhaps we’ll see a synchronized gluocometer-insulin pump offering or an intelligent, symbiotic ecosystem for diabetes devices in future.

I’ve talked about the ‘last-mile’ of remote patient monitoring in the past. Conventional medical devices produce digital manifestations of physiological parameters, but the information collected hardly goes beyond the device itself.  We need consumer-oriented medical devices to become monitoring services that automate/transform the last mile for consumers. The future is arriving piecemeal, and sadly enough, it’s not being delivered by the incumbent behemoths of the medical device industry. Withings BP Monitor (which I can personally validate since I use it) enhances the value proposition of a regular BP Monitor for hypertensives. Zeo does the same for people with sleep disorders. Granted these offerings are perfect yet, but all vectors are aligned in the right direction. As for Glooko, look out J&J.

Today, clinical professionals have tools (like Ovid, ScienceDirect, UpToDate, Trip) that help answer complex questions and are connected to validated knowledge bases derived off of sources like PubMed. But how does a patient, with no access or expertise in the domain find and leverage this information? Medify tries to solve that.

The value proposition of Medify is not easy to describe. In fact, the ‘What is Medify‘ description on the site was banal enough to be dismissed, just like most other online social health startup marketing. They do a better (albeit prolix) job on the ‘How it works‘ page. Medify will appeal to the well-informed patients who are not afraid to sift through piles of academic articles burdened with medical jargon to understand and manage their own disease. Medify gives them a dashboard of existing literature – with it they can monitor things like which treatments are gaining traction in the provider community, which institutions are on the forefront of relevant research, etc. Affiliated web 2.0 functionality like faceted search, social sharing, tracking, annotating are bundled in to make it more personal.

Under the hood, it is smartly leveraging what public knowledge bases are already out there. The citation and abstract are free from PubMed. Interstitial phrases and terms in the content are further linked to sources like Wikipedia and MeSH. Brief outcomes or summaries are synthetically constructed from the article text.

Medify is not alone. There are other sites that try to help patients navigate the vast sea of research literature. PubMed’s parent NLM runs MedLinePlus,  UpToDate has a patient-oriented version, and niche startups like MyDailyApple, PatientsLikeMe are also tackling this to some extent.

In 2001 Brian Haynes, MD, PhD wrote an article describing the landscape of such ‘pre-appraised’ resources through a hierarchical structure that had four layers (called “4S” Model):

• Original ‘Studies’ (what PubMed provides) at the base
• ‘Syntheses’ (systematic reviews sources like The Chochrane Library) of evidence just above that
• ‘Synopses’ (like EBM, EBN Online) of studies and syntheses next up, and
• the most evolved evidence-based information ‘Decision Support Systems’ at the top.

He later expanded the model to 2 more layers (read about the “6S” paper here), but the basic argument remained same – Information seekers should begin looking at the highest level resource available for the problem that prompted their search. That is a good framework to understand why services like Medify are needed.

The skeptics would argue that offerings like Medify will do little more than empower hypochondriacs. But I believe that well-served health information only makes outcomes better. The lag time between published research being implemented in real-world medical practice can be in the order of decades. As consumers, we are entrusted to make choices about other important topics like money, and the market provides personal finance tools/services to help. Same can apply to healthcare, without diminishing the role of experts.

Alliance Health offers services to create health-related social networks. So it’s like Ning (Marc Andreessen‘s online platform for custom social networks) for healthcare, except that users can’t self-service and start a health-related network on Alliance Health.

They currently operate separate networks on over 40 physical and mental health issues (see screenshot below). Each community offers the standard fare expected in a online social networking site- discussion forums, videos, posts, reviews, etc. The star performer in their portfolio is DiabeticConnect, which is reportedly the largest diabetic community online with around a million unique visitors monthly.

If you look at the top most active social networking websites today, there are hardly any entries related to health (DXY.cn, DailyStrength, CaringBridge are the only ones). Yet health information is one of the most commonly sought-after content online. So there is definitely scope and need for leveraging social features of internet for health. Doing so on a combined platform increases viability, since the mainstay of revenue for social networking is still advertising. Cumulative audience across all networks is a better sell to potential advertisers.

I have high hopes for Alliance Health. Once the user base is there (like in DiabeticConnect), there are significant revenue opportunities in data analytics and mining. Beyond niche topic-based networks, I think they can extend services to private organizations like large care delivery organizations, insurers to create white-label social networks.

I first heard about MyBasis during a talk given by Bharat Vasan (founder?) at Bay Area Quantified Self gathering in June 2010. He referred to it as PulseTracer back then, and described its use for pulse monitoring. Based on the current description on their website, the product concept seems to have matured. Similar to BodyMedia, it now has 4 Sensors: Pulse, Temperature, Accelerometer, Skin Conductance (i.e. moisture). It is USB and bluetooth enabled; and comes with integrated social functionality (gaming, sharing, rewards, etc.). There seem to be smartphone, iPad and online applications that help provide analysis and understanding of the collected data.

MyBasis certainly has the concept nailed: A smart device with multiple sensors and long battery life in a familiar form-factor + Always-on and connected to desktop, mobile and online dashboards that simplify analysis of the aggregated raw data + Integrated social features that help make it sticky and viral. If they play it right, this can be a hit. Mainstream competition from products (like the lackluster Polar offerings) is uninteresting and hardly addictive.

But critics can say that there are always technophile early-adopters (like me) who crave anything that is novel and web-enabled. So before we get over-optimistic about the impending success of such devices, consider two important caveats.

First, it’s not about sophisticated monitoring or granular data. Whether they realize it or not, the key value proposition for an average end-customer is the personalized insight that results from it. Gathering 24X7 data from multiple sensors is great, but it’s all pointless if the user doesn’t understand the ultimate picture that results from all that data. Most users are interested in revelations into their health and lifestyle, not numbers. So the way MyBasis handles analysis is going to be critical. I was disappointed with MyZeo and FitBit for the very same reason. An interesting approach that MyBasis seems to have is the creation of a virtual pet that gives a quick proxy of your overall status. It may sound silly, but abstractions like these have shown promise in encouraging self-monitoring and positive behavior change in users (e.g. see UbiFit project at University of Washington).

Second, the technology and device needs to be so well-integrated with a user’s lifestyle that they essentially ‘disappear’. If someone needs to put a headband one (like for Zeo) or remember to find a USB cable and synchronize every week to prevent data loss, you can be assured that it’s not going to work out long term. As a species, we humans have remarkable lack of discipline even when it comes to things/habits that are good for us. So the offering needs to add minimal extra work and be seamless with your daily life. Neil Versel at MobiHealthNews calls it “passivity”. Example: FitBit gets a better grade than Zeo in this regard. I clip it onto my belt (almost sub-consciously now) every day and plop it on to the USB hub (always connected to my desktop) once in a couple of weeks. That’s it.

MyBasis is still in early beta, so my impression is based on what their website claims and not actual usage. I’ve signed up for preorder and will update this review when I get my hands on one. Seems like the cost is a one-time $199 for now. It would make a lot of sense to have  a subscription-based model of some sort though. Also, it’d be great to see such solutions go beyond just wellness and be tailored for medical-grade serious conditions like diabetes, hypertension, etc. All clues indicate that such applications are not very far in the future.

Established in 1995, the Center for Connected Health is another such example within Partners HealthCare in Boston. They’ve dabbled in a number of remote monitoring pilots- diabetes, dermatology, heart failure, etc. Healthrageous is their first spin-off. It started as a pilot project conducted in 2006 with EMC Corp. to give employees self-management tools for blood pressure. In June 2010, Healthrageous raised $6 million in a Series A funding led by North Bridge Venture Partners of Boston.

Having read enough of them, I think the marketing message around the concept of continuous care through remote monitoring has now been perfected from multiple angles. Read the descriptions from Welldoc, HealthBuddy, Telcare, iMetrikus, Hommed, Cardiocom, Gentag, BL Healthcare for example. Healthrageous also does a good job at describing the high-level value proposition.

But it seems that the transition from online paragraphs to a generally available, well-known and affordable solution has not happened. I searched for what product/service I could buy through Healthrageous to help a close friend manage her hypertension, but couldn’t find anything. There are some encouraging success stories on the website, but no explanation as to where can one sign up for becoming a success like that. I wish these websites were more transparent and lucid, maybe even at the risk of being less enchanting.

PS: Found two candidate consumer-oriented solutions for remotely managing hypertension. One is not available yet (Withings BP Monitor), and other needs an Apple iOS device to work (iHealth Lab’s BP3) and didn’t get great reviews. If anyone knows of other products/services, please share through comments below.

There are exceptions though, perhaps due to changes like Orphan Drug Act of 1983. Take Genzyme‘s wonder drug cerezyme for example. It’s target population (worldwide) are the roughly 10,000 patients affected with Gaucher’s Disease. For each patient, the drug treatment costs $200,000 annually and is needed for life. No wonder that even with that small target market, cerezyme accounts for about 30% of Genzyme’s revenues, netting close to a billion dollars every year ($1.24B in 2008, for example).

Such exceptional, near-magical stories are not limited to pharma wonderland. Patients with some rare conditions have found exceptional support through dedicated online communities started by inspired individuals who are often patients themselves. PatiensLikeMe was started for ALS, for example. Ben’s Friends was started by Ben Munoz in 2006 for AVM. There are many more niche online destinations for rare conditions, and that fact is hardly surprising.

The really interesting trend, though, is the emergence of companies/organizations that offer something at a higher level; beyond just a focused online destination for an uncommon disease. CureTogether is a good example. By aggregating self-reported data from patients, it aims to create an open-source research database for uncommon conditions. Similarly, Bens’s Friends acts as an incubator and clearinghouse of online communities focused on the long tail of rare medical conditions. They claim to have around 25 networks and over 7,000 patients in their family of ad-supported communities. The sites don’t have huge number of visitors, but that is perhaps due to the implicit rarity of target audience. See the quantcast chart below, for example, where I compare couple of their communities that are supposedly the most popular.

Regardless of visitor numbers, Ben’s Friends points to an interesting evolution phenomenon for healthcare information online. Building communities is now old-school. The new set of ideas are at a higher level of abstraction.

Pharma, Media, Government organizations sometimes find themselves in dire need for a quick survey of licensed physicians. They are happy to pay honorariums for a response, but how does one quickly assemble a large enough group of physicians based on a specific criteria (like specialty, location, etc.)? TruthOnCall aims to serve that need. Physicians, verified through their provider ID (NPI), sign-up on TruthOnCall to receive text questions through SMS. If they respond within 24 hours, they earn $10 per question. Once the amount reaches $100 or above, TruthOnCall mails a check to the physician.

Granted that there is a need here. Big companies often find it hard to get any objective granular data on strategic issues- surprise move by a competitor, drug recall in same class, end-of-the-year justification for a marketing campaign, etc. The usual source are industry analyst firms like Frost or Gartner, but the facts in those reports are often too generalized. So getting feedback from a thousand physicians in a few hours can be worth a lot.

But all that depends on the critical assumption of consistent demand and supply. There needs to be enough supply of physicians (in a given specialty) signed up, and there needs to be a demand from an organization willing to pay. Getting the former is the hardest. Metcalfe’s Law from telecom applies here. It’s clear that the value of such a network grows exponentially with the number of connected users in the network. But niche social networks don’t crystallize by themselves overnight. To reach that critical mass (where networks start having “value”), they need significant money or marketing or both. No good way to tell how TruthOnCall is doing with respect to incoming demand and supply.

Some side-notes: There are a few physician twitter celebrities- (@KevinMD, @DeanOrnishMD, @jhalamka, @tedeytan…). Maybe a viable alternative for rapid physician feedback is getting these guys to tweet the question. Generic networks aside, Epocrates is one good example of a viable physician network. Incidentally, this sort of honorarium service is a good fit for Doximity, which is another physician networking startup by the co-founder of Epocrates.

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..

MeYou Health is a ‘well-being company’, in their own words. Their offerings help users engage in a healthy lifestyle, using their social network support. If you are like me, that doesn’t really tell you what they do. So I decided to find out more.

MeYou Health started in 2009, and is funded by Healthways, Inc. Healthways is a 30-year old, publicly traded health services company based in Franklin, TN. They main business is to provide disease management and wellness programs to managed care companies, self-insured employers, governments, and hospitals. MeYou Health seems to be a good extension to what they do.

The current ‘products’ being offered are all aimed at fostering behavior change and provide social support. The available lineup is:

• Daily Challenge: Released September 2010. Sign up through a Facebook account, and you get daily emails encouraging one small ‘positive’ action like eat an apple, rearrange your desk. Points, badges and levels are achieved as actions are completed. There is added social functionality of peer-to-peer competition, benchmarking etc.
• Community Clash: A web-based game that allows players to discover their communities’ health to other U.S. cities by choosing “cards” that represent health indicators such as obesity, smoking, diabetes, etc. The goal of this poker-like game is to bet on which city is more healthy. Underlying data for it is sourced from several databases that were promoted by the HHS led challenge, the Community Health Data Initiative (CHDI). This page lists those databases, and I found it to be a good bookmark of what open-databases are available around certain health-related topics like diabetes, uninsured etc.
• Change Reaction: Another Facebook app that lets you record a small ‘positive action’ and pass it on to your friends. The idea is to create a growing chain of people who do it, and hopefully create a big trend.
• EveryDRINK: A slick Adobe AIR desktop widget that lets you set a daily goal of drinking water, and then subtly reminds you to get a drink periodically.

They have some other under development, listed here. There is no doubt that behavior is a critical factor for healthy lifestyle. And changing behavior is about influencing the micro-choices we make hundreds of times every day (like taking the stairs instead of elevator or skipping soda for water). So there is a role for services that guide and encourage individuals making the right healthy micro-choice.

But such guidance source needs to be omnipresent in order to be effective. What if I end up ignoring my email or desktop alert after the first few times? Or don’t really care about Facebook? Intelligent mobile platforms, ubiquitous connectivity and sticky networks are promising trends that will eventually pave the way for viable solutions. Ones that consumers may even be willing to pay for.

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.

The crown jewel offering is the educational content- they have 3D medical animations around a long list of conditions. These are meant to help patients and relatives better understand the medical condition. The content is developed by another company (Blausen Medical) and is high-quality, professional grade. I reviewed some of the videos and found them quite useful.

Its been around since 2007 and gets substantial visitors- around 2K+ per month. The site is completely free, and one of the press releases points to their business model “CareFlash is completely free to our users because select industries value having their advertisements tastefully and unobtrusively displayed in the circumstances on which each unique community is based.” Although I didn’t see any ads next to the videos I saw.

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.

September 2010 Update: The website is no longer functional.

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.

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.

It’s not focused on healthcare issues, but I see potential for something like this in chronic conditions that affect an individual’s lifestyle. A good example is migraines. Those who have these terrible headaches would benefit from knowing exactly how many did they have this month vs. past 6 months and what were they doing when it started. So If one could log the onset/end of a migraine attack and the preceding activity conveniently, it’d be easy to spot a pattern (e.g. higher chance of migraine after cold shower).

Why not keep a simple diary bedside? or spreadsheet? Yeah, you can. But how many people do? And how many diaries can remind you to enter latest information in them and chart/graph your progress? It’d be a good idea to add some social networking features to ZeaLOG- finding comparative stats or just connecting with others in the same state as you are powerful motivators for using such tools (for example- Qwitter). ZeaLOG has twitter integration, but it’d be neat to have a mobile app too, especially one that syncs up intelligently with online data.

There is a paid service idea in this concept somewhere. I’m sure we’ll see one soon in healthcare.

MedHelp gives the (now) standard online community features to users looking for better information and support around thier medical problems. It was started around 1994 and now draws more than 2 million unique visitors a month.  Perhaps that is why they have long-standing partnerships with the top medical institutions like Cleveland Clinic and Partners Health. Not sure if advertising is the only source of revenue for them- plenty of companies willing to pay for access to this kind of rich data for patient insights.

Jan 2011 Update: Just read that MedHelp has partnered with GE to create a new mobile mood diary app that helps users keep tabs on their mood to better understand their mental well-being. The app, called MoodyMe, is available as a free download on iTunes for the iPhone and iPod touch.

For a site started in early 2007, their numbers are pretty good. Dataopedia shows around 400,000 unique visitors every month. The site self-reports its major user demographic to be females between 25 -55 years. In Dec 2008, it was acquired by HSW International, the digital content company that owns the China and Brazil flavors of HowStuffWorks.com (which itself is a part of Discovery)

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.

They are still in beta so maybe other features are in pipeline, but honestly, FoodFeed seems to be a solution looking for a problem. So here is a wild thought- why not transform it into a service for people with food-related conditions? Diabetes, Bulemia, Celiac disease, IBS… the list is extensive for the number of diseases that force patients to monitor what they eat and seek treatment/help accordingly.

Example- say a $9.99/month service for young diabetics who need to log, analyze and accordingly modify their eating habits. The service could take real-time user tweets via FoodFeed and provide the following: an online diary of food, instant ‘nutritional info’ tweet back, offer expert monitoring, and the usual host of social networking features. This hypothetical ‘service’ would be an interesting extension to huge online diabetes communities like Tu Diabetes, or Lunch Clubs. BTW, startups like SugarStats are already twitter enabled, but pursue it only as a way of data input.

September 2010 Update: FoodFeed seems to have closed shop permanently. Rest in peace.