Jitterbug Health Services

Jitterbug Wireless is a Mobile Virtual Network Operator (MVNO) founded in 2006. They offer simplified mobile hardware and service targeted towards baby boomers, with the value proposition being the opposite of a feature-rich phone. Few big, buttons and great customer service are it’s selling points for seniors who are looking for hassle-free wireless connectivity. Verizon Wireless is their main underlying network provider.

My interest piqued after I heard David L. Inns (Jitterbug CEO) speak at the Mobile Health 2010 event held in May 2010 at Stanford University. He described a sizable list of Health-related services available to Jitterbug customers. Here is the current list, and pertinent facts (from May 2010 time frame) from the presentation he gave at the event:

  • Check-in Calls: Automated calls to check-in on the user or a loved one. $5/month.
  • Medication Reminders: Automated calls at the right time to remind taking medication. Neat functionality includes a prescription refill reminders (with option to be connected to the pharmacy), personal dashboard that tracks medication adherence, and the ability to share it with others. In partnership with Meridian Health. $10/month.
  • LiveNurse: Unlimited 24-access to a registered nurse for health advice and information. Free on rate plan $29 and up, $4 month otherwise. 12,000 reported users in 6 months post-release and about 4000 calls handled per month. One-fifth of the callers end up seeking medical attention within 24 hours.
  • Daily Health Tips: Daily guidance and tips on living a heart-healthy lifestyle. Free. In partnership with the American Heart Association’s Go Red For Women Movement. Reported 4,000 users.
  • Wellness Calls: 5-minute per week motivational calls with tips and techniques related to topics like sleeplessness, stress, loneliness etc. Attracted 1,000 users in one month. Free with plans above $29. Content by Brian Alman who runs TruSage.
  • 5 Star Emergency Response: Personal emergency response service. Based on the offering by startup MobiWatch that they acquired late 2009. Supposed to be launching around Fall 2010.
  • D-Coach: A little-known, yet-to-be-launched diabetes management service in partnership with WellDoc. Incidentally, WellDoc’s Diabetes service recently got FDA clearance in August 2010.

None of these service concepts are unique per se, each has been attempted by other wireless (and non-wireless) companies. But two things make them highly viable within Jitterbug. First is their niche target market. It’s no secret that majority of healthcare costs are due to individuals age 65 and up. And that is Jitterbug’s target user too. A personal mobile device may provide the elusive ‘last-mile‘ access to such individuals. Second is the personalized, high-touch nature of Jitterbug’s service. Jitterbug users are already used to connecting with a human operator with one button-click and use them for pretty much everything – find a contact, dial the number, get weather info, etc.. Adding health-related services to that framework makes undeniable sense.

It’s not hard to imagine other services waiting to materialize- outpatient appointment scheduling and reminders, preventive services (flu shots, etc.) assistance, personal health record information access, to name a few. I bet we’ll see more wireless network operators move into the healthcare services vertical. For now, advantage Jitterbug.

iTriage

iTriage is a mobile app that helps users understand, prioritize their acute health-related symptoms and seek appropriate and close-by care. Its service is also available on the web at iTriageHealth.

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.

FreeMD

Around 1989, Steven Schueler started working on a computer program that could perform symptom triage. The intent was to create something that patients could use to safely decide what to do when they were sick. In 1990, his company DSHI Systems released “Home Medical Advisor” on a floppy disk. Later it was issued on CD-ROM’s, and claims to have sold over 2 million copies over the years. A major win for DSHI since 1999 has been its adoption by the Veterans Health Administration (VHA) as the Veterans Health Gateway (VHG). VHG provides over 300 symptom/condition-based triage algorithms and related patient education information and is used by VHA nurses to provide health advice via the telephone.

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.

Feb’10 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.

Dec’10 Update: FreeMD has a new look now. The user interface is much better and the interaction is much more easy (handy pain scale, descriptive pictures for example). Some interesting new functionality has been added too:

  • Triage results now provide more information: FAQ, video explanations, and images
  • Best options for care included in results, like ER, Urgent Care. Especially interesting are newer venues like eVisit and Retail Clinics. Hovering over each option gives some useful information like average charge expected at that venue. Very cool.
  • The final ‘Triage Report’ can be printed or copied to clipboard.

These are all steps in the right direction. A more integrated future (like export capability to Google Health Record, or ER wait times from iTriage, or provider rankings from Vitals) would definitely establish FreeMD as a viable online triage destination.

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