Specializations in care delivery are a natural evolution but they have the side effect of increasingly partitioning processes and, in turn, increasing cost and complexity of coordination. When patient care changes hands, it becomes susceptible to errors and communication failures. ‘Transitions of Care‘ is the broader topic that covers problems that arise when patient moves between different care settings: between primary care physicians, hospital-based physicians, specialists, home-based caregivers, and others.

HealthLoop was founded by Jordan Shlain, MD to address outpatient transition to home-based care. The service is in very early stages, and the site explains little about exactly what it provides. All I could find was “… (it) enables medical practices to efficiently monitor signs and symptoms, and communicate with patients during the recovery process“. So I’m guessing the core is case management and communication functionality, with perhaps some way for patient to input their vitals (hopefully it’s not manual data entry). Healthloop is in the embryonic stages, so I won’t attempt to read the tealeaves any further.

Potential issues for HealthLoop are low barrier to entry and powerful incumbents. If they choose to pursue, big EHR vendors can potentially create a much more comprehensive and integrated solution for care transition management. Today the inpatient/outpatient care is digitally captured in EHRs anyway, and theoretically comes coupled with PHRs. So care transition becomes one of the natural value propositions of the EHR-PHR continuum. Besides EHRs, HIEs are the other upcoming intermediary that may find this space relevant. It makes business sense for HIEs to offer care transition management as a paid-service.

The underlying space of care transition is valid enough that startups in this space have a chance to be viable. Especially given that currently very few EHRs or HIEs are explicitly and completely tackling it.

PS: Read more about care transitions on the National Transitions of Care Coalition (NTOCC) website.


Accounting for only 7.2% employment in healthcare, Home Healthcare is perhaps one of the lesser known and advertised sub-markets in the industry. It serves patients who prefer to stay at home but need ongoing care that cannot easily or effectively be provided solely by family or friends. These providers deliver a wide variety of health care and supportive services like professional nursing, physical therapy, occupational therapy, social work, nutritional care, medical equipment supplies, etc.

According to the National Association for Home Care, about 12 million people in this country receive care from more than 33,000 home health care providers. The market is made up of few large, publicly traded companies (see LHCG, AFAM, AMED stocks for example) and many small/mid-size players. The challenges faced by these companies are typical of those with field-based employees: scheduling the visits, then figuring out if their employee actually visited the patient, if they did then what was the real time and mileage, ensuring the data collected during visit is archived and accurate, etc.

Which brings me to CellTrak. It was founded in 2006 and delivers mobile-based automation to Home Healthcare agencies. I think it’s a brilliant application of healthcare information technology for alleviating self-reported information issues and paper-processes in a niche market. Given that everyone carries a phone today, using mobile modules to increase compliance and productivity makes a lot of sense for a field-based business. Some examples of the modules available:

  • Care Plan Management
  • GPS and Directions
  • Time and Attendance
  • Travel Time and Mileage
  • Supply Management
  • Alerting and Messaging
  • Scheduling
  • Nurse Care
  • Wound Care

Solving logistical issues like location, time capture, attendance, inventory etc. is pragmatic. But providing modules around clinical care is the more interesting strategy from my perspective. Usually, software solutions that enable care documentation and collaboration are associated with either care-delivery enterprises (e.g. fixed location hospitals using EHRs) or with patients themselves (e.g. PHRs). Neither of those have a particularly critical need to be consumable in a mobile form-factor- that is just a nice-to-have functionality. CellTrak has found a special need where the inherent care delivery workflow necessitates even the clinical Healthcare IT solution to be exclusively mobile. It is a good example of the hidden corners within the complex maze of healthcare system which require thinking outside the traditional bounds.

Other examples of using exclusively mobile-based electronic health records are mostly restricted to public health context in developing countries (see ChildCount for example). That skew is mostly due to the field-based nature of public health and mobile being the primary means of connectivity in emerging economies. With CellTrak, we see the same technology paradigm tackling the problems of a conventional health industry segment in a developed country.

CellTrak partners with some EHR (Cerner, Allscripts) and wireless providers (AT&T, T-Mobile, Sprint, Verizon) currently. I expect that the future iterations of most enterprise EHRs would include incorporating a solution like CellTrak which enables running operations in the field and  seamlessly connects health information to/from a mobile workforce.


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Here is a half-baked idea that adds another data point to my rant about how keeping a record of health-related activities is useful, and how web 2.0 technologies can help enable such a record. Bedpost is a web application (currently in private beta) that helps in keeping track of user’s sex life. I’ve not used the site myself, but they claim simple functionality- log in after the fact and fill in some fields about it. Thankfully, they also claim ‘zero social networking’ functionality to keep things private.

Sure all this can be a simple iPhone app (maybe there is already one out there) or even a one-line cryptic entry in your google calendar. My point is not to critique the utility of an independent website to track one’s sex life. I’m reflecting on the overall trend of niche health and wellness ‘trackers’ (read my previous posts about FitBit, Proactive Sleep, ZeaLog, Qwitter). Given the myriad sexual disorders (e.g. Erectile Dysfunction) and their probable causes, an application like this could provide rich history for clinicians. Overall, it underscores the importance of web 2.0 technologies in enabling consumers to keep granular, accurate health records.

Update: Few weeks after writing this post, I found a number of mobile apps (with integrated online version) that let you count/track anything you want. Few examples: TallyZoo, Dayta, Daytum, TheCarrot. There are also multiple websites that let you track and analyze anything- Graphomatic, Kibotzer, Track-n-Graph, Me-trics, LifeMetric, DailyDiary.

Practice Fusion

PracticeFusionLogo 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.

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polkalogoPolka‘s mission is to make your up-to-date basic health information available to you all the time, on the web or your iPhone. They claim that their ‘secure aggregation and collaboration service’ can help users manage their health. Here is what they offer:

  • My Health – An application to store your basic health information (allergies, meds, diagnosis, emergency contacts, and a twitter-ish 140 char Health Log). Available as a 99¢ iPhone app or a free online dashboard.
  • If Found+ – A 99¢ iPhone app that can display a short message and contact info on the wallpaper of a locked iPhone.
  • My Emergency Info – Another 99¢ app that essentially does the same this as If Found+ but instead of a short message, you can show ‘summary health info’. (So how is this different if I choose to write health info as the message in If Found+? I’m not sure.)
  • Close Call – A free iPhone app that apparently does the same thing as If Found+ and My Emergency Info. It displays important emergency contact info as a part of wallpaper on a locked iPhone. Don’t know how that is different from the other two 99¢ apps.

Polka is the first funded company created at the Lab2Market progam at UCSD Rady School of Management and they started around mid-2008. I think they are certainly on the right track since the fast-growing, 24X7 access mobile platform is ripe for healthcare information storage and communication.  Except that I’m lost at the product differentiation and pricing level. In terms of competition, there are other In-Case-of-Emergency category apps available for the iPhone like Easy I.C.E for 99¢, EMT ICE for $1.99, Health n Me Pro for $2.99. None of them do any better job at it, though.

There are rough edges to what Polka offers today (tried their online dashboard.. not particularly impressive) but that may be understandable given that they are relatively new startup. iPhone apps are fine, but I think online dashboard may be a stretch unless there is a really ground-breaking, never-before feature that they can offer. Why not integrate with Google Health/Healthvault for the online PHR-like functionality right out of the box?

September 2010 Update: doesnt work anymore. Although the applications are still available on iTunes store.


mycalogolPrimary 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),…

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