Docmein

Docmein is an online appointment scheduling service focused on private practices. The value proposition is that providers and patients can both use this online service to request and confirm appointments without any software to install. Side benefits are timely email reminders and custom pages for patients and practices.

It’s a bit surprising that healthcare continues to get the onslaught of simple web ideas repackaged from elsewhere. Perhaps its due to the relative ease of executing on internet-based ideas today. More importantly, it underscores how poor is the public perception of healthcare IT. Those who have observed the disruptive force of information technology elsewhere wonder why it hasn’t penetrated healthcare effectively. Hence the constant idea and technology arbitrage.

Most internet users are probably aware that online group scheduling services are free. Choices are plenty (Google Calendar, Tungle, TimeBridge, Jiffle, Doodle to name a few) and they are all very good. So what does healthcare need that can’t be fulfilled by these companies? Consider it from two perspectives: inpatient and outpatient.

Outpatient scheduling is more aligned with the services described above. The need is for patients and providers to coordinate a mutually convenient appointment time. But usually patients already know their provider by the time they are trying to find an appointment (e.g. they’ve called the insurance company or the doctor’s office). So finding an appointment time is just a short conversation away. The real value proposition is when patients are still open to picking a provider. That’s when such consumer-oriented outpatient scheduling services are really worth using. ZocDoc does this.

On the inpatient side the need is for a enterprise-grade, rules-based scalable system that integrates with various existing healthcare information systems. To figure out what is the most suitable appointment time for a patient coming in for knee replacement, the scheduling department needs to know the status of radiology/lab reports, clinical resource availability, OR schedule etc. Even just scheduling in-house clinical staff is often an insurmountable and complicated task. For example, YourNurseIsOn is s start-up specifically focused on the nurse scheduling and communication.

Docmein may not be there yet, but scheduling in healthcare delivery systems is definitely a problem waiting to be solved.

Ben’s Friends

The long tail of rare medical conditions has mostly been an unexplored market. Office of Rare Disease Research at NIH defines a disease or disorder as rare when it affects fewer than 200,000 people in America. Another non-profit organization, the National Organization for Rare Disorders‘s database lists more than 6,000 rare disorders that cumulatively affect approximately 25 million Americans. No wonder that “Orphan Diseases” is a synonym for the list, aptly describing the lack of attention from commercial organizations.

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.

MeYou Health

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.

MedWatcher

Drug safety surveillance (more formally, pharmacovigilence) is a serious and complex issue. Once a drug is FDA-approved and on the market, it needs to be constantly monitored for long/short-term side effects. That process is currently rigid: once observed conclusively, these effects are reported by providers to relevant authorities and disseminated back to all medical community (after some lag time) through literature or subscribed updates.

MedWatcher is a mobile application trying to streamline this process, and increase public (patient) participation in pharmacovigilence. FYI- it’s not out yet (some sources projected Aug 2010 release, but I couldn’t find it in iTunes), so all that is known is intended functionality.

The application will serve two major purposes. First, users can receive drug-related alerts through it, based on FDA MedWatch and less-formal sources (news, media etc.). FDA MedWatch may be a treasure-trove of information, but it’s not easy to use. You can subscribe to an RSS feed, get email or text messages about all drug-related warnings. With tens of thousands of drugs on the market, that is like drinking from a fire hose.

If you are a patient worried about your cholesterol-lowering Zocor or a cardiologist who wants to stay informed about statins in general, there needs to be a way to subscribe to only what you care about. I’m hoping that MedWatcher leverages a comprehensive drug-database like FDB, Medi-Span, Red Book etc. to lets users do exactly that.

The second major functionality is for users (both patients and provider) to submit side-effects through a lean process. They mention that serious side-effects will ‘automatically’ be submitted to FDA (rest probably become discussion topics on MedWatcher itself). The current FDA MedWatch online reporting process is cumbersome and a bit disconnected (who remembers to submit voluntary information after they have seen/experienced a side-effect?).  Having a user-friendly mobile application form would solve some of that.

I think the direct patient engagement is very promising in this niche space. The concept may run the risk of becoming yelp for drugs, but even yelp reviews hold useful information once you figure out how to get rid of the noise. By opening direct communication channel with patients, it has the potential to provide the same disintermediation that TrialX provides for clinical trials.

ScanAvert

In the last few years, bar code scanning with smartphones has become much more robust and dependable functionality. Predictably enough, it’s main application has been in real-time comparison shopping and product information area, giving rise to new services like RedLaser (recently acquired by eBay).

ScanAvert is an interesting paid application of the same functionality. It allows users to scan the usual UPC barcode information on their supermarket items and cross-check the ingredients with their health profile. Consumers register and create their profile with facts like allergies, prescriptions, diagnoses, dietary needs, etc. ScanAvert uses data provided by Gladson (a major CPG product images and information provider) to do real-time checks on the ingredients of the item to detect incompatibilities. Now I know the usual critique would be that why wouldn’t the consumer just read the ingredient list or package label? And the counter would be that an average consumer may not find the information easily readable or understandable.

Those and other evident arguments aside, the service has obvious value for people with serious dietary issues (think gluten allergy, Celiac, Diabetes, Obesity, Prescription drug interactions). But I’m more excited about another aspect of the service- ScanAvert users can specify custom limits on a labels nutritional box values (calories, carbs, fat…) and get instant recommendation. To me, that is pretty useful for the rest of the population that doesn’t deal with any significant dietary restrictions. In fact, most of us end up buying food items without paying much attention to what it means nutritionally. Even those few that give a thought to the nutritional box items, the mental calculation done is only at a high level (“100 Cal drink…sounds low….I’ll try that”) and inconsistent (how many times have you checked the fat vs. saturated fat numbers?). I doubt most of the ‘normal’ population even knows what is their actual average dietary intake in terms of calories, fat, proteins, etc.

So if someone can setup a profile that puts a limit on the daily fat/protein/cal intake and have a real-time summary report given to them while they were grocery shopping, that would be an darn useful service, I think. Seems like currently ScanAvert can also suggest alternatives (if it detects incompatibility) and send alerts about scanned items that have been recalled. That makes the service even more useful.

It’s intriguing to think about expanding this service into a space where it can potentially be the long-term dietary record for an individual. Suppose one could combine that with a personal activity monitor like FitBit.  That would make a great ‘wellness solution’ for an individual to record, analyze, set goals and then get guidance on two important aspects:

  1. Energy input (your food intake)
  2. Energy output (your daily activity)

I also found some other apps that help manage food allergies (FoodContentAlerts, iCanEat/iEatOut), although they don’t have bar code scanning ability. This space just keeps getting more interesting every day.

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