Consumer tools that help deal with healthcare system complexity are unquestionably needed. A recent niche has focused on dealing with healthcare bills.

Simplee helps it’s users track medical expenses in an friendly online dashboard. The aggregated data and management tools can help manage health care costs and perhaps be used for finding the right medical plan and services for an individual or family. The service can also be used to pay medical bills since it has an integrated payment platform.

Obvious comparisons can (and have) been made to personal finance management websites like Mint. No surprises there since managing health and wealth are equally daunting tasks, riddled with complicated verbiage and stressful decision-making for most. The need is obvious and there is competition (CakeHealth, HealthExpense and Quicken Health for example). Payer coverage is key ground to cover quickly- I couldn’t find my insurer in Simplee, for example.

Regardless, the real utility of a service like this is in its integration with existing channels that push healthcare billing information to patient. A white-labeled Simplee would be fantastic for Payers so they can evolve the annoying EOB letters sent to patients. PHR or Patient Portals (whether provided by the insurer or provider’s EHR) would be another channel for using Simplee’s service to explain the bills. Without channels partnerships like these, I’m less optimistic about Simplee’s uptake in the real world. Another perplexing topic is business model. Providing free management tools can only get a user base, and to monetize that Simplee will need to add more services – perhaps become a shopping engine for health services, provide comparisons and ratings, etc. That can’t be a viable option for short-term since building a value proposition like that would need significant traction in a given healthcare market.

As a patient do I want a new, independent, smaller company to access, analyze and archive my healthcare bills? How comfortable am I want to give them my credit card info? The answer would probably be no for a significant part of conventional patient population, unless this useful ‘billing translation service’ was embedded in my usual interaction channel with the healthcare system. I’m looking forward to the partnerships that Simplee can muster going forward.



A startup that helps you access and retain your medical records (to which you are entitled) from providers. Another proof of how impenetrable and complex our healthcare system is.

It’s a brilliant niche. MotherKnows will interact with the healthcare system (your physician, hospital, insurer, etc.) on your behalf to procure a copy of the medical record, store it, analyze it and make the information available to you on-demand. Anyone who has tried getting their child’s immunization record will agree that the conventional interaction is a sub-optimal customer service experience at best. So having someone else do it for you is worth paying for.

Once collected, the information is available in a PHR manner – view meds, problems, allergies, immunizations, growth charts in one place; create emergency cards; get reminders; mobile access, etc. But the key to MotherKnows’ viability, in my view, is being the authorized agent for painful extraction of medical records. As long as the pricing is right (which, at $19-$98/year, is in the right range) it will gain traction.

It’s a prudent strategy to market it initially to parents as a way to keep the records straight for their precious progeny. But I don’t see why it can’t be extended to adult healthcare consumers themselves. I’d like to be able to get my medical data all in one place, hopefully showing me trends found in my quasi-annual physical exams and labs. Today in the patient population, the motivated few try to save copies of records; and the enlightened few go one step further and manually key the data into an online PHR like Healthvault. In either case manual labor and discipline is required. Perhaps having a real-world service (of paper record collection) is what really can make a difference to PHR uptake by consumers. Hopefully, MotherKnows will reach beyond just child medical records in future.

The overall idea of patients paying an agency to wrest to their medical records from providers point to the underlying systemic inefficiencies. Theoretically, there are solutions on the horizon. An enterprise EHR used by care providers could pass the relevant info into a PHR accessible by patients. And if they change providers, a community-wide Health Information Exchange (HIE) could still enable patients to be the custodian of thier own information in another system. But we are not there yet.

The unmet need for electronic systems (like PHRs) to interface with the physical world (i.e. bricks and mortar organizations and paper processes) is very real. Till every end-point in healthcare delivery is digitized and interoperability is no longer a pipe dream, we’ll need services that handle real-world complexities. Take companies like eHGT who are already in this ‘record retrieval services‘ niche. By actually having real account managers who can get imaging records from facilities, they elevate the value proposition of an “Image Exchange” to new level. The phenomenon exists outside of healthcare too. The now defunct Random Acts of Genealogical Kindness (RAOGK) site was a volunteer effort to bridge the gap between virtual demand and physical supply of genealogy records.



Scientific and medical research has seen explosive growth in the past few decades. Since 1996, the United States National Library of Medicine (NLM) has maintained PubMed, a free portal providing access to references and abstracts on life sciences and biomedical topics. PubMed now has over 21 million citations going back to 1966, and continues to add a staggering amount (about 500,000 new records) each year. The chart below was adapted from a recently published journal article about PubMed.

Article by Zhiyong Lu

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

There have been plenty of success stories of online networks that help aggregate individuals with a common interest in a health condition. PatientsLikeMe, MedHelp, DailyStrength, Sermo to name some. So it was only a matter of time before we saw a network of networks. Something that went beyond a online community with singular focus.

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 (, 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.

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 On the continuum of healthcare IT solutions, there are two distant ends. One extreme can be thought of as the complex, medical-grade enterprise EHR systems that cater to large institutions and mainly providers. The other would then be a consumer-grade solution that is designed for delivering health interventions to the masses. The latter is where Voxiva‘s offerings lie.

Voxiva provides the technology platform, professional services and support needed for designing and deploying a mobile-based health solution for consumers. When you read that, think beyond the now-hip smartphone app market. Less than a fifth of mobile handsets out there are smartphones. So to reach the remainder, the solution has to encompass relatively simpler mechanisms like feature-phone data entry, SMS and IVR.

There are a number of unique design challenges for creating an engaging public health solution that can work across any/most devices and be delivered through multiple channels to a varied set of end-users. It needs to work synchronously across web, mobile, email. It should support data entry across all kinds of user interfaces (feature phones, smartphones, different mobile operating systems, multiple-languages, etc). It needs to deliver real-time alerts (SMS, voice, email, web portal) and provide real-time analysis for decision-makers. And obviously be scalable and dependable with near-100% uptime. What appears to be a simplistic low-end IT solution on the surface is really a huge undertaking to communicate with an end-user population that is as diverse as it can be.

Voxiva’s real impressive achievement is doing a lot of what they do in international market- specially developing countries. They have created a HIV/AIDS mHealth solution for Rwanda Ministry of Health, disease surveillance solution for Peruvian military, diabetes management program in Mexico, and plenty of others. In US, their most famous offering was Text4Baby (see Multiplyd’s previous review on it), an SMS-based maternal health education service launched in early 2010. Since then, they have diversified into Text2Quit (smoking cessation) and Care4Life (diabetes management). Simple interventions, but designed for massive implementation and adoption. Which is why Voxiva continues to stand out.