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
Alerting and Messaging
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 andÂ seamlessly connects health information to/from a mobile workforce.
Of all the consumer healthcare device ideas, this may be the most ingenious one. In August 2009, Massachusetts-based Vitality announced availability of GlowCaps– a web-enabled $99 cap for prescription bottles that helps remind patients to take their medications on time.
GlowCaps fits the standard pill container, and uses short-range wireless communication to talk to a gateway hub at home that is connect to the internet. There is also a reminder light (looks like a night light) that plugs into any standard power outlet. If the bottle isnâ€™t opened at the appointed time, the cap and night light start blinking to remind the owner to take the medication. If after an hour, the pill is still not taken, GlowCap starts start playing jingles as well. After yet another hour, it’ll send a message to Vitalityâ€™s system which can then place an automated phone call or send a text message with a reminder. Brilliant.
Beyond having a ‘smart lid’ for bottles, Vitality has integrated functionality that keeps caregivers in loop. There are social support features (shareable weekly email reports), refill facilitation (refill reminder calls) and physician interaction tools (printed monthly reports to you/doctor). So it hits all the major interaction points for a patient’s medication regimen. Last month AT&T put out a press release about GlowCaps running on its wireless network. So the Vitality gateway now has mobile phone technology, and I assume that precludes the need for an ethernet connection.
Every clinician knows that medication adherence is a huge problem ($100B figure has been thrown around as the cost of poor adherence in US). More than a consumer product, this is a fantastic service that can change medication packaging in general. And looking at the Managed Care (enhance the personal/medical record), Research (change patient behavior) and Pharma (reduce brand-switching) focused pages of their website, I think Vitality knows that. It’s definitely the next stage in evolution of the standard pill dispensers (like ePill, Philips).
Their CEO David Rose has an interesting background in creating internet-connected everyday devices at his last company, Ambient Devices. Somewhere in a press release I read his quote about “…providing minute-by-minute adherence data to motivate healthy behavior.” If you take the word ‘adherence’ out, that may be a basis for a lot of future medical solutions and an adage for next-generation of medical device companies.
Zume Life is a San Jose start-up that is planning to develop its own dedicated device to allow individuals to keep track of and manage their own care regimen. It’s target users are individuals with complex care requirements- taking a multiple medications, specific diets, frequent measurements, daily exercise etc.Â What they offer is a ‘Zumi Life Service’ that helps coordinate the logistics of doing these multiple activities. The service can be accessed via the device, an iPhone app, and a website. The device (designed by Dubberly Design Office, seems still under development) is called “Zuri” and below is a pic and video that, interestingly enough, I found elsewhere on the web.
In an effort to understand what is unique about Zumi Life, I stumbled upon this interview with its CEO. Crunchbase tells me that they started with $700k seed funding in 2007 and got a Series A infusion of $1M in April 2008. With that context, several questions come to mind. Zume Life needs manual input for all the data it needs from the user- and that assumes the user to be reliable enough to put it in. If Zuri had a sensor to automatically capture the critical vitals (like Zeo, Bodymedia, DirectLife, FitBit, LifeShirt and scores of other devices), that would make it infinitely more useful. But I understand that there is no automatic sensor for your mood or for what you just ate, so somethings need to be captured manually. Which is why there are services like RememberItNow, Reqall, Zealog, Polka etc. Still, why not get the medication list for Zuri from PHR platforms like Google Heath? If we assume that the chronically ill and overworked individual remembers to input their care regimen in one place, why wouldn’t they use a simple paper sticky note or a smartphone reminder app? Even a simple Google Calendar or 30Boxes event can be configured to deliver reminder emails that show up as audible, sms alerts on your phone. So is there really a need for a dedicated hardware device in a world that is slowly converging mobile computing platforms? Zuri reminds me of the device that is made to do twitter only.
The price tag was also a bit of surprise. Although there is no official mention of pricing on the Zume Life website, I found a PCmag article from Sept’09 that quotes $35/month or $300/year for the service, and $4.99 for the iPhone app. That sounds way too much money for a basic alerting and journal-keeping service that is 100% manual entry based.
Of course, it’s easy to criticize others idea. I don’t have the complete facts on the service, its utilization and its founder’s vision. The overall trend of using patient-oriented hardware devices integrated with web and mobile dashboard/analytics to manage chronic conditions is for real. I just think sensors are a key aspect of such devices and that pricing can be Achilles heel for adoption.
Early 2010 Update: ZumeLife has closed operations and is no longer in business.
Pittsburgh-based BodyMedia makes personal monitoring devices that can help consumers keep track of their physical activity and nutrition. Their products and accessories contain innovative sensors that measure physiological data Â like heart rate, body temperature, calories burnt, sleep duration, etc . The collected data is then interpreted online to help wearers aim for and monitor a balanced, healthy lifestyle.
They smartly target three different segments using different pricing/marketing strategies: Consumers (as GoWearFit), fitness clubs (as BodyBugg) and clinical researchers (as SenseWear). The specifications, features and services differ for each offering and a good comparison table can be found here. All that detailed health info does come at its price- their consumer product starts at $199.95 for the hardware and a $12.95/month subscription to the online personal manager tool.
The company has been around for more than a decade and has certainly come a long way.Â BodyBugg is used by contestants on NBC’s television show The Biggest Loser, you can find GoWearFit in Dick’s Sporting Good Stores, and there are a bunch of peer-reviewed publications and studies done using SenseWear. I’m a fan of products that let consumer manage their own health, and BodyMedia is certainly doing the right things to ride that growing trend.
Tying the mandatory monthly subscription seems like a walled-garden approach, though. Integrating with electronic records would be a fantastic growth opportunity- think of all the apps that can be built on top of such monitoring data if it were available on PHRs (like Healthvault or Google Health) and/or the outpatient Electronic Medical Record with your physician. Perhaps a more affordableÂ pricing strategy would also help, since insurers are still a long way from paying for such devices.
October 2010 Update: It’s been a while since the original post above. A lot has changed. Externally, there are number of start-ups that compete with BodyMedia now (like Fitbit and others). Internally, seems like they’ve built up a solid management team. Apparently ‘GoWearFit’ brand has been decommissioned- they have focused the consumer offering to the parent BodyMedia brand. BodyBugg is now showing up as a trademark of 24 Hour Fitness USA, Inc. and they offer a program called Apex Fitness based on it. SenseWear is still out there.
January 2011 Update: BodyMedia just announced a deal with Sprint to enable cellular connectivity in it’s products. A smart evolutionary step on BodyMedia’s part. And of course, another evidence that wireless network operators are really serious about consumer healthcare as a vertical. Tomorrow’s devices will take anytime, anywhere connectivity as granted.
LifeShirt is a wearable ‘smart fabric‘ that can be used to remotely monitor multiple vital signs. It is made by VivoMetrics, a Ventura, CA based startup founded in 1999. From what I can gather, LifeShirt captures data around heart rate, respiration, posture, activity level, temperature, limb II ECG and can connect to optional peripheral devices for EEG, skin temperature, blood oxygen saturation, blood pressure and galvanic skin response.
Remote Patient Monitoring (RPM) is a subset of telemedicine that includes devices and software that enable healthcare providers and educators to diagnose, monitor and follow up patients remotely. There is a lot of potential in smart fabrics to enable RPM, especially for chronic diseases like Asthma, CHF, Hypertension, etc. I’m personally very excited to see companies enter this space and solutions becoming more and more mainstream.
Currently VivoMetrics is focusing on clinical research and sleep apnea study market. Their next generation product is supposed to be lighter, more comfortable and with the ability to transmit data wirelessly. Also in the works is a partnership with OBS Medical to incorporate their VisensiaÂ® software as a predictive tool.
September 2010 Update: LifeShirt and VivoMetrics websites don’t work anymore. Seems like they ran out of runway.