Carolinas Medical Center, which already has a mobile website that allows users to find facilities and look up ED and urgent care wait times, releases a mobile app for both Android and iOS. It looks similar to KP Locator, Kaiser’s app that I was impressed by last week, and has positive reviews in the app store.

Quantia, the online physician collaboration network with ~125,000 members, releases a new mobile app on its QuantiaCare platform. The new app, called DailyCoach (free), is supposed to help diabetics, or those at risk of developing diabetes, get motivated to exercise and have fun doing it. That’s a good start, but I can’t really imagine having much success with such a passive, non-customized app.

The American Telemedicine Association is calling for "abstracts on any topic relating to telemedicine, telehealth, mHealth and remote medical technologies" for its spring conference next April. Full guidelines are here.

VC firm Morgenthaler Ventures announces 11 finalists for DC to VC: HIT Startup Showcase. Their founders will compete in front of investors and other entrepreneurs with their presentations. Many finalists are mobile or related to virtual care, either messaging or apps. Only a couple fall outside these categories.

AliveCor, the maker of a skin that transforms an iPhone or Android phone into a single-lead EKG, raises $3 million in Series A funding. One of the investors is Qualcomm. We reported several times about AliveCor after it made a splash at the Consumer Electronics Show in January. The funds will be used for clinical trials, FDA approvals, and commercialization of the product. This is a very cool technology, but I’m curious to see how it plays out in terms of consumer uptake, if that is a target market.

I saw this timely article on the lessons to be learned from health technology startup failures. Many points related to who will pay, enterprise partnership/sale cycles, and reimbursement, which speakto a lack of knowledge and insight into the industry.

Pharmacy relationship management firm OPUS Health partners with VoicePort, a speech recognition company in the pharmacy industry, to offer retail pharmacy customers med adherence and co-pay assistance. It sounds like automated, speech recognition-based adherence reminders to hopefully get people to fill prescriptions and be more compliant. I’m surprised that retail pharmacies wouldn’t do this themselves, but maybe OPUS’ strong links to pharma and VoicePort’s technology make it a winner as a vendor.

A new app from IMO (Intelligent Medical Objects, Inc) and Nuance allows providers to use voice to match terms to problem and diagnosis codes. It supports ICD-9, but ICD-10 will be available in October. If you look at the IMO website, it looks like they integrated IMO into the Dragon Medical Search app, not actually releasing a new app as the press release states.

A retrospective study assessing the use of telemedicine for diabetic retinopathy screening with patients seen physically at PCP sites finds it to be effective at increasing screening compliance and helping to streamline specialty care, or at least referrals to a specialist. If 24% of those screened were uninsured, I wonder what percent actually saw the specialist?

AFrame Digital gets a follow-on NIH grant to study its wrist-worn fall monitor. The device, which looks like a very large watch, tracks seniors and can detect falls and deliver tailored alerts. This tool gets over the hump of having to remember the device, as long as the user wears it constantly. AFrame also has a web interface for caregivers to track users. I didn’t see how much the grant was worth.

Along similar lines, a new wearable antenna developed for the military may have applicability to track seniors and connect to health devices and apps. The antennas can be sewn into clothes. I wonder how well they’d stand up to washings? I’m not as sold on this as a constant monitor, but I could see it being useful in certain healthcare settings as a lightweight tool to communicate data, say from a chair or bed.

Google forfeits $500 million worth of revenue from 2003 to 2009 for allowing online Canadian pharmacies to target US consumers to illegally import drugs into the US. Google is now required to comply with new reporting and compliance standards to assure it doesn’t do it again.

Travis Good is an MD/MBA involved with health IT startups.

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I’m going to wrap up the series of posts I’ve been writing on consumer health success and then assess the key takeaways.

I started out looking for companies that have been successful in targeting consumers with health offering. I wanted to see what companies have seen decent consumer adoption and why. I also wanted to examine whether their offerings could have an impact on chronic disease.

It’s important to focus on the applicability of solutions in chronic disease care. It’s a massive driver of healthcare spending. Diseases like diabetes, CHF, and hypertension are great targets if you want to make meaningful improvements in the health system. However, as I outlined in the opening post, this is a hard group to target, even if you exclude the very ill, post-catastrophic patients.

Along the way I examined six very different companies and/or offerings: WebMD, Walgreens Mobile, RunKeeper, ZocDoc, WellDoc, and PatientsLikeMe. I think the last four are the most exciting — they are new and trying to carve out space in our changing healthcare system. The first two, WebMD and Walgreens, are big, broad consumer brands today. I’m sure ZocDoc (700,000 consumer searches per month), RunKeeper (6 million users), and PatientsLikeMe (114,000 users) would argue that they are very real brands today, particularly with their target audiences.

I don’t think any companies I’ve profiled are effectively reaching chronic disease patients, at least not at scale. However, WellDoc has a compelling offering for diabetics. If it can convert more health systems, payers, and employers, it will extend its consumer reach considerably. Prolonged adoption is still a big question, however.

The other companies aren’t targeting chronic disease patients. That taught me something about the best way to be successful, at least if you want to be successful quickly.

Despite a lack of widespread consumer success with chronic disease patients, there are important takeaways for any company launching a new product or service in health or wellness. We’re seeing — and will continue to see – many companies both new and old offering technology solutions to improve the care of patients and the connections between patients and providers.

1. Fill a Need

It seems so simple, but can be hard. Lots of cool ideas don’t fill a need and don’t go anywhere.

Consider a couple of the companies having success directly targeting consumers. WebMD provides easy access to health information that people are increasingly looking for online. ZocDoc helps consumers find appointment slots within 24-48 hours, while at the same time filling open slots and driving new patients to providers.

PatientsLikeMe helps patients and families with niche diseases find others with similar conditions, providing support over a wider geographic area, something desperately needed with rare diseases. People want to easily fill prescriptions, and Walgreens eases the process over mobile.

2. Engage Providers

I’m convinced providers are the key to success with health offerings. This doesn’t necessarily apply to wellness tools and programs, which can be sold directly to consumers (RunKeeper, Nike+, Zeo) or through employers (Keas, Red Brick, Accolade).

Instead, sell something that directly fits in the healthcare system – ZocDoc for appointment slots; WellDoc for disease management;  iTriage and text4baby for mobile apps. These leverage the influence of the provider.

Doctors remain the trusted source for health information and services. Engaging and enlisting providers can be challenging. Filling a need they have, such as filling appointment slots or streamlining messaging, is the key. 

It’s easier to go after the outpatient or office setting. An enterprise sale takes too much time and money in dealing with the legal, IT, and compliance departments.

3. Stay Focused

This is hard when building something for health and wellness. Our health system is so broken and our population is so unhealthy that it is very easy to start adding features to offerings because they seem to make sense. But the more you add, the harder it is to get people to use it for the intended purpose.

The best examples of focus are ZocDoc, WebMD, and WellDoc. ZocDoc has not become a PHR or started to collect direct payment from consumers. WebMD is purely about finding health-related information — that focus got them through the Internet bubble ten years ago.

WellDoc focused on diabetes initially instead of a mobile chronic disease management platform because platforms are hard to sell. I think WellDoc should remain focused instead of moving to oncology and other areas. Diabetes is big enough.

4. Sell Something Somebody Will Pay For

This is a big risk for healthcare startups. Lots of companies are banking on bundled payments, accountable care, and paying for cost-effective quality.

Finding the right model may be tough if you’re selling something that improves quality. It’s tougher if you are selling it to a provider, payer, or employer, but hoping that a consumer will use it because somebody else is paying for it.

RunKeeper, until recently, was focused on delivering tools to help motivated people track and share their fitness results. Lots of people, including me, are willing to pay for that.

Another model is getting family caregivers to fund the service, which is being done by companies like Independa and GreatCall.

5. Do Research 

If you’re going to sell something that improves outcomes (like chronic disease management tools), get data that backs your theoretical claims.

WellDoc has done this very well, in large part because of its strong links to an academic medical center (University of Maryland).

Others, such as Vitality (GlowCaps) have had great success with research that isn’t exactly rigorous. I think Vitality’s original study included 50 users. No control group, no peer-reviewed study, no academic medical center. The company went on to do studies with Harvard and Duke, but the initial data it used for marketing wasn’t rigorous.

6. Have a Story

Who doesn’t love a good story? Have a good reason why the founders formed the company. The more personal, the better.

PatientsLIkeMe has a sad but memorable reason for its formation. Two of the founders had a brother with ALS and the family couldn’t find a large ALS community. This not only gave it legitimacy with the ALS community (of which PatientsLikeMe is now the largest), but it also built trust that PatientsLikeMe leverages today in creating a sustainable business model that involves selling patient data.

ZocDoc has this too. One of the founders was traveling and couldn’t find a specialist. 

These stories make the companies more relatable.

7. Give Consumers Something They Want

Consumers may or may not realize they need some help managing their health. Either way, it’s important to offer tools and services they value, even if those are not directly related to health. This only applies to developers of personal health management or wellness services, like WellDoc and RunKeeper.

This is probably the most negative realization in looking at these companies. The ones that are successful with consumers target a reachable and engageable group.

WellDoc is trying to reach a very important group, but I don’t if it goes far beyond its trials. In fact, I’m increasingly wondering if the chronic disease cadre is engageable at all. Maybe the employer-targeted solutions are doing better.

To reach this audience, companies are assuming that consumers want social media. Lead with social, but have it relate to and hopefully improve health.

Others are trying games. Social gaming could be effective in health, but still needs to be done in the right way. It also needs to somehow engage providers.

I didn’t review iTriage and text4baby since I cover them regularly, but their key takeaway is the second item — engage providers.

Travis Good is an MD/MBA and is involved with health IT startups.

DrLyle added a good deal to my post on PatientsLikeMe in his comment. He discussed the case of the network collecting data to discover that lithium didn’t really help in ALS, as well as the reasons why the site is focused on niche diseases. He went on to write in, with regard to PatientsLikeMe: 

Very, very cool stuff you’d never find on a WebMD community, and shows the power of a PHR/social network/data analytics engine IN THE RIGHT SETTING… and the key is they were smart to find the right setting. I don’t know if they will be able to easily expand outside that setting – will Diabetics ever give the intense level of data required? My hunch is it would only be a few – there is a big difference in motivation when you are simply dealing with a long-standing disease vs. knowing you might die from it in the next year.

Perfectly stated, and I agree with his hunch that diabetics will not simply flock to PatientsLikeMe to enter data and connect with other diabetics. There needs to be something more to drive patients with longstanding disease — ease (or automation) of data entry is only one piece of the puzzle. Lots of money is going into creative solutions for this problem.

Denis Baker writes:

Mobility apps remind me of apps on Windows V3.0 – there is no communication between them, that I am aware. (e.g. passing logon data on to the next app you access like CCOW in another world.) They obviously interact with whatever platform OS they are running on, but not each other. Is there any discussion or development around this? Thanks.

Good points and comparison, Denis. I think Microsoft HealthVault is gunning to be the data source with its open API and support of mobile, at least Windows Phone 7. To my knowledge, though, the only app that is doing this on HealthVault is Akvelon’s Health Guard. With this solution, users might still use one app for data entry and then Health Guard for aggregated views and analysis. It’s not really app-to-app (a2a) communication, as described by Denis, which is being done by non-health apps. Other insight is welcome. 

HP announces a massive restructuring effort to remove itself almost completely from the consumer technology business. It will stop making tablets (which it just started making) and smart phones by October and will spin off or sell its PC division. Questions remain about WebOS, the HP-branded version of Palm OS that HP acquired last year for $1.8 billion. My favorite quote from the article is about Apple: "Apple singlehandedly knocked HP out of the PC, smart phone, and tablet business".

Mobile messaging company mobileStorm, which entered healthcare with the launch of its "mobileStorm for Healthcare" HIPAA-compliant messaging platform in May, releases a guide for "mobile enabling" healthcare. According to mobileStorm’s website, Humana and Kaiser are featured clients.

Healthcare communications firm Ignite Health acquires mobile development firm Syndicated Methods to increase Ignite’s mobile capabilities. The acquisition includes MobilePipes, a mobile development platform meant to make the process of developing mobile services and apps faster and easier, especially on multiple devices.

The 15 winners of Broadband Adoption Model eHealth Communities Awards are announced. The awards are meant to showcase communities as models of the use of technology and telecommunications in healthcare, using the California Telehealth Network. The average award is $300,000 and each winner gets $50,000 to hire "eHealth trainer/project managers."

I somehow missed the release of Kaiser’s KP Locator app a few weeks ago. The app (free) allows users to find Kaiser facilities and contact info. It has 62 positive reviews in Apple’s App Store. I was about to write something about how basic it, is but I just tried it, and as a regrettably former Kaiser patient, I would have loved this when I was a member. I was able to quickly locate specialty department numbers instead of calling and bouncing around operators and menus on the phone. Next steps should be Member Profiles and appointment scheduling, but this is a good first app with functionality that people probably want.

The VA issues a 22-page statement on staff use of social media, drawing a clear distinction between personal and professional use. The statements calls for the appointment of dedicated staff at each facilities to manage what will soon become over 150 Facebook pages and Twitter feeds VA wide.

The above video introduces the new Echo Prelude continuous glucose monitoring system. The system is designed for ICU and diabetic patients, neither of which is represented very well by the model demonstrating the wearable device. Echo is awaiting FDA approval.

A new report, Global Mobile Health Applications Market 2010-2014, predicts that the market for mHealth apps will grow by a CAGR of 24% through 2014. The main driver is expected to be remote monitoring, with the main limiters of growth being security and accuracy. Reimbursement, though not mentioned, is probably a valid limiter of the mHealth and remote monitoring market as well. The report includes a SWOT analysis that includes Apple, Allscripts, Epocrates, GE, and Voxiva.

iPad EHR vendor drchrono raises an additional $650,000, on top of the $675,000 it raised in July. It also launches an iPad-based, integrated patient check-in app, which intakes basic information directly from the patient on medical history and insurance. It also does HIPAA consents.

Does the recent Google acquisition of Motorola open the door for Google to re-enter healthcare using Motorola’s existing healthcare clients? While it’s hard to rule anything out, especially if you’re a radiologist, I don’t think Google is going to leverage this purchase to move into healthcare.

I light of the recent fitness app post I wrote, here’s an interesting and timely comparison of several fitness tracking tools. The article walks through BodyMedia Fit, FitBit, RunKeeper, and the Withings Wifi Body Scale. The conclusion: Withings and RunKeeper are the ideal combination for the author, whose main form of exercise is jogging.

Travis Good is an MD/MBA and is involved with health IT startups.

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From Denis Baker: “Re: Facebook/Pharma – are there other entities that have special privileges?” I couldn’t find any other entities with special Facebook privileges, though all companies can remove negative comments on Walls if they are constantly monitoring them. Reader Vicente Fernandez seemed to come to a similar conclusion: “Denis – In the articles I’ve read about the Facebook/Pharma news the special privilege was described as ‘exclusive’ to certain Pharma companies and that some of them will still maintain the ability to block postings on their walls.”

Continuing the series on consumer health success, I’m excited to be writing about a company that I’ve heard a ton about but have never really looked into — PatientsLikeMe. Maybe I’m the only one that has heard it mentioned frequently, but it seems like almost every company pitch I’ve heard around chronic disease makes a comparison to PatientsLikeMe. That seems like a pretty good compliment for PatientsLikeMe, especially for companies that are trying to compete in the same area.

In terms of relevance to this series, PatientsLikeMe is all about chronic disease patient profiles, social connections, and educating patients about their conditions. I think of it as LinkedIn for chronic disease patients instead of professionals. The fact that they have over 100,000 members is pretty exciting as a potential real success in the chronic disease space.

All you need to sign up is basic information information about yourself. You can then create a health profile. One of the cooler features on the home page is that you can enter a condition, treatment, gender, and age range and it will spit out the public profiles that match that.  I looked for profiles that matched family members of mine and found tons of young female patients with epilepsy, but no older male patients with Type 1 diabetes. I also searched for middle-aged males with diabetes and hyperlipidemia, but the number of patients I found was still pretty low.

Something else I thought was a nice feature was the individual health profile maps, which are almost like mini-infographics that give a snapshot of a member’s health.  I’ve included one above from a public profile that I found.  It’s a nice visual way to show an individual’s health status, though it wasn’t intuitive enough for me to understand what all of it meant without digging deeper.

The site also provides a much larger visual health profile of a person’s conditions, treatments, and symptoms, all of which have information about the number of other members that have similar profiles or entries.  This is what a lot of people keep talking about in terms of making your health data pretty and understandable, though I wouldn’t call the profiles here actionable.

What I discovered quickly is that the majority of members, at least the public ones that I could see, all suffered from some very serious, and typically non-lifestyle related conditions. The large number of epileptic patients in contrast to low numbers of middle-aged diabetics hinted at that, but if you look deeper at the diabetics, you discover they are male patients that also have other conditions like breast cancer, ankylosing spondylitis, or major depressive disorder.

The Story

The types of conditions that are prevalent on PatientsLikeMe are not surprising if you look at the story behind it and its early days.  It was founded in 2004 by a three MIT engineers, two of whom had a brother who suffered and eventually passed away as a result of ALS (Lou Gehrig’s Disease). In the search for information about and support for their brother’s condition, they discovered a void and decided to try to address it.  If you’re familiar with ALS, and I’ve only seen it through patients and not family or friends, then you know how insanely sad it is to see young and healthy people quickly deteriorate in ways that are extremely hard to watch.  It’s always been hard for me to imagine how families cope with such extreme loss and hardship, but ALS sticks out to me as one of the most painful.

Not surprisingly, PatientsLikeMe has become the largest online community for ALS patients. From ALS, it expanded into other conditions, such as Parkinson’s, epilepsy, MS, organ transplantation, and others. In April of this year, PatientsLikeMe rebuilt the site and launched it for patients with any condition. Since then, it has expanded to over 500 conditions and 114,000 users, though not surprisingly, it is still heavily populated by users whose conditions allowed them to register before April.

How Do They Make Money?

Another thing I like about PatientsLikeMe is the message and the transparency. It relates back to the story behind the launch of the company. It calls itself a for-profit company, but not one with a "just for profit" mission.

One of the core values is transparency and I was surprised how transparent it is about making money. PatientsLikeMe sells member health data to companies to improve drugs, equipment, insurance, devices, and services for patients. The idea is that by sharing this information, treatment can be improved. The messages goes on to say, "Except for the restricted personal information you entered when registering for the site, you should expect that every piece of information you submit (even if it is not currently displayed) may be shared with our partners and any member of PatientsLikeMe, including other patients." No vagueness there.

Despite that and the current fears about selling or stealing patient data, the site has over 100,000 members willingly telling them how they are feeling and what they are taking. I think it just comes down to a matter of trust and PatientsLikeMe has done a phenomenal job of building trust in these disease communities. I also think the candid story behind the creation of the site goes a very long way to get trust and buy-in from consumers.

Where They Could Go?

PatientsLikeMe may try to expand from more (lumping here) congenital conditions to more chronic lifestyle conditions (diabetes, hyperlipidemia, CHF, hypertension, obesity, etc.), though again I’m not sure if it needs to. It is filling a niche and it is a pretty big niche with pharma partners signed on and paying. The conditions that are the biggest on the site require a lot of support both for patients and for their families, and PatientsLikeMe is doing a great job of providing them with a transparent platform and venue to connect, share, and find support.

If PatientsLikeMe was to look at expansion more aggressively, maybe it would look to an integrator like MedApps or perhaps even RunKeeper to pull in glucose, weight, blood pressure, and other relevant home-based parameters. PatientsLikeMe is a great venue to connect people and engage them in a dialogue about health, treatments, and symptoms. I say aggressively because PatientsLikeMe is open to all conditions, so nobody is stopping Type 2 diabetics from joining, and in fact, it has over 1,000 members who are Type 2 diabetics.

On this front, PatientsLikeMe is testing a mobile site, InstantMe, which I assume it will eventually convert from a mobile app to a native app. The app allows you to log basic symptoms and look at them over time.

I in no way want to come off as disappointed in what I found in PatientsLikeMe. I think it teaches a lot of lessons and has had a lot of success directly targeting consumers with health information and connections. That is probably more than all of the other sites out there that claim to be doing similar things. If nothing else, you should be impressed that it is a successful company collecting health data directly from consumers and openly selling that health data to pharma and insurance. That’s a lot of trust.

Travis Good is an MD/MBA and is involved with health IT startups.

Welcome to Kony as a Platinum Sponsor of HIStalk Mobile. Kony offers a mobile platform and associated custom mobile libraries for the healthcare industry that are flexible and guaranteed to run natively on all major devices and operating systems as well as over 9,000 mobile browsers; or, in Kony’s words, it will "future-proof a company’s mobile investment." Kony speeds the time and reduces the cost to market while assuring healthcare organizations are reaching their customers regardless of the mobile devices being used. To me, this makes a ton of sense for an EMR vendor, payer, or provider wanting to go mobile.

From Medhavi Jogi (in response to my questions about the new GE Centricity Advance iPad app): "I have been using the application for a week now. It is beautifully designed and we are working it into the current office flow. I like the mobility it brings to our practice. I’m able to fill prescriptions and respond to patient messages without going back to my desk. In addition to the advantage to the “digital notepad” advantages, Centricity Advance mobile seems to make a better connection with my patients. There is a perceived communication barrier by a traditional desktop EMR, and perception is reality. Anyone with questions can feel free to reach out to me directly."  That’s a pretty good review.

It’s been a busy week for Healthagen, the mobile app vendor that offers premium listings for partner providers. First it announced a partnership with ED staffing firm Schumacher Group to provide premium listings for Schumacher’s 180 hospital partners. That’s not a bad sale. Second, Healthagen announced it has added medication information from the National Library of Medicine for 1,000 common medications. Users can now find relevant drug information in the context of specific diseases. The above video talks about the new medication information in iTriage, but all I remember from it was the bouncing dock icon at the bottom of the computer screen in the background of the interview.

The ONC plans to expand efforts to educate and inform consumers about health IT, including EHRs, PHRs, and mobile apps. HHS videos and animated education are great, but to do this effectively, ONC will need to leverage providers. To do that, it will need to give them a CPT code for HIT Education and Counseling.

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I found this next one to be a very interesting story. Medagate, which is a "benefits disbursement and redemption network" serving CMS program members, partners with prepaid wireless vendor ReadyWireless to offer Medicaid members free cell phones with free, limited monthly airtime via the FCC’s Lifeline Assistance Program. The dedicated phone lines can be used by Medicaid to reach member and to send alerts. Once the free airtime runs out, users can top up at their own expense at ReadyWireless locations. It’s an interesting concept that is taking full advantage of government assistance programs to target health. It’s also something that serves both Medagate and ReadyWireless

A new report from Frost & Sullivan examines the different mobile opportunities available in healthcare today. The report analyzes four types of devices: 1) smart phones, 2) tablets, 3) push-to-talk devices, and 4) machine-to-machine (M2M) devices. The report is touted as a tool to assist organizations with mobile vendor decisions, but seems somewhat Sprint-heavy as it uses the company as a model. The images I found for the report don’t include iOS devices, which seems a little odd considering the high uptake of Apple devices in the provider community.

I was unaware of this, but apparently drug companies were granted special privileges on Facebook to block public comments on their Walls. Now Facebook has changed its policy and opened up most drug companies’ Walls to comments. Specific drug pages are still able to block comments on Walls, but this is a minority of pharma-owned pages. Several drug companies are shutting down pages because of the new policy.

HHS announces a new contest called "The Lifeline Facebook App Challenge". It seeks a Facebook app that helps people connect and improve personal preparedness during a disaster. In the words of HHS, "The app should integrate the concepts of disaster preparedness and community resilience into an app that better prepares individuals for disasters, thereby strengthening national health security". If you read further, it sounds a little bit like creating a "Lifeline" Circle in Google+.

Aetna expands services to providers in Florida by extending the Navinet Mobile Connect smart phone platform with e-prescribing services and clinical alerts based on gaps in care. The gaps in care are identified using ActiveHealth’s CareEngine. I’m interested to see how successful payers will be in targeting providers with mobile offerings.

In response to the recent presentation on the vulnerabilities associated with mobile health devices, Representative Anna Eshoo (D-CA) and Representative Edward Markey (D-MA) draft a letter to the Government Accounting Office (GAO) to assess if the FCC is appropriately identifying risks associated with such devices.

The army is planning to upgrade the four-year-old Motorola mobile devices that are currently used in combat zones by medics to document clinical encounters. iOS and Android devices are being tested, some of which are tablets. If they can make a protector and lock down an iPad’s OS for the battlefield, it seems like we should be able to do it for a hospital environment. I can’t wait to see that on an Apple commercial.

ABI Research issues a new report finding that the WiFi-based healthcare segment will grow by close to 20% this year. I’m not 100% sure what this includes as the report is not free.

Travis Good is an MD/MBA and is involved with health IT startups.