I hope everybody has been having a happy holiday season. I’m still recovering from several days of turducken that my brother was kind enough to send to us from Lafayette, LA. It’s rather tasty but incredibly heavy and makes me feel like I’ve been in a fog for the last several days.

I was trying to avoid writing a 2011 summary / trends / events post and a 2012 predictions post, but I just couldn’t help myself. There hasn’t been too much news over the last week, so I decided, why not? I ‘ll break them up and cover 2011 and 2012 as separate posts, so look for the predictions post in the next couple of days.

2011 has been a busy year for mobile and consumer health, with lots of new investments, ventures, partnerships, policy changes, and hype. 2011 has been defined by fitness apps, consumer empowerment, and price transparency. Despite all the talk about the transformative and disruptive power of connected technology, much of the healthcare delivery industry has been focused on putting out fires and meeting Meaningful Use.

Clinical transformation does not mean meeting Meaningful Use, but that is where most of transformation resources have been devoted this year. This will start changing as physician adoption of EMRs and eligibility for federal funding increases (but more on that in the next post about 2012.)

For now, here are the biggest events in 2011 according to me:

iTriage growth and acquisition. iTriage, a very new mobile health company, found a way to grow through partnerships this year to the point that it was attractive enough for Aetna to acquire it earlier this fall. I’d heard about the acquisition months ago but didn’t know it was Aetna, just somebody very big. This is significant, as it shows the value of creating a mobile solution that links providers and patients. It’s also a company founded by two MDs, another big win in my book.

ZocDoc funding and expansion. I’m not sure how this can’t be seen a very big news despite being seen by many as OpenTable for healthcare, which is an accurate description of ZocDoc today. ZocDoc, like iTriage, has been rapidly successful because it is free to consumers, generates revenue through providers, and targets acute needs in healthcare (finding and booking in the very near future.). It does not depend on chronic care and behavioral change.

Epocrates IPO. The company, whose product all docs under 40 know and rely on for drug info, went public and is now worth close to $200 million. This is the best example of a successful mobile company that will only grow as mobile adoption amongst physicians grows. It showed that if you can put a useful mobile tool in the hands of providers and charge pharma to sponsor it, you have a very valuable offering. Epocrates also updated its mobile app considerably, launched a web-based EMR, and will be launching a mobile EMR with Nuance integration in 2012.

Health accelerators. Rock Health, Blueprint Health, Healthbox, Startup Health, and Nant Accelerator all made news this year. No really big successes have emerged, though several Rock Health companies have received funding. This is a trend that should only get bigger in 2012.

Google Health dies. Google fed industry commentators everywhere this summer, myself included, with the announcement that it was phasing out Google Health, essentially giving the PHR business over to Microsoft. Google proved that if you just build it (a PHR), they (consumers) won’t come. Microsoft continued to extend HealthVault’s integration with partners, including iTriage last week. Combining the PHR trend with the health accelerator trend, I’m wondering when MS is going to announce the HealthVault Accelerator? I read about the MS Kinect Accelerator and HealthVault, though I’m sure not anywhere close to the revenue of Kinect or XBox, seems positioned as a personal health platform waiting for value add apps and services.

Health games. Gamify everything! It is a great way to keep people using a services and motivate them to participate in healthy behavior. I still advocate healthifying exisiting games or platforms rather than trying to gamify health. This is just in its infancy, but I see the biggest expansion over the next 12 months being in the area of health games as part of employer wellness programs. Look to Keas to lead the way here.

Design, experience, interfaces. Collectively — and this isn’t unique to health — user experience has become increasingly valuable. Some believe UX is the key to consumer adoption of health applications and wellness services. While I agree that UX is extremely important, both for clinicians and consumers, I disagree that UX is what is preventing widespread consumer adoption of mobile health services and apps. Either way, if you’re a UX expert or just pretending to be, likely there is a health startup or established HIT company looking for your skill set.

Health innovation challenges. CMS, drug companies, and payers are committing money looking for new ideas for technology application in health. Health 2.0 has a good list.

Reverse innovation. Lots has been written about the innovative ways that mobile technology is being used in developing countries for health-related services. I used to agree. I now think that while some very cool things are happening internationally in mobile health, they are not applicable to the US or other developed countries. SMS is great and should be used in the US as part of a mobile strategy but we all get that. We also don’t need health workers submitting patient forms via SMS. The main use case I can see for importing innovation is in the arena of very cheap touch devices, mostly Android, but I see these as patient-facing tools in the US while I see them as provider-facing in developing countries.

Wireless carriers becoming health companies. Qualcomm, AT&T, Verizon, and Sprint are all targeting health as a key vertical for revenue growth. Through apps (Zipnosis, WellDoc) and connected devices (MedApps, Vitality) the carriers are looking to partner with companies in the hopes of generating revenue from the existing wireless networks.

That’s how I remember the year. My next post will cover predictions for 2012, many of which include trends that started or grew in 2011.

Travis Good is an MD/MBA involved with HIT startups.

For those who haven’t seen or heard of them, health-focused startup accelerators are cropping up across the country. Granted, there are only five that I know of – Rock Health, Healthbox, Blueprint Health, Startup Health (not even sure if this is an accelerator or not), and NantAccelerator. The accelerators are trying to duplicate the success of non-health incubators and accelerators like Y-Combinator and TechStars.

Rock Health is the only program that has been around long enough to have a class of companies to call alumni, but that will change by next spring when Healthbox and Blueprint should have completed one cycle. This week both Rock Health and Healthbox announced their new incoming classes of startups. I thought it would be fun to look at what ideas are getting into the accelerators. Today I’ll cover Healthbox, and next week Rock.

For some context, Healthbox is in Chicago. It runs for three months (January-March, which means you have to be committed to it because who would want to be in Chicago for those months?), provides $50,000 and downtown office space, and takes a 7% equity share of the companies. Like all accelerators, a big part of the sell is the intangibles, like having access to knowledgeable and well-connected people to guide strategy and business development.

The most interesting part about Healthbox is that it is funded primarily with BCBS money. If you’re a startup hoping for an exit/acquisition, having the links to a payer and having them own a piece of your company seems like a good launch strategy.

OK, now finally to the startups.

1. CareHubs – "healthcare social enterprise platform". I’m not exactly sure what that means, but it sounds a bit like Avado. Connecting patients and providers is a great idea, as long as (a) somebody will pay the providers, and (b) patients care enough to want to be connected.

2. CareWire – text messaging services to improve appointment prep and enrollment as well as patient satisfaction. I’m curious how patient enrollment works over text messaging and also about the ease of PM/EMR integration ("compatible with any mobile phone and PM/EMR.")

3. Corengi – helps people with type 2 diabetes find clinical trials.It looks like they put a pretty front end on ClinicalTrials.gov, made it slightly more searchable, and are using the API to pull trial info. I’m not sure how many people with type 2 diabetes will use this.

4. The Coupon Doc – a centralized repository for manufacturer discounts on prescriptions and OTC meds. It sounds like it will have reviews and price
comparisons.

5. DermLink – streamlines referrals to dermatology by enabling both patients and referring docs to take pictures of skin lesions to be interpreted remotely. I like this one a lot. First, suspicious skin lesions scare people, so I think they’ll be motivated to pay to get a fast response. Second, I love growing the network through referrers (PCPs) and letting them earn money for taking the picture and answering symptom-related questions. I’m not sure what the cost is and the site talks about insurance, but I’d make it self pay. A lot of people would be willing to pay and dermatologists would prefer instant payments.

6. Iconic Data – a Patient List Manager (PLM) to assist physicians accessing patient info across different locations. They must be pulling patient lists, including clinical data, from ambulatory systems. The physician can then track his/her patients across different facilities where the physician has privileges. I see the value to docs and the ease of layering in additional functionality like analytics and electronic prescribing, but I just wonder how easy it will be to scale this with each provider patient list and associated clinical data? That’s a lot of integration.

7. Patient Journey Record (PaJR) – readmission prevention using risk stratification based on patient and caregiver reported data. Phone calls are placed to patients and responses are logged to assess ongoing risk. It’s been used in pilots in Ireland and apparently reduced readmissions by 50%. The next step is to add in machine learning and language patterns. I really like the outsourced model for readmission prevention because of the ease of scaling. I’m not sure how this company is doing patient intake, but I think that will determine its success. Also, it’s one of the worst names I’ve heard for a company in a while.

8. Push Wellness – an incentive model for encouraging healthy behavior. It’s a tool for employers to engage employees and lower healthcare costs. Employees are financially incented to be healthy, presumably sharing in the savings that employers get from healthier employees. This makes sense. I also think selling to HR departments is easier than health systems.

9. SwipeSense – a personal hand sanitizing device that records compliance of staff. It will come down to how much it costs and how good it is at reminding staff to use it.

10. UnitedPreferences – a service for payers and employers that offers prepaid cards that members and employees can use only on approved preventative health initiatives. I’m sure there is an incentive angle in here somewhere, but it’s not clear in the very limited info available.

OK, there you have it. The future of healthcare in 10 startups. Really though, some of the concepts are very good. Some aren’t, but that’s likely where Healthbox comes in to help pivot them in the right direction. It will be interesting to see what success they all have being in the accelerator.

I’m taking the long weekend off to be with family. Have a safe and happy holiday.

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

I try a lot of apps and web services searching for the best ways to optimize my time, productivity, and enjoyment. I sometimes think that my search for incrementally better tools ends up being a detriment to productivity because of the time I spend learning, but I also think I learn a lot about design, new tech, and features that can then potentially be applied to health. I’m going write about them from time to time to document and share the experience.

A new service I’ve recently discovered, though it’s been around for a year or so, is Path. I never used the original Path, but Path 2 is fantastic. Path is a "smart journal" for iPhone and Android. You can use it as a personal journal or for sharing with friends and family. I was inspired by the promo video on the site that had a dad traveling and keeping up with his family that was home via Path.

I’m not a Facebook fan because I consider it a waste of my time to see irrelevant updates from "Friends." I use Twitter only for professional purposes. I don’t do Foursquare because I don’t want to be the Mayor of Chipotle. What I’m lacking is a fast and easy way to keep a running, interactive dialogue with the people that I really care to keep up with personally — my close friends and family.

That’s where Path comes in. The idea is that you can only have so many trusted relationships. That is supported by the research of an Oxford professor. From Path: "We tend to have five best friends, 15 good friends, 50 close friends and family, and 150 total friends." I think 150 is too many – I think 10-15 people is the biggest network I’d want.

There are some flaws to this approach. My wife has struggled with turning down requests from people she knows that she doesn’t really consider good friends. You can add people to your Path, then remove them — they will just stop getting your updates without getting a message that you’ve disconnected them. This isn’t an optimal approach, and I prefer the more direct method of saying I use Path only with family and my closest friends.

You can connect Path to Facebook, Twitter, Foursquare, and Tumblr if you choose. I think Posterous should probably be added to the list of connected services as well. I don’t ever use any of these services through Path because, as I wrote above, Path is personal and the rest are non-personal. My wife uses Twitter and Tumblr for personal posts, so she sometimes posts through Path to these services. In this way, she uses Path like her inner circle and only posts select things more widely.

I use Path to keep up with good friends and family. It only really works if you can convince people around you to join and those people use smart phones. I’ve successfully gotten nine of my closest friends and family to join and they all seem to like it, or at least they are still using it. We’ll see if it lasts. Download and give it a try if you’re like me and have been looking for some way to keep up with people outside of Facebook.

The iPhone app itself is fantastic. It’s one of the best I’ve tested from a usability perspective. The ability to swipe left or right to open up different menus is great. The "Chooser" (red plus button in bottom left) is a phenomenal way to declutter the small screen of buttons and give you fast, flexible posting options.

As I use it, I realize how nice of concept this would be for a personal health journal. Path is built and optimized not only for smart phones, but also for smart phone users who are comfortable with smaller fonts and buttons. I don’t see GreatCall rolling out this app to it’s senior users, but I do see this as a potentially beautiful app for the right cohort of patients.

The ideal patient populations that come to mind for me are pediatric anything, breast cancer, pregnancy, and new moms (notice almost all women.) These are groups of people looking to connect intimately with others sharing the experience. Just retool the app slightly so the "Chooser" offers the ability to add a side effect, mood, treatment, pain, glucose, milestone, or whatever else might be relevant based on user and clinician feedback. Then get health systems, or maybe payers or individual providers, to refer patients to it with unique codes that link patients to that referring entity. It would also be interesting to explore the ability of providers to interact with patients through something like this.

Another feature of Path is that you can make any post private so it’s only for you. This also would work well for a personal health journal.

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

Lots of people, myself included, have been writing commentaries this week and last about the mHealth Summit. Much of the writing has been positive. While I agree the event was a great opportunity to see some innovative concepts and products, I was left wondering why almost no mainstream — as in enterprise established HIT companies — were exhibiting.

None of the EMR companies were there. Even the mobile EMR vendors drchrono and Clear Practice weren’t there. No HIE or RCM companies. The only clinical communications company I saw was EXTENSION, which was also presenting at the event. I didn’t see any workflow companies. Even Epocrates didn’t exhibit at the Summit. The Epocrates CMIO presented at one of the panels, but the company, which I think can be labeled the biggest mHealth success story to date, didn’t have a booth. iTriage, which is another huge success story in the mobile health space (having been started two years ago and just acquired this fall by Aetna — more on this in a later post) was not an exhibitor either.

Why did they all decide not to bother sending sales or PR people to exhibit? A friend suggested two reasons to me: 1) they didn’t want to be shown up by new, innovative technology that might be far ahead of their own, and 2) they didn’t want to legitimize the event and the mobile health movement as being separate from the rest of healthcare.

Both reasons make sense. HIT companies, in particular those selling EMRs, aren’t really known for their superior user experience. I’d love to see a rolling demo of Meditech alongside some fancy new fitness gadget that tracks everything about you and displays it beautifully in real time on a Retina display.

The reality is that lots of health startups are getting funded, in part because they believe they can win on design and usability. While very valuable and likely necessary to succeed long term in a competitive market, this isn’t the only ingredient needed for success in healthcare. Additionally, existing firms are entrenched in relationships with their customers and aren’t focused solely on product building, something you have to do when you run out of investment money. That’s not to say more attention shouldn’t be put into new product design or development (look at Eric Ries’ examples like Intuit in The Lean Startup), just to say design can’t be the only focus for these existing companies.

The second reason, not wanting to legitimize the mHealth movement as separate and unique, also has some merit. Maybe existing vendors don’t want to give any validity to the new guys on the block talking about disrupting healthcare delivery and ushering in a new era in health and wellness while staying away from many of the existing players.

Despite the validity and defensibility of these two reasons, I think it simply boils down to the fact that existing vendors — those with relationships, contracts, and real revenue in healthcare today — did not see the Summit as an opportunity worth their time. That means that by and large, decision makers in US healthcare (providers, health systems, or even payers, were not there.)

I know this isn’t universally true. I ran into a couple of people with very large HIT budgets at health systems and payers. Overall, though, real healthcare customers were not represented. If they were, the existing vendors would have been there with swag.

Maybe the Summit will remain an event for consumer health, which is really fitness and wellness in its current form. I’d like to see what vendors are represented next year and if it becomes worth the effort.

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

Reader Naveen writes in response to the mHealth Summit summary:

Excellent summary. I (and many others) would agree wholeheartedly with your assessment of the clinical lag in mHealth. At the end of the day, the folks who are trying to innovate with mHealth solutions seem well-intentioned, but somewhat misinformed. It’s akin to trying to redesign the handle of a bucket to make it easier to throw water onto a fire…while the house is burning.

Folks who are talking about “clinical solutions” rarely seem looped into the ‘actuals’ of health care delivery – HEDIS measures and reimbursement policy, organizational workflow challenges, and above all else integration into current care management. While ‘patient-centeredness’ and ‘consumer-orientation’ have emerged as themes du jour in mHealth, these ideas aren’t really about healthcare as much as they are about lifestyle and convenience. An emerging strategy is to use them as a crutch to secure seed funding without real regard for the heart of care delivery challenges.While progress is palpable and inevitable, until we start aiming at the right targets, we probably won’t hit them. Thanks again for sharing your thoughts.

Much better put than my own words. I need to use more analogies. Also, I’m planning to follow up on this with more information from firms in the industry.

This news somehow got lost last week in my posts about the announcements at the mHealth Summit. WellDoc presented and released information about a study of 32 patients that found significantly a lower number of hospital stays and ER visits associated with the use of WellDoc’s mobile diabetes management system. Participants in the study were given a $20 monthly discount on their mobile phone plans, which I’m sure helped with adoption. $240/yr per patient means you only have to prevent one hospitalization per year in about 1 out of every 16 patients to get a positive ROI. I’m sure WellDoc is pitching this to payers and CMS as I write. I was looking around for a logo of WellDoc and stumbled on a recent interview with the founders. This quote was telling, especially in light of all the consumer-driving-health discussions lately: "We work in a really challenging industry in health care, and it’s been a good lesson learned for us that it’s not a consumer industry. It is an enterprise industry, and there are really some entrenched players and entrenched ways of doing business." Seems like WellDoc gets it.

Jawbone announces refunds for all people *claiming* to have a defective Up device. The device, a wristband and associated app for monitoring activity, sleep, and nutrition, was released last month. It’s a nice offer from the company but not a great way to launch into a new vertical. If you get the refund, you still get to keep the device.

Initial results of a study out in the UK show that the use of telehealth for chronic conditions reduces mortality by close to 50%. It also reduced ED visits (called A&E in the UK apparently), admissions, and days inpatient. The paper is so high level it’s hard to get much else.

El Camino Hospital (CA) launches the Family Medical Officer (FMO) App. The term family medical officer, according to Google, seems like something El Camino came up with to represent the person in a household that is responsible for the majority of healthcare decisions, usually the mom and adult daughter. The app is a facility app (ED wait times, provider listings, directions, news) that also allows users to track family medical information. It’s available on Android and iOS.

Researchers are testing a device that’s portable and relatively cheap for HIV testing in remote areas. The idea is to improve ongoing monitoring of HIV patients in developing countries, especially those in rural areas that have to travel for tests. The next version of the device will be slightly larger than a smart phone.

GAIN Fitness raises $650,000 to expand its mobile fitness app. The app is a marketplace for personal trainers and premium workouts. Starting in January, users will be able to buy bundles of workouts in different categories and for different lifestyles. It seems like a cool idea for the fitness conscience population.

A team from the Worcester Polytechnic Institute, in collaboration with the University of Massachusetts School of Medicine, gets an NSF grant worth $1.2 million to "develop a smart phone application that will help people with advanced diabetes and foot ulcers better manage their disease". The first two years are for prototype development and the second two years are for a clinical trial. I really hope that in four years somebody has already built a product and found a sustainable business model for this kind of app. If not, I guess the NSF money will be put to good use.

A new company from California is building ultraportable and apparently ultra-cheap x-ray devices. The devices are cheap and portable, about the size of an iPhone, because they harness the power of static electricity. It’s a very interesting concept that may find its way to healthcare eventually.

My wife would love this one. A new app called Safe Sushi from the Sierra Club lists the mercury levels in different kinds of sushi. She doesn’t really care any more, but when she was pregnant she was concerned about eating sushi. It’s only available on Android.

Sotera Wireless raises $12.2 million in Series D financing. Investors include Qualcomm, West Wireless, and Cerner. Cerner, hoping to maximize its ROI, also signed a commercial agreement with Sotera. Sotera offers vital signs monitoring tools to help identify early signs of badness so that clinicians can intervene and hopefully reverse it.

I’m not sure this is really mobile health news, but if fitness is health, then so is safety. Has anybody heard of Life360? It just raised $3.5 million. It’s a mobile app and location service that enables families — or I assume any group if they so chose — to see family member locations and check in. The primary value seems to be parents tracking kids. Apparently it has 10 million users. Anyway, the use of the money is to extend the feature set, and I would think home monitoring and tracking elderly parents would be another potential source of revenue. What I don’t understand, as this is meant for internal family communication, is why it all has to be about checking in for safety reasons and not something a little more fun, like a family journal. Although maybe kids are more motivated by fear of punishment for not checking in than by sharing any thoughts or experiences with parents.

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