In my post earlier this week on the new class of Rock Health startups, I mistakenly wrote the name of a mobile image viewing company as Nephrosity, instead of the correct name of Nephosity. I think I saw the name and assumed it had to be "nephros" for kidney, but one of the founders was kind enough to reach out and tell me that it is "nephos," which apparently is Greek for cloud. Thanks for the correction.

Over the last several weeks, I’ve covered the new startup classes for Rock Health and Healthbox, the health specific accelerators based in San Francisco and Chicago, respectively. Earlier this week, the New York-based health accelerator Blueprint Health announced its first class of startups.

Blueprint is a member of the TechStars Network, which has had success as a general technology accelerator. The three-month program started this week, providing  $20,000, free office space, legal, and other support. It takes 6% of each company. The Blueprint list of mentors is impressive, with lots of investors and diverse representation from payers, healthcare orgs, pharmacies, and even Allscripts and Cerner. I also like the size of the program at only nine companies instead of the 15 that are a part of Rock Health.

5 O’Clock Records. A nifty name for a company with a tagline of Work less. Make more. Go home early. The idea is that the company can streamline the process of requesting medical records through a HIPAA-compliant website. The company states that "at least 6 phone calls are made to the practice for each medical record request," which seems bit extreme to me. Whatever the number of calls, it’s true that requesting records can be a real nightmare — I’m experiencing it right now. This would work well if providers could get requestors to use the 5 O’Clock site. Also, the company seems, from the very limited info it provides, to be catering to indirect medical records requests, or those from people other than the patient themselves.

AHEAD Research. The company, founded by two fourth-year med students at Hopkins, has a platform called Symcat (http://symcat.com/), which is up and running to test but only intended for educational purposes. The tool takes symptomatic and other historical information and comes up with a list of possible diagnoses with probability attached to each. From there, you can get summaries from the NIH as well as studies related to the diagnosis. You can even find local providers that can treat the condition. It’s really impressive in speed and usability. I tested out "pain in testicle" and said I was a pediatric female, which the system didn’t seem to think was odd, and gonorrhea was the most likely diagnosis it found. I think the success of this is dependent on believing the premise of the company that, "At our core we believe that people given access to information the right way will make good decisions". I don’t agree with this, but I do see the value of Symcat for more acute conditions.

Aidin. This service hopes to streamline the discharge process and create a competitive marketplace for post-acute care providers. Discharge is a cluster of a process, so any streamlining would be great. Discharge itself has a lot of different kinds of bottlenecks so I don’t see this solving the entire problem of discharged patients waiting around all day to go home, but I think this could help discharge planners and coordinators and maybe even patients make more informed post-care decisions. I thought GetWellNetwork did something like this, but maybe it is more passive and not meant for discharge planners.

iCouch. I love the name and the concept. Users fill out a questionnaire and are then given a list of qualified counselors to choose from. Once chosen, they use Skype to do a remote counseling session. Counseling is perfect for telecare. I’m curious if patients will be able to either bundle services (buy bundles of sessions) or choose specific providers once they’ve forged a relationship.

InquisitHealth. This company offers a service that connects new patient with experience patients based on medical needs. It sounds like a good idea and something in which both new and old patients would want to participate. I’lll be curious to see how this works.

Meddik. It sounds a little like Google for health information. The company wants to provide intelligent, personalized health information to each user. User are able to rate content they find and in the process help refine their own search results, but also those of others as user ratings (up or down) affects the overall ranking of that data. I’m not sure if this is right, but it seems a bit like Zite + Google for health. And both docs and patients can use it. It’s a concept with a lot of potential, but I assume it will be dependent on heavy adoption.

Patient Communicator. This is a platform to improve communication between providers and patients. It allows patients to do things like schedule appointments or pay co-pays. What I’m confused about is if this is a full practice management system or a separate system. It might work well just to customize Kareo PM with the added patient-facing tools. The systems also does patient reminders.

Procured Health. There is very little information on this one except that it’s a great founding team and it is going to help hospitals with "medtech product evaluation and purchasing.”

Needl. Again, not much on this one either. It’s a platform to help hospitals connect to vendors. I read recently that it has a pilot going on in Minnesota.

What impressed me about the Blueprint class is most of the offerings are B2B and there are not any fitness-related companies. I’m curious to see how this class does compared to the classes at Rock and Healthbox. It won’t really take that long to find out, as all the accelerator programs are either three or five months long.

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

Last July, the FDA issued draft guidance for mobile medical applications, hoping to solicit comments before finalizing rules. Many groups, including HIMSS, AMIA, and the ATA responded with comments and recommendations. Only time will tell what rules are actually put in place for mobile medical apps.

For now, I’ve been curious what mobile app developers are thinking about regulation and if proactive steps are being taken. Until the rules are official and mobile apps are regulated, getting FDA clearance is more about marketing than safety. Several vendors have proactively earned approval. It always makes for a good PR splash and I’m sure helps, especially with a clinical product.

I reported on the new guidance last July, summing up my thoughts based on the FDA documents. I recently had reason to go back and dig a little deeper into the guidance, as I’m working on IRB (institutional review board) approval for a study of the efficacy and usability of a mobile app for mental health patients.

The app is used by the patient at different intervals — including immediately prior to an appointment — to collect specific subjective information. This information is then used to help the patient with targeted topics to discuss with a PCP, including treatment options. The questions and all the education and treatment options are evidence-based, using well established guidelines. The PCP can see the algorithm used, with references, within the app. No treatments or recommendations are made to the patient, just topics to discuss with their PCP.

I thought we were in the clear in terms of FDA regulation, but the IRB wanted confirmation from the FDA. The initial FDA contact hedged, saying it sounded like it would be a regulated app, but that he couldn’t actually confirm or deny. I’m now waiting to hear back from a supposedly authoritative FDA official.

This is the section of the draft guidance that most closely applies:

Mobile apps that allow the user to input patient-specific information and – using formulae or processing algorithms – output a patient-specific result, diagnosis, or treatment recommendation to be used in clinical practice or to assist in making clinical decisions. Examples include mobile apps that provide a questionnaire for collecting patient-specific lab results and compute the prognosis of a particular condition or disease, perform calculations that result in an index or score, calculate dosage for a specific medication or radiation treatment, or provide recommendations that aid a clinician in making a diagnosis or selecting a specific treatment for a patient.

Interestingly, I think our app is going to be addressed more closely by the FDA’s guidance on clinical decision support systems. We intend to offer the same app on the web, so it will be more of a mental health service and less of a mobile app for mental health.

For now, my opinion is that our tool is low risk, especially considering that it presents evidence-based options of care to the PCP and does not make any specific treatment or even lifestyle recommendations to patients. It also provides transparency into the algorithm and evidence behind the algorithm.

What I’m worried about is that we could get stuck in IRB and won’t be be able to study the app. We’ve already gotten several PCP groups signed on to participate and have the app developed and ready to go. With a little bit of positive data, I think we can approach payers and health systems.

The FDA does not want to be perceived as impeding innovation. In a rapidly changing industry, high risk apps should be targeted and regulated, but small players should not be subjected to unnecessary hoops for low-risk apps. Maybe the specific IRB we’re working with is being overly careful in requiring us to have a statement from the FDA that our app does not need FDA approval. We could always shift things around, as we have a partner at another institution with a different IRB.

I’m curious to get thoughts from readers because I’m a little torn on the whole thing. After recently watching my wife download and test three drug dosing apps on her iPhone, each calculating different does for the same pediatric patient, I’m a believer that FDA regulation is necessary. What do you think?

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

Before the holidays, I profiled the startups accepted into the new Healthbox accelerator in Chicago. Rock Health, the most established health-specific accelerator with one group of startups having completed the program, also announced its second class of startups a couple of weeks ago.

Rock Health is a five-month program based in San Francisco. Companies are given office space; access to design, health, and legal resources; and a grant of $20,000, I assume to cover Ramen noodles for the founders for five months. Companies don’t lose any equity in exchange.

I think the biggest sell — and I assume Rock agrees, as it lists this on the top of its list of what companies get — is access to big clinical names like Mayo, Harvard, UCSF, and Cincinnati Children’s. This is a clear difference from both Healthbox and Blueprint, the other two main health accelerators, which lack blue chip clinical names. Healthbox and Blueprint bring great value to startups, but in other ways. Healthbox is funded by BCBS and has Walgreens as a partner. while Blueprint has tons of investors and Joseph Kvedar as mentors, but these are not on par with the clinical names that Rock Health has as partners.

Below is a list of startups in the Rock’s second class. I’m curious to watch these new and also some of the more interesting startups from Rock’s first class, namely Cake Health, Omada Health, and Skimble.

Agile Diagnosis. The company wants to delivery tailored, actionable evidence-based algorithms to assist clinicians provide the best care to patients. It’s a good goal, as dissemination of evidence into practice takes way too long. It’s not easy to do, though, as you either have to integrate into systems clinicians already use (which is no small task) or get them to use a new tool which, even if it is almost instant, will interrupt the workflow and generate push-back.

Avva. I like this concept of helping to maximize the value of face-to-face time between patient and doctor. Focusing on breast cancer is a good move, as patients will be engaged. I think oncologists, as much as probably any specialty, will be very receptive to listening to a list of questions and concerns from patients. Marketing in the right online communities or partnering with pharma for funding and promotion will go a long way.

Cardiio. According to Cardiio, it “empowers ordinary people with simple yet powerful tools to experiment, gain insight and take charge of their health and wellbeing.” I’m betting this was just an idea pitched to Rock that got accepted because of an impressive team with a very good designer. Pet peeve: please don’t promote a Twitter feed as the only option on your website if you don’t tweet.

Care at Hand. Mobile medical records system for home health with a workflow optimization angle as well as tools for family members. This seems like a good idea for home care, especially if you can combine it with another Rock Health company, GetMyCare.

GetMyCare. A home health marketplace with different home care specialists. Building this network of independent providers might serve GetMyCare very well, especially if it can find a B2B partner that coordinates between-care care for hospitals, payers, and eventually ACOs.

ChickRx. An online health community specifically for young women. It sounds like a focused version of HealthTap, and HealthTap’s CEO is a Rock Health mentor. Targeting women makes sense, as they are the gatekeepers to consumer health.

Cognitive Health Innovations. An online community for people suffering from mental health disorders. The site plans to offer therapy and social interactions to assist members. Mental health is a huge untapped market. The best way to grow this is to get a big-name clinical partners on board and then target patients through providers.

Docphin. Maybe I don’t understand the name, but I don’t like it. It’s touted as “Bloomberg for Doctors,” delivering tailored medical news and research. If it can help sorting the crazy amount of stuff that is out there for providers, it has a good start. It also has some academic partnerships with Penn and Michigan, which is great because this service will likely grow and prosper in academic settings more than community settings.

Epi.MD. A social population management tool that is meant to assist providers with managing the health of their patients. Seems like a cool idea, and the founder won the Practice Fusion “Analyze This” competition last year. This might be easier to sell to healthcare orgs or payers as a tool that can be pushed to/on providers. It should try to get a partnership with Practice Fusion and then hope to get acquired by them.

Health Rally. A very cool and novel concept for a subset of the population, namely those with friends who will pledge cash for fitness goals. It has already received some funding, so the founders will be able to eat more than Ramen for five months. Friends and family pledge money to motivate people to achieve certain goals, like lose weight or run a marathon or whatever.

Helpful Systems. An analytics tool to identify patients at risk for hospital-acquired infections, a huge problem and burden to hospitals due to associated reimbursement penalties. Some of the variables used are based on hospital staff, so a partnership with one of the new hand hygiene tracking vendors would be a good and would reduce integration issues.

Nephosity. The product is MobileCT ($9.99), a medical image (DICOM) viewer on the iPad that enables providers to collaborate on images. It allows docs to annotate images. I’m not sure if this is supposed to be an enterprise sale, like AirStrip, or something any doc can download and use. I image the value is in accessing PACS images, so it likely needs to be an enterprise sale. I hope the team has experience with that or can get an investor with experience.

Sano Intelligence. It is building a real-time mobile monitoring system with sensors that continuously monitor biometrics, starting with the metabolic panel. This seems to be based on the TED talk by Daniel Kraft, MD, about Stage Zero medicine, or curing patients before they are really sick. Since Daniel Kraft is a Rock advisor and seems like a very smart guy, Sano was probably hand picked.

Senstore. This is an online community that wants to crowd source the best and brightest to build a network of open source sensor technologies that developers can leverage. The long-term goal is to create a medical tricoder that anyone can use for diagnosis.

Sessions. Localized, social exercise. Users can find and join others in exercise. I prefer to exercise alone so this holds zero appeal to me, but I could see some people getting into this. I wonder when Fitocracy will add this feature?

Well, that’s it for Rock and Healthbox. I’ll try to keep up with news from both as well as Blueprint once it announces its class of startups.

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

2012 will be another big year for mobile and health, with CES kicking it off next week. Look to CES to be the launching pad for several big new mobile health devices, as it was last year for Withings (blood pressure cuff), AliveCor (EKG iPhone case), and others. I also think we’ll see some big mobile news at HIMSS12 in February from lots of new vendors, but also from some established vendors.

Below are my predictions for 2012. I’ve tried to be specific with some of them, not because I necessarily have any inside information, but because I’ll look good if I’m right and people will likely have forgotten if I’m wrong.

Smart phones everywhere. My mom and dad got iPhones while visiting me over the holidays. My wife’s 84-year-old Greek Yia Yia also got one. Pew numbers show close to 40% of the US population has a smart phone and I’ve seen projections that it will reach 50% in 2012. Despite the iPhone data pricing, I think the dropping iPhone prices, combined with the presence of Apple stores everywhere, will see iPhone numbers increase as a percentage of total smart phones. Despite this, building apps for iPhones or even generally for smart phones in 2012 will not hit the majority of those who need connected health tools. On the clinician side, obviously we’ll see the same trends, but also with increasing tablet adoption, specifically the iPad. If you’re a CIO at a hospital and don’t have a bring-your-own-device (BYOD) policy, look forward to more pressure to create one.

More evidence. HIT generally — and mobile specifically — will see more research being completed and published. Lots of pilots, both for pre-launch and launched companies, are underway, and 2012 will see the results, I’m betting mostly positive. The question will be around cost savings and decreased health utilization associated with mHealth technology and I think we’ll see several studies this year with positive findings. Having this lead to these services being covered by payers or hospitals is another story, which I don’t see happening on a big scale in 2012.

Biggest mover. My bet is that it will be AirStrip. AirStrip had a great 2011 and I think that will continue on three fronts in 2012: (a) more big enterprise deals like the one last month with CHW; (b) expansion to other acute mobile monitoring areas beyond OB and cardiology; and (c) expansion into home monitoring, where AirStrip will look to become the big player in monitoring lots of different home monitoring devices through its partnership with Qualcomm. I don’t know AirStrip’s cash position, but my bet is it will ra4ise over $10 million in venture funding in 2012.

Price transparency. Several companies that are trying to bring consumer insight into the cost of healthcare made big news in 2011 – Castlight, Brighter, and Cake Health come to mind. I think we’ll see Brighter continue its success in dental, while Castlight continues to succeed as a employer SaaS offering. Cake Health, a Rock Health company that is very new and consumer direct, will see stiff competition from the best-funded startup in HIT, ZocDoc. I think ZocDoc will continue to scale geographically (just look at where it is hiring sales people), but will also look to test the waters with cost and price info on providers and specific services. This makes more sense as the next wave for ZocDoc rather than expanding into PHRs, because people care more about cost than past lab results. Speaking of ZocDoc and scaling, I think we’ll see it partner with Practice Fusion in 2012.

App consolidation. Even in health, there always seems to be an app for that. I think we’ll see attempts made to consolidate health apps for consumers. Leading the charge will be Mayo, using its name to help consumers find the right apps. It will be interesting to see if this can be done through a mobile health platform, sort of like how Facebook integrates apps and services.

Transitions in care. Mobile will see more utilization for transitions in care, starting with discharge and readmission prevention. I think we’ll see several dedicated mobile health devices for these exact purposes in 2012. How usable these are and how they are funded beyond the immediate post-discharge period will be interesting to see.

Acquisitions. I think 2012 will see several mobile health acquisitions by payers to resell to ACOs and hospitals. ZocDoc is too pricey, but I’m going to go out on a limb and predict that WellDoc will be acquired in 2012. It won’t be cheap, as WellDoc has raised ~$20 million and has some revenue (though it is still not profitable.) Lots of smaller acquisitions will happen as well, as iTriage showed us this fall.

Tablets for patient entertainment. Beyond patient registration, I think we’re going to see healthcare organizations start to use tablets as patient entertainment and education devices, like GetWellNetwork, but not on a TV. Discharge instructions and patient education can be tailored and delivered interactively. I think lots of details need to be worked out with infection and access control, but these aren’t insurmountable.

Mobile EMRs gain momentum and adoption. I see this happening at least on the ambulatory side. I think we’ll see some tablet offerings from entrenched enterprise EMR vendors, but the real uptake will be on the outpatient side. In this, I think we’ll see Practice Fusion become a mobile EMR force. drchrono has been getting all the attention, but with Practice Fusion and Epocrates entering the mobile EMR market in earnest in 2012, it will be a lot harder for drchrono to differentiate.

NantWorks emerges. I predict we’ll start to understand how all the pieces of Dr. Soon-Shiong’s HIT conglomerate fit together. I don’t think all of the portfolio companies will necessarily take off, but we’ll begin to see through pilots the NantWorks plan to combine and integrate remote monitoring and home care delivery to reduce the overall cost of care.

Sensors on everything. Look no further than GreenGoose for proof of this. It is building sensors and games for tracking how you care for your pet and if you put the toilet seat down (no joke). On the health side, I think the push will be related to aging at home with Independa and GE/Intel leading the way. On the fitness side, we’ll see more and more people tracking activity and sleep.

mHealth fitness. Though I don’t think everybody will get a Fitbit for activity or a Zeo for sleep or RunKeeper for exercise, I think more and more people will start using services like these, especially as they become gamified and social. Also, new concepts like Health Rally are testing methods to get people back in shape. If I was in the fitness area, I’d want to be selling annual subscriptions for the next two weeks when everybody is still motivated by New Year’s resolutions.

Mobile to extend the patient visit. 2012 will see pilots for apps to link patient to doctor between visits to maximize face-to-face time. I’m not talking about home monitoring or secure messaging, but simply providing mobile access to tailored doctor recommendations from visits as well as pre-visit questionnaires. I’m friends with my pediatrician so it was OK, but I couldn’t help but laugh at him when he handed me a little orange book for each of my kids that I was supposed to hold on to between visits to track growth and age-specific recommendations. I already have an app for this, but I had to find it on my own.

Telehealth growth. For certain issues such as URIs, UTIs, skin issues, and other non-emergent situations, I think more people are going to turn to online tools like Skin Of Mine, DermLink, and Zipnosis. On the enterprise side, I think we’ll see more partnerships between healthcare orgs and employers with vendors like American Well to deliver cheap visits at convenient times.

Carrier offerings. In 2012 we’ll see more carriers offering mobile health apps — not just connected health devices — as part of subscription services. This is what GreatCall is doing, and I think we’ll see AT&T and likely Verizon start offering these services direct to consumers as line items on a monthly bill. I’d pay for several for people on my family plan.

That’s 2012 to me in the area of consumer and mobile health. Look forward to another exciting year and take advantage of opportunities you see around you.

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