A couple months back, Zeo was kind enough to send me one of its sleep monitors to try. I’ve been using it off and on for about two months now so I think I’ve finally settled on my opinion of it.

For those that haven’t heard of Zeo, it is a sleep tracking and management tool. It has lots of additional features to capture sleep hygiene (caffeine intake, alcohol intake, etc.) as well as subjective mood and impression, both with sleep as well as through the day at at waking.

Tracking is done with a headband-mounted sensor. I wouldn’t describe it as comfortable, but it didn’t seem to affect my ability to fall and stay asleep, though it did make my wife laugh at me from time to time. The company offers two ways to interface with the headband – a bedside monitor (like a sleep-tracking alarm clock) and a mobile app. The bedside monitor is $149 and the mobile option is $99. Both include the headband and sensor.) I used the mobile (iPhone) version.

For the record, I thought before trying Zeo — and still think — that good, quality sleep is not one my strongest attributes. I stay up too late working and have little kids that seem to take turns waking up each night, with very few nights where they take the night off. To make matters worse, my wife is a medical resident, so typically gets up between 5 and 6 AM.

I was curious to quantify my sleep with what Zeo calls ZQ, or a score it generates based on the different factors of sleep. The factors are total sleep, deep sleep, REM sleep, time in wake, and times woken. According to Zeo, my ZQ is about 80, or pretty much average for my age compared to other Zeo users. This is probably not a perfect reflection of the population, as I think a certain type of person self-selects for the Zeo and that person is likely type A, meaning higher strung, higher stress, and less sleep.

My big gripe with the ZQ score is that it feels too inflated to me. Come to think of it, I’m not actually sure what the total possible ZQ is. I guess it doesn’t really matter but for me, anytime scores for anything hover from 70-90, I instantly assume it is a 100-point scale and then start assigning pass/fail to the scores.

I personally like when apps take advantage of the sensors to adjust display automatically for landscape or portrait.

In terms of the weighting of factors that go into the ZQ score, I’d like to see more penalty points for times woken and time awake. As an example, my average total sleep was 6:50 and this is worth 58 ZQ points. Add in points for REM and deep sleep and you have a decently high score. The detractors seem to be less heavily weighted. Waking up three times through the night only takes away 2 ZQ points and being awake 15 minutes only takes away 1 ZQ point. My subjective feeling is that these detractors affect my sleep quality and should be more heavily weighted. I’m not a sleep expert, but that’s my gut.

In addition to the automatic monitoring and sleep scoring, or ZQ, Zeo also collects subjective information, what it calls your sleep journal (pictured above) that Zeo can then use to provide virtual sleep coaching. What is shocking to me is that you have to go to the website to enter this information, all of which could be collected very quickly over mobile using slider bar-based questions. Being able to see your sleep score in the app is great, but why not allow mobile data entry as well? Because it wasn’t enterable in the app, I didn’t really use the journal much, which I think limited the power of Zeo.

Would I recommend it to a friend? Yes, if you like to quantify yourself or you feel like sleep is something that you want to improve. The key is that you need to be motivated, especially to use the web-based sleep journal, or it’s not worth it. I keep trying tools like this, wanting to collect info about myself, but then stop using them. I think the reason I can’t get hooked is my lack of motivation to collect data just to get back info that I already know (eat better, drink less caffeine and alcohol, exercise more, etc.) Maybe it is in part because the tools are not intuitive or fast enough at entering data? Maybe I’m just not into quantifying myself, as much as a I think I want to be.

I’d love to hear from others that have used this or other sleep monitors like the one from Fitbit or Lark or several others.

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

drchrono raises $2.8 million, which is on top of the $1.3 million or so it raised last summer. With a certified EMR, practice management system, and patient-facing registration iPad app (OnPatient), drchrono will be looking to scale sales and likely start integrating value-add apps, ideally creating a clinical ecosystem around its primary mobile offerings. The article says drchrono has 15,000 registered providers, a number that I’m guessing is higher than the total number of active users but still very good.

Glooko raises $3.5 million to grow its glucose tracking and connectivity hardware. Glooko offers a mobile (iOS-only for now) glucose logbook in combination with a $40 cable that automatically loads results from major glucometers. This is a different approach than the connected glucometers like Telcare. 

In related news, PositiveID certifies its iglucose system on AT&T’s network. iglucose takes readings from standard glucometers, much like Glooko, but instead of a cable it sends them wirelessly to PositiveID for cloud-based storage, analysis, and distribution. It’s similar to MedApps in that way. It’s great to see the competition heat up.

MacPractice, the Apple-based EMR vendor, is testing a new iPad patient registration app called Clipboard. For an Apple platform developer, the company isn’t terribly creative about names.

Clinical communications company EXTENSION hires Tom Berger, RN, BSN, MS as chief nursing officer. Hiring a CNO seems like a positive step and an indication of growth for EXTENSION.

The VA is working with vendors DSHI and Document Storage Systems (DSS) to build an ED triage tablet app called ER Mobile. DSS will provide two-way connectivity to VA HIS systems and DSHI will build the app and algorithms to streamline triage decisions. DSHI has been working with the VA by providing a triage nurse call center, so presumably the mobile app will become a scalable, mobile version of the call center.

A new Aetna program is testing the effectiveness of having dentists use iPads as a platform for a clinical decision support system (CDSS) for providing tailored smoking cessation advice to patients. According to one of the coordinators, "We anticipate that devices like the iPad can be used to break down barriers between clinicians and their patients.” Maybe I’m a little old fashioned, but couldn’t they cheaply test this by having dentists ask patients about smoking and then direct them to additional resources if interested, before buying tablets? Or maybe just make an app to reach the 3/4 of dentists (probably higher in NY) who have smart phones? I’m hoping these cheaper alternatives have already been done and the iPad is just the next stage.

Here are 20 examples of social media strategies used by health systems. Not surprisingly, all but one of the systems are household names for those in healthcare. The article highlights lots of different examples of how to use social media and some of the channels — mostly Twitter and Facebook — that are being used.

Know some students that want to try to build a health app? Check out the Second Annual Go Viral to Improve Health Challenge. Teams must use data from the HHS Health Indicators Warehouse to address a health problem in their collegiate community.

Palomar Pomerado Health (CA) is building an almost-finished mobile app for EMR access. The app was developed in house with Cerner’s help in accessing the records. I’m curious how this works for Palomar physicians, but also how portable it is to other Cerner sites.

The ONC launches a Privacy & Security Mobile Device project to develop guidelines and best practices for securing mobile health apps and services.

More mobile app challenges from the ONC have also been announced, and these don’t require you to be a student to compete. The ONC is looking for apps that will help patients with disabilities access medical records and apps to help with post-discharge care coordination.

In an effort to foster collaboration across organizations and sectors, the mHealth Alliance announces a new membership program. I imagine this is an attempt to virtually bring together the various groups that attend the mHealth Summit, ideally making collaboration ongoing. Membership is free.

Kony signs to be the mobile platform for Intermountain Health, the most geographically desirable health system out there. That’s a big sale for Kony, as Intermountain is a good-sized system and also well respected in terms of health IT.

AirStrip signs a deal with Sunrise Health System (NV) to offer AirStrip Cardiology to providers affiliated with Sunrise’s four facilities. Now cardiologists can monitor patients from the casino floors.

Microsoft plans to launch a Windows 8 tablet later this year. This article lays out why it is likely to late to catch or even really affect iPad sales. The key point is that the iPad defines tablets, so beating it will take a significantly better product and marketing, a combination that will be impossible to muster.

This is BlackBerry’s last chance for a comeback with its new CEO. The article highlights several great historical examples of massively successful companies, like RIM, that were overtaken. Two of the examples — Palm and Sony, specifically in the area of portable music players — were overtaken by Apple.

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

I’ve been researching mobile technology use and strategy for pharmaceutical companies. I find the whole drug discovery, distribution, and marketing industry to be fascinating because of the sheer size and tightrope walking that needs to be done around regulation and brand marketing to consumers.

I also think pharma has a lot to overcome when it comes to perceptions, especially with the younger generation of providers that has been taught that drug companies are the evil empire. I don’t think any issues are that black and white, but it is certainly the perception that most of my friends and I gained from medical school.

I met a couple of people from Merck recently at a conference. When the subject of pharma’s rep in medical training came up, both told me that Merck has always had a commitment to medical education, dating back to the original Merck Manual from the 1800s. It was funny because I obviously knew the Merck Manual, but hadn’t even made the association that it could be the mega-drug company. I was told by the Merck folks that the Manual is kept separate from the rest of Merck so as not to tarnish its image.

Whether you like it or not, pharma is a major player in healthcare. Like payers, pharma has a lot to gain through technology-enabled services and also has some resources to invest in the area. What I’ve found is that pharma seems to dabbling in different types of mobile health services, but no major successes or standards exist. The big areas of mobile that seem to fit best with pharma are clinical trials, adherence, and education on the consumer side and med reference and access on the provider side.

In terms of consumers, clinical trials are a big area where mobile can be utilized. Mobile enables pharma to do better recruitment and pre-screening, reducing the cost and burden of CROs. Once a patients is enrolled, mobile also enables collection of mobile patient reported outcomes (mPRO) and better connectivity to study coordinators, ideally leading to higher engagement levels and higher retention rates.

A good example of the potential of mobile in clinical trials was the recently initiated Participatory Patient-Centered (PPC) trial in which Pfizer leveraged Exco InTouch as a mobile platform to recruit, enroll, and retain study subjects, regardless of location and without dedicated clinical sites. With clinical trials recruitment, especially of minority participants, so expensive and time consuming, leveraging mobile to breakdown geographic boundaries while maintaining virtual connectivity is something we should be seeing a lot more of in the future.

Medication adherence is another area with lots of different people are going after it. In addition to the reduced cost associated with better adherence rates, pharma companies have a lot to gain from increased utilization (more frequent refills) associated with higher adherence rates. From connected devices like Vitality’s Glowcaps and MedMinder’s Maya (connected pillbox) to ingestion monitors like Proteus Helios, companies and investors are betting big on automated monitoring of medication adherence.

I think some of these (like Proteus) are probably a bit much, but I’d love to see something like a Striiv for medication adherence — something that combines automated collection of adherence data (like GlowCaps) with an always-on indicator of adherence status. I’m not sure if it will work for adherence, as I think the cause of adherence is multi-factorial, but I’d love to see somebody try.

On the provider side for pharma, there are the obvious apps that can act as dynamic and focused product inserts and dosing guides. I think to make this higher value for providers, it would be great to add in some functionality around samples and access programs. Maybe providers could be able to automatically order more samples of medications, providing pharma with good insights on sample use while also helping providers have enough samples on hand for those patients that need them.

Additionally, helping providers with the process of enrolling, or initiating enrollment, in patient access programs benefits both the provider and the patient while helping to meet the mission of access programs to deliver medications to those that need them, but otherwise might not have the means to acquire them.

As I’m writing this, I’m realizing lots of these services, which have obvious financial and image benefits for pharma, really do have significant benefit to both providers and patients, not to mention retail pharmacies and connected family members. It even makes me wonder if pharma couldn’t extend some of these services, if done correctly, to be more than complementary to existing products.

Could pharma start earning real revenue as a technology and mobile services provider? I’ve heard people at both insurance companies and pharma companies say their companies want to become technology companies. For pharma companies, I can’t really buy it. What do you think?

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

If you’re interested the potential of mobile from the pharmaceutical industry perspective, sign up for a free webinar I’m co-presenting next week with Aaron Kaufman, general manager for Kony Healthcare and Life Sciences.

Apple releases incredible quarterly sales numbers. Putting itself in the normally exclusive domain of oil companies, Apple made $13 billion in profit on $46 billion in revenue last quarter. The math comes out to 378,000 iPhones and 157,000 iPads sold every day, respectively. Apparently Apple is now worth more than Greece.

Wireless glucose monitor company Telcare signs a partnership agreement with health plan management company MagnaCare. It’s not totally clear in the release, but I’m guessing that MagnaCare will offer this as an additional service to its clients, taking a piece of the transaction. What was interesting was the quote from MagnaCare that talked about the how Telcare’s product enables patients to connect with loved ones, not providers. In many ways, it’s a better group to lean on than providers, especially in the short term.

Fitbit, which announced a partnership with UnitedHealth last week and unveiled its new wireless scale at CES, closes a Series C funding round worth $12 million. I imagine with this funding, Fitbit will be looking to scale sales both direct to consumers as well as through partnerships like the one with United. I’d also expect to see more testing of Fitbit as a part of an employer wellness program. I think we’ll also see a lot more gamification of the activity tracking that Fitbit does, which would tie well to partnerships with both payers and employers.

Kaiser releases an Android app and mobile-optimized site for patients. The app and site provide access to medical records, messages, location listings, test results, and appointment scheduling. It looks a lot like a mobile version of the web portal, which I guess it is, but it makes me wonder why it took so long to build for mobile. I would have used it when I was a Kaiser member. Now I can’t even get my crappy insurer to send my paper cards to the right address. I guess I’m insured, so I shouldn’t complain.

A new Pew Internet survey finds that tablet ownership in the US doubled from 10% to 19% from mid-December to mid-January. That trend definitely contributed to Apple’s monster numbers.

With Quantified Self and self-monitoring predicted to be a big trend in 2012, this is an interview with a guy struggling to get access to his heart rhythm data recorded by his implanted defibrillator. It brings up some interesting issues he encountered. It also ties nicely to the push to provide consumers access to all of their medical data. Personally, I say give patients the data they want — just don’t expect it to fix our health and lifestyle problems.

Sharecare announces it has raised $14 million and acquired physician directory The Little Blue Book. (TLBB). Sharecare is similar to HealthTap, which recently raised $11.5 million, in that it is a platform where healthcare consumers can go to ask questions of physicians. With the acquisition on TLBB, Sharecare will be trying to be the place consumers come not only to ask questions but also to find providers. It’s taking an interesting approach as it is planning a premium subscription model for providers, but will also be making money from real-time analytics sold to drug companies and other brands in health an wellness. Sharecare was co-founded by Dr. Oz of TV fame.

AT&T adds two new offerings that it hopes will help with mobile adoption in healthcare. The first, AT&T Managed Tablets, is a device management offering that apparently works on both enterprise-owned devices as well as employee-owned personal devices. The second, AT&T Global Smart Messaging Suite for Healthcare, is a partnership with Soprano that enables encrypted messaging from providers to patients, as long as both have the app from AT&T. The app apparently works on any smart phone on any network. It would be nice if it worked on non-smart phones.

This post is very Quantified Self (I’m not sure why I started capitalizing that) heavy, so I’m sorry, but here’s one more. The video above is for the new Nike+ FuelBand. It’s a wristband, much like the Jawbone UP, that tracks daily activities. Each activity is assigned a point value. The points are called NikeFuel and you have daily goals. The wristband’s lighted scale shows daily progress towards your goal and tells you things like steps taken and calories burned. It also syncs with iPhone and iPad apps (no Android until spring.)Retailing at $150 won’t help with competition priced at $99, but Nike does have a great fitness brand.

A new corporate survey (non-healthcare specific) finds that iOS devices are the most common platform connected to "corporate environments." 30% of devices were iOS, followed by BlackBerry and then Android. Android was considered by IT professionals to be the least-secure platform. I’m curious about specific data from hospitals and healthcare organizations.

A new study of women aged 50 years or older finds that fewer of them accessed health information posted online than reviewed identical print health information. The content was related to colon cancer and screening recommendations. I think the main conclusion to be drawn is that taking paper material and digitizing it into non-interactive material does not get you very far when it comes to health education and prevention.

An American Medical News story says payers are moving into the mobile health space to offer more health-related tools, not just mobile member cards. The examples given are Aetna (iTriage), UntitedHealth (CareSpeak, Fitbit, Lose it!), and WellPoint (Verizon).

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

I’m an iPhone user. I like it a lot, although I don’t line up at stores for new product releases and I don’t like to spend time in the stores unless I’m with my kids.

With that out of the way, one of the new features in iOS 5 that I was particular excited about last fall was the new Notification Center. I was surprised it took so long to make the lock screen useful and to put a little user control in the way that notifications (e-mails, SMS, etc.) are displayed.

I like having notifications appear briefly at the top of my screen without requiring any user action. I also like the ability to adjust notification settings on an app-by-app basis. I still love the Notification Center after several months of use, at least compared to life prior to it. But I’ve recently discovered inconsistencies with some of my apps and notifications.

I actually only have a few apps that show up in my lock screen or pop up a notification when a new message or alert is triggered. Several (mail, calendar, and SMS) are Apple apps and seem to work fine. Others (for social stuff, productivity, or tasks) are non-Apple and have started to not work as set.

One app (Path), which I wrote about recently and love, does not work at all for notifications any more. I’ve turned notifications on and off, changed them around, uninstalled and reinstalled the app, and made sure I’m on the most recent version of iOS. Nothing seems to fix the problem.

(Before anybody suggests that this is user error, which I’m sure it could be, let me say that it doesn’t really matter. My point is that if I can’t fix it, then it is either flawed in deliver of notifications or in the experience of setting notifications. Either is a problem.)

This specific case with Path is not exactly life or death. it’s actually probably a positive for me because it’s not distracting. It did get me thinking of apps that are life and death, or at least billed as tools to help people manage their health. I’m thinking of things like medication reminders, ovulation calendars (life or death for some), appointment reminders, or any other health reminders. 

A reminder app or a reminder service should never be counted on 100%, but in reality, once people start using things like this, they become reliant on them. Once the apps stop working and people start missing appointments or doses or ovulation windows, there is a problem.

This isn’t unique to the iOS notification center. The same problem could happen on Android or one of the 14 BlackBerry phones still in use today or even with iMessage (iMessage has it’s own problems) or SMS-based notifications, though I imagine to a much smaller degree with SMS. It’s a problem with being reliant on any platform or wireless network when it comes to health.

If an FDA-approved diabetes app or connected glucometer takes glucose readings, uploads them, analyzes them, and then sends back an insulin or dietary recommendation that never arrives, whose fault is it? The platform, the app, the carrier, the provider that recommended it?

As I was thinking about this, it reminded me of an interview I read with MedApps CEO Kent Dicks several years back, in which he said MedApps had decided to develop a dedicated connected health device after trying to develop tools for mobile phone because "using a mobile phone platform helped us realize that we didn’t want to be at the whim of mobile phone makers." A platform maker can at any time change the way that notifications work as Apple did, how Bluetooth functions, or whatever a health app might depend on.

This issue — dedicated device vs. app — is a broader post. I’ll be reaching out to MedApps and a couple of other vendors with questions about dedicated devices vs. apps. For now, I’m curious if readers — especially providers or health systems looking at apps and services for patients — think about being dependent on platform and carrier performance for health issues?

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