There’s been a lot of recent scrutiny on the concept of ”free” as it relates to apps and technology services. It’s fueled by incredibly crazy valuations for companies like Facebook and newly discovered data access strategies for free apps such as Path. And most recently, there is anger as people apparently finally realize that Twitter might try to make money by selling user data to marketers.
In healthcare, we’re seeing more and more funded companies launching free services, apps, and networks. Some examples include Jiff (patient-centered care platform), HealthTap (social Q&A), Doximity (Facebook/LinkedIn for docs), ShareCare (interactive health network and social Q&A), DocBookMD (secure doc communications), TigerText (secure doc communications), PracticeFusion (ad-supported EMR), DrChrono (iPad EMR), MS HealthVault (PHR), Kareo (for basic PM service), and GoodRx (drug price lookups).
Some of these companies, like GoodRx, are obviously going to make money by helping consumers find products and enabling the transactions. I’m good with that model, though my bet is that eventually GoodRx will start doing more than this. Other companies, like ShareCare, will sell data and intelligence to brands. Still others, presumably Doximity, DocBookMD, PracticeFusion, and HealthTap, will make money from a combination of ads and selling data. I don’t think we’re empowering patients or doctors by putting brands and pharma in the middle of their interactions.
Part of my problem is the lack of transparency into how these companies will actually make money. Maybe it will be ads or maybe data mining, but some companies are still growing and haven’t determined how they will do it yet. As a current or potential user of these services, that’s concerning.
I don’t have a fundamental problem with companies selling my data, but please at least tell me what you’re going to sell. Or tell me that I can expect to start seeing ads at some point. Or tell me I’m going to have to start paying at some point. If you don’t know — or aren’t willing to tell me — how you’ll make money and are focused only on growing the network or user base, then I’ll pass.
I think (or hope) we are reaching the end of expecting everything for free, at least outside of healthcare. I’m willing – in fact, I prefer — to pay for apps and technology that I use and value. Dropbox is a great example. I started using the service for free several years ago. It’s evolved into my main storage and I now happily pay for the space that I need. There are a slew of other apps that are now collecting anywhere from $2-$20/month from me.
The one thing all of my paid services have in common is that they are relatively cheap subscription services. I’m more than happy to pay because pricing is transparent and, although my privacy is not assured just because I pay a subscription, I feel a lot better footing some or all of my own bill and not forcing companies to sell access to somebody trying to capitalize on me.
The potential problem for this cheap subscription model in healthcare is that the number of users is likely a lot smaller than a typical consumer service like Dropbox. There is a finite number of doctors and patients that will use these services, and maybe subscription fees would have to be prohibitively high to get investors their desired ROI. One of the major concerns with funded startups, especially in healthcare, is that investors will drive the revenue generation discussions.
Does anybody else worry about the growth of free-to-the-user models in healthcare? Any other good examples?
I’m a Google Mail user. I have a Gmail account and four other Google Apps accounts that I use for e-mail. I’m also a Mac and iPhone user. If you use Apple for phone or computer to access Google Mail like me, then I’d highly recommend trying Sparrow. Sparrow doesn’t just support Google Mail — it also works with iCloud, MobileMe, AOL, Yahoo, or custom IMAP.
I’ve been using Sparrow on my Mac Book Pro for probably a year now and I love it. It creates a unified inbox of all of my accounts so I don’t have to have separate Google Mail windows or tabs open (or switch between accounts within the same window/tab). It also can be customized with three-finger swipes to show as much or as little of your mail system (folders, accounts, messages, previews) as you want to see.
Conversation style reading is slick. It pulls in all of your labels and priorities from Google. You can link Sparrow to Dropbox or CloudApp so larger attachments are not actually e-mailed, but uploaded, with only links sent to download the file. It connects to Facebook too if you want to pull in photos of people. All that for $10. I probably use it more than any other program on my computer.
A few weeks ago Sparrow released an iPhone app that I was excited to try. The price is lower at $2.99, but still slightly more than the free Mail app from Apple that I’ve been using for the past several years.
If you want to Push updates for e-mail so you can respond instantly to all incoming messages, Sparrow for iPhone isn’t for you because it doesn’t do Push. I stopped using Push and all other notifications (badges, lock screen) for e-mail a while ago because I thought it was a) not necessary, b) stressing me out, and c) a drain on my productivity. I think responding the same day should be acceptable and it gives me the very rewarding experience of deleting tons of junk mail at one time with on button. So I don’t have a problem with Sparrow not doing Push, but I imagine others might.
Just like Sparrow for Mac, Sparrow for iPhone is a great way to access e-mail, especially if you have multiple accounts. Some of the features that beat the Apple mail app are:
Custom signatures for each account. I love this.
Swiping between messages in a thread or conversation. Instead of going back to and opening up the other messages in a conversation, you swipe up or down to move between them. Very Clear-esque.
Attachments from within the compose window of a message.
Floating buttons. Sparrow uses one for composing a new message and one for message options when in a message.
Swipe left and right everywhere. Sparrow takes advantage of touch. Swipe one way to access a list of accounts and settings (it keeps slivers of the frames you are swiping between, like the Facebook and Path app do). Swipe another way and open up a list of individual message options (delete, stay, label, etc.) without opening the message.
Swipe (or tap) the top bar to go filter between Inbox, Unread, Starred, or Priority messages. Also, if you dig into a specific folder, just tapping the top bar once takes you back to the Inbox.
For all these reasons, I’m a big fan of Sparrow. It makes good products that I use literally all the time. There are still some quirks with Sparrow for iPhone, like not properly formatting messages to window size all the time, but this isn’t a deal breaker for me.
Telemedicine platform vendor Consult A Doctor introduces a new service called MyHealthPlan 24/7, a cloud-based platform to enable payers to quickly offer members access to virtual consults. The platform provides members access to care remotely via phone, email, mobile app, or video chat. Payers can provide access to their own provider network or can leverage Consult A Doctor’s national network of providers. This new offering sounds very similar to others from Consult A Doctor, but specifically targeting payers as customers.
A pilot in New York is testing the feasibility of using tablets to help educate and consent patients for health information exchange. The tablets will be equipped with apps that provide whatever level of detail the patient desires about exchanging their health data. I’m sometimes floored by how much time, money, and effort goes into consenting patients about health information exchange.
T-Haler from Cambridge Consultants teaches users the proper technique for using an inhaler. The device has sensors and Wi-Fi to assess if the inhaler is being used properly and then displays results on a computer. It’s a neat concept. I had no idea that 75% of peds patients don’t use inhalers correctly. According to data from Cambridge Consultants, the T-Haler can increase the percentage of correct users threefold. Since it’s a connected device, I imagine down the road it will be able to track inhaler usage and issue reminders that add value beyond teaching proper technique.
AirStrip keeps getting good press from HCA’s strategic investment. HCA has a blog post that speculates about the potential for improving care and access with remote monitoring tools.
Good news for startups, especially those in healthcare. Average angel investments (I assume this is by round of investment) grew from $500,000 last year to $700,000 this year. Even better news is that healthcare was the number one industry in terms of total angel dollars invested. Not surprisingly, the most active region was California. I realize California is a state and not a region, but to make it competitive the state was broken out as its own region.
The Johns Hopkins Global mHealth Initiative aims to make sense of all of the noise in the mobile health app area. The Initiative has 49 studies underway. It’s a lofty goal considering the more than 40,000 health apps. To me, what this really means is there will be a small subset of app winners that get validated by groups like the one at Hopkins. Those will rise above above the crowd to help providers and patients.
Patients using a PDA (what is a PDA these days?) to track weight and receiving daily feedback were more likely to be adherent to a weight loss regimen than those using a paper journal, according to a new study. This improved adherence and weight loss was only noticeable for the first 24 months, after which time the study groups were equivalent. It’s interesting that the difference in outcomes between groups dropped off after 24 months, indicating that programs need to be continually updated to continue to engage users.
Is anybody going or speaking at the Health Data Initiative – The Health Datapalooza? Submission are being accepted through March 30. The event is in DC June 5-6. The idea is to bring together a diverse group of stakeholders around innovative applications that use health data.
Aging at home company Independa announces a partnership and integration with Telcare’s connected glucometer. Independa’s CloudCare platform integrates sensor and other data about elderly users, making it available to remote caregivers. Independa has a pretty cool platform that is much more than just remote health monitoring.
In a very similar integration, eldercare company ActiceCare acquires 4G Biometrics. 4G Biometrics has a Bluetooth-enabled glucometer that ActiceCare will integrate into it’s home care platform and emergency response mobile device.
A new report from The Advisory Board Company concludes that accessing virtualized desktops for EMR access over mobile devices, both tablets and smart phones, "invites" an increase in medical errors.
A new HHS contest seeks a Web app that use Tweets to track health trends in real time. I love the this concept. I’ve reported in the past about correlating historical Twitter data with flu outbreaks and using it to track Dengue fever outbreaks. I’m curious to see what people come up with for this. The winner gets $21,000.
A new study finds that the ordering of symptoms on web sites affects the perceived risk of having a specific diagnosis. Users are more likely to believe they have a given condition if general, non-specific symptoms such as fatigue are listed first, and less likely if unusual symptoms such as increased salivation or rash are listed first. If you’re looking to drive patients to your clinic or urgent care or office, launch a site or mobile app that shows vague symptoms at the top and offer help with those symptoms.
A Deloitte survey finds that healthcare is seen as the most promising industry for the growth of mobile technology. Woohoo!
At SXSW a couple of weeks ago, StartupHealth formally announced its program and the 10 "Healthcare Transformers" that make up its inaugural class of startups. We first heard about StartupHealth last summer but had to wait until the formal announcement to learn how it was actually trying to "energize entrepreneurial talent" into healthcare.
StartupHealth took a different approach from the health-specific incubators Rock Health, Healthbox, and Blueprint Health. Whereas the incubators provide seed capital and require 3-5 months of intensive work to build a prototype and presentation for investors, StartupHealth is a three-year program that offers no seed capital. Instead of calling itself an incubator, it is calling itself an Academy, specifically The Academy for Health and Wellness Entrepreneurship. Also, StartupHealth seems to enroll individuals directly and not companies.
If not capital and free workspace, what do you get if you are selected to be a part of StartupHealth? StartupHealth provides ongoing support through access to peers, coaches, mentors, funders, customers, and anything else you need to grow a business in healthcare. The list of mentors and speakers is an impressive one, with representatives from lots of funds, HHS (I think Todd Park’s profile needs to be updated to CTO of the US, not HHS), and the VA. Participants have video conferences monthly, in-person meetings quarterly, and demo days to showcase products to potential investors and customers.
There is no cost to be in StartupHealth, though participants need to fund their own travel to the quarterly in-person meetings. Startups can be located anywhere. Since startups don’t get any capital, they don’t give up any equity.
Even though StartupHealth claims to be stage agnostic, the inaugural class of startups is predominately more later stage than what we’ve seen from the health incubators. It makes sense, considering startups don’t get any capital and StartupHealth is committing to enroll startups for three years. I think some incubator companies haven’t been much more than an idea and online application.
It’s certainly an interesting model and I like the longer timeline a lot more than the 3-5 months for an incubator. I’m curious how much value participants get, seeing as it is all intangible and hard to quantify, especially today. It’s almost like a trade association for health startups to network and gain access to new customers and investors. I’m sure you get a lot more out of the peer connections and mentors than a trade association, but the value is ultimately going to be defined by the ROI for participating, meaning how much revenue does it generate. I think we’ll have to just wait and see.
Initially the press reported that StartupHealth was a partnership between OrganizedWisdom and HHS. I can’t really find anything directly about OrganizedWisdom as a partner on the StartupHealth website today. OrganizedWisdom is a startup that is trying to help physicians create Digital Offices (it sounds a bit like ShareCare and HealthTap.) I’m not really sure what OrganizedWisdom has to do with a startup academy for health, but the leadership of StartupHealth is almost all founders, executives, or investors in OrganizedWisdom. Can anyone shed light on this connection?
In the first class of 10 are:
Sundeep Bhan (medivo). I’ve reported on this company a couple of times — first when it raised $7 million, and then when it acquired WellApps a few weeks ago. Medivo initially was going to improve care by leveraging lab testing data, but with WellApps, I imagine it will extend itself into more of a patient relationship management platform to connect providers and patients using technology outside the care setting. It will probably try to leverage clinical data to optimize care and increase revenue for providers by identifying gaps in care.
Veer Gidwaney (dailyfeats). Another one that I’ve heard of. The company is trying to change behavior — a very lofty goal — through daily feats and accomplishments. It has a payer and a pharmacy partner already. I have no idea how many people use it, but StartupHealth claims it is already profitable.
Samer Hamadeh (zeel). Zeel is like ZocDoc for alternative medicine. Almost all of these services are self-pay, so the company is able to offer transparent pricing at booking and is even doing cool things like bundling services (massages, for example) for discounts. It’s already raised $1.5 million. The "Z" browser icon is eerily similar to ZocDoc’s.
Nadeem Kassam (BASIS). Basis is a trendy-looking watch that tracks your heart rate. It’s like a more advanced, more stylish Fitbit. It takes that data, creates a dashboard, and makes suggestions about behavior. It has badges and games based on Basis data. The company has raised $9 million.
Hesky Kutscher (motherknows). MotherKnows is a specialty PHR for families to store and share medical information about kids. It’s a paid service and you sign a release of information when you register. I think MotherKnows pulls paper charts and enters the data manually to create and update medical records four times per year. It’s a nifty way to avoid integration costs. Once the data is imported to MotherKnows, parents get convenient tools like mobile apps, vaccination records, and emergency medical forms for kids. I like this idea. It’s already raised $1.7 million.
Bill Scott (BrainPaint). BrainPaint makes it possible for different kinds of providers to offer neurofeedback to their patients. From what I can gather, providers pay a subscription and then can administer neurofeedback in the office. BrainPaint captures the data and comes up with therapy recommendations. It’s a very cool way to scale neurofeedback to providers that don’t have the time or inclination to train themselves. The intro video on the provider site is a bit freaky to me, with the deep voice and strange company logo.
Bronwyn Spira (FORCE Therapeutics). Similar to BrainPaint in concept, FORCE is building apps (web and mobile) that physical therapists can use to extend their practice and offer to patients for remote treatment. Once a patient is enrolled and paying for the service, the PT can monitor activity.
David Wong MD, PhD (Direct Dermatology). Another service to extend clinical practice and improve access, Direct Dermatology enables referring physicians to get reports back from dermatologist within 48 hours based on basic clinical data and an image. Founded by two dermatologists, it seems like a worthy competitor to several other services trying to do teladerm. I’m not sure who is paying for the services, but I think revenue can be worked out once its up and running.
Faheem Zaman (Care Dojo). Stealth mode currently.
George Zamanakos, PhD (stealth mode startup). Again, not much info on this one except that it is trying to enable remote access to pregnancy care anywhere in the world.
Walgreens continues its push to stay in front of the pack when it comes to mobile retail pharmacy. The pharmacy giant has released new features for its mobile app, including med reminders and Transfer by Scan. Reminders is an interesting shift for Walgreens from purely a convenience offering — which may actually increase adherence by making refills easier for patients — to more of a patient care support tool. Walgreens makes it easy to add reminders just by taking a photo of the barcode and setting notification preferences. It will be interesting to see if Walgreens allows for export of adherence info to PHRs like MS HealthVault. My guess would be it would release adherence data without the name of the medications. The Transfer by Scan feature is genius in that it makes it incredibly easy for patients to move prescriptions from competitors over to Walgreens. Above is an infographic about its mobile offerings.
Google Circles for healthcare startup Jiff raises $7.5 million in Series A funding. Jiff also named Derek Newel, former CEO of Robert Bosch Healthcare, as CEO. Jiff offers a patient-centered, secure platform and apps to connect patients, caregivers, providers, and potentially payers. JiffPad is an iPad app that allows providers to create custom instructional videos of common topics for patients. I like Jiff’s approach of going direct to consumers who can then invite providers, as well as going direct to providers with JiffPad who can then invite consumers. Jiff literally calls its groups Circles of Health — could that infringe on a Google trademark? I’m just curious, especially on the heels of the similarly-named DocBookMD raising seed money for clinical communications.
I wrote last summer on medical schools issuing iPads to students (Stanford, UC Irvine, Yale, a couple others I can’t remember). Now a study out of the University of Chicago finds that medical residents were more efficient with iPads, translating to more time spent on education. For Apple, it also translates to a new crop of residents becoming used to its products for patient care. A friend of mine that had an iPad during residency can’t live without it now that she is in practice.
ED vendor (and recently discussed T-Sheet maker on Dr. Rick’s posts) T-System signs a partnership with iTriage. The partnership enables T-System’s 1,700 facilities to offer premium listings, wait times, and remote check-in through the iTriage mobile app. As an aside, in case you haven’t been reading some of the EHR Design Talk posts from Dr. Rick, you should check them out on HIStalk.
Google missed the PHR boat. A new report by Frost & Sullivan finds that consumer engagement and subsequent use of PHRs will increase over the next several years with increased awareness, increased use of health IT tools, and better usability and functionality. The report predicts PHR-generated revenue will grow by 5.8% through 2015. While I’m not sure I even agree with the immensely positive tone of the report, doesn’t 5.8% revenue growth make it a pretty weak segment compared to other health IT segments? I know mobile health gets crazy growth predictions, but I thought EHR growth was predicted to be around 10%. What about telehealth and PMs?
So much for apps! A new Geisinger study finds that interactive voice response (IVR) — which I personally despise — plus case management reduces 30-day readmissions by 44% over case management without IVR. According to the release, this was a two-year, large-scale program. Those are pretty impressive numbers. The IVR protocol is the Geisinger Monitoring Program (GMP) and the technology is from AMC Health.
Based on an environmental scan of mobile health, mobile consulting and research firm Float Mobile Learning concluded that 40% of docs thinks mobile health can reduce office visits. There are lots of other findings as well and they are nicely laid out in the above infographic. Unfortunately, you have to buy the report to see the sources.
Secure clinical communications platform vendor PerfectServe keeps signing new customers. The new ones over the last couple weeks are St. Jude Medical Center (CA, not TN) and WellStar Health System (GA).
Highmark, a BCBS licensee with 4.8 million members, launches mobile sites for members, along with motivational health text messaging. Of the text message examples in the press release, this is my favorite: “Whatever the mind can conceive and believe, it can achieve.” Pictured above is the mobile app from Highmark, which I think it already had released.
Insurer Fidelity launches a new mobile app for iOS and Android. The app provides access to benefit info, provider info, and a retail pharmacy finder.
UnitedHealthcare also updates (I don’t think this was a launch) its mobile Health4Me app. The app now allows for benefit lookups, downloading insurance cards, calling a nurse 24/7 (is that extra?), and callback button so member can have a United rep call them to answer questions about benefits.
For the first time in the history of the company (at least according to TechCrunch), Nike opens up an API to developers. It’s a beta version of NikeFuel API and seems to be somehow music focused, but still, it’s a start. The Nike FuelBand is a wristband that tracks activity and syncs to a mobile app wirelessly (or to a computer via USB). Other fitness trackers, like RunKeeper, have already opened up APIs, but Nike certainly has more brand power.
In related news for both Nike and APIs, collaborate journal app Path (which I love) has integrated Nike+ and Fuelband into the app. I don’t use Nike+ or Fuelband, but I imagine you configure the integration on the Nike end, as I can’t find anywhere in Path to do it and the posts from Nike should be automated based on activity.
For those interested in international health, the CDC and The Kenya Ministry of Health presented data recently finding that collection of disease surveillance data using smart phones was faster, cheaper, and more accurate than paper-based data collection. What surprised me most was that the initial setup costs for smart phone collection were only about 30% higher than paper.
