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June 30 2011

ePayments Week: Growing demand for connected health services

Here's what caught my attention in the payment space this week.

Report: Connected health devices poised to take off

SparkPeople screenDo you monitor your health activity — your calories, your exercise, your sleep — on your smartphone? If so, you're an early adopter in a movement that appears poised to become much larger, according to a recent study and white paper from IBM, "The future of connected health devices." The report is based on an online survey of 1,300 users of home healthcare electronics, 80% of whom are chronically ill patients and 20% of whom are their caregivers. It starts with the observation that there are two pools of users already deeply involved with connected devices: those with health conditions that require monitoring (the "Chronically Monitored") and another group of relatively healthy geeks who are interested in using technology to keep themselves healthy longer (the "Motivated Healthy"). The latter group includes the Quantified Self movement, which Gary Wolf discussed recently on Radar. It's made up mostly of tech-savvy folks who are pushing the boundaries in monitoring and analyzing everything from their body chemistry to emotions and clothing options to improve their daily lives.

In between these groups lies a larger group of potential consumers that the report calls "Information Seekers": "... a willing — but currently underserved — market for health device makers." This is a broad group with widely varying needs, including weight loss, breaking destructive addictions and other habits, monitoring high blood pressure, migraines, mood swings, or ADHD. The market to serve them, the report continues, is poised to grow quickly given the convergence of a few important trends, including the improvement (and cost reduction) in sensors that can automatically monitor and transmit data from the body, the rise of smartphones and better connectivity, and better tools for analysis. Of course, the effects on any individual are just part of the story: as with any set of big data, the bigger story may arise out of the analyses that will be performed on the aggregate data from millions of these devices, connected and collecting data implicitly and explicitly.

The report's authors expect these systems to create a new revenue stream for service providers — not just the cost of devices, which may be paid for by insurers in some cases and out-of-pocket by consumers in others, but also for monthly fees paid for premium services. Only 5% of the people IBM surveyed pay monthly fees for these kinds of services today, but 35% said they expected to be doing so within two years. Seeing the data will be valuable, but an intelligent, synthesized, human response will probably be worth even more. Sure, it's great when my Spark People app delivers an automated message telling me enthusiastically that I've burned enough calories for the day. But I might pay real money for the added service of a human adviser who could coach me through the day and keep my diet on track.

Mobile research firm research2guidance conducted a survey on this topic last fall, and the results are summarized on Slideshare. Their report found that, among other things, app stores could lose their dominance as the main distribution channel for mHealth apps, with hospitals, physicians, and health websites taking over that responsibility. It's easy to imagine that health consumers may be more likely to trust a health-monitoring app that's been sanctioned by their care providers — though it's difficult to imagine a mechanism for delivery that would be easier than the app stores where consumers are used to getting their apps. Still, hospitals and insurers may determine it's worth investing in a different distribution channel, particularly if they feel that the app store owners are likely to take an unwarranted cut in their revenues.

Android Open, being held October 9-11 in San Francisco, is a big-tent meeting ground for app and game developers, carriers, chip manufacturers, content creators, OEMs, researchers, entrepreneurs, VCs, and business leaders.

Save 20% on registration with the code AN11RAD

Consumer Watchdog asks FTC to check out Facebook Credits

Facebook CreditsJust days before Facebook's new terms requiring game developers on the world's most popular social network to offer virtual goods only in Facebook credits, Consumer Watchdog has filed an anti-trust complaint with the Federal Trade Commission (FTC). The complaint notes that the new rules coming into force on July 1 require game developers to sell all their virtual goods on Facebook using only Facebook Credits (not credit cards, PayPal or any other method), refrain from offering those digital goods at lower prices elsewhere, and give Facebook a 30% cut on earnings. While one could argue that it's Facebook's sandbox and if game developers want to play in it they must play by the Zuckerberg rules, the more damning charge is that Facebook has made a joint venture agreement with Zynga, the biggest game developer on Facebook, which largely exempts it from these burdensome rules. "The agreement between Facebook and Zynga," the complaint reads, "if published reports are correct, would therefore constitute a conspiracy between competitors and further extend Facebook's already overwhelming monopoly power."

While a blog post on Consumer Watchdog's site appears to be exaggerating the significance of the new rules, saying they "could well put the Internet powerhouse on the road to dominance of all online commercial transactions," the complaint raises an interesting question about whether Facebook's dominance on the web will translate into dominance of online commerce. Certainly, the financial transactions among its members and developers must fall far behind those of web-native leaders like Amazon, PayPal, and the iTunes store, not to mention the much larger bundles processed by MasterCard and Visa. But as Venessa Miemis, the author of The Future of Facebook project pointed out in a recent column on Forbes, Facebook's commercial influence may extend far beyond dollars transacted as it increasingly taps its knowledge of users' social graphs not only to facilitate Facebook Credits transactions, but perhaps transactions based on more ethereal concepts like trust and time.

For now at least, Consumer Watchdog's complaint looks at more familiar questions: Is Facebook abusing its monopoly on social media to coerce developers to operate under onerous conditions, and are they giving unfair treatment to one partner in particular? As Stephen Shankland points out on CNET, Consumer Watchdog has been a critic of Google, thanks in part to a grant to monitor Google's activity, but with this charge it expands its scope, taking on another online giant.

Square collects $100 million in one swipe

How often do you get to tweet about a $100 million infusion to your company? I guess if you're Jack Dorsey, it may not qualify as a once-in-a-lifetime experience, but it's still worth noting that's more than $700,000 per character in Dorsey's tweet reporting that Square had landed another $100 million in funding.

Thrilled to announce that Mary Meeker of @KPCB is joining @Square's board! And we raised $100 million. Putting more people into business.less than a minute ago via Twitter for iPad Favorite Retweet Reply

Just as surprising was the new valuation reported: more than $1 billion. Six months ago, it was $240 million. What changed? GigaOm noted the increasingly high-powered board (that now includes Mary Meeker, Vinod Khosla, and Larry Summers), "charismatic founder, [and] seasoned operator Keith Rabois" as key reasons why the company's so hot.

I think equally important were the two new product offers that Square has introduced this year. Square Register expands on the original handheld app, but its additional capabilities are aimed at tablet users (giving them the ability to see quick analytics on their businesses) seem to raise its capabilities from the swap meet and farmer's market to something that could be a serious retail tool. Perhaps more importantly, Square Card Case shifts the focus from the merchant to the consumer, creating a product that consumers can use — specifically, setting up tabs that let them pay quickly at their favorite places. If it takes off (and we're yet to see if merchants enable it in great numbers) it introduces a whole new, larger class of users to Square, along with all the data and marketing possibilities inherent in those relationships.

Got news?

News tips and suggestions are always welcome, so please send them along.

If you're interested in learning more about the payment development space, check out PayPal X DevZone, a collaboration between O'Reilly and PayPal.


May 12 2011

Parsing a new Pew report: 3 ways the Internet is shaping healthcare

On balance, people report being helped by the health information they find online, not harmed. While social networking sites are not a significant source of health information for online users, they do provide a source of encouragement and offer community for caregivers and patients. One quarter of online users have looked at drug reviews online, with some 38% of caregivers doing so. One quarter of online users have watched a video about health. And a new kind of digital divide is growing between users who have access to mobile broadband and those who do not.

Those are just a few of the insights from a new survey on the social life of health information from the Pew Internet and Life Project. The results shed new light on how the online world is using the Internet to gather and share health data.

The Internet has disrupted how, where, when and what information we can gather and share about ourselves, one another and the conditions that we suffer from. Following are three key trends that reflect how the Internet is changing healthcare.

Health IT at OSCON 2011 — The conjunction of open source and open data with health technology promises to improve creaking infrastructure and give greater control and engagement for patients. These topics will be explored in the healthcare track at OSCON (July 25-29 in Portland, Ore.)

Save 20% on registration with the code OS11RAD

The quantified self

As Edd Dumbill observed here at Radar last year, network-connected sensors that track your fitness can increasingly be seen on city streets, gyms and wrists. Gary Wolfe has likened the growth of the quantified self to the evolution of personal computing in the 1980s.

The trend toward a data-driven life that Wolfe describes as the quantified self is no longer the domain of elite athletes or math geeks. Fully one quarter of online users are tracking their health data online, according to Pew's survey. "The Quantified Self and PatientsLikeMe are the cutting-edge of that trend, but our study shows that it may be a broader movement than previously thought," said Susannah Fox, Associate Director of Digital Strategy for the Pew Internet Project.

Carol Torgan, a health science strategist cited in the report, has shared further analysis of self-tracking. "Self-tracking is extremely widespread," writes Torgan. "In addition to all the organized tracking communities, there’s a growing number of organic self-tracking communities. For examples, take a look at the diabetes made visible community on Flickr, or the more than 20,000 videos on YouTube tagged weight loss journey."

Below, Gary Wolf delivers a TED Talk on the quantified self:

Participatory medicine

Another trend that jumps out from this report is the rise of e-patients, where peer-to-peer healthcare complements the traditional doctor-to-patient relationship. While health professionals were the number one source of health information cited in this survey, the Internet is a significant source for 80% of online users.

We're entering an age of participatory medicine, where patients can learn more about their doctors, treatments, drugs and the experiences of others suffering from their conditions than ever before. Twenty-five percent of American adults have read the comments of another patients online. Twenty-three percent of Internet users that are living with at least one of five of the chronic conditions named in the survey have searched online for someone that shared their condition.

Online forums where people voluntarily share data about symptoms, environmental conditions, sources of infection, mechanics of injury or other variables continue to grow, and there are now dozens of other social media health websites to explore. As Claire Cain Miller wrote in the New York Times last year, online social networks bridge gaps for the chronically ill. And as Stephanie Clifford wrote in 2009, online communities can provide support for elderly patients who are isolated by geography.

"These networks provide sense of distributed community, where you can find others who suffer from your condition and support for treatment," said Fox. "PatientsLikeMe is example of that."

PatientsLikeMe, in fact, recently published the results of a patient-driven clinical trial in Nature, the first such study in a major journal. Fox shared further thoughts on mapping the frontier of healthcare at

The online conversation about health is being driven forward by two forces:  1) the availability of social tools and 2) the motivation, especially among people living with chronic conditions, to connect with each other. Pew Internet has identified two important trends in our data. One is what we call the "mobile difference" — hand someone a smartphone and they become more social online, more likely to share, more likely to contribute, not just consume information.

The other is what we call the "diagnosis difference" — holding all other demographic characteristics constant we find that having a chronic disease significantly increases an Internet user's likelihood to say they both contribute and consume user-generated content related to health. They are learning from each other, not just from institutions.

This trend emphasizes the link between health literacy, media literacy and digital literacy. When citizens search for information about health online, they're presented with a dizzying array of choices, including targeted advertising, sponsored blog posts, advertorials and online forums. One area where this will be particularly challenging is in pharmaceutical information. More open data about pharmaceuticals released by open government projects like Pillbox inject trustworthy information into the Internet ecosystem, as users searching for aspirin will find. However, the United States Food and Drug Administration has still not issued any official guidance for the use of social media by the industry. Given the growing percentage of caregivers and those suffering from chronic disease that are searching for information about drugs, such guidance may be overdue.

As the role of the Internet as a platform for collective action grows, its ability to connect fellow travelers will become increasingly important. As Clay Shirky observed in January, "we have historically overestimated the value of access to information and underestimated the value of access to one another."

A new digital divide

Internet access is information access. Citizens who are not online are by definition on the other side of the digital divide. In the 21st century, however, a data-driven life is also profoundly mobile.

According to the Pew Internet survey, 18% of wireless Internet users are tracking their own healthcare data, twice as many as those who do not have a wireless-enabled device. Open health data can spur better decisions for mobile users if they have access to a smartphone or tablet and the Internet. Without it, not so much.

"The difference that we see is in the mobile space," said Fox. "It's a younger demographic, and connected to that it's more diverse. When you look at who is accessing the Internet on their smartphone and has apps, you're likely to see a more diverse population. That's the promise of mobile health: that it will reach different audiences. And yet, these are not the audiences that are in the most need of health information. If you look at the numbers of people with disability or chronic disease, mobile is not closing that gap."

Fox spoke about the promise of mobile and the new digital divide at Transform 2010:

It's no secret that the ability to pay for data plans and smartphones is correlated with socioeconomic class status. Access to hardware may change as inexpensive Android devices continue to enter the market. According to ComScore, as of January 2011, 65.8 million Americans owned a smartphone, out of a total of 234 million users ages 13 and older. If 20% of those users switch over the course of this year, smartphone penetration will be just shy of 50%. That doesn't address the needs of those without access to broadband Internet. Simply having a smartphone and connection, however, doesn't result in the information literacy and health literacy needed to apply these tools.

That's a lot to ask of citizens, who will need well-designed healthcare apps to help them make sense of the data deluge. Given spiraling healthcare costs, however, the future of healthcare looks like it's in the palms of our hands.


November 12 2010

Open health data: Spurring better decisions and new businesses

itriage-multiphones.jpgAs Network World reported this week, iPhone apps that could save your life have come to an App Store near you.

"A growing number of developers are tapping into a treasure trove of U.S. government healthcare data and coming up with innovative iPhone apps that help consumers make better medical decisions," wrote Carolyn Duffy Marsan. She was reporting on a trend that started at the National Institute of Medicine in May when the U.S. Department of Health and Human Services launched its Community Health Data Initiative.

Network World covered Medwatcher, Asthmapolis, and iTriage -- the latter two also showed up here on Radar back in May. iTriage, a free app for iPhones, Android, Blackberry and other web-enabled devices, has enjoyed continued growth over the summer and fall, with nearly 1 million users to date, and a new iPad app.

Peter Hudson, one of the physicians who founded Healthagen, the company that created iTriage, spoke with me at this week's mHealth Summit. In the following video, Hudson discusses his app and the kinds of data that would help him and other mobile health entrepreneurs grow their businesses.

iTriage is free and genuinely useful. It also looks like a viable business, as more healthcare providers pay to add their data to its database. If that vision for open government at HHS continues to gain traction, the innovation released in the private sector could meet or exceed the billions of dollars unlocked by GPS and NOAA data. To see the first steps in that direction, look no further than the healthcare apps that have already gone online. When goes live later this year, entrepreneurs will have even more indicators to build into their applications.


June 11 2010

Here come the healthcare apps

"People in communities can improve their healthcare if they just have the information to do it," said Kathleen Sebelius, Secretary of Health and Human Services (HHS), at the Community Health Data Forum in D.C. last week.

The forum took place almost exactly a decade after President Clinton announced he would unscramble global positioning system data (GPS) for civilian use. Now, the potential for private enterprise to provision services using open data from the Community Health Data Initiative could match the billions of dollars made when the government unlocked GPS and NOAA weather data. Last week, in fact, I wrote about how HHS is making community health information as useful as weather data.

Sebelius delivered her remarks to both an online audience at and the collection of government officials, technologists and researchers gathered at the Institute of Medicine at the National Academy of Science. Her speech is embedded below.

After the jump, learn more about the healthcare apps that were featured at the forum's showcase.

Apps that use open health data

Health IT at OSCON 2010I covered the healthcare apps developed by National Association of Counties (NACO), GE, Bing, Healthways and Google last week.

Glimpses of a nascent ecosystem of innovation around community health data were on further display in the apps at the Community Health Data Forum. The selections included games, visualizations, web services, crowdsourcing platforms, and smartphone software.

Walking around the expo, I learned about the following apps:

  •, an interactive database that provides state- and country-level health data.
  •, an in-development iPhone app that engages healthcare practitioners about drug safety alerts
  •, an interactive website for describing the overall health of a community
  •, a web-based mapping platform that mashes up community and health resource data. It includes a HIPAA-compliant means for uploading patient information.

The following are six different apps / web services that also caught my eye at the forum.

Finding connections with Palantir

analyzetheus.jpgPalantir wowed the crowd in the main hall with its tech demonstration, which can be viewed in the video embedded above. Alex Fishman, an engineer, also announced at the forum that Palantir had integrated community health data into Analyze The US, a web application that allows citizens, researchers and government officials to explore community health data. A video comparing Medicare quality to Medicare spending -- an example of this tool in use -- is available at Palantir's Government data analysis blog.

Game mechanics and health data

scvngr.jpgCommunity Clash isn't the only game that's using community health data: SCVNGR combines the location-based technology that has become familiar to many through Foursquare and Gowalla with specific challenges to earn points. SCVNGR provides a platform for organizations to build games upon. To date, more than 550 institutions in 44 states and 20 countries have taken them up on the opportunity as clients, including museums, conferences, universities and cities.

John Valentine, SCVNGR's conference and events manager, says that SCVNGR now has more than 20 million locations in its system and is being downloaded thousands of times daily from the iTunes and Android app stores. In D.C., SCVNGR will be a part of the upcoming Digital Capital Week.

Medicare data gets mapped

The Community Health Map is being used by HHS internally to visualize and organize data, says Sohit Karol, a PhD student in the kinesthesiology department of the University of Maryland. The video below provides an overview of the core features of Community Health Map, a web application for visualizing Medicare datasets.

The tool was developed as a part of a course on Information Visualization at the University of Maryland. More information on the project is available through the class wiki.

iTriage puts hospitals in patients' hands

itriage.jpgThe iTriage app combines open health data with a large database of symptoms and a directory of healthcare service providers. A pair of emergency physicians, Peter Hudson and Wayne Guerra, developed iTriage to empower consumers to make better decisions.

"People are making bad decisions with third-party information," said Hudson at the expo. "The people making those decisions are costing the system money, mostly because they don't have the tools they need to understand."

Now, users can get quality reports on doctors, research symptoms, click to see nearby healthcare facilities and, where available, view emergency room wait times. "We're seeing a high level of engagement," said Hudson. "With people using it to find doctors, hospitals and pharmacists. We've seen 2 million page views on mobile already." Hudson said an iTriage API is in development.

Pillbox turns FDA drug label data into a platform

pillbox-screenshot.jpgPillbox, an open data initiative developed within the National Library of Medicine and the Food and Drug Administration (FDA), makes pill identification easier. Pillbox lets developers build applications for the web and smartphones through an open API.

David Hale, Pillbox's project manager, says a call to a poison control center for a pharmaceutical identification costs $45. With Pillbox and a web browser, that cost can be substantially reduced.

Hale explains more in this video from the USP Annual Scientific Meeting in September 2009:

Asthmapolis crowdsources better health for asthma patients

asthmapolis-screenshot.jpgAsthmapolis has developed a specialized device called a "Spiroscout" that, when attached to an asthma inhaler, uses GPS to track use, and share the time and location of symptoms.

Asthmapolis aggregates the data voluntarily provided by users and gives it to physicians, scientists and health agencies. The goal is to identify environmental exposures that trigger attacks. Asthmapolis has released a web app and its building a mobile phone diary and website for later release to the public.


The opportunities in healthcare IT will be explored at the upcoming OSCON conference. Learn more about OSCON's health track here.

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