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May 16 2012

How to start a successful business in health care at Health 2.0 conference

Great piles of cash are descending on entrepreneurs who develop health care apps, but that doesn't make it any easier to create a useful one that your audience will adopt. Furthermore, lowered costs and streamlined application development technique let you fashion a working prototype faster than ever, but that also reduces the time you can fumble around looking for a business model. These were some of the insights I got at Spring Fling 2012: Matchpoint Boston, put on by Health 2.0 this week.

This conference was a bit of a grab-bag, including one-on-one meetings between entrepreneurs and their potential funders and customers, keynotes and panels by health care experts, round-table discussions among peers, and lightning-talk demos. I think the hallway track was the most potent part of this conference, and it was probably planned that way. The variety at the conference mirrors the work of Health 2.0 itself, which includes local chapters, challenges, an influential blog, and partnerships with a range of organizations. Overall, I appreciated the chance to get a snapshot of a critical industry searching for ways to make a positive difference in the world while capitalizing on ways to cut down on the blatant waste and mismanagement that bedevil the multi-trillion-dollar health care field.

Let's look, for instance, at the benefits of faster development time. Health IT companies go through fairly standard early stages (idea, prototype, incubator, venture capital funding) but cochairs Indu Subaiya and Matthew Holt showed slides demonstrating that modern techniques can leave companies in the red for less time and accelerate earnings. On the other hand, Jonathan Bush of athenahealth gave a keynote listing bits of advice for company founders and admitting that his own company had made significant errors that required time to recover from. Does the fast pace of modern development leave less room for company heads to make the inevitable mistakes?

I also heard Margaret Laws, director of the California HealthCare Foundation's Innovations Fund, warn that most of the current applications being developed for health care aim to salve common concerns among doctors or patients but don't address what she calls the "crisis points" in health care. Brad Fluegel of Health Evolution Partners observed that, with the flood of new entrepreneurs in health IT, a lot of old ideas are being recycled without adequate attention to why they failed before.

I'm afraid this blog is coming out too negative, focusing on the dour and the dire, but I do believe that health IT needs to acknowledge its risks in order to avoid squandering the money and attention it's getting, and on the positive side to reap the benefits of this incredibly fertile moment of possibilities in health care. Truly, there's a lot to celebrate in health IT as well. Here are some of the fascinating start-ups I saw at the show:

  • hellohealth aims at that vast area of health care planning and administration that cries out for efficiency improvements--the area where we could do the most good by cutting costs without cutting back on effective patient care. Presenter Shahid Shah described the company as the intersection of patient management with revenue cycle management. They plan to help physicians manage appointments and follow-ups better, and rationalize the whole patient experience.

  • hellohealth will offer portals for patients as well. They're unique, so far as I know, in charging patients for certain features.

  • Corey Booker demo'd onPulse, which aims to bring together doctors with groups of patients, and patients with groups of the doctors treating them. For instance, when a doctor finds an online article of interest to diabetics, she can share it with all the patients in her practice suffering from diabetes. onPulse also makes it easier for a doctor to draw in others who are treating the same patient. The information built up about their interactions can be preserved for billing.

    onPulse overlaps in several respects with HealthTap, a doctor-patient site that I've covered several times and for which an onPulse staffer expressed admiration. But HealthTap leaves discussions out in the open, whereas onPulse connects doctors and patients in private.

  • is another one of these patient/doctor services with a patient portal. It allows doctors to upload continuity of care documents in the standard CCD format to the patient's site, and supports various services such as making appointments.

    A couple weeks ago I reported a controversy over hospitals' claims that they couldn't share patient records with the patients. Check out the innovative services I've just highlighted here as a context for judging whether the technical and legal challenges for hospitals are really too daunting. I recognize that each of the sites I've described pick off particular pieces of the EHR problem and that opening up the whole kit and kaboodle is a larger task, but these sites still prove that all the capabilities are in place for institutions willing to exploit them.

  • GlobalMed has recently released a suitcase-sized box that contains all the tools required to do a standard medical exam. This allows traveling nurse practitioners or other licensed personnel to do a quick check-up at a patient's location without requiring a doctor or a trip to the clinic. Images can also be taken. Everything gets uploaded to a site where a doctor can do an assessment and mark up records later. The suitcase weighs about 30 pounds, rolls on wheels, and costs about $30,000 (price to come down if they start manufacturing in high quantities).

  • SwipeSense won Health 2.0's 100 Day Innovation Challenge. They make a simple device that hospital staff can wear on their belts and wipe their hands on. This may not be as good as washing your hands, but takes advantage of people's natural behavior and reduces the chance of infections. It also picks up when someone is using the device and creates reports about compliance. SwipeSense is being tested at the Rush University Medical Center.

  • Thryve, one of several apps that helps you track your food intake and make better choices, won the highest audience approval at Thursday's Launch! demos.

  • Winner of last weekend's developer challenge was No Sleep Kills, an app that aims to reduce accidents related to sleep deprivation (I need a corresponding app to guard against errors from sleep-deprived blogging). You can enter information on your recent sleep patterns and get back a warning not to drive.

It's worth noting that the last item in that list, No Sleep Kills, draws information from Health and Human Services's Healthy People site. This raises the final issue I want to bring up in regard to the Spring Fling. Sophisticated developers know their work depends heavily on data about public health and on groups of patients. HHS has actually just released another major trove of public health statistics. Our collective knowledge of who needs help, what works, and who best delivers the care would be immensely enhanced if doctors and institutions who currently guard their data would be willing to open it up in aggregate, non-identifiable form. I recently promoted this ideal in coverage of Sage Congress.

In the entirely laudable drive to monetize improvements in health care, I would like the health IT field to choose solutions that open up data rather than keep it proprietary. One of the biggest problems with health care, in this age of big data and incredibly sophisticated statistical tools, is our tragedy of the anti-commons where each institution seeks to gain competitive advantage through hoarding its data. They don't necessarily use their own data in socially beneficial ways, either (they're more interested in ratcheting up opportunities for marketing expensive care). We need collective sources of data in order to make the most of innovation.

OSCON 2012 Healthcare Track — The conjunction of open source and open data with health technology promises to improve creaking infrastructure and give greater control and engagement to patients. Learn more at OSCON 2012, being held July 16-20 in Portland, Oregon.

Save 20% on registration with the code RADAR20

December 10 2011

HealthTap's growth validates hypotheses about doctors and patients

A major round of funding for HealthTap gave me the opportunity to talk again with founder Ron Gutman, whom I interviewed earlier this year. You can get an overview of HealthTap from that posting or from its own web site. Essentially, HealthTap is a portal for doctors to offer information to patients and potential patients. In this digital age, HealthTap asks, why should a patient have to make an appointment and drive to the clinic just to find out whether her symptoms are probably caused by a recent medication? And why should a doctor repeat the same advice for each patient when the patient can go online for it?

Now, with 6,000 participating physicians and 500 participating health care institutions, HealthTap has revealed two interesting and perhaps unexpected traits about doctors:

  • Doctors will take the time to post information online for free. Many observations, including my own earlier posting, questioned whether they'd take the time to do this. The benefits of posting information is that doctors can demonstrate their expertise, win new patients, and cut down on time spent answering minor questions.

  • Doctors are willing to rate each other. This can be a surprise in a field known for its reluctance to break ranks and doctors' famous unwillingness to testify in malpractice lawsuits. But doctors do make use of the "Agree" button that HealthTap provides to approve postings by other doctors. When they press this button, they add the approved posting to their own web page (Virtual Practice), thus offering useful information to their own patients and others who can find them through search engines and social networks. The "Agree" ratings also cause postings to turn up higher when patients search for information on HealthTap, and help create a “Trust Score” for the doctor.

HealthTap, Gutman assures me, is not meant to replace doctors' visits, although online chats and other services in the future may allow patients to consult with doctors online. The goals of HealthTap remain to the routine provision of information that's easy for doctors to provide online, and to make medicine more transparent so patients know their doctors, before treatment and throughout their relationships.

HealthTap has leapt to a new stage with substantial backing from Tim Chang (managing director of Mayfield Fund), Eric Schmidt (through his Innovation Endeavors) and Rowan Chapman (Mohr Davidow Ventures). These VCs provide HealthTap with the funds to bring on board the developers, as well as key product and business development hires, required to scale up its growing operations. These investors also lend the business the expertise of some of the leaders in the health IT industry.

April 22 2011

HealthTap explores how big a community you need to crowdsource health information

A new company named HealthTap has just put together an intriguing combination of crowdsourced health advice and community-building. They rest their business case on the proposition that a battalion of doctors and other health experts--starting at the launch with 580 obstetricians and pediatricians--can provide enough information to help people make intelligent decisions. For me, although the venture is worthy in itself, it offers a model of something that might be even better as a national or international effort.

I had a chance just before the launch to visit the HealthTap office and get a pitch from the boisterous and enthusiastic Ron Gutman. The goal of HealthTap is to help ordinary people--in its first project, pregnant women and new mothers--answer basic questions such as, "What possible conditions match this symptom?" or "What should I do about this problem with a baby?" They don't actually provide health care online, but they provide information directly from doctors on the health issues that concern individuals.

The basic goals of HealthTap's "medical expert network" are:

  • To improve the public's understanding of their own health needs by providing precise, targeted information.

  • To engage patients, making them more interested in taking care of themselves.

  • To allow doctors to share their knowledge with communities, including current and prospective patients, by publicizing answer and tips they often share with patients.

  • To increase the efficiency and effectiveness of healthcare by helping users record personal information while researching their concerns before doctor visits.

  • To promote good doctors and create networks around caring

HealthTap needs to bring two populations online to succeed: health care provides and individuals (which I will try to avoid calling patients, because individuals can use health information without suffering from a specific complaint). I'll explain how they attract each population and what they offer these populations. Then I'll explore three challenges suggesting that HealthTap is best seen as a model for a national program: motivation, outreach, and accuracy.

Signing up health care providers

As I mentioned, HealthTap is demonstrating is viability already, boasting of 580 obstetricians and pediatricians. These doctors answer questions from patients, creating a searchable database. (And as we'll see in the next section, the customization for individuals goes far beyond search results.) Doctors can also write up tips for individuals. If a doctor finds she is handing out the same sheet to dozens of patients, she might as well put it online where she can refer her own patients and others can also benefit.

Doctors can be followed by patients and other doctors, an application of classic social networking. Doctors can also recommend other doctors. As with cheat sheets, doctor recommendations reflect ordinary real-life activities. Each doctor has certain specialists she recommends, and by doing it on HealthTap she can raise the general rating of these specialists.

Signing up individuals

Anyone can get a HealthTap account. Although you don't need to answer many questions, the power of customization provides an incentive to fill in as much information about you as you can. The pay-off is that when you search for a symptom or other issue--for instance, "moderate fever"--you will get results tailored to your medical condition, your age, the state of your pregnancy, and so on. A demo I saw at the HealthTap office suggested that the information brought up by a search there is impressively relevant, unlike a typical search for symptoms on Google or Bing.

HealthTap then goes on to ask a few relevant questions to help refine the information it provides even further. For a fever, it may ask what your temperature is and whether you feel pain anywhere. As explained earlier, it doesn't end up giving medical advice, but it does list the percentage match between symptoms reported and a list of possible conditions in its comprehensive database. All these heuristics--the questions, the list of conditions, the probabilities, the other suggestions--derive from the information entered by the providers in the HealthTap network and data published in peer-reviewed medical journals.

Some natural language processing is supported, letting HealthTap interpret questions such as "Should I eat fish?" Gutman ascribed their capabilities to a comprehensive medical knowledgebase built around a medical ontology that is designed especially for use by the lay public, coupled with a Bayesian (probabilistic) reasoning engine driving user interactions that lead to normative value-based choices.

HealthTap lets individuals follow the doctors whose advice they find helpful, and connect to individuals with medical conditions like theirs. Thus, HealthTap incorporates two of the key traits of social networks: forming communities and raising the visibility of doctors who provide useful information.

HealthTap uses easy-to-understand data visualization techniques that distill medical content into simple visual elements that intuitively communicate data that otherwise could seem complex (such as the symptoms, risk factors, tests, and treatments related to a condition).

So now let's look at the challenges HealthTap faces.

I'll mention at the outset that HealthTap doesn't have as much of a problem of trust as most social networks. Doctors have passed a high threshold and start out with the expectation of competence and commitment to their patients. This isn't always borne out by individual doctors, of course, but if you put 580 of them together you'll end up with a good representation of the current state of medical knowledge.

The challenge of motivation

Time will tell whether HealthTap can continue to attract physicians. Every posting by a physician is an advertising opportunity, and the chances of winning new patients--which can be done both by offering insights and by having colleagues recommend you--may motivate doctors to join and stay active. But I suspect that the most competent and effective doctors already have more patients banging down the door than they can handle, so they might stay away from HealthTap. Again, I like the HealthTap model but wish it could be implemented on a more universal scale.

The challenge of outreach

Pregnancy and childbirth was a clever choice for HealthTap's launch. Each trimester--not to mention the arrival of a newborn--feels like a different phase of life, and parents are always checking other people for insights. Still, the people who sign up for HealthTap are the familiar empowered patients, the ones with time and education, those who take the effort to take care of themselves and are likely to be big consumers of information in other formats such as Wikipedia (which has quite high-quality health information), books, courses, and various experts in fields related to birth. HealthTap will have more impact on health if doctors can persuade other people to sign up--those who don't eat right, who consume dangerous stimulants, etc.

And if HealthTap or something like it were a national program--if everybody was automatically signed up for a HealthTap account--we might have an impact on people who desperately need a stronger connection with their doctor and encouragement to lead healthier lives. The psychiatric patients who go off their meds, the diabetics with bad diets, the people with infections who fail to return for health checks--these could really benefit from the intensive online community HealthTap provides.

The challenge of accuracy

Considering that most people depend on the advice of one or two doctors for each condition treated, the combination of insights from 580 doctors should improve accuracy a lot. Still, clinical decision engines are a complex field. It seems to me that a service like HealthTap would be much more trustworthy if it represented a national crowdsourcing effort. Every doctor could benefit from a clinical decision support system, and the current US health care reform includes the use of such systems. I'd like to see a large one that HealthTap could tap into.

Gutman says that HealthTap has indeed started to work with other institutions and innovators. "We have worked with the U.S. Department of Health and Human Services to help make the public health data they released easy to access and useful for developers, and last year we held the first-ever 'health hackathon,' where hundreds gathered to build apps using the newly released health data we organized. We can become a platform for a world of health apps tied to our growing, open data, created by leading physicians and validated research."

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