Ringadoc scoops up $1.2 million to take on physicians’ after-hours practice management

By: Brian Dolan | Jan 31, 2013        

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Ringadoc iPhone appThis week San Francisco-based Ringadoc announced an additional $450,000 in funding, which combined with its $750,000 from last year brings its total seed round funding to $1.2 million. The round was led by Founders Fund’s FF Angel and includes contributions from Practice Fusion CEO Ryan Howard but the additional funding comes from angel investor Sharon Knight, former president of concierge-style health provider One Medical Group, and other undisclosed angels. Ringadoc plans to use the funds to scale its new offering Ringadoc exchange, develop new patient-facing apps, and to develop a premium service offering that could add video conferencing capabilities to the current voice-only communications offering.

Apart from the $750,000 funding raise last summer, the last we heard of Ringadoc was in November 2011 when we reported on its first patient facing app launch, which enabled patients to record video messages ahead of a virtual visit with a new physician. Ringadoc CEO Jordan Michaels told MobiHealthNews that the company has dropped the video-enabled offering for now — they currently have no patient-facing apps, actually — and have re-focused on improving after hour phone consultations for patients and physicians, alike.

Patients who already have a physician likely have to deal with an annoying 1970s call center system to get a hold of them after hours, Michaels said. Patients who don’t have a physician could also use a service that might help them decide whether they should go to the emergency room or the urgent care center — or, perhaps, whether the issue could be handled over the phone.

“Initially we developed a direct to consumer play where patients could go to a bank of doctors that we curated in California to pay for an on demand consultation with a doctor,” Michaels said. “That is still available and still being piloted in California, but we quickly learned from that those doctors that they wanted to use the same technology with their own patients for after hour calls — not just to attract new patients.”

Michaels describes Ringadoc’s evolving platform as a “one stop shop” for after hour calls and practice management. While the on demand pilot see patients paying about $40 per visit, the new Ringadoc Exchange offering costs doctors $50 a month. Ringadoc will use some of its new funds to build out additional premium services like video conferencing and text messaging to help physicians make additional, incremental revenue from their after hours calls.

The company believes enabling a better after hours calling experience will help doctors ensure that the patients that come to visit them in person are the ones that really need to be there and aren’t there because there’s no alternative way to reach them. Michaels said that doctors receive between 200 and 250 after hours calls a month and about 10 percent of those request to speak with a doctor. Telephonic visit reimbursement is not available right now, but Michaels noted that a bill is pending in California.

Ringadoc believes physicians could treat patients over the phone for routine diagnoses like sinus infections or urinary tract infections — something that the patient might get two or three times a year and doesn’t need to necessarily go in for. Ideally, this could help reserve in-person visits for those patients who have more serious, less routine issues, which, of course, generally have a higher reimbursement rate per visit.

When doctors receive an after hours call via Ringadoc Exchange they receive a message in their Exchange inbox, which can be accessed a number of ways including via a new iPhone or Android app that the company launched in tandem with this recent funding announcement. Michaels said the goal was to provide physicians with the flexibility to manage their patients after hours with as much ease as they would their Netflix qeue or Amazon Prime account.

While Ringadoc is based out of Practice Fusion’s offices in San Francisco and has that company’s CEO as an advisor and investor, it has no formal partnership with the company. Ringadoc, however, could find a lot of points of integration with EHR providers and others working in the practice management space. There is also an opportunity for Ringadoc to partner with those aggregating doctors online — sites like ZocDoc could offer telephone or (in the near future video) consultations with some of the physicians it has on its online appointment booking site.

“We really want to be the backbone of all out-of-office patient-physician communication,” Michaels said.


Interview: E-patient organization’s first executive director

By: Neil Versel | Jan 31, 2013        

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Barbara KornblauThe Society for Participatory Medicine, which has been advocating for greater patient engagement in healthcare since 2009, has hired Barbara L. Kornblau, former dean of the School of Health Professions and Studies at the University of Michigan’s Flint campus, as its first executive director.

Kornblau will be tasked with spreading the word about patient engagement to healthcare professionals and the general public. “We will be working from a micro level to improve healthcare on a macro level,” says Kornblau, a veteran of numerous healthcare and advocacy pursuits.

Kornblau, an attorney and licensed occupational therapist, also has been a professor of occupational therapy and public health at Nova Southeastern University in Fort Lauderdale, Fla., a Robert Wood Johnson Health Policy Fellow for U.S. Sens. Tom Harkin (D-Iowa) and Jay Rockefeller (D-W. Va.), a government relations consultant for the Special Olympics and founder of the Coalition for Disability Health Equity.

“Everything I’ve been doing in my career has been geared toward participatory medicine. I just didn’t know it was called that,” she says.

SPM is intended as a partnership between empowered patients – otherwise known as e-patients – and healthcare professionals.

Digital health tools are considered essential to the e-patient movement. While health IT policy-makers and more than a few academics refer to technology as an enabler of better, safer and more efficient care, Kornblau has a different term for it. “I think it’s more of an empowerer, if there is such a word, than an enabler,” she said.

Kornblau, who is based in Washington, tells of being a member of Rotary International, which had a saying: “Everyone is a Rotarian. You just have to ask them to join.” She says the same principle applies to e-patients, and it will be her job to ask people to join in taking a more active role in their own care.

In an interview with MobiHealthNews, Kornblau relates the story of searching for a primary care physician when she moved to the Washington area from Michigan, where she was used to her doctor practicing with electronic health records. She went to three different practices, none of which had EHRs. “I felt uncomfortable in their offices because [it seemed like] there was a wall between the doctor and me,” Kornblau says.

She wanted to ask for a copy of her doctor’s handwritten notes, but Kornblau said it felt like an imposition.

One of her roles as executive director of SPM will be to inform clinicians about how sharing records with patients can have a positive impact on care. Kornblau also will be trying to get the general public accustomed to asking for their own health data and how to understand clinician notes. “If you can see the records, it benefits everybody,” Kornblau says.

While there historically has been reluctance among clinicians to show patients their notes, the resistance is fading, according to Kornblau. Older physicians and nurses who might fight this shift eventually will retire. “The hope is that new docs/nurses will be trained in EHRs and will embrace this,” Kornblau says. She reports seeing this already in nursing education, and new physicians are more likely than ever to encounter EHRs and patient portals during their medical residencies.

Public policy also is shifting toward patient empowerment.

Stage 2 of the “meaningful use” EHR incentive program, which starts in 2014, requires providers to give at least 50 percent of their patients the ability to view and download their own medical records through online portals, up from 10 percent in Stage 1. And unlike in the first stage, 5 percent of patients will actually have to log in to those portals for physicians and hospitals to earn their Medicare and Medicaid bonus payments. For the first time, EHR adoption won’t be completely in the hands of the provider.

“That makes a lot of sense,” Kornblau says.

Another significant breakthrough for the Society for Participatory Medicine is that its members contributed signficantly to a book set to be published by the Healthcare Information and Management Systems Society (HIMSS). The book is about consumer engagement in healthcare and it is coming out in March, according to Kornblau. “There will be other projects with HIMSS,” she adds. (Correction: An earlier version of this article incorrectly stated that the book was the result of an official partnership between SPM and HIMSS, however, it actually just includes contributions from SPM’s members.)

BlackBerry gears up for comeback, will doctors follow?

By: Jonah Comstock | Jan 30, 2013        

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blackberry Z10

Research in Motion (RIM) finally renamed itself “BlackBerry” after its signature product, even as it launched its much-awaited iPhone/Android competitor: the BlackBerry 10 operating system, touchscreen BlackBerry Z10 and keyboard-equipped BlackBerry Q10. The launch has been described as a Hail Mary pass for the struggling company, a last chance for a comeback that the company hopes could put it back in the running against Apple and Google in the smartphone race. The devices are heading to the UK first.

BlackBerry’s offerings were once the devices of choice for doctors, but the company’s popularity has been in decline for the last few years, with Apple’s iPhone and iPad products largely supplanting it. As recently as April 2012, RIM was making a bid to get those physician customers back on board with BlackBerry Bold.

According to Manhattan Research, BlackBerry and Apple were neck and neck among physicians in 2010, with Apple taking 22 percent of physicians, BlackBerry taking 20 percent, and Android taking only 4 percent. In 2011, the percentage of physicians using Apple products doubled, while the BlackBerry numbers went down 2 percent. The next year, only 10 percent of doctors were using BlackBerry devices, even lower than 2009 levels, while apple had skyrocketed to 57 percent — more than half of all the physicians in the country.

So if BlackBerry wants to make a comeback with physicians, it has a long way to go. However, several of the features announced for the new device suggest it could reel some of those doctors — not to mention hospital CIOs — back in.

BlackBerry has always pointed to its physical keyboard as a perk that touchscreen only devices couldn’t touch, and the new release does include a QWERTY keyboard model. But it also contains an improvement to the virtual keyboard, with opt-in rather than opt-out predictive text, which received accolades from the New York Times’ David Pogue. Touchscreen keyboards are a sticking point for clinical data entry, which needs to be fast and accurate, as MobiHealthNews has reported in the past.

BlackBerry takes on BYOD

Another reason physicians might adopt the new BlackBerry is BlackBerry Balance, a feature designed with Bring Your Own Device (BYOD) worries in mind. BlackBerry Balance allows users to partition their mobile data storage so that everything related to work — work apps, work email, work communications — is stored in a separate, secure “perimeter.” When an employee leaves a company, the work perimeter can be easily and permanently deleted. The perimeters won’t interrupt the rapid multitasking the OS is designed to facilitate — once a user is signed in to the work side, they can move back and forth between work and personal easily.

Physicians Smartphone AdoptionOne feature that third-party BYOD security companies often tout is the ability to lock out or wipe a phone remotely if its lost or stolen. With BlackBerry Protect, the new BlackBerry devices will have that feature built in from the manufacturer.

Another feature the company is highlighting is called BlackBerry Remember, an organizational aid for taking notes and keeping track of events. The feature will even sync with Evernote, a memory app that has proven popular with doctors. (Evernote also recently partnered with iHealth, reflecting an increasing inclination towards participating in the health space.)

BlackBerry 10 is launching with 70,000 downloadable apps, including a number of health apps. In 2010, we reported that BlackBerry executives said they were interested only in serious health apps — no “goofy” apps or games. However, a browse of the BlackBerry AppWorld’s health and fitness section demonstrates the same range of serious to frivolous health apps we see in the AppStore and the Google Play store now. Certainly some of the big names in consumer health, like ZocDoc and Walgreens, are represented. Companies like Allscripts and Epocrates, too, haven’t given up on BlackBerry, and will likely provide offerings compatible with the new operating system.

Smartphones just the start for BlackBerry 10 OS

BlackBerry CEO Thorsten Heins also told the Globe and Mail that the Blackberry 10 operating system is not just for smartphones. He described a long-term plan to push into machine to machine verticals, pointing specifically to the healthcare field, implying that the OS could find a home in connected medical devices. The Globe and Mail also mentioned RIM’s acquisition of software company QNX, which MobiHealthNews wrote about in our 2011 tablet report:

“In fact, QNX demoed a new software reference design for medical devices earlier this year,” we wrote at the time. “In that demo, the company showed a medical device running QNX Neutrino RTOS and connecting via Bluetooth to blood pressure monitors, weight scales, pulse oximeters and…you guessed it, a BlackBerry PlayBook. All of this was accomplished using the Bluetooth Health Device Profile, which allows medical devices to relay data to PCs and mobile devices. Seeing how QNX Neutrino RTOS has a long history of being deployed in FDA-certified devices, considering that QNX was just acquired by RIM and keeping in mind that RIM has demoed the PlayBook running healthcare-specific software, it’s not hard to imagine a scenario where RIM pushes the PlayBook in the healthcare market in a big way.”

If BlackBerry’s Hail Mary is going to succeed, they’ll certainly need to attract consumers on a wide scale. But doctors are an important market for mobile devices and services, too, and they’ve shown that they are willing to switch devices when something new works better. Whether BlackBerry 10 can win back physicians remains to be seen, but it is the best shot the company has taken in some time.

Remote monitoring startup Intuitive Health nabs $3.4M

By: Jonah Comstock | Jan 30, 2013        

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intuitive healthCloud-based patient monitoring company Intuitive Health has raised $3.4 million, according to an SEC filing first spotted by the Dallas Business Journal. The company isn’t yet willing to talk much more about the funding raise; CEO Eric Rock told MobiHealthNews in an email that they are still in stealth mode. This appears to be the company’s first public funding raise.

Although the Plano, Texas-based company has kept quiet, they’ve emerged as a notable player in the remote patient monitoring space, partnering with AT&T and health system Texas Health Resources on a pilot last year. Intuitive Health is developing remote monitoring software that is cloud-based and device-agnostic, so that it can interface with devices ranging from touchscreen mobile devices to Internet-enabled televisions. The company currently has a free tablet app in the Google Play store, apparently for participants in their pilot. Screenshots suggest that the company leverages a Withings connected weight scale and a pulse oximeter, which may be from Nonin.

More recently, at the mHealth Summit in December 2012, AT&T announced a new remote patient monitoring Software as a Service offering that also included software from Intuitive Health. Intuitive’s software “helps providers to implement and manage care plans and integrate the resulting data with clinician workflows,” according to a press release from AT&T. The company said the model “evolved from” the pilot study, which reduced hospital readmissions by 27 percent for chronic heart failure patients, according to the Dallas/Fort Worth Healthcare Daily.

Rock told the Dallas Business Journal that Intuitive has “a significant agreement with the largest U.S. network operator,” likely a reference to AT&T, which also features Rock prominently on the remote patient monitoring section of its website.

Ginger.io tests passive monitoring for diabetes

By: Jonah Comstock | Jan 29, 2013        

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Ginger.ioPassive behavior monitoring and analytics company Ginger.io is now soliciting participants for a diabetes pilot study, building on the work that won them the Sanofi Data Design Diabetes Innovation Challenge in 2011.

Ginger.io, which recently raised $6.5 million in a round led by Khosla Ventures, makes passive monitoring software for smartphones, with the goal of creating profiles for how different diseases and conditions affect behavior. Ginger.io’s software monitors how often users make calls, how long they talk for, how often they text, and similar metrics, as well as location data. Eventually, the company will be able to compare their behavior to a baseline and send out alerts when it’s out of the ordinary. To make the system work for particular chronic diseases, like diabetes, the company needs to collect a lot of data to form what it calls a “Behavior Genome” for a given condition.

“The infrastructure for collecting data, the infrastructure for processing it, … all of that is similar [between conditions],” CEO Anmol Madan told MobiHealthNews late last year. “There’s one platform we use for all these conditions, but the specific models for how patients behave would depend on the specific conditions.”

The company is looking for participants with Type II diabetes between the ages of 18-65 who own an Android or Apple smartphone and speak fluent English. Pilot study participants will install the Ginger.io software on their phones, and, additionally, take occasional three- to five-question surveys about their health and mood. In exchange, users of the app will get feedback from the program — alerts, insights, and observations about their health. Down the road, the company will also let them set up the software to alert family members of behavioral red flags.

Ginger.io won the first-ever Sanofi Data Design Diabetes Innovation Challenge in November 2011 with a version of the app the company is now testing. According to the Ginger.io blog, the company has spent the intervening year on improving the interface and the user experience of the app. In May, the company launched a similar pilot in partnership with the Collaborative Chronic Care Network (C3N) for patients with Crohn’s disease or ulcerative colitis. The company appears to be launching the diabetes pilot alone, though they are turning to clinical trial-patient matching website Corengi.com to help solicit participants.

Phone detection of Parkinson’s approaches 99 percent accuracy

By: Neil Versel | Jan 29, 2013        

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Parkinsons Voice InitiativeA British mathematician is applying “big data” algorithms to detect Parkinson’s disease from voice recordings and now claims accuracy up to 99 percent.

“We also know how to predict the severity of symptoms to within a few percentage points of clinical judgment,” Max Little, a mathematician on the faculty of Aston University in Birmingham, England, and a visiting researcher at both the Massachusetts Institute of Technology and Oxford University, wrote Friday in the Huffington Post’s TED Weekends column. He gave a TED talk in Edinburgh, Scotland, last June.

The technology has the potential to make drastic cuts to the time and cost of diagnosing Parkinson’s, a neurological disease that manifests itself not only through the telltale physical tremors but through changes in speech patterns, among half a dozen other typical symptoms.

“Current symptom tests are done in a clinic. They are expensive, time-consuming, and logistically difficult. So mostly, these tests are not done outside clinical trials,” Little wrote. “Our technology could enable some radical breakthroughs, because voice-based tests can be administered remotely, and patients can do the tests themselves. Also, they are high speed, taking less than 30 seconds, and since they don’t involve expert staff time, they are ultra low cost. That makes the technology massively scalable.”

Little founded the Parkinson’s Voice Initiative and is in the process of analyzing 10,000 phone calls he and his team collected for a current research project. He has been working on the project for seven years since a friend, spurred on by the fact that a friend, a former ballet dancer, suffers from Parkinson’s disease.

“This incredible and unique dataset will tell us whether it is possible to use something as ubiquitous as the telephone to detect and monitor the disease,” Little said. “This now becomes a ‘big data’ analysis problem, and until the analysis is done, we can’t know for sure if it will work. But if it does, we would have the technology to check out some 75 percent of the world’s population at a negligible cost.”

Little reported achieving 86 percent accuracy with mathematical algorithms he developed while working a Ph.D. at Oxford. As a professional, he said he now has algorithms that come close to 99 percent in laboratory conditions.

If the analysis does prove successful on a wide scale, Little said the technology could eliminate some physician office visits by providing a remote means of monitoring how Parkinson’s is progressing and also assist in research projects. “We could do high-frequency monitoring for individualized treatment decisions. This might allow clinicians to optimize drug timing and dosage,” Little surmised.

“For clinical trials, we could do cost-effective mass recruitment for new treatments. By recruiting very large numbers into trials we could help speed up the search for a cure. And finally, this could enable population-scale screening programs, that might allow us to search for ‘biomarkers’ that show early signs of the disease before the damage done is irreparable,” he continued.

Little also said scientists in other fields might be able to apply his algorithms outside medicine. “One particularly fascinating application is the detection of extrasolar planets β€” that is, planets circling other stars,” he wrote.

While the voice angle is new, this is not the first time someone has tried to bring mobile technology to Parkison’s care. Great Lakes Neurotechnologies has won FDA 510(k) clearance for Kinesia HomeView, which combines a tablet computer and wireless sensors to assess the effectiveness of treatments for Parkinsonian tremors.