Doximity’s new iPad app and the “poor man’s HIE”

By: Jonah Comstock | May 2, 2013        

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DoximityDoximity, the medical communications platform headed up by Epocrates co-founder Jeff Tangney, has announced its first tablet app, an iPad product that offers various improvements to its existing iPhone and Android offerings that take advantage of the larger screen real estate. The company also announced that it now has 160,000 physician users.

“We’ve always been a mobile first company. We started with an iPhone app, then an Android app, and then a website,” Tangney told MobiHealthNews. “But doctors have always used the iPhone app on the iPad. The key thing was to add the ability for doctors to sign, make notes, and share notes on faxes on their iPads. That takes a little while to do, but now we have it and it looks great. It really is the doctor’s new electronic clipboard.”

Doximity has always competed with doctors’ use of fax machines to correspond with one another and with pharmacies. With the iPad app, each doctor will get their own fax number, allowing them to receive faxes directly on their iPad. On the tablet’s large screen, doctors can notate and sign the faxes, CC them to emails and other faxes, and in many cases send them right back to their sender, allowing quick turnaround for much of a physician’s paperwork. And unlike consumer products that offer electronic faxing, Doximity’s process is all HIPAA-compliant.

In addition, other features of Doximity’s app are enhanced in the context of the new form factor.

“It is the same functionality we had on the iPhone, just bigger and reformatted,” Tangney said. “We didn’t just do a straight port, we went through and added a few fun things. Like when I do a search for cardiologists in my area, before we would just show you a list, but now we’ll show you a map with their faces as pins on the map.”

A core feature of Doximity is a social reader function that lets doctors share and comment on academic research. Tangney said that the new form factor is ideal for reading journal articles.

“Just like a lot of people use Flipboard as their magazine e-reader, our DocNews, which filters through all the news that a doctor’s colleagues are reading, I can flip through more like a magazine experience,” he said.

Doximity’s 160,000 physicians users make up more than 20 percent of the physicians in the United States, according to Tangney. The company hit 50,000 physician members in March 2012, and 100,000 in October 2012, according to their press release. Tangney compared Doximity’s growth to the early days of Epocrates, his former company.

“I can say the growth at Doximity has been multiple times the growth we had back then at Epocrates,” he said. “At Epocrates we kind of stalled at 100,000 users, because there was just no network effect to it. In the last five years, Epocrates has had a lot of growth. But here we have the effect that the value of the product to the 100,000th doctor is a lot greater than it was to the 10,000th doctor. There’s a huge first mover advantage for being the place where most other people you want to talk with are.”

Tangney said the company wasn’t sharing how engaged the 160,000 doctors are with the platform other than it was “more than LinkedIn, less than Facebook.” He said Doximity wants to be an available tool for doctors, but doesn’t necessarily need them to use the platform as voraciously as the average Facebook user.

“We haven’t been trying to goose engagement, but we see pretty decent engagement. A decent chunk is the journal club, and the other is just secure messages. Some are patient-related, but some are just reconnecting with friends from your residency. I think that’s because we offer HIPAA compliance and an easier way to do some of the day to day interaction.”

Tangney declined to comment on whether an Android tablet app was coming. He said a next step for the company is EHR interoperability, but doctors are already finding workarounds.

“We don’t have a lot of interfaces built to EHRs yet. We’re working on some. I have seen some physicians who will take a screenshot of their EHRs, and attach that message through a secure message on Doximity. That becomes a poor man’s HIE,” he said. “The billion dollar question is ‘Will we get interoperability in healthcare?’ The answer is ‘We’re not there yet.'”

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Virtual patient advocate shows promise in reducing risky pregnancies

By: Neil Versel | May 2, 2013        

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Gabby AvatarYoung, low-income, minority women respond favorably to a “virtual patient advocate” that talks to them in plain English in a conversational, non-confrontational manner about birth control and other “preconception planning” issues, preliminary testing of the technology shows. Some even prefer the avatar to an actual physician, according to an article in the American Journal of Health Promotion.

The study, conducted at Boston Medical Center using technology developed at nearby Northeastern University, asked 24 African-American women between the ages of 15 and 25 to interact with a virtual character named Gabby to screen them for risks of unintended and dangerous pregnancies. Questions address issues as diverse as family planning, whether people have diabetes or other medical conditions that could affect the risk of birth defects, exposure to teratogens – substances that can cause developmental disorders – and preventive measures sexually active women can take.

Minority and low-income communities tend to have higher incidences of unplanned pregnancies and of maternal and infant mortality, the researchers say, citing earlier studies.

The Gabby system, created by Timothy Bickmore, a computer science professor at Northeastern, speaks in simple, conversational language. Users respond by clicking buttons on the screen specific to each question, and Gabby provides further dialog based on each response. “She’ll talk to you as long as you want,” lead author Dr. Paula Gardiner, a family physician at Boston Medical Center and a faculty member at Boston University School of Medicine, explains.

Gabby also educates users about unhealthy behavior and helps women create to-do lists for mitigating risks through lifestyle changes. “She’s helping you set goals,” Gardiner says.

“She lets you set the goals and she reinforces the goal settings,” Gardiner continues. “In that sense, she’s like a coach.” Keep reading>>

Five percent of broadband households have digital fitness devices

By: Brian Dolan | May 2, 2013        

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Parks Associates Health AppsAccording to a recent survey conducted by Parks Associates in March, about 5 percent of households with broadband internet have at least one digital fitness device — like a Fitbit, Jawbone UP, or BodyMedia FIT Armband. The survey, called Digitally Fit: Healthy Living and Connected Devices, polled about 10,000 broadband-enabled households.

The survey found that memory improvement mobile apps or online services were the most widely adopted type of app or service among those surveyed, followed by weight loss, diet and nutrition, and exercise apps or online services.

A Parks report from last year, called Health Entertainment 2012, found that 29 percent of consumers with health problems would try out an easy-t0-use device to track their health conditions and 27 percent said they were interested in a personalized plan to help guide them through their care regimen. That same report found that about a third of people who said they used fitness apps (or said they’d potentially like to use them) considered the integration of fitness data with nutritional data as a “must have” feature of an app.

Parks predicts that more than 32 million US consumers will actively track their health and fitness online or via mobile devices by 2016, up from about 15 million in 2011. Online and mobile wellness service adoption will also increase from 14 million users in 2011 to 29 million by 2016, according to Parks. Sales of fitness tracking devices — both stationary and wearable — will ramp from $337 million in 2011 to more than $2.4 billion by 2016. The firm estimates that unit sales of wearable fitness tracking devices will almost hit 14 million by 2016, up from just 1.5 million sales in 2011.

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The MobiHealthNews Podcast: Q1 in Review

By: Brian Dolan | May 2, 2013        

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Podcast imageIn this past month’s MobiHealthNews podcast, Jonah Comstock and I reviewed some of the most important mobile and digital health stories and trends that emerged during the first quarter of the year. This short (7-minute) podcast riffs off our recently released Mobile Health Q1 2013 State of the Industry Report, which we just published yesterday morning.

We’ll be back later in May with our podcast dedicated to fitness apps and devices, which should be particularly interesting considering the recent acquisition of longtime wearable health sensor company BodyMedia by cash-flush Jawbone.

Our April podcast is available for download or streaming over at Hipcast now (check it out here!) and over at iTunes (here’s the link).

Intuitive, now Vivify Health, raised $3.4M from Ascension, Heritage Group

By: Jonah Comstock | May 1, 2013        

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vivifyPlano, Texas-based remote monitoring startup Intuitive Health has finally emerged from stealth mode with a new name, Vivify Health. At the end of January, MobiHealthNews reported that the company, which offers a cloud-based device-agnostic remote monitoring software, had raised $3.4 million from undisclosed sources. Our January report also noted that the company was participating in a pilot with AT&T and Texas Health Resources.

This week, the company announced that the funding came from healthcare investment firms Ascension Health Ventures and Heritage Group. The company is using the money “to accelerate the delivery of Vivify’s cloud-based remote care management platform that enables hospitals, home health agencies, payers and other stakeholders to accomplish population health objectives, including reducing readmissions, managing chronic diseases, improving care transitions, and engaging patients in their own wellbeing,” according to their press release.

Vivify has been quietly working on its software-as-a-service offering since CEO Eric Rock founded the company in 2009. The company claims to market its software directly to consumers, but its website seems to court providers, health plans, and even pharmaceutical companies. Vivify’s software suite includes a wide range of home monitoring features: coaching, customized care plans, video conferencing with physicians, and educational video content. The system integrates with remote monitoring technology like health and vital sign sensors, as well as with EHRs, PHRs, and HIEs, according to the company. Consumers can access the software through mobile devices, computers, and Internet-connected television.

Vivify has been deployed in large health systems since 2011, according to the company. In addition to the partnership with AT&T, the company has worked with Ericsson, Polycom, and Samsung.

“We recognized early on that delivering a scalable consumer-connected platform, including mobile high-definition video conferencing, requires core competencies of these leading consumer technology providers,” said Rock in a statement.

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Tips for integrating health apps and EHRs

By: Jonah Comstock | May 1, 2013        

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WellDoc DiabetesManagerBaltimore-based WellDoc has announced the publication of a case study on the integration of it’s mobile diabetes management offering with the electronic health record system Allscripts, implemented at George Washington University School of Medicine. Back in 2010, MobiHealthNews reported on the partnership, which was funded by the US Air Force.

WellDoc’s diabetes management offering is FDA-cleared as a Class II medical device, and the study refers to it as a “mobile-integrated therapy” (MIT). It uses patient-entered data, data from sensors built into a smartphone, and data from connected sensors (like a continuous glucose monitor), to provide personalized coaching to the user. In integrating the MIT with the Allscripts EHR, patient data was shared bi-directionally, according to the paper.

For the study, which was published in the Journal of Diabetes Science and Technology, WellDoc conducted interviews with mobile development and testing teams, the EHR software consultants, the hospital IT team, patients, project managers, and business analysts. They collated that information into eight lessons learned from the integration.

1. The integration must take into account each user’s day-to-day life and workflow, including patients, providers, IT staff, and additional caregivers. Some users will need access to a greater depth of information, while for others design and usability will be paramount.

2. The design should be interoperable and support the integration of multiple MITs into a single EHR. In particular, developers should make sure to eliminate redundancies between the systems, where app users and EHR users might enter the same data into different fields.

3. Multiple environments have to be secure, but their security can’t keep them from interacting with each other. Stakeholders WellDoc interviewed reported problems with competing firewalls in implementing the integration.

4. Both halves of the integration, but especially the patient-facing app, should work natively on as many mobile devices as possible. Patients are most likely to use a system that allows them to continue using their device.

5. The mobile health offering is subject to a limitation already standard for EHR apps: it must be able to run even when network connectivity is sparse or intermittent, as is sometimes the case in large hospital complexes.

6. It’s crucial to have a support team in place familiar with the technology  to help acquaint users with it.

7. Make sure the two systems adhere to common standards. Not only data interchange standards like HL7, but also making sure that measurements in both systems use the same units. If lab-collected blood glucose data in the EHR and patient-collected blood glucose data have the same unit, but one is potentially more accurate, the integrated system should easily identify and distinguish the two.

8. The team working on an integration should be ready for a more complex process than anticipated. A clear vision, good communication, and a steering committee are important for anyone attempting to integrate a mobile heath offering and an EHR.

The paper also indicates that a paper with results from a clinical trial with more quantitative data about the George Washington University School of Medicine trial is still to come.

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