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The Web-based health-management tools collectively known as Health 2.0 generally suffer from a major shortcoming, in that they typically put the onus on individuals to learn about them and put them to use. But a few startups are taking an interesting new tack by getting health insurers to offer their Health 2.0 services to their customers — an important development, although one that may present a whole new set of problems.

Last week I wrote about American Well, which plans to offer Web-based video chats with doctors via insurers, although it doesn’t appear to have struck any such partnerships yet. So one of the first companies to actually take this plunge with a major insurer appears to be the health-focused search company Healthline Networks, which today is announcing that Aetna, one of the largest health insurers in the country, will be offering a new service to its members using Healthline technology. Dubbed Aetna SmartSource, the service will be integrated into Aetna’s existing online members-only Web site in order to provide “personalized” responses to various health-related queries. (Over time, that is; the service is only available to Aetna’s 30,000 employees so far, and the insurer only plans to roll it out to select employer-based plans over the course of the year.)

In practice, that means any Aetna member who logs onto the insurers site will be offered the same kinds of searches Healthline offers on its own site, such as queries related to disease, symptoms, medications or treatments. At Aetna, however, the results will be matched against a patient’s own medical history, at least as it’s recorded in the insurer’s claims information, in order to provide what Aetna and Healthline think are the most “relevant” results. (Click on any of the following images, which I’ve cut-and-pasted from a slideshow, for larger versions. They’re still kind of fuzzy, I’m afraid.)

The interface itself is intriguing enough, and the personalization touches that are visible in a demo seem moderately useful. Searching for doctors, for instance, will specifically turn up those in the Aetna network that are also geographically close to the patient, while a “costs” tab will outline what various medical treatments or drugs would cost at particular medical centers or clinics.

SmartSource also includes a fascinating-looking disease “health map” that visually links all the important topics you might want to explore about a particular condition, from diagnosis to treatment and prevention:

It’s a lot harder to say, though, exactly how well this sort of personalization will work when searching on disease symptoms or medications — or to what uses the information will be put by the insurer itself.

Healthline CEO West Shell acknowledges, for instance, that Aetna will know exactly what its members are searching for, although he dismisses concerns that it might be tempted to put the information to nefarious use, such as seeking ways to divest itself of members whose searches suggest they might be worried about developing a serious — and expensive-to-treat — condition. (Dropping coverage this way is generally illegal, although you don’t have to look far to find stories of insurers that have done something very similar, even without knowledge of their members’ search history.)

The other problem, of course, is that many of these tools don’t appear to be available to anyone without health insurance — or even anyone who doesn’t like the idea of their insurer peering over their shoulder while they search. That will probably change over time, of course — Healthline says it would be happy to make its tools available as applications for personal health-record services from the likes of Microsoft and Google. So while it’s interesting to see a major insurer like Aetna, which appears to cover 36.7 million people, stick its toe in the Health 2.0 waters, I suspect these sorts of services still have a long way to go.

See our earlier coverage of Healthline here.

(UPDATED: Added screenshots and a link to video of the Myca patient-record interface.)

The just-concluded Health 2.0 Conference in San Diego showcased some 30-odd startups and Web sites — with dozens more in the audience — all intent on using the Internet to improve patient care, streamline healthcare practices and bolster the ability of individuals to take charge of their own medical treatment. There’s lots more to say, and I hope to do so over the next few days.

For now, though, I want to highlight six startups with some big, and very different, ideas for reinventing the doctor-patient relationship — everything from making it deeper and more convenient to practically doing away with it altogether.

Visualize your medical records, keep your doctor on call

In their current form, even electronic medical records have a significant drawback: Most amount to little more than a digital representation of the paper forms that preceded them and consist largely of dense lines of biographical, family and medical information. (This is, of course, a fine place to start given that only 14 percent of all U.S. physicians use such systems in the first place, but it’s not exactly the end of the story.)

So in the same way that Web publications have adopted designs that exploit the advantages of the new medium (which also took time — even the pioneering online magazine Slate launched with a design that quaintly displayed page numbers just like a print publication), the folks at Myca have re-envisioned the display of medical records for the digital age. Unfortunately, the company doesn’t have any screen shots of its interface on its Web site, but their conference demo was quite striking. (You can see a brief 25-second example in this video produced for the conference; forward to 1:19 to see the Myca interface.)

Calling up a patient’s record displays her major health problem — asthma, say — surrounded by floating word tags for each of her other medical conditions, each sized larger or smaller depending on its severity. Clicking into any of these conditions zooms and centers it in the display, again surrounded by word tags for various important details, each of which can be expanded in place — for instance, visual displays of the patient’s recent medical appointments for the problem, or prescription drugs she’s taking, or X-rays and other medical images immediately available for viewing.

Here are two screenshots I just grabbed from the above-linked video (click for larger versions):

“The whole point of the interface is to show you exactly what’s going on,” says Jay Parkinson, a young New York City doctor with a pioneering Internet-based practice who now serves as Myca’s chief medical officer. “It’s kind of the geek squad for medicine.” (For more about Parkinson, who grandly proclaims himself “the future” on his Web site, see this interview at the WSJ Health blog. Don’t miss the comments, where Parkinson squares off against critics of his approach.)

Read the rest of this entry »

(UPDATED: See below.)

For all the fuss over “Health 2.0″ companies that hope to revolutionize the U.S. medical system by tapping the bottom-up information-sharing capabilities of the Web, the unfortunate fact is that many of them are busily piling into business areas that are already seriously overcrowded. Worse, many seem to have no business model at all. iMedix, a new site hoping to draw users into a community where they can share information about their medical conditions, illustrates both of these tendencies.

For starters, iMedix aims to stake out a position in both health-related search and patient-community building, neither of which is exactly a new idea. The Health 2.0 Wiki lists 11 different healthcare-community sites — a conservative count, as there are several others, including iMedix, it hasn’t yet rated — at least seven of which do much the same thing iMedix intends to do. These range from broad patient communities like DailyStrength and Inspire to communities focused on diseases such as diabetes and psychological disorders.

Online health search sites are even more common, running the gamut from Google’s health directory and Microsoft’s HealthVault to portal sites like WebMD and Healthline to human-organized sites such as Organized Wisdom.

The upshot of all this is that anyone hoping to make a splash in these areas had better have built one hell of a better mousetrap — which, of course, is exactly what iMedix claims to have done. Essentially, the site aims to put users in immediate touch with others who share similar medical or health interests, allowing them to chat in real time or send personal messages back and forth. It then aims to tap this community to improve its parallel health-info search service, inviting users to rate the sites returned by each search with a thumbs-up or a thumbs-down.

All of which is fine in broad outline — it’s the execution that leaves something to be desired. The iMedix opening screen is a fairly bare-bones affair (click on the image at left for a larger screenshot), offering a search bar and a list of “getting started” community options for finding your iMedix “friends,” seeing who’s online, and checking messages. It’s certainly a different approach from the crowd-the-page-until-it-groans tack that some online-health sites take, but information-packed it’s not.

The meat of the site lies in its online community, which users are encouraged to join by creating a profile, choosing an avatar and inputting their medical interests and any other personal information they care to share. A “People” page shows an array of other users and their profiles, each of which gives you the opportunity to initiate conversations and trade information. The effect, though, is a bit unsettling — it’s like looking at a wall of mugshots, all representing individuals pleading with you to chat with them or send them messages.

Of course, the moment you sign up, you’re up on the wall as well, unless you explicitly choose to change your setting to “offline” or “invisible.” The exposure can be immediate — within minutes of establishing my profile, I’d already received a message from a self-described Israeli biotechnology student who wanted to tell me all about a new “business initiative” that sounded suspiciously like a weight-loss scheme. Unlike other community sites, there are no online forums or any other way to take in or share info with others in a group — here, it’s all one-on-one. Whether this sort of thing works for others is a matter of individual preference, but it’s a little creepy for my taste.

iMedix is also fairly insistent about getting you to input as much personal information as possible. A progress bar at the top of the screen measures the “completeness” of your profile, and the site frequently asks if you’d like to add more information to your profile — for instance, after completing a search on some topic. Of course, this is all pseudonymous, but I can’t help wondering whehter people are really going to want to let their personal health interests, coupled with their age and location, hang out for everyone to see.

The site’s search function (see screenshot at left) has a few interesting gimmicks, most notably an autocomplete function that’s surprisingly good at filling out complex medical terms. The quality of search results, at least on rarer conditions, however, leaves something to be desired. I looked up Fabry disease, a rare congenital disorder, and the first entry returned was this almost information-free page. Google, by contrast, popped up a helpful resource page on the condition from the National Institutes of Health. The search function doesn’t seem to cope particularly well with symptoms, either — a search for “stabbing chest pain” returned a pair of forum posts from other sites instead of anything helpful. Supposedly user input will help hone the search results, but there’s little evidence so far that it’s had much effect.

Which is, perhaps, a little unfair of me, since iMedix only officially launched on Dec. 10. It’s entirely possible that the community features will prove wildly popular and the search results will skyrocket in quality. We’ll have to see, but so far, the hype over the site — such as its nomination for a “best new startup” award in the Crunchies — seems premature. Among other things, I found it odd that despite having what iMedix co-founder Iri Amirav told me were “thousands of users,” the site never displayed more than a dozen as being online at any given time.

Actually, the more I think about it, the stranger this site seems. In effect, iMedix users have only two sources of information — the intermittently useful search function and individual conversations with other users. Now, some of these people may be great resources — I didn’t have the time to chat with them to find out. The effect, though, is to give the site a conspicuously information-deprived feel. Some of this may simply reflect the fact that iMedix was founded by two Internet entrepreneurs with no medical or healthcare background at all. The company does claim to have an advisory board consisting of “strategic investors, successful internet entrepreneurs, information retrieval specialists, artificial intelligence professors and medical experts,” but it’s not exactly encouraging to see the medical experts listed last there.

The other mystery about iMedix is exactly how it plans to make money. Amirav says the site is exploring options for advertising — it already runs a few inconspicuous Google Adsense ads — but to call his plan “vague” would be an insult to vague plans. (It amounts to something like: Online health is a big business that’s growing quickly, so we’ll build out the site and advertisers will flock to us.) Of course, advertisers might be interested in aggregated data from iMedix users, but Amirav was adamant that the site will never share any user information with anyone, and implied that would include anonymized, aggregated data. That’s certainly a plus from the user perspective, assuming iMedix actually holds the line there, but it’s not at all clear how you sell advertising against an undefined, monolithic community.

All that said, iMedix is still very much in flux, and will undoubtedly continue to grow and change in response to feedback as long as its funding holds out. It’s certainly different, although whether that’s a good or bad thing remains to be seen.

UPDATE: So iMedix won a Crunchie for “best new startup.” I’m still not a fan, at least in its current incarnation.

UPDATED: See below. Also, this is now part one of a two-part post; for the second part, which actually reviews the HealthVault service, click here.

Microsoft has finally unveiled its first stab at managing personal health records on the Web, and it’s an interesting, if underwhelming, attempt to realize a future in which individuals have much more control over their personal health information.

Called HealthVault, the Microsoft offering combines yet another healthcare-info search engine with the record-storage application itself. Both are very clearly Microsoft products, with all the clunkiness and user inconvenience you’ve come to expect from the Redmond giant.

For starters, to use any of this you apparently have to give up Firefox, and possibly any other browser alternative to Microsoft’s own Internet Explorer. For instance, the search engine, dubbed HealthVault Search, doesn’t seem to want to display results in Firefox (click the upper image at left to see it full-sized).

Viewed in IE, however, the page displays perfectly. (In the lower-left image, I’m using IE Tab, a Firefox extension that renders pages using the native IE engine).

To be fair, the Firefox version eventually does display the same information a scroll or two down the page, past the field of hypnotic green boxes. But this is still an inauspicious sign.

Once you can see it, the information provided by HealthVault search seems generally well organized, with a few exceptions. The display is somewhat reminiscent of RightHealth.com, which I reviewed here, although a bit cleaner if less comprehensive. Searching on conditions like “heart disease” or “diabetes” returns a set of organized links grouped under heading such as “personal health,” “conditions,” “procedures,” “drugs” and so forth. One major omission, however, is anything pertaining to symptoms, so if you have chest pain and jump straight to “heart disease” on this engine, you’re not going to find what you’re looking for. For that, you need to search on “chest pain.” While this makes sense in a logic-chopping sort of way, it almost certainly doesn’t map onto the way ordinary people are actually going to use health search. Surely it makes more sense to cross-index such info six ways from Sunday just to make sure people can find it when they need it.

The search results also pop up a major article on the subject from sources such as the NIH, Wikipedia or the Mayo Clinic, as well as a series of Web links via MSN search and some sponsored links that are clearly identified and in many respects even helpful, such as a widget that proffers related books on Amazon. Overall, it’s a decent effort if not exactly a knockout, particularly given that Microsoft is on more of an even footing with other startups in this area given its historical difficulty driving traffic to its Live.com service in the first place.

And small wonder, for when I try to get a look at HealthVault medical records, I’m immediately plunged into Microsoft Hell. My first attempt to create a HealthVault account forces me to register a Live.com account, which in turn wantsrequires me to divulge a bunch of personal information (birthdate, gender, occupation, industry, state of residence and Zip code) to MSN for no particularly good reason. It also asks for my marital status and the number of children in the household, but fortunately both questions are “optional.”

Then we get to HealthVault itself, which doesn’t consider my Live.com password strong enough and asks me to change it to something harder to crack. There’s a link to click for advice on how to do this, but clicking it somehow causes the site to resize my entire browser window to a narrow bar on the right-hand side of the screen. (The help file that opens there also doesn’t actually contain any advice on making a strong password, just standard FAQbait on what to do when, say, you forget your Live password — an option I’m already strongly considering.) I’m actually kind of bewildered here — you’ll just have to take my word when I say that I worry a lot about password security and that the one HealthVault is rejecting involves a mix of alphanumerics and in no way, shape or form resembles any word or phrase in English or any other language.

Aha. Turns out the FAQ does have the info I was looking for — buried in a link under “How to change your password.” You can see it here, assuming that link actually works. (I was only using lowercase letters and numbers.) I can’t blame Microsoft for wanting individuals to feel their medical info is safe, but this quickly runs into the central paradox of password security, which is that if you make the requirements too stringent, people won’t be able to remember their passwords and will jot them down on a Post-It, which is not exactly the most secure medium in the world.

With the addition of a capital letter or two, my password is in business. Or so it seems until I try to actually log in with it, at which point the site refuses to recognize it. I go through the password reset process, and it dings me because a new password can’t be the same as the old one — which would seem to imply that it should actually recognize the old one, right? No dice — the login page still barfs on me. So I change the password and finally the site logs me in. If Google gave users even a fraction this much trouble, it would be lucky to be worth $180,000, much less $180 billion.

But it’s not over. I answer a few more personal questions (name and birthdate, mostly) and then get an error page: “Could not return to program: The location information is missing for this program.” Well, that’s charming. Oh, it turns out I haven’t yet validated my e-mail address for either Live.com or HealthVault. A few moments later and I’m finally in.

At this point, I think I’ll cut my losses and review HealthVault itself in a separate post, which I’ll link here when it’s up. (UPDATE: My review of HealthVault and some overarching issues about personal medical records is now up here.)In the meantime, the NYT and the WSJ have more on the background of all this.

UPDATE: Description of search engine expanded considerably.

UPDATE REDUX: I descend into Microsoft Hell in order to establish a HealthVault account.

FINAL UPDATE: Added a link to my HealthVault review.