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

health-20-conference-logo.gifThe 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

myca-logo-150px.gifIn 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.)

The visual display is part of a service Myca calls Hello Health, which it intends to roll out in May. Hello Health goes well beyond making a patient’s medical history more intuitively comprehensible — it’s essentially a support package for doctors who want to adopt Parkinson’s prepaid service model, which might entail a monthly subscription fee of $15 or so and per-visit charges for house calls and chats via email, IM or Web video. (Parkinson describes it more fully here.)

This sort of model raises any number of questions, starting with Parkinson’s own preference for treating patients under 40, who of course tend to get sick far less often than older folks. (In that WSJ item, Parkinson even says it strikes him as “somewhat sick” that some doctors find “occupational joy” in “chasing someone’s chronic disease.” I can’t help wondering how many 38- and 39-year-old patients the good doctor has, and how they’ll react when he drops them the day they turn 40).

Another big issue is whether this sort of service, which has definitely struck a chord among people disaffected with traditional medicine and insurance, amounts to a kind of “cherry picking” that might pull younger, healthier people out of insurance plans and thus drive up costs for the older, sicker folks who remain in them. But these are subjects for another day.

(UPDATE: Parkinson replies — twice! — in comments.)

Buy healthcare direct and save!

carol-logo-150px.gifAnother radical idea comes courtesy of Carol, a site that aims to be the shopping mall of medical procedures. The service, which for now is only available in the Minneapolis-St. Paul area, basically lets you compare prices for “care packages” ranging from alcohol-addiction treatment and CT scans to hernia treatment and evaluation of rectal bleeding. (Here’s a link to the complete range of offered packages, although it might not work thanks to the fact that much of the site appears to be displayed in what looks like Flash animation, oddly enough.)

On one hand, this is a welcome innovation. Medical pricing has long been a black box, as I noted here, and with more people being pushed into “consumer-directed” plans that saddle them with financial responsibility for their own care, knowing what procedures cost at various hospitals or clinics is essential information.

On the other hand, there’s something just a bit chilly about Carol’s notion of the “medical marketplace” — an approach that essentially turns doctors into hired contractors, and which also assumes that consumers already know what’s wrong with them and have only to put out a bid, metaphorically, for the best deal. Still, it’s definitely an innovative approach, although I question just how popular it will end up being, particularly for chronic conditions such as diabetes, where the doctor-patient relationship can be especially important in tailoring treatment to the individual patient.

It’s also worth noting that Carol frequently offers only one provider for many of its packages, so your ability to “shop” remains somewhat limited until the site negotiates further deals with other clinics. Still, CEO Tony Miller argues that the startup did an analysis of over one million insurance claims and concluded that fully 70 percent of them involve medical treatment that is “plannable and shoppable.”

Carol plans to expand to Seattle in the fall. The name, by the way, is a play on the conventional wisdom that most people seek healthcare advice from people they already trust — from “Carols,” that is, who know how to work the insurance system or how to find a relevant specialist.

Reach out and chat with a doc

If it takes you weeks to see your doctor and he won’t come to the phone, you might welcome the opportunity to chat with a medical professional online, or even to see if a Web-enabled doctor can diagnose your mysterious cough or nagging pain. If so, then two Health 2.0 startups have a proposition for you.

organizedwisdom-logo-150px.gifOrganizedWisdom already has an established presence in Health 2.0 with its “human-powered” medical search engine, a Mahalo-like attempt to bring expert attention to search requests. The startup essentially lets people search through precompiled “wisdom cards,” each vetted by medical experts, that list reliable resources on diseases and drugs along with recent news headlines, treatment alternatives, support groups and message boards, and research findings.

OrganizedWisdom now plans to supplement that information with a new service it calls Live Wisdom, in which anyone can chat online with a medical professional for $1.99 a minute. CEO Steve Krein demonstrated what he described as an actual chat between a patient just diagnosed with laryngeal cancer and a doctor, in which the two discussed treatment options and probable outcomes — and even the physician’s response when the patient asked, “Am I going to die?” (The cure rate for an early-stage cancer turns out to be pretty good, the doctor replied.)

Live Wisdom doesn’t aim to replace actual doctor appointments. Instead, the startup views these chats as “a dialogue about educating the consumer” in which its experts are careful not to make diagnoses or take any other action that might constitute practicing medicine (and thus potentially run afoul of state law).

american-well-logo-150px.gifNot so American Well, which is happy to bring an updated form of telemedicine into the Internet age. Patients can — eventually, at least — click through the site view profiles of physician specialists, select the one they want and then talk via chat, phone or Webcam. The company will match individuals with doctors in their state to avoid legal issues, and at the end will package up the results and doctor’s notes for transmission to the patient’s primary-care physician.

American Well hasn’t disclosed what the chats will cost, at least to the best of my knowledge. Since the doctors will be free to make diagnoses or to suggest treatment — but not to prescribe drugs — it’s possible that this sort of service could be more useful than Live Wisdom, especially if the docs are willing to probe more deeply into a patient’s problems.

At the moment, though, American Well’s Web site is one of the most annoying I’ve encountered in a while. Although it offers “Talk to a Doctor Now” as a front-page option, that link just takes you to a series of pedantic animations accompanied by an inescapable voiceover that explains the service. If there’s a real pony in there, American Well hasn’t dug it out yet.

(UPDATE: Turns out that’s because American Well mostly hasn’t bothered to explain itself very clearly. CEO Roy Schoenberg expands on the company in comments, noting that consumers will be contacting physicians through their health plan — meaning, among other things, that those without health insurance are probably out of luck. American Well doesn’t appear to have actually struck any deals with health insurers yet. Schoenberg adds that physicians will be able to prescribe medications over the Web, although somehow I doubt that freedom will extend to Schedule III narcotic painkillers.)

Minimizing drug-interaction side effects

pharmasurveyor-logo-150px.gifFile this one under “Services you never thought you’d need — but actually might someday.” PharmaSurveyor has built a thorough database of all the known ways different medications can foul each other up and lead to gruesome side effects, and now is set to provide it as a free service to individuals.

The company says current drug-interaction checkers miss many ways in which drug cocktails can interact, and doesn’t pull punches in making its case. CEO Erick Von Schweber excitedly told the conference that 18,000 people die each month from “adverse drug reactions” — or, as he put it, the equivalent of a major air disaster six days a week, a 9/11 scale terrorist attack, the sinking of two Titanics, three Katrina-sized hurricanes, two tornadoes and a flood. (The company’s site doesn’t give a source for its figure.) PharmaSurveyor distributed cards to the audience with photos of Heath Ledger and Anna Nicole Smith, noting that their drug regimens were supposedly free of dangerous interactions — and yet killed the celebrities anyway.

The startup soon plans to take the analysis a step further by suggesting alternative medications that might lower the risk of serious consequences. PharmaSurveyor will soon open its “regimen checker” to the public, and plans to offer the “alternative drug” analysis later this year. The service will be free for individuals and supported by advertising; PharmaSurveyor will charge companies who would like to integrate the service into their own data offerings.

Throw away those patient clipboards

phreesia-logo-150px.gifWe’ve previously covered Phreesia, a startup that offers doctors free tablet computers that handle patient check-in questionnaires, here. The basic idea is this: The three-pound tablets replace the dreaded clipboard full of forms, automating the process so that returning patients don’t have to fill out the same forms again and again and double-checking answers to ensure that no one has skipped important questions or given inconsistent information. The device even allows doctors to incorporate survey questions in order to get a better sense of their patient population. (It transmits the data to a server, where it can be incorporated into electronic medical-record systems or printed out.)

The catch is that the device eventually displays patients a sponsored “educational” message — one provided, of course, by drug companies eager to extend their brand awareness. Doctors can review these sponsored infomercials and reject individual “messages” if they want, although you have to wonder how many harried doctors are going to bother. (The infomercials are also supposed to be tailored to patients’ biographical data, interestingly enough.) Meanwhile, the device gives drug companies one more entree into the physician’s waiting room, just as the AMA and other authorities are starting to try — so far, without a whole lot of success — to push them out.

The Phreesia device is certainly nifty — I was able to try one out at the company’s exhibition booth, and while it was heavier than I expected, it was perfectly easy to enter my (fake) information and to flip through the medical-history questions. The sponsored page in my demo looked innocuous enough — it warned me about the dangers of high blood pressure — but of course it was sponsored by Novartis, maker of the hypertension drug Diovan, whose logo appeared twice on the lower left-hand-side of the page.

It’s a neat enough idea, but I’m still unconvinced that Phreesia’s tradeoff of digital convenience for a disguised form of pharmaceutical advertising is worth it — or that it won’t one day run afoul of gradually tightening restrictions on the promotions drug companies have long offered doctors.

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