BIG IDEA
Health Care Is Social
Is the crowd smarter than your doctor? Just possibly.
"Five of six doctors will say that diet doesn't play any role in Crohn's disease," says Sean Ahrens, the 26-year-old co-founder of Berkeley, California-based Healthy Labs, which runs Crohnology, an information-sharing platform for people with the inflammatory bowel condition. "But talk to 300 patients, and 99 percent will say that diet plays a major role. That's one example of the disparity between what doctors and patients know."
Who's right? By combining social networking with a powerful analytics platform, Ahrens aims to find out. Web forums focused on chronic medical conditions, of course, are nothing new. But Ahrens, a Web developer who previously co-founded a Y Combinator social-messaging start-up called Message Party, is committed to building a platform that's more than a collection of unvetted "what worked for me" anecdotes. "You don't just listen to what people think is working," says Ahrens. "You have to make the wisdom of the crowd smarter."
Crohnology does that with software that allows users not just to track their diet and treatments but to correlate these things with their actual symptoms over time. As more users input their data, Ahrens believes, Crohnology will become the go-to destination for information on treatments that remain ahead of the curve for mainstream medicine. "I think of anecdotes as raw data that the medical system has run away from," says Ahrens, who was found to have Crohn's at 12. "There's a lot of power in there that we haven't invested in."
Another peer-to-peer health start-up, PatientsLikeMe, which launched its first online community in 2006, has raised $15 million in venture funds and generates revenue by selling patient-reported data to pharmaceutical companies and medical-device makers. But Ahrens, who launched Crohnology in mid-2011, is taking a cautious approach to monetization. "To maintain the independence of user-generated content, there are a lot of reasons to avoid ads," he says. The company is designing a clinical study in partnership with the Mayo Clinic; the University of California, San Francisco; and the Kauffman Foundation to determine if patients using the Crohnology platform experience improved outcomes and reduced costs. If they do, says Ahrens, "it will give us some evidence to stand on, and hopefully open up health care providers to, in a sense, prescribe our software as a treatment and for insurers to cover it."
Ahrens also anticipates versions of the Crohnology platform for other chronic conditions. Autoimmune conditions, like multiple sclerosis, affect 50 million Americans, and mental conditions such as posttraumatic stress disorder, depression, and panic attacks afflict another 50 million. "Almost all chronic conditions are hidden," says Ahrens. "They create a pent-up need to connect. In a world where disconnection from other patients is the norm, I think there's a compelling case for technology like this."
BIG IDEA
The House Call Makes a Comeback
A computer screen becomes an exam room.
You talk to your loved ones via Skype and other online networks. Why not doctors? In fact, plenty of ailments can be diagnosed online. "Consumers are looking for different ways to interact with physicians--modes that are more convenient and that don't require going through the traditional calling and scheduling," says David Wong, a dermatologist and a co-founder of Direct Dermatology in Palo Alto. Dermatology, he adds, is a perfect match for telemedicine. An image captured by the camera on a mobile phone or any point-and-shoot camera, he says, can allow accurate diagnosis of a rash, acne, or a suspicious growth.
With no appointment, Direct Dermatology customers can simply upload photos of a skin condition or rash and receive a timely response from one of the dermatologists in the network--as well as any necessary prescriptions or referrals to local specialists--all for an $85 fee (insurance reimbursement is limited at this point). Launched as a service for primary-care doctors, Direct Dermatology debuted a direct-to-consumer service in mid-2012.
Whatever happens with health care reform in Washington, Wong says, "the trends point to a larger place for telehealth in preventive care, early detection, and to deliver care more efficiently at lower cost." Telemedicine can also provide access to people who might not otherwise get care at all, like the farm workers Wong and his co-founder, Rajnish Gupta, used to drive an hour and a half from their Bay Area offices to see. "We'd diagnose patients with melanoma at a late stage because they couldn't get in to see a dermatologist," Wong says. "We can be so insulated from what kind of health care is really available for most of us--with telehealth, geography shouldn't be an issue."
Ron Gutman, CEO and founder of Palo Alto-based HealthTap, an online health-information platform, is tackling access and cost problems another way: by putting an army of doctors at consumers' beck and call, online, all the time, free. Since launching a beta version last May, HealthTap has enlisted nearly 15,000 physicians across the country to answer questions submitted on the site. "I'm surprised how quickly we get answers from some of the best doctors in the country, people you'd wait four months to schedule an appointment with," Gutman says.
What motivates them? Apart from altruism, says Gutman, doctors use the site to "create and build a reputation among patients and peers in a safe environment where you're not exposed to liability." (Gutman worked with insurer Lloyd's to design special coverage for participating docs.) HealthTap checks that participating doctors are licensed and in good standing, and, uniquely, offers a peer-review feature that lets physicians on the site rate one another's responses. Algorithms direct users' questions to appropriate specialists, who can post responses at their convenience.
A new premium service lets users send a question to a particular doctor, and have a private online conversation, for about $9.99 per transaction. That's a lot cheaper than an office visit--and in many cases, it's all you're going to need. "Americans spend more than half a trillion dollars on visits to the doctor, and about 25 percent of those are just Q&As," says Gutman. "Why can't you do it from the iPhone or iPad instead and save yourself half a day and all the hassle?" In December 2011, HealthTap nabbed $11.5 million in Series A funding from a consortium of investors led by the Mayfield Fund.
