Since last year, the Palo Alto, Calif.-based health startup has given users a platform for connecting with a network of more than 12,000 doctors nationwide, who provide written answers to medical questions for free via desktop and mobile apps. On Thursday, the company is announcing several significant updates to its service, including the ability to privately message specific specialists for a small fee.

“We’re bringing the house call back,” said co-founder and CEO Ron Gutman. “We’re connecting you to physicians in the convenience of your home, office [or] coffee shop. We’re connecting you with a real person who’s knowledgeable and accessible.”

As healthcare moves online and to mobile devices, Gutman said, HealthTap wants to be the trusted network for providing immediate access to reliable health information. “On the Internet, every headache becomes a brain tumor in four clicks or less,” he joked. A growing number of companies, including startups like Meddik and Symcat) are trying to provide people with better health information, but HealthTap’s bet is that people will still want to consult with real doctors, not just data-driven algorithms.

And consumer health is a space Gutman knows well. As a graduate student, he led a personalized health research project that ultimately became a university-implemented health and well-being program for employees. Prior to HealthTap, he was founder and CEO of health 2.0 site WellSphere, which was later acquired by HealthCentral. The company has raised nearly $14 million from investors including the Mayfield Fund, Mohr Davidow Ventures, Eric Schmidt’s Innovation Endeavors and angel investors Esther Dyson and Aaron Patzer, founder and former CEO of Mint.com

‘DocScore’ rankings help patients find most relevant doctors

With the new app, users can continue to pose anonymous questions to the general network of 12,000 doctors for free. Or, they can use the app to search for a specific doctor in one of 112 specialities (and in their location, if they want) to ask a question via a targeted private message. Along with the doctor’s name, specialties and other information, the service will indicate a doctor’s immediate availability. If a green dot is displayed, it means the patient can send the doctor a private, HIPAA-secure message, which can include images, lab tests and other records that could give the doctor a better window into the patient’s condition.

HealthTap charges users $9.99 for one message (plus a clarification message if they don’t understand the doctor’s reply). If they want to continue the conversation, the app charges an additional $4.99. (The app also allows doctors to distribute promo codes, which can allowthem to consult with current patients through the app or develop relationships with new patients.)

The price might sound steep for a text message, but compared to seeing a doctor in person, it’s cheaper and much more convenient. According to HealthTap’s research, the average co-pay is $29, and a 2009 survey of family physicians found that the average wait time to get an appointment can be 20 days. For the one-quarter of doctor visits that are mainly informational Q&A sessions (according to HealthTap figures), the company’s service is a compelling alternative.

HealthTap is about information, not practicing medicine online

Gutman says HealthTap’s intent isn’t to migrate the practice of medicine to the Web but to give people better access to quality health. For example, unlike Ringadoc, a recently launched startup that enables video chats between doctors and patients, HealthTap doctors won’t prescribe medication or diagnose conditions. Startups providing tele-health services are constrained by some state medical boards, so they tend to operate only in certain states. HealthTap’s focus on education might also make the platform more attractive to doctors concerned about liability issues.

In addition to the private messaging and micropayments features, HealthTap rolled out several features today. Here are a few more interesting ones:

• The ‘DocScore’
  To help patients find the most relevant doctors in HealthTap’s network, the company assigns each doctor a ranking based on publicly-available information (for example, their medical school, residency, number of years in practice, and other data points), as well as the reviews of other doctors on the site. As doctors respond to anonymous patient questions, their HealthTap peers can weigh in to “agree” or “disagree,” which can increase or decrease their overall ranking on the site.

•  The ability to follow specific doctors to get personalized information
  To keep up with information most specific to their concerns and conditions, patients can follow the comments of specific doctors on the site, as well as topics and questions they care about.

• A secure digital health file
  As patients correspond with doctors on the site, HealthTap archives the information securely and privately. Users can also use the site to store information not exhanged on the site (such as test results, vaccination records, etc.) At any time, the company said, users can transfer the information.

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Two weeks ago, a small green box showed up in my mail. Inside was a “spit kit” my wife had ordered me from DNA sequencing startup 23andme. Within a few minutes, I’d completed and returned the sample. In a few weeks, I’ll be able to analyze my DNA online. What if I find something I don’t like?

Thanks to technology, such diagnostics are now within the reach of consumers. As more people test themselves, doctors and insurers may face the additional burden of just-in-case surgery and a “previvor” mentality. So, will technology cure health care, or kill it?

Normally, doctors prescribe tests when patients report symptoms. Occasionally, the U.S. Preventative Services Task Force decides to recommend blanket testing, particularly for diseases that are hard to detect until they’re fairly advanced. Sometimes the task force actually recommends against testing, partly because treating the condition is unlikely to prolong life. But increasingly, we can ignore their advice and just test ourselves.

The cost of diagnostics is dropping fast, particularly for DNA. 23andme’s service recently fell from $999 to $399. “We always knew the technology cost would drop,” said Linda Avey, the company’s co-founder. “The decline in genotyping costs surpasses that of Moore’s Law.”

Testing can get as low as $60, as Familybuilder recently showed. Founded in 2007, the company received a $1.5M Series A funding from DN Capital in February 2008. While the company only analyzes enough DNA to trace genealogy, it stores the raw samples for two years, so CEO Ilya Nikolayev hasn’t ruled out the possibility of selling additional analysis to customers in future.

By slashing prices, DNA-testing companies hope to build big databases of customers’ DNA sequences. For Familybuilder, this means more chances to find its clients’ relatives. For 23andme, it means better research. “It’s about getting statistical power,” said Avey. “As we get enough people with a certain phenotype, we can get them to enter data on when they contracted the disease and what drugs they’re on, and we can do genome-wide studies.”

But will widespread diagnostics increase the burden on healthcare? Somewhere between 10 and 50 percent of autopsies reveal diseases other than the one that killed the patient. If consumers test themselves, then tell their doctors, the medical system could wind up treating 50 percent more diseases than it does today — even those that wouldn’t have killed the patient.

Avey believes some patients will want to get tested for everything, but says she hopes that their doctor will be there to talk to them about it. “The data isn’t that definitive. Your risk [of having a disease] might be 12 percent, someone else’s 8 percent,” she points out. Understanding these finer points of diagnostic analysis is something medical professionals are trained to do, and a skill most of us lack.

DNA testing has also raised concerns that insurers or employers might use a person’s knowledge of genetic conditions against them, but recent legislation makes this illegal. According to Avey, the Genetic Information Nondiscrimination Act, passed in May, says that if you know about your genetics, your insurer and employer can’t discriminate based on that knowledge. The FDA is watching consumer diagnostics closely: It recently sent a warning to Laboratory Corporation of America that one of its customers, Ovasure, is illegally marketing a DNA test for ovarian cancer without the administration’s approval.

Anne Wojcicki, co-founder of 23andme and wife of Google co-founder Sergey Brin, says she thinks widespread DNA research will help, not harm, the medical system by encouraging prevention. “17 percent of [U.S.] GDP goes to health care but we need a radical change,” she said. “We are a country that has really been focused on reactive care; now, we’re at an inflection point where we’re transitioning to a preventative model.” She points out that DNA research can also improve treatment by showing which medication will work best for a particular genotype.

Advances in technology may well strain the healthcare system. But in the end, they may also be our best hope for fixing it.

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