Starting Thursday, on top of searching for nearby doctors and booking appointments online, users of the site will be able to use ZocDoc Check-In to fill out medical forms on the Web. The product, which the company said was the most-requested feature by patients, is free for patients and is no extra charge for doctors already paying to be listed on ZocDoc.

Check-In not only stands to save time for patients planning an immediate visit (it means no more arriving early to scribble your medical history on a clipboard full of forms), it extends that convenience to future appointments booked on ZocDoc. The platform securely saves the information and will pre-fill forms when a patient schedules appointments with other ZocDoc doctors. If that doctor needs new information, the patient can add it to her profile and check in again. At launch, the product will be available to 10 percent of users on the site and expand over the coming weeks.

Despite past resistance to digital records, patient response seems positive

Digital health records have become an increasingly big topic, as the government pushes medical providers to be able to exchange patient information electronically. But, as surveys and history indicate, patients have been hesitant to share their medical information online.

Dr. Oliver Kharraz, ZocDoc co-founder and COO, said that while patients have been reluctant to submit information on insurance websites, Google Health (which is now shut down) and other platforms, early testing with Check-In has been positive.

“For us to be a trusted partner in maintaining this information is very important to us,” said Dr. Kharraz. “This has been a tremendous success with the patients we’ve offered this to because of the experience they have with us and the general orientation of the company in putting consumers first.”

That orientation is clear in the sheer efficiency of booking on the site, as well as in the company’s policy of sending Amazon gift cards to patients who have a doctor cancel on them. And, as the company moves into the more sensitive area of patient information, that goodwill will serve them well.

ZocDoc as a ‘GPS for health’

In the five years since Kharraz and CEO Cyrus Massoumi launched ZocDoc, other startups, such as HealthTap and BetterDoctor have also started to provide services that help patients discover doctors and schedule appointments with them (among other services). But ZocDoc’s platform is tightly integrated with doctors’ scheduling systems and is very expansive, reaching 1.8 million people a month and available to book appointments with healthcare providers in 31 major metropolitan areas.

For ZocDoc, which has raised $95 million and has been valued at $700 million, the new Check-In feature points to a future in which the platform becomes a central hub for all kinds of patient information and interaction.

“We just want to help you navigate health – to use ZocDoc and the information stored there as a GPS for your health,” said Dr. Kharraz.

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Screenshot of Doxo healthcare (click to enlarge)

Doxo, the Seattle startup that makes “digital file cabinet” software, has thus far focused on giving users a single place to manage regularly occurring bills for services such as telephone, cable, and credit cards. But now, the company is taking on a much bigger and more complicated system: Healthcare.

Doxo is announcing Friday that a number of major healthcare provider systems have signed up to send medical bills and receive patient payments through the online service. According to Doxo, its new clients comprise 40 hospitals and 3,000 physicians, and include Saint Luke’s Health System, Advocate Health Care and Advocate Medical Group, Novant Health, Northwestern Memorial Hospital, University of Illinois Medical Center, Rockford Health System, and Rush-Copley Medical Center.

It’s a big coup for the Doxo, which was founded in 2008 and launched its service to the public in mid-2011. The company has raised $15.3 million in venture capital from Sigma Partners, Mohr Davidow Ventures and Amazon CEO Jeff Bezos’ VC firm, Bezos Expeditions. Doxo is free for consumers, and the company charges the businesses who sign up to send bills through the service. According to Doxo CEO Steve Shivers, companies pay for the service because it saves them a significant amount of money compared to paper billing — and the healthcare space can especially benefit from this type of savings.

“Hospitals send invoices to patients three times, on average, before they pay it,” Shivers said. “So for a $10 copay, they’re spending $10 to $15 just to collect it. This is an industry that has runaway costs, and from a consumer standpoint there’s runaway complexity.”

But of course, it’s not easy to convince complex, entrenched industries like healthcare to try something new. That’s why it’s a big deal for Doxo to have inked these initial contracts. The hope is that after this initial batch, many more healthcare providers will be emboldened to sign up to do paperless billing through Doxo, Shivers said.

“Since we launched to the public last summer, the first providers we really signed up were what I call more conventional categories like banks, credit unions, alarm systems,” Shivers said. “But healthcare has been one of most important verticals for us to get into. We have these six providers signed up now, but the healthcare industry is huge. This is just the start.”

I think it’s a great move: The time for healthcare to really adopt technology is right now, and going paperless is a great first step toward that goal. Many health providers have websites that patients can create profiles for, but the reality is most people don’t go to the doctor enough to create a log-in ID and remember a password. So we end up getting paperwork sent in the mail that often goes ignored, since many of us prefer to do our bills online. It’s a big cycle that ends up creating stress for consumers and costing healthcare providers lots of money. There’s a big opportunity here, and it’s nice that a startup like Doxo is gaining a good foothold in the space.

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Apple has a medical market manager, Afshad Mistri, who was profiled by Wired in a feature on Monday. Mistri is rare because he has a specific type of business to sell to: health care. Mistri is behind the dedicated iTunes store section for professional health care apps, has organized conferences on how to use the iPad in medicine, and is known to make house calls for medical professionals hoping to set up their organizations with iPads for use in treatment and patient care.

We have talked in the past about how iPads can help hospitals and doctors modernize their record-keeping systems. A program instituted in July offers doctors incentives for using electronic medical record (EMR) software on the iPad, and during our recent RoadMap conference, MIT Media Lab’s director of new media medicine, Frank Moss, said that “everyone’s got an iPad” at the nation’s leading medical schools these days.

Much of the iPad’s use in medical settings so far has been in the form of pilots and trials, but it’s getting ready to take off in a much bigger way. The Veteran’s Administration in the U.S. is looking at rolling out as many as 100,000 tablets across 152 hospitals, says Wired, based on the success of the 1,500 trial iPads it currently has in use. Over 80 percent of U.S. hospitals have similar trials in place, according to recent comments made by Apple CEO Tim Cook, which means that many more could soon take the plunge, resulting in a huge uptick of orders from medical organizations for the generally consumer-oriented device.

IPads can help on both sides of the stethoscope. For patients, they can act as a source of entertainment, providing a way for those who are bed-bound to escape their situation and just browse the web, play games or watch a movie privately and in comfort. Doctors can use them to consult more easily while out of office, and they increase the likelihood of uptake for EMR programs, since they make such records convenient and accessible, instead of a chore tied to a stationary desktop.

Apple’s iPad is a hit with consumers, that much is certain. But its success in health care, which, due to the slower nature of institutional adoption is only now beginning to become significant, might be the key to its remaining the king of the tablet heap. Apple can offer apps, security and a uniformity of experience both within and between medical organizations that Android devices can’t match; if the iPad becomes a tool young doctors just can’t live without, as it already appears to have become in many ways, it could be the go-to slate for healing hands for decades to come.

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Sprint has partnered with AirStrip Technologies to bring remote patient monitoring to the physician using Sprint 4G-capable smartphones. AirStrip produces a suite of monitoring apps that provide real-time access to hospital patient monitoring equipment, giving caregivers direct access to patient’s vital signs remotely. The system displays patient information on the doctor’s smartphone, allowing for instant analysis.

The Sprint system works on the two network smartphones that have 4G capability: the EVO 4G and the EPIC 4G. There’s an app for physicians in OB/GYN that provide fetal monitoring and tracking of labor during childbirth, an app for cardiologists that displays ECG information (both real-time and historical), and an app for critical care physicians. Patient information is not stored on the smartphone, so confidentiality is maintained at all times.

The system is deployed at the hospital level for access by staff physicians. The apps have received FDA approval and are HIPAA (Health Insurance Portability and Accountability Act) compliant.

Image credit: Business Wire

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Verizon’s not the only company to see potential gold in medicine. Google has a similar pilot project that I wrote about in 2008, and other technology firms such as Intel, Cisco and Microsoft are hoping that both doctors and patients will become more comfortable integrating technology and broadband into medical care. As part of a push to put medical records online, the Obama administration yesterday made it easier for doctors to access incentive programs that could result in $27 billion in spending over the next 10 years.

Patients would benefit as well, as long as medical records remain private — not just from folks looking to nab some social security numbers, but also from companies looking to market to people with medical conditions and discriminate against them on the basis of their health. About a year ago when my daughter broker her leg, I wrote about the experience, noting that I had to carry her X-rays around with me on a DVD and hope that the doctors I visited were able to read the data.

Solutions, such as the one Verizon and Google are offering might help eliminate some of those problems, although I imagine the turnaround time on uploading those images to the Verizon cloud and then seeing them on the ER computer would be longer than the 30-minute drive. Plus, we’d have to have better connectivity at the hospitals and doctors’ offices in order to shunt the terabytes of medical data around the network.

But by delivering what is essentially medical records as a service for hospitals and physicians, Verizon is not only trying to get a chunk of federal money, but also trying to provide the type of cloud service that will fill up its networks. Verizon isn’t using it’s actual cloud computing infrastructure, however, to host the exchange because the multi-tenant nature of the cloud service violates privacy and HIPAA regulations. Other telecom providers are getting into medical records storage as well, with Spain’s Telefonica announcing yesterday that it has created a new business unit focused on e-health solutions.

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It makes sense for Apple to test the waters in non-consumer markets where tablets have found some purchase in the past. The iPhone is making gains in enterprise, and is even used by many doctors because of the low cost and good design of a variety of medical database apps available on the device’s App Store.

Combining that kind of knowledge repository with a device that can replace a clipboard and act as a connected link to the hospital’s central database would obviously be something that might appeal to doctors. It would reduce the need for extraneous devices and trips back and forth from a central nursing station where information is collected and stored, and could conceivably lower wait times and increase patient turnover, an important concern in privatized health care.

Add to that the fact that even at the fairly high price that’s been rumored lately, around $1,000, the Apple slate would be a bargain. Currently, the Motion Computing C5 is one of the more successful devices in the medical tablet space, one that isn’t yet very crowded either. The C5 costs double the proposed price of the Apple tablet, a full $2,000 per unit. Specialized software for the device can add significantly to the overall cost health organizations end up paying for the tech.

If Apple manages to break into the medical market, and other industrial and commercial fields where tablet tech is useful, then the sales projections that have been floating around begin to make sense. One to one and a half million units per quarters seemed like an awful ambitious figure for the consumer market alone, especially for a device that seems to fit a very specific market niche. But imagine interactive exhibits at museums and exhibitions, self-service at retail chains and outlets, and, as we’ve just been discussing, doctors making rounds. In all of the above, an Apple tablet, at $1,000 or less, becomes a very sensible business proposition, especially if it makes use of the App Store platform for software, which should make it relatively inexpensive to source and develop custom applications to suit any and all needs.

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Don Witters, Chairman for the FDA Center for Devices and Radiological Health, gave a presentation at a healthcare IT conference last week during which he suggested that the FDA ought to have some regulatory jurisdiction over healthcare apps developed for the iPhone. His reasoning is that the FDA is responsible for all healthcare monitoring devices, including those that work on mobile phones.

When the issue of FDA-regulated iPhone apps initially came up at the conference, Witters said the iPhone didn’t meet the criteria for a medical device, which he defines as:

“…an implementation, product, apparatus or other component or accessory, which is used in the diagnosis, cure, mitigation, treatment, prevention of disease or effects any structure of the body–that could actually include some information technologies and performance technologies–but usually it’s something that is performed on the patient, touches the patient or is performed between physician and patient.”

Loosely put, a mobile device is anything portable that’s used for diagnosing or treating a patient. Obviously, as a standalone device the iPhone doesn’t meet that definition. While it’s possible to add applications that can assist someone with medical diagnostics or healthcare maintenance, it’s really unlikely that an iPhone app — at least in the near future — would function as much more than a way to keep track of medical information or perhaps communicate with physicians.

At first Witter dismissed the idea that the FDA should be involved in regulating iPhone apps, but he quickly backtracked when questioned further and said part of the reason he was attending the conference was “to begin this dialog and see where [the FDA] fits.”

Now, before anyone gets worked into a frenzy, it’s important to realize that something like this is a long way off — if it ever happens at all. Witter himself admits that he isn’t sure how to go about developing regulatory standards, much less how to assure an iPhone app’s safety and efficacy.

Even if the FDA did get involved, the amount of negotiating that would have to happen with Apple about how to approve and distribute apps is enormous. Once those issues got sorted, then there are concerns over update processes, whether developers would need special certifications in order to develop medical applications, and how they would fit into any mandates President Obama puts into effect regarding digital medical records.

Talk about a can of worms. Given that consumer-oriented health apps developed for the iPhone aren’t likely to create life and death medical situations, it’s unlikely the FDA would elect to get involved in regulating them any more than they oversee similar apps developed for the desktop.

iPhone apps for healthcare workers aren’t a new phenomenon. They’ve been around almost as long as the iPhone itself. Paramedics use software like Life Support 360 to manage patient care algorithms or the native phone features to access patient case histories in the field. Physicians use apps like Epocrates to manage dosing, diagnostics, and other clinical information.

If the FDA hasn’t already gotten involved in regulating existing healthcare apps for the iPhone, I don’t see it happening any time soon. After all, they kind of have their hands full right now. What’s your view on this? Should the FDA establish any sort of regulations or standards for medial iPhone apps? Or should they butt out?

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