The round, which included Siemer Ventures, Telegraph Hill Group and Dr. Lyle Dennis, a neurologist and founder of HealthKeep, brings the startup’s total amount raised to $1.9 million. Previous investors include FF Angel, Practice Fusion CEO and founder Ryan Howard and former president of One Medical Group Sharon Knight.

The startup launched in 2010 as a service for providing on-demand telephone and video chat access to physicians. For $40, consumers could use Ringadoc to connect with doctors anytime, day or night. But earlier this year, in a bid to bring more doctors on to its network, it pivoted to its current product, which targets physicians with an after-hours messaging and phone service.

Typical after-hours messaging services require patients with after-hours questions to leave messages with a non-medically trained operator, who then looks up an on-call doctor and passes the message along. When the doctor calls back, the patient needs to recount her symptoms all over again.

With Ringadoc, patients leave a secure message with a cloud-based answering service that automatically finds the appropriate physician – patients only need to explain their issues once and the cost, Ringadoc says, is cheaper than most existing systems. To date, the company said it has handled more than 100,000 phone calls for physicians.

With the new funding, CEO and founder Jordan Michaels said the company plans to beef up sales and marketing, as well as enhance the product so that it could integrate with other tools used by doctors’ offices, including practice management and electronic health records systems. Since Ringadoc is capturing valuable patient engagement data through its telephone calls, Michaels said, they want to enable doctors to make the most of that functionality.

“We’re tracking a lot of two-way conversations and that’s an important piece of the health care conversation,” Michaels said. “Our vision is to be on the frontline of virtual care for patients.”

For now, the company is focusing on its physician-focused product. But, later this year, he said, it could start expanding to patients and restore the startup’s initial mission of providing on-demand physician access to patients.

Recognizing the need to address the shortage of doctors in the U.S., other companies are also working to streamline physician-patient communication and promote virtual health care. For example, PingMD targets physicians with a mobile app for more efficiently communicating with patients and peers, HealthTap offers consumers a mobile- and web-based service for messaging and querying doctors and Sherpaa works with employers to help patients and doctors connect via video chats and phone calls.

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PingMD, a New York startup, initially launched a few years ago as an app to help digitally-savvy parents communicate with their kids’ pediatricians. But after analyzing how tens of thousands of patients and doctors were communicating during their pilot, they decided to expand their scope. This month, they relaunched their app for iOS and Android as a service that enables doctors to securely communicate with their patient, as well as peers. And on Wednesday, the company said it had raised $2.5 million from angel investors, including Matthew & Stewart Greenfield, Ernest Pomerantz and Jessica Nagle. The round follows $1.33 million raised last year.

According to a 2010 New England Journal of Medicine study analyzing communication in a Philadelphia doctor’s practice, the average doctor in that practice took 24 phone calls a day and wrote 17 emails on top of seeing a full load of patients, processing their prescriptions, reviewing lab reports and completing all the other tasks that come with the territory.

“There’s a lot of call volume going on,” said CEO Dr. Gopal Chopra, who co-founded PingMD with his wife Dr. Manju Chopra. “And the indirect cost is the time spent trying to get you [the patient] an answer.”

Even though electronic medical records and digital practice management tools can enable doctors to look up patient information and history more efficiently, Chopra said the call volume can be difficult for doctors. And that’s especially true for those doctors who are open to emailing or messaging with patients through mobile phones or other more secure services.

Through PingMD, doctors can enable patients to securely message them with text, as well as relevant pictures and video, and they can easily loop in other doctors and nurses in their practices as well as other specialists.

For example, if you have a weird rash on your arm, you could send a note and picture to your doctor and then she could reply with her feedback, as well as add a dermatologist to the circle.

While Chopra estimates that response times on email and other secure messaging systems tends to average 72 hours because the message is routed through an administrator and then the doctor, the average response time on PingMD is an hour (although it can take from a few seconds to several hours depending on the severity of the case).

To make money, PingMD takes a software-as-a-service approach, billing itself to hospitals and physician networks as a way to gather data about how doctors are communicating and spending their time and how the hospital should allocate their resources. At the moment, Chopra said they’re piloting PingMD with several institutions and physician networks.

The startup is one of several companies attempting to help doctors improve their productivity and prepare for an influx of new Obamacare patients. American Well and Sherpaa, for example, work with employers to help patients and doctors connect via video chats and phone calls. HealthTap targets consumers with a service for messaging and querying a network of doctors. And Ringadoc offers doctors a simple service for handling after-hours calls and streamlining patient communication.

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For the past couple of years, Qualcomm Life has helped doctors remotely monitor patients’ biometric data through its 2net platform, which provides a secure, universally interoperable network for collecting and sharing data from connected fitness and health devices. With the acquisition of HealthyCircles, the company will enable caregivers to integrate a richer set of data and share that data among a greater set of parties.

“It’s a great way to augment what we’re doing [around] biometric data with other sources of data,” said Qualcomm Life General Manager Rick Valencia. “It’s about creating the ties between patients, caregivers and family members.” The companies declined to share financial details on the deal.

HealthyCircles, which was founded by Dr. James Mault, a former executive behind Microsoft’s HealthVault, offers a software-as-a-service product for helping caregivers, patients and family members securely share information related to chronic care or outpatient care situations.

Through the HIPAA-compliant service, different doctors involved in a patient’s care can share and view medication history, lab data and other information provided by the care team, and the patient (and his caregivers) can share self-assessment data as well as view data submitted by doctors.

As more hospitals shift to an accountable care model encouraged by the Accountable Care Act and other health reform changes, they’re increasingly becoming responsible for managing patient care outside of the hospital setting. By bringing HealthyCircles capabilities onto the 2net platform, Valencia said, they can open up more sales opportunities for the platform and enable caregivers and patients to better communicate across settings.

As part of the acquisition, Valencia said Dr. Mault has become Qualcomm Life’s chief medical officer and he added that the company has doubled its headcount.

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With the rise of high-deductible plans, patients are increasingly on the hook for more of their medical expenses than they’ve ever been before. For patients, that means a bigger need for tools that provide more transparency about health care costs. And for doctors, particularly independent physicians, said Medlio co-founder and CEO David Brooks, that means a growing problem with collecting payment.

According to a 2007 report from McKinsey, hospitals and providers usually only collect about 50 percent of the postinsurance balance (or the amount owed by the patient beyond what insurance covers or what they pay at the time of treatment). That’s not because patients are inherently delinquent, Brooks emphasized, it’s often because they’re either too confused about what they need to pay or they don’t believe that they were billed correctly.

Reaching patients where they are

With a virtual insurance card, Brooks believes, physicians would get a more seamless, reliable way of collecting payments and patients would get better information on how much health care costs. And, he added, it achieves the new “holy grail” of health care: greater patient engagement.

“We’re taking this very simple concept as a starting point to engage patients,” Brooks said. “A challenge most companies have is they shoot really high in the adoption curve… we’d like to meet people at the most basic level where they are today.”

The company, which is part of the new Dreamit Health startup accelerator, said the first version of its app is still a few months away. But the initial plan is a mobile app that enables patients to check in from their smartphones. Instead of handing over a physical card, patients would use the app to provide doctors with their insurance information and the app would automatically verify insurance eligibility for the provider. Medlio also intends to give patients an estimate of their treatment’s cost before they receive it, and it enables patients to initiate (and doctors to collect) payments directly through the app.

As the system evolves, Brooks said, it could store and share medical information so that patients don’t need to fill out forms every time they visit the doctor and it could deliver appointment reminders.

While they’re still working out the details of the business plan, he said, their goal is to keep it free for patients. Even if doctors don’t use the service, patients could use the app to store insurance and health information and potentially enter a doctor’s fax number to share medical information instead of filling out forms.

Privacy and security issues could be challenges

The idea is that, initially, physicians would pay for Medlio services and, ultimately, insurance companies eager to win the trust and attention of their members could also use Medlio to advertise and communicate with patients.

Digital cards are slowly taking off for car insurance – in a few states, drivers can show their insurance with apps or pdfs. But health care obviously implicates a wider range of concerns. Consumers may be wary of the security and privacy consequences of storing and sharing medical and financial information in an app and providers may be reluctant to adopt a virtual card because of HIPAA issues.

Personal.com gives consumers a secure way to store health insurance information and insurance companies are increasingly giving their members mobile apps for storing information and looking up claims. But the big difference between those apps and Medlio is that they don’t directly connect the patient to the provider.  Startup Simplee also aims to give patients more transparency into their health finances and it offers an app that lets patients pay from their phones, but while Simplee has started by targeting larger hospitals with its payment product, Medlio said it plans to start by targeting independent primary care physicians.

Getting the attention of a critical mass of independent physicians could be a challenge for an upstart company. But Brooks said they believe that this is a big problem providers need to solve and, he added, because consumers can download and use the app on their own, they could help push doctors to the service.

Image by Olga Danylenko via Shutterstock.

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“We have not been technologists and now we can be,” said founder and CEO Derek Flanzraich. “Now we can figure out how to get people from not just reading and talking about our content to actually doing something about it — which is ultimately our whole purpose.”

First launched a couple of years ago, Sportaneous is a small four-person startup that offers an app for finding fitness classes nearby. But like other recently acquired health startups MassiveHealth (sold to Jawbone) and 100Plus (sold to Practice Fusion), Flanzraich said Sportaneous was strong in design and technology, but was having trouble building traction.

“It’s hard to get noticed in the App Store. It’s hard to get that attention unless you’ve got some other way to drive people to that product,” Flanzraich said. “We solved that problem [by going] the other way around and building the brand first.”

With the Sportaneous team’s tech chops, Flanzraich said he plans to build a new product that puts a social layer around people’s fitness tracking activities. Now, Nike Fuelband users can socialize with other Fuelband users and Fitbit (see disclosure) users can communicate with other Fitbit users. But Flanzraich wants Greatist to provide a social hub that pulls in data from a range of tracking services so that people can motivate and encourage (and maybe trash talk…) friends using all kinds of devices.

Another health app, Fitocracy, enables health enthusiasts to interact with others trying to achieve similar goals (for example, people trying to keep a paleo diet or run a marathon can encourage and get motivation from others in the same camp) and it integrates with running app Runkeeper. But Greatist, which has raised a little more than $1.1 million, wants to reach a broader audience of people and integrate with a wider range of tracking services.

As part of the acqui-hire, Flanzraich said Sportaneous co-founder Omar Haroun will become Greatist’s chief product officer and co-founder Reuben Doetsch will be the chief technology officer. The other members of the team will join as developers.

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That’s where Kinsa comes in. Launched Wednesday at the Demo Mobile and TEDMED conferences, the New York-based startup wants to create a real-time picture of the country’s health by using smartphones and simplified digital thermometers.

“Today, I can know what my friend’s dog at for breakfast, but I have so little insight into the health situation around me,” said founder and CEO Inder Singh. “We’re creating… a real-time map of human health [to] keep families and neighborhoods healthy.”

Building on technology developed by entrepreneur and investor Edo Segal and others, Kinsa developed a thermometer that plugs directly into a smartphone’s earphone jack. (Singh said they focused on the thermometer because a fever is often the first sign of illness.) Because it connects with a smartphone, it doesn’t include batteries, processors or an LCD, which means the device is cheaper and lighter than other digital thermometers.

After downloading the Kinsa app, users can see their temperature on the smartphone screen, as well as log other symptoms and share the information with a doctor, family or a private group.

Over time, as the thermometer gains traction, the company’s hope is that it can provide individuals, doctors, public health officials and health companies with better data on where and when illnesses are spreading, as well as inform next steps. For example, it could let individuals and doctors know about possible illnesses in the area. Or, it could enable pharmaceutical companies understand where and when their products might be most in demand.

But even before the company amasses a critical volume of data, early adopters will already be able to use the app to track a child’s symptoms and then share them with the doctor or create a private group to share information and check the health status of others in the group. For example, Singh said, parents could create a group for a child’s class and anonymously view illnesses among classmates.

Users who don’t want to join a private group can consult a map to view the “health weather” in their area, which is a report that combines data from Kinsa with public health data from other sources.  The app also includes features for calling a nurse with one tap and forecasting when you’re likely to be contagious and when you’ll likely recover.

The startup, which has raised $2 million, expects the thermometer to become available later this year, after receiving FDA clearance.  Initially, the company plans to sell the thermometer at a price comparable to other digital thermometers ($15 – $20) but, as penetration grows, they plan to drop the price.

To build buzz around the product, Kinsa also launched an Indiegogo campaign on Wednesday, with a goal of raising $75,000.

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“We’re continuously generating digital breadcrumbs from the services we interact with,” she said. But “there are no existing vehicles that package that data about me in a format that’s useful for me and that make it accessible to me. [And] there should be because there’s a lot that I can learn about my personal health from my digital behavior.”

Search engines, social networks and mobile carriers capture and analyze that data to serve up advertising, improve services and provide personalization. But delivered to the user, Estrin said, that data could generate a “digital social pulse” for tracking health in more implicit ways than Fitbits (see disclosure), Nike Fuelbands and other quantified self-type devices.

For example, she said, an app could process data from a mobile carrier to determine whether new supplements for early-stage arthritis are actually helping a patient. If the patient is checking her phone earlier in the morning and moving around more frequently, that could indicate that the medicine its doing its job.

Service providers may balk at the prospect of releasing their troves of user activity data – and Estrin acknowledged that they would likely worry about PR headaches and privacy issues. But not only should enhanced transparency provide the foundation for a strong privacy policy, she argued that access to their data would make smartphones and data services even more valuable to customers.

Startups like Personal and the Locker Project have started building tools that help people manage and use their personal information. And Ginger.io uses sensor data from mobile phones and other devices to identify signals of behavior change to understand users’ mental and physical health.

But Estrin wants to encourage an entire ecosystem of apps. And, along with colleagues at the mobile health non-profit OpenM Health and Cornell Tech, she’s beginning to build prototypes that demonstrate the benefits of using small data for personal health, as well as create the architecture for service providers, app developers and others to create additional small data health apps and algorithms. (You can learn more about Cornell’s small data initiative here.)

“We need an open architecture, so that a rich market of apps and services can grow up around that data just like http created the World Wide Web and led to the rich array of internet services,” she said.

Image by Digital Storm via Shutterstock.

Disclosure: Fitbit is backed by True Ventures, a venture capital firm that is an investor in the parent company of this blog, Giga Omni Media. Om Malik, founder of Giga Omni Media, is also a venture partner at True.

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I was at MDRevolution’s La Jolla, Calif., office about a month ago, sitting in on a consultation as a patient huffed away on a treadmill. A staff member hovered nearby, monitoring the patient’s heart rate and pushing her to keep up the pace. As the staff member took note after note on the patient’s performance and tapped away at a calculator and keyboard to analyze the results, I felt like I was in a research lab, not a doctor’s office — and a lab modeled after a gleaming Apple store.

According to its founder, cardiologist Samir Damani, that’s the point. The office — with its sleek, spa-like aesthetic and shelves of connected devices — is a showcase for a data-driven future of medicine that puts technology at the center of the patient experience and moves actual doctors into managerial, less visible roles.

As the era of the more-affordable “$1,000 genome” draws closer, the phrase “personalized medicine” is popping up all over the place. But for the most part, matching medical treatments with a patient’s genetic profile is an option for only the wealthiest Americans.

With his patients, Damani is trying to create customized health care that is more accessible and affordable — and he’s doing it by blending cardiology, nutrition science and genetics with emerging mobile technology. But that’s just the first step: He believes he can build a big business by using the data he’s gathering and the algorithms he’s creating to design software that will allow employers and hospitals around the country to replicate his approach.

“I got tired of people saying this is what it’s going to be like. I said, ‘I’m a 37-year-old cardiologist, I need to know what it’s going to be like today,’” said Damani, a slight, well-dressed man with a seemingly boundless memory for medical literature.

So, in 2011, he rustled up $1.6 million in angel funding from several local MDs, Ph.Ds and other supporters (no traditional “vulture capitalists” allowed). He hired an IT guy, an office manager, a metabolic specialist, nutritionist and medical assistant and, about a year later, opened up his doors — all while keeping an active cardiology practice at a local San Diego clinic.

A new medical specialty?

Since launching in February 2012, MDRevolution has worked with about 250 patients; about a quarter of them have a chronic condition, and the balance are people who are generally in good health and who are willing to take that extra step to stay that way (patients continue to see their regular primary care doctor in addition to Damani). He says that each of the last 60 patients has seen statistically significant changes in every health marker analyzed, including weight, body mass index, metabolism and visceral fat (the notoriously hard-to-lose fat that accumulates around organs).

Damani’s model? A new patient starts with a spin through a lab to determine their resting metabolic rates, visceral fat levels and other fitness indicators. They also get a genetic assessment that tells MDRevolution whether they’re a slow processor of caffeine, whether they’re genetically inclined to overeat, and whether they have any other nutrition and fitness-related predispositions. From there, the practice uses proprietary algorithms to craft personalized health plans that include guidance on things like how high and how often to push their heart rates while exercising, what kinds of food to eat, and the types of foods to avoid.

As patients follow the program, fitness trackers like Fitbits (see disclosure), wireless Withings scales and heart monitors report progress back to MDRevolution, while a website enables specialists to give encouragement and direction online.  For the genetic assessments, the company partners with Pathway Genomics and 23andMe, and it uses Qualcomm’s 2Net platform to integrate all of its technology. For the 10 percent of patients who live outside the area (and even for some who live close by), Damani conducts virtual visits via Skype.

The financial model

Just about every week, a new activity tracker, personal genome service, iPhone-based medical device or online patient program hits the market. But for the most part, those tools and services exist in isolation. MDRevolution is a first stab at trying to show how mobile health tracking tools, genomic assessments and personalized coaching can work together to show real results.

The fact that the company is based in sunny Southern California is no accident. Between wireless health leader Qualcomm Life, genetics company Pathway Genomics, The Scripps Research Institute and plenty of other National Institutes of Health-funded research institution, San Diego is a hotbed for health innovation and research. Scripps is also the academic home of Eric Topol, a longtime cardiologist and researcher as well as one of the most influential voices in digital health. Before launching MDRevolution, Damani published several peer-reviewed articles with Topol, who he said has been a mentor.

As health reform pushes medicine to a model that rewards doctors based on how well they keep patients healthy, not just the procedures they perform, more doctors are turning to concierge-style practices in which patients pay an annual retainer for a higher level of care. One Medical Group, which has offices in five cities, lets patients book appointments online and renew prescriptions as well as email with doctors. CarenaMD, in Seattle, offers patients 24/7 virtual doctor visits via webcam.

MDRevolution says its model is closer to a gym membership. Patients pay between $25 and $75 per month (depending on the level of service and attention needed) for access to the clinical lab and personnel, as well as its web-based service. The practice also takes most insurance plans, so each time patients visit the office, they’re also charged a co-pay.

Brad Lally, a 46-year-old San Diego executive with an outdoor sports company, said he decided to see Damani in 2011 after a brief episode of cardiac arrhythmia. He wanted to try treating his heart condition without drugs, and also wanted to get rid of his belly fat. In addition to putting more proteins and vegetables in his diet, MDRevolution told him to do metabolic interval training workouts twice a week to push his heart rate into the anaerobic zone. Since genetic testing revealed that he was a slow caffeine metabolizer, Damani’s team told him to stay away from evening cups of coffee.

For the next 12 months, he reported his workouts and diet to MDRevolution — even on frequent overseas business trips his blood pressure cuff sent back data — and received nearly bi-weekly feedback from staff. After three months on the program, he says he lost 10 percent of his visceral fat and increased his resting metabolic rate and VO2 level — two measures that Damani believes are more predictive of heart health than cholesterol — by more than 10 percent. It’s been a year since he finished the program, and he said he hasn’t had any heart irregularities. Even when he slips, he said, he knows how to quickly correct his diet and exercise plan.

“It’s empowering to know what’s going on,” Lally said. “And the level of interaction you get — it’s really good. It’s nothing like what you get with your regular primary care doctor because they’re so busy seeing patients.”

The real ‘billion-dollar’ business

As MDRevolution tries to help patients reach new levels of fitness and heart health, it is building a robust data set to support what Damani said could be the company’s real ‘billion-dollar’ business idea: a patient-engagement platform.

RevUp, which MDRevolution uses internally for its 250 patients, is a web-based dashboard that aggregates all of a patient’s information, from fitness trackers and other devices to genetic and other health data. It provides each patient with a personalized health plan, including custom fitness and nutrition guidelines depending on their needs and goals. Physicians and other health experts can use it to track patient progress and send updates and guidance. Corporate and health system administrators are able to see what employees are doing in aggregate but not an individuals’ specific information.

According to a recent study from human resources company Aon Hewitt, the average employer spends about 40 percent more on health care now than it did six years ago. Another report found that poor health costs the U.S. economy $576 billion annually, with nearly 40 percent of that due to employee absenteeism or low productivity.

To address those issues, companies like Keas, Healthrageous and ShapeUp pitch employers on corporate wellness programs that integrate with digital devices to keep employees active, healthy and out of the doctor’s office. Damani argues that RevUp will have an edge in this market because its program is backed by clinical results.

He says the data that he’s compiling with just 250 patients is already leading to fresh insights. For example, he said, people can increase their heart and lung capacity independent of age, and women increase oxygen consumption (an indicator of fitness) slower than men. When the company reaches 1,000 patients, he believes, their research could be used to influence public debate about how to maintain health in the population at large.

“Our competitive advantage is that we have a lab driving the software. We’re always going to be creating software based on needs for the practice and outcomes,” Damani says. He says that while other corporate wellness programs tend to only focus on basic health markers like cholesterol and body mass index, the indicators underpinning his program (resting metabolic rates, visceral fat levels and oxygen consumption) will prove to be the key to preventative medicine.

Can MDRevolution compete against tech companies?

The ultimate plan is for the dashboard to serve as a vehicle for gathering even more data, he said; creating a repository that could be a licensable asset in itself. It could also inform the development of future products or make MDRevolution a valuable partner for companies developing medical devices or conducting clinical trials, he said.

With a doctorate, a master’s degree and a medical degree, Damani is clearly not one to shy away from a new challenge. But in turning MDRevolution into a technology company, he’s moving into an uncertain and increasingly competitive terrain. While Damani has led the company so far — he said it has already signed up four corporate customers, a mix of companies and hospital systems, and should be profitable by next year — running a doctor’s office arguably requires a different kind of skill set than building a technology company. The company now employs 15 people, but only the COO, CTO and a new database manager have technical backgrounds. Six contractors work full-time on its software development, and Damani said he plans to bring several programmers in-house in the next year.

Damani may find that the market for his data isn’t what he anticipated. Abhas Gupta, a partner at venture firm Mohr Davidow Partners who focuses on digital health, said that he’s seen promising health startups that have amassed strong and unique datasets but that haven’t been able to generate revenue like they expected. “Who do you sell that data to?” he asked. “There may not be individuals ready to do something with that data.”

The new role for doctors in a tech-driven world

One thing patients at MDRevolution don’t see much of is a doctor. The practice is still small enough that patients know Damani oversees the entire operation but he has delegated much of the day-to-day interacting to patients to metabolic experts and nurse practitioners. Even though the office sees patients five days a week, his face time with them is just five to eight hours weekly. He says MDRevolutions in other locations could operate with barely any doctor oversight at all. (To bill as a doctor’s office, they will need to be led by doctor, but day-to-day operations could be entirely run by a nurse practitioner, he said.)

It makes you wonder if Vinod Khosla’s controversial prediction that technology will replace 80 percent of medical experts is coming true. Damani said his vision isn’t one that minimizes doctors (although the impending doctor shortage means the country will have to make do with fewer doctors, relatively speaking) or one where doctors play CEO and tech entrepreneur. But it is a world where physicians will have to adapt.

“Physicians are going to have to be in a management role as opposed to being the primary person seeing [patients],” he said. “Most physicians out there are unhappy. Because cost-containment pressures are so great, they’ve become assembly-line type physicians who see as many patients as possible in as little time as possible. I want to offer those doctors a new process.”

Disclosure: Fitbit is backed by True Ventures, a venture capital firm that is an investor in the parent company of this blog, Giga Omni Media. Om Malik, founder of Giga Omni Media, is also a venture partner at True.

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Mango Health, a health startup launched by former executives from mobile gaming company ngmoco, believes that by combining game mechanics with an intuitive, fun design and useful features, they can keep patients on track. Since August, the company has been beta testing the app with a small set of users, but on Tuesday it said it had launched in the app store.

“One of the biggest challenges in this space… is long-time use, loyalty and retention – and that’s the skill we bring,” said co-founder Jason Oberfest. Over the course of a 16-week pilot, he said, Mango Health’s medication adherence app saw engagement rates that were three to four times higher than any of its best performing mobile games.

The app offers several tools, including a simple way to check for medication interactions and timed reminders to take your meds. The app’s colorful, clean design is more inviting than many health apps on the market. But the real trick to getting people to stay hooked is a reward system. Each day, users have the opportunity to earn 10 points for letting the app know that they took their medication. Over time, those points can be redeemed for perks like Target gift cards and charity donations.

The reward system also provides a way to keep the app free. Oberfest declined to share details but said the brand integrations are paid for as a form of advertising.

Several other  health startups are attempting to address the same problem with different kinds of technology. MediSafe, for example, also offers a mobile app that reminds patients to take their meds, and if they don’t indicate that they’ve done so, the app notifies a friend, family member or a caregiver. AdhereTech, which was part of health startup accelerator Blueprint Health, uses sensor-equipped pill bottles to monitor whether patients take their prescriptions. And AllazoHealth, another Blueprint company, uses demographic, behavioral and other data to help health insurers and pharmaceutical benefit managers (PBMs) predict who will stick to their regime and who won’t and then determines the most appropriate interventions.

With a successful background in gaming, Mango Health’s founders bring an interesting perspective to the health care. But, as with all new approaches to behavior change, it will be interesting to see how effective the app is over time. The company, which launched last summer, has raised $1.45 million from Floodgate Fund, First Round Capital, Steve Anderson with Baseline Ventures, Zynga co-founder and CEO Mark Pincus and Khosla Ventures’ Keith Rabois.

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In July 2011, the Food And Drug Administration issued draft guidance on the regulation of mobile apps. But since then, developers and health entrepreneurs have been waiting for the agency’s final word. In the absence of clarification, some say, the threat of intervention and uncertainty has already held innovation back.

This week, Congress held three days of hearings to explore how to regulate health apps on smartphones and tablets. Executives from technology companies like Qualcomm (QCOM) and health services giant McKesson joined economists, medical leaders and regulators to weigh in on the debate.

Ben Chodor, CEO of health app store and certification service Happtique and one of this week’s speakers, said that while the hearings and FDA testimony didn’t provide as much clarity as developers ultimately need, the hearings and the attention they generated gave the mobile growing health industry exposure to a larger audience.

“I think it moved the needle a little bit,” he said. But “the bottom line is … we still need to see the guidance.”

The industry will have to wait a bit longer for the FDA’s final decision — but this week still uncovered a few interesting details worth considering for developers and investors in mobile health. Take a look at seven below.

• The FDA has been regulating mobile medical device software for more than 10 years, said Christy Foreman, director of the Office of Device Evaluation at the FDA’s Center for Devices and Radiological Health. In fact, she added, the agency’s first clearance of a mobile app goes back to 1997. So far, the agency has reviewed 100 mobile medical apps, including remote blood pressure, heart rhythm and patient monitors, as well as smartphone-based ultrasounds and glucose meters.
• Some estimate that there are 40,000 health apps available globally, but during her testimony before the Committee on Energy and Commerce (video here), Foreman said the FDA focuses on a small subset of “mobile medical apps.” These are apps that meet the definition of a medical device according to the Federal Food, Drug and Cosmetic Act and are intended to be used as an accessory to a regulated medical device or turn a mobile platform (smartphone or tablet) into a regulated medical device. Among those apps, there are three classes of apps that vary in potential risk and regulation requirements. But, so far, the agency has only regulated the less risky class 1 and class 2 apps and has not yet seen a class 3 app.
• The FDA does not intend to regulate apps that track a person’s daily steps, enable patients to refill prescriptions, search medical references, provide electronic health record services or offer similar services. The only thing that would change the FDA’s mind, Foreman said, is if they learned of anything related to those apps that compromise patient safety.
• Despite concerns that the FDA will have trouble keeping up with technology, Foreman said the FDA receives less than 20 applications to review mobile health apps a year. Once the agency releases its final guidance, it’s very likely that number could climb, but to put it in perspective, she said that’s just 0.5 percent of the total number of medical device applications they receive each year.
• Based on its performance over the past three years, the FDA estimates that it takes them about 67 days to review a mobile medical app. That is well within the 90-day time period the FDA has to review any medical device looking for a 510(k) clearance to come to market.
• When pushed by members of Congress to share when the FDA plans to issue final guidance on regulating medical mobile apps, Foreman said it would come before Oct. 1 (the end of the government fiscal year).
• Despite rumors that smartphones and tablets could be subjected to a new 2.3 percent medical device tax, Foreman said those devices would not be regulated as medical devices and therefore not subject to the new tax.  During the week, others discussed the possibility of taxing mobile medical apps, with some saying that mobile health apps would be exempt from the tax if they were distributed through retail channels.

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