was happening to his friend, and what was working or not working between different treatments, other than on paper. "We can do this in so many areas of life -- share information very easily, share all our professional stuff through LinkedIn, but there is no way you can share health information," he said.
Zibdy hasn't solved this problem, or at best has barely begun to do so. Whatever Bhathal's bigger ambitions, he is starting with a medication-management app, offered on the web and on mobile devices. It is, however, a medication-management app that allows data to be shared among family members. That's a good start, he said, because a lot of healthcare data can be extrapolated from knowing which medications someone is taking -- and which ones that individual is allergic to.
"We know it's not perfect, but we're not going for perfection. If this will allow you to have a better conversation with your doctor, then that's a success," Bhathal said.
He says he has been talking with Scripps Memorial Hospital Encinitas, a local hospital in the San Diego area, about the possibility of integrating the app when patients are given their discharge instructions. If it helps patients take their medicine on schedule, that could be a way of driving down readmissions, about 30% of which the hospital attributes to medication adherence issues, Bhathal said. "We have the best healthcare system in world, but when you leave the hospital, you're on your own," he said. Yet that's starting to change, with Medicare starting to penalize hospitals for readmissions within 30 days and private payers moving in the same direction.
Meanwhile, Zibdy's most automated way of getting data into the app involves scanning barcodes on pill bottles.
The software is set up so you can tweak your sharing and privacy settings something like the way you do on a social network, except in this case you might be specifying that it's OK to share information about your asthma, but not your sexually transmitted disease. The Zibdy app puts a "Private" button next to each medication on the list, trying to make including/excluding data as simple as like/unlike on a social network. You can share whatever you want with friends, healthcare professionals, and/or family members.
Once you've set up these relationships, those people get notified whenever an update is posted to your account, in much the same way that you get alerted to job changes by your LinkedIn contacts, Bhathal said.
In the context of a medication-management app designed to help patients adhere to a doctor's orders on what drugs to take on what schedule, tying in the social network of family and caregivers is helpful because it provides more opportunities for reminders. If a patient fails to take his or her meds on schedule and fails to respond to automated reminders, a family member can be alerted to deliver a reminder in person.
That aspect of integrating family into a medication-management app is not original to Zibdy, having already been tapped by apps such as MediSafe. The idea is to not let a patient die just because his smartphone battery did, instead engaging a "secondary reinforcement system of loved ones" to make sure the message always gets through. Based on an internal analysis, MediSafe figures it may have prevented 4,600 emergency room visits after sending out alerts to family members after users of the app failed to comply with a prescribed drug regimen.
"We know because we have the data -- after a family member engaged, people recorded, 'yes, I took my drugs,' " MediSafe CEO Omri Shoor said. The Israeli company was founded by Shoor and his brother, inspired by their father's near-fatal insulin overdose caused in part by miscommunication within the family about whether the medicine had already been administered. Engaging family and other caregivers is essential because they are often the ones tracking medications, particularly for very ill patients.
Shoor wasn't familiar with Zibdy but said support for family and caregiver networks has been built into several competing apps. "It's good to see the road we've paved is being used by others as well," he said. The barcode scanner method Zibdy uses to import data is one MediSafe tried and discarded because "we found people simply didn't use it." He has higher hopes for smart pillbox containers that could record medications dispensed as an aid to dosage tracking. MediSafe's APIs are capable of connecting to any electronic health records system to obtain prescription data, but the company is still working on putting together a pilot project using that approach.
Integration with medical records software, or with health information exchanges that consolidate that data, would also be useful to Zibdy, particularly if Bhathal is serious about creating a family medical record, not just a family drug record. We talked about it, but he had nothing definite he to tell me about his plans in that regard. We also didn't get far into discussing business models, other than that the app will be free to consumers. Suffice it to say there's plenty of money in the pharmaceutical industry and the emerging accountable care business models to make very valuable both the data Zibdy gathers from users and Zibdy's role in boosting medication adherence.
As evidence that others are rethinking the balance between healthcare privacy and data sharing, Bhathal pointed me to a Bloomberg interview with Larry Ellison. Google CEO Larry Page recently expressed a similar sentiment at a recent TED conference in Vancouver. "Wouldn't it be amazing if everyone's medical records were available anonymously to research doctors?" Page said (quoted on Wired). "We'd save 100,000 lives this year. We're not really thinking about the tremendous good which can come from people sharing information with the right people in the right ways."
Rather than trying to rewrite health privacy law, Bhathal wants to work around it, with a web-based app that will start out simple and get better, in the same way that Google and LinkedIn grew. "We're looking at building a system for the masses," he said. "There has never been a healthcare system that is used globally in the same way," no electronic health records equivalent to Google and LinkedIn.
At a minimum, you have to give him credit for thinking big. "When we came up with this idea, we realized it was very high risk; nobody was going to do it," unless he and his cofounders were crazy enough to try it themselves.
Download Healthcare IT in the Obamacare Era, the InformationWeek Healthcare digital issue on the impact of new laws and regulations. Modern technology created the opportunity to restructure the healthcare industry around accountable care organizations, but IT priorities are also being driven by the shift.