Providing care for a child with special needs, or an aging parent, can be a treadmill of challenges.  Often many family members are willing to help out, but are unable to coordinate effectively.  Introduced months ago in a post “ACM for Home Medical Caregivers” today I update this with more about how the technique of adaptive case management fits well with the challenge of coordinating care for a loved one.

Care Zone

Care Zone is a new startup (just over a year old) that targets the space effectively, with three core capabilities:

• organize – there is lots of specialized information to keep track of.  Storing this in the drawer in the study is note safe enough, instead us an online ‘case folder.’  The value is in keeping it all together so you can look at trends over time.
• share – the others who help out need access to this information as well, so giving helpers access to the right information at the right time is critical to allowing them to help out.  Like all health data, it might be very sensitive, so sharing must be done carefully.
• coordinate – much of this care is just a large number of very small tasks.  Many people might like to volunteer, but the overhead of just knowing what to do when can be greater than the task itself.  It is even more critical to make it really easy to involve someone in a small task.

In most case management we think of the case worker assigning tasks to others using either management authority (job responsibility) or negotiated agreement (service agreement).  The volunteer situation is a little different.  Care Zone includes a special assignment mode for “needs a volunteer.”  This appears in a special mode to encourage others to volunteer.  At a high level, this is like pattern of assigning a task to a group, and having one person accept it, but the difference is in the presentation: it embodies a polite request, with an explicit negotiation.  These requests appear on the calendar so a volunteer can seen opportunities that might be convenient, and also to make it clear to everyone when an important task remains unselected close to the due date.

The New York times articles says that Care Zone will charge a small monthly fee ($5/month for 5 to 10 people, and $25/month for 10 to 100) because they are committed to never having advertisements and (of course) never selling your data.  However, the Care Zone website does not mention anything about fees, and both that it will be free forever, and strict terms that you have to promise to pay everything in a timely manner with a credit card.  I think users should expect to pay small monthly rate for such a service, but the inconsistency of the web site leaves me uneasy.

Lotsa Helping Hands

Lotsa Helping Hands is based on the idea that there are a lot of people who would be willing to help, if only their time can be coordinated well enough to handle a large number of smallish tasks.  LHH calls the primary unit of coordination a “community” which is started by a community leader (who can be anyone).

While there is clearly support for care of a particular person, or to help a particular family care provider, what is unusual about this service is the support for peer groups that want to help each other.  Apparently there is a option to make care groups public.  There is an “I want to volunteer” option to search for groups that need additional help.  While this is all quite honorable, I have doubts that this really works to link up unacquainted people.  It seems unlikely that such a blind search would find people in need in your area that you might be interested in really helping.  If you knew that a particular person (or group) had an entry on LHH, this feature might be a convenient way to find them, yet I wonder how many such groups will make themselves public enough for this to work.  Healthcare is a sensitive topic, and few of us want the exposure from making the details public.

Dossia Health Manager

Dossia Health Manager helps you manage the health records of a family.  Store them all on line, and share records in a controlled way with others, like doctors before your next visit.  The sample scenario is that of a mother needing to find a particular record for a child.  This fills a real need to get a handle on the complexity of running a family, and it seems to me that this service is less about handling chronic care, and more about routine family management in a slick user interface to help motivate healthy activities.

Billed as a personal health manager, the business model is that this will be provided as free to the participant as part of a health plan from a workplace.  This explains the focus on leading a healthy life.  I view this as positive except one must be aware of the inherent conflict of a health provider offering this kind of capability; you don’t really personally own the information stored, and it is not clear whether you can take the information with you if you leave that health plan.  (The terms and conditions eliminate any commitment to permanent access to the service.)

Interesting points:

• some of the tracking is based on pre-defined processes: such as tracking a child’s status according to standard immunization schedules.  It is not clear who sets this up or how you determine whether a particular schedule is appropriate.
• some task management and calendar features
• gamification to offer badges for specific achievements.
• features to help encourage healthy lifestyle, such a group challenges to walk regularly.
• feeds of healthy information list recipes of healthy dishes, not clear to me who curates this information.
• Even a shopping list app

Patient Portals

Confusing the overall space are a number of systems providers who offer patient portals as part of their clinic management system to allow patients to have a direct access to the information being held by the clinic.  These are not personal case management systems, but instead simply a B2C portal in the trend of allowing companies to reach out directly to customers and providers.  While this is very important to allow patents to get information easily whenever they want it, and to save staff from having to handle the quite routine task of retrieving and providing that information manually, these capabilities should not be confused with a real Personal Health Record service.  Many of these portals do not allow the patient to store health records from other sources, and don’t have the kinds of case management capabilities that a real personal health record service would need.  They are really portals to information for that clinic.

• Cerner Patient Portal – Provide new patient registration forms online; send appointment information, share lab results and data from Cerner’s EHR.
• Epic MyChart – gives patients controlled access to the same Epic medical records their doctors use, and it provides convenient self-service to reduce costs and increase satisfaction.
•  GE Centricity Patient Online – enables providers and staff to easily and efficiently interact with patients within their native workflow.
• MedSeek – portal for organizations that want to increase satisfaction, loyalty and outcomes by providing patients a tool to access information regardless of the backend systems being used to house data.  Claims to allow patient to upload their own information as well, but this is clearly not the primary purpose.
• RelayHealth – clinical connectivity to physicians, patients, hospitals and more using innovative health information technology.
• eClinicalWorks Patient Portal – a patient portal for their electronic health records product.
• AllScripts Patient Portal – a user-friendly online interface that allows patients to interact with staff when it’s convenient for them.
• Intuit Health Patient Portal – a user-friendly online interface that allows patients to interact with staff when it’s convenient for them.

Summary List

• Care Circles – an SAP sponsored collaborative site for focused care directed by a primary family member (case manager) tracking information, planning, and tracking.
• Care Circle (.net) – a cloud based collaborative space on any topic designed to help people take action on global issues.
• Care Circle (.com) – a fee based service for friend helping friends, and a couple of the examples given are medical examples.
• Care Zone – a cloud based site to help organize, share, and coordinate help around the care of person.
• Dossia Health Manager – health plan provided, offers fairly comprehensive capabilities to store records, track progress, and lead a healthy life.
• eCaring.com – Has Care Tracker which offer sophisticated planning and tracking capabilities, in a very easy to use iconic UI.
• Health Vault – A Microsoft sponsored information storing, organizing, and (controlled) sharing site.
• Lotsa Helping Hands – cloud based collaborative site to help coordinate people in both giving and receiving help.

• Zibdy Health – (Update May 2014) appears to be offering a person health record management capability, and allows controlling which other people can see what.  (See Startup Aims To Unlock Family Medical History)