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DrChrono (YC W11) Makes The iPad A Doctor’s Best Friend In The Exam Room
- allangrant 16y agoI don't know anything about this industry, but the UI looks stunning.
- brudgers 16y agoThe UI looks like a HIPAA violation as soon as the Katelyn can see that Boris is in Exam Room 3.
- jrockway 16y agoI'm also a little uncomfortable with having my balance due more visible to my doctor than what my medical problems are. Doctors should deal with medicine, office clerks should deal with the balance due. Having emotional information like money on the info screen can adversely affect the emotional doctor/patient relationship in a way that's completely unnecessary. Fucking programmers.
- Skeletor 16y agoThere is a clear divide between the clinical tools on the iPad and practice management (medical billing and invoicing) tools for Doctors.
- Skeletor 16y agoThe drchrono EMR is fully compliant with HIPAA. One of the screenshots shows the Dr. the overview of patients coming in for the day (that view isn't for patients to use.)
- brudgers 16y agoHaving the charting function next to the schedule is problematic for any medical staff which writes their notes while with the patient - and that's a practice many experienced healthcare professionals use because it allows them to spend more time with the patient without spending more time per patient and it allows them to get answers to questions which arise during the writing.
- muhfuhkuh 16y agoI've been to two separate dental practices that are under the exact same HIPAA scrutiny as doctor's offices and they have a printout of exactly who they are seeing at what time and in what operatory taped on the wall when you enter. Somehow I doubt an iPad being clutched in the doctor's bosom as they read it is anymore a violation than that.
- brudgers 16y agoHIPAA is why sign-in sheets such as these are common. http://hipaasignin.com/info/info.html http://hipaasignin.com/info/info.html
- ams6110 16y agoNot much worse than the paper sign-in log where I can see the name, address, phone number, and physician's name for the 10 people who came in before me.
- krazook 16y agothis is revolutionary...wow.
- benmathes 16y agoGood luck with this one. After spending a couple of years working on something like this, I found the following: 1) A majority of doctors are in small private practices that reinvent the wheel of how they run their practice. 2) All of these doctors are extremely pressed for time and are practically _always_ behind schedule. #1 means you need to build heavily-configurable software, and #2 means the doctors don't have the time or energy to learn and configure your software. At best you can get the practice managers to force it down the doctor's throats, which doesn't exactly help either. Record keeping is to doctors like text editors is to us hackers. Imagine if a doctor had built your text editor; They're probably very smart and energetic, but they don't really understand your problem and how much you personally need specific things just so.
- jpeterson 16y agoMy guess is that this is more targeted to the "hip" crowd among MDs who embrace this sort of thing (of which there are quite a few).
- Skeletor 16y agoOver 120,000 doctors in the US own an iPad and doctors (even non-"hip" ones) get immediately that the iPad is the ideal platform to use in the examroom.
- niels_olson 16y agoiPad is not the best. Massive, rapid text entry on an iPad sucks. I took an iPad and a cr48 to the a big orthopaedics conference last week, and the cr48 was the hands down winner, using nothing but qemacs. Fundamentally, on the ipad, character recognition or dictation would be best, but I can barely read my own writing sometimes! The iPad would be a lot better if the input precision was as good as the output resolution. If you've tried any drawing apps on these things, you know what I mean. Wacom tablets have much better input precision, or at least they seem to. I want Pilot G-2 0.5 mm black speed, precision, and reliability. Right now only a keyboard comes close.
- earino 16y agoCompany launches practice management software. Film at 11.
- muhfuhkuh 16y agoWow, it's almost as if we weren't on a social news site catered toward companies and their launching products.
- earino 16y agoLiving in Nashville, a healthcare center, and having personally seen >100 million dollars blown by healthcare startups, have made me very cynical. HCA is about to "go public" again making the Frist family another 15 million dollars while healthcare informatics continually gets underinvestment and underdevelopment. An iPad app isn't what healthcare IT needs. A drastic smashing of the legacy of MUMPS and overgrown piss poor legacy solutions will require a large health crisis, with opportunities blown due to bad processes and bad systems.
- axod 16y agohow is this better than the existing computer systems doctors use? (It's on a iPad doesn't cut it IMHO)
- Skeletor 16y agoBeing on the iPad is a huge win since the Doctor won't have their back turned to the patient while using the system. The base EHR (Electronic Health Record) system is also FREE and a doctor can start using it right after downloading the free App from iTunes. Our price point for advanced features and integrated billing is also better than any competitor, $199/month to do all of a Doctors medical billing will save a Doctor thousands of dollars a year (in addition to EMR incentives!)
- axod 16y agoBack turned? :/ Over here (UK) there's a desk, in a corner, with a chair next to it. The doc sits at the desk, using the computer, facing you sitting on the chair to the side. Works pretty well for doctors surgeries anyway. But I have no idea how things work in the US so maybe it's completely different.
- Skeletor 16y agoSeveral clinical studies have shown that patients will have better healthcare outcomes if their doctors make eye contact with them. One of the reasons I co-founded drchrono was because I went to a lot of doctor visits with my Father when he was ill and sat through countless appointments where the doctor spent 10 minutes talking to us over their shoulder. Computers are always an afterthought in most Doctor office setups, that is why they seem to be universally built into walls or tucked away into corners.
- niels_olson 16y agoI applaud your effort. I think dictation is going to be crucial. Keep pushing!
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- flyosity 16y agoThis is probably a solid idea (I have a friend working on a similar app) but I've gotta say, the user interface looks horrendous. Form fields slapped anywhere, nothing is aligned with anything else, the sizes of UI elements are all over the place so there's no visual hierarchy, it looks incredibly amateurish. I know that for an app like this doctors are probably looking at functionality first, but it'd be nice if one of the first iPad apps in this niche actually looked decent. Right now it looks like Interface Builder exploded.
- Skeletor 16y agoWait, interface builder isn't supposed to explode when you use it? We are releasing a new version of our iPad application roughly once a month and we are always working on making it better. I think we have a better UI than any other medical company out there, but that isn't hard! It is like playing basketball against Junior High School kids. If you know a designer who could help us email me and put me in touch with them as we are rapidly expanding the company!
- jrockway 16y agoSo what happens when Apple pulls this app for $arbitrary_reason? Are your medical records gone?
- Skeletor 16y agoThe iPad is a front end for https://drchrono.com https://drchrono.com which is a full SaaS product in its own right to manage all of the backend of the doctor's office. We have a really good relationship with Apple, and we are one of the killer apps that make doctors go out and buy iPads. We launched on the iPad initially within a month of its release and work closely with Apple to make sure we comply with security and Apple standards. So it is unlikely Apple will yank our app. We do have an Android phone application frontend and we can invest more in Android tablets as they evolve in the future.
- JoeAltmaier 16y agoApps for corporate use go thru different qualification. Does this app fall under those rules?
- dools 16y agoWhat about their recent changes to billing models? Do the doctors pay your $99 fee through the iPad's in app purchasing?
- alphaoverlord 16y agoI'm interested in learning how DrChrono is planning to market to physicians. I personally think DrChrono is going for a diminishing slice of the healthcare pie. The current trend in healthcare is that a decreasing proportion of physicians are working in small private practices - the cost of healthcare infrastructure, logistics, and billings means large practices and hospital based have significant savings on scale and tremendous bargaining power with insurance and etc. This kind of app, with the appointment scheduler and prescription system, seems very much geared to small private practices. I imagine this kind of system will make limited leeway in large healthcare practices and large academic institutions - this is the difference between enterprise software and web applications. Epic and the like, despite being aesthetically unpleasing and rather cumbersome, is dominating this segment of the market. It's not even a question of cost - these solutions cost much more than competitors, but there is a perceived level of stability and a proven track-record. In both culture and priorities, I think YC companies are not as well prepared to offer enterprise solutions. Large institutions are fickle, full of politics, and without a dedicated sales team, difficult to sell to. They are definitely going for the "meaningful use" incentives as part of healthcare reform - the healthcare reform gives physicians incentives to adopt an EHR (electronic health record) system and going for the sex appeal of using ipads - but I am wondering if that is enough incentive to adopt an electronic health system. Personally, I type 1000x faster on a keyboard than with an iPad, and speed would be an consideration - ie. even as a physician-in-training (hypothetically with comfort in technology), I would have to look hard to decide whether to use such a system. As a medical student, don't think there is enough of an market for general primary care physicians and not enough specificity (currently) to most subspecialities. There are a lot of older physicians that have limited comfort in medicine. I would imagine there is a good market for concierge medicine practices - the kind of places that already have iPads and are interested in distinguishing themselves from the market.
- Skeletor 16y agoMost US private practice healthcare providers (roughly 80%) practice in small groups of 1-5 physicians. That is our target market and still the way that the majority of personal healthcare is delivered in the US! There is a multi-billion dollar per year market in selling EHR services to the private practice doctors we all see everyday. Large hospital level systems are designed for hospital admins 1st, doctors 2nd; they are widely hated even in hospitals and unusable in a small practice. We are launching a speech to text integrated product in the coming few weeks that will remove the need for most typing on the iPad.
- atgm 16y agoThe idea of doctors using iPads scares me; I know plenty of people who make casual typos with numbers on the iPhone or iPad as it is -- the last place I want someone doing that is in a hospital or doctor's office.
- Skeletor 16y agoYou bring up a really good point. Moving to electronic systems has both huge benefits and some risks that have to be mitigated. An example of a huge electronic benefit you can't get on paper charts is drug interactions. drchrono can automatically check drug interactions and warn the Doctor in realtime based on latest available clinical information and drug warnings. My parents take 20+ prescription and non-prescription drugs each, there is no way even a genius Physician would be able to process that number of associations at first glance of a paper chart. The risk of misentered information being accepted as factual because the computer presents all information in the same way is a very real risk that has to be addressed and have safety nets put in place to scrub and check for these errors. One cool way we are tackling this problem is launching an industry leading speech to text processing system in the coming weeks. Letting Doctors record their notes and have an automated transcription can give a safety net for errors.
- atgm 16y agoWhat about a number interface -- hit a button to bring up an oversized numeric pad?
- kmfrk 16y agoI really don't like your UI, but on another note, Jay Parkinson is the guy you should seek out and ask for advice. He's probably the go-to guy in innovating health sector tech. http://jayparkinsonmd.com/ http://jayparkinsonmd.com/
- 2mur 16y agoI'm a physician. I would love to hear about you implemented HIPAA compliance for both the iOS app and for the web service. I think it is a huge problem for any healthcare startup with potentially serious penalties (even criminal!) for mis-implementation. It is a serious third rail.
- bconway 16y agoDing ding ding. That's the elephant in the room, I was surprised the article neglected to mention it.
- niels_olson 16y agoDing ding nothin'. Physician fear of the unknown is the elephant in the room. If you know anything about crypto and read the hipaa security rule, it's very underspecified. The Gov't will be the first one to bear culpability if they push too hard on this. That said, no serious data custodian is going to lack for vastly more than adequate tools for data security.
- bconway 16y agoSorry, still disagree. Software gets into healthcare one of two ways: a.) pre-packaged from big vendors or b.) contracted custom code. It doesn't get in from Apple's App Store, no matter how much we wish it did. The Gov't will be the first one to bear culpability if they push too hard on this. Riiight.
- niels_olson 16y agoI'm a physician too. I would definitely be interested in this also. However, having developed a web app in med school, my experience was the HIPAA security rule is pretty weakly specified compared to credit card auditing. PGP is specifically mentioned as a best practice last I read, and plain fax in the same rank of good enough. Seriously, you're relying on an underfunded agency with a distinct lack of crypto expertise for auditing. Compare that to, say, FIPS and other serious requirements that NIST manages. Meanwhile, I have seen IT departments sell physicians on obviously flawed security products, mainly because few physicians have any idea of what crypto is, let alone could they explain the most basic ideas. And frankly, they are not competent to even hire competent IT people. Whole university systems seem have this problem.
- logjam 16y agoI understand the motivation for these applications, but anything that, in a room with a patient, takes one away from interacting with the patient has drawbacks. A lot of docs are taught NOT to use this kind of device in the room. Even burying your nose in the patient's chart, of course, is problematic. Using it outside may have its advantages, but in the room it's ideally two humans and not much between them. And if you'll forgive me, I have a hard time believing an app like this will drive pad adoption by physicians. Most docs have pads because, well, they just like toys. Some docs have used laptops, which are a lot easier for data entry than these pads, and these don't require turning away from the patient either. In my experience, it's not common for physicians to write their progress notes in the room with the patient. Certainly writing a prescription and sending that to a pharmacy directly makes sense in the room, but there are classes of prescriptions where that cannot be done. Looking up drug interactions may be useful, but dedicated applications like eProcrates and other dedicated apps probably have become standard for that and I'm not sure I'd trust an "everything and the kitchen sink" app like this more than dedicated solutions (eg, these drug interaction databases require constant updating and care). Billing info and medical data combined on a view is a no-go, if that's there. They don't belong together. Period. Probably most importantly, most of us would need details about security of the transmission and storage of medical records before considering this at all. Someone said below this app is "HIPAA compliant", but I'm leery of that overused phrase because the HIPAA requirements are quite vague, and as far as I know there is no actual certification for something like HIPAA compliance. Vague claims of "HIPAA compliance" are likely NOT going to impress or satisfy juries and medical licensing boards. In addition, some information (depending on the state) requires more stringent care; for example, mental health records, record of drug abuse/dependence, etc. Hospitals and clinics typically have dedicated IT departments who put into place much more security than HIPAA requires. If someone hacks a system like this, the fact that you require passwords and do some encryption is not going to cut it if you can't demonstrate you are using standard of practice medical record security measures. Specifically, many physicians would want to know, at a minimum, complete details for: - backup, recovery, and retention policies for all data. - logging mechanisms in place to track access and change of data. By "access" tracking, I mean a record of every last living creature who views the data, at any time, for any reason, and that includes everyone at "DrChrono", the employees of any firms that manage their servers, etc. - audit mechanisms and schedules. - policies Yet Another Third Party ("DrChrono") would have in response to subpoenas, direct request from patients for their medical records, requests from insurance companies, etc.
- ihodes 16y agoIt seems as though people may not know what exactly goes on in an exam room, and how exactly is the one taking notes. Often, especially with specialists, there's an MA or RN taking notes. Note only that, but this seems vastly superior to digging through a pile of charts or working with an ungainly EMR system. The market has been BEGGING for this, and this looks like it might be the right answer. Good luck!
- togasystems 16y agoI just finished a large project for a healthcare company in Canada. I wish the drchrono team the best of luck. Here are some pointers to watch out for in the healthcare industry. 1. Doctors can be extremely cheap. I had to port over a legacy dial up system because the doctors would refuse to upgrade to high-speed. 2. The entire industry, at least here in Canada is ass backwards. It takes ten people to do a single task. You will run into having painstaking long conference calls 3. Multiple standards. Every provider has there own standard that sometimes overlap. 4. Older doctors barely know how to use a cell phone, let alone an iPad. Luckily these doctors are fading out fast. 5. Market to the secretaries. They will pitch to the doctors anything to make their life easier. Good luck guys....hit me up if you have anymore questions.
- robryan 16y agoMy girlfriend does some admin work at a hospital that uses meditech software, seems like the kind of old bulky enterprise software startups are trying to replace. It covers a lot of areas in hospital admin as far as I know, more than just the doctors interactions with patients. I have mnetioned it would be great for doctors to take out the middle man and use things like ipads so this seems great for that. Just wondering if you have thought about integrating into the big bulky industry standard type software? (of course I could be off on what most hospitals use, sample size of 1)
- JSig 16y agoThree years ago when we took my daughter to her first pediatrician appointment, the doctor brought a laptop into the examining room with her. The doctor barely looked at my kid. She just sat there typing away looking at her machine. In my mind technology had become a barrier to the doctor/patient (parent) relationship. It was very frustrating. But, there were many things frustrating about that Dr. so it could have just been her. We quickly found a much better one. So, maybe you should design the interface good enough that docs want to use it but not too good that they use it all the time. Or you can put some alerts in there so that when the doc has been watching too many videos, it reminds them to look at the patient..... just kidding....
- tom_b 16y agoI work with electronic medical records on the research side, integrating clinical patient data with medical research and clinical trials. However, I work with a large teaching hospital rather than small practices. A home run offering for our environment would include a migration path for data from years (and many thousands of patient's data) currently in a patched-together system with 40 years of duct tape holding it all together. Top it off with a massive dose of free text data fields (so no easy field extraction) and you're looking at a huge custom effort to pull it off. But . . . I think there is room here for something that does something nice with machine learning and NLP. Some folks looking into this have found that even free text in path reports contains a significant amount of exploitable structure from a data mining perspective. And once you solve the migration, you'll have to go around the heavily entrenched IT groups holding the duct tape. But, it would be a big win for patients and most physicians are looking for a better solution . . .
- niels_olson 16y ago>you'll have to go around the heavily entrenched IT groups The fattest IT guy I ever saw worked database administration for a university hospital. He had his own elevator to his own floor of the building, and you needed a key to get on the elevator! In 2009 that hospital was still using meditech, and still using it on dedicated terminals with orange monochrome CRTs.
- dr_ 16y agoPersonally I am pleased to see more of an effort being made of late with advancing health care technology. It's a fact - doctors are using the iPad. I see more and more of them in the hospital. I'm not certain whether this will lead to widespread adoption or is just a novelty. In our hospital you can use the iPad to first log into the hospitals Windows based network, then log into HMS, which only works with Internet Explorer. Given how tedious a process this is, and to perform order entry using this technique, to me doesn't seem like its going to last long. I'm thinking a 11" MBA would come in more handy. In the office, tablets should be used to review patient data, but the physician should probably not be entering any data - such as writing up the progress note or billing - while in the exam room. This takes away from the physician patient relationship. So to review data, tablets can be helpful, but are not exactly revolutionary. Real changes in how healthcare is delivered will be determined by how data is collected and how it is interpreted (like the Crimson Initiative). Still, considering that EMR systems like AllScripts are charging over $600 a month PER physician (and that's at a "special" discounted rate for a few years), it's nice to see companies like DrChrono taking a stab at it, to see if they can offer something better, or equally compelling, for a cheaper price. A lot of existing EMR systems are bloated with features that most physicians will never use, and don't even really fully understand.
- jason_slack 16y agoI worked on an EMR app for a while and DrChrono feels very childish. HIPAA compliance seems like a back seat at this point instead of first priority. Maybe a dr would pay $99, but the first HIPAA lawsuit they are going to spend $99,000+ defending all due to software. I also have to admit that DrChrono reminds me of Dr Mario Nintendo game..
- Groxx 16y agoSpeaking as a patient, I've vastly preferred my visits to doctors who had a laptop with an inverted touch screen. Fewer questions about what was already in my (occasionally quite large) medical history - they could find it. Access to the relevant info like X-rays or blood tests, with more information than printouts carry, and adjustable contrast on digital X-rays. And the full history of every similar test I've ever had. My visits have been faster and far more useful every single time. Bring on the tech! I'm tired of having doctor visits where I have to re-state my history when they can read it in a second, and they're tired of lengthy reviewing of my data before the visit (if they do so at all). The only complaint I've heard from the doctors / nurses (and I've asked every single one I've encountered with them) is that they hate using a pen and hate the interface (missing the maximize button and closing the application, for instance). The nurses in particular loved that the doctors typed. Universally, they've said they had fewer medication errors, fewer "what is that?" questions for the doctors, and they get a bit of history and can see abnormal changes and question them in case of a mis-type. Which happens, but usually goes unnoticed if it's not on a computer. YMMV, of course. And theirs. Billing and medical: why do they belong together? I doubt the doctor is also the accountant in even the smallest clinic, and they have no need to see the information. It's more noise, doesn't help them, and can influence their perception of the patient in front of them.
- niels_olson 16y agoyeah, the medical coders will occasionally have coaching sessions for their doctors on how to drop more valuable words in their notes, but I haven't seen docs get much more in the weeds with the money.
- dagw 16y agoThe tech has been around for years, the hard problem is getting the doctors to actually use the tech. The doctor I used to go to seemed to have no idea who I was I why I was there every time I showed up for an appointment, despite the fact that there was a perfectly good computer standing on his desk where he could quickly have looked up everything he needed to know.
- atirip 16y agoThat's another "burning platform" in a week from YC (the other one was that fax-in-a-browser thing). The correct solution to this kind of problem is government backed centralized system. Like in Estonia: http://eng.e-tervis.ee/overview.html http://eng.e-tervis.ee/overview.html . Sooner or later all countries will have this kind of solutions in place and sadly, DrChrono will die..
- viggity 16y agoThe growth of the internet was impeded by a government backed centralized service in France, it was called Minitel. Centralized planning never has and never will work as well as a decentralized market driven system where the best ideas can rise to the top. Dr Chrono may have its drawbacks, but I'd rather see my physician make that call instead of some over-age government bureaucrat.
- atirip 16y agoIt works that way in Estonia, that all the doctors are _forced_ to use that system, which results to a wonderful thing where _every_ doctor has access to _all_ data there is about you - so when you lie unconcius on the street, 911 knows all your allergies, illnesses and treatments etc in that second.
- slee029 16y agoI wonder if having an Ipad-enabled EHR system will be a compelling enough proposition to migrate practitioners from existing experienced vendors with a track record. I would imagine if you already have a system, even if it is an old expensive legacy system, you would not switch simply because of an IPad enabled device. Even if there are other benefits associated with it such as being SaaS-based and cheaper/more secure, the conversion rates I would think would be low when there already exists free cloud based solutions and open-source solutions which they haven't already converted to already. Thus, this makes me think the target market would be the pen & paper crowd. I'm curious to see what the conversion rate is for this crowd since this seems like a tough crowd to convince. Even in scenarios where the EMR/EHR system is completely free (either through pricing plans or government grants) you don't see many of them moving away from the pen & paper which signals price might not be the most important factor here either. To me this leaves overall usability and learning curve which I'm not sure if DrChrono necessarily promotes as their pitch seems to be portability. I'd like to see how their product matures to tackle that issue since in my opinion their competitors really aren't other EHR vendors as much as the huge pen & paper market that's a much larger share of the pie.