In what they say is a first, a group of technology vendors has teamed up to add heart and lung sounds to an EMR. The current effort extends only to the drchrono EHR, but if this rollout works, it seems likely that other vendors will follow, as adding multimedia content to patient medical records is a very logical step.
Urgent care provider Direct Urgent Care, a Berkeley, CA-based urgent care provider with 30,000 patients, is rolling out the Eko Core Digital Stethoscope for use by physicians. The heart and lung sounds will be recorded by the digital stethoscope, then transmitted wirelessly to a phone- or tablet-based mobile app. The app, in turn, uploads the audio files to the drchrono HR.
Ordinarily, I’d see this as an early experiment in managing multimedia health data and leave it at that. But two things make it more interesting.
One is that the Eko Core sells for a relatively modest $299, which is not bad for an FDA-cleared device. (Eko also sells an attachment for $199 which digitizes and records sounds captured by traditional analog stethoscopes, as well as streaming those files to the Eko app.) The other is that the recorded sounds can be shared with remote specialists such as cardiologists and pulmonologists, which seems valuable on its face even if the data doesn’t get stored within an EMR.
Not only that, this rollout underscores a problem just been given too little attention. At present, what I’ve seen, few EMRs incorporated anything beyond text. Even radiology images, which have been digital for ages (and managed by sophisticated PACS platforms) typically aren’t accessible to the EMR interface. In fact, my understanding is that PACS data is another silo that needs to be broken down.
Meanwhile, medical practices and hospitals are increasingly generating data that doesn’t fit into the existing EMR template, from sources such as wearables, health apps and video consults. Neither EMR developers nor standards organizations seem to have kept up with the influx of emerging non-text data, so virtually none of it is being integrated into patient records yet.
In other words, not only is it interesting to note that an EMR vendor is incorporating audio into medical records, at a modest cost, it’s worth taking stock of what it can teach us about enriching digital patient records overall.
Eventually, after all, patients will be able to capture — with some degree of accuracy — multimedia content that includes not only audio, but also ultrasound recordings, EKG charts and more. Of course, these self-administered tests and will never replace a consult by a skilled clinician, but there certainly are situations in which this data will be relevant.
When you also bear in mind that the number of telemedicine consults being conducted is growing dramatically, and that these, too, offer insights that could become part of a patient’s chart, the need to go beyond text-based EMRs becomes even more evident.
So maybe the Eko/drchrono partnership will work out, and maybe it won’t. But what they’re doing matters nonetheless.
For those that don’t know the history of EMR and HIPAA, I wrote the first post on EMR and HIPAA back on December 11, 2005. It’s fun to read that first post. Short and sweet. I hit some high level points which amazingly still represent my desires 10 years later. “I will try to incorporate any aspects of EMR and HIPAA because I think best practices across the industry are important to know.” – I still try to incorporate any aspect of healthcare IT. Lately I’ve been writing even more about the business of medicine, but I still try and find best practices.
In my original post I invited people to participate in the conversation. I still desire this greatly, but I’ve found that much of the conversation has moved to social media versus the blog comment section. Plus, as I’ve refined my blogging skill, it avoids many comment threads. In the beginning I wasn’t as skilled and so there was a lot of opportunity to correct me which made for great comment threads.
The last line of that original post really expressed my understanding of EHR at the time: “This is my best knowledge from my research and is not guaranteed in anyway.” Pretty funny that I thought to put in a disclaimer from the start. When I started I knew so little. It’s amazing how much you can learn over 10 years. Yet, I’m still learning.
5 months into my EMR and HIPAA blogging journey I celebrated reaching 30,000 visitors to my blog. I was amazed by my achievement. Little did I know that less than 10 years later I’d be celebrating 2300 blog posts and 11 million pageviews. For some perspective, we celebrated 3 million pageviews in August 2010 and then last Valentine’s day we celebrated 9 million pageviews. I was nostalgic for those posts and still am today.
I’m really not sure how to process 2300 blog posts and 11 million pageviews for one of my Healthcare Scene blogs. I mostly feel to say: Thank you!
I never thought I’d be a full time blogger when I grew up, but I feel lucky to do so. Over the past 5 years as a full time blogger, it’s been amazing to see the blogging business model change. When I started blogging people were happy to buy links from my site (We stay far away from that now). We always have done some pay per click and display advertising and those both still do quite well for us. However, as we’ve matured, we’ve been able to offer a variety of email marketing and sponsored content options which really take healthcare IT marketing to the next level.
With that in mind, I want to take a second to thank those companies who are currently supporting the work we do here at EMR and HIPAA. Without their support, none of this would be possible.
What I love about each of these companies is that they are looking to promote their company, but they’re also interested in supporting the work we do here at EMR and HIPAA. Almost all of them are not only sponsors of the site, but also readers of the site as well.
If your company would like to support the work we do here at EMR and HIPAA, we’ve created a new landing page which outlines all of the various healthcare IT marketing and advertising options we offer across the Healthcare Scene network. We’d love to work with you on sharing your message. Just drop us a note on our contact us page.
We’ve got a lot of ideas on how to continue to make what we do here at EMR and HIPAA better. However, what won’t change is our efforts to provide valuable content that helps make our readers’ lives easier.
The vendor, California-based Drchrono, is claiming that the application is the first “wearable health record.” Whether or not that’s the case, this is clearly a step forward in the development of Google Glass as a practical tool for doctors.
According to a Reuters report, Drchrono worked closely with cloud-based storage and collaboration service Box along with Google Glass to create the app.
The new Google Glass at allows doctors — with the patient’s permission — to use Google Glass to record a consultation or surgery. Once the work is done, physician can store the video, as well as photographs and notes, and the patient’s EMR or in Box. The app also allows the data to be shared with the patient.
The app is still in its infancy — so far, just 300 of the 60,000 doctors using Drchrono’s EMR platform have opted to use the Google Glass app, which is currently available at no cost to users.
But Google Glass apps and options are clearly on the rise, and not just among providers. A recent study by Accenture found that consumers are are very interested in wearable technology; they’re particularly interested in wearable smart glasses like Google Glass as well as smart watches.
As things stand, devices like Google Glass are in the very early adoption stage, so it’s not surprising that few of Drchrono’s physician users have opted to try out the new app. But things are likely to change over the next year or two.
I believe Google Glass will follow the same trajectory the iPad did in medicine. First it was a toy for the well-financed, curious and tech savvy, then an option for early adopters in medicine, then eventually a tool that made sense for nearly every provider.
For the next year or two, most Google Glass announcements will be like this one, reports of experiments whose only uptake will come from leading-edge experimenters in medical technology. But within the next two years or so, Google Glass uses will proliferate, as will the apps that make them a worthwhile investment.
This level of success isn’t inevitable, but it is likely. I’d bet good money that two years from now, you may be reading this blog on a Google Glass app and managing your EMR through one as well. It’s just a matter of time.
We have a number of really big announcements we’re going to make in the next month. One of them I can’t really mention, but the other is a Healthcare Marketing and PR Focused conference in Las Vegas (of course, since I live in Vegas). I’ve floated this conference idea to a couple healthcare marketers and their response has been nothing short of amazing. I think they’re really excited to go to a conference which helps them do their jobs versus going to conferences to market their company. Watch for the official announcement to come out soon. Plus, the other announcement I can’t talk about is even more exciting for the network.
With that said, Healthcare Scene (which EMR and HIPAA is a part) is doing really well. We’re well over 12 million pageviews and over 6500 blog posts since we started blogging on EMR back in 2005. I want to take a second to thank all those organizations that support what we do. Some have just started working with us and then there are many who have been supporting us for a lot of years. Either way, their support is always appreciated.
If you enjoy the content we create, I hope you’ll take a second to check out these EMR and HIPAA supporters. Their support keeps the lights on.
New Supporters interfaceMD – One of the things I like about how interfaceMD looks at the EHR market is that each installation needs some custom work to match the unique needs of a doctors office. To use the oft quoted phrase, if you’ve seen one clinic, you’ve seen ONE clinic. I’ll be doing a G+ Hangout with the interfaceMD President and CEO, Joel Kanick where I’m sure we’ll explore this topic more.
DrChrono – A lot of EHR vendors talk about their iPad EHR application, but there are few EHR vendors that have created an iPad first EHR application. That’s the way DrChrono has approached the development of their EHR. Plus, they offer a free version where you can give their EHR a test drive before you buy. Just download the drchrono EHR on your iPad and try it out.
gMed – I’ve often written about the value of specialty doctors purchasing a specialty specific EHR. If you’re looking for a Gastroenterology EHR, then you should check out gMed. Plus, they’ve even put out this free whitepaper called Independent Gastroenterology: A Look into the Future. It’s a good example of their deep understanding of gastroenterology.
The Breakaway Group (A Xerox company) – This company takes a really unique approach to EHR and ICD-10 training. Plus, I love that they have deep roots in researching the most effective leaning techniques which they then use to refine their product. So, I’m excited to have them contributing to a monthly series of blog posts that we’re calling the Breakaway Thinking Blog Series.
GNAX Health – As healthcare IT continues to be implemented, I’m seeing more and more organizations looking at their disaster recovery plans using an external data center. GNAX has a whitepaper called Healthcare IT Disaster Recovery: 9 Steps to Help Target a Reliable DR Datacenter where they cover some of the challenges associated with finding the right disaster recovery data center. The time to prepare the disaster recovery is now and now when the hurricane is bearing down.
These organizations have renewed their support of EMR and HIPAA. It’s always appreciated to see these companies renew year after year. Ambir – Advertising since 1/2010 Amazing Charts – Advertising since 5/2011 simplifyMD – Advertising since 9/2012 Canon – Advertising since 10/2012 Xerox – Advertising since 2/2013
When the topic is health IT, it’s easy to get caught up in discussing the major EMR players.
And because of Meaningful Use, there’s a tendency for everyone to do the same things — even if they go about it in different ways. Whether you’re a giant like Epic, an upstart like Kareo or a specialty firm like the gastroenterology-focused gMed, you’re likely making sure, for example, that your customers will be able to exchange structured care summaries with other providers and with patients.
But there’s still plenty of innovation in health IT, much of it with little or no connection to MU2 or other federal requirements. Startups all over the country are trying to improve lives through more efficient collection and use of data.
Here’s a sampling of startups and specific innovations:
HealthLandscape. This Cincinnati-based firm markets a mapping application that lets you input data from a variety of sources. The idea is to better understand health information by visualizing it. The company is a subsidiary of the nonprofit Health Foundation of Greater Cincinnati, which worked with the American Association of Family Physicians and the Robert Graham Center to develop the platform.
SwiftPayMD. This iPhone and iPad app from Atlanta-based Iconic Data allows physicians to note diagnostic and billing codes by voice right after seeing a patient. I have to admit, when I stopped to think about it, I was surprised that doctors couldn’t already do this. The major selling point: It helps practices to get paid as much as two weeks sooner.
Vivify Health. Based in Plano, Texas, this startup has created a cloud-based platform for monitoring and testing patients remotely. Its system works with just about any consumer mobile device to provide customized care plans, coaching, educational videos and interactive video conferencing. In a press release, Vivify Health said it’s helping hospitals, home health agencies, payers and others to reduce readmissions, manage chronic diseases and improve care transitions. It received funding this year from Ascension Health Ventures and Heritage Group.
Drchrono. This Mountain View, Calif.-based company bills its flagship product as “the original mobile EHR built for the iPad.” It was part of the Y Combinator, a Mountain View-based seed accelerator, in 2011. Drchrono in 2012 raised $2.8 million in funding led by venture capitalist Yuri Milner.
Doc Halo.This firm, based in Cincinnati, makes possible HIPAA-secure texting. (If this list seems slightly Cincinnati-centric, it’s because I worked in the city for eight years and know the market better than I know others.) Many doctors use regular text messaging to discuss patient information, but they shouldn’t. Doc Halo’s mobile app system uses several levels of encryption.
These are just a few projects that I thought were cool. Based on what they’re doing, there’s plenty to be hopeful about in health IT. There are, of course, many other firms equally worthy of mention. And there are now accelerator programs all over the country specifically for health IT startups.
I often get the feeling that the federal government’s involvement is taking the joy out of health IT. That’s not the case, but amid the push to meet MU2 requirements, you might have to look a little harder to find it.
And with these startups, here it is.
Disclosure: gMed and DrChrono are both advertisers on this site.
Another week has passed and we’re back with some of the interested EMR and Health IT related tweets this week. Tomorrow I’m flying to AHIMA in Chicago. It’s setting up to be a really great event that should produce some really interesting content. More on that in future posts. Plus, I’m bringing a camera with me and hoping to get a lot of the people I talk with on video.
Now on to the EMR tweets!
First heard @doctor_v talk about EMR & Social Media integration 4 years ago when I met him. It’ll happen someday #MedX
Most doctors cringe at even the thought EMR and social media in the same sentence. This is a huge barrier for any EMR to integrate with social media sites. Although, I agree with Dr. Sevilla that it’s going to happen some day.
This article was pretty terrible and felt like the journalist was trying to sell DrChrono. Who knows, maybe the were. Although, the headline and their conclusion is pretty insane. Their logic in the article is that because a large percentage (62%) of physicians use a tablet for professional uses, then it’s the perfect solution for EMR. Talk about a stretch. Maybe the tablet will eventually become the EMR device of choice, but it hasn’t happened yet. It’s fine for consuming content, but not so good at entering data.
I recently came across this really interesting comment from Abby Nardo on the DrChrono blog:
Thanks for featuring me. I’m really liking Dr. Chrono, and what I’m liking most is your responsiveness to suggestions. As an early adopter to new technologies, this is often what makes/breaks my allegiance, and you guys are great. If you aren’t able to respond to feature requests right away, you tell me why or let me know when it’s going to happen. I’m never left hanging. So far, I’m really happy.
This is one of the challenges in selecting an EMR software vendor. If you choose one of the older EMR vendors with a large established client base, then your comments and feature requests often fall on deaf ears. I’m not saying that these larger EHR vendors don’t listen to their customers. It’s just that they’re getting messages from 1000’s of EMR users at the same time and so you have to work a lot harder to make sure that your request is heard above the noise of the other 1000 voices that are shouting at the same time. Even with only 100 EMR users it’s hard for an EMR vendor to be able to really give personalized attention like is described above by Abby.
As a new entrant into the EMR world DrChrono and other new EMR software have this to their advantage. Since they only have a few customers, they can be very responsive to those customers in ways that a large company never could do. Part of it is what I described above (ie. lack of noise), but the other part is that DrChrono is still really actively developing the features in its EMR. Older EMR systems have likely already built the features that DrChrono is just now getting requested. Some consider this an advantage and some consider it a disadvantage.
Turns out that this is a perpetually cycle. Assuming DrChrono lasts, one day they’ll be the entrenched player and some other company will come along that can be more responsive to customers for the same reasons that DrChrono can be responsive today.
Which is Better?
I’m sure some people are then asking, which option is better? Is it better to have a more responsive EHR company or an EHR company that already has the EMR features that I need?
My answer is that it likely depends upon the nature of the clinic. Certainly you want to be really careful adopting any EHR that doesn’t have essential functions that you need in your office. However, after those baseline features, it depends how involved as a clinic you want to be in the future development of the EHR software. Most providers that I know don’t really want to actively participate in the development of the EHR software. They just want to open the box and have it work. However, for those few who really want to play an active role in shaping the future of an EMR, working with a smaller company can really produce great results for their clinic.
I hate to keep bashing Silicon Valley, since I’ve come to think that it’s venture capitalists, not tied to one particular region, who are the ones not “getting” healthcare. That said, we got a bit more overblown hyperbole coming out of Northern California this morning from drchrono.
The Mountain View, Calif.-based company, which likely is correct when it says it created the first EHR that it native to the iPad—and a free one at that—announced today that it has received an new round of $650,000 in seed funding from the VC community. (Congratulations on that.) Drchrono today also introduced OnPatient, an iPad app that replaces the hated clipboard and paper form for taking patient history at the doctor’s office. Here are the details, from the drchrono press release:
drchrono Launches iPad App to Replace Paper-Based Check-In at Doctor’s Office; Closes Additional $650,000 in Seed Funding
Free OnPatient App Digitizes Patient Waiting Room and Integrates Seamlessly with Electronic Medical Records
Mountain View, CA – August 18, 2011 – drchrono, the company modernizing healthcare through a free Electronic Health Record (EHR) platform on the iPad, today announced a new patient check-in app which replaces the traditional paper check-in process in the physician waiting room. OnPatient is an app that can be downloaded to the iPad for free and integrated into a medical practice as a stand alone onboard app. The patient check-in app also seamlessly integrates with drchrono’s Meaningful Use-certified iPad EHR.
On the heels of the OnPatient product launch, drchrono recently closed an additional $650,000 in seed funding from prominent start-up investor Yuri Milner, founder of DST Global, and venture capital firm General Catalyst. This follows $675,000 in seed funding from General Catalyst, Charles River Ventures, 500 Startups and angel investors, previously announced in July.
“The OnPatient check-in app digitizes the waiting room and eliminates significant barriers to mass adoption of patient check-in technology by leveraging sophisticated iPad technology. Proprietary check-in hardware is prohibitively expensive and integration with existing EHR systems is too complex,” said Michael Nusimow, co-founder and CEO of drchrono. “We designed the OnPatient app to be intuitive for both physicians and patient users to create a better patient check-in experience.”
OnPatient is a full-featured app with customizable templates that enable physicians to eliminate paper forms and clipboards in the waiting room. There are no contracts or monthly fees; the only hardware investment is the iPad itself. Upon download, the OnPatient app allows patients to:
Complete family medical history and demographic information
Complete insurance information
Snap a profile photo
Sign the HIPAA consent form with a digital signature
The touch screen interface is user-friendly and the information auto-populates directly into the drchrono EHR platform. On subsequent visits, patients do not have to complete duplicate forms—they need only review their information and make any necessary changes on the iPad. OnPatient meets all industry security standards, ensuring the privacy and safety of patient data.
For more information on drchrono and the OnPatient app, please visit www.drchrono.com.
drchrono focuses on Apple’s iPad and cloud computing to build a better healthcare experience.
They offer a free EHR platform built on the iPad that is Meaningful Use certified. drchrono is also the first iPad EHR to implement real time clinical speech-to-text. drchrono handles everything a doctor needs to run their practice, including medical records, electronic prescribing, medical billing, and patient management. For more information, visit https://drchrono.com
The drchrono iPad EHR is 2011/2012 compliant and has been certified by InfoGard Laboratories, an ONC-ATCB, as a complete EHR in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. drchrono version 9.0 was Stage 1 certified on June 3, 2011. The ONC certification ID number is IG-2492-11-0083
What got me was the claim in the e-mail that accompanied the press release. “Today, drchrono, a hot Y Combinator start-up focused on Apple’s iPad and cloud computing to build a better healthcare experience, announced OnPatient, a groundbreaking app that digitizes the medical practice waiting room,” the message started. This was the same claim that drchrono included in a media advisory earlier in the week.
Sorry, there is nothing “groundbreaking” about software that collects medical history electronically and automatically populates an EHR with this information. Instant Medical History, a program from Primetime Medical Software, Columbia, S.C., has been doing this for years. Though it is primarily a PHR vendor, NoMoreClipboard.com‘s name betrays one of its products, a patient portal for medical practices that collects patient history online. ePatientHistory.com is similar.
No, IMH does not have a native iPad app, but it’s worked on tablets going back to the bulky Windows tablets circa 2003, even if few customers actually chose that option. NoMoreClipboard.com is Web-based, which means it’s accessible from any device with a Web browser such as, say, an iPad.
When I called the publicist on the “groundbreaking” claim, I got this back. “Of the physicians I’ve spoken to, the user-friendly interface of the iPad app really makes patient onboarding easy and they love the ‘novelty factor’ of using the iPad as well. It’s less intimidating for patients who have limited experience with healthcare IT.”
Fair enough. But that doesn’t make OnPatient “groundbreaking.” The iPad is groundbreaking. OnPatient is interesting, useful and frankly, long-overdue competition to Instant Medical History. I hope it catches on. But it’s not much of a breakthrough.
I can’t wait to see the breathless coverage from the other tech press who don’t know the, ahem, history (sorry, couldn’t resist). If you want the unvarnished, occasionally acidic truth, come here.
For that matter, here’s the company’s own message, via video:
It’s rather low-key, actually. I have just one question: Why do they say “tax breaks” for meaningful use? The money is in the form of Medicare/Medicaid bonus payments. As EMR and HIPAA readers know, those payments are considered taxable income. Just sayin’.
Once in a while, I run out of Big Ideas to share and resort to a rundown of short items. This is one of those times. Often, though, that approach turns out to be more interesting than a well-thought-out commentary. (Thus, the popularity of Twitter, right?)
Speaking of Big Ideas, I’m thinking that the age of the massive EMR project may be coming to an end. You may have seen my piece in InformationWeek today about the reported end of the national EMR in England. London’s The Independent reported earlier this week that the Cameron government will announce next month that it will scrap the national strategy in favor of allowing local hospitals and trusts to make independent EMR purchasing and implementation decisions.
This news comes on the heels of a decision by the government of Ontario to give up on hopes for a single EMR for all of Canada’s most populous province.
On the other hand, here in the States, we’ve seen a lot of consolidation among healthcare providers, but I’m guessing that has more to do with administrative Accountable Care Organizations and the prospect of bundled payments than any desire to build a more unified EMR. Though, consolidation does make health information exchange somewhat easier, and that’s going to be key to earning “meaningful use” dollars beyond 2013.
On a somewhat similar note, doesn’t a headline like, “Positive Outlook for Small Practice EHR Adoption” sound like a no-brainer? I mean, isn’t that the segment of healthcare providers that historically has had the slowest adoption rates? More than anyone else, small practices—particularly small, primary care practices—are the intended target of the federal EHR incentive program. And most of the news from health IT vendors of late has been about how they are going after this long-neglected market, right? The innovation seems to be happening in ambulatory EMRs, as evidenced by DrChrono’s newly certified iPad EHR app, aimed squarely at independent physicians.
That said, vendors and publicists, please do not start inundating me with news about other EHRs getting certified. There are hundreds of certified products out there now, and I cannot and will not write about, oh, about 95 percent of them.
While you’re at it, please stop using the word “solution” as a synonym for “product” or “service.” Tech journalists hate this trite, lazy and, frankly, inaccurate term so much that I’ve been instructed by the editors of InformationWeek not to use it, except in direct quotes. In fact, I get reminded not to use it pretty much every time I’m forwarded a press release laden with news about someone’s “solution.” Solution to what? I’ve been seeing that term since I started covering health IT more than a decade ago, and I still don’t see much getting solved in healthcare. With all the “solutions” out there, you’d think that healthcare had been fixed by now.
I could get a whole lot more curmudgeonly on you, but I think I’ll stop now and await your comments.