Podcast interview with Doctations CEO Dr. Louis Cornacchia (transcript)

This is the transcript of my recent podcast interview with the CEO of Doctations, Dr. Louis Cornacchia.

David Williams: This is David E. Williams, co-founder of MedPharma Partners and author of the Health Business Blog.  I’m speaking today with Dr. Louis Cornacchia, CEO and President of Doctations.  Dr. Cornacchia, thanks for your time today.

Dr. Louis Cornacchia: You’re welcome.

Williams: Tell me about Doctations.  What is it?

Dr. Cornacchia: Doctations is a software system.  It’s a suite of Google Apps-like applications using a standard web browser for doctors and their patients.  It contains the entire suite of functionalities that are found in any EMR/EHR and billing software.  Also it’s tied directly to web applications for patients, allowing  them to share space or Internet space with doctors in real time.

Williams: How would this be different from a typical application that might be set up in a physicians office?  Is it mainly the patient portal piece of it that makes it different?

Dr. Cornacchia: No, it’s the difference between having an intraoffice phone system versus a phone system that connects to the rest of the world.  It’s an Internet based system so it allows for clinical interactions, business interactions between physicians and both clinical and supportive interactions between doctors offices and patients.  So it’s really a whole new approach.  This isn’t an in-office client/server system.  This is a true network-based system that people can log onto today for free and actually start using a lot of the functionality without even paying a penny.

As physicians have gone on to do that, many have actually called and begun paying us a subscription fee per month specifically to gain the ability to add additional functionality to the software.  We have over twodozen partners that provide services such as real-time voice recognition and back end voice recognition tied to transcription. They’re all listed on our website.

These are all available because they are web services provided by corporations specializing in their specific niches and providing services to doctors to improve the workflow within the office, improve cashflow, and improve the ability for the physician to take care of their patients. For example, on the scheduling side, there is the ability to tie into a web service that allows for automated phone reminders to patients 48 hours before an office visit.  There is really nothing for a physician or an office staff to do other than schedule the patient and the phone calls are automated.  So as a true Internet creature the Doctations system can take advantage of all these basic Internet web services that have been available to the big guys for years and make them available to small offices or big offices alike.  It doesn’t make a difference.

Williams: How does this change the practice of medicine from the standpoint of the patient or the physician?  What are the sorts of things that can be enabled when somebody pulls all these web services together?

Dr. Cornacchia: Well that’s just the beginning. I don’t know if you’re familiar with what’s going on with Health 2.0.  We’re in the very early stages of forming companies based on web services for patients, services that will define whether or not a new symptom of a patient is related to a new medication they started, for example.  We’re seeing a large number of web 2.0 web services that are coming to us and asking to partner with us so they can provide services directly to patients through the same network system we’re using to help patients connect directly to the doctors.

Williams: As you say, we’re still at the early part of this. What are you seeing in terms of the typical profiles of your users?  What are they like?

Dr. Cornacchia: There is no typical profile.  That’s the most unusual part of this.  It isn’t as if it’s all 25 year old women or 35 year old men.  We see a full spectrum of people from the teens all the way up to the 70’s and 80’s using this.  It’s surprising to me because I actually expected that it would be more of the younger crowd who grew up with computers like we did.

I think that what’s happened is that the Internet world has just made it so clear to everyone, even those who are older than we are, that in fact the conveniences of using the web are so great that it’s worth the effort. The result is that you end up with services that are provided more efficiently and therefore more cost effectively than through standard bricks and mortar approaches.

Williams: Is there a benefits for a Doctations user if they want to interact with another physician that is also Doctations user?

Dr. Cornacchia: Well David, yes.  Just think of the implications of having a free version of the software available to everyone. Now collaboration can occur between doctors and referring physicians without the physician having to be a paying member.  But then what happens is the non-paying physician looks at the system and begins to realize it’s a full-fledged comprehensive system with task management and integrated billing. They can look at their own billing in real time and then interface with medical billers in their office or outsource. They begin to realize it’s a fully certified system that’s as good as any system they’ve ever seen.  It’s better because now it’s truly an Internet creature and so they end up with the best of both worlds.  So most doctors are saying: I’m coming with you.  We’ve had a lot of doctors moving in our direction just because doctors who are collaborating with doctors who are using our system suddenly realize this is a great way to go.

Williams: Obviously a lot of attention is being paid at the Federal level to the concept of meaningful use as part of the stimulus package and health care reform.  How does the stimulus package tie into what you’re doing at Doctations?

Dr. Cornacchia: We invented meaningful use ten years ago.  I’m a physician and I went to this not to become another EMR vendor, but to fix problems. As a physician and as somebody who has experienced health care from the patient’s side rather intimately, I can tell you very clearly that having a client/server system is a shadow of what an Internet based system can do.  So in meaningful use, it’s all about how can you achieve health care efficiencies without creating more work and at the same time building quality.  It actually turns out that it’s a common denominator for both, so building an Internet based system solves both problems. Meaningful use basically means an Internet based system.

Taking client/server systems that are in every office and tying them together is ultimately not a satisfactory answer because there are problems of synchronization. Unless each office is continually connected and continuously synchronized with some central database, there is a remote potential that there could be miss synchronization resulting in inappropriate or incorrect or incomplete information being looked at by a single physician.

It could result in a death because the wrong medication was prescribed and doctors didn’t know another medication was prescribed five hours earlier and had never been synchronized with the central system.  That approach has failed and I think that people are beginning to realize that that’s just not going to work.  In fact, what we visualized in 2001 and 2002 as the only real answer to these problems was right on.  It has to be Internet based.

I know a lot of people have put a lot of work into client/server systems and I think that there is a way to incorporate such systems into this type of a network, but I think that it requires that certain central repositories of data become integrated at the code level. I don’t think it requires a tremendous amount of work but for the most part what we’re going to see is a migration into Internet systems in order to achieve true meaningful use, simply because the cost efficiencies of providing services to Internet architectures like Google apps and like Doctations are just so much more cost effective, so much less expensive. That alone is a decision maker, but then when you look at all the connectivity and collaboration and other options that then become available at the Internet level, there is just no other choice.

Williams: If a Doctations patient is in the hospital, are you able to have collaboration between the hospital and the ambulatory physicians or is that harder than doing it among ambulatory physicians?

Dr. Cornacchia: Connecting to hospital-based systems using collaborative-based modern technology built on a .net backbone is actually straightforward.  The cost of integrating systems like these are actually remarkably low.  The only variable that can’t be accounted for is the bureaucracy associated with achieving agreement to connect between the vendors and on behalf of the particular facility or hospital.  That’s the only unknown variable.

The actual technology costs of connecting these systems is almost trivial. You end up connecting to a whole backbone of people so the cost of connections in a cloud based system just makes it a much more viable option as opposed to trying to connect each and every client/server based system to a hospital system.  So there is the advantage of numbers.  On top of that, there is the reality that our interface is available as an add-on to an existing hospital system so that they can simply link it directly to the various portions of their hospital system and make our collaborative technology immediately available.

Williams: There are some other companies that have gotten on the Internet health care band wagon.  Maybe I’ll ask you to contrast yourself with a couple of those that are fairly prominent.  One is Practice Fusion that focuses on the EMR side and another is American Well that’s more focused on the clinical interactions.  How do you fit in with them?

Dr. Cornacchia: I think they’re both great companies and I think that they’re thinking in a similar direction and I think that’s great.  The more people moving in this direction the better.  I think that the EMR system in Practice Fusion is a good start.  I think that it’s a good basic SOAP based system.  Most physicians are familiar with and it’s reasonable.  I think that they have not gone through the certification process, in fact they have ridiculed it, which I think is wrong.

We went through the certification process and as a physician trying to achieve a vision it was a painful process because there are a lot of hoops you have to jump through to make that work.  In conclusion, they’re not inappropriate hoops.  They were hoops that are actually required for complicated workloads that are found in doctors’ offices and other clinical settings.  So what’s present in the certification project is actually laudable.  It’s very well thought out and I don’t think it’s biased at all. It’s a very well thought out set of requirements and I think it’s unwise to challenge that.  I think it’s unwise to contradict that whether or not there are vendors involved.

I know all the rest of the issues.  I don’t see it.  I don’t really believe that.  I think things probably happen that we don’t know about of course, but for the most part what we saw was legitimate requirements and criteria for a system that has to live in a very complex world for doctors and patients.

American Well deals with communications. If you take a communications system and it just exists out in its own place, separate from the actual software system used to run the office, both clinical processes and billing processes, it becomes a non-integrated separate process. We originally thought about moving in that direction, but what’s really required is one comprehensive Internet based system that then gets expanded and becomes the foundation for communications and collaborations.

There’s no reason why there should be one EMR approach, probably multiple EMR approaches.  So what we’ve built is a software platform for Internet health care that we make available to government agencies and universities at the source code level.

So the answer to your question is that they are both excellent companies and I think that they’re both moving the entire industry forward. They both have a lot to contribute and I think that they’re very much along the lines of functionalities that exist already in Doctations.

Williams: I’ve been speaking today with Dr. Louis Cornacchia.  He is President and CEO of Doctations.  Thank you very much for your time today.

Dr. Cornacchia: You’re welcome.  You’re very welcome.

November 20, 2009

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