Drchrono bills itself as the “original mobile EHR built for the iPad.” With that in mind, I decided to ask the company’s co-founder and COO, Daniel Kivatinos for his thoughts on Apple’s entry into the healthcare space with its new Health app and HealthKit development tool. Here are my questions and his replies:
What is drchrono? How is it different and better than other EHRs?
Drchrono was the first to develop a native EHR solution for the iPad and Google Glass. Our technology is disruptive in that we fuel the easiest, most-innovative patient care experience on the market today. Our platform has dramatically improved the patient point of care experience by allowing doctors to communicate face-to-face with patients (rather than behind a PC), improved the flow of information between doctors and patients, and reduced the time spent on charting and other historically time-intensive tasks.
We have over 70,000 doctors and 3 million patients benefiting from our platform. That number continues to grow rapidly. We were voted the top EHR two years in a row by Blackbook Rankings, and recently joined the INC500.
What does it mean that Apple itself is moving into health? What are the broader implications for the market?
Apple has some of the best designers and engineers in the world, and having them put mindshare into healthcare is a big deal. Apple serves both business and consumers, but I think we’ll see the most evolution in consumer-facing technologies, namely those that make logging wellness data and taking action easier.
What is HealthKit and why does it matter? How does it relate to the Health App in iOS8?
HealthKit allows developers to plug into the “Health” app on iPhone. The iPhone “Health” app connects medical hardware and software alike, pulling in data from many sources. For example when an individual has an iPhone that connects to FDA approved devices such as blood pressure cuffs, thermometers, fertility monitors and glucose meter, the “Health” app can pull that data in if the person wants.
Drchrono just announced the launch of OnPatient, your personal health record platform. What is it and how does it tie in with HealthKit?
OnPatient allows patients to book appointments, fill-out forms, message their doctors and most importantly have access to their medical records at their fingertips. Our most recent integration with HealthKit lets patients import their wellness data (via Health) directly into OnPatient. Best of all, patients can share that wellness data in an easy-to-digest format directly with their doctors.
PHRs have never really caught on. What’s different about this new attempt?
People love their phones. They like being able to access banking, their social networks, email, and more in one place. Health information is no different. In the past, PHR’s generally required patients to enter their health data on the web manually. This took plenty of work…and busy people didn’t have the time to spend on data entry.
Our solution pulls in data from doctors, and now, information from Health…all without the patient manually entering a single piece of data.
How will it impact physician practice and specifically patient visits?
Our EHR impacts physicians every day by making their –and this will sound clichéd– lives easier. They have access to their entire practice’s data in one place, their iPad or laptop. Doctors can easily access patient data on the go, and as a result, provide better service to their patients.
Patients will have immediate access to their medical records, prescriptions, and now wellness data.
Does my doctor have to be using drchrono for a patient to use onpatient? If so, how do you overcome that barrier?
With this initial release, yes, but you can have your physician join Drchrono for free at your request.
The Apple Watch was announced but not yet released. What do you think of it? What will its rollout look like?
I am very excited about Apple Watch. It will be a great way to track more health data like heartbeat and steps. Doctors will be able to use the Watch in their practices: for example, to see a list of patients coming in for the day.
Big players, especially Epic, are gathering up more and more of the total EHR market. Is there room for a company like yours or is the battle hopeless?
Epic is going after a different market, they are going after hospitals. drchrono focuses is on smaller offices with one to 20 physicians.
Many physician offices have patient portals, since they’re a requirement for Meaningful Use Stage 2. But a new survey from Software Advice confirms what we knew intuitively – these portals don’t get much use. Patients don’t know they exist and doctors don’t use them a whole lot. That’s kind of odd considering that portals can be useful and efficient. They’re good for checking lab results, asking non-urgent clinical questions, renewing prescriptions, managing appointment schedules, patient education and paying bills.
Why then is uptake so low? I have a few ideas:
The systems are clunky -frustrating to navigate, often down for maintenance or for no explained reason, and slow
Workflows are awkward. For example a physician may have access but her admin may not
There’s often no value proposition for a physician who wants to use a portal
Messaging is inflexible with no access to attachments web links or other enhancements
Some of the more important communications, like sharing a diagnosis don’t lend themselves to asynchronous communications
Privacy and security remain concerns and the required safeguards create barriers
Contrast the weak state of portals, which have been available in one form or another for 20 years, with other changes in communication that have been embraced much faster. Think texting, Skype, and mobile commerce, all of which have rocketed to prominence since patient portals were invented. I do think we’ll get there, but it will take a new generation of doctors, patients, software developers and payment models to make it happen.
You can find the original item from Software Advice here.
In health information technology, there are no clinical trials or tests with randomized controls, as there are for drugs, for example. True, digital data does not go into the body, but it can increasingly guide what does.
Using vignettes of real cases and the SimulConsult diagnostic decision support software, neurologists listed a differential diagnosis and workup before and after using the decision support. Using the software, there was a significant reduction in error, up to 75% for diagnosis and 56% for workup. This error reduction occurred despite the baseline being one in which testers were allowed to use narrative resources and Web searching. A key factor that improved performance was taking enough time (>2 minutes) to enter clinical findings into the software accurately. Under these conditions and for instances in which the diagnoses changed based on using the software, diagnostic accuracy improved in 96% of instances. There was a 6% decrease in the number of workup items accompanied by a 34% increase in relevance. The authors conclude that decision support for a neurological diagnosis can reduce errors and save on unnecessary testing.
The government and healthcare providers are investing a fortune in health information technology. A lot of time, effort and cash has been spent on installing EHRs and getting the initial data into them. But the real clinical and financial value will come from using the information in electronic health records for better communication and clinical decision making.
The Times does readers a disservice by asserting that high quality clinical trials aren’t and can’t be done.
“To cut medical costs and diagnose minor ailments, WellPoint and Aetna, among other health insurers, are letting millions of patients get seen online first.”
“In a major expansion of telemedicine, WellPoint this month started offering 4 million patients the ability to have e-visits with doctors, while Aetna says it will boost online access to 8 million people next year from 3 million now.”
This has been a long time coming, and we’re still at the early stages of adoption, with plenty of naysayers remaining. I first worked on eVisits (or webVisits) in 2001, when Healinx (now RelayHealth) commercialized them. Researchers at Stanford and UC Berkeley studied the webVisit and concluded that their use cut total medical costs while improving patient and physician satisfaction. Here’s a press release from January 2003 on the study (Final Results: webVisit(SM) Study Finds RelayHealth Reduces Cost of Care While Satisfying Doctors and Patients).
It’s interesting to be in late 2009 and see e-visits described as a “disruptive innovation” that “the medical establishment is fighting.” It’s a sensible concept, fairly straightforward to implement, efficient, and effective for certain situations. Yet growth has been slow. Part of the issue is that it’s health care we’re talking about, where innovation tends to be retarded when it involves changing physician practices. Another, related problem is that there’s no great financial incentive for the physician or patient to make a change. Health plans that do cover e-visits often charge the same co-pay for patients as for in-person visits, even though they often reimburse physicians at a lower rate.
My guess is that over the next decade we’ll see e-visits become common. Why?
Adoption will follow the typical S-shaped curve, and we’ll soon get to the steep climb almost regardless of other changes
More patients and physicians will simply expect to communicate online, as they do in every other area of their personal and professional lives
Payment systems will evolve to support e-visits, rather than penalize them
Adoption of electronic systems in physician offices in general will enable e-visits
Supporting technologies will evolve and emerge. These include remote monitoring, higher bandwidth, personal health records, and mobile applications
Enjoy the next decade and don’t expect things to change too quickly.
Halfway into the decade these five factors are still playing out. Having said that I could probably have just reposted the article and changed the date and no one would have noticed.
Will things speed up dramatically over the next five years? In 2019 will we still be reading articles about this “novel” approach? I hope not but fear that we may.