

Drchrono (YC W11) is building a health care revolution on the iPad - d8niel
http://thenextweb.com/apps/2011/03/15/drchrono-is-building-a-health-care-revolution-on-the-ipad/

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siculars
I take my hat off to what Drchrono is doing in the space. They are moving the
discussion forward. It's a fact, Dr's love the iPad. They want more medical
and healthcare related apps on the iPad. Drchrono's platform is a big win.
Nevertheless, getting one doctor or a small office of doctors to use an
EMR/EHR is one thing, getting an institution to use a system is quite another.
I work for such an institution and have built solutions that are in production
now. Believe me, it is an incredibly difficult, time consuming, error prone
and expensive proposition.

Where government intervention could really shine is in offering incentives for
interoperation by way of public API publication. As a developer in this space
in an institutional setting, I can tell you from years of experience that an
institution of any meaningful size is going to have many, many electronic
system repositories of varying depth and breadth. The problem from my vantage
point is that it is nearly impossible to get these systems to talk to each
other to do necessary data exchange. Multiple systems that refuse to
interoperate will become a major stumbling block in the short to mid term.
Eventually this will all shake itself out but I would rather that be sooner
than later and government policy can do a lot to make this whole endeavor work
better.

As it stands, virtually every single provider is entirely focused on "owning"
the entire pie. What they should be focusing on is making their applications
"team players" that are able to integrate into a suite of legacy applications.
Not doing so is a major mistake because, as we know, there is no single tool
that is right for every job. The healthcare field is so varied and so
fractured from a specialists perspective that you need specific solutions for
specific situations. I am absolutely in favor of using as many tools as
necessary as long as there is some mechanism for information exchange. I think
the ability to exchange data will be the critical differentiator of the next
generation of healthcare applications.

~~~
absconditus
The government is pushing standards for interoperability. The organization
responsible is HITSP. The standards that they are pushing are the typical
designed-by-committee mess.

HL7 2.x is the only standard that is widely supported in the industry. I have
not come across many systems that offer no HL7 2.x interface options. The IHE
monstrosity is picking up steam too.

~~~
noonespecial
Unfortunately, it seems to be a catch-22. If you don't involve doctors in the
design, you'll end up with something that doesn't cover enough ground to be
usable, if you do involve them, they'll mistake their (admittedly large)
domain expertise in medicine for expertise in system design and bike-shed the
thing into boondoggle territory. Any standard is going to be a tough
proposition.

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waterside81
Glad to see DrChrono taking health care on and I hope many others follow. With
that said ...

The problem with the healthcare industry's lack of modern technologies isn't a
technology issue - the tech that doctors and hospitals need to manage
EHR/EMR/PHR existed 20 years ago. This isn't a computer problem, it's a human
problem.

You wouldn't believe the hoops I had to jump through to get a Django app into
the VA in Los Angeles. Why? Because Python isn't an approved language and
Postgres isn't an approved DB. "Someone" has to approve them and I'm guessing
"someone" has something else they'd rather o. They're both on the "For
consideration" list. Anyone who has worked in a bank can probably relate.

So we put our Django app into a JAR file and run it using Jython. "Oh it's
Java now? That's OK."

I think the true tipping point will be when people of a new generation
(readers of HN perhaps?) become hospital administrators and with that bring a
new culture and view of technology.

~~~
siculars
>I think the true tipping point will be when people of a new generation
(readers of HN perhaps?) become hospital administrators and with that bring a
new culture and view of technology.

I have very little hope of that happening. Hospitals are run by doctors and
frankly, they lack the technical foresight and respect for non-doctor advisors
(cio, cto, etc.) to make correct technical decisions.

~~~
aladoc
> Hospitals are run by doctors

Typically US hospitals are run by MBA types, whether it's a for-profit or not-
for-profit facility. They, or their corporate overlords, make all the
decisions about capital outlays, like IS. The marketing folks just have to
tell them, "The docs'll love it!" No EMR system I've ever looked at
successfully models my clinical thought process. I have to work around or
against the tool, rather than it disappearing into the task at hand. </rant>
Now ask me about modal popups...

~~~
michaelbuckbee
"Run" is a somewhat subjective term. I used to work on implementing EMR/EHR
systems for radiology groups within hospitals. Twice (separate states,
separate hospital systems) I arrived onsite to find that all of the
radiologists had quite en masse over the implementation of one of our systems.

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dr_
It's great to see more and more companies tackling the healthcare industry.
Although you can get the most cutting edge medical treatment in terms of
surgical procedures and CT scanners - storing and communicating most types of
data is archaic. It's primarily because most physicians and hospitals do not
see how moving to an electronic medical records system helps their bottom
line, with the exception of electronic prescriptions, which can reduce errors
that result in death.

It's actually sad that we need a stimulus to do all this. We really shouldn't.
If there are more and more providers offering services at a competitive rate,
doctors and hospitals would more readily switch over. Right now AllScript is
charging close to $700 a month at our hospital (that's the discounted rate
btw) to use their EMR system. With the understanding that one would get the
44K grant from the government. That's an absurd amount to charge for any such
system. I'm not familiar with what DrChrono is offering, but at least their
price point is reasonable and if there were other providers in the price range
as well, docs and hospitals would switch without the need for a stimulus.

Our own office went electronic before there ever was such a thing as a
stimulus. Just cause it seemed like the right thing to do for ourselves and
for our patients.

~~~
absconditus
$700 per month or $44K total is not high for such a system. It is not uncommon
for enterprise systems to cost thousands of dollars per user. You must realize
that the sales cycle for a hospital can be years, 24 hour support must be
provided, hospital IT staff is often incompetent and clinicians are very
demanding users.

Disclosure: I work for one of Allscript's competitors.

~~~
dr_
This is not for a hospital. Its for physicians in private practice. It's $700
per physician per month and hardly anyone is signing up. I'm sure for very
large groups there is discount pricing and they must be signing up, but for
smaller groups or solo practitioners this is not a reasonable option.

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bherms
While I agree that the healthcare industry is ripe for innovation, I think
it's a very hard industry to get into. My gf is an ICU nurse here and is
constantly telling me how averse to technological change everyone in the
hospital is. Nurses and doctors have even quit when the hospital has
implemented new software in the past. In addition, a lot of people are jumping
on the healthcare bandwagon right now. Lots of great ideas out there, but I'm
skeptical that a new system will be taking off on a large scale anytime soon.

Just my two cents, but best of luck to all the startups trying to shake up
that industry.

~~~
sbp26
You bring up a valid argument. Physicians and hospitals are reluctant to adopt
new technologies.

Healthcare startups that become successful in the GRAND SCHEME of things will
happen because of proper execution. I am currently working on a healthcare
startup. I understand all of the issues at hand. For one, the industry and
government are focusing on the backend (healthcare provider) technologies, but
many companies lack the insight of realizing big change happens on the patient
side; although it's not the focus because physicians are the ones "providing
the care." See, patients DO trust their doctors, so why not take "advantage"
of that. Physicians need to INTERACT more with their patients directly through
technology - and here's the kicker - only then can we slowly incorporate new
technologies in EMR and hospital systems. Those integrations need to be on top
of a layer of a "social" technology interaction with patients. Key word being
"on top of" an already established system that engages patients. Now this is
how physicians' attitudes will change - because they see patients already
using the system.

~~~
sbp26
here is our link: <http://www.healthpager.com>

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j2d2j2d2
My favorite thing about dr chrono is that these guys aren't the usual YC young
kids.

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mleverne
People are always talking about "the new", but the hardest thing any one of
these groups will face is complete buy in from the required health groups.
Although these innovations may offer something new, they are coming in to an
already crowded space. And a lot of the big players have strong relationships
with their client base. Making sure that the solution allows for ease of
integration with other IHE/EMR solutions is a big thing. Staying with the
standards, as absconditus mentions, is a plus. If Drchrono can partner with a
big player in the IHE space and provide a specific use that they are missing
they will do well. All of these will break down the reasons for rejection by a
client.

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atrevisan
Love this. The health care industry was due for some needed technology
innovation in regards to billing and prescriptions and the iPad is the perfect
platform to do so.

Can someone make a "doctor's handwriting" font?

~~~
draz
sure, though rendering random shapes on the screen might be easier and will
achieve the same results (utter confusion by pharmacists, nurses, etc, and
subsequently poor patient care)

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arctangent
My day job is in healthcare informatics in the UK. I'd love to see us making
more stuff like this, but I think that it somewhere gets lost in all the
bureaucracy.

We're currently diverting a lot of our considerable efforts on
"interoperability", which will hopefully see this kind of thing take off over
here.

The geek in me is still waiting for the Tricorder, of course:
<http://en.wikipedia.org/wiki/Tricorder>

~~~
mleverne
I was at HIMSS a few years back and there was a dictation device that hung
around the neck of Physicians made by Vocera
(<http://www.vocera.com/products/b2000_badge.aspx>). There was an easter egg
in it, which when a user asked "Scotty, beam me up", it would make the
transporter sound. It's a start.

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scotthalfon
Check out PracticeFusion.com. It's free for an unlimited number of doctors and
is a web application, so you can use your existing laptop/desktop.

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zopticity
Cool.

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phlux
We built something similar 3 years ago (Contineo, which was iPhone based (pre-
iPad)) and was rejected by YC... We had too much trouble getting any traction
- even though we had a working product and great contacts in the industry.

I am still in the healthcare space (I design hospitals and their
networks/datacenters etc) and am currently doing SFGH in San Francisco.

I believe in the idea (obviously) -- but there are still a great number of
hurdles to overcome to get hospitals to adopt tablets (especially iPad).

I am working on a pivot of Contineo, that could also work with DR Chrono - and
am talking to several facilities about pilots -- but most everyone is taking
it slow to adopt iPads due to Apples large % of revenue, the supportability -
lack of control etc.

I am building a health care platform for android at the moment - I'd be
interested in knowing what Dr Chrono has to give up to Apple... I haven't
looked at their business model too closely - but the market is ripe for
change.

