

Drchrono Is the iPad App That Could Transform Your Doctor’s Office - d8niel
http://singularityhub.com/2011/03/04/chrono-is-the-ipad-app-that-could-transform-your-doctors-office-video/

======
arn
So, I don't know. I haven't had time to delve into their backend, so I'm not
sure how they import all that data (lab results, ekgs, xrays). But the
interface seems clumsy (coming from a former physician, and current ipad user)
from the videos I watched.

Neither of the founders are from medical backgrounds:
<https://drchrono.com/team/>

They do have a "Senior Medical Director" who is currently a psychiatry
resident, which means relatively few years practicing medicine. I don't want
to discount his abilities just for that, but for instance, it seems unlikely
he has really worked in a private practice which is what this seems whole
package seems targeted to.

I know disruption can happen from outside the system, but in the case of
physician's medical record systems, I feel like the main hurdle is trying to
show/teach doctors that your system can be a more efficient system in day-to-
day. And to do that you really need to understand that day-to-day workflow.
Especially since they are targetting these small practices it seems.

~~~
haribilalic
I've worked on an iPad app targeted at an entire state's hospitals.

Doctors, particularly specialists that travel, _love_ their iPhones. They
_love_ tablets/iPads. You don't need to convince them. You need to convince
the accountants, insurers and lawyers.

~~~
arn
Regardless of the interface? You seem to be saying that if an app is on an
iPad, doctors will blindly love it (and it can't have a bad interface, which
is obviously not true)

~~~
haribilalic
Drchrono isn't any uglier than what a lot of doctors using now. There's
software out there that continues to use the blue and grey DOS style
interface.

The _hardware_ is the killer app here. The iPad and other tablets like it are
off-the-shelf blank slates that cost less than $1,000 and run all day.

There are already proprietary tablets in the medical world, but they can cost
thousands more per unit than the iPad and you're stuck with the software
that's already on it.

You can go out and buy an iPad today and have electronic health records,
medical imaging viewers, medical references and can move towards paperless
environment for under five figures per year.

------
arn
Ok, I've given some more thought to this. To give some constructive criticism.
I've been watching the videos, watching people enter data, soap notes, and the
transcription. It all seems so painful.

The interface is a lot of small screens, with buttons connecting them. In the
dictation screen, you can't reach anything else. You can't seem to look at
labs, look at xrays. Similarly, the soap note interface brings up a large text
entry with an iPad keyboard. Several of the other interfaces bring up these
somewhat jarring iOS inputs. None of this seems to flow well.

I feel like you have this open 10" multi-touch device, but you are using
interface paradigms from old point and click interfaces.

Here are some interesting possibilities:

\- Use the fact that you can scroll infinitely on the iPad. A page could have
a ton of data vertically, that you can scroll up/down.

\- Maybe you can also scroll/swipe left/right to get to different sections.
from Note to Xrays to Labs. Let there be a definite order of those pages. I'm
thinking like the Wired magazine app for iPad. Swipe left a couple of times,
I'm at labs. I can find what I want, swipe right a couple of times to be back
where I started. Or at least short cut buttons for every section so you can
jump back and forth easily.

\- Current labs could be embedded in the current note/encounter page. It's
obvious I'm going to want to see those. Scroll down to see them, swipe
left/right to see older ones.

\- Why are soap notes in full text input? Why not a large page of customizable
Positive/Negative toggles? Most EMRs are like this, but having it on the touch
screen seems like it might be nice, especially if you can scroll past ones you
don't care about quickly. This also helps to minimize pulling up a full
keyboard, which is an awkward event on the iPad. You don't want to be typing
long passages if you can avoid it.

\- Seems custom interfaces could be explored for making data entry easier. Be
it medicines, or complaints etc...

anyhow, obviously those things are just top-of-the-head wild thoughts, but the
abilities are there. I just don't see this as an "iPad EMR" but an EMR that
was put on the iPad.

------
atirip
That's a "burning platform". The correct solution to this kind of problem is
government backed centralized system for all doctors. Like in Estonia:
<http://eng.e-tervis.ee/overview.html> . Sooner or later all countries will
have this kind of solutions in place and unfortunately DrChrono will lose.

It works in Estonia so that all doctors are _forced_ to use that system, which
results to a wonderful end result where _every_ doctor has access to _all_
data there is about you 24/7 - so for example when you lie unconcius on the
street, 911 knows all your allergies, illnesses and treatments, everything
that every doctor has ever written about you etc in that second.

~~~
arethuza
That approach might work in somewhere the size of Estonia - but large
centralized IT projects have been a bit of a disaster for the UK NHS:

<http://news.bbc.co.uk/1/hi/8397854.stm>

The chances of it being made to work _by the government_ for somewhere like
the US are pretty small.

------
fullduplex
I own an IT services company and we have a medical vertical. There is a demand
for this and I am a big fan of what you are doing. What I can tell you however
is that no amount of iPad UI wizardy will overcome the hairball that is
EMR/EHR. Table stakes are Meaningful Use certification and assurance, HL7,
Labs, PACS, HIS integration and the list goes on and on. The hardest work
happens there, and Dr. Chrono will need "street cred" there to grow.

------
jjm
Unless you work with the doctor, assistant, nurse or office manager for at
least 6 months you will have no idea what actually needs to be done or how
things could be streamlined. Sometimes it's not just data organization.
Surveys won't help, online chats or discussion will not suffice either.
Understanding the problem will require more attention.

However much like how another HN post showed us, the baseline market will eat
this up even if the product is mediocre at best.

So take note readers, this segment is ripe for a competing startup.

I had a doctor tell me just last week, nextgen is shit. Which by the way would
probably be your best corp competitor or prospective buyer as they're coffers
are filling up.

Disclosure: I have many years experience in this field.

Update: when I say working with, I mean you need to tail and do the work as if
you were an employee for some time.

------
e40
Kaiser doesn't use mobile devices, but they have all this and more. They are
an HMO, so they're integrated from top to bottom. There's a computer in each
exam room and your chart follows you from Dr. office to lab to therapy to
pharmacy. They have bracelets for those admitted to the hospital, and before
giving you medication the bracelet is swiped and the computer-controlled
delivery mechanism will only give you the meds if you should get them. (Cuts
down on deaths due to incorrect medication.)

I could see them augmenting their system with a tablet, but it would be
software they build themselves, I'm sure.

------
IDisposableHero
Am I wrong to stop reading at the grammar error in the second word?

~~~
Zakuzaa
Yes.

~~~
IDisposableHero
I tried reading a bit further; it reads like PR not journalism.

------
dman
As a patient something that I would really appreciate is a realtime queue
showing how much behind schedule the doctor is on that given day. Ive had to
wait for over an hour on occasion inspite of having a prior appointment. Also
self serve appointments would be nice.

------
gacek
It would be nice if an article about "new cool" ipad app was viewable on the
ipad (videos).

~~~
d8niel
All of our videos are on youtube. Feel free to check them out:

<http://www.youtube.com/user/DrChronoTV>

