DrChrono (YC W11) Makes The iPad A Doctor’s Best Friend In The Exam Room

Good luck with this one. After spending a couple of years working on something like this, I found the following:<p><pre><code> 1) A majority of doctors are in small private practices that reinvent the wheel of how they run their practice. 2) All of these doctors are extremely pressed for time and are practically _always_ behind schedule. </code></pre> #1 means you need to build heavily-configurable software, and #2 means the doctors don't have the time or energy to learn and configure your software. At best you can get the practice managers to force it down the doctor's throats, which doesn't exactly help either.<p>Record keeping is to doctors like text editors is to us hackers. Imagine if a doctor had built your text editor; They're probably very smart and energetic, but they don't <i>really</i> understand your problem and how much you personally need specific things <i>just so</i>.

This is probably a solid idea (I have a friend working on a similar app) but I've gotta say, the user interface looks horrendous. Form fields slapped anywhere, nothing is aligned with anything else, the sizes of UI elements are all over the place so there's no visual hierarchy, it looks incredibly amateurish.<p>I know that for an app like this doctors are probably looking at functionality first, but it'd be nice if one of the first iPad apps in this niche actually looked decent. Right now it looks like Interface Builder exploded.

I just finished a large project for a healthcare company in Canada. I wish the drchrono team the best of luck. Here are some pointers to watch out for in the healthcare industry.<p>1. Doctors can be extremely cheap. I had to port over a legacy dial up system because the doctors would refuse to upgrade to high-speed.<p>2. The entire industry, at least here in Canada is ass backwards. It takes ten people to do a single task. You will run into having painstaking long conference calls<p>3. Multiple standards. Every provider has there own standard that sometimes overlap.<p>4. Older doctors barely know how to use a cell phone, let alone an iPad. Luckily these doctors are fading out fast.<p>5. Market to the secretaries. They will pitch to the doctors anything to make their life easier.<p>Good luck guys....hit me up if you have anymore questions.

I work with electronic medical records on the research side, integrating clinical patient data with medical research and clinical trials. However, I work with a large teaching hospital rather than small practices.<p>A home run offering for our environment would include a migration path for data from years (and many thousands of patient's data) currently in a patched-together system with 40 years of duct tape holding it all together. Top it off with a massive dose of free text data fields (so no easy field extraction) and you're looking at a huge custom effort to pull it off.<p>But . . . I think there is room here for something that does something nice with machine learning and NLP. Some folks looking into this have found that even free text in path reports contains a significant amount of exploitable structure from a data mining perspective.<p>And once you solve the migration, you'll have to go around the heavily entrenched IT groups holding the duct tape. But, it would be a big win for patients and most physicians are looking for a better solution . . .

I'm a physician. I would love to hear about you implemented HIPAA compliance for both the iOS app and for the web service. I think it is a huge problem for any healthcare startup with potentially serious penalties (even criminal!) for mis-implementation. It is a serious third rail.

Speaking as a <i>patient</i>, I've vastly preferred my visits to doctors who had a laptop with an inverted touch screen. Fewer questions about what was already in my (occasionally quite large) medical history - they could find it. Access to the relevant info like X-rays or blood tests, with more information than printouts carry, and adjustable contrast on digital X-rays. And the full history of <i>every</i> similar test I've ever had. My visits have been faster and far more useful <i>every single time</i>.<p>Bring on the tech! I'm tired of having doctor visits where I have to re-state my history when they can read it in a second, and they're tired of lengthy reviewing of my data before the visit (if they do so at all). The only complaint I've heard from the doctors / nurses (and I've asked every single one I've encountered with them) is that they hate using a pen and hate the interface (missing the maximize button and closing the application, for instance).<p>The nurses in particular loved that the doctors <i>typed</i>. Universally, they've said they had fewer medication errors, fewer "what is that?" questions for the doctors, and they get a bit of history and can see abnormal changes and question them in case of a mis-type. Which happens, but usually goes unnoticed if it's not on a computer.<p>YMMV, of course. And theirs.<p>Billing and medical: why do they belong together? I doubt the doctor is also the accountant in even the smallest clinic, and they have no need to see the information. It's more noise, doesn't help them, and can influence their perception of the patient in front of them.

Personally I am pleased to see more of an effort being made of late with advancing health care technology. It's a fact - doctors are using the iPad. I see more and more of them in the hospital. I'm not certain whether this will lead to widespread adoption or is just a novelty. In our hospital you can use the iPad to first log into the hospitals Windows based network, then log into HMS, which only works with Internet Explorer. Given how tedious a process this is, and to perform order entry using this technique, to me doesn't seem like its going to last long. I'm thinking a 11" MBA would come in more handy.<p>In the office, tablets should be used to review patient data, but the physician should probably not be entering any data - such as writing up the progress note or billing - while in the exam room. This takes away from the physician patient relationship. So to review data, tablets can be helpful, but are not exactly revolutionary. Real changes in how healthcare is delivered will be determined by how data is collected and how it is interpreted (like the Crimson Initiative).<p>Still, considering that EMR systems like AllScripts are charging over $600 a month PER physician (and that's at a "special" discounted rate for a few years), it's nice to see companies like DrChrono taking a stab at it, to see if they can offer something better, or equally compelling, for a cheaper price. A lot of existing EMR systems are bloated with features that most physicians will never use, and don't even really fully understand.

I'm interested in learning how DrChrono is planning to market to physicians.<p>I personally think DrChrono is going for a diminishing slice of the healthcare pie. The current trend in healthcare is that a decreasing proportion of physicians are working in small private practices - the cost of healthcare infrastructure, logistics, and billings means large practices and hospital based have significant savings on scale and tremendous bargaining power with insurance and etc. This kind of app, with the appointment scheduler and prescription system, seems very much geared to small private practices.<p>I imagine this kind of system will make limited leeway in large healthcare practices and large academic institutions - this is the difference between enterprise software and web applications. Epic and the like, despite being aesthetically unpleasing and rather cumbersome, is dominating this segment of the market. It's not even a question of cost - these solutions cost much more than competitors, but there is a perceived level of stability and a proven track-record. In both culture and priorities, I think YC companies are not as well prepared to offer enterprise solutions. Large institutions are fickle, full of politics, and without a dedicated sales team, difficult to sell to.<p>They are definitely going for the "meaningful use" incentives as part of healthcare reform - the healthcare reform gives physicians incentives to adopt an EHR (electronic health record) system and going for the sex appeal of using ipads - but I am wondering if that is enough incentive to adopt an electronic health system. Personally, I type 1000x faster on a keyboard than with an iPad, and speed would be an consideration - ie. even as a physician-in-training (hypothetically with comfort in technology), I would have to look hard to decide whether to use such a system.<p>As a medical student, don't think there is enough of an market for general primary care physicians and not enough specificity (currently) to most subspecialities. There are a lot of older physicians that have limited comfort in medicine. I would imagine there is a good market for concierge medicine practices - the kind of places that already have iPads and are interested in distinguishing themselves from the market.

So what happens when Apple pulls this app for $arbitrary_reason? Are your medical records gone?

It seems as though people may not know what exactly goes on in an exam room, and how exactly is the one taking notes. Often, especially with specialists, there's an MA or RN taking notes. Note only that, but this seems vastly superior to digging through a pile of charts or working with an ungainly EMR system.<p>The market has been BEGGING for this, and this looks like it might be the right answer. Good luck!

The idea of doctors using iPads scares me; I know plenty of people who make casual typos with numbers on the iPhone or iPad as it is -- the last place I want someone doing that is in a hospital or doctor's office.

Three years ago when we took my daughter to her first pediatrician appointment, the doctor brought a laptop into the examining room with her. The doctor barely looked at my kid. She just sat there typing away looking at her machine. In my mind technology had become a barrier to the doctor/patient (parent) relationship. It was very frustrating. But, there were many things frustrating about that Dr. so it could have just been her. We quickly found a much better one.<p>So, maybe you should design the interface good enough that docs want to use it but not too good that they use it all the time. Or you can put some alerts in there so that when the doc has been watching too many videos, it reminds them to look at the patient..... just kidding....

I wonder if having an Ipad-enabled EHR system will be a compelling enough proposition to migrate practitioners from existing experienced vendors with a track record. I would imagine if you already have a system, even if it is an old expensive legacy system, you would not switch simply because of an IPad enabled device.<p>Even if there are other benefits associated with it such as being SaaS-based and cheaper/more secure, the conversion rates I would think would be low when there already exists free cloud based solutions and open-source solutions which they haven't already converted to already.<p>Thus, this makes me think the target market would be the pen &#38; paper crowd. I'm curious to see what the conversion rate is for this crowd since this seems like a tough crowd to convince.<p>Even in scenarios where the EMR/EHR system is completely free (either through pricing plans or government grants) you don't see many of them moving away from the pen &#38; paper which signals price might not be the most important factor here either.<p>To me this leaves overall usability and learning curve which I'm not sure if DrChrono necessarily promotes as their pitch seems to be portability.<p>I'd like to see how their product matures to tackle that issue since in my opinion their competitors really aren't other EHR vendors as much as the huge pen &#38; paper market that's a much larger share of the pie.

My girlfriend does some admin work at a hospital that uses meditech software, seems like the kind of old bulky enterprise software startups are trying to replace. It covers a lot of areas in hospital admin as far as I know, more than just the doctors interactions with patients. I have mnetioned it would be great for doctors to take out the middle man and use things like ipads so this seems great for that.<p>Just wondering if you have thought about integrating into the big bulky industry standard type software? (of course I could be off on what most hospitals use, sample size of 1)

That's another "burning platform" in a week from YC (the other one was that fax-in-a-browser thing). The correct solution to this kind of problem is government backed centralized system. Like in Estonia: <a href="http://eng.e-tervis.ee/overview.html" rel="nofollow">http://eng.e-tervis.ee/overview.html</a> . Sooner or later all countries will have this kind of solutions in place and sadly, DrChrono will die..

I worked on an EMR app for a while and DrChrono feels very childish. HIPAA compliance seems like a back seat at this point instead of first priority.<p>Maybe a dr would pay $99, but the first HIPAA lawsuit they are going to spend $99,000+ defending all due to software.<p>I also have to admit that DrChrono reminds me of Dr Mario Nintendo game..

I really don't like your UI, but on another note, Jay Parkinson is the guy you should seek out and ask for advice. He's probably <i>the</i> go-to guy in innovating health sector tech.<p><a href="http://jayparkinsonmd.com/" rel="nofollow">http://jayparkinsonmd.com/</a>

I don't know anything about this industry, but the UI looks stunning.

how is this better than the existing computer systems doctors use? (It's on a iPad doesn't cut it IMHO)

I understand the motivation for these applications, but anything that, in a room with a patient, takes one away from interacting with the patient has drawbacks. A lot of docs are taught NOT to use this kind of device in the room. Even burying your nose in the patient's chart, of course, is problematic. Using it outside may have its advantages, but in the room it's ideally two humans and not much between them.<p>And if you'll forgive me, I have a hard time believing an app like this will drive pad adoption by physicians. Most docs have pads because, well, they just like toys.<p>Some docs have used laptops, which are a lot easier for data entry than these pads, and these don't require turning away from the patient either. In my experience, it's not common for physicians to write their progress notes in the room with the patient. Certainly writing a prescription and sending that to a pharmacy directly makes sense in the room, but there are classes of prescriptions where that cannot be done. Looking up drug interactions may be useful, but dedicated applications like eProcrates and other dedicated apps probably have become standard for that and I'm not sure I'd trust an "everything and the kitchen sink" app like this more than dedicated solutions (eg, these drug interaction databases require constant updating and care).<p>Billing info and medical data combined on a view is a no-go, if that's there. They don't belong together. Period.<p>Probably most importantly, most of us would need details about security of the transmission and storage of medical records before considering this at all. Someone said below this app is "HIPAA compliant", but I'm leery of that overused phrase because the HIPAA requirements are quite vague, and as far as I know there is no actual certification for something like HIPAA compliance. Vague claims of "HIPAA compliance" are likely NOT going to impress or satisfy juries and medical licensing boards. In addition, some information (depending on the state) requires more stringent care; for example, mental health records, record of drug abuse/dependence, etc. Hospitals and clinics typically have dedicated IT departments who put into place much more security than HIPAA requires. If someone hacks a system like this, the fact that you require passwords and do some encryption is not going to cut it if you can't demonstrate you are using standard of practice medical record security measures.<p>Specifically, many physicians would want to know, at a minimum, complete details for:<p>- backup, recovery, and retention policies for all data.<p>- logging mechanisms in place to track access and change of data. By "access" tracking, I mean a record of every last living creature who <i>views</i> the data, at any time, for any reason, and that includes everyone at "DrChrono", the employees of any firms that manage their servers, etc.<p>- audit mechanisms and schedules.<p>- policies Yet Another Third Party ("DrChrono") would have in response to subpoenas, direct request from patients for their medical records, requests from insurance companies, etc.

this is revolutionary...wow.

Company launches practice management software. Film at 11.