Drchrono (YC W11) is building a health care revolution on the iPad | Hacker News Reader

Drchrono (YC W11) is building a health care revolution on the iPad

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53 pointsd8niel31 comments

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.

It isn't a major incentive, for interoperation but the government is sponsoring a contest for a web app that provides value to patients, providers, or researchers using patient-level data delivered through the SMART API. See the SMART platform challenge:

http://www.smartplatforms.org/challenge/

The reference platform data model is pretty limited but is an interesting start.

Thanks for the heads up on this.

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.

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.

I've been wading through this muck for quite a while, I'm well aware of these "standards". I'm not looking for standards, per se, I would be far more interested for a product specific api. Think Twitter, FB or Google. Standards by committee especially when doctors are involved is a recipe for utter disaster as we have seen time and time again.

We are in the midst of deploying some of your competitors. Ping me offline to chat some more.

I forgot to mention that the government is pushing the HITSP-chosen standards by making them part of "meaningful use" standards that are required for ARRA funds.

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.

>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.

> 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...

"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.

The VA are a very special bunch. A lot of hospitals are now forward thinking in terms of solutions. Sometimes to much so. I have often had to deal with "buzz word" syndrome, explaining why Web Services, SaaS and HL7 3 are not necessarily required components of their EMR solution.

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.

$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.

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.

DrChrono is offering these terms

>DrChrono’s pricing model ranges from a free base offer including storage for 1,000 patients and one doctor login to a premium offer including 10 staff logins and unlimited patient record storage for $199 per month. Setting up medical billing costs quite a bit, which is why they charge for the premium versions of the app. Kivatinos also notes that most doctors pay upwards of $50,000 for a similar electronic system.

The bigger question is, will Drchrono be forced to pay Apple the 30% in app subscription fee from June 30?

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.

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.

here is our link: http://www.healthpager.com

As with most industries, sales of healthcare software are made to executives and not to the actual users. Sometimes an outspoken physician will be involved in the sales process, but the final decision is usually made by the CIO/CTO and CFO and is typically made for financial reasons more than anything ("Vendor X promised us that our revenue per patient would increase by Y").

You're mostly right - the one caveat to this is that most providers are not as "revenue focused" as you'd think. Most of them are more focused on the potential outcome ratings improvement that they could see. Often times this means going with Epic, Cerner, Allscripts, eClinicalWorks etc.

The phenomenon going on here is that CIOs don't want to get fired. They're the gatekeepers - and as someone famous put it, "No one ever got fired for buying IBM." Except in this market it's Epic.

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

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.

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?

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)

The last time I had to get a prescription it was passed electronically to Walgreens by the Dr, no need for any paperwork.

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

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.

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.

Cool.

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.

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