Drchrono (YC W11) raises $2.8 Million for iPad Health Record Platform

http://bits.blogs.nytimes.com/2012/01/26/drchrono-raises-2-8-million-to-digitize-doctors-visits/

by Skeletor • 14 years ago

94 41 14 years ago

bits.blogs.nytimes.com

Skeletor4• 14 years ago

Also covered on techcrunch: http://techcrunch.com/2012/01/26/drchrono-raises-2-8m-from-y...

chubs• 14 years ago

Keep up the good work. Wow - i just read all the comments here - there's a lot of 'can't be done' negativity. All that means is that you'll have few competitors. To be honest, i'm thinking of not bothering reading HN comments any more.

Keep making a difference - if you guys succeed in improving the efficiency of US hospitals, that's something MAJOR to be proud of :)

Nat0• 14 years ago

I am very excited to see what Drchrono will do in the medical field. The industry is overdue for a smart company to come in and innovate.

I don't have any hands on experience with the app yet, but it seems to address one of the biggest hurdles to adoption, the physicians' reluctance to learn/use the cumbersome interfaces of the existing systems.

leak2• 14 years ago

Healthcare is less about these cool technologies and more about how do they devices and software interfaces get access to the patient data. I worked at a startup that launched a tablet application back in 2005 for healthcare professionals to interface with patient records while walking around the hospital. Building the software was and still is the "easy" part.

Getting IT to give you access to patient data is the extremely difficult part. It takes literally years. Lots of proprietary stuff that is very hard to get into. Maybe Drchrono is tackling small doctors offices and it might be easier but trying to get into major hospitals is another story.

I wish them luck either way.

Skeletor4• 14 years ago

We are going to change healthcare from the ground-up. Small 1-10 doctor practices can easily make the decision to completely move to a new solution like drchrono. Once you get every private practice doctor using better tools, you can start banging on the gates of the hospitals to let you in and adopt new technology.

It's similar to how Salesforce.com started with small businesses and eventually broke into enterprise sales from the bottom up.

leak2• 14 years ago

Good luck with that.

baran• 14 years ago

The problem is Epic has effectively locked-in the top end of the market. Their strategy, which is brilliant, is to only go after the biggest, most well-known clients (I know nothing groundbreaking, but it works). They say they only focus on whales, academics, and children (hospitals). Due to this, they have been able to capture 265 of the most prestigious hospitals in the country (and soon in the world). With the lock-in they have, I can't see them giving up this market. It would take a lot to justify replacing that half a billion dollar system for someone else, especially after the hell the administrators have gone through to get the systems up in the first place. Also, in many ways Epic is becoming the de-facto standard, which is leading to network effects that would have to be broken down. I don't think you can fight Epic at their game and win.

Added to that they will likely begin to move downstream (recently heard a rev. projection $8.4B in 2016, up from $1.2B today) as the mid-size players would love to have an Epic install if only to mimic the respected healthcare organizations.

The most secure place from Epic is the small practices. The IT/intemplmentation/costs requirements of Epic are far too high, in its current form, to sell to them. The problem becomes selling. It recently talked with a VP of Sales at a HIT vendor and he said of 10 hours spent selling a doctor, 9 hours are spent trying to get a hold of him. Difficult.

samstave6• 14 years ago

I don't agree.

A little background:

I am a hospital systems designer and consultant. I actually built one of the first EHR clients for iPhone, before the iPad came out (Rejected from YC in 2009), I was the technology implementation manager for the new El Camino Hospital build, I was the primary technology designer for San Francisco General's new 850MM facility. I am consulting on the UCSF Mission Bay project for technology and transition, and the same for UTSW in Dallas. I am also the transition planner for a small 100MM facility in Nome Alaska.

In all of these projects I design and or consult on all aspects of technology implementation, use, training etc..

I even sent an RFP for EHR implementation to Dr. Chrono to see if you guys could step up to a larger facility ($5MM budget for that piece), I heard nothing back for weeks until after the deadline when I was then told that you couldn't respond - and then had a sales guy call me trying to get me to sign up as a physician.

Anyway -- getting a private practice of ~10 physicians to use your product is in no way a gateway to hospitals. They are completely different markets.

The EMR implementations in large hospitals are multi-million dollar implementations and they take ~18 months to accomplish.

The sheer number of workflows needed and the integrations with various systems are daunting and non-trivial.

You are going after a massively entrenched market with many many millions of dollars committed by all the customers

I fully hope that there can be a serious shakeup in health IT, but having some success with 1-10 physicians and then expecting to parlay that to hospitals with thousands of employees, or even hundreds (like in Nome) is a tall tale.

I think there are TONS of opportunity to disrupt healthcare, and DrChrono is a great app - it is just not mature enough or on scale enough to compete against the larger EHR market YET.

EDIT:

I'd like to add - that if you want to continue to build a free product, and you want to get into the larger scale EHR space - I suggest you partner with/learn from/attempt to implement on-top-of MedSphere's OpenVista EHR.

DrChrono has some great features - and if you make the capabilities more robust then you can get into this market more easily.

OpenVista is used widely outside the US as well, and this would be an opportunity to capture the Asian/Indian market.

Also, if you take some of the features you have (Voice Notes, etc) and offer them as a stand-alone-ish product - then you can attempt to get physicians already in large hospitals to use that product - not selling it as an EHR, but a needed tool, and expand from there.

If you stay away from the EHR/EMR moniker when infiltrating physicians in larger hospitals you'll more easily get under ITs radar.

Every hospital has iPad users already, and most are rolling out official IT support for them - so you need to get an app that physicians can use in parallel to their epic/siemens/cerner/eclypsis solution without pissing IT off.

caycep• 14 years ago

I hope this works.

As a lot of other posters have noted - hospital level deployments, where good data practices and IT are arguably the most needed due to the mission critical nature and the larger volumes of data generated, is hobbled by entrenched interests, IT policy dominated by insurance revenue concerns rather than driven by patient or practitioner needs, and being swallowed up by a oligopoly (soon to be monopoly) consisting of Cerner, McKesson and Epic.

All of these companies use antiquated databases (MUMPS forms the basis of the products of these companies for the most part, a data language invented in the basement of Massachusetts General that predates FORTRAN and COBOL). The UI/UX design is nonexistent (all of them would crush any of the Daring Fireball interfaces of shame posts).

More ominously - these companies protect their business AND their data formats ferociously. Epic is famous for lock ins - once you pay the $50-100 million contract for them to take over your IT, your data will not interface with any other system again, ever. They are good at generating numbers for Medicare and insurance billing revenue that make hospital CEO's giggle with glee (ignoring user experience and good data practices for the doctors, nurses, and patients on the line - which translates into lousy care administered to patients). Judy Faulkner, the CEO of Epic, is known for having much of the Wisconsin Congressional delegation in that company's back pocket, such that she sits on some congressionally mandated committee for EHR's promoting closed, proprietary systems as a means for "patient privacy" (lolwut).

The system I work in actually has a reasonable setup. Not nearly as sexy as some of the advanced hadoop/linkedin/facebook/netflix setups - it was build on an Oracle back end running MS IIS and ASP. But at least it's on the web and the database isn't creaking along on a system that looks like this: http://thedailywtf.com/comments/A_Case_of_the_MUMPS.aspx?pg=...

Yet swayed by whatever koolaid Epic fed them, they forked over the millions in contract to go 40 years back in time.

I think this industry is so so so ripe for disruption. Focus on the doctor/nurse/patient user experience, make EHR software that does what every facebook/google+/linkedin, heck even blogger user takes for granted, get the adoption rates up, and kill these greedy as sons of bitches at their own game.

zeratul• 14 years ago

> We are going to change healthcare from the ground-up

This is so impossible!

You have a great product for 1-10 general doctor practices. You should focus on that and just that. If you feel like you have a lot of free time on your hands try knocking on 1-5 pain management doctors clinic. See how you do there. If you manage to customize their workflows and menus for pain management, move to 1-5 MDs obesity clinics, and so on. I suspect that after single pain management clinic you get burned out.

Have you ever looked at UMLS http://www.nlm.nih.gov/research/umls/ ? It has 2,612,024 mln medical concepts and counting. Many diseases are still poorly covered. Any time you talk with a specialist in a hospital he/she will need those terms in their documentation. Every disease has different workflow and different vocabulary. If a hospital thinks about adopting a new EMR, they will send ~100 their own IT people to EPIC/GE HQ to have them trained how to configure their system. Then, those ~100 IT people will work with ~1000 MD to have progress notes, flowsheets, and what have you configured to everyones liking. This is SO MUCH work and huge investment that has to have 0.0001% risk for the hospital and for the patients. Keep in mind that if patient dies and there are lacks in documentations someone will have to pay ... a lot.

I'm sure that some day you will have ~1k engineers and ~2k support team, each encumbered with basic medical knowledge and patient workflows. But then you will notice that healthcare can be changed only top-down not ground-up.

brudgers3• 14 years ago

>"It's similar to how Salesforce.com started with small businesses and eventually broke into enterprise sales from the bottom up."

No it's not.

Missteps with something like Salesforce might cost people jobs.

When a hospital makes a misstep, people might die as a result.

A hospital's operations are no more a scaled up version of a small group practice, than its physical plant is a scaled up version of a bungalow.

Kadrith4• 14 years ago

How is this iPad app any different from what Canto provides from Epic for physicians and MyChart for patients?

Disclaimer: Where I work we use Epic as our EMR and have been on it since 2005.

Skeletor4• 14 years ago

For starters, drchrono offers a completely free version (in a freemium model) with the free version being a full EMR that qualifies doctors for $44,000 from Medicare in Meaningful Use incentives.

drchrono has also been building on the iPad exclusively since the iPad was first launched in April of 2010 (much longer than any other company). So drchrono on the iPad is more advanced with features like realtime speech to text, customized templates, and automatic note generation and billing features that have evolved over the last 2 years.

csallen• 14 years ago

Congrats guys, awesome!

gshayban• 14 years ago

Exciting, inevitable news. Healthcare needs a shakeup. How does drchrono interoperate with medical systems? Other than SureScripts. Does it support regional labs or just LabCorp/Quest?

Disclaimer: I am writing a modern interface engine.

blasdel• 14 years ago

Is the screen capture used in the announcement an "I didn't know I was pregnant" joke?

zmmmmm• 14 years ago

I looked into Drchrono when I was looking for work last year. I turned away because I found the iPad-centric strategy obnoxious and short sighted. The iPad is a wonderful device, but any company that builds their entire strategy around their love of a device has dangerously blurred vision and a horrible risk (one adverse decision from Apple you're done). Besides which, the last thing healthcare needs is more walled gardens and information silos.

naner• 14 years ago

iPad-centric strategy obnoxious and short sighted

I agree that this is short-sighted. I have worked in the Healthcare field and am also related to a couple Doctors who built their own private practice. All the software they use for medical records is buggy as hell and extremely outdated. (Technically the software is updated frequently but it looks like something out of 1998.)

An iPad-only (or any tablet) interface, however, would be a non-starter for every practice I've worked with. It would be a great supplemental device for some situations, though.

brudgers3• 14 years ago

The biggest issue I see is Apple's approach to legacy operating system versions - typically three years at best - and no ability to purchase old versions.

This makes standardization of the platform difficult - i.e. purchasing new devices for replacement or growth may mean different hardware and different software.

On top of that, Apple has a tendency to change development requirements and to require updates to existing apps to meet the latest standards.

In short, Apple's ecosystem in general is not conducive to the needs of businesses, and the iOS ecosystem in particular is entirely intended to be consumer facing.

taurussai2• 14 years ago

Congratulations! If private practices are willing to use Ipads and meet some of the criteria for the $44k, why not then? Was at a recent healthcare event and met a random med student from John Hopkins, enquired about the exact same problem and a solution that his advisor was asking him to build. Question though - if doctors are already using something for EMRs how will drchrono convince them to switch?

Kadrith4• 14 years ago

I don't think that is their target market right now. There is a land rush on for people that do not have an EMR and do not want to join with a larger facility that already has an EMR.

taurussai2• 14 years ago

Sorry I didn't see this earlier. We are actually working on making HIPAA compliance easy in the cloud by providing a platform where developers can easily encrypt/track/audit their data and establish compliance to auditors. We plan to do this using a custom-built stack + a centralized management console. Do you have any feedback on something like this, or would it be okay if I could contact you offline? My email is in my profile. Thanks

Drchrono (YC W11) raises $2.8 Million for iPad Health Record Platform

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