A novelty? Or the wave of the future?
MOUNTAIN VIEW, CA – In what its CEO billed as a development that "could finally drive global usage and adoption" of the technology, drchrono, which makes electronic health records for iPads, received meaningful use certification as an ambulatory EHR this past July.
Its certification, from San Luis Obispo, Calif.-based InfoGard Laboratories, an ONC-Authorized Testing and Certification Body, became the first for an iPad-native EHR, according to executives.
The certification holds the promise of giving cash-strapped or technology-shy docs yet another avenue by which to pocket as much as $44,000 in meaningful use incentives. But, is this a model that will finally catch fire with the legions of small practices that have yet to make the switch to electronic records? Or is it just a fad?
The drchrono application is touted as a complete solution to run a physician’s practice. Its features include e-prescribing, a real-time speech-to-text capability, custom workflows, the ability to integrate photos and videos into a patient chart and integrated electronic medical billing. It tracks how much a doctor uses the EHR and gives them key metrics to report to the government in order to get incentive payments.
Even still, says drchrono CEO Michael Nusimow, other, larger vendors have "kind of looked down on the iPad as a toy, as a consumer device." That's why getting certified by an ONC-ATCB was so crucial.
Normally, government certification is "not very friendly to startups," says Nusimow. But while he concedes the process was difficult at times, he says InfoGard stipulations were "well thought-out and balanced."
In fact, its rigors forced drchrono to speed up some of its features. "Things I think we may have gotten to, say, six months down the line, or even in a year, it forced us to address them really early," he says. "It made us a much stronger product."
Most of all, he knew that if his well designed and intuitive interface was to be taken seriously, it was a necessary process. "Early on, there was a lot of excitement from doctors" about an iPad EHR – “but there was also this fear, uncertainty and doubt," says Nusimow. "Is this a toy? Is this going to get me government certification? Is this a heavy-duty system?"
Drchono customers "wanted meaningful use certification," he says. “That convinced them to pull the trigger… That's what they were waiting for, kind of a sign of maturity."
Simply put, docs love iPads. Thirty percent of them own the tablets, according to Manhattan Research. Vince Kuraitis, principal at Better Health Technologies and proprietor of the eCareManagement blog, says the appeal for physicians is obvious.
"The iPad is intuitive, easy to use, reasonably priced, easy to carry around, and has a lot of apps that have been developed for the platform," he wrote on his blog. At the same time, he warned that Apple's sexy hardware also represents a "walled garden" that could trap unwitting healthcare consumers. "Apple has created a technology platform that people love. That love translates to high switching costs and high levels of customer lock in."
Still, says Daniel Kivatinos, cofounder and COO of drchrono, the iPad is "a natural fit in the medical space."
CHALLENGES, OPPORTUNITIES
But there are challenges. As Steve Fox and Vadim Schick wrote on their Health IT Law Blog, drchrono's certification is "a huge step for a mobile EHR app," but the "regulatory hurdles may not be over."
Mobile technology presents providers "with a very long list of legal concerns," they point out. "Privacy and security of patient data, compliance with state and federal laws (including Stark and anti-kickback statutes), assumption of risk and liability, along with many other critical issues, should be addressed in the contract between the healthcare provider and vendor of such software."
Nusimow agrees that security has been a "number one concern in the minds of our customers." But, he says, with the iPad connected to drchrono's cloud-based platform, "there's no information stored on the iPad except a temporary cache ... it's more secure than locally stored laptops and servers."
Moreover, he says, "We had a third-party security audit – which very few companies actually do. We had InfoGard look at our levels of encryption and even look at our source code, where we are implementing our security features. It's a very thorough audit that should reassure our customers."
One of those customers is Surinder Saini, MD, a gastroenterologist in Newport Beach, Calif. "Once I installed the drchrono app on my iPad, it was love at first sight," he says. "I could not believe how clean, intuitive and beautiful interface it had."
His previous EHR, a server-based hybrid system that required scanning of handwritten paper notes and included scheduling, document management and prescription software from different vendors, "fulfilled my need for recordkeeping,” Saini says. “It would not have qualified for meaningful use."
So Saini opted for a new approach. And since switching EHRs the benefits have gone beyond more intuitive interface and efficacious capabilities, he says.
It starts in the waiting room where patients are given an iPad to register using drhrono's On Patient app, filling out a questionnaire about their symptoms. In the exam room, Saini is able to offer more eye contact to the patient – "since data entry is touch based or via speech, the distraction is minimal," he says. "The speech-to-text feature is just amazing. As a consultant, it gives me complete freedom of expression of thought. The accuracy of medical terms is just unbelievable."
Saini plans to attest for meaningful use. And he's trying to convince his colleagues they can do the same: "Several physician colleagues look to me for friendly advice on healthcare technology. I encourage them to sign up and try it in their practice," he says.
"Most physicians acknowledge the need to migrate to EHRs, but they have been looking for better solutions so far," he adds. With the ONC's imprimatur, products such as drchrono could be the technology to catch on.
"I think the iPad and the broader trends of tablet and cloud computing have really shaken up this space," says Nusimow. "It's an evolutionary leap forward in technology. And users are already seeing that and responding. Doctors love that accessibility, and they love the cost savings. I think it's going to be used, and will be a huge advantage for the adoption and success of EHR technology.”
