Enterprise Provider Apps (1 of 2) – 9/30/11

As a reminder to anybody interested in attending the mHealth Summit this year (December 5-7, Washington DC), early registration ends next Friday. If you are going and want to save $100, register before then.

I wrote a couple of posts (Part 1 and Part 2) recently about the overall mHealth landscape and included mobile apps for pharmacy, pharma, payers, and health systems. I didn’t really cover enterprise apps for health system, at least those used by providers, because it was just too big and broad.

For these posts, I’m defining enterprise apps as those used by health system employees or affiliates. These include clinical systems, practice management systems, clinical communications, RFID and asset tracking, data collection, patient care tools, and coding. I’m loosely defining enterprise to include entities from tertiary care centers to ambulatory clinics and everything in between. I’m also going to only cover, for the purposes of this post, clinical systems, patient care tools, and communications tools.

Enterprise apps aren’t really getting as much attention as all of the consumer-facing health and fitness apps. But in reality, enterprise apps are being used and will likely have a greater impact on healthcare in the short- to medium-term than anything designed to improve patient care outside of the four walls.


EMRs vendors are increasingly going mobile, though most with limited functionality. Vendors Epic (Canto and Haiku), drchrono, AllScripts (Remote), ClearPractice (Nimble), Practice Fusion, GE Centricity (Advance), Capzule, and eClinicalWorks all have mobile offerings. I’m sure there are more, but these are the ones that I know.

I’m surprised by what some are calling mobile. Both Practice Fusion and eClinicalWorks (through easeMD) offer mobile apps that are just remote desktop applications. The experience does not take advantage of iOS or Android the way it should, leaving much to be desired. I know Practice Fusion demoed a native app for iOS and Android earlier this week, so at least improvements are on the horizon, even if still a few months off.

In looking at mobile EMRs, you can divide them into those that allow data access and those that allow both data access and data entry. For data access, which is what most are currently offering, both tablet and smart phone versions are probably fine. For those few that offer a true mobile EMR experience (both data access and entry), such as drchrono and Nimble, the iPad is the right form factor.

I’ve used both Nimble and drchrono in demo mode and neither really thrills me, but hey, they’re EMRs. I think data entry over mobile for a complete, meaningful use EMR is a challenge. That’s why I like that drchrono offers voice-to-text functionality, making it possible to dictate and edit at one time and all over mobile.

Voice is helpful, but what I’m really waiting for is a mobile EMR that leverages touch and mirrors clinician workflow. I had a demo of the new Epocrates EMR about a month ago and I have to say that I was impressed with what I saw. I saw the Web version and it was almost totally clickable with auto-populating of content, functionality that I imagine will work well on a touch device. It also followed the way a clinician is trained to do a patient encounter.

Epocrates is also working with Nuance to integrate medical speech recognition into its EMR. If they can combine touch, clinical workflow, and speech well in a mobile EMR, that seems like a winner. Couple that with linkages to Epocrates drug and clinical decision support, not to mention its brand name with providers, and I bet Epocrates will have good uptake in the small physician office market that it is targeting.

It’s probably no coincidence that the two most advanced mobile EMRs (Nimble and drchrono) and the most promising (Epocrates) are all built for ambulatory practices. It’s a much simpler market to penetrate than trying to unseat Epic, Meditech, Cerner, and a host of others in the hospitals. I’m curious to see how AllScripts, Athena, and eClinicalWorks respond in the ambulatory market.

Mobile EMRs have great potential and will likely change the way that providers document and encounter patients. Also, docs love iPads, so using them for EMR access and entry takes some of the sting out the transition to an EMR.

But EMRs are only one aspect of patient care, and a pretty limited aspect in my opinion (more next week on that.) Next week, I’ll cover mobile offerings for clinical communications and direct patient care (nursing, data collection, barcoding, etc,) It’s a bit of a departure from the consumer-facing stuff that I’ve been writing about, but it is very important for healthcare delivery organizations, providers, and ultimately patients.

Travis Good is an MD/MBA involved with health IT startups.

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