The Other HIT

I’m sure I’m not the only one, but this is a very frequent part of a conversation for me: "I see, you do health technology. So you work for an electronic records company?" Invariably I have this discussion multiple times at every one of my wife’s department functions, or at conferences, or just on the street.

I can’t be the only one, right? I’m sure lots of readers out there, whether they work for an EMR vendor or not, get this response from people when health technology comes up. The conversation may also include a comment like, "what else is there?" or, "Oh, that’s interesting.”

If it’s a more informed person and I’ve been talking about mobile health or mobile generally, they might ask, "Do you mean like MyChart?" That was the conversation I had this morning. It’s also what triggered me to write this post. I understand the reference to MyChart because I do live in Epic’s backyard, but don’t we all live in Epic country these days?

It’s a bit annoying at times, but I understand the knee-jerk reaction about working for an EMR vendor. EMRs are the key part of HITECH and a monster part of healthcare IT generally. They are widely used and known by consumers who read about them and also increasingly see them when they go to the doctor. I also understand MyChart being representative of mobile health for lots of people; there are likely more MyChart users than just about any other mobile health app. Maybe iTriage and WebMD mobile would contest that last statement.

Whatever the reason, I get it. But it’s still a barrier — or an extended explanation — that I face every day when I try to describe to people what I’m working on or what I write about. This got me thinking about mobile health success stories, specifically how they relate (or don’t relate) to EMRs and EMR workflows.

I’ll try to confine myself to true success stories, meaning mobile health apps and services that have been or are widely used, not just those that are well funded and get a lot of press. I’ll also focus on those that are mobile only or mobile first. I get asked all the time about what I consider the main mobile health success stories. Below is my typical answer, though I put more thought into it now that I’m writing it and not answering live. What’s interesting is that none of them were dependent on an EMR for success.

Epocrates. Always the go-to example for mobile health success – big growth and eventual acquisition by Athena. It grew before HITECH and health reform. Still today it’s used outside of the EMR for medication reference and decision support. Adding the ability to e-prescribe from within the app would be good, but then you’d have to integrate the entire patient panel so docs don’t have to re-enter them. But that’s not even necessary because it’s a reference tool and something to which providers need access.

AirStrip. It is still relatively new, but has had a good amount of success selling and with adoption, beyond the huge amounts of financing it has secured. AirStrip didn’t launch as complete mobile health platform with the ability to be a mobile front end for EMRs. It was based on device data initially, fetal monitoring then cardiac monitoring. AirStrip is now more broadly a mobile health platform for clinical content, inclusive of EMR data. I assume working with device data, like data from ECGs and fetal heart monitors, is an easier start than integrating with EMRs.

iTriage. This is the only non-provider facing, or consumer-facing, app on my list. iTriage got out quick and offered something that consumers wanted. As consumers downloaded it and used it, enterprises wanted to sponsor listings and enable pre-registration from within the app. None of this really has anything to do with the EMR. It has to do with patient search and entry into the health system, something that has become a very competitive area.

VisualDx. I have a half-written post just about this company. It does clinical decision support at the point of care, starting in dermatology but with plans to expand much more broadly. It recently added the ability to e-mail educational content straight from the mobile app to patients, which is again pretty cool. It’s widely in use in terms of licensing to medical centers. I’ve used it and my wife uses it all the time. It’s similar in its utility to Epocrates.

Decision support obviously holds a lot of value because it motivates a user — a clinician user — to open a standalone app, often during a patient encounter. We’re seeing decision support integration into EMRs so clinicians can get it all in one place. Ideally these integrations will get better and the decision support will be available contextual, or based on the medical record being viewed. Hopefully clinicians aren’t in apps or any technology during the entire time with patients, so standalone decision support still makes sense.

Also on mobile, assuming good mobile EMR options become the norm or at least available, it doesn’t make sense to bloat them with all of these add ons. People will use apps for specific functions at specific times, and I think most people are OK to have multiple apps for common tasks. Clinical decision support or reference is a very common task.

Mobile messaging. As many have written, EMRs should be primarily communication tools. But as EMRs have become increasingly bloated, the focus is on documentation without much thought about or focus on communication. I wrote a series of posts way back in 2012 about all the activity in the clinical messaging space, or all the apps that are vying to be pager replacements. This is another great example of a tool that should be integrated with the EMR but is independent today, whether it’s pagers or smartphone apps. Messaging from within the EMR makes sense on the Web, but ideally messaging (or at least inbox) apps would be standalone on mobile to keep them from being too mobile.

One area I’m not listing but I think will see big growth is telemed and virtual visit companies, many of which will be available on mobile. The reason I’m not listing is that I don’t think these have really hit the tipping point yet for consumer usage.

I think EMRs have the potential to be amazing data platforms. I’ve written about this and it was discussed on Washington, DC recently during Datapalooza. I think we’ve seen some good examples of mobile health success stories that have been built, grown, and even been acquired despite being separate and distinct from the EMR.

I think tons of opportunities remain to grow apps and services with similar models, though it’s not easy. It’s not easy because you have the non-EMR stigma to get past. But in certain respects, I think that’s a good thing because you can clearly start to address some of the shortcomings in current EMR offerings and help enterprises start to think about answering the question, "Now what?" I think the answer to "Now what?" is going to be huge.

What do you think? Have you had similar experiences when you talk to people? What is your take on the EMR / non-EMR buckets?

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

  • Neil Jordan GMHealth Microsoft

    Love the sentiment here and the point of view. Adds further weight to the NEJM article “Escaping the EHR trap” which clearly articulates that the core EMR is mere table-stakes in the road to digital health nirvana. See also Dr Bill Crounse’s comments on this in Healthblog. Let’s keep the debate going….

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