The Rise of Specialty-Specific HIT

Outside of the big boy HIT world of large enterprise companies like Epic, Cerner, athenahealth, and Allscripts, health IT seems to mostly be going the route of specialized products. Maybe it’s just my personal filters these days, but I seem to see more and more niche offerings. Niche makes sense, as I don’t think most companies — startups or large enterprises entering health IT — would have success if they tried to sell Kaiser on an Epic replacement.

Just this week was news about offerings specific to cardiology and ophthalmology. AliceCor is now offering remote, expert review of ECG readings from the AliveCor device. Patients or providers can opt to pay a fee for a cardiac technician or a larger fee for a board-certified cardiologist. The site doesn’t list the price for these services. The sell is around peace of mind and the ability of the patient to do ECGs as needed.

Based on the example reports on the AliveCor website, the cardiac technician report seems like it’s almost without value, at least to the patient. It’s a technical review and the example "Non Sustained Atrial Fibrillation-Sinus Rhythm w/3.3 Pause/PVC/Artifact" with a reference definition of "Atrial Fibrillation" can’t really be useful to most patients.

And how is a physician supposed to treat a technical review of an ECG from an unknown technician? I’ve talked to a few physicians about the liability associated with this and none seem too keen on making clinical judgments and exposing themselves to liability based on AliveCor reports. Suspending the reimbursement issue, any providers out there have an opinion on making clinical judgments on this data or these reports? I did meet a concierge doc recently who uses AliveCor when he does home visits. I thought that was interesting.

The more in-depth reports from cardiologists hold more value since they make a recommendation and don’t just give a technical review of the ECG. Again I wonder about the liability for AliveCor and for the cardiologist making these reads.What cardiology groups would think about using this as a value-add service for patients? Are there cardiology-specific concierge groups?

The other specialty-specific HIT news this week was in the field of ophthalmology. CheckedUp is launching a platform specifically to help ophthalmologists educate and extend care beyond the clinic walls. The offering sounded a bit like Uprise Medical, which is now Centrana Health apparently, as that was the other ophthalmology-specific patient engagement platform I knew about. 

CheckedUp is offering a mobile platform for providers to offer services to patients. Services include education, access to digital forms, and medication management. I assume it also does refills and hopefully appointments. I’m not sure how interactive it is beyond the forms, but the idea is to improve communication between doctor and patient, in this case an eye patient.

In the last few months, there have been countless others about products, platforms, apps, and devices for specific areas like pulmonary medicine (Propellor Health), diabetes, and acne. These help patients self manage specific conditions, and many have tools for providers to integrate the services into care delivery. I was having a conversation this morning with a home health company that wanted to track four physiologic data points and needed three different apps and services to do it. I had a similar conversation with a concierge management group last week.

I’ve mentioned concierge a few times in this post and written about it before. Concierge is the main area that these services should be targeting for customers. These digital engagement services, if they add value to the consumer, would presumably help get them to join a concierge practice and differentiate that practice, assuming there is some competition in the cardiology- and ophthalmology-specific concierge service areas. With concierge, you solve the reimbursement problem associated with most of these services and pass on the cost of these value-add services to the patients.

Of course then I start to wonder how many different concierge practices one patient can join. What about a patient with glaucoma, CHF, diabetes, and COPD? Do they have to choose between cardiology (AliveCor), ophthalmology (CheckedUp), endocrine (Telcare), and pulmonary (Asthmapolis)? The argument I’ve heard for concierge is that a certain percent of the population likes fine wine, wants to fly first class, and is willing to pay for better access to a doctor. But are they willing to pay multiple doctors for better access? I’m hoping they are and that concierge can sustain some of these services until mainstream healthcare is motivated and reimbursed to do so.

On top of all of the specialized digital engagement services, my wife is creating a dermatology practice, so she’s looking at EHRs specific to dermatology. She’s narrowed it down to eDerm and Modernizing Medicine, but we’ve looked at others like CareCloud and even Atlas.MD. Unfortunately for providers, EMRs are a bit different than these other, patient-oriented offering, but her process has helped increase my perception that HIT has been moving to be more specialized.

How do you think all these segments of the HIT market will get along? I assume at some point they’ll consolidate either through data integration or acquisition. Of course some big players are offering more general services — look at the news from eClinicalWorks this week.


Travis Good is an MD/MBA and co-founder of Catalyze. More about me.

  • Kevin Muller

    Hi Dr. Travis.

    I recently started reading your blog, and find it very insightful and inspiring as an HIT student. You mentioned that you see no value to the end user of the Alivecor product, but what about for the purposes of telemedicine? If a patient is miles away from care and needed to see a cardiologist, wouldn’t that product then give value to those specific customers?

  • Thompson Aderinkomi

    Thanks for the write up Travis. I hope all is well at Catalyze. I think that as concierge (I prefer the term direct pay care DPC) gains traction that DPC clinics will become one stop shops with multi-speciality capabilities, primary care, cardiologists and all the rest coming together and offering packages at various levels for various patients. Or perhaps even custom developing packages to meet specific patient needs. As this happens, these types of practices will be able to fully leverage these new devices without the risks you point out. This is certainly where RetraceHealth is headed.

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