The pMD Blog
POSTS BY TAG | Mobile Health



As I mentioned in a previous post, almost every EHR vendor out there has some sort of mobile component to their offering. This tool is typically a useful extension of the EHR for every physician using the system, from primary care providers to specialists. Try to envision a car that will satisfy the needs of every person in America. It needs enough seats to fit a large family, and don't forget about good gas mileage and passenger comfort. If you're building a car for everybody, it would probably look like a minivan. Similarly, the mobile component to most large EHR systems is the minivan of mobile software. You sacrifice performance for the ability to do something for everybody.

Now imagine that you're a consultant for a large health system that just spent millions dollars and thousands of man hours implementing a cutting-edge EHR across all of their facilities and clinics. Sure it was expensive and took a few years, but since it's such a comprehensive offering the health system only has to work with a handful of vendors instead of a hundred. Your job as the consultant is to help them determine which vendors will comprise that handful. Some of the physicians have mentioned an app they currently use called "pMD," so you've started investigating the EHR's mobile offering. Doctors can use the EHR’s mobile software to look up patients’ clinical information and order medication refills without logging into a desktop environment. You start wondering what it can't do and schedule meetings with doctors to discuss your findings.

In your meeting, primary care physicians and specialists rejoice! The EHR's mobile app, as you would expect from a minivan, offers utility for nearly everybody. 70% of the doctors are satisfied and head home. But the specialists hang around and keep asking you questions. The cardiologist is wondering if it can work offline. The critical care doctor asks how quickly she can capture hospital charges for 30 patients on her iPhone. A hospitalist asks how fast he can take over his partner's patients and view handoff information in the app. What is this "pMD" thing they keep mentioning? Although these specialists only comprise about 20-30% of the physician headcount, you know they command a huge percentage of the health system's revenue.

So what's going on here? You just tried to replace somebody's race car with a minivan. The minivan can go farther and fit 8 people with all of their luggage. A race car can't do that, and frankly it's not all that comfortable to drive. But how fast is the minivan? What if somebody is extremely busy, and their primary need is to get from Point A to Point B, on a paved road, disgustingly fast? The number of passengers, luggage capacity, comfort, and all-around capabilities take a back seat to speed.

These specialists need the race car of charge capture because they are insanely busy. They usually spend half of the day seeing patients in their clinic and the other half driving around to around to various hospitals rounding on another 20-30 patients. They are up before the sun and still working on documentation at midnight. The math on an extra few seconds or clicks on a per patient basis adds up quickly. This is why they can't use a minivan for charge capture. If you give them the minivan, they will wait until they have time to use it: at the end of the week or at the end of the month. And where does this revenue reside between weekly or monthly submissions from the specialists? On paper.

A significant amount of the revenue these doctors generate, and therefore a significant percentage of the health system's revenue, is generated outside of their office clinic, so this can be hugely detrimental to the health system's business. At best, it slows down a large amount of revenue. Worst case, the paper (and revenue) goes missing entirely.

EHR mobile solutions and pMD Charge Capture are not mutually exclusive for the same reason that you might keep a minivan alongside your race car in the garage. The minivan is the clear choice for taking the family to a tee-ball game, but it would be absurd to show up in a minivan for some track time at the local raceway. The EHR's mobile solution is built with every physician in mind, and pMD is purpose built for specialists. Although a user may never be able to articulate why, they can definitely tell you that using pMD for charge capture is insanely fast. I can't fault them; I can't clearly explain the excitement of driving a race car with words, but I sure can tell you I love the feeling of such raw power and performance. What is it about pMD that doctors love so much? I've worked with doctors that use pMD all across the country and I'll do my best to articulate why on the next post. Cheers!
I had been chatting with a doctor for a while about his hospital rounding and charge capture process and how he ended up with his current practice, when I suddenly had a question for him about the Apple Watch.

We’d been looking at different aspects of pMD together and his excitement about the mobile software kept growing. Meanwhile, we had also swapped stories about Seattle and New York and about the geographical challenges caused by pursuing a career in medicine. On a whim - not certain yet myself if I would get one - I asked him if he was thinking about getting an Apple Watch.

"Ah," he said regretfully, "I don't think I will get one."

I noticed that he was wearing a large, elegant, solid-looking steel watch and asked him about it. His face lit up with pride. "I will be buried wearing this watch," he smiled. "I won it in a race..." He began telling me about his hobby of street-racing BMWs and of his excitement at winning the rally. I could tell that the watch meant a lot more to him than timekeeping or as a fashion statement. It was something that he had earned - a badge of honor.

It made me think about the increasing overlap between the professional and the personal, and also between fashion and technology. We use our own devices to do our jobs better, and we've begun to wear and carry and accessorize these computing devices as they have become more mobile. A watch, more than a phone or a computer, has always meant something different to different people: time keeper, fashion statement, status symbol, memento.

I myself did eventually decide to spring for the Apple Watch - but I wasn't replacing anything. If I were in his shoes, I might also hold off, at least until I had a chance to win an Apple Watch Edition in a street rally!


The highly anticipated Apple Watch opened to the public last week for pre-order, drawing nearly 1 million people to place an order for the wearable gadget. The cutting edge device not only presents a new fashion statement for the tech-centric, but it also opens the door for innovative software development for its users. Doctors can expect great things to come from the iWatch, which will help with point of patient care services and overall daily efficiencies.

Accessing and sharing medical information from a watch during a patient visit is certainly less intrusive than a computer, tablet, or smartphone. And although smartphones are continuing to grow in physical size each year, they still seem to get lost in our bags, backpacks, cars, hospital rooms… you name it, you can probably lose a phone in it. The smartwatch changes everything because it’s always accessible and far less cumbersome. Doctors can dictate into the device to record information, make calls, and send messages (secure messages, of course.) The Apple Watch has the potential to transform the way HIPAA compliant messages are sent and received.

The new app interface also opens the floodgates for iWatch apps - both from current apps syncing to the device, and brand new smartwatch apps altogether. App notifications and alerts will come through the watch and vibrate or tap you on the wrist, making reminders more powerful and less likely to be missed or ignored. It could actually help doctors stay on schedule! The Apple Watch doesn’t have a camera (yet), but users can display photos and medical images on demand.

Apps that already allow doctors to easily access medical information from their mobile devices can link their app to the watch for an even more mobile and hands-free option. Doctors could track their patient list, pull drug information for dose guidelines, capture their patient encounter charges, dictate patient orders, and even document their notes, all from their wrist. The potential for the Apple Watch for health care providers is powerful and the onus is on medical software companies now to utilize the innovative technology that Apple has developed.
Apple is gearing up to report their Q1 FY15 Earnings on Tuesday, January 27th, and as usual we’d like to chime in from the roots of the grass of the medical technology world to predict how Apple market share has been faring.

Since Q4 FY14, the market share among our growing physician charge capture user base remains stable with a mild increase in Android usage. Looks like the holidays saw proportional gifts from both platforms.


Even though Apple did not gain any ground on our Android users, the iPhone 6/6+ achieved a very large and impressive number of upgrades among preexisting iOS users, particularly from the iPhone 5 segment.


Given these numbers and trends, we feel that Apple stock will have minimal upward pressure from changes in market share, but the large number of upgrades may provide a strong bullish indicator. Although the unknown impact of the Apple Watch is already priced in, it still holds quite a bit of uncertainty in the coming months.

Here's What You May or May Not Have Missed This Week:


• The Office of the National Coordinator (ONC) released a five-year health IT strategic plan that focuses strongly on interoperability. It also emphasizes patient engagement and the expansion of IT to long-term care and the mentally ill and other areas of health care that have been without it. Source

• Medical school students staged a nationwide protest against police brutality by means of a white coat "die-in." Students for a National Health Program backed the protests, stating "We as medical students feel that this is an important time for medical institutions to respond to violence and race-related trauma that affect our communities and the patients we serve." Source

• CMS submitted a rule to require all hospitals across the country to recognize gay marriage. It's an important proposal (pun intended) for same-sex spouses to be afforded equal rights in medical facilities that accept Medicare. Source

On The Front Lines:


In the Apple-Android device wars among pMD's charge capture physician users, Apple has fallen even further with six straight weeks of lost market share. What will it take for Apple to reverse this sinking trend?


FINAL RESULTS:


iOS: 90.41%
Android: 9.59%

Each Friday, Signor Goat reports the latest from the week in health care alongside the front lines of the iOS-Android wars among pMD's charge capture physician users. Check back next Friday for your dose of our little medical corner of health care news.

Apple has stumbled these last three weeks. This week they lost an additional 0.11 percent to Android in the platform wars among pMD's charge capture physician users. Meanwhile in tech news this week, Android released its latest dessert-themed update to its operating system, called Lollipop. Lollipop comes with a brand new look and feel, with a lighter and brighter user interface. Sound familiar? That's because Apple's iOS 7 release last year had a very similar design overhaul. Analysts expect that Lollipop will give Android a big push into the enterprise space.

Rumors are surfacing of Lollipop rendering Android devices unusable, so we may see Android take a turn in next week's breakdown.


Signor Goat reports updates from the front lines of the iOS-Android wars. Each Friday, we report the current device breakdown of our charge capture physician users and identify the net winner for the week. Check back next Friday for your dose of our little medical corner of the platform wars.

FINAL


iOS: 90.62%
Android: 9.38%

Happy Halloween!

The biggest news out of Apple this week wasn't related to devices, but it did reinforce the company's long list of trailblazing. Tim Cook is the first CEO of a Fortune 1000 company to publicly say that he is gay. We're not sure if this is causation or correlation, but Apple devices among pMD's charge capture providers increased this week.

Apple has topped Android in net mobile devices for the week, adding 0.07 percent to its dominance among pMD's mobile charge capture providers. Many of pMD's health care providers use pMD on their iPhone and iPad, taking advantage of the larger screen real estate the iPad has to offer. Apple is still the top tablet manufacturer in the US and earlier this month they released the iPad Air 2 to glowing critic reviews. The iPad Air 2 is significantly thinner, lighter, and overall more powerful, making it a popular Apple mobile device for doctors to use for work.


Signor Goat reports updates from the front lines of the iOS-Android wars. Each Friday, we report the current device breakdown of our charge capture physician users and identify the net winner for the week. Check back next Friday for your dose of our little medical corner of the platform wars.

FINAL


iOS: 90.89%
Android: 9.11%%

America's beloved Apple stays on top yet another week with a .10 percent gain! Undoubtedly, the new iPhone 6 has had a heavy impact on the mobile device breakdown among pMD's charge capture physicians. Android users have been crossing enemy lines to switch to the iPhone, and our data below shows the breakdown in iPhone device models since the introduction of the iPhone 6 on Sept. 19.


Signor Goat reports updates from the front lines of the iOS-Android wars. Each Friday, we report the current device breakdown of our charge capture physician users and identify the net winner for the week. Check back next Friday for your dose of our little medical corner of the platform wars.


FINAL


iOS: 90.83%
Android: 9.17%

For the second week in a row Apple took away more of the mobile device pie from Android among pMD's charge capture providers. Apple took a big dip in the month of Sept. but gained it all back by Oct.; see graph below. This comes at a time when Samsung warned that its third-quarter earnings would fall below market expectations. (courtesy of Daring Fireball). Samsung's answer? New mid-range and low-end devices, which would make Samsung's products more competitive in markets like China. In the meantime, Apple seems positioned to continue its control in mobile health and charge capture in America.

Signor Goat reports updates from the front lines of the iOS-Android wars. Each Friday, we report the current device breakdown of our charge capture physician users and identify the net winner for the week. Check back next Friday for your dose of our little medical corner of the platform wars.


FINAL


iOS: 90.73%
Android: 9.27%

Apple went up .13 percent this week, taking back much of the mobile device market share they lost to Android in Sept. This means that the thousands of people who didn't wait in line on 9/19 or wake up at 12am are finally starting to get their hands on the sought-after iPhone 6 and iPhone 6 Plus.

Signor Goat reports updates from the front lines of the iOS-Android wars. Each Friday, we report the current device breakdown of our charge capture physician users and identify the net winner for the week. Check back next Friday for your dose of our little medical corner of the platform wars.


FINAL


iOS: 90.57%
Android: 9.43%