About disruptmedicine

I am a physician, a student of technology and an entrepreneur. My medical specialty is in Advanced Medical Imaging (radiology). I trained at Johns Hopkins Hospital, where I was Chief Resident. I went to medical school at the University of Michigan. I am interested in disruptive innovation in healthcare, especially those that empower patients, decrease costs and improve quality. I am the cofounder of Radiology Response, where we are working to connect people directly to their medical images.

You are the Patient Experience


Great video on what the patient experience is and looks like. Very useful for healthcare organizations.


How should doctors market themselves in the age of patient empowerment?

In the age of Patient Empowerment and the trend towards patient consumerism, it’s important for doctors to market themselves to patients.  Patients are making informed decisions about who they see, and who they trust, which is a good thing for healthcare.  I believe strongly in patient empowerment and participatory medicine.  As I’ve said before, the age of paternalistic medicine is over.

Many physicians like to eschew the idea that they are actually conducting business, let alone try to market themselves.  A number like to pretend that medicine and business have nothing to do with each other, and that business pressures can only serve to pervert medicine.

That’s BS.  Medicine is big business, and natural market forces should create pressure to provide a better product.  That’s good, not bad.  We need a better product.

Patients should be seen as customers, because they are.  We often forget that in our third party payer system it’s the patient and not just the insurance company that is our customer.  That leads to the kind of crappy customer service that patients get in our healthcare system: long wait times, short visits, repetitive questioning, lack of patient-centric care, etc.  If we’d been focused on the patient as our primary customer (instead of the insurance company) for the past 3 decades, we would have developed a much better customer service.

At least we are forced to focus on it now, with patients having become engaged consumers.  To that end, I thought this was a great article about how the modern, patient-centric medical practice can market itself.  

This was especially interesting to me, as my patient-centric, patient-empowerment focused healthcare startup is working on developing our marketing strategy.

Got ideas for us?

EHRs and Health Information Exchange: Will increased access decrease costs?

The federal dollars in the HITECH act, and much of the enthusiasm for new innovation in the healthcare IT space is predicated on the assumption that better access to information will result in better and cheaper care.  Avoiding unnecessary duplicated studies, especially, expensive medical imaging, is one way that’s supposed to happen.

As a medical imaging specialist, I can attest to the fact that unnecessary and wasteful imaging tests get ordered all the time, at significant cost.  It see it many times a day, and I’m a believer in the power of increased access to health records.

Two articles have recently been published in the medical literature that aim to test this assumption.  And the results seem to be in conflict.  The first article, published in the Journal of Health Affairs, examined access to medical imaging and results, and found that physicians with electronic access were actually more likely to order additional imaging tests.  The second article, published in the Archives of Internal Medicine, found that doctors ordered 49% fewer lab tests after the introduction of an electronic health information exchange (HIE).

So, what are we to believe?  I’ll try to make some sense of this.

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EHR Innovators Part 2: drchrono

drchrono ehr digital health

This is the 2nd part in my round up of 4 EHR innovators that have caught my attention.  Last week I covered Practice Fusion.

Today I’m taking a look at drchrono.

Next week, we’ll check out hellohealth and
Avado.  There are other EHR/EMRs.  Lots.  Why aren’t they listed above?  They haven’t grabbed my attention yet.  Am I missing someone exciting?  Drop it in the comments!

In an earlier post I wrote about the top 5 features I need and my patients need in an innovative EHR: Integration, Web-based Interoperability, Mobility, Provider Sharing and Patient Access.  I’m evaluation how each of these EHR innovators does on meeting these top 5 features.

On to drchrono…

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EHR Innovators Part 1: Practice Fusion

As promised, this is the first in a multipart series, about the innovation going on in the Electronic Health Record space.  This isn’t meant to be a comprehensive review of all the EHR vendors out there.  It’s a short list of a few of the EHRs that have caught my attention for being innovative or exciting.  Those EHRs that make it easy and free to sign up I’ve evaluated first hand.  Those that don’t I’ve evaluated based on their own feature lists, demonstations and published materials.  This isn’t mean to be a usability evaluation, but just an overview of what’s being done out there.

So, here’s the group that has my attention:
Practice Fusion
There are others.  Lot’s.  Why aren’t they listed above?  They haven’t grabbed my attention yet.  Am I missing someone exciting?  Drop it in the comments!

<begin digression>
A short digression on EHRs and disruption:  In my *ever-so-humble* opinion, the innovative EHR is not a truly disruptive technology, by strict definition.  Maybe Clay Christensen would disagree (in which case I would submit), or maybe history will prove me short-sighted and wrong.   But, I believe that in spite of the exciting innovation in this space, EHR innovation won’t replace or up-end any markets, particularly the market that it most directly influences: the Doctor-Patient(-Insurance) transactional market.  I do think EHR innovation may expand or create new markets.  It will reduce waste and inefficiencies.  It will improve care.  But it won’t truly disrupt the market.  It’s not going to take us from the realm of treatment/reaction medicine to preventative medicine.  It’s not going to change the payer models.  It’s not going to change the customer.  It doesn’t fit the pattern of disruptive technologies layed out in The Innovator’s Dilemma.  I see it as exciting evolution, but not revolution.
</end digression>

In an earlier post I wrote about the top 5 features I need and my patients need in an innovative EHR: Integration, Web-based Interoperability, Mobility, Provider Sharing and Patient Access.  I’m going to evaluate how each of these EHR innovators does on meeting my top 5 needs, starting with Practice Fusion.

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Top 5 things my patients and I need in an EHR

There is a lot of exciting innovation in the Electronic Medical Record space right now, in part thanks to meaningful use dollars available from the American Reinvestment and Recovery Act.

That is good new for patients and doctors both.  I’ve got my eye on a few of innovators in the space, both young startups and more mature companies.  I’ll write about some of them soon.  But first I wanted to list some of the key features that an innovative (or disruptive!) EHR should include.  I’m not talking about HL7 feeds and HIPAA compliance here.  Those kinds of things are important, but I’m interested in innovations that have the potential to be transformative—or at least empowering.

#5 – Integration – Especially with medical imaging

OK, I know I just said I wasn’t talking about HL7 feeds.  But there is more to EHR integration.  When I publish this post, it will automatically get posted to Twitter and Facebook…without HL7, thanks to APIs.  Any EHR worth its salt should expose an API so that others can integrate with it, extend it, and innovate on top of it.

This is especially important when it comes to viewing medical images, like CT scans and MRIs.  Ideally, the EHR itself should be what I call the “clinical viewer.”  (A clinical viewer is like a PACS that emphasizes clinical necessity and convenience over advanced visualization tools.)  But, most EHRs aren’t there yet, and clinical viewers are in their infancy, a topic I’m speaking on at the Society for Imaging Informatics in Medicine this June.  So, if the EHR can’t have a clinical viewer built right into it, it should at least expose an API robust enough for a clinical viewer, or any other clinical application, to integrate with it.

Why?  Because medical images are freaking important, that’s why.  And so are about a million other different things and use cases, including a boat load that haven’t even been thought of yet.  Closed platforms are sooo 2001.

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