How Michael and His Team Built an EMR Solution By Building What Physicians Want with Michael Nusimow, CEO at drchrono

Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez

: Welcome back once again to the Outcomes Rocket podcast where we chat with today’s most successful and inspiring healthcare leaders. I really want to thank you for tuning in again and I invite you to go to outcomesrocket.health/reviews where you could rate and review today’s guest because he’s an outstanding health care contributor. His name is Michael Nusimow.

: drchrono is focused on the Ambulatory Medical space and I could give kind of my a quick overview of what drchrono does kind of give you the elevator pitch. So what we’ve done at drchrono is we built the world’s best mobile electronic health record focused on the iPad and iPhone platform. And that’s targeted at the Ambulatory Medical Practice. So any private practice outside of a hospital is in our target market. And we kind of start off with an iPod electronic health record. We were actually the first company to ever launch an electronic health record out in the iTunes App Store we launched in April 2010 right when the iPad first came out onto the market and we’ve been voted the number one mobile electronic health record by Black Book rankings for the last five years really ever since they started tracking the category and we’re also the only literary H.R. that’s a mobile enterprise partner with Apple. So we get to work very closely with them as a preferred partner on building our product and coordinating very closely with them on healthcare strategy and how we can bring the iPad and our software to the broader medical market. And that’s kind of where we start off and kind of I think our business has a one two punch. And the first punch what really is kind of the tip of the spear is the iPad EHR. that is very distinctive on the market really has gotten a lot of attention. And our second punch kind of the follow up or the shaft this fear that follows through is taking over a doctors something called revenue cycle management or CME and basically what that is is we give the doctor software and or services to do all the work for that doctor or that medical practice to get paid by Shurins companies and patients. And that’s kind of the main economic engine of what our service is doing is taking care of of those point of care tools. A doctor needs to know when the doctors in the exam room with the patient. The goal is everything they can do everything they need to do for that patient. They don’t need any paperwork. They don’t need a laptop computer. They don’t need a fax machine or anything else they could do it. All right on their iPad and iPhone they can document clinical notes send a prescription including controlled substances that require you know a DA reproval. Things like Vikan and very powerful pain medications they can do all of that were right on the iPhone and iPad. And at the point of care and then the big sell later is kind of taking over their revenue.

: Michael this is very interesting and it sounds very seamless and before we dive into a little bit deeper on know your thoughts on hot topics and health care. What is it that got you into health to begin with.

: So my background is I am a software developer as is my co-founder Dan. We actually both went to college together and after college I studied to be a computer engineer and a software developer. I went to go work for a really great company in the financial services space called Bloomberg LP in New York City really awesome company and I was there for about eight years working on building software and it was really a very set of personal experiences that got me interested in healthcare. I was not working in healthcare I knew very little about the business side of this base but as a consumer as a patient myself and also as a family member helping to care for my parents and specifically my father who had a lot of health issues. I just kind of saw from the patients point of view the consumer point of view what it’s like to go into the healthcare system and I got to see a few parts of it walking into you know circa 2000 six to 2008 walking into the average doctor’s office they hand you a paper clipboard to fill out and you fill that out and I read to Stigler call helping my father who had a lot of serious health issues filling out two or three page form about a health history and every time I went to a different doctor with my father and had to fill out his health history I’d be in the waiting room helping him as he had some vision problems and he had a lot of different health things going on he was taking over 15 different prescription drug medications he unfortunately had a few hospitalizations every year due to emergencies to his health condition and every time I filled out some form and were seeing a doctor a specialist. I recall putting different information down right because they’re asking you to summarize a ton of info and I’m just doing it from my own memory for my father’s memory. And every single doctor I’m sure I gave a different story because it was just counting on what I happen to remember that day were in the waiting room. And when you go in and sit in in the doctor’s office the city of healthcare doctors were still on paper medical records so no matter how ill you are something I’ve learned is the doctors still only gives you about 10 minutes of face time when they’re seeing you. Just the way economics are set up. They just don’t have more time to spend with you. And you know imagine a doctor sitting down with someone with a very complex medical history and that manila folder filled with paper is two inches thick. How are they going to look with that in 10 minutes and still have a meaningful conversation of moving forward with your health and specifically dealing with a very complex health issues and managing someone’s care is having multiple health problems and adherence problems. And the answer is it’s really difficult. You know so I saw that most doctors in the ambulatory space didn’t have great tools they didn’t have electronic tools available to them to help them in they’re kind of drowning in paper. I would also share that. I saw this first of my father. I recall going to Cornell Medical Center in New York City which is really a world class facility if you’re ill and you’re lucky enough to be able to go to Cornell medical center for medical care. You’re really lucky you know in the worldwide scope of things but at the time I went to Cornell my father now sitting in the summer with my father the doctor. They were on some enterprise level H.R. system I don’t really know which one it was or you don’t want to pick a fight with them. But it was I could kind of see it the doctor you know are waiting in the exam room and the doctor comes in and there’s a workstation built into the wall and the doctors using a PC with a mouse and keyboard you know with his back facing me and my father where the patients in the Zammar is kind of working at this workstation and really engaged for a full 20 minutes with the workstation kind of throwing paper over his right shoulder. And my father and me asking us questions typing along using the mouse and keyboard and I could kind of see what the software looked like because the monitor is facing us and it looked terrible it was you know it looked like it had done something close by. When you go into setting Shiomi all my printer settings and there were a hundred text entries that required the mouse and keyboard to navigate. And there are several of these screens walk into Dr. Drew they are all exempt so just being a software developer I saw that and I’m like wow that was. A disparity I saw small doctors offices you got a lot of face time a lot of eye contact with your doctor but they’re kind of drowning in paper and they’re struggling to meet efficiency to kind of really know what’s going on and at the enterprise the H.R. space. I just saw a huge opening up and this is typical of a lot of enterprise software but it’s you know software that’s very out of touch with what the doctors the providers the nurses the kind of care they would like to give. And also what the patient expects. You know if you walk out of a 20 minute is it and you’re having serious health issue and the doctors did not make eye contact with you. Never call my father sharing with me at that time. You know he was like hey we waited four months for this is it. This guy if I walk back in there that guy would not recognize me apart from what I might have seen on his screen. She even traveling but me yeah you feel even though they’re great doctors. They are and they’re excellently trained in giving amazing care. It takes a lot away from that interaction. So that’s what you know kind of a very personal story. What got me interested in the healthcare space was just seeing her smaller ambulatory practices not having access to technology not being able to go out and buy a 50 dollar hospital enterprise system and then even in these larger health systems that did go out and had that 50 million dollars to go and buy one of these giant enterprise software systems. So much is left to be desired in how the real frontline users the doctors the nurses the providers and the patients and their families like how they’re going to be treated and how they’re going to interact in such a system that really inspired me. It showed me there was a market opportunity and also that there was good work to be done there. And that’s really kind of what got me inspired and to found Dr. króna went to get into the healthcare space was just saying hey if we put better technology in in these smaller doctor’s hands the smaller ambulatory practices. There’s an open market there they need the help. They’ll be grateful for it. And that’s you know one way to kind of hopefully that technological innovation would go from those early adopters and push its way up market to the large enterprise systems which are also kind of probably meeting a lot of needs. There’s a lot of reasons the hospitals buy them they’re doing a lot more. You know it’s kind of the tip of the iceberg. That doctor patient interaction is really the tip of the iceberg. And you know 90 percent of the work that happens in a hospital is kind of beneath that surface so I’ve learned a tremendous amount over the last nine years about you know if you want to impact and make the point of care better. You also have to have an answer for that 90 percent of the work that happens underneath the surface after the patient leaves the room. There’s you’ve only done 10 percent of the work for that as there is still a lot more to do and the bureaucratic side on the insurance side near collection side on the medical compliance side so there’s so much more that has to get done and you kind of need a holistic answer. The whole iceberg the whole hundred percent if you want to make the doctor patient interaction better and that’s what I have. We’re really working towards it drchrono is you know we have an amazing I think we built the best point of care tool in the world on the iPad for doctors to treat their patients. That’s not enough in isolation. Doctors can’t just pick that up and use it. We need a solution for their medical billing in their lab ordering we give them an API solution for you know the possibly dozens of other vendors are going to have to try operate with. So you really need to give kind of a holistic solution for the whole medical business. You know the whole the medical side the business side the legal side in order to improve that one point of care tool.

: For sure, Michael and appreciate you sharing that story. What would you say one of the things that you guys have done to create results or improve outcomes with drchrono.

: So one thing I would focus on I would like to believe that I’ve definitely heard personal stories of doctors using our tools and having more time to have face time with their patients. Kind of if you take care of a lot of the bureaucratic work like getting the notes done getting the billing codes and getting all the orders and follow up steps around it I really think it creates a space where the doctor can have a more human interaction have a real face time interaction with their patient and see what else is going on. This is I actually had dinner a couple of weeks ago with one of our first users who’s a doctor down in Orange County and he shared a story with me that you know he had a patient who was having a lot of health issues. And you know he just had to take kind of five minutes aside in one visit to ask this patient about you know how they were dealing with the death of a family member that was really impacting them. And it really created a human connection and you know kind of tied it together from that hey there’s when you do build better tools and you can take care of a lot of that work you know creates that opportunity for doctors to really connect with their patients and really notice sometimes cut through a lot of the bureaucracy and red tape that happens in the healthcare space and really try and help people. So I’d like to think there’s a very qualitative part of what we do. I would say in order to achieve that we’re really focused. I think this year we’ve been really focused on the quantitative business of how doctors and how and Latorre medical practices you know small medium and large run their business. And that’s something we’ve really focused on. We’ve really turned our eyes to. We are actually doing for all of our existing software customers and for most of our new customers are new potential customers who we’re talking to. We’re starting to do something called an ROI analysis on their medical billing and it’s kind of a return on investment and we look out what they’re spending to get all of this bureaucratic work done of all that beneath the water line 90 percent of the iceberg work on getting your medical claims coded and out the door and file that admitted into insurance company and paid and deal with the rejections and getting those bills to the patients in a timely way. And we are really just asking ourselves like one of the overall themes is how could we make zero work for this doctor for this medical practice to get all of their revenue from insurance companies and patients whatever zero work on their part they had no staff sitting in their back office crunching and fighting with insurance companies calling up and having to bother patients what if all of that was taken off their hands just like when you buy an iPhone you know you know you’re going to be able to do phone call text and e-mail and get all this great stuff. What if it’s just all zero work for them. And that’s kind of our goal and what these are why analysis we’re breaking down how much doctors are spending and how much Mellat medical practices and they are spending doing billing themselves how much they’re spending with all in with their cost of contractors and software and everything. And we’re also looking at the results they’re getting and we’re taking public datasets from the MDMA and other sources. And we’re just helping doctors compare apples to apples and say hey look this is what you’re spending to get these results. And you know we’re finding that most medical specialties. If you were to ask the average doctor or even the CEO of the average you know ambulatory health care company how is your business doing as a business compared to national averages. Most doctors and most medical practices cannot answer that question and they may have a feeling they’re doing better they may have a sneaking fear they’re doing worse. But I think having that conversation really making it a very data focused thing of how much you’re spending and what results you’re getting I think has been very powerful and I think we really cared we started the company to really focus on that journey of improving the doctor patient interaction. But in order to do that you really have to make sure as I said all those other bases are covered. And I think that’s one thing we’re looking at improving the economic outcomes of doctors making them more successful as business people. But I think to me how it ties back to our original mission is if it was zero work on the doctor and their staffs are to get paid and they got paid well you know where they don’t feel they’re being ripped off by the insurance companies and we could tell them when they’re getting underpaid contracts with an insurance company. We can tell them you know they’re being underpaid on specific procedures. If we give them that analytics and it’s very it’s like zero work on their part then 100 percent of that the doctors work and the staffs work and all the providers and nurses and a practice 100 percent of their attention will be on the patient and giving them great care and getting them good outcomes healthwise so that’s kind of how we’re approaching it in a very pragmatic way of balancing the economic needs of the business to do well and to be able to pay everyone and have confidence there. And also just taking that burden off of their time off of the staff offers just even before they have so much of what I see when I talk with average doctors and average medical practices. So much of the bureaucracy and wasted effort is being put into just getting the doctor paid there’s a lot of fear and superstition around it about how it works. And I think we just shine a light on it when you really just break it down for them and compare it to public datasets that tell them how how the medical business is running nationally. It gives them a lot of peace of mind. You know if the doctors doing for the national averages we can assure them hey we’re going to get you closer to those national averages and if they’re doing you know at or above the national average as it comes to hey how can we keep getting these amazing results and make it less work on your part and lower your expenses and focus your time and your staff’s time on the patient take over that heavy lifting the real dirty work of getting you know medical bills paid.

: Well Michael there’s no doubt that you’ve taken a personal experience that with your dad and you know everything that was going on in New York and you’ve put together a team a technology a solution and you’re offering so much that’s going to help improve outcomes for patients because you know these physicians are going to have extra time. And it’s also going to help outcomes by way of better business results with this new service offering. So I just want to say congratulations to you and your team for all the things that you’ve put together. As we near the end of this podcast episode wishing that we had another 10 20 minutes. But I think what we’ll do is we’ll we’ll make a part 2 for this. I want to just put together a quick leadership course for the listeners on what it takes to be successful in medicine today. It is the 101 or ABCs of Michael Nusimow. And so I’ve got four questions lightning round style for you followed by a book and a podcast that you’d recommend to the listeners. You ready.

: OK.

: What’s the best way to improve healthcare outcomes.

: From my view as the CEO of drchrono one of our core values is having an open platform having an open set of API eyes and really being open to working with everyone. And what I kind of digging in deeper what I think that means is if you go to work with the average electronic health record company in the United States there is kind of a gauntlet facing you a huge obstacle of even seeing their API documentation. If they have anything that you can look forward to a six month process of signing contracts with them paying them tens of thousands of dollars just to be able to see if they have an API you can integrate with you and they may not even at the end of this journey. So to me I think that’s one of the most egregious things broken is that the EHR companies see their customers data as belonging to the H.R. company which is wrong and they also see every other company in the healthcare space as a competitor that they cannot work with. And it’s really killed collaboration and innovation and it’s left the world with these huge silos of healthcare data. And with these giant enterprise systems that don’t talk to anybody. There’s two hospitals right down the road from each other can’t you know can’t transfer patients electronically can communicate with each other. So that’s kind of one of my goals would be it’s something we try and aspire to it. drchrono if you go to drchrono.com/api or API documentation is public. We’ve got a really darn good API that we’ve got a lot of kudos for. And I think is industry leading and you could sign up for a free account and start building on that API in a sandbox mode with just your account in under 2 minutes and then you could contact us and work. And we’re really committed to working with everyone as well. There’s companies where that are doing a lot of amazing innovative work in the healthcare space that are just getting started up and we want to work with everyone we want to make it easy for them to build on the API and even make it really easy for our users with zero work. How could I just flip on this which go log into the site my Chron to ID and connect this service like Zark docs like Demandforce. Like a clinical tool or business tool. How can I connect that into all the data in my church and just have a work without a lot of headaches so I would say you reiterate is really opening up the data and the platform having open API as anyone to use and build on and also really being open to working with other companies. You know we’re a startup in the healthcare space we can’t we realized like the only way we’ll be successful is if we work with everyone not if we kind of like keep everyone at arm’s length and keep them away from our users and away from our data. And we want to do it in a secure way that follows that in anyone’s mind. But it’s just that willingness to say hey we’ll start working with you on day one. We want to work with startups and get you know help them get their first 5 10 users onto their platform and it’s just kind of that openness and willingness to work.

: Love it, Michael. Hey listen this has been a great time together. Before we conclude I’d love if you could just share a closing thought with the listeners and then the best place where they could get in touch with you.

: Sure. So there’s two really good ways to get in touch. One would be if you’re a startup or someone working in the healthcare space you could go to https://www.drchrono.com/api/ and sign up for an account there and someone in Dr. Cronos business development team will you know build a relationship with you and talk to you. Also anyone listening to this cast who wants to talk with me you can email me directly at CEO@drchrono.com. I’m pretty efficient at e-mail I usually always almost always get through almost all of my e-mails every week or at least read them and we’ll try and route people to the best person to doctor and speak with them. And as far as a closing thought I think really I probably should just rest on the openness because I think that’s a really good closing thought. And we’ll be considerate of the time we have. But I think just the willingness to work with everybody and the investment in technology. I truly believe that’s kind of one of our core beliefs will really help improve healthcare. You know there’s a lot of amazing people I get to work with every day our customers and our partners who are doing no really smart people working really hard and we’re committed to improving health care and I really do believe if people are willing to work together and make investments in good technology and good process and get people that you know we can really dramatically take care of that 90 percent of that iceberg work and some of the dirty work and the hidden work in the healthcare space and we could really shrink that down and get a lot more resources into that patient health care doctor interaction which I think is what everyone wants. More and more of in the healthcare space. And I think we could cut out a lot more of that bureaucracy and there’s a much bigger win if we cut down on all the back office work all of the bureaucrats were sitting there pushing health care claims around and just focus on automating a lot of that process and focusing on the doctor patient you and kind of the patient journey.

: Michael I love your passion and I love the bottom up approach that you’re taking to tackle some of the biggest problems and just want to say a big thank you to you for the time that you’ve spent with us and for the listeners to get a hold of the links that Michael shared including their apis and some of the things that they’re doing at at Dr. Krono. Just got outcomesrocket.health/chrono that C H R O N O. You’ll be able to pull that up. So thanks again so much Michael. This has been a ton of fun and really excited to keep up with the progress and the big advancement you guys are moving there.

: Great thank you, Saul.

Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration and so much more.

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