I am a hospital systems designer and consultant. I actually built one of the first EHR clients for iPhone, before the iPad came out (Rejected from YC in 2009), I was the technology implementation manager for the new El Camino Hospital build, I was the primary technology designer for San Francisco General's new 850MM facility. I am consulting on the UCSF Mission Bay project for technology and transition, and the same for UTSW in Dallas. I am also the transition planner for a small 100MM facility in Nome Alaska.
In all of these projects I design and or consult on all aspects of technology implementation, use, training etc..
I even sent an RFP for EHR implementation to Dr. Chrono to see if you guys could step up to a larger facility ($5MM budget for that piece), I heard nothing back for weeks until after the deadline when I was then told that you couldn't respond - and then had a sales guy call me trying to get me to sign up as a physician.
Anyway -- getting a private practice of ~10 physicians to use your product is in no way a gateway to hospitals. They are completely different markets.
The EMR implementations in large hospitals are multi-million dollar implementations and they take ~18 months to accomplish.
The sheer number of workflows needed and the integrations with various systems are daunting and non-trivial.
You are going after a massively entrenched market with many many millions of dollars committed by all the customers
I fully hope that there can be a serious shakeup in health IT, but having some success with 1-10 physicians and then expecting to parlay that to hospitals with thousands of employees, or even hundreds (like in Nome) is a tall tale.
I think there are TONS of opportunity to disrupt healthcare, and DrChrono is a great app - it is just not mature enough or on scale enough to compete against the larger EHR market YET.
EDIT:
I'd like to add - that if you want to continue to build a free product, and you want to get into the larger scale EHR space - I suggest you partner with/learn from/attempt to implement on-top-of MedSphere's OpenVista EHR.
DrChrono has some great features - and if you make the capabilities more robust then you can get into this market more easily.
OpenVista is used widely outside the US as well, and this would be an opportunity to capture the Asian/Indian market.
Also, if you take some of the features you have (Voice Notes, etc) and offer them as a stand-alone-ish product - then you can attempt to get physicians already in large hospitals to use that product - not selling it as an EHR, but a needed tool, and expand from there.
If you stay away from the EHR/EMR moniker when infiltrating physicians in larger hospitals you'll more easily get under ITs radar.
Every hospital has iPad users already, and most are rolling out official IT support for them - so you need to get an app that physicians can use in parallel to their epic/siemens/cerner/eclypsis solution without pissing IT off.
>"The EMR implementations in large hospitals are multi-million dollar implementations and they take ~18 months to accomplish"
This is approximately one and a half revisions to Apple's product line and developer agreements, and this creates serious uncertainty for a large organization on the scale of a US hospital which needs needs to plan changes to its operations well in advance.
Unfortunately, Apple does not provide a technology roadmap around which organizations can make the sort of serious decisions that affect health, safety, and welfare.
Respectfully, I disagree with your assessment of their business. Anybody who has ever worked for an enterprise startup knows that requests for custom installations and implementations of your product are a dime a dozen. No startup will ever win a RFP from a big company and it's just a time waster. I would say not only is drchrono taking the right path, it's the only possible path to getting into the larger hospitals. Once they've refined their product and built up a name for themselves, they only need to win that one bigger contract and they are off to the races. But what you are suggesting is simply impossible for a startup. And you should have known better than to contact drchrono for your large hospital, that's just irresponsible. If you didn't believe in their product then you were knowingly wasting their time.
I in no way thought Dr Chrono could respond to the RFP - that wasn't why I sent it to them - and I was very clear about why I was sending it to them and told them so. I said that I wanted to give them the RFP to see what they COULD cover within the requirements, that I was interested in seeing where they were in their capability and what market they were going with. I spoke to them on the phone as well and explained this.
I was sharing the RFP with them so they could see what an organization of that size specifically needed.
After this - they just took a few weeks and said "Nope we cant do that" but offered no analysis of their capabilities, which is fine. However it showed me that they were young and immature as a company when I then received several calls from their sales team trying to get me to sign up for the service as a physician.
I DO believe in their product, however in each of my exposures to them I see them faltering and operating a little blindly.
I want them to succeed - but it is plain foolish to say that getting a 1 - 10 physician private practice is the gateway to knocking on the door of a large hospital.
Those are totally different markets.
I followed up and said that they should seek out offering a tool to hospital physicians not under the premise of being an EMR - get the tool into the facility and let the physicians champion your product that way.
Epic, Cerner and Eclypsis are very very territorial and are not very open to working with scrappy startups like DrChrono... so they need to take a strategic approach.
Further, hospitals spend million upon millions on these systems. Saying that a free app with 44K in meaningful use funds support is going to really compete on the same level is just false.
I would do anything I can to help further their efforts - but lets deal with reality as well.
> I see them faltering and operating a little blindly.
What are they doing "blindly"? Can you offer specfics?
> I want them to succeed - but it is plain foolish to say that getting a 1 - 10 physician private practice is the gateway to knocking on the door of a large hospital.
I don't think they ever wanted to knock on the door of a large hospital. Why do you insist that they must find a way to do this? More importantly, why so immediately? Of course they know they can't compete with Epic, Cerner, etc. So they're not even trying.
It's quite possible that enough small practices adopt a system for it to be hard for big hospitals NOT to notice. Then hospitals will be knocking on their door. Many many markets have been disrupted this way, where the big players don't take small ones seriously until it's too late.
I'm just speculating here, but another option is that one of the entrenched players with millions committed notices the success of Dr Chrono with smaller clinics and decides to acquires them to get a leg up on the competition.
"Me too" reply concurring with your business analysis.
Politely, respectfully disagree with recommendation for OpenVista. Of all the tech stacks I've worked with, only InterSystem's Cache (also popular for healthcare IT) is worse.
I will not say their tech is great - but they are an open and hungry company that does like to make partnerships, work with startups and they do have larger deployments outside the US.
EPIC, Cerner etc are all going to stonewall against DrChrono.
At a minimum - they should look at the robustness of the system. While the implementation may suck, the fact is that openvista has a hell of a lot of thought hours into it given it is based on vista.
Hopefully someone at DrChrono REALLY knows what is needed in an EHR.
Hell - they should be actively trying to poach employees from the big guys, as well as going after med CIOs (except for some who are all ego, but I can't call them out here).
A little background:
I am a hospital systems designer and consultant. I actually built one of the first EHR clients for iPhone, before the iPad came out (Rejected from YC in 2009), I was the technology implementation manager for the new El Camino Hospital build, I was the primary technology designer for San Francisco General's new 850MM facility. I am consulting on the UCSF Mission Bay project for technology and transition, and the same for UTSW in Dallas. I am also the transition planner for a small 100MM facility in Nome Alaska.
In all of these projects I design and or consult on all aspects of technology implementation, use, training etc..
I even sent an RFP for EHR implementation to Dr. Chrono to see if you guys could step up to a larger facility ($5MM budget for that piece), I heard nothing back for weeks until after the deadline when I was then told that you couldn't respond - and then had a sales guy call me trying to get me to sign up as a physician.
Anyway -- getting a private practice of ~10 physicians to use your product is in no way a gateway to hospitals. They are completely different markets.
The EMR implementations in large hospitals are multi-million dollar implementations and they take ~18 months to accomplish.
The sheer number of workflows needed and the integrations with various systems are daunting and non-trivial.
You are going after a massively entrenched market with many many millions of dollars committed by all the customers
I fully hope that there can be a serious shakeup in health IT, but having some success with 1-10 physicians and then expecting to parlay that to hospitals with thousands of employees, or even hundreds (like in Nome) is a tall tale.
I think there are TONS of opportunity to disrupt healthcare, and DrChrono is a great app - it is just not mature enough or on scale enough to compete against the larger EHR market YET.
EDIT:
I'd like to add - that if you want to continue to build a free product, and you want to get into the larger scale EHR space - I suggest you partner with/learn from/attempt to implement on-top-of MedSphere's OpenVista EHR.
DrChrono has some great features - and if you make the capabilities more robust then you can get into this market more easily.
OpenVista is used widely outside the US as well, and this would be an opportunity to capture the Asian/Indian market.
Also, if you take some of the features you have (Voice Notes, etc) and offer them as a stand-alone-ish product - then you can attempt to get physicians already in large hospitals to use that product - not selling it as an EHR, but a needed tool, and expand from there.
If you stay away from the EHR/EMR moniker when infiltrating physicians in larger hospitals you'll more easily get under ITs radar.
Every hospital has iPad users already, and most are rolling out official IT support for them - so you need to get an app that physicians can use in parallel to their epic/siemens/cerner/eclypsis solution without pissing IT off.