Since launching in 2007, Practice Fusion has attracted more than 150,000 doctors with its free web-based service for managing patient information, medical billing and other aspects of practice management. But Patient Fusion is now opening up its information to the public for the first time, enabling patients across the country to search for doctors by specialty and location, read reviews from verified patients and instantly book appointments.

“This is a place where, as an individual patient, your health starts and ends,” said Practice Fusion founder and CEO Ryan Howard.

The company said Patient Fusion lists information for more than 27,000 verified doctors in the U.S., includes 1.5 million verified doctor reviews (an average of 14 per doctor) and has 3 million open appointment slots available for April alone. While other doctor review sites like Vitals.com and Healthgrades, as well as Yelp, enable anyone — even those who have never seen the doctor — to leave reviews, Patient Fusion only allows patients it knows have visited the doctor to review their experience. ZocDoc similarly provides verified patient reviews.

The company also estimates that its pool of doctors is three times as large as ZocDoc’s. ZocDoc doesn’t share the number of doctors who pay to list availabilities on the site, but says it’s available in 1,700 U.S. cities and that 2.5 million people use it a month. In major cities like New York, patients might not see a big difference in coverage between ZocDoc and Patient Fusion, Howard acknowledged. And, certainly, it could take Patient Fusion a while to build ZocDoc-like name recognition among consumers. But he added that in more remote parts of the country, Patient Fusion could provide more more doctors and more available slots.

Another benefit for patients who pick Patient Fusion over other sites: they’ll be able to get instant access to their personal health records. While some doctors on ZocDoc or other doctor discovery and booking sites may use electronic medical record services that enable the easy exchange of medical records, patients using Patient Fusion will not only be able to book appoints online, but access digital lab reports, view real-time updates to their records and potentially benefit from other kinds of digital communication.

While ZocDoc charges doctors about $300 a month to list their availabilities on its site, Patient Fusion is free to patients and doctors. It eventually plans to serve advertising (as it does on Practice Fusion) but its bigger play is aggregating even more data about patient conditions, medication, treatment outcomes and more. That data (de-identified and in aggregate) gives it an interesting view of health trends and could be valuable to pharmaceutical companies and other health care players.

According to a survey of health entrepreneurs conducted last November, both Practice Fusion, which has raised $70 million in venture capital, and ZocDoc, which has raised $95 million, were considered two of the health tech companies likely to file for an IPO next.

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According to recent studies, pediatricians aren’t the only ones who find that electronic health records include design flaws that make it difficult to find data and complete important tasks.

The SMART Platforms Project, led by doctors at Harvard Medical School and Boston Children’s Hospital, is building a set of apps meant to optimize EHRs for doctors. Their most recent project combines medical expertise with design thinking to give clinicians an interactive growth chart that quickly highlights the most important information.

“Central to the practice of pediatrics – both in prevention and diagnosis – is this growth curve,” said Isaac Kohane, a pediatric endocrinologist and principal investigator of SMART (which stands for (Substitutable Medical Applications & Reusable Technology). “And, sadly, it’s the most neglected portion of the record in EHR because a) it’s different and doesn’t look like most of the data and b) pediatrics is a relatively small market compared to adult medicine.”

How can doctors’ intuition inform design?

SMART has already built a handful of apps, but to recreate the pediatric growth chart, the program turned to a design firm for the first time. Over several months, designers from design consultancy Fjord worked with a panel of medical experts, including a pediatric cardiologist, statisticians and pediatric endocrinologist.

At first, the designers’ role was absorbing as much as they could and, at times, that meant totally recalibrating their perspectives, said Charlie Gower, the lead designer on the project. “We’d find ourselves saying ‘that sounds ridiculous,’” he said. “Initially, it’s quite different, the things they want and the things they need.”

But, over time, his team came to understand the doctors’ point of view, he added.

“Doctors tend to do an awful lot from their gut – they’ve sucked in knowledge over a great deal of time and this knowledge informs what they do,” Gower said, “They have ways that they like to do things and ways of doing things that they rely on.”

The result of the partnership is an interactive tool that gives clinicians an easy way to view graphs showing a child’s entire growth picture, including length, weight, head circumference or body mass index, while letting them choose the graphs and comparisons that are most appropriate for that child. For example, while most clinicians might only look at a standard Centers for Disease Control chart, SMART’s tool lets them choose from other charts from the World Health Organization or those for children with Downs Syndrome.  It also lets them quickly plot development measurements against several charts at once.

All of that may sound fairly simple, but Dr. Kohane emphasized that children quickly establish a pattern of growth, and deviations from that pattern can provide early signals of obesity, thyroid disorders, Celiac disease and other conditions.  While standard EHR tools may make it harder for doctors to pick up on those aberrations, SMART’s app actually detects anomalies and notifies the doctor to take a deeper look.  It also spots data entry errors and provides parents with a less technical view of their child’s growth — another helpful feature given the confusion and concern growth charts can often create.

Building an app ecosystem for electronic health systems

Beyond the specific use of the tool, this partnership between doctors and designers highlights a growing trend. As doctors bring more of their devices to work and as more direct-to-patient health and wellness tools emerge, design is becoming an increasingly important consideration in building health services, said Gower.

And, added Dr. Kohane, the hope is that apps like this can motivate a larger community of developers. Recognizing that the world of electronic health records is dominated by giant vendors that can take time to innovate to meet clinicians’ needs, SMART was created with funding from the Office of the National Coordinator for Health Information Technology of to support an ecosystem of apps that can be layered on top of existing EHRs.  Once a vendor or hospital IT department implements a software container, Dr. Kohane said, a hospital can install a SMART app for free.

When it first launched, the program focused more on the technical aspects of adding its apps to an EHR system, but now its emphasis is building apps that can show its potential. “[We want to] make apps that really inspire people to work forward much in the way that many of the early iPhone apps were inspiring to others,” Dr. Kohane said.

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The previous HIPAA rules applied to healthcare providers, doctors and insurance companies. But under the new rules, their “business associates” – contractors or service providers – also have direct specific compliance obligations, said Kirk Nahra, a partner at Washington, D.C.-based Wiley Rein LLP who specializes in health care. That could include electronic health record companies, telehealth companies and others that contract with hospitals or insurance companies.

Even though the ruling has been expected for some time, companies in the industry are all over the map when it comes to being prepared. Some have the security infrastructure, policies and documentation in place, he said, but others have a ways to go before being in compliance. Although the act goes into effect in March, companies don’t need to be compliant until September.

To meet the new standards of the law, Nahra said, companies may need to evaluate the extent to which they encrypt data, train all employees on privacy and security, develop appropriate procedures for the disposal of information, designate a security official and implement appropriate contracts with subcontractors, among other tasks.

The report itself is not for the feint of heart – it clocks in at 563 pages. But anyone in the business of health care information will want to be aware of the changes they contain.

“They need to consider whom they are doing business with, how they will obtain information from those in the circle, whether they can sell their product to enough people without getting into the circle and how to build sufficient confidence with these other entities (and consumers),” Nahra added.

As digital technology changes how patient information is collected and stored, and how quickly it can be moved and compromised, the new rules attempt to strengthen safeguards and expand the pool of parties held to the highest security and privacy requirements.

For example, they raise the maximum penalty for negligence, strengthen data breach notification requirements under the Health Information Technology for Economic and Clinical Health (HITECH) Act and provide new requirements on how patient information can be used for fundraising and marketing.

“It’s a big deal,” said Nahra. “The government hasn’t been incredibly aggressive about enforcing it, but they’re getting more aggressive.”

Image by Chad McDermott via Shutterstock.

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On Monday, athenahealth said it will pay $293 million for the mobile health company, which marks a 22 percent premium over Epocrates’ closing price on Jan. 4.

On a conference call with investors, analysts and journalists, athenahealth CEO and co-founder Jonathan Bush said that the company has long been looking for a way to gain awareness among physicians. In Epocrates, which says it reaches more than 330,000 doctors with its iOS, Android and BlackBerry apps, Bush said, “we believe we have found a breakthrough.”

“We have so much to give doctors,” Bush said. “And so few know who we are.”

Epocrates, which was founded in 1998, initially offered doctors a Palm Pilot-based free drug reference resource. When it transitioned to iOS, the app quickly became a hit, reaching 2,230 downloads per day, Bush said. Athena estimates that 90 percent of doctors are familiar with the app, with about half using it regularly.

Watertown, Mass.-based athenahealth was founded in 1997 and provides hospitals with cloud-based medical billing and patient records services.  Assuming the deal closes, athenahealth will look to Epocrates as a way to extend the company’s name recognition and give doctors a “light” entry point for the service, Bush said.  Beyond using the app for marketing, he said Epocrates will integrate with its electronic records service athenaClinicals so that doctors will be able look up Epocrates drug information straight from Athena’s software, initiate processing the prescription and complete other tasks.

Now, he said, Epocrates is like a “Yelp” for drugs, providing doctors with quick summaries on safety information, interactions and side effects. But, Bush said, in the future, it could be more like an interactive “OpenTable” for drugs, as well as other procedures.

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But New York-based Hello Health is one company trying to change that with an electronic health records (EHR) platform that helps doctors and patients make the shift to digital.

The company on Monday announced that it had raised $11.5 million from First Generation Capital, which follows a $10 million round raised last year.

As more doctors move their patients’ health information online – incentivized by the federal government – Hello Health says it offers physicians a platform that is not only free, but helps them earn additional revenue.

Through its Web-based system, physicians can share lab results and other information with patients in a HIPAA-secure environment, as well as enable patients to schedule appointments and upload documents. But instead of charging physicians (like many of its older rivals), Hello Health charges patients a monthly subscription fee of $5. Hello Health takes a percentage of the fee and the physician gets the remainder.

“It’s more of a partnership than a simple SaaS model,” said Steven Ferguson, vice president of physician marketing for Hello Health.

With the new funding, Ferguson said the company, which is a subsidiary of Quebec-based Myca Health, plans to build out new features, including those to better manage patients’ medical charts and streamline referrals.

When it launched in 2008, Hello Health was intended to be more of a consumer-friendly concierge service. (And, interestingly, one of Hello Health’s original co-founders, Dr. Jay Parkinson, has gone on to launch Sherpaa, a concierge-like service, paid for by employers, that provides round-the-clock access to doctors.) But later, Hello Health pivoted into its current version.

While Hello Health may offer doctors an interesting business model, it has many competitors in the EHR industry, including public companies Allscripts and Cerner, and rising startup Practice Fusion, which also offers physicians a free option.

Image by RTimages via Shutterstock.

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