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Think you’ve got a great technology idea to improve your clinical work experience and optimize patient care?
You’re probably not alone. But identifying an opportunity and taking it to the next level – a successful business solution adopted by many of your colleagues – are a long, arduous, and complex process, according to two hospitalists who are developing apps designed to improve productivity in daily practice, optimize patient care, and save money.
Dr. William Morris, vice chair of clinical informatics and director of the Clinical Solutions Group at the Cleveland Clinic, is in the final phases of testing a novel electronic medical record (EMR) interface, which he developed along with a cardiothoracic surgeon and an orthopedist at the Cleveland Clinic.
Dr. Elizabeth Farrell of Beth Israel Deaconess Medical Center in Boston has just released an iPhone app that uses Bayes nomograms to inform decision-making on testing and treatment. The app draws on a database of likelihood ratios and performs the calculations at the point of care.
Both physicians saw gaps in their daily practices – things that didn’t work well or were inefficient – and devised app-based solutions to solve those problems.
Dr. Morris saw the limitations in the existing EMRs being used in his hospital. The EMRs contained a lot of data, but provided little clinical information in a context that mattered according to the type of provider, the particular setting within the hospital, and the particular patient status, he explained.
"For example, if you open any electronic medical record, a normal value for creatinine is set across the enterprise," Dr. Morris said. The value appears in red if the patient has kidney dysfunction. "But a patient with end-stage renal disease should be red – you already know that."
Dr. Morris and his colleagues realized that the EMR needed to be taken to the next level. They began by devising an interface that synthesizes and presents the newest and most relevant information at the point of care. The experience is "like having a seasoned resident standing right next to you who is only going to give you those pertinent things" needed to have an impact on that patient’s care.
To get that depth of information, the physicians developed several "novel data presentation layers" that work with the EMR in real time to present data that is tailored to the specific clinical situation – it is context-, provider-, and patient-aware. Clinical items that a physician typically puts together now "cohabitate" the screen. As an example, a chest x-ray might come up along with a trend line showing a patient’s oxygen saturation.
The app designed by Dr. Farrell grew out of her experience teaching on medical rounds at Beth Israel several years ago. Multiple providers varied widely in how they were accessing and interpreting data for individual patients.
As an initial solution, Dr. Farrell printed out index cards with Bayes nomograms that internists, residents, and medical students could use on rounds to convert a pretest probability to a post-test probability for a particular patient.
But the low-tech approach was too limited in its scope. "I ran into a lot of problems because someone would lose their cards or leave them in their white coat back in the workroom," Dr. Farrell said. "Sometimes a test would come up that we wouldn’t have the likelihood ratio for. It got a little frustrating."
Dr. Farrell realized that iPhones were ubiquitous among the medical staff, many of whom were already using the devices to seek out information for patient management. "Once I thought about putting the nomograms on the iPhone and having the app perform the calculations, the idea came to me that building a database of likelihood ratios would be even more useful," said Dr. Farrell, staff internist in Beth Israel’s Hospitalist Medicine Program.
And both hospitalists credit their success to strong business cases built in collaboration with their hospitals.
It didn’t hurt that Dr. Farrell’s husband, Alan Nawoj, is a software developer who has started a business developing iPhone apps. "We felt like this would be a great way for us to work together and partner my content expertise with his software development skills to create a new product," Dr. Farrell said.
Mr. Nawoj’s advice for would-be physician app entrepreneurs? Before you start, clearly define the goals of the application, including potential end users and where they will likely use the technology. Meet with developers, physicians, and any other end users in person to brainstorm. Draw out – literally on a whiteboard – everyone’s expectations for the product. Development of a new app through e-mail and telephone calls is much less time efficient in the end, he said.
The in-person meeting also is important because "a developer’s perspective and a physician’s perspective are going to be very different," Dr. Farrell said.
Be sure what you choose is something you are passionate about, Dr. Farrell said, "because if you’re not, it’s just going to be in the way of other things you’d rather be doing." The ideal situation is to develop a technology you yourself will ultimately use on a daily basis, she said. "That keeps up your motivation and keeps you interested and excited."
Also, solicit ongoing feedback from likely users as the product is further and further refined, added Mr. Nawoj, founder and chief software architect at Beacon Mobile.
Dr. Morris also outlined advice for physicians seeking to develop a health care business idea. "Find someone in your organization to mentor you, someone who has been successful in finding an opportunity and executing their idea."
In addition, realize that the problem you’re trying to solve rarely is a gap in technology alone, Dr. Morris said. More often it’s a "people-process gap," which makes it all the more important to know your stakeholders. "The fact that you’re a doctor is not enough. You can get your blinders on. You may veer off if you don’t have frequent interactions with other clinicians or trusted advisers."
A willingness to take some calculated risk is essential if you’re going to become an entrepreneur, Dr. Morris said. "It’s a little unnerving. This is real money, health care dollars, and a real investment in time."
When he and his colleagues at the Cleveland Clinic decided to develop technology to make the institution’s EMRs make more sense from a user standpoint, they spent "an enormous amount of time developing a business case," he said. They had to prove a demonstrable return on investment that would support development of the new EMR interface.
Dr. Farrell said that for her, and probably for any medical entrepreneur, navigating potential conflict-of-interest issues was a challenge.
"You certainly need to be transparent. This is something my husband’s company has developed, and though I’m specifically not the one receiving the money, that is obviously very close to home. The wife-husband team spoke with the intellectual property personnel at Beth Israel. "Because they fund my salary, [the institution] would be at least able to make an argument that they would own part of the rights to the product as well." The same would be true for any physician developing a product related to the work a hospital is paying them to do, Dr. Farrell said.
"Beth Israel decided that because of all the liability associated with a medical application, and because Apple’s policy is that they do not accept any of the liability [for any applications used on their products], it all falls on the developers." That process took 5 months, Dr. Farrell added, because like Dr. Morris’ interface, the situation was a first for the institution.
Throughout the process, one of the most important things to Dr. Farrell was "to find that balance where I don’t feel like I’m self-promoting and trying to make more money, but at the same time not holding back on something I think would be really useful for everyone."
App’s Profit Measured in Rewards Not Dollars
Bettering medicine aside, what’s the payoff for following the entrepreneurial muse? Measuring a profit can be complicated, says the team behind the Medicine Toolkit app.
"I think it would be hard to define what a ‘profit’ would be. It’s hard to put a price tag on the ‘costs’ that went into making the app, in regards to the amount of our free time we spent developing it, and the ongoing time investment that will be required to keep it updated," says Dr. Farrell.
In a similar vein, her husband, whose software company, Beacon Mobile, developed the app adds: "In general, my business (Beacon Mobile) is a for-profit enterprise ... but when Elizabeth and I partnered together to create the Medicine Toolkit app, the primary goal for this particular product was not around profit but more around helping to make teaching opportunities between med students, residents, and attendings more efficient and effective ... starting with the members of Elizabeth’s team. The fact that others have also shown an interest in the app and found it to be useful in their daily work has been very rewarding for both of us."
Dr. Farrell says that several of her current and former colleagues have used the app at Massachusetts General Hospital, Georgetown, and University of California, San Francisco.
Developing an app for the iPhone/iPad can be "in the several-thousand-dollar range" for a "basic app that doesn’t have much functionality" to "hundreds of thousands of dollars" for one that can easily interface with other systems," Mr. Nawoj estimates. He lists the individuals typically involved with developing an app: "graphic designer(s) to create all of the images that go into the app, software engineer(s) to write the code that brings the app to life, a project manager to keep the project on track ... and possibly a sound-effects engineer to develop any custom sounds/music/etc."
He adds this bit of wisdom: "As with many other disciplines, the old saying that "you get what you pay for" almost always holds true when you are talking about developing any type of software application."
Think you’ve got a great technology idea to improve your clinical work experience and optimize patient care?
You’re probably not alone. But identifying an opportunity and taking it to the next level – a successful business solution adopted by many of your colleagues – are a long, arduous, and complex process, according to two hospitalists who are developing apps designed to improve productivity in daily practice, optimize patient care, and save money.
Dr. William Morris, vice chair of clinical informatics and director of the Clinical Solutions Group at the Cleveland Clinic, is in the final phases of testing a novel electronic medical record (EMR) interface, which he developed along with a cardiothoracic surgeon and an orthopedist at the Cleveland Clinic.
Dr. Elizabeth Farrell of Beth Israel Deaconess Medical Center in Boston has just released an iPhone app that uses Bayes nomograms to inform decision-making on testing and treatment. The app draws on a database of likelihood ratios and performs the calculations at the point of care.
Both physicians saw gaps in their daily practices – things that didn’t work well or were inefficient – and devised app-based solutions to solve those problems.
Dr. Morris saw the limitations in the existing EMRs being used in his hospital. The EMRs contained a lot of data, but provided little clinical information in a context that mattered according to the type of provider, the particular setting within the hospital, and the particular patient status, he explained.
"For example, if you open any electronic medical record, a normal value for creatinine is set across the enterprise," Dr. Morris said. The value appears in red if the patient has kidney dysfunction. "But a patient with end-stage renal disease should be red – you already know that."
Dr. Morris and his colleagues realized that the EMR needed to be taken to the next level. They began by devising an interface that synthesizes and presents the newest and most relevant information at the point of care. The experience is "like having a seasoned resident standing right next to you who is only going to give you those pertinent things" needed to have an impact on that patient’s care.
To get that depth of information, the physicians developed several "novel data presentation layers" that work with the EMR in real time to present data that is tailored to the specific clinical situation – it is context-, provider-, and patient-aware. Clinical items that a physician typically puts together now "cohabitate" the screen. As an example, a chest x-ray might come up along with a trend line showing a patient’s oxygen saturation.
The app designed by Dr. Farrell grew out of her experience teaching on medical rounds at Beth Israel several years ago. Multiple providers varied widely in how they were accessing and interpreting data for individual patients.
As an initial solution, Dr. Farrell printed out index cards with Bayes nomograms that internists, residents, and medical students could use on rounds to convert a pretest probability to a post-test probability for a particular patient.
But the low-tech approach was too limited in its scope. "I ran into a lot of problems because someone would lose their cards or leave them in their white coat back in the workroom," Dr. Farrell said. "Sometimes a test would come up that we wouldn’t have the likelihood ratio for. It got a little frustrating."
Dr. Farrell realized that iPhones were ubiquitous among the medical staff, many of whom were already using the devices to seek out information for patient management. "Once I thought about putting the nomograms on the iPhone and having the app perform the calculations, the idea came to me that building a database of likelihood ratios would be even more useful," said Dr. Farrell, staff internist in Beth Israel’s Hospitalist Medicine Program.
And both hospitalists credit their success to strong business cases built in collaboration with their hospitals.
It didn’t hurt that Dr. Farrell’s husband, Alan Nawoj, is a software developer who has started a business developing iPhone apps. "We felt like this would be a great way for us to work together and partner my content expertise with his software development skills to create a new product," Dr. Farrell said.
Mr. Nawoj’s advice for would-be physician app entrepreneurs? Before you start, clearly define the goals of the application, including potential end users and where they will likely use the technology. Meet with developers, physicians, and any other end users in person to brainstorm. Draw out – literally on a whiteboard – everyone’s expectations for the product. Development of a new app through e-mail and telephone calls is much less time efficient in the end, he said.
The in-person meeting also is important because "a developer’s perspective and a physician’s perspective are going to be very different," Dr. Farrell said.
Be sure what you choose is something you are passionate about, Dr. Farrell said, "because if you’re not, it’s just going to be in the way of other things you’d rather be doing." The ideal situation is to develop a technology you yourself will ultimately use on a daily basis, she said. "That keeps up your motivation and keeps you interested and excited."
Also, solicit ongoing feedback from likely users as the product is further and further refined, added Mr. Nawoj, founder and chief software architect at Beacon Mobile.
Dr. Morris also outlined advice for physicians seeking to develop a health care business idea. "Find someone in your organization to mentor you, someone who has been successful in finding an opportunity and executing their idea."
In addition, realize that the problem you’re trying to solve rarely is a gap in technology alone, Dr. Morris said. More often it’s a "people-process gap," which makes it all the more important to know your stakeholders. "The fact that you’re a doctor is not enough. You can get your blinders on. You may veer off if you don’t have frequent interactions with other clinicians or trusted advisers."
A willingness to take some calculated risk is essential if you’re going to become an entrepreneur, Dr. Morris said. "It’s a little unnerving. This is real money, health care dollars, and a real investment in time."
When he and his colleagues at the Cleveland Clinic decided to develop technology to make the institution’s EMRs make more sense from a user standpoint, they spent "an enormous amount of time developing a business case," he said. They had to prove a demonstrable return on investment that would support development of the new EMR interface.
Dr. Farrell said that for her, and probably for any medical entrepreneur, navigating potential conflict-of-interest issues was a challenge.
"You certainly need to be transparent. This is something my husband’s company has developed, and though I’m specifically not the one receiving the money, that is obviously very close to home. The wife-husband team spoke with the intellectual property personnel at Beth Israel. "Because they fund my salary, [the institution] would be at least able to make an argument that they would own part of the rights to the product as well." The same would be true for any physician developing a product related to the work a hospital is paying them to do, Dr. Farrell said.
"Beth Israel decided that because of all the liability associated with a medical application, and because Apple’s policy is that they do not accept any of the liability [for any applications used on their products], it all falls on the developers." That process took 5 months, Dr. Farrell added, because like Dr. Morris’ interface, the situation was a first for the institution.
Throughout the process, one of the most important things to Dr. Farrell was "to find that balance where I don’t feel like I’m self-promoting and trying to make more money, but at the same time not holding back on something I think would be really useful for everyone."
App’s Profit Measured in Rewards Not Dollars
Bettering medicine aside, what’s the payoff for following the entrepreneurial muse? Measuring a profit can be complicated, says the team behind the Medicine Toolkit app.
"I think it would be hard to define what a ‘profit’ would be. It’s hard to put a price tag on the ‘costs’ that went into making the app, in regards to the amount of our free time we spent developing it, and the ongoing time investment that will be required to keep it updated," says Dr. Farrell.
In a similar vein, her husband, whose software company, Beacon Mobile, developed the app adds: "In general, my business (Beacon Mobile) is a for-profit enterprise ... but when Elizabeth and I partnered together to create the Medicine Toolkit app, the primary goal for this particular product was not around profit but more around helping to make teaching opportunities between med students, residents, and attendings more efficient and effective ... starting with the members of Elizabeth’s team. The fact that others have also shown an interest in the app and found it to be useful in their daily work has been very rewarding for both of us."
Dr. Farrell says that several of her current and former colleagues have used the app at Massachusetts General Hospital, Georgetown, and University of California, San Francisco.
Developing an app for the iPhone/iPad can be "in the several-thousand-dollar range" for a "basic app that doesn’t have much functionality" to "hundreds of thousands of dollars" for one that can easily interface with other systems," Mr. Nawoj estimates. He lists the individuals typically involved with developing an app: "graphic designer(s) to create all of the images that go into the app, software engineer(s) to write the code that brings the app to life, a project manager to keep the project on track ... and possibly a sound-effects engineer to develop any custom sounds/music/etc."
He adds this bit of wisdom: "As with many other disciplines, the old saying that "you get what you pay for" almost always holds true when you are talking about developing any type of software application."
Think you’ve got a great technology idea to improve your clinical work experience and optimize patient care?
You’re probably not alone. But identifying an opportunity and taking it to the next level – a successful business solution adopted by many of your colleagues – are a long, arduous, and complex process, according to two hospitalists who are developing apps designed to improve productivity in daily practice, optimize patient care, and save money.
Dr. William Morris, vice chair of clinical informatics and director of the Clinical Solutions Group at the Cleveland Clinic, is in the final phases of testing a novel electronic medical record (EMR) interface, which he developed along with a cardiothoracic surgeon and an orthopedist at the Cleveland Clinic.
Dr. Elizabeth Farrell of Beth Israel Deaconess Medical Center in Boston has just released an iPhone app that uses Bayes nomograms to inform decision-making on testing and treatment. The app draws on a database of likelihood ratios and performs the calculations at the point of care.
Both physicians saw gaps in their daily practices – things that didn’t work well or were inefficient – and devised app-based solutions to solve those problems.
Dr. Morris saw the limitations in the existing EMRs being used in his hospital. The EMRs contained a lot of data, but provided little clinical information in a context that mattered according to the type of provider, the particular setting within the hospital, and the particular patient status, he explained.
"For example, if you open any electronic medical record, a normal value for creatinine is set across the enterprise," Dr. Morris said. The value appears in red if the patient has kidney dysfunction. "But a patient with end-stage renal disease should be red – you already know that."
Dr. Morris and his colleagues realized that the EMR needed to be taken to the next level. They began by devising an interface that synthesizes and presents the newest and most relevant information at the point of care. The experience is "like having a seasoned resident standing right next to you who is only going to give you those pertinent things" needed to have an impact on that patient’s care.
To get that depth of information, the physicians developed several "novel data presentation layers" that work with the EMR in real time to present data that is tailored to the specific clinical situation – it is context-, provider-, and patient-aware. Clinical items that a physician typically puts together now "cohabitate" the screen. As an example, a chest x-ray might come up along with a trend line showing a patient’s oxygen saturation.
The app designed by Dr. Farrell grew out of her experience teaching on medical rounds at Beth Israel several years ago. Multiple providers varied widely in how they were accessing and interpreting data for individual patients.
As an initial solution, Dr. Farrell printed out index cards with Bayes nomograms that internists, residents, and medical students could use on rounds to convert a pretest probability to a post-test probability for a particular patient.
But the low-tech approach was too limited in its scope. "I ran into a lot of problems because someone would lose their cards or leave them in their white coat back in the workroom," Dr. Farrell said. "Sometimes a test would come up that we wouldn’t have the likelihood ratio for. It got a little frustrating."
Dr. Farrell realized that iPhones were ubiquitous among the medical staff, many of whom were already using the devices to seek out information for patient management. "Once I thought about putting the nomograms on the iPhone and having the app perform the calculations, the idea came to me that building a database of likelihood ratios would be even more useful," said Dr. Farrell, staff internist in Beth Israel’s Hospitalist Medicine Program.
And both hospitalists credit their success to strong business cases built in collaboration with their hospitals.
It didn’t hurt that Dr. Farrell’s husband, Alan Nawoj, is a software developer who has started a business developing iPhone apps. "We felt like this would be a great way for us to work together and partner my content expertise with his software development skills to create a new product," Dr. Farrell said.
Mr. Nawoj’s advice for would-be physician app entrepreneurs? Before you start, clearly define the goals of the application, including potential end users and where they will likely use the technology. Meet with developers, physicians, and any other end users in person to brainstorm. Draw out – literally on a whiteboard – everyone’s expectations for the product. Development of a new app through e-mail and telephone calls is much less time efficient in the end, he said.
The in-person meeting also is important because "a developer’s perspective and a physician’s perspective are going to be very different," Dr. Farrell said.
Be sure what you choose is something you are passionate about, Dr. Farrell said, "because if you’re not, it’s just going to be in the way of other things you’d rather be doing." The ideal situation is to develop a technology you yourself will ultimately use on a daily basis, she said. "That keeps up your motivation and keeps you interested and excited."
Also, solicit ongoing feedback from likely users as the product is further and further refined, added Mr. Nawoj, founder and chief software architect at Beacon Mobile.
Dr. Morris also outlined advice for physicians seeking to develop a health care business idea. "Find someone in your organization to mentor you, someone who has been successful in finding an opportunity and executing their idea."
In addition, realize that the problem you’re trying to solve rarely is a gap in technology alone, Dr. Morris said. More often it’s a "people-process gap," which makes it all the more important to know your stakeholders. "The fact that you’re a doctor is not enough. You can get your blinders on. You may veer off if you don’t have frequent interactions with other clinicians or trusted advisers."
A willingness to take some calculated risk is essential if you’re going to become an entrepreneur, Dr. Morris said. "It’s a little unnerving. This is real money, health care dollars, and a real investment in time."
When he and his colleagues at the Cleveland Clinic decided to develop technology to make the institution’s EMRs make more sense from a user standpoint, they spent "an enormous amount of time developing a business case," he said. They had to prove a demonstrable return on investment that would support development of the new EMR interface.
Dr. Farrell said that for her, and probably for any medical entrepreneur, navigating potential conflict-of-interest issues was a challenge.
"You certainly need to be transparent. This is something my husband’s company has developed, and though I’m specifically not the one receiving the money, that is obviously very close to home. The wife-husband team spoke with the intellectual property personnel at Beth Israel. "Because they fund my salary, [the institution] would be at least able to make an argument that they would own part of the rights to the product as well." The same would be true for any physician developing a product related to the work a hospital is paying them to do, Dr. Farrell said.
"Beth Israel decided that because of all the liability associated with a medical application, and because Apple’s policy is that they do not accept any of the liability [for any applications used on their products], it all falls on the developers." That process took 5 months, Dr. Farrell added, because like Dr. Morris’ interface, the situation was a first for the institution.
Throughout the process, one of the most important things to Dr. Farrell was "to find that balance where I don’t feel like I’m self-promoting and trying to make more money, but at the same time not holding back on something I think would be really useful for everyone."
App’s Profit Measured in Rewards Not Dollars
Bettering medicine aside, what’s the payoff for following the entrepreneurial muse? Measuring a profit can be complicated, says the team behind the Medicine Toolkit app.
"I think it would be hard to define what a ‘profit’ would be. It’s hard to put a price tag on the ‘costs’ that went into making the app, in regards to the amount of our free time we spent developing it, and the ongoing time investment that will be required to keep it updated," says Dr. Farrell.
In a similar vein, her husband, whose software company, Beacon Mobile, developed the app adds: "In general, my business (Beacon Mobile) is a for-profit enterprise ... but when Elizabeth and I partnered together to create the Medicine Toolkit app, the primary goal for this particular product was not around profit but more around helping to make teaching opportunities between med students, residents, and attendings more efficient and effective ... starting with the members of Elizabeth’s team. The fact that others have also shown an interest in the app and found it to be useful in their daily work has been very rewarding for both of us."
Dr. Farrell says that several of her current and former colleagues have used the app at Massachusetts General Hospital, Georgetown, and University of California, San Francisco.
Developing an app for the iPhone/iPad can be "in the several-thousand-dollar range" for a "basic app that doesn’t have much functionality" to "hundreds of thousands of dollars" for one that can easily interface with other systems," Mr. Nawoj estimates. He lists the individuals typically involved with developing an app: "graphic designer(s) to create all of the images that go into the app, software engineer(s) to write the code that brings the app to life, a project manager to keep the project on track ... and possibly a sound-effects engineer to develop any custom sounds/music/etc."
He adds this bit of wisdom: "As with many other disciplines, the old saying that "you get what you pay for" almost always holds true when you are talking about developing any type of software application."