PatientKeeper

As a clinical student, Dr Maulin Shah soon realized that "the key to success was having the ability to manage large amounts of patient and medical information quickly and easily". Although he knew the Palm Pilot was the machine to use, he couldn't find the software to match. So... he wrote his own. With over a hundred downloads in the first night, he knew he was onto something special. Now, having formed PatientKeeper software company, then joined Virtmed, he discusses handheld technologies' promise for clerking.

Tell us a little about your program

PatientKeeper is a patient management application designed for health professionals. It replaces what we have all termed "scut cards" in giving us a place to keep all of our relevant patient information.

I was a third year medical student and had just started on the clinical part of my education. I realized early on that the key to success was having the ability to manage large amounts of patient and medical information quickly and easily. I tried many approaches - from index cards, to clipboards, to spiral notebooks - with very little success. Each had its own set of problems.

Until Christmas of 1998 I received a Palm Pilot from my wife as a gift. It occurred to me instantly that this device had the potential to really make a difference in the way I took care of patients.

I looked long and hard for an application that would allow me to keep my patient information, and found very little. I tried some generic database programs, but nothing seemed to fit the health professionals' work flow. So I decided to make my own.

Initially, PatientKeeper was intended to simply replace the note cards I carried around. The goals were simple - make it as quick to use as note cards. If I could simply do this, then I would already be ahead of the game, as I would be able to read the writing (my handwriting is terrible) and I would be able to quickly sort data.

This was the basis of the first release of PatientKeeper on August 11, 1999. The first night I released the software I had over a hundred downloads! Yikes! I had stumbled upon something big...

Wow, how did they hear about the program?

I put the program on the major Palm web sites, like PalmGear.com and (then) PalmCentral.com (now known as handango.com). People actively were searching for patient management apps, just like I had done 9 months earlier.

So I started to receive many e-mails about the program, and there was one consistent message - now that someone's put this info into a Palm, couldn't I give them a useful way of outputting the data?

The new version of the program enables the user to produce useful output, like infrared printing of notes (history and physicals as well as daily progress notes) and also allowed beaming patients back and forth between different users of the product. This rapidly improved the workflow of the physician. If one person used PK, he saved maybe 10 minutes, if two on a team used it, they both saved 20 minutes, if all members of a team used it, they saved a half hour each per day. So it started spreading like wildfire.

Viral marketing at its best

Absolutely, the viral marketing was really a key to the utility. But really the fact that this was saving people time made it work.

The next big issue that came up was connectivity. How many practicing docs are really willing to enter this data into a Palm? I knew that the ideal solution would be back end connectivity to the Hospital's existing information structures.

Exactly - solve this, and you solve my colleagues' final objection.

Imagine it... Sync up in the AM, and pull down all your new labs. Sync up in the evening and push down all your new notes. It would be brilliant!

This is where Virtmed entered the picture.

Virtmed, a company founded by 5 MIT engineers a couple of years ago, was built around a technology called GlobalSync. GlobalSync is a server that sits on site at the institution and listens to the back-end hospital information systems. It then brings that information to the point of care via handheld and web-browser technology.

I got a phone call from Dr Huang, the director of clinical application at Virtmed, and former director of the Healthcare Vertical at Newton (back in the early 90's) and I immediately saw the natural fit.

I understand the founders were engineers rather than medics - what directed their attention to the medical field?

Actually the two first "founders" of the company were Steve Hau, an MIT engineer, and Joe Bonventre, the director of the Harvard-MIT Health Science Technology program. It was Dr. B (as he is affectionately known) who pointed out this huge opportunity. He is now on our Board of Directors as well as a member of our outstanding Medical Board.

There were really a lot of factors that made Virtmed the perfect fit. Obviously for a techno-rat like me, their powerful technology was great. The fact that it actually existed (ie it is not vaporware) resounded loudly.

Second, the team that was assembled at Virtmed was unbelievable. Aside from the fact that over 10% of our company has a doctoral degree, we only recruited top talent. The CEO is Gary Foster, former GM of GE Healthcare in a billion dollar division. A senior VP, Rick Hall, was former divisional president at HBOC, a huge health care software vendor here in the states (perhaps abroad too, I'm not sure). Our CTO is Jeff Sutherland, former CTO at IDX, the largest medical software company in the US (I think it's the largest). Third, we had solid venture capital funding, which is so important in dictating the success of a startup. In fact, 3Com made a public announcement that Virtmed would be their only investment in the healthcare space.

Impressive. In which case let me ask about you - how did you manage to take that step from a busy medic using a Palm, to one who programs it?

I was a biomedical engineer as an undergrad a Duke University. I took two semesters of C programming there, which really isn't much, so I had to learn a lot as I went. Mostly it was the drive and the vision that there was a better way to do these things. An analogy we like to make is when we go to the rental car dealer to return a car, some 17 year-old kid zaps our car with a handheld device and knows our whole life story. Why were doctors still managing information the same way they did over a hundred years ago?

Are you working on the next killer app?

Absolutely. I can't wait to bring clinical connectivity to the point of care. Virtmed's first application is a charge capture application, a significant problem here in the states, that allows physicians to bill for their professional services at the point of care and then automatically send that information, via the globablsync server to back end, complicated billing systems. But what I am really excited about is our future in clinical applications.

I imagine a day when a physician rounds on his patients with a handheld as a tool as important as his stethoscope, that allows the physician to make decisions based on the most recent and most accurate information available. Virtmed has the vision and the team to really get us there.

Can you guess at a timeline?

Wow, that's a tough one. I'd say that connectivity is possible now. It's a matter of adoption by health professionals, who have always been slow to adopt new technology. I think as the technology becomes more standard, widespread, and wireless, you'll see a very rapid assimilation of the handheld into the physician's life.

Ah, the keyword wireless. I've heard you say before that you thought of handhelds as "remote controls". Can you elaborate?

Imagine the scenario. You walk into a patient's room, and their record is automatically brought up on your device, based on what room you are in. With some bluetooth-type [wireless] connection you automatically get the most recent data from the bedside monitors, and via a wireless LAN [Local Area Network] you automatically have all the most recent medications, labs, etc. for the patient.

You decide then that the patient needs a CT scan. You press a button on the Palm, and start a chain of events, from ordering the test and scheduling the machine, to ordering the contrast sent up to the room, to ordering a transport to the patient's room at the appropriate time to take the patient to scan. All by pressing one button on your Palm. Now that is connected.

Final question. I've heard a recurring comment from the doctors that I've shown all the gizmos to - with the increasing technology, the last patient-doctor link is the taking of a history, and performing an examination. It allows closeness to the patient. Will technology, handhelds inclusive, obliterate this too?

Technology will never eliminate the patient-doctor interaction. It is this interaction that is at the core of medicine. All the technology can do is facilitate the process and make it more efficient. It can decrease the amount of time you spend doing busy work, and increase the amount of time you spend doing what you love to do - helping people.

Interview with Dr Maulin Shah