Troy Russell, MD, MPH - Founder of Carescribr
What is Carescribr?
Carescribr is an EMR documentation application that addresses two of the largest health IT problems in the U.S. healthcare system at this time: 1) the administrative burden of charting for medical providers and 2) EMR interoperability or the ability to transfer patient information from one clinical setting to another.
Currently, the application interacts with patients through an iPad in a doctor’s waiting room. Patients use the iPad to enter their medical information through a simple patient-friendly questionnaire. The information is saved in a secure, cloud-based HIPAA compliant account. A patient can log in to their account at any clinical location with a Carescribr kiosk and with the patient’s consent, the patient’s medical record is then visible to any healthcare facility (urgent care center, ER, etc.) using the Carescribr platform.
An important function of the technology includes translating a patient’s questionnaire responses into a provider-friendly format for the clinician to use before a medical visit. For now, the patient’s information is formatted as a clinical report, but after integration with the EMR, the information will directly populate into the visit note. A detailed account directly from the patient would be available before the clinician even entered the room.
The product roadmap includes adding any kind of lab value, immunizations, imaging reports, biopsy results, etc. to a patient’s Carescribr account which allows portability of the relevant past information to help make clinical decisions easier. Historically, organizations and smaller clinics had to endure lengthy processes and operations to gain open access to each other’s patient records. In the Boston area, we are fortunate to have a lot of interoperability between the larger systems, but that is atypical for mucht of the country right now.
What is your role within this venture?
My role as both a CEO and a physician in a health IT startup is to provide insight into the workflow and thought process of the clinician - who the user is, the logical flow in clinic visits, intuitive user interfaces, etc. Understanding the clinical audience for our product is critical because every specialty will have some differences in clinic flow. A pediatrician’s workflow will be different from a geriatrician’s due to their different common conditions and needs of the patient populations they serve. While that may seem obvious to healthcare providers, developers, who may not have spent much time in clinical environments, are less likely to identify these nuances. My role is to ensure that Carescribr not only provides the solution to the clinician’s charting needs and their patient population but also create a seamless integration with primary care workflow that considers the gamut of varied nuances that I have personally encountered as a physician.
Mission/vision for Carescribr
Our mission is to expand the Carescribr platform so it connects any patient’s medical record to any clinical location for any provider type and specialty.
How would that information follow the patient (eg., if they forget they had their gallbladder removed) as the patient goes from provider to provider if the patient is relying on the pre-supplied information?
The patient’s information will be accessible through any Carescribr-contracted facility providing convenience for the patient and efficiency for the provider. The application routinely asks the patient for any updates to the patient’s medical information (past medical history, surgical history, medication list, etc.). As is common clinical process, the patient’s physician can update the relevant information and it will sync with the patient’s Carescribr account. Patient information comes from multiple sources, such as physicians, nurses, IoTs/wearables, Apple Health, not just the patient.
What EMR companies have you been working with, if any?
Carescribr is diligently developing and refining our technology and is open to collaborations with EMR vendors that share our mission to improve clinical flow and improve patient care. Our product works with and independently of any EMR system.
What is the current status of the product in terms of development?
We are very excited to announce our current trajectory to officially launch in Spring 2019. We are currently encouraging any interested administrators and clinicians to visit us on our website (www.carescribr.com) for information how to become beta testers and sign up for their free trial.
It seems that EMRs might be opposed to the idea of interoperability and working with other EMRs. Have you experienced that at all or thought about how to circumvent that?
I agree that there are not a lot of incentives for the big EMRs to talk to each other. I think once Apple released their intentions to roll out FHIR integrations in 2018, it became clear that things might actually start happening. That was one of the nudges for us to get started as the technology appears to be getting closer to mass adoption.
What is your biggest hurdle moving forward?
The biggest hurdle is probably going to be developing a widespread base. As the base grows it will develop network effects that will accelerate our growth. The purchasing process is a challenge as well in the sense that the consumer and buyer may or may not be the same person. Identifying the person who can actually make the decision to purchase the product will be a challenge. One way we’re trying to address this challenge is by focusing on smaller practices that may not be getting lots of attention. Put another way, getting the word out to the right buyers and having them perform a trial to see the benefit for themselves.
How would you recommend balancing these pursuits for those of us who may want to become practicing physicians and involved in something else, like what you’re doing now?
I wonder if there is a possibility of balance as a physician. We just tip the scales one way or another depending on the requirements of the situation with the hope it will move back towards balance. One thing I have come to realize is that the power of collaboration and teamwork help provide some balance.
What do you enjoy most about working on your product?
The satisfaction comes from addressing a need (EMR charting), which I feel has been overlooked for too long. I’ll be honest; it's not a sexy problem. EMR charting has to share space with far more hyped trends such as augmented/virtual reality, AI/machine learning, etc. While we wait for these technologies to fulfill their promises, frontline physicians struggle to keep up with their clinical work. Not to discourage anybody from these trending technologies, but there still has not been an adequate solution to how the EMR has disrupted the doctor-patient relationship. Therefore, for me, I enjoy tackling a real problem that I experience all the time, every day, because I know that my product can better the lives of my patients and colleagues.
I practice in a community health setting just north of Boston. I recognize that community health centers help care for some of the most vulnerable populations and unfortunately these settings suffer notoriously high physician turnover rates. This problem is detrimental to the patient population, the stability of clinics and their revenue. If we are trying to provide quality care for all, including the most vulnerable patients, this type of burnout and subsequent turnover needs to be addressed. It is a major problem that everyone seems to be mentioned in passing but rarely is headline news. The design of the Carescribr platform reflects my commitment to alleviate the burnout and turnover of the physicians caring for our most vulnerable populations.
Are there any particular skills or experiences that you’ve had so far that you think are useful in doing what you're doing right now, either on the business or clinical side?
I have a Masters in Public Health, with a focus on health administration and high performing health systems. These focuses introduced me to the idea of evidence-based management. Not all ideas produce effective solutions or a product people want. Also, all ideas need to be tested/piloted to determine their potential impact.
Experiencing how healthcare has changed in the last few years--seeing physicians retire early and seeing clinicians complain about developing standards of practice with technological integrations has been impactful as well.
Would you like to add in anything else?
I think the one thing I would recommend doing for anyone interested in startups is to read The Lean Startup by Eric Ries. It is one of the most influential books I have ever read on business. The concepts in the book work well with healthcare because the book draws parallels to the scientific method and how we might approach evidence-based medicine. Therefore, if someone has an idea, they need to first validate the concept and then determine its demand rather than “going out on a limb” and “solving your own problem.”
I know medical students are more interested in learning everything they possibly can (about medicine), acing all their rotations, and preparing for their future careers in medicine. However, learning about EMR technology and health IT will be essential for physicians to create future solutions in medicine.