Reporter with Silicon Hills News

20131029_130615-1If something scary pops up on an X-ray or CT Scan or MRI, radiologists have always had to play phone tag to let the attending physician know. For someone like Seton’s Dr. Christopher Ziebell, an emergency room physician who has a small window to decide whether to release patents or admit them to the hospital, this was a bad system.
“There are some things that can be very subtle on an X-ray,” Dr. Ziebell said. “The radiologist might see some tiny thing that looks normal to me. But it’s a partial collapse of a lung or a small shadow that, to his trained eye, looks like a very early lung cancer. The radiologist can pick up on things I might otherwise miss.”
The problem was communicating the information in time. Texting violated HIPAA standards, though several doctors did it anyway. Enter DocbookMD, an Austin startup founded by a married couple, both of whom are physicians. DocbookMD sends encrypted information over a secure server that exceeds HIPAA standards. And the company’s latest product is a tool by which radiologists can send their results and assessment to the ordering physician. It will arrive on the physician’s phone within 30 seconds, with a unique tone. If the doctor hasn’t seen the results within five minutes, the radiologist is alerted and is prompted to either send another message, or use a more traditional way to reach them
“I am always getting the results before I’ve had time to admit or discharge the patient and I’m always armed with the information I need when I have that final trip to the bedside to assess patient for the last time,” Dr. Ziebell said.

Doctors Don’t Communicate Well

Dr. Tracey Haas, a family physician and Dr. Tim Gueramy, an orthopedic surgeon, never thought of building a tech startup. In fact, they tried to interest other tech companies in building the first iteration of DocbookMD, a directory of specialists you could look up on your mobile device, press a button and contact.
“There used to be fewer subspecialties,” Dr. Gueramy said. “Now for every 100 Medicare patients, a primary care doctor must coordinate with 99 physicians across 56 specialties. (Dr. Gueramy is a foot and ankle specialist). It’s just gotten so complicated,” he said. That includes the nursing staff, which might include a rehab nurse, a home health care nurse, or a hospice nurse. Physicians traditionally did not communicate well because they often worked independently rather than being interdependent. Today, interdependence is required, so all health care workers need to be able to leverage technology to communicate.
So in 2008, the couple built DocbookMD so doctors could look up a specialist in their area, push a button and be connected. And that was great. Until they started thinking about other things they could do. Like what if they could see images of wounds, test results, X-rays and the like right on their mobile devices? They could make decisions, or send photos to other doctors for consultations, and get instant results.
For example, one Thanksgiving the couple was driving out of town and learned that a friend’s child had hurt his foot. Through the app, the doctor was able to send the X-rays to Dr. Gueramy’s phone. One look told him the child needed surgery immediately to avoid bigger problems later. He contacted Dell Children’s Hospital and managed to get a cast scheduled for the same day.

Who Will Pay for This App?

As Drs. Haas and Gueramy recognized the potential of what they were doing, they decided they needed to go all in for the business. They mortgaged their home, cashed in their 401K, sold a car and later received private funding rounds from friends, family and other doctors. The problem was the revenue model. They have 21,000 users across 37 states. And the bulk of messages are opened within five minutes. The company only wanted to charge $50 a year for the app. But doctors, Dr. Haas said, “don’t want to pay for anything.”
Medical malpractice insurers, though, would pay. Communication errors are behind 60-to-80 percent of medical malpractice suits. DocbookMDs tools would provide records about conversations that had taken place, decisions that had been made, and they all lived on the secure server, not on the doctors’ phones.
DocbookMD connected with the Texas Medical Liability Trust, which is one of many sponsors for the company.
“I was introduced to the principals at DocbookMD in late 2011 after I joined TMLT,” said Charles (Chip) Ott, president and CEO of TMLT. “Going into that meeting I was skeptical. TMLT’s sponsorship had been portrayed to me as an opportunity for TMLT to write additional Medical Professional Liability business through advertising tied to the application. I was not convinced this was a good use of our advertising dollars.”
“Upon seeing the application first hand, it was immediately clear that this application would have a distinct impact on future liability claims while improving the practice and delivery of medicine. The ability to share patient information through a secure connection improves the speed of care to the patient while protecting privacy concerns. I am certain that many physicians have shared confidential information through their smart phones in an unprotected format. As a medical professional liability carrier, the DocbookMD application significantly reduces the potential for claims arising from such activity… DocbookMD’s application continues to drive down risk and improve patient outcomes.”
It was interesting for the founders to realize that doctors wouldn’t pay for the app. It was also interesting to learn what would encourage engagement. If doctors could see how it would help patients, they would sign up.
“Physicians need to trust the technology,” Dr. Haas said. “They need to know it will help them take care of their patients. That’s what motivates them.”
All doctors must sign a business associates’ agreement acknowledging their responsibility in protecting patient confidentiality. For example, if the phone is lost or stolen, they must report it to DocbookMD immediately.
The company has recently made it possible for physicians to add important members of the care team to their circle of communication on the app, a distinction for DocbookMD, Dr. Ziebell said, that will set them apart. And they’re working to create specific models for different groups such as a model that connects all the doctors and nurses who work for a specific hospital. They’re also working to involve labs, so that results go directly to doctors.
Eventually, Drs. Haas and Gueramy plan to take the app to the rest of the world.
They both quit their practices a few years ago to focus on DocbookMD. But while they miss certain aspects of patient care, Haas said, they’re impacting the care of far more patients now. As Dr. Gueramy said: “We could have a bigger impact on the world of medicine than we ever could in traditional medical practice.”