Monthly Archives: December 2013

How to Start A Tech Company in Healthcare

The best person to start a company with is someone you have known for years. Someone who has a talent, drive and who you have seen work intensely work. Through the course of our life, there are a handful of people in your mind you think you could start a company with. I have only a few people in my mind and picked one when I started the company drchrono.

Michael was my college roommate. He had a talent for understanding complex software and could hack out just about any idea. He was doing a dual major in computer engineering and science major, and it was a breeze for him. I was a psychology and computer science major, and understood people. We took a bunch of classes together and worked well as a team, doing scrum like teamwork. As in all of our courses together. I made a mental note, he would be someone who I could work with in the future. After we both graduated Michael went on to work for Bloomberg LP and I went on to work at several startups in NYC. Several years passed when we got together to talk about working on an idea.

I recall sitting down with Michael in 2008, and we spoke about how we wanted to change healthcare over a cup of coffee. We didn’t have a business model, nor medical backgrounds, but we could build software. He was one of those people on my list I would start a company with.

After swapping personal stories about healthcare, we decided to start a company in that market. From seeing family members have a hard time working with the healthcare system we thought we could make a difference. Doctors were doing everything with fax machines, pen and paper. It was clear to us both healthcare was broken.

We really didn’t think too much about our name, jumping in with the name drchrono from day one. We picked that name as it related to time. We wanted to build something that took people and managed health over time, “dr” for doctor and “chrono” for time. There was no hard path for the company, but we had a vision for connecting doctors and patients and tracking health.

Michael quit his job of eight years to start the company with me. This was a commitment check for me to see if he was serious about doing this startup. Michael quitting his job showed to me he was serious, very serious.

We started working out of a small place called the Sunshine Suites, where we rented two desks. It was an on-demand office space with virtual offices in New York City. We then moved into an incubator space were we expanded the team.

he company jumped on an unconventional band wagon of using the cloud back in 2009, most companies were just starting to think about cloud. Most medical records company during 2009 were not using the cloud, part of our vision is to run all medicine in the cloud, the data, scheduling, billing, etc. Other companies were building for the desktop or using Adobe Flex, Flash or .Net, we decided that was the wrong route and it was a mistake. So we built on the same type of infrastructure that Google was using, Python and Linux. It pays off to really look at the tech stack you use, not to jump on a tech fad band wagon, it can hurt you in the long run. There are a number of healthcare companies in the cloud that are using bad tech stacks and they just aren’t able to build fast which hurts them. Using a good technology stack is critical to having an amazing experience for your customer.

For the first year, we spoke to doctors, one by one, shadowing and listing to them, asking them what they wanted. We would rapidly iterate over the feedback and repeat. We interviewed and shadowed doctors in hospitals, in large clinics as well as private practice doctors.

Ever entrepreneur should take as much feedback as possible and work on it, but remember filtering is critical. We get feedback from all kinds of doctors and patients; we picked what makes the most sense. Some physicians would give amazing input and others would give unproductive feedback. We still shadow doctors today, and that is how we know what we are doing right and what we are doing wrong. Software is an ever evolving thing that needs care.

After working for over a year, we built out a medical platform that could do medical billing, scheduling and email reminds to patients. In April 2010 the iPad came out, and I pushed us to build an app for it, I believed mobile was the future and it is. Thousands of doctors downloaded the initial release. We were the first medical records app on the iPad. It was an inflection point. It pushed us to build the best mobile EHR in the world. Today we have the highest rated medical records app in the iTunes app store. Our goal is to create the best healthcare experience through technology and we are doing just that.

Doing a startup in healthcare is not an easy thing. I tell entrepreneurs who want to jump into the healthcare space to do a startup be ready to take at least 7+ years of your life to create something meaningful and passion is a must and find people who are as passionate as you to build the company with.

It takes years to build something meaningful in healthcare. drchrono isn’t an overnight success, it was years of hard work. Yes most startups are a long journey, but startups in healthcare are the hardest type of companies to build. Overnight successes just don’t happen in healthcare.

When Michael my cofounder and I started drchrono, no one told us that it would take years to make something meaningful, it is our passion for changing healthcare that pushes us every day. We feel like we have only started.

drchrono now has over 45,000+ thousand physicians signed up and over 2,500,000+ million patients.

Will Open EMR Survive?

When we started drchrono, we contemplated using open source software to build the company.

We thought about running instances of Open EMR for medical practice clients. The idea was great in concept, we would become the “Red Hat” like company to the EMR world. There were and still are other companies doing this and it looked like a viable option at the time.

Showing our first paying users Open EMR to see if it would fit their needs, the physicians looked at the software in a skeptical way saying it was missing critical components.

We reviewed everything Open EMR over and over, it has scheduling and it’s cloud based. Sounds good right? Well there is a lot that is missing. It doesn’t really cut it. To me it almost felt like a valiant effort to a failed operating system Kernel.

I thought about it and asked myself, why isn’t Open EMR up to par with where it should be? The passion wasn’t persistent over time with the people working on it. The love that was needed to build and maintain something of that magnitude wasn’t there, it looks like the developers gave up.
Yes it is there and yes it “works”, but it is more of a starting point. It needed and needs massive amounts of work.

Take a look at how old Open EMR feels –


So we looked for other solutions and there simply wasn’t a good open source EMR with a good vibrant developer and support community around it. We thought about it, we could invest our time submitting updates to Open EMR, that was an option, but we didn’t like the technology and the lack of love that was put into the project. It felt like we would be doing the heavy lifting if we invested into the project.

It was at this point we realized we needed to build our own EHR from scratch, from the ground up, it was a long term endeavor, but we committed to building the best EHR in the world. Year after year, improvement after improvement, we leap leapfrogged anything Open EMR could do. There is still a lot to do. ( I just want to thank the drchrono team for working so hard to get to were we are. )

We are meaningful use stage 1 certified and working on getting meaningful use stage 2 certified. We were voted the best Mobile EHR by Blackbook rankings who surveyed over 16 thousand physicians. We are pushing hard to be the best disruptor in the space.

Open EMR isn’t meaningful use certified, hasn’t won any awards that I have heard of. We made the right move building our own platform.

But now that we have built the best EHR, “the kernel to our operating system”, we are now focusing on having developers join the platform as we just released the drchrono healthcare API. There is so much the developer community can do to help us fix healthcare.

Coming full circle we are now allowing developers to build on the drchrono healthcare API. With 100’s of developers looking to join our vibrant community, we would love to see the open source community build on top of drchrono along with proprietary being developed.

So this is a challenge to every developer out there, build on the “new Open EMR”, our goal at drchrono is to supporting the “Kernel”, with developers building with us.


The answer is no, but will the community of developers who are building the software keep innovating on Open EMR? I would say no.