Daniel Cane Founder and CEO Modernizing Medicine
When we think about electronic medical records (EMR), lots things come to mind including the hiccups and headaches that have come with the technology’s lack features and functionality over the years. But that’s all changing, according to Modernizing Medicine’s CEO Dan Cane; EMRs are evolving to better assist physicians in unprecedented ways.
Cane should know since he’s helping his Boca Raton, FL-based company lead the way in developing a new league of sophisticated EMR technology across a number of medical specialties. Gone are the yesteryears of fumbling through irrelevant data-inputs. Today, EMRs are adapting an encouraging a natural fluidity between technology and patient interaction, along with the functionality of tapping into the valuable groundswell of unstructured data.
Modernizing Medicine is tackling those feats through its partnering with IBM’s Watson Ecosystem, developing EMR apps that take advantage of Watson’s cognitive computing capabilities. Turns out, Watson’s potential goes far beyond outsmarting opponents on Jeopardy and could lead to more intuitive healthcare technology on the horizon.
To learn more about this EMR evolution, we sat down with Cane to talk about his company, its plans for further technological development, and how Watson-powered EMR technology is poised to change the way physicians tap into relevant data at the point of care:
Q
Today, Modernizing Medicine is serving more than 5,000 U.S healthcare providers, including approximately 30% of today’s dermatologists, but tell us a little about how Modernizing Medicine began? What’s the story behind the company’s inception and its growth up until this point?
Modernizing Medicine is the result of a partnership between myself and Chief Medical Officer Dr. Michael Sherling, a practicing dermatologist in Palm Beach County, FL. In 2009, I took a trip to Dr. Sherling’s office for a routine medical exam and marveled at the lack of technology that was available. We both agreed that dermatologists needed an effective EMR system to save time and be more efficient than paper charts – one that knew dermatology diagnoses, treatments and workflow out of the box. One didn’t exist, so I agreed to help Dr. Sherling build it using my entrepreneurial and software skills plus his medical expertise. Soon after, we began coding a new solution specifically built around dermatologists’ workflow.
This led to the creation of company’s flagship product, EMA Dermatology®, and the foundation of Modernizing Medicine in 2010. The dermatology EMR model proved so successful that we hired additional physicians from other specialties to begin coding their knowledge into EMA. This would soon allow functionality in other specialties – ophthalmology, orthopedic surgery, plastic surgery, otolaryngology, gastroenterology and urology – that other EMR vendors largely ignore.
In just five years, Modernizing Medicine has gone from a small startup to a powerhouse in the highly competitive healthcare IT industry, raising capital of roughly $49 million. Modernizing Medicine has also grown its revenue and employee base, year over year, impacting job creation in Palm Beach County, FL. We have doubled our workforce since 2012, currently employing almost 300 workers in our Boca Raton, FL, office, as well as in our new west coast office in Roseville, CA.
Q
How did your former experience of starting education-technology company Blackboard translate to you working in HIT? Do you think you were able to bring something unique from the education industry into the healthcare?
My experience at Blackboard allowed me to recognize the much needed revolution the healthcare industry needed. During the inception of Blackboard, my partners and I were told repeatedly that education has been done a certain way, and to change it would cause total disruption. It was this disruption that allowed people to realize that one cannot simply rely on the traditional tools that had dominated for so long – primarily pen and paper – to maintain a productive concept of learning.
It was evident that the healthcare industry was slow-moving and in dire need of technology to improve how physicians practice medicine and how patients receive care. Much like the student experience in the classroom, the patient experience in the doctor’s office needed to be more engaging, collaborative, dynamic and practical. And more importantly, physicians needed the right tools at their fingertips to efficiently provide evidence-based care to patients in the exam room. I took my background in economics, entrepreneurship and software development that I honed at Blackboard and used this knowledge to create a unique approach that would change the conventional idea of treatment and care options – and it worked.
Q
Similarly, what were some of the challenges you encountered when starting a company in healthcare? We know regulation can be a big one for those making the crossover.
Like any highly regulated industry, there are considerations that must be made around compliance. At a time in healthcare when the government is heading up numerous mandates around how providers use technology, the challenge lies in remaining compliant while still addressing practical business challenges such as workflow, billing and the physician/patient relationship. Modernizing Medicine is deeply committed to addressing issues such as Meaningful Use, PQRS, HIPAA and ICD-10, and we’ve been able to do that through tight collaboration with our on staff practicing physicians who know what it takes to develop tools that will help not hinder, but actually help with daily practice.
The increased regulations can be extremely time consuming for physicians using paper or first generation EMR systems. The fact that EMA collects structured patient data at the point of care means that physicians only have to enter information once. This data can then be used for multiple purposes from generating Meaningful Use reports, to populating PQRS forms, and to seeing how a patient’s disease has progressed over time.
Finally our intuitive user interface facilitates various regulations and will make the transition to ICD-10 a non-issue for our users. Our EMA Anatomic Atlas™ is a zoomable, 3D image of the body that physicians can zoom in or zoom out plus peel back layers of skin to see muscles, bones and joints. And by merely touching on the iPad screen, physicians capture the body part, laterality, etc. – the specificity that will be required by ICD-10. Physicians won’t have to worry about translation tools, crosswalks, GEMs, etc. It’s all built in.
Q
So what makes Modernizing Medicine’s EMR technology different? How does the specialty-specific features of EMA help demonstrate the company’s philosophy about data input and decision-making at the point of care?
Our Electronic Medical Assistant®, or EMA, differentiates itself from other EMR systems because it doesn’t run on macros or templates and automatically adapts to the way physicians practice using predictive algorithms. The conditions physicians treat most often are automatically moved to the top of the list – no more clicking to find most common treatments.
By having practicing physicians develop it, EMA is available out of the box with built-in diagnoses, procedures and treatment regimens for that particular specialty. For example, EMA Dermatology remembers laser settings, units of Botox used for a given area of the face and even a physician’s choice of anesthesia and suture for biopsies. Input anything once, and EMA will remember. Like a great medical assistant, EMA anticipates what physicians need without them asking for it.
Another key differentiator is EMA’s cloud-based approach to collecting and storing patient information in a structured way. Modernizing Medicine visualizes this treatment data at the point of care on an iPad so doctors can make more effective decisions. In real time, a provider can see their treatment profile for any given disease and see how it compares to the patterns of their colleagues in their practice and their peers nationally. This creates a national standard of care to improve medical compliance and decision-making. Plus, collecting patient data on an iPad improves the physician/patient relationship. Physicians don’t have to turn their backs to patients or spend time typing, plus the iPad is an excellent patient education tool.
Q
There are a lot of companies out there struggling to get EMR technology aptly tailored for general practitioners, yet Modernizing Medicine is customizing its technology for a number of specialty areas, with good results so far. What’s the secret to the company’s success here?
It was clear that specialty physicians weren’t happy with the EMR system options on the market because none were tailored just for them. They want to treat their patients, and it took too much time away from patient care to customize generic EMR systems. So we do the hard part for them. We employ 18 specialty physicians that build software for their colleagues so EMA is ready upon purchase.
While doctors calling a typical software company with feedback end up speaking with an engineer or customer service rep who doesn’t understand what they need, doctors who call Modernizing Medicine can speak directly with other practicing specialty physicians who understand the medical language and workflow. Because Modernizing Medicine’s on staff physicians learn how to code EMA, they do not have to relay the information to a coder and risk losing elements of the system’s customization.
As a result, our clients enjoy a tailored product that understands their field and style of practice. In turn, physicians can work more efficiently, save time, code more accurately and offer patients greater quality of care. This strategy lies at the foundation of the company’s initial success, and we have stuck to it ever since.
Q
How is the partnership with IBM’s Watson shaping the future prospects for the company? I know it began with the development of schEMA, an application to help dermatologists deliver optimal treatment at the point of care. How exactly have the two technologies come together to meet that end?
Modernizing Medicine became one of the first companies to be invited to join the exclusive IBM Watson Ecosystem, and through this partnership the company is developing schEMA, a powered by Watson application utilizing the cognitive computing capabilities of IBM Watson. Modernizing Medicine’s on-staff physicians teach schEMA the content of peer-reviewed journal articles from leading publications. This enables users to ask questions about conditions using natural language and at the point of care. schEMA matches those queries with clinically useful content, providing physicians and their patients with an instant, expert source of evidence-based data.
The physician gains near-instant access to relevant clinical information, which is then saved into the patient’s medical record. The patient can walk away from the visit with the necessary information, without the physician having to take the time to find it and delaying appropriate medical care. To further strengthen the relationship, IBM invested in Modernizing Medicine during the company’s $20 million Series D financing that closed in February 2015.
Q
With the approximate 20 million in funding from IBM and other parties, what’s next in terms of development? I know you will be developing apps similar to schEMA powered by Watson across eight other specialties, but what else is on the drawing board?
Our partnership with IBM Watson is focused heavily around cognitive learning, which inherently focuses on the parsing of unstructured data – like that found in the most cutting edge medical research journals. While this is an area we believe holds substantial value, we must balance EMA’s ability to draw insight from structured patient data as well. Because EMA is built on structured data everything over the course of a patient visit is captured in a way that it can be easily compiled and mined at the practice level and even population level.
This allows physicians to easily view and report on outcomes and quality of care, by seeing how a patient is responding to treatment over time. This also means that EMA’s physician network can gain insight from what others in their field are doing. The capture of structured patient data is also at the core of EMA’s ability to completely automate ICD-10 coding, without the need for manual crosswalks or other complex, time consuming methods for addressing the new code set.
Q
I read that the funding will also be used to enhance the current capabilities of schEMA, can you expand on that?
When we first started developing schEMA, we began with three common dermatological diagnoses: psoriasis, melanoma and atopic dermatitis. The first iteration of the application enabled dermatologists to pose queries, describe symptoms or search for information and statistics about these conditions and match those queries with clinically useful content. The goal is to aid dermatologists with an expert source of evidence-based data that they can use to inform their treatment recommendations – at the point of care.
Our team works very closely with IBM Watson to develop schEMA, so the plan is to continue expanding from these first three diagnoses to all dermatological diagnoses and then to EMA’s other specialties. schEMA is not a replacement for physician decision-making, but rather the tool to support the physician’s decision to improve health outcomes for their patients.
Q
Adapting and integrating this technology into multiple specialties poses quite a challenge I would imagine, what do you foresee being the most challenging part of this process as you take on this task?
schEMA has to be “taught” medicine, and our physicians teach the corpus by repeating and restating every question in every way a user may ask it in natural language. And each journal article over years of publication has to be ingested into the system. It’s a time consuming process!
Q
Is there a particular specialty that you think will benefit the most from the melding of Modernizing Medicine’s technology with Watson?
Our ultimate goal is to have equal improvement in all specialties, but dermatology will be the first field to benefit from the cognitive computing power of IBM Watson. Modernizing Medicine’s schEMA application can give physicians the ability to, in seconds, query thousands of medical journal articles from peer-reviewed publications. Since approximately 30 percent of the dermatology industry uses EMA and would have the ability to use schEMA, this is a huge opportunity for practitioners in this field to maintain evidence-based clinical decision support at the point-of-care.
Q
How will the development of these kinds of more sophisticated tools change the game when it comes to how we think about EMR/EHR systems’ role in healthcare? What do you think will be the most profound result from this next evolution of products?
An opportunity to truly revolutionize healthcare lies within evidence based medicine and cognitive computing. This enhanced technology will generate more desired and accurate outcomes for patients. Furthermore, automated systems and those combining the use of structured and unstructured data will help physicians not only make informed decisions about their patients but also make it much easier to succeed with outcome-based payments, supporting their bottom-line. These systems can also automatically integrate vital information on past or present disease epidemics (e.g. the Ebola outbreak). This will impact the healthcare tremendously by expediting the treatment of patients at a much faster and effective rate.
Q
What else is on the horizon for Modernizing Medicine? Are there any trends in the industry you are keeping an eye on in terms of shaping future innovations?
To steer the company to lasting success in an environment characterized by change, Modernizing Medicine will capitalize on the growing trend of telemedicine. Starting with integration with EMA Dermatology, our telemedicine app will allow dermatologists to treat existing patients when a virtual visit is appropriate. The app will also enable physicians to get paid for their time and record the visit in the dermatology EMR system.
In addition, we’re introducing EMA DermPath™, a new dermatopathology module that will be integrated with EMA Dermatology. DermPath has been designed to support a wide range of users, from individuals or small groups of providers who interpret their own slides, to practices that outsource the technical component, to practices with larger laboratories that, in addition to processing EMA generated requisitions, process external requisitions received via courier.
Q
You are nominated for EY Entrepreneur of the Year 2015 in Florida. What does that nomination represent to you when you think about the relative success of Modernizing Medicine?
I am honored to be nominated for EY Entrepreneur of the Year 2015, however, I would not be considered for this award if it weren’t for the support of our company’s incredible team. Since my trip to Dr. Sherling’s office in 2009, my ultimate goal has been to transform how healthcare information is created, consumed and utilized. The future of healthcare requires tailored technologies that make it easy to manage the exploding amounts of patient data. In a relatively short time, we have developed a solution that does just that, enabling us to capture substantial market share and emerge as a physician-favorite EMR system. This recognition serves as a testament to the hard work that the Modernizing Medicine team has put into making our goal a reality.