It’s the stuff of Star Trek: a doctor pulls out a tablet computer and begins to examine a patient. Instead of typing or writing, the physician touches the screen to record observations, make a diagnosis, consult a medical book, send a lab order, print a patient handout, and file a bill. Recordkeeping and paperwork that once took 10 minutes now take 60 seconds or less.
That science-fiction scenario is reality, thanks to a group of enterprising School of Medicine alumni who have added computer coding and entrepreneurship to their skill sets. The four physicians play key roles in Modernizing Medicine, an electronic medical record (EMR) company based in Boca Raton, Fla., whose contracts have skyrocketed from $200,000 to $16 million in its first three years. The firm’s software systems include touch-screen technology, a built-in medical library, and the ability to learn a physician’s habits to streamline examination, diagnosis, and treatment.
“We call it the virtual exam room because there’s a virtual interactive anatomical atlas of the patient sitting right in front of you,” said company co-founder and chief medical officer Michael Sherling, M.D. ’02, M.B.A. ’02. “It’s very visual. If you touch a diagnosis, it knows all the plans for that diagnosis. We can take some of the burden off the doctor so they can do what’s best, which is treat patients.”
EMRs are a growing market. The American Recovery and Reinvestment Act of 2009 provided funding for hospitals and physicians who adopted the electronic records, with the goals of increasing efficiency and safety, reducing costs, and providing information for clinical researchers. To jumpstart the transition, the federal government has offered generous subsidies for converting to EMR systems, up to $44,000 through Medicare and up to $63,750 through Medicaid.
Modernizing Medicine’s iPad- and cloud-based EMR system goes far beyond the government’s initial vision; it is better described as a virtual medical assistant than an e-filing cabinet, Sherling said. He added that the product’s biggest attraction for doctors—the key to its explosive increase in sales—is its ability to save time. Used properly, the product slashes the time needed for examination recordkeeping and paperwork, he said. “Time is the most precious asset of a doctor, whether it’s time spent with a patient, time to see more patients, or more time to spend with your family,” he said.
Sherling isn’t concerned that the software applications could lead doctors to see too many patients or make decisions and diagnoses too quickly or by rote. The product’s aim is the opposite: to free doctors from onerous paperwork so they can devote more time to patients and focus on really tough cases. “Modernizing Medicine hopes to put the human interaction at the forefront of medicine again,” said Daniel Prince, M.D. ’04, an orthopaedist with the company.
Not only does the company’s EMR save time, it also helps doctors practice more effectively by adapting to each user’s practices and preferences. “The EMR learns how you treat a given disease,” added Steven Rosenfeld, M.D. ’80, the company’s chief of ophthalmology. “The next time you have that same diagnosis, it brings forward the methods you would use to treat it. It makes you practice in a much more efficient manner.”
The product also includes a virtual medical library—Rosenfeld entered 2,000 eye diagnoses in the ophthalmology version—and cloud technology that allows immediate updates. And of course, it records and stores data on each patient. It works in any medical setting from private practices to hospitals, Sherling said.
Modernizing Medicine was born of snow and serendipity. Sherling and his wife Dawn Harris Sherling, M.D. ’02, who practices internal medicine, were living in Boston in the late 2000s, when “it snowed one too many times.” They relocated to Florida, where Sherling started a dermatology practice. One day in late 2009, a patient named Daniel Cane came in for a routine skin exam. Sherling didn’t know until his nurse told him, but it turns out that Cane is a co-creator of the popular e-learning platform Blackboard, used by many universities including Yale. A programmer and entrepreneur, Cane co-founded what eventually became Blackboard in 1997 while an undergraduate at Cornell University, and helped raise $100 million in 2004 to take the company public.
“I just started talking to him about how there really wasn’t any solution out there for physicians that could save them time; that allowed them to focus on the patients instead of the computer,” Sherling said. “He said he thought he could help.”
Sherling, one of the first students to earn joint degrees in business and medicine at Yale, wanted to do something entrepreneurial. He and Cane had lunch; and in February 2010 they launched Modernizing Medicine, introducing the dermatology EMR that summer. The product took off, capturing 13 percent of the dermatology market as of the end of 2012. The company then added ophthalmology, orthopaedics, optometry, cosmetic surgery, and plastic surgery—specialties underserved by other EMRs because they make up such a small portion of the market, Sherling said.
As the company grew, Sherling turned to the local Yale network. After hiring Rosenfeld, Sherling took on his friend from medical school, orthopaedic surgeon Matthew Stiebel, M.D. ’03, and then Prince. The four physicians, all of whom still practice clinical medicine, say that the School of Medicine’s culture of research, leadership, and risk taking has played a vital role in the company’s success. “(Former) Dean (David) Kessler told us we should strive to be not only excellent physicians, but to become leaders in the world of medicine,” Stiebel said. “I think that we are attempting to do this at Modernizing Medicine because we are actively trying to change the way physicians practice medicine.”
Modernizing Medicine isn’t sitting on its laurels. The company plans EMRs for orthopaedic surgery and other specialties, Sherling said. It is also developing a data analytics tool around de-identified aggregate patient outcomes and a clinical trials platform for the company’s cloud.
“Filter and show me all 20-to-40-year-old Asian Americans with psoriasis and show me what works and doesn’t work—that’s where we’re headed,” Sherling said.