[As mentioned in yesterday's review of Nimble, ClearPractice has been in business long before last month's release of Nimble, its iPad EMR. In this interview, we learn from Joel Andersen & Dr. Doerr how the founding principles of ClearPractice still drive its current evolution.]
Dr. Doer, please tell us a little about your background, and the start of ClearPractice
I am a practicing internist and in 1996, I had an epiphany while in an exam room, that medicine was an art not a science. I thought there should be some consumer reports for doctors to help them make decision. So, I, wrote a drug reference for myself. This grew to 140 pages by 1998. I recruited a pharmacist to help edit it and started to share it with partners.
When I told this to my brother John, the investor, he told me to write a business plan. I co-founded the company in 1999. We hired more pharmacists and the document eventually became 5000 pages. We indexed it by diagnosis codes in order to help find information faster. Using this guide, in1999 United Healthcare told our group that we were one of top two in the country in terms of cost-effectiveness. This led to the development of our data driven company servicing Medicare Advantage plans.
What were the goals of ClearPractice ?
We feel like we’ve been ahead of our time for some years. We feel that EHRs should render decision support and better outcomes. So far, reimbursement has been so focussed on meeting bullet points that the resulting care has not been as focussed on outcomes. The current ARRA incentive may be turning the direction.
We are interested in “point of thought decision support”. I’ll give you an anecdote. Cox-2 inhibitors were studied in a 2000 study named “CLASS” in which the Cox-2 inhibitor, Celebrex, was compared to NSAIDS over a six month period. Eight thousand patients were randomized and it was published in JAMA. However, the cohort actually continued to be followed and by 12 months the benefits had disappeared. Still pharma decided to target subset of patients with GI sensitivities and used direct to consumer advertising and by 2007, Cox-2 inhibitors were 60% of all NSAID prescriptions.
The information [showing no benefit] was actually available on the FDA website. We had it in our prescribing guide. We feel if all docs had ready access to this type of information, it would help them make their own best decisions.