In July, Epocrates released Epocrates EHR, an electronic health record system designed for smaller clinic-based practices. It goes without saying that Epocrates is an industry leader in mobile medical apps, and their successful IPO speaks to the potential their market position holds.

With Epocrates EHR, the company enters a highly competitive industry with a focus on a niche that has already proven itself interested in alternatives to the standard industry behemoths. With over a million physicians using their products, they certainly have a lot of potential.

Epocrates recently gave iMedicalApps a glimpse into their EHR and provided insight into future innovations that will soon be added. Here, we review what we saw and what we learned. Does Epocrates EHR have what it takes to extend their market dominance into the all-important industry of electronic medical records?

What We Got to See:

One of the largest selling points of the Epocrates EHR is that it was designed from the ground up by physicians, for physicians. Dr. Tom Giannulli, a small practice internist who has an impressive resume in medical technology (including being the CEO of the Caretools, who designed the first iPhone-based EMR), led the development team and personally demonstrated the functionality behind Epocrates EHR.

As the demo took place over conference call and screencast, it’s important to mention that we were not able to actually do a hands-on review of the product. However, the Epocrates team graciously allowed us to ask questions at any time and assured us that the real-life use of the product would resemble what we were shown. After the demonstration, we felt we were able to get a solid grasp of the functionality and flow of their product.

The Basics:

The rollout strategy for Epocrates EHR includes a multi-phase release schedule, with new and significant features being rolled out over the coming months. The current product is intended for smaller clinic-based practices, generally consisting of up to ten doctors.

Even in its current phase of release, the Epocrates EHR does not skimp on features. Taken from their product website, here are the current features that were demonstrated for us:

• Well-structured Patient Encounter Notes
• At-A-Glance Face Sheets for Patients
• Electronic Lab Orders
• Electronic Lab Viewing
• ePrescribing with Full Interaction Checking
• Interruption Handling with Task Manager
• Epocrates Essentials Ð Premium Version
• Epocrates Online

Pricing:

The Epocrates EHR is priced very competitively, at an Early Adopter price of $179/month per clinician (Physician, PA, or NP’s). After March 31, 2012, the pricing will increase to standard rates at $359/month/clinician. It’s worth noting that this pricing does NOT include Epocrates PM, powered by Nuesoft, which is the accompanying software that addresses practice management, including patient registration/scheduling, medical billing, etc. Epocrates PM will cost $200/month/clinician.

Web-Based Client: Pros and Cons

At its core, the Epocrates EHR is a web-based, SaaS (Software as a Service) system. In this sense, it resembles other Web 2.0 services like Gmail that run inside a web browser. This brings many notable advantages, including the fact that having expensive hardware becomes less of an issue. The service should run effectively on any Mac or PC running a recent web browser like Safari, Internet Explorer, Chrome, or Firefox. This also makes initial setup much easier as there is no hardware or software that needs to be installed or configured in the office.

Also, another advantage of being web-based is that data is heavily encrypted and backed up in the cloud. Since patient data will not be stored directly on site in your office, leaving patient files unencrypted won’t be a concern. Also, the data will be backed up in multiple Epocrates-maintained data centers throughout the country, so patient records will not be susceptible to disasters, like flooding, theft, or fires. Lastly, as a result of being based in the cloud, the Epocrates EHR is accessible from any computer, including computers at home, or laptops brought from home. This allows for the easy addition of new workstations to the office or the reviewing of files from home.

Being web-based does not come without disadvantages, however. Most concerning is the fact that the Epocrates EHR requires a steady internet connection to run. While I have full confidence in the stability of the internet service on the end of Epocrates with a full-time staff of internet technicians, I am less confident in a 100% steady uptime of a local clinic’s internet connection. If the internet connection service is not completely reliable, then the Epocrates EHR could be frustrating. An iPad app is currently in development that will not require a seamless internet connection, but it is still a work in progress.

The User Interface: Clean, Simple, and Effective

At iMedicalApps, the importance of User Interface (UI) design cannot be stressed enough. User Interface is key to the overall experience and workflow of any medical software, and this is where many products really frustrate and alienate clinicians and staff. Thankfully, the approach taken by the Epocrates development team hits the sweet spot combining simplicity, intuitiveness, and complex functionality. Functioning as a web app already provides a healthy dose of simplicity, and it avoids the archaic interfaces of older, legacy Windows-based software. I also appreciated the inclusion of a simple horizontal navigation bar at the top of the screen, and the omission of a persistent left column vertical navigation bar, which is found in some competitors. For one, this simplifies navigation and prevents the need for complex sequences of clicks to access certain menus. This also allows the primary screen area to span the entire horizontal width of the screen, which is especially helpful for smaller monitors and lower-resolution screens often found in clinics.

Particularly helpful is the initial home screen (pictured above), which intuitively lays out the clinic schedule on the left and the list of to-do’s (such as med refill requests and lab reviews) on the right. The development team went out of their way to streamline the workflow and prevent “alert fatigue,” which often occurs with competing products when users have so many warnings and dialog boxes to click through that they begin to ignore their contents. Such attention to detail goes a long way in improving the overall user experience.

Creating Patient Encounter Notes: Straightforward and Effective

Along with User Interface, the creation and viewing of patient encounter notes holds special significance to medial staff as it directly effects the bulk of their practice. Along with free text input, there are 3 tools provided to assist in automating note creation, two of which are in development and not yet available.

The current automation method utilizes the use of customized templates that focus around problems highlighted in the problem list (pictured above). For example, if the patient presents with a cough, navigating a series of pop-up menus and checkboxes directly relevant to cough are easily accessible and will highlight pertinent positives and negatives in the patient note. We were particularly fond of the final versions of the notes that were generated with these templates. In my experience, using templates often creates wordy sentences that are difficult to quickly navigate at a glance. Epocrates EHR avoids this by simplifying the final note with short phrases such as: “(+) fever, (-) chills.”

Future updates to the program plan on integrating voice-to-text transcription using the Nuance Speech Recognition engine. We were not able to see these features, and look forward to their release.

Electronic Labs and ePrescribing: The Epocrates Advantage

The Epocrates Mobile App is most widely used for its medication prescribing database and guidelines, and this database is seamlessly integrated into the ePrescribe workflow. When the physician enters the electronic medication prescriptions, the corresponding Epocrates drug information is displayed on a small window pane along the right edge of the screen. Wielding this trusted database in this manner is a major advantage to this service.
Likewise, the Epocrates EHR allows for the simple entry and retrieval of patient labs. Arrangements have already been made with major medical diagnostic laboratories, including Quest Diagnostics and LabCorp, allowing for automatic viewing of patient lab results.

Coming Soon: iPhone/iPad Apps, Speech Recognition, etc

As mentioned earlier in the app, the Epocrates team is committed to upgrading and enhancing their EHR service. Soonest to arrive is a mobile app for the iPhone that is planned for release over the next several weeks. This app would be a simplified interface for the EHR service that is more focused on the basic tasks for the physician, such as viewing schedules, viewing patient charts, writing prescriptions. For more thorough chart dissection or encounter note modification, clinicians should be able to access their EHR from any web-connected computer, as the data is stored on Epocrates’ own remote servers.

Another significant feature is planned with the arrival of the iPad app, which would allow the clinician to access all of the complex features of the service right from their iPad. This would allow for clinicians to carry out the encounter simply from their iPad, and holds a lot of promise for drastically simplifying the work flow and allowing for more face-to-face interaction with the patient. Also, the development team told us that the iPad app would allow for some off-line syncing of data, and would be able to accommodate small interruptions in internet connectivity.
The last important feature in development that the Epocrates team was able to share with us was the inclusion of Nuance’s Speech Recognition software when creating patient notes. Although we were not able to test out the real-life practicality of this service, the Nuance-powered experience should resemble the industry-leading products that Nuance provides.

Room for Improvement:

Without being able to use the demo first-hand, we cannot speak to any specific bugs or troublesome issues that might arise with regular use. However, as mentioned earlier, Epocrates EHR is a web-based service and the fact that local interruptions in internet connectivity could significantly disrupt the service is troublesome. Thankfully, the iPad client that is currently in development should solve this issue, as it will allow for off-line access and saving of data.
Also, as a resident physician, I have a soft spot for medical education and I think the current pricing scheme makes it difficult for adoption by medical residencies. My current medicine residency program’s outpatient clinic is a fairly small practice staffed by about 7 attending physicians, but there are approximately 35 residents who would be considered as “paid users” or “clinicians.” While I understand that Epocrates is taking a gradual, deliberate approach into the market, educational discount pricing would be helpful.

Conclusion: A Worthy Competitor

Epocrates wisely selected their target audience for their first entry into the competitive arena of EMR/EHR’s by focusing on smaller outpatient clinics based around less than 10 physicians. For a small owner of a group practice, there is an dizzying number of competing products advertising similar features and few distinctions. Epocrates, via their prominence in the medical app field, provides a welcome and trusted name, especially to the more tech-savvy physicians. With Epocrates EHR, physicians have a solid and rapidly developing groundwork that utilizes the strengths of Epocrates (eg. including drug prescribing information on the prescription entry screen). And with their successful funding and market-leading mobile app, Epocrates has the financial support and resources to continue innovating and upgrading their services.

There is reasonable cause for concern with the fact that Epocrates EHR is a newcomer with some features still in development, and is a web-based app relying on a steady connection to the Internet. However, it is this same focus on new and upcoming technology that makes Epocrates EHR a promising service and differentiates it from its more “old-fashioned” competitors. If I were choosing a new EHR to start a practice with, I would highly consider the Epocrates EHR.

by: Brittany Chan, MS3

Medical training is dotted with a series of milestones that we dread until the moment they arrive and look back on with some degree of bittersweet nostalgia. I am now happily in my third year of medical school and done with the dreaded USMLE Step 1. One of the apps that helped me get here was First Aid Q&A for the USMLE Step 1, by Modality, Inc.

The First Aid series is one of the most trusted resources among medical students. Published by McGraw-Hill and written/edited by a group of physicians and medical students, it is a great resource. As an app, it costs $44.99, almost exactly the same price as the book of the same name. Here, we look to see if it is just as valuable.

This app features almost 1,000 practice questions to help students ace Step 1. Seventeen subject areas are covered, including:

• Behavioral Science
• Biochemistry
• Embryology
• Microbiology
• Immunology
• Pathology
• Pharmacology
• Cardiovascular
• Endocrine
• Gastrointestinal
• Hematology-Oncology
• Musculoskeletal and Connective Tissue
• Neurology
• Psychiatry
• Renal
• Reproductive
• Respiratory

Upon entering the app, users are greeted with the welcome screen (above). From here, you can create a new quiz, view saved quizzes, use the question browser, or view your cumulative stats.

My favorite feature was the question browser. Here you can answer questions by topic and receive feedback and explanations immediately. Answering questions is easy and simple – select your answer choice with one tap, then tap “Check Answer.” The app will instantaneously inform you if your answer is correct or incorrect. From there, you can view the rationale for the correct answer. Unfortunately, your answers are not saved in question browser mode, so the questions you do here are not recorded in your stats. The question browser also has an option for “reference mode,” in which correct answers are automatically displayed.

In quiz mode, you can create a custom timed quiz for yourself. This mode allows you to select topics you wish to be included in your quiz and set the number of questions in the quiz as well (up to 50 at a time). The timer, visible in the upper right-hand corner, gives you one minute per question, which is slightly less time than you will receive on the actual Step 1 exam. Your scores from these quizzes will be recorded in your cumulative stats.

You may also take one of seven pre-set timed quizzes in quiz mode. Each quiz contains 48 questions different from the ones available by topic, providing you with an additional 336 practice questions.

Finally, you can easily monitor your performance right within the app. Performance statistics can be viewed by subject section, completed quizzes, or all questions answered, allowing you to assess your strengths and weaknesses with just a few taps.

Overall, this app makes USMLE Step 1 preparation faster and easier for busy students.

Pricing:

• $44.99

Likes:

• No need to carry around another book!
• Friendly user interface and easy navigation within the app.
• Instant feedback and explanations –no need to keep flipping to the back of a book or calculating your own percentages.
• Ability to bookmark questions that you wish to return to at a later time.
• Automatically records your performance statistics.

Dislikes:

• Recent update requires an Epocrates login to use the app.
• Impossible to annotate questions, explanations, or cross out answer choices.
• Though the price of the app is approximately the same as the list price of the book, the text may be purchased at a significantly lower price online.

Conclusion:

• This app allows students to answer questions and receive feedback quickly, without the inconvenience of having to flip back and forth in a book.
• It is also a great choice for students on the go, who can answer questions on their iPhones whenever they have a few spare minutes.
• If you’re a student that needs to highlight, underline, and mark out answer choices while answering questions, this may not be ideal for you, as annotations are not currently possible.
• However, its ease of use made it one of my favorite study tools, and I found it highly useful.

While there are very few things in life that are free, the developers of the popular Epocrates line of apps beg to differ.  For the first two weeks of August, Epocrates Essentials will be available to download FREE to all medical students who attend an accredited school. This is quite a good deal, as the original value of the app is $159.00.
In a previous post, we weighted the pros and cons of the Epocrates Essentials app and recommended it for download. With this current promotional offer, it is definitely something to take advantage of. The app is available to download for numerous platforms including iOS, Android, BlackBerry, Palm OS and Windows Mobile.

The product page gives additional insight on Epocrates Essentials:

“Our information is developed by healthcare professionals and specifically formatted for the mobile devices listed above.  The Epocrates Essentials premium drug and disease reference provides reliable clinical information to you at the point of care. Select from the available platforms and learn about the helpful features included, like the integrated disease database with conditions, plus over-the-counter medications and hundreds of diagnostic and laboratory tests. This product also includes continual free updates and medical news!”

The process to attain the free Epocrates Essentials app is fairly simple. The first step is to go to the website and create an account. Next, the accredited med school is selected, followed by a guided process that shows you how to download the appropriate version of the app. It’s that simple! Don’t miss out on this great deal, as it will expire very soon!

Last week, Epocrates announced the availability of its long-anticipated EHR platform cleverly named Epocrates EHR .  Targeted to small and solo physician practices, the service is a web-based software-as-a-service platform which will be offered on a monthly-subscription basis. At launch , it includes a native iPhone app that appears to include access to patient records as well as e-prescribing functionality, with iPad support reportedly in the works. Epocrates EHR will also include support for billing/coding, data analysis and reporting, and an interesting task-management feature. Missing at launch is the SpeechAnywhere feature, which integrates Nuance’s cloud-based medical speech-recognition technology to allow for rapid mobile dictation.  We commented earlier in the year how the speech to text feature would be a game changer, and are disappointed it’s not going to be integrated at launch.

There are several factors that make this offering particularly unique and raise some interesting questions. First, given the wide-spread brand recognition, Epocrates is likely to be successful in signing up customers in its target audience. Since all data is stored remotely by Epocrates, they will be in a position to gather information on populations that would otherwise be left out of large prospective and retrospective studies typically run out of large academic centers.

Also, it will be interesting to see how Epocrates integrates its mobile app offerings with its EHR. Included in the EHR packages are both the Epocrates Essentials iPhone app as well as Epocrates Online, a web-based resource for keeping up with medical literature. Currently, it is not clear to what extent the offerings – Epocrates EHR and Epocrate Essential – are functionally integrated nor whether Epocrates has any plans to integrate its newly acquired Modality products into its EHR offering. We can be sure though that if anyone is going to integrate mobile medical apps more directly with an EHR, it’s going to be Epocrates.

However, this also raises a notable ethical question. As we pointed out recently, Epocrates main revenue source is from pharmaceutical companies, particularly through sponsored offerings built into Epocrates EHR like DocAlert and Mobile Resource Centers. In its recent statement to the SEC, Epocrates even acknowledges the importance of this revenue source and plans to grow it further by improving its free app portfolio. So where exactly does the EHR fit into this – is it being effectively compartmentalized from the rest of Epocrates which is largely driven by pharmaceutical revenue, money these companies are spending to influence physician prescribing practices? Is that even a responsibility Epocrates has?

We’d love to know what you think. Would you mind using an EHR in your practice that has a close relationship with pharma?

Nearly one month ago, iMedicalApps took a closer look at how pharmaceutical companies were driving production of our favorite apps, including Epocrates. Through services like DocAlert, Virtual Representative, sponsored disease-specific resources, and more, pharmaceutical companies are redirecting their large marketing budgets to the medical app world.

And while this trend certainly isn’t limited to Epocrates, they were highlighted yesterday in the New York Times . In the article, the concern for pharmaceutical companies influencing prescribing practices is apparent, particularly as the article highlights claims from Epocrates that services like DocAlert increase revenues for pharmaceutical companies.

Unfortunately, thats where the article stops. It fails to delve into why this is the case – why one of the most popular medical apps is largely pharmaceutical financed.

The answers are simple:

1. It costs money to develop and maintain medical apps, especially ones that contain large databases and repositories of medical information that are dynamic and often changing.

2. The pharmaceutical industry is hungry for the attention of doctors, who individually wield enormous economic power by their prescribing habits. While the article seems to lament this fact, it fails to acknowledge the underlying issue – if we want to have resources like Epocrates be free of pharmaceutical influence, then ultimately that means that we, providers and patients alike, will have to pay for it.

The medical app industry is a big business, but the apps are no longer the product – the physicians, nurses, and other healthcare providers who use them are. In the first part of this series, we examined some of the financial forces driving the medical app industry. Our focus then was Epocrates, the veritable founder of the industry. As is clearly stated in their recent SEC statement, Epocrates primary revenue stream has become the pharmaceutical industry and as such a key goal has become to further grow their user base by enhancing their free offerings.

Now, one might be tempted to say that this is just one company or even that it is just limited to free apps. An expected counter-example would be Skyscape, which probably has the largest cache of apps of any developer and nearly all for fee. As a private company, there isn’t much financial data available nor is the website particularly forthcoming, but it does appear that the company has been enjoying some success. A deeper look however suggests they in fact have more in common with Epocrates than you may think.

In 2009, Skyscape became part of rather complicated web of companies when it was acquired by Physicians Interactive Holdings (PIH), a “direct to healthcare provider” marketing company. The PIH family includes several holdings and services that provide marketing services to healthcare providers, including:

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Skyscape is one part of this rather complicated web, which is actually ultimately owned by a large holding company called Perseus. That brings us to a far larger web which includes various pharmaceutical and device companies including Cardiac Sciences Corp, Ascenta Therapeutics, PhotoMedex Inc, and others.

For now, we’ll just stick to Physicians Interactive, where it’s clear that there is movement to develop Skyscape as another marketing channel. One example is Skyscapes eGuides, free conference guides that, according to PIH,

provides sponsorship opportunities to life science companies, allowing them to reach thousands of HCPs in a new venue and format.

Another program, RepAssist, allows pharmaceutical reps to purchase suites of Skyscape apps and distribute them for free to physicians. There are many other similar examples of integration of medical apps and pharmaceutical marketing – eResource Centers, Smartlink, and MedAlert are a few.

So what’s the point? Quite simply that the financial trends, namely pharmaceutical marketing investment, are not isolated to free apps. This is by no means an argument for or against pharmaceutical marketing – it’s merely a look into the realities of the industry. Ultimately, the incentives of our current healthcare structure mean pharmaceutical companies will continue to aggressively market their products to healthcare providers. As healthcare providers, it is important that we know about the factors shaping the content at our fingertips. Only then can we become the drivers, instead of the followers, of the coming changes in medicine.

We’d love to hear what you think about the partnership of free medical apps and pharma via our comment section below.

Medical apps are becoming big business. Epocrates is now a publicly traded company worth nearly $500 million. Medscape is owned by WebMD, another publicly traded company worth nearly $3 billion. Despite the clearly powerful financial factors at play here, the most popular and comprehensive apps are free. Even for fee-based apps, the prices and volumes don’t explain the overall financial pictures of the companies behind them. Clearly the money is not coming from the physicians, medical students, and other healthcare professionals who are using these apps.

In the past ten years, there has been a growing movement to restrict marketing of drugs to physicians by pharmaceutical companies. As a result of programs like the PharmFree project, traditional marketing avenues like free samples, sponsored dinners, and so on have become far more limited. And so naturally, pharmaceutical companies have looked to new avenues through which to reach physicians.

So what’s the connection to your favorite apps?

Epocrates was one of the first medical apps, a mainstay on the Palm devices of physicians over a decade ago, and remains one of the highest quality and most popular medical apps available. In the past, access required a rather substantial subscription fee. However, recent company filings note that the subscription base has shrunk substantially, with far more users opting for the free app. And yet the company is recording tremendous growth. A statement in the companies recent SEC filing makes it clear how:

Through our interactive services, we provide the healthcare industry, primarily pharmaceutical companies, access to our user network to deliver targeted information and conduct market research in a cost-effective manner.

These targeted services include the features that many users have seen develop in recent years. DocAlerts are short clinical updates which can be sponsored by pharmaceutical companies (e.g. Lipitor manufacturer Pfizer sponsoring an alert related to heart disease); the virtual pharmaceutical representative service allows physicians to reach companies for drug samples and product information; formulary hosting for insurance companies allows physicians to identify coverage for medications they prescribe.

And these activities have been quite lucrative, generating $23 million in the first quarter of this year, nearly four times as much as subscription revenue in the same period. Furthermore, it’s an area we can expect to expand as they note planned offerings for more sophisticated drug sampling services, among other things.

Now this should not be misconstrued as a rant about pharmaceutical marketing or as questioning the integrity of folks at Epocrates – with regard to the latter, Epocrates makes it clear in their filing that the medical content is independently generated and that sponsored content is clearly identified. Besides, as we shall see in Part II, this trend is much broader than just Epocrates.

Frankly, Epocrates is an app I use on a daily basis and has been a fantastic, trusted asset. And as can be seen even on our own site, pharmaceutical marketing is present in numerous medical forums.

What this is, however, meant to illustrate is simply that providers should be conscious of the forces at play in medicine. Whether it’s the way pacemaker manufacturers work with cardiologists, the proliferation of same-day surgery clinics while urban ER’s shut down, or the motives behind the $4 Wal-Mart formulary, there are a lot of powerful yet hidden financial currents driving medicine. Unless physicians become more proactive and vocal as industry leaders, we will find ourselves in surprising territory.

One statement in the filing is particularly poignant in this regard:

A key focus of our business during 2011 and beyond is to strengthen and maintain our user network and generate revenue from our interactive services. We intend to devote significant resources to enhancing the clinical functionality of our free offerings and more actively focus our marketing efforts on increasing awareness and adoption of these products and services.

The app is no longer the product – the physicians who use it are.

Part II will look at other popular developers facing similar trends, some of which is quite surprising.

Pill Identifier Lite :  Head-to-Head comparison Against pill identifiers in Epocrates and Lexi-Comp

Pill Identification can represent a challenging but occasionally even life-saving endeavor for healthcare professionals and the general public.  Examples where pill identification techniques can be of great assistance include: an ER physician diagnosing beta-blockade toxicity in a bradycardic patient or oral hypoglycemic toxicity in a seizing patient, parents discovering an unknown stray pill in their teenager’s belongings, an EMS finding an unresponsive patient who overdosed on opiates, or a hospitalist unraveling an elderly patient’s antihypertensive regimen in the setting of acute renal failure.  Thus, pill identification is often crucial in clinical practice.

On June 1, 2011, the Pill Identifier Lite App for iPhone from Drugs.com hit the #1 spot in the paid medical app rankings in the iTunes App Store.  This App, based on the Drugs.com Pill Identifier Wizard website (here), aims to help users identify pills by color, shape, and imprint from the convenience of the iPhone or iPad.

Read below the jump to see how the Pill Identifier Lite stacks up against the Epocrates (reviewed here) and Lexi-Comp (reviewed here) Pill Identifier functions, concluding with a direct comparison:

Of note, Pill Identifier comes in Lite and Pro versions.  The Lite version requires connectivity to view images, while the Pro version includes these images without connectivity required (and no ads).  Here, we review the $0.99 Lite version.

The Pill Identifier Lite app start screen quickly explains how to get started in finding a medication, offering the tip of using a space to separate front and back imprints when searching.

The app is simple and streamlined, offering only a search screen.

In addition to featuring popular searches, the search screen offers options to refine the search by shape or color.

The Pill Identifier Lite app offers “search-as-you-type” functionality, facilitating a more robust search.

Once a medication is chosen, “Pill Details” offers basic information such as manufacturer, strength, pregnancy category, and CSA schedule, as well as links to pill images and drug information.  Notice the advertisement on the bottom, an unfortunate feature of the Lite version of the app.

Clicking on “View Images” loads (over several seconds) information on use and pregnancy risk from Drugs.com, images of both sides of the medication, and further resources on the medication (links to side effects, drug interactions, drug class, etc.).  However, all of these various sections are interrupted by ads.

The “Drug Information” link, after loading and interruption from ads, features further links to the information that would normally be found in a drug reference program.  However, unlocking the information here requires further links and loading to reach separate parts of the information that could otherwise be easily obtained through MedScape, MicroMedex, or Epocrates.

Read on to see how Pill Identifier Lite compares to free versions of Epocrates and Lexi Comp.

Anyone that has turned on a television in the past week knows that global political conditions are creating new waves of fear over potential economic catastrophe. The crisis in Libya, protests in Iraq, and even hints of unrest in Saudi Arabia have set off a sharp spike in oil prices in the United States, with concerns growing to a point that some politicians have even proposed tapping the strategic oil reserve. During a nascent economic recovery, oil price shocks are certainly not a good thing and investors are clearly beginning to get a bit antsy.

I suppose no one told the folks buying EPOC, a.k.a. Epocrates. According to a report from investment firm Ernst & Young, IPO’s have surged in the first quarter of 2011 with 26 offerings raising nearly $10 billion dollars. Included in that report as one of the top-performing IPO’s of this year is Epocrates, which went public on February 1st. As of March 7th, shares were up 49% from their initial offering price of $16. That equates to a value of $563 million.

While that’s certainly exciting news for Epocrates, its investors, and mHealth enthusiasts in general, there are plenty of skeptics out there – and they may have a point.

As we discussed in our initial post on the IPO, Epocrates value largely relies on one key fact – it has access to a very high value demographic. With approximately one million health care providers using Epocrates across a variety of platforms, there are naturally a lot of medical device companies, pharmaceutical companies, and others who would be willing to pay for access. However, some industry observers, Andy Obermueller in this piece, raise concerns about the excitement surrounding Epocrates.

(1) He notes with concern that Epocrates current paying subscriber base has been shrinking yearly, from 32% of all users in 2007 to 9% in early 2010. While this has been a significant revenue source, it certainly can not be relied on the future.

(2) He argues that the usability of Epocrates as a marketing channel to healthcare providers is flawed. If only 9% of users think Epocrates is “worth it” to upgrade, he wonders why they would pay attention to any marketing information that comes through this channel. Second, he argues that as soon as Epocrates tries to monetize this asset, its users will flee.

(3) He argues that Epocrates is largely doomed to becoming obsolete as EMR’s become more comprehensive and supplant Epocrates and similar apps. He makes a fair point that institutions, fearing liability issues, are likely to eventually bar providers from using many apps, particularly those supplying drug dosing information.

Some of the points are fair critiques of where Epocrates currently stands, but I think the overall position reveals a lack of practical understanding of the healthcare system for a number of reasons.

When Epocrates first opened up shop in 1998, it was entering what, at the time, seemed to be a niche market – providing medical reference tools on PDA’s. Turns out, what they were really doing was catching the leading edge of a transformation in medical information technology, largely powered by developments in the consumer telecommunications industry. And they have now ridden that wave into a wildly successful IPO yesterday. And in the setting of an otherwise relatively anemic market and modest gross economic growth, their success is only that much more impressive.

After the first IPO attempt in 2008 was put on hold in the setting of a collapsing global economy, the company refiled with an initial plan to raise $75 million. According to Bloomberg Businessweek, Epocrates (EPOC) made an offering of just over 3.5 million shares at an initial price of $16, demonstrating a fair amount of optimism on the part of the company given that analysts expected somewhere between $13-15. According to Reuters, not only did they raise nearly $90 million in capital, the EPOC ticker symbol spent the entire day with a green arrow next to it as it gained over 20% in some pretty high volume trading considering the size of the company. While this is obviously great news for Epocrates, its also has some pretty big implications for the mHealth industry as a whole.

A huge IPO. A $15 million acquisition of Modality. A recent partnership with Pfizer. Epocrates has made some big moves lately. For a company that lost money last year, that may be surprising. But as Francis Gaskins, president of IPOdesktop.com, puts it in an interview with Reuters,

They have a million doctors (registered as users) and a lot of those are free apps, so they will want to monetize those eyeballs and that’s what people think will happen here.

So if Mr. Gaskins is right, investors are basically betting more on the audience being catered to than the products themselves. Given that Epocrates has a product used by 45% of US physicians, is planning on launching an EMR service, and is may be heading in the direction of a formal nationwide medical alerting system, that’s a bit surprising if true. What it suggests is that other future innovators in mHealth may be supported in large part by industries trying to reach clinicians – pharmaceuticals, device manufacturers, advocacy groups, etc – rather than the actual clinicians themselves. While this is not inherently a bad thing, it does mean that as the mHealth sector continues to expand, it will be important to take some of the same steps that academic medical institutions, medical literature, and others have taken to maintain their own integrity given potentially conflicting interests.

And on a complete aside, just over a million privately held shares were sold in the IPO as well. So while there are probably a lot of people celebrating at Epocrates right now, I’m guessing there are a few that are celebrating just a tad more than everyone else.

By: Amit Patel, MD

Which Medical Reference Tool for the iPhone and iPad is the Best?

In this comprehensive review, iMedicalApps compares the free versions of the six of the best-known medical drug reference apps for the iPhone/iPod touch/iPad:

*Epocrates
*Lexi-Comp
*MedScape
*Micromedex
*Pepid
*Skyscape.

All of these apps excluding Epocrates and Pepid are also customized for the iPad format. This review concludes with our analysis of the strengths and weaknesses of the various mobile medical reference applications — and how they can be utilized in the clinic setting.

Continue on for the Analysis:

Epocrates

Epocrates, which recently came in at #4 in our Top 20 free iPhone Medical Apps rankings is a useful medical resource for both the physician and trainee. Celebrated as the first legitimate medical application for the iPhone, we provided a full review of the Premium versions of the app (which runs between $99 and $199 yearly) in February. The basic free version of the app, however, is still useful in its own right. One of its strengths is its Pill ID feature, which facilitates identifying medications based on descriptions and pictures of the actual medication pills, a fairly unique highlight among the apps compared in this article.

Another strength is the app’s Medication InteractionCheck, which is useful for checking drug interactions, but somewhat more cumbersome to use and inclusive of less medications when compared to the Interaction Checker offered by MedScape and depicted below.

Downsides to the free version of the Epocrates app include MedMath (its medical calculator, which lacks in content compared to other free medical calculators we have reviewed, particularly MedCalc ( iMedicalApps review) and other functions that require the paid subscriptions (including Disease monographs with treatment options, Infectious Diseases, and an IV compatibility checker). In short, most of the free Epocrates’ functions may be outclassed by the apps below, but its Pill ID function is both unique and useful.

Epocrates, the venerable medical reference company, has bought Modality – a prolific iOS app making company.  With the launch of the App Store by Apple, Modality bet big early by focusing on apps and were the first large company in the medical educational app space – boasting titles such as Netters and Procedures Consult and bringing them to life in a mobile and aesthetically pleasing form.  We have reviewed quite a few of their apps and more often than not come away impressed [click on links for full reviews by iMedicalApps].

Although Modality does boast a wide variety of medical apps, they have worked on non-medical apps as well.  It will be interesting to see if this partnership will cause Modality to focus more on the medical and health care aspect of app making or if they will maintain their non-medical educational component.

This is clearly a move that makes sense for Epocrates. From the press release, it appears they are eager to use Modality’s mobile app development expertise for medical app making – possibly for an iPad customized Epocrates app?  Remember, Epocrates still does not have an iPad customized app. To those who might be unaware, Skyscape came out an iPad customized version of their medical reference app many months ago – currently I defer to Skyscape instead of Epocrates when using my iPad to look up medical reference information.

From an educational component, this deal has huge ramifications for Epocrates.  If you look at the extremely popular MedScape app – it has a large educational component that has helped make it number one in our top 10 free medical apps list.  Modality knows how to develop great educational modules, and Epocrates would be shortsighted not to add educational functionality to it’s app in the future.

Android and other non-iOS smart phone users could be left out

One area of concern for Android and other non-iOS users – Modality is currently focused on making apps in the App Store – not Android. They have apps for the iPhone, iPod Touch, and the iPad, but have not ported these applications over to the Android platform.  Of note, Modality works with medical publishers to bring their content to a mobile platform – they do not create original medical content.

This might be why the apps they have made have not been ported over to the Android platform, but it’s also cause for concern to non-Apple device holders.  This is highlighted even more when you see that Epocrates still does not have a premium version of their popular medical reference app for the Android.

Hopefully this partnership will instead allow Epocrates to focus on the medical content, while Modality can focus on bringing the content to mobile form, not only for Apple devices, but other mobile devices as well.

-Prior Epocrates app review by iMedicalApps

Source: Press Release

[Editors note: Tomorrow, we will present an exclusive interview with Doximity CEO Jeff Tangney]

>Doximity is an app that launched in the App store just over a week ago and has the potential to significantly change the way physicians use their smart phones.

The main focus of the app is physician communication and for this, it incorporates an innovative, secure SMS-like text service. But, its real power lies in its deep incorporation of multiple databases of physician and related information. In particular, the makers of the app carefully integrated data from the physician NPI and Medicare databases as well as lists of medical schools, hospitals, imaging centers and pharmacies. What they have produced is a surprisingly refined version 1 product that can quickly answer the myriad of small, practice-related questions that pop-up all day long during a busy schedule.

The depth of integration is evident early on during the registration process. Simply by entering your name and state, your profile is automatically populated with your medical school, residency and fellowship. In fact, the website immediately lists some of your medical school classmates’ specialties and cities, reminding you of old friends and quickly evoking a sense of physician community – similar to the Facebook experience.

From there, one can add “colleagues” to your list simply by selecting from among nearby physicians in your specialty or from your training program. The application also prompts you to enhance your profile with your practice name, group, clinical interests. It even gives you the option to add your publications directly from PubMed. Any of these profile items would show up in a search on the network, so that anybody nearby or even far away looking for a physician with a specific clinical interest can immediately find you. Use of the app is restricted to physicians and verified health care providers.

One of the central features of the app is secure text messaging among physicians. This feature is only available among members of Doximity. In contrast to standard SMS, messages are sent encrypted and archived, thus HIPAA compliant. Importantly, a return receipt is generated informing the sender what time the recipient read the message. As most practicing physicians are painfully aware, the current paradigm stubbornly remains the fax machine and pink message slips. For colleagues who communicate frequently, such as a specialist with a primary care physician or a teams of residents, this feature alone is a remarkable advance.

Other features include the ability to locate nearby pharmacies, imaging centers, hospitals and labs. Any of these can be added to your speed dial list. For physicians with whom you communicate frequently, you can also supplement their profile with their cell phone or back line numbers. Even easier is to include these data in your own “private” profile and then opt to share these with other physicians – again – similar to Facebook.

If the above list of features sounds like the app and its back-end infrastructure were designed by a team with intimate knowledge of physicians’ needs, it is probably not a coincidence. Doximity was founded by Jeff Tangney, co-founder of Epocrates who was its president and COO until leaving in late 2009. The team includes physicians and developers and is advised by other Epocrates co-founders.

Of course, there are a few small glitches in this first version of the app. Despite being iOS 4.0 compatible, it does not always preserve screen state when fast switching apps. Registering for my Doximity account using the iPhone required me to enter information three times before I gave up and used the online portal via my computer. Also, it does allow the ability to add facilities to the speed dial call list if the search function is used.

On the whole, however, Doximity is an impressive tool that shows the advantages of highly focused design and development. It is clear they have used some existing paradigms of social networking – but have also put in privacy safeguards that are essential for health care professionals.

Thus far Doximity seems to be much of its way toward achieving its goal of facilitating physician communication and practice-related information retrieval. Given the pedigree of its creators and lack of financial constraints, it should have a bright future.

For a quick run-through of Doximity features, check out the brief video below.

Tomorrow, we will present an exclusive interview with Doximity CEO Jeff Tangney, and learn how he came up with the idea for Doximity and the vision propelling it.

iTunes link

Epocrates has released the results of its fifth annual Future Physicians of America survey. As reported yesterday by Medgadget, the survey reached 700 medical students who answered myriad questions on their motivations to pursue a career in medicine and what resources they use for medical information. Epocrates, of course, is the maker of the popular mobile drug reference application of the same name as well as more in-depth disease references and a forthcoming mobile EHR application (see our March 2010 news item here).

The exact methodology for conducting the survey was not posted but within the supplied data, it is stated that a total of 710 responses were analyzed and that “Students [were] randomly selected to participate”. Click here to see Epocrates’ press release on the survey.

As with all surveys, results are necessarily skewed by selection bias. In this case the respondents all use Epocrates software and thus one would assume already demonstrate an increased interest in mobile medical apps compared to the total cohort of medical students. However, since the methodology has not changed over the last few years, one could also infer that trends within the cohort are reliable and may at least partially reflect trends within the larger group.

To download the complete results from the survey click here: PowerPoint

With that in mind, here are a few of the many interesting results:

• cohort year in medical school – 4th year: 46% – 3rd year: 34% – 2nd year: 15% – 1st year: 5%
• place you are most likely to turn for information increased over the last year for “mobile” from 19% to 34% while decreasing for internet from 52% to 33%
• current smartphone usage was iPhone 69%, Blackberry 14% and Android 11%
• 42% of respondents stated they are planning on buying a new device in the next year
• of these, 64% were planning on purchasing iPhone (iOS) device, 24% Android and only 4% Blackberry
• having an electronic health record is a very important factor for 70 percent of medical students in deciding where they will practice medicine.

Overall, the results show increasing use of mobile medical software. Blackberry seems to be losing interest among medical professionals, at least among medical students. We will be curious to follow the results of the survey in future years.