TECH: JSK on PDAs, me on Epocrates, and eRx

The ever wonderful Jane Sarasohn Kahn has written a pretty definitive piece on physician PDA use at iHealthbeat. (Yes, Jane is a co-author and long time friend, so I’m biased, but she is wonderful). It’s called PDAs Reach the Tipping Point . The point is that somewhere between 50% and 60% of doctors and plenty of other clinicians are using PDAs for reference use.

Epocrates is a big reason why. I met with Epocrates’ Michele Snyder briefly at HIMSS. Epocrates has now some 135 people and hasn’t taken any more cash since the dotcom days when it took in $35m. It still gives away its drug databases for free to any PDA user, including a scad of formularies—some 400. It’s got around 500K active subscribers (updated in 6 months) — including 200K physicians in the US alone. The struggle is of course to make money off that database.

They do that by charging for a symptom and diagnosis checker ($60 a year each or $149 for the lot) and by charging health plans and PBMs to show their formularies. In addition they have 130K physicians in a market research panel which you can ask questions of, for a fee of course! Doctors can even do CME short credit courses on the device. And one of five of their alert messages are sponsored, so there is a little advertising, but less than on a prescription pad. And apparently using the database is worth it for doctors

Let’s use one of Epocrates’ findings from the Brigham and Women’s study to calculate potential revenue savings generated by using a PDA for drug reference information alone. The study found that 35% of Epocrates physicians saved at least 30 minutes per day. Assuming the average physician generated $1.26 a minute (according to the MGMA’s 2004 physician compensation survey), using a PDA for drug reference could produce about $10,000 a year saved for a single physician. Now, consider additional applications for the PDA and what they could generate in productivity savings (and thus income enhancement). Epocrates’ recent survey on Medicare Part D offers another factoid to consider: 70% of physicians surveyed believe accessing Medicare Part D formularies via Epocrates software will help them save at least an hour per week. These time savings would be in addition to the drug reference savings already calculated.

Of course the key question is whether the PDA as a platform becomes a transaction tool rather than just a reference tool. Palm, whom I met with last week, of course hopes so, and has recently brought out a Windows mobile version of its Treo to increase its range in health care—as well as other industries. (Epocrates already ran on both systems, but some ePrescribing tools like Zix were Windows only). It’s also worth noticing that cell phone penetration amongst docs is in the 90% range, and that the integration of PDA capability into the smart phone makes it easier to get transactions into the work-flow. When everyone’s used to getting email on their smartphone, eRx will fit right in.

In fact JSK has a list in her article of PDA applications in health care. Several (like PatientKeeper) are looks into larger health care IT systems, and Allscripts’ Touchscript is probably the leading eRx application—a transactional system. So this is coming together. And as we told you in our recent piece, the infrastructure is being laid so that the eRx applications can get to the pharmacy work-flow and improve efficiency in the pharmacy and the physician’s office.

Now we just have to beat the clinicians to the point of pain to make them use it!


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5 replies »

  1. Can’t wait for full Epocrates on Iphone now. I wasted my time with windows mobile devices , had to change three times and they suck. Iphone version is very well discribed with pill pictures, worth looking into.

  2. All great comments. Quick response
    Kevin. I agree. PDAs may be too small for EMRs. But for charge capture, looking up lab results and eRx, they’re big enough. For most docs, that’s as much as is needed for EMR for now…and better than paper
    Dan. You’re right but Jane (the $1.36 it’s a number she’s taken) is guessing that a doc is thinking in terms of their income not their practice revenue. And the main point is that while Palm and EPocrates are being widely used, eRx is not even though it’s probably a money saver for the rpactice overall. That’s what has to be “beaten” into the docs
    JQ. Sure. Any company is going to overstate their numbers. They claims that the 500K have updated/synched in the last 6 months. My guess is that to really increase the usage they have to combine their date into more workflow (especially eRx). After all if the use of it is not directly connected to an eRx, but is sometime before or after a paper script is written, how can you really tell anything about its influence on formulary compliance, error reduction, etc….

  3. I have been following PDAs, and ePocrates in particular, for many years. ePocrates’ penetration among physicians may not be all that it seems. I have always been bothered by the following things:
    –Of their INSTALLED user base, how many are syncing? How often? If you investigate, you’ll find that well over half of their users haven’t sync’ed in over 6 months. That isn’t the number that gets quoted. Their ACTIVE user base is much, much smaller. Even smaller yet is the active physician user base. And are these users the ones looking at a lot of pages?
    –What pages are users looking at? ePocrates records every page click. Even active users don’t use the product as much as ePocrates leads you to believe. It is my understanding and belief, however, that they don’t sell personally identifible data (but they must sell aggregated data.)
    –All of their “study” data is self-reported. Can they tell if their page lookups occured immediately before a prescription is written? I don’t see how. All of the data they publish is that perceived by users. None has been proven.
    –Regarding adverse drug event avoidance, how many SIGNIFICANT events were avoided? Likely, few.
    –Why haven’t we seen any data regarding formulary shift? This is, of course, the big selling point for PBMs and Plans to load their formulary on the system. My guess is that they haven’t been able to prove anything. This may not be their fault given the difficulty in doing any kind of controlled analysis.
    Great product but let’s not get carried away.

  4. I don’t think you have to “beat” any such useage into physicians’ heads — most of those who are provided the palms and epocrates use it without much prompting.
    Also, your $1.36 is off — remember that the operating leverage of a medical practice is often 50% or more. In a higly leveraged area like primary care, it could affect revenue much more than $1.36/min. In fact, based on annual collections of $400k / physician, it calculates out to $3.47 / minute (assuming 48wks / 40 hrs).

  5. It seems to me that the PDA’s form factor is just too small to do a full EMR, and there is no productivity in entering free-language text with a stylus.
    When EMR’s make it into the examining room, providing all the PDA does plus much more, it makes no sense for the physician to use two systems. Tablet PCs look much more promising to me.