Drchrono | Daniel Kivatinos

 

About Michael Nusimow & Daniel Kivatinos

Michael is co-founder and CEO of Drchrono. He has worked as a software engineer since 2000. He had implemented components of the Bloomberg Terminal, used by customers worldwide. Michael has a B.E. in Computer Engineering & Computer Science from Stony Brook University. Michael attended Columbia University in Information Systems.

Daniel is co-founder and COO of Drchrono. His focus has been in the technology space since 2001, as a software engineer and entrepreneur. Daniel holds an M.S. in Computer Science and a B.S. in Computer Science & Psychology from Stony Brook University.

 

Interview Transcript:

Alan
Welcome back. I’m here today with Michael Nusimow. And Daniel Kivatinos are the co founders of Dr. Chrono and welcome to today’s show.

Daniel
Thank you. Thank you for having us.

Alan
Thanks for having me. So let’s go. What is Dr. Chrono.

Michael
So Dr. Chrono is a really innovative technology company in healthcare that’s based here in Mountain View in Silicon Valley. Our primary product is an iPad electronic health record that we launched right when the iPad first came out in April 2010. And that allows a doctor to use their iPad to do everything they need to do when they’re at the point of care with a patient. So when they’re in the exam room with a patient, they don’t need a computer or a laptop, they don’t need any paper medical records are their prescription pad, they can view all of the patient’s information on the iPad, their complete medical history. And they can document their medical encounter that creates the medical and legal record. And they can even do all their medical billing, which runs the financial side of their practice. And there’s a lot of other workflows that are also printed on the iPad, such as sending electronic prescriptions directly to any pharmacy in the US right from their iPad, they can also do lab ordering through quest and LabCorp and other third party labs. So they don’t have to give you a sheet anymore, they can send the lab order directly to the lab. So when you get there, or they take a specimen, they could just do all the ordering there and they’ll get your lab results. So really, everything is just designed to replace all the kind of awkward paper workflows that doctors used to use. And I think it’s a much better workflow on the iPad because they’re not using a computer. And one encounter I had that really inspired me to start Dr. Chrono was I was helping to care for my father in New York City at the time, and I took them to a doctor visit. And I just noticed they were doctor visits where, you know, doctors would be have a thick stack of manila folders with crammed full of paper. And they only have 20 minutes to kind of paging through it, figuring out what’s going on. And you know, my father at the time, like a lot of seniors was taking over 20 prescription drugs, that’s a lot of drugs to kind of look at on paper. And the doctors just seem a little bit hapless, they’re really overwhelmed by the paper and how much time it takes to go through all that data. And then another encounter, we went to Cornell Medical Center, really great Medical Center and the best medical facilities you could go to in the world. And the doctor was using a big kind of big box EMR like a more hospital focused system. And the doctor spent 20 minutes with his back facing me and my father in the exam room, just hacking away in this computer terminal of computers built into the wall. And I could see him interacting with the software, and he’s kind of throwing care over his shoulder. And my father, you know, was just was like, I can’t believe we waited three months for this visit, the doctor never even looked us in the eye. He didn’t ask me how it was doing. He’s just kind of moving the case along with his computer. And I saw what the software looked like. And it looked like really, this was around 2000 2008, it looked like just really old software even for you know, for 2008 It looked like old kind of you know, Windows 2000, there were software that was just like 10 or 15 years old with, you know, like the old Windows system dialogues and 100 text entries and 100, you know, displays there and it just didn’t look very workflow oriented, it really distracted the doctor. So that’s what we really focus on doing with the iPad is you know, it’s very natural, the doctor could hold the iPad, keep eye contact with their patient, there’s not a lot of typing. So it’s an input device that, you know, is not super engrossing, we use a lot of touch inputs and speech to text technology. And we give all that away for free. So we give that tool completely for free. The doctors, they could download it from the iTunes App Store and start using it for free. And we’re certified for the government’s meaningful use program which which actually earns doctors who use our free software 10s of 1000s of dollars in government incentives. And we monetize by taking over the Doctors Medical Billing, and practice management. We give them software, they do it and we also sell them separate services to help them do all of that for them. And that’s how we monetize which is something doctors are already paying several 100 to several $1,000 a month for. So we’re giving them this really cool mobile focused EHR for free and taking over their existing kind of boring back office work taking it off their hands and monetizing by doing that more efficiently.

Alan
I understand both you were college roommates. We were in this this this business. Dr. Chronos start well, you were in school still then ahead you graduated.

Michael
No. So yeah, so So we both went to SUNY at Stony Brook on Long Island. I studied computer engineering computer science and I was in a lot of classes with Dan were roommates for part of our time there. And we each went our separate ways. After school I went to go work at Bloomberg LP in New York City. I was a software developer there for over seven years. And I learned a lot about building software there and great customer service and how you know really successful large company works is very inspirational and Dan went to go work at a bunch of different startups. So we reconnected I guess about seven or eight years after After college to start Dr. Chrono.

Alan
And then and then what brought you from New York City out to Silicon Valley.

Daniel
We were looking for the right investors while we were building the company. So we wanted, we built the company got several users, several paying users, got featured by apple.com. And a really interesting investor. We started having a dialogue with a really interesting investor, Y Combinator. So Y Combinator is really well known in Silicon Valley. And we flew out here, we had a meeting with the Y Combinator partners, and they wanted to invest. So we moved out here with the intention of going back to New York City, after being here for three months. So Y Combinator has a program that’s a three month program, they invest in your company, you stay for three months, and then it’s up to you what you want to do, whether it be moved back to wherever you’re from, or stay in Silicon Valley. For us. When we came here, we realized there was a lot of really good talent pool of developers, brilliant people, and investors all around the area. And essentially, what that did is it we saw value in that it was very much a plug and play kind of environment where you can start your company have a lot of support, and there’s a lot of support infrastructure. And we stayed, we decided it was more beneficial for us to stay here.

Alan
I’m visiting here today with MichaelNusimow and Daniel Kivatinos they’re, the founders, the Dr. Chrono. It’s a practice management system that doctors use on their iPad. I need to take a quick break. And we’ll be right back after these messages.

Alan
Welcome back, I visiting with the founders of Dr. Chrono, Michael Nusimow and Daniel Kivatinos. And we’ve been talking about how Dr. Chrono came about is that medical practice, piece of software that you can manage on doctors can manage on the iPad. But let me move into why should a doctor think it’s so great to put their their their medical practice on an iPad? How does that benefit everyone?

Michael
I would say initially, the government has passed something called the High Tech Act that was part of a really large healthcare reform package. And they set aside $27 billion in 2008 2009, to actually pay out incentives for doctors to adopt the EHR technology. And there’s also penalties that are starting as early as next year if they don’t adopt the technology. So to the individual doctor, they’re really feeling a pressure to adopt the technology. Because of these government programs, there’s opportunity to get huge incentives now. And they also if they don’t see the light, they’ll kind of feel the heat from these penalties that are looming in the future. There are practical benefits to why the government is asking for EHR technology. I saw from my own personal encounters as a patient and caring for family members, that the majority of health care workflows happening on paper are very inefficient. And just very troubling, it’s very troubling to go in as a patient and have your doctor not know what’s going on with you or just take a long time to kind of get a grasp of what’s going on. So there’s huge efficiency gains to be had. Why and that’s one reason the government is pushing for Eastar.

Alan
So Michael, I’m a doctor my ears perked up 28 billion of incentives yet is that is that designed for, you know, allowed me to transition to to electronic.

Michael
So in a software thing, the Arish, the initial grant for doctors who bill Medicare was $44,000 paid out over four years. And for Medicaid, it’s over $63,000 paid out over several years. And the reason the government chose that amount, is because that’s how much they estimated back in 2007 2008, that an EHR system would cost if they go to a big company that usually sell systems to hospitals, they would sell a system to doctors that cost about 40 to $60,000. And there’s costs for adoption and training. So we give our EHR product away for free. In fact, doctors can download it right on their iPhone or their iPad from the iTunes App Store for free and sign up in under a minute and start using the system. So I think the government at the time didn’t count on innovative entrepreneurs coming out offering a free product that would meet these needs, and kind of the existing vendors in this space who’ve been around for you know 10 20 years, some of the really big box vendors, they primarily sold to hospitals, they didn’t really like selling the small practice doctors, they weren’t geared to it. But the systems were quite expensive. So I think that’s something that we, you know, really offer doctors and I’m really proud of is that we just give them something that they would normally have spent 40 to $50,000 on, they get it for free, right on their iPad, and they can get that incentive money and just pocket it and essentially reinvest it in other parts of their practice.

Alan
And I imagine that helps make an easy sale there. How big are you right now?

Michael
So we have 33 people here in Mountain View, and another 50 People who are outside contractors and consultants who work remotely, and they do a lot of support and support and medical billing for the doctors has kind of outsourced contractors.

Alan
That you made the Inc 500 fastest growing company list. And, you know, that was issued in 2014. So where do you anticipate you’ll be within a three to five year window?

Michael
That’s a really great question, we’re really proud to make the Inc 500 list, I really would like to thank all of our customers out there because you know, we have a upsell product, we product, we don’t just give our product away for free. So I’m really grateful for all of the doctors who buy our paid services to take over their medical billing, because that’s what allowed us to grow our revenue so quickly. And I would say our goal is to really keep growing as fast as possible, kind of true north for us, what I always consider because me and Dan are both software developers, we really care about the product. So there’s a lot of technology things, we focus on just making the product better, adopting new technologies and making them relevant for doctors to start using day to day in their practices. And TrueNorth is really to keep investing in product, really keep growing our revenue. If we made the Inc 500 list again, next year, we’ll be doing amazingly well, if you could keep up, you know, 18 100% growth, you know, every three years, we’ll be doing phenomenal if we can maintain that. And also, just personally, I really care about improving our customer service as well. We’re a real tech focused company. But I think unlike a lot of other Silicon Valley Tech focused companies in the healthcare space service is incredibly important. doctors and health care providers really need a lot of support and training. A lot of them are coming from environments where they were just using paper and didn’t even have a computer in the office. And we’re introducing really cutting edge technology to them. So we have to give them a lot of training and support to get up to speed. And also, I think to be successful in our industry, we just have to raise the bar on supporting our customers and training them better. And I think it’s something we’ve improved amazingly on in the last year. And it kind of shows in our revenue numbers. You know, doctors sign up with us month to month. So it’s great to have amazing technology and grab their attention and get them to sign up. But then we kind of have have to fulfill that contract by giving them really good support and training to keep them paying us every month because if we don’t, they’ll stop paying us after a few months and we won’t be able to keep growing our revenues in a sustainable way.

Alan
I’m visiting here today with Michael Nusimow and Daniel Kivatinos are the founders, co founders of Dr. Chrono. And as a medical practice software that the professional can doctors can put on their iPad, I need to take another break. And we’ll be right back after these messages.

Alan
Welcome back. I’m visiting here today with the cofounders of Dr. Chrono they’re Michael Nusimow and Daniel Kivatinos We’ve been talking about how the company has been putting the the doctors being allowed to put his own medical practice billing and, you know, patient records on an iPad. Which when you started this is really cutting edge. How do you stay ahead of the curve here to keep putting more and more things on the cutting edge? I’m going to just throw out a question of Apple talks about a watch coming out. Or this this wireless, you know, basically saying we’re going to eliminate the computers altogether. Are you for that in the company? Do you see a vision of of that moving down the road? Or how do you stay on the cutting edge?

Daniel
Sure. I could take this question. So I would say that technology moves at a really rapid pace. In the last 100 years. You went from no computers basically effectively. Nothing out there to what we have today. And every single year Lee leaps and bounds of progress are made, whether it be the iPad, whether it be the computer, whether it be a tablet, or an iPhone. One thing that just came out was, Apple had produced something called Health, and it’s an app on your phone. And what this does is this connects all these internet of things, all these devices around you blood pressure, cuffs, glucose meters, software, interesting software, Fitbits, all these things are pulling it into this one way that you could take that data and do interesting things with it. And I see the Internet of Things becoming the next wave of interesting interactions for us as human beings, right? You can even have whatever it might be a sleep apnea device, and you can pull that into your iPhone now. And this is sort of unheard of before, right? So you as the, as an individual, your your health becomes more accountable, you become more accountable for your health. So this is sort of one of the new waves that’s happening. And it’s, it’s hard to predict exactly what these waves are going to be, but they keep happening year after year. And we see what’s happening. And we sort of say this is the future. So we I personally believe in Michael believes that the Internet of Things, all these things coming together, taking that data, giving it to the individual to share with their physicians, it’s definitely something that’s happening right before your eyes, and the Apple Watch has a pulse, right? So you literally will wear an Apple watch, and you’ll get a pulse, a pulse rate on that which you have on your iPhone, and you can share that with your doctor. You’ve never had that before.

Alan
And it just seems that the wearables are the next best thing. You know, the jawbone did, they’re up 24 apple with the iWatch. Now they’re talking about companies coming out and putting the computer right into the textiles that you wear. So, so as you’re developing this and keep in the medical practice, the medical industry, you know, fluid with, with the movement of the rest of technology, what are some of the difficulties that you’re encountering, as you’re trying to, you know, use the cross platforms between the iPad, back in 2010, to Google Glass today, is that easy to stay up with?

Michael
I’d say it’s really hard to build on these cutting edge platforms. But it’s also really valuable. And being a tech focused company, that’s one of our greatest advantages over other healthcare companies trying to sell software to doctors is that we’re always building really early on the next cutting edge wave of technology. So we launched our iPad EHR, in April of 2010, and got featured by Apple really early, because nobody else was building on the platform in the healthcare space at that time. And I feel like now, for over four years later, in 2014, a lot of other of the large vendors are finally starting to move to the iPad as a platform. But we have a huge advantage because we have a very mature product that’s been battle tested and field tested and used by doctors for the last four and a half years. And we keep improving it every month. So we just have a four year Headstart. And even if a company has billions of dollars in reserves, they’re not going to be able to make up for that for years of time by throwing a lot of resources at it, and catch up in a very short period of time. And so I think that’s a huge advantage of us. But it’s very hard to build on these early platforms, you face just technical challenges, because people haven’t done it before in healthcare. And you have to make sure the security and compliance is up to date. And even doubt and kind of fear, uncertainty and doubt in the market. Where I remember when the iPad first came out. There was huge traction among doctors, 10% of the pre orders, there were 300,000 iPads ordered before they came out in April 2010. And 10% of those pre orders were to doctors. So there you in the US, there are 30,000 us physicians who had an iPad on the first day of launch, you could download their app and start using it. So that was a really great early market to have, but they still kind of viewed it. They were a bit skeptical. They’re like, can I use this in my practice to treat patients? Or is it kind of a toy? Is it just kind of like a cool thing to play around with? Or is it a real powerful business tool? And I think now nobody questions that iPad is ubiquitous. It’s replacing laptops. It’s everyone has one people use it at work, people use it everywhere. But at the time, there’s kind of this data, is it kind of just the next fun kind of iPad device? Or is it a really powerful tool you can actually use, you know, to treat patients use it in business.

Alan
So when you’re dealing with the healthcare professionals, I would view then this is just me that they would not necessarily be early adopters. How difficult is it to take the technology to them and encourage them to to adopt that within their organization?

Michael
I would say I think physicians are really great early adopters of tech. They’re fluent. They have money. They’re always buying the latest gadgets like every new iPhone and iPad and you know the Apple Watch I think You know, every physician in the US is going to buy a gold apple watch right when they first come out. So I’m really excited about that platform. And I but I think when you’re dealing with a healthcare organization and the healthcare industry, it’s not just the physicians, there’s also their staff members and nurses and lots of other people who, you know, in the health care system, one way I like to think of it is like an iceberg. When you’re being seen by a physician, that’s the 10% of the iceberg above the water that you see, and the other 90% of health care dollars and effort. And what people are doing in health care is once you leave all the paperwork, all the filing, all the medical billing all the accounting, or the lab works. So that 90% of the iceberg is I think, where the biggest obstacles to adopting newer technology is so the doctors I think, are really big advocates, over 90% of us physicians own an iOS device, an iPhone or an iPad. So they’re definitely early tech adopters there with it, they want to use newer tech, and it’s just that other 90% That’s kind of hidden below the waters, all the medical billing these they’re these huge billion dollar companies you’ve never heard of who just operate on just processing your medical billing claims and moving them around the insurance companies. And that’s where I think the part of the healthcare system we’re kind of dragging forward when we’re trying to adopt new technology.

Alan
So if a person wants more information on Dr. Chrono, where would they go?

Michael
So they could go to our website, Dr. chrono.com, Dr. ch, AR Oh no.com. Or they could just search for EHR, which is stored for electronic health records in the iTunes app store, where the first result there are a search for Dr. Khan on the app store and download our apps.

Alan
I’ve been visiting today with Michael Nusimow and Daniel Kivatinos. They are the co founders of Dr. Pronto. Thank you for being on today’s show. Thank you. Thank you. We’ll be right back after these messages.

 

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This transcript was generated by software and may not accurately reflect exactly what was said.

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