MobiHealthNews recently had a chance to catch up with PatientKeeper's CEO Paul Brient to discuss how his company's mobile software can help healthcare organizations meet certain requirements under Stage 1 of Meaningful Use; the opportunity for Windows Phone 7 devices in healthcare; the growth of Android devices among US physicians; and why PatientKeeper is toying with the idea of opening up its API to create a new ecosystem for medical app developers.

MobiHealthNews: I read recently that PatientKeeper's software can help a care facility move toward Meaningful Use. How?

Paul Brient, PatientKeeper: Maybe surprisingly, meaningful use requirements do dovetail into the mobile space. Look at meaningful use on the in-patient side: There are a series of things hospitals have to do to meet Stage 1 to qualify for HITECH money, and that will get you to about 40 percent of the overall funding. That's about $6 million for a 200-bed hospital, so we're talking about a reasonable amount of money.

The basic idea behind this legislation is for the government to help the healthcare industry get the stuff implemented that they have had trouble getting implemented in the past. Certain things have gone well and sort of happened on their own: PACS, lab and pharmacy automation are examples of things that really happened on their own.

Getting doctors to put in their orders and documentation electronically has been a particular problem. It has not happened. The penetration rate is in the low single digits. That's why the stimulus and meaningful use are largely focused on those pieces. Interestingly, for Stage 1 requirements, the government backed off a lot on their requirements. Originally it required hospitals to have 10 percent of orders to go in electronically. Now the requirement is that one third of a facility's patients have to have one medication order put in electronically. That's a huge step back. At PatientKeeper, we have a strategy for helping a hospital get to full-blown adoption of CPOE and electronic documentation, which we believe will be required in later stages, but right now just getting to Stage 1 is a lot easier.

You don't really have to do anything with documentation, you just have to do a small piece of CPOE for Stage 1.

As a result we are featuring the mobile offering of CPOE quite a bit because it was designed to help physicians put in orders that are one-off orders from the bedside or for when they're not in the hospital. This mobile offering is designed to get around verbal orders. In fact, in many cases, with the volume of verbal orders alone it's enough to help providers meet Stage 1 requirements for CPOE. And by the way, doctors love this. Verbal orders are a huge pain for them. It's an interesting time and opportunity to be [PatientKeeper] and be able to offer all physician facing components to meet Stage 1 and ultimately Stage 2 and 3 requirements.

Are PatientKeeper's customers doing this today?

No one is doing it yet because regulations were just finalized two months ago. We are engaged with a variety of customers who are doing this, though. They have to be live and doing it for 90 days before they can get any stimulus money. That probably won't happen until Q2 of next year, but this is certainly real from a 'people are buying it and deploying it' standpoint.

When I think of PatientKeeper, I see the company as one of the first to embrace mobility in healthcare and make that a focus. Is that a fair characterization?

Well, we are unique in a lot of ways. We are particularly unique in the way we come at physician workflow, especially the way it relate to physicians who cross between outpatient and inpatient worlds. Traditional HIS companies automate a place: A physician practice or a part of a hospital. At PatientKeeper, we automate doctors. That causes us to cross traditional lines of categories. We are not an ambulatory EMR, but we do have all the ambulatory data. We are not an HIS system that runs your hospital, but we do have all of the data that a doctor needs. What we are about is getting that physician's workflow automated and getting the data they put in to the right place. So, yes, that also requires mobile technology because physicians are not physically present in front of computers. The mobile piece is so fundamentally critical to what we do. A lot of people look at us and say, 'Ah, you are a mobile company.' We say: 'Not really, but as a company that automates physicians, we darn well better have a mobile strategy!'

Since mobility has been a focus for PatientKeeper for so long, how has the trend changed over the years. Is it fair to say it has received much more attention these past two years than in years past?

It has been a huge trend. The reality is that devices today are so much better than they were before. When we were trying to make this work on Treos, Palm Pilots or old Windows Mobile devices, these devices had volatile memories. If a doctor let their device's battery run down, everything would be erased and have to be reloaded. Yet we still had people do it. Today, these devices are computers and we can do so much with them. We can create incredible user experiences. The challenge for folks in healthcare looking at mobile and trying to get on the bandwagon now is: 'Well, which device do we go with?' Sure, you can standardized on the iPhone, yes, a lot of doctors get iPhones. That won't work for those doctors who live in areas where AT&T doesn't work though. Then you can look at Android devices, which are much better computational platforms than the iPhone and they have incredible interfaces. Now Windows Phone 7 is coming out and it looks like it could be really interesting. Also don't count out BlackBerry, they have the security thing nailed. So, it's a really complicated technology environment if you are a vendor. Fortunately, about three years ago we made a huge investment in redoing all of our mobile technology with the notion there would be a variety of mobile platforms coming out. If we hadn't done that back then we'd be dead in the water now.

One of the faster growing category of apps for healthcare providers are what we call "operational" apps. Do you see the flood of point solutions for operational apps available in the app stores as competitive threats?

Well, yes and no. The healthcare space has always been filled with what I'll call "one app wonders" where a doctor maybe went out and built a system for this type of doctor in this specialty. At one point in the practice management space there were 1,500 vendors approved to submit electronic transmission. Obviously those were a lot of one-hit wonders, but it included some major players too. There are still many small, niche-y players out there. That's cool. We don't see that as competition. What we do is the enterprise stuff which connected back into the system. Put your note in here and maybe we will print it somewhere or sync it up to the desktop but we will not allow you to take that note and put it up to your Cerner system or Epic system. It will be interesting to see how those apps evolve. They might work as components for our system. A lot of these apps are medical reference or calculators, which fit nicely in. If someone creates the best dosing calculator ever, then we would love to incorporate that and find the best way to do that. Our original business proposition actually way back in the Palm days was that we had an open API because we envisioned doctors writing apps to work on our platform. We planned to do all the integration work but providing them with our API and all the data they could create an app. We didn't get the timing right obviously. Given that was 2003, though, it's not surprising that it never happened.

Maybe 2010 or 2011 a good time to re-launch that initiative?

It may very well be. We now have 23,000 almost 24,000 doctors using our system. Back when we had 1,000 doctors using our system on Palm Pilots an open API offer probably wasn't that appealing as a channel. If we could say, here's your API to get data, here's how you submit it, here's the tools to sell this thing -- it may be the right time. We have our hands full with all this other stuff, but it's certainly something that's been kicked around here more than once: Do we want to resurrect that as an ecosystem to allow some of these standalone apps to become much more powerful and in turn allow our system to become that much more powerful.

Any other trends going on in mobile health that aren't being discussed enough?

The notion that physicians are all getting a smartphone of some sort [should be discussed more]. Everyone paints doctors as being some sort of Luddite. They aren't when it comes to stuff that works for them. Smartphones have that going for them in spades. The question really will be where will this all go -- we think it's important to certify our application on each device. Trying to keep up with that is nearly impossible. That's difficult for enterprise rollouts. If you are going to do something meaningfully though, it needs to be enterprise software not one-app wonders. It will be interesting to see how that enterprise model reconciles with these fundamentally consumer devices -- with the exception of BlackBerry devices, of course. It's a great question and I have no answer for it.

You mentioned Windows Phone 7 before -- you think that platform has a chance?

I didn't say it had a chance. I said it was a good platform. Does the world really need another mobile platform...

Google says no.

Right, Google says 'no' and, frankly, I agree. Part of me says: 'Guys, please don't foist another one on us.' Windows Phone 7 is, however, another interesting play. Microsoft does have the whole Xbox connection going for them. I'm very skeptical, though. It does seem like 'too little, too late' to me. When the iPhone launched no one thought the world needed another mobile phone manufacturer. I never count Microsoft out. I've seen what Android has been able to do in a short period of time. For the record, though, we are planning to support Windows Phone 7. When we talk again in another three months we should know where it's going.

Last we spoke you pointed to Android as a winning platform, is that still proving to be true?

The more we get to know it individually and through our customers in the field we are convinced it is a winning platform, yes. Still, right now when you look at physicians the predominant platforms are the iPhone followed by BlackBerry. Still, we see very significant momentum on Android. We also still see a remarkable number of Windows Mobile (not Windows Phone 7) users among our user base. Just like anything else, people like to focus on the new stuff, but there still are a lot of physicians using Windows Mobile phones out there. Lots of iPhones, lots of iPads and a fair number of BlackBerry devices, largely skewed by places that own physicians and equipped them with BlackBerry devices. So, Android's growth rate has been huge but it's also still making up a small percentage of our users.

Thanks for your time today, Paul.