Epocrates co-founder hopes Doximity becomes as 'indispensable' as Facebook

Epocrates co-founder Jeff Tangney last week officially launched Doximity, a professional network that helps streamline communication between physicians with a goal of improving the speed and quality of patient care. Doximity, which allows doctors to use their iPhone or Android devices, as well as their computers, to connect with their peers on a secure platform, initially launched (in beta form) in October, and has since grown to more than 7,000 doctors throughout the U.S.

FierceMobileHealthcare recently spoke with Tangney about his newest venture and the future of the mobile healthcare industry.

FMHC: Describe Doximity in your own words.

Tangney: Basically, Doximity links medical professionals through a secure platform, which makes it easier to provide faster, smarter treatments. And that happens in a lot of ways, whether it's helping a primary-care physician find the right hand surgeon, or connecting an interventional cardiologist who speaks Mandarin to the right expert for that patient, or just coordinating with other physicians who might be treating the same patient.

Let's say I'm a primary-care physician and you just finished your LASIK surgery and you're back in my office and I need to shoot a quick note to the ophthalmologist who did the procedure; I need a secure way to do that, and it's not worth really all of the protocol and overhead of a phone call. What we allow them to do is send a secure text message--HIPAA compliant--from their iPhone to an Android device or a website, and just have that network of colleagues that they have that they can message with.

FMHC: Where do you expect Doximity to be one year from now? Five? 10?

Tangney: Our No. 1 goal for I'd say the next one- to even five-year time frame is just to make sure that we can reliably and quickly answer these communication problems with doctors. Today, a lot of the cost of medical care and a lot of the errors in medical care are due to communication breakdowns.

If you look at how residents and younger doctors are trying to address this therapy, they're SMS texting each other. But that's not legal, they can get fired for doing that because it's not HIPAA compliant. So in the age of instant communication, really the only secure ways for doctors to communicate are faxes and pagers, which are the norm. The government is putting a lot of focus and emphasis on adopting electronic medical records, which is terrific, but a lot of the EMRs are based on these decades-old systems that really don't talk to each other structurally and competitively. The ability to offer this type of security from smartphone to smartphone is really taking advantage of technology that Apple and Google and BlackBerry have really only put out in the last year. We think it's a good time to really rethink the way we allow physicians to communicate.

FMHC: You mention the push for EMRs. How important do you think this platform is in terms of helping doctors to achieve Meaningful Use?

Tangney: Communication isn't a Stage 1 Meaningful Use criteria, but it is likely to be a Stage 2, so I think we will be able to help providers with that. But I'll be very up front: Our core audience here, our goal is really to make something that doctors adopt--like they did with Epocrates, frankly--not because of checklists that require it, but because it actually helps them treat their patients and saves time in the day. We have a lot of physicians here inside the company and we're very physician-centric. A lot of software really is built--since it really needs to be approved and sold to the CIO of the CFO or to the office manager--not as physician-centric in its thinking and design. We really are.

A lot of what we do with HIEs and EMRs is we track transactions. And that's good, we need to do that, but a lot of how healthcare really works is that social layer that's on top of the transaction. So it's one thing to know that Doctor X did such and such a procedure, but it's another thing to know that, 'hey, that's a doctor I went to residency with' and 'oh, he knows this other doctor I know' and 'you know what? I'll just shoot him a note and ask him about this patient.' That kind of ability to socially interact, it's just important.

It's important for referrals, if you're a tertiary referral center that's looking to have patients come into you for inpatient work; it's important for just making sure that the right thing to do is being communicated. If you look at you and me, I'll bet we spend a lot more time in our lives communicating with other people--sending emails, texts and whatnot--than we do browsing through big, deep databases. That's just because it's more human. It's how we're wired. 

FMHC: What was the impetus for creating Doximity in the first place?

Tangney: Really it was really two things: One, being a player in this mobile medical market now for over a decade, we really saw an opportunity to take this next leap toward using [smartphones] as true, integrated communication devices. I can see and read faxes on this [my iPhone]. I can browse the web. I can have secure documents. ... The second thing is that a lot of my best friends are physicians. I just see the time that they spend each day with the yellow sticky notes that say things like 'I need to call this family physician back because the guy you sent over here to do a colonoscopy has a tumor and I'm having my medical assistant try to find his medical assistant.' All this time that's wasted trying to securely communicate because all you have is phone and fax. I think those were the two key drivers.

FMHC: What differentiates Doximity from an online group like Ozmosis?

Tangney: I think there have been a number of websites that have been created where physicians can go and congregate. Some allow them to share their real identities, some are anonymous forums where they can throw out a question and get an answer. None that I'm aware of offer secure messaging. None I'm aware of have iPhone and Android capabilities. And really the main thing is that none of them, that I'm aware of, deeply embed this full pre-populated database.

We actually have virtually every physician in the country already in this heavily integrated pharmacy/hospital/physician directory. I can just type in--it's like a little 'Google' bar at the top of my Doximity page--what I'm thinking of. For example, if I'm looking for a lab that does MRIs and accepts Aetna, it'll pull up the answers in my area. What we seem to see some people using it for is looking up other doctors, colleagues. They'll type in 'Smiths, cardiologists on Main Street' because that's all the patient can remember, and sure enough, it'll pull up that doctor--their name, where they went to med school and their phone number.

So we've made it useful, even if all your buddies haven't joined yet.

FMHC: Do you see Doximity as becoming almost as indispensable as say, Facebook--something where everybody's on it and can't imagine their life before it?

Tangney: Well, I never answered your 10-year question before when you asked it, but at the risk of sounding overly bombastic, yes, that's our hope, that's our vision. We do believe that in this age of instant communication having our physicians use technology that is arguably less sophisticated, more onerous and more time consuming than what our teenagers use doesn't make a lot of sense.

Fewer than 7 percent of physicians use email today routinely for clinical issues. Most physicians, the vast majority, report difficulty communicating with colleagues--spending 40 minutes a day trying to connect with other colleagues. I would like it to feel like, when I'm there talking to my doctor at my bedside, that there in his pocket it's like I have a whole team.

Facebook is very indispensable. But a lot of doctors aren't on Facebook today because they're disallowed from doing it. I hear that Kaiser actually has a policy about their doctors being on Facebook, at all. It's really because you can't have any discussion with a patient or anything that could be considered discussion with a patient for both liability and security reasons. That's what I think we offer is that private, safe place for physicians to communicate about tough cases and just coordinate the logistics of everyday cases.

FMHC: Where do you see the mobile healthcare industry going the near future (let's say in the next two years)?

Tangney: Having helmed Epocrates for 10 years, I feel like the mobile medical industry is just right now hitting its stride. Comparing to what we were doing with the PalmPilot 10 years ago that we were excited about to what can be done today--in many ways, this iPhone I'm holding in my hand is more usable and more of a computer than my actual computer.

I think the future is rosy. I think physicians have, more so than most professionals, a very mobile career. They go from clinic to hospital to clinic to lab; that's part of their job. They don't have desks. Who needs information more than physicians? Everything they do is just processing information and making decisions and communicating those decisions. What they have and need are these mobile devices.

We've seen a lot of activity here: Incubators, funds that are focusing on mobile health, certainly Epocrates very successful IPO is garnering investor interest in the market and showing that there is investor appetite for mobile health. The short answer is there's a lot happening here. I think one of the things that hasn't been tapped yet that will be really big is using these devices to do video more frequently.

FMHC: How important do you think it is for the medical community--doctors in particular--to be involved in entities like Doximity and social media, in general?

Tangney: Primarily right now, the excitement and greatest traction you're seeing is in hospitals and practices using social media--i.e. Facebook, Twitter--to have a better relationship with their patients. I think it does provide that nice sort of forum.

They say that all word-of-mouth businesses are going online. That's sort of the big seismic shift that's happening right now. Well, medicine is the quintessential word-of-mouth business. It really is a lot about people talking about their experiences. The most activity is happening with patient marketing on social media, and that makes a lot of sense. It provides a real transparent way for patients to make their own comments about things, too, which keeps everyone more accountable and more honest.

The area that's been lacking, though, has been professionals using social media and the technology that's created to better collaborate around patients and providing smarter, faster care. There's a lot of lab tests that need to be shared, or quick opinions. Facebook and Twitter, by their very nature, are completely insecure. You don't need to be an engineer or hacker to try to get in and just see what flows through those. They're never going to be places where doctors can talk about patients with other doctors. I think that's really the next wave [in social media], and hopefully one that we're leading.

This interview has been edited and condensed.

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