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Practice Fusion Cuts 25% of Staff

Posted on February 4, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Following on our post a few weeks ago about the potential Practice Fusion IPO, news just came out that EHR vendor, Practice Fusion, has now cut its staff by 25%. The Techcrunch report says that the cuts were across the board and affected roughly 74 people. Many are suggesting that the two reports are related since cutting staff is a great way to improve your profit numbers before an anticipated IPO.

While I think the IPO could be in mind, I think there are likely some other trends at play too. While Techcrunch notes that it’s a down market for many IT companies, I think it’s fair to say that many EHR vendors have felt the pinch of late. I wrote a year or so ago that the golden era of government incentivized EHR sales was over and we’re entering a much different market. So, it shouldn’t be a surprise that an EHR vendor might go through some cuts as the false market created by meaningful use disappears. I won’t be surprised to see more layoffs from other EHR vendors. Especially ambulatory EHR vendors like Practice Fusion.

No doubt another factor at play is that Tom Langan replaced Ryan Howard as CEO back in August. It’s very common for a new CEO to go through a round of layoffs after taking over a business. Doing so is hard for the previous CEO who’s so connected to the staff. Not that layoffs are ever easy, but it’s much easier for a new CEO to layoff people in order to make the organization more efficient. That’s particularly true when the previous CEO was the original CEO and Founder of the company.

The cynical observer could also argue that Practice Fusion needed to do these layoffs in order to slow their burn rate since they aren’t in a position to raise more capital. You’d think the $150 million they already raised would give them plenty of run way. However, you’d be surprised how quickly that disappears with that many staff on payroll (Not to mention rents in San Francisco). I personally don’t think this is a case of Practice Fusion cutting staff because they can’t go and raise money. However, it could be Practice Fusion cutting its burn rate so that they have some flexibility on when they go public without having to raise more money.

All of this said, 74 people lost their jobs at an EHR vendor. That’s never fun for anyone involved. At least they’ll likely have plenty of job opportunities in silicon valley. Unless that bubble pops like some are suggesting. It will be interesting to see how many now former Practice Fusion employees search for another job in health care IT.

$34 Million Series C Funding for Practice Fusion

Posted on June 28, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Artis Ventures led the Series C funding round for Practice Fusion. They raised $34 million in this round with them now having raised over $64 million total. The full list of investors joining the Series C round includes long-time investors Felicis Ventures and Band of Angels, plus Glynn Capital, Ali and Hadi Partovi, Founders Fund, Morgenthaler Ventures, Scott Banister, SV Angel, Ghost Angel, and several other institutional and individual investors.

Some other good stats from the Techcrunch article on the EHR investment:
*Currently 170 employees, and expect to reach 250 employees by year’s end
*Added 4x a many users as Allscripts last quarter (Who Ryan Howard considers their largest competitor)
*2012 Q1 Revenue was “comfortably in the seven figure range”
*Hosts 40 million patient records
*150,000 doctors signed up (This is their signed up user number, not their active user number)
*7 months ago they were at 25 million records and 130,000 signups

I also found this Techcrunch quote fascinating: “Howard was careful choosing Artis Ventures to lead the round, telling me “it’s a wedding. You’re married to that investor. Artis is a hedge fund with a venture fund. It’s preparing us. It’s who would be buyers in a public market” indicating the company has its sights on an IPO.”

It’s worth noting that the founding doctor/CMO (Chief Medical Officer), Robert Rowley, MD, also recently left Practice Fusion. He’s still actively blogging about healthcare IT on Robert Rowley, MD and he tells me it was an amicable departure. I think it’s noteworthy though since Dr. Rowley was the physician face of Practice Fusion since the start of the company.

There’s no doubt that Practice Fusion is now a major player in the EHR world. Although, I’m still interested to see if they can live up to a $64 million financing at around a half a billion dollar valuation. I wonder how quickly things like having their software built using Flash will catch up with them. Plus, Practice Fusion was designed with the small doctor office in mind. Will it be able to evolve its platform to be able to support larger group practices?

I do think they have the right culture when it comes to opening up their data to other outside developers that will be required for them to have a widely adopted healthcare platform. We’ll see how the healthcare ecosystem responds to that type of open platform. They now have plenty of money in the bank to be able to find out.

Full Disclosure: Practice Fusion is an advertiser on a couple Healthcare Scene websites.

Craig Be Nimble: “Disruptive” Medicine or Inefficient Method?

Posted on March 16, 2012 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

I came across this very thought provoking post by Dave Chase on Kevin MD today, outlining “nimble medicine”. A little bit of googling revealed that a vastly better version of it, again by Dave Chase, ran on TechCrunch in late Jan. Yes, I’m that late to the party, and I will admit I’m feeling a little cheated by Kevin MD (really, how much trouble does it take for you to point out that a version of this article ran elsewhere?) But I digress.

To exemplify nimble medicine, Chase talks about a few interesting cases:
– Dr. Craig Koniver, who has closed his B&M clinic, and now runs a mobile clinic visiting patients at their homes or workplaces
– Medlion, a Silicon Valley company, completely bypasses the insurance brokered model of primary care and uses the Direct Primary Care model instead
– Companies like 2nd.md have made it easier for patients to get a second opinion.

Ladies and gentlemen, here’s medicine, as it perhaps should be practiced in this age of 4GS. Of the many cases that Chase discusses, the one that is most iffy for me is the mobile clinic one. Don’t get me wrong – I’m as much a sucker for a David-Vs-Goliath story, and if Dr. Koniver’s story were on Hallmark tonight, I’d be reaching for the tissues right about now.

However. The idea sounds awesome in theory. In practice, I’m not sure the model is sustainable. In fact there might be plenty of inefficiencies built into it.

Let’s say Dr. X sees about 8-10 patients a day. This is well below the 20 minute per patient average that most PCPs see their patients for.

Patient 1 lives in the North east quadrant of the city, Patient 2 work in the heart of downtown, and Patient 3 is in a city suburb, and so on.

One way to see all his patients is to go on a strictly First-Come-First-Serve basis, based on whatever his medical assistant has scheduled. This is not a feasible alternative at all. What if Patient 1 is 20 miles W from patient 2 and Patient 3 is far, far East of Patient 1. Horribly inefficient, which is exactly why algorithms such as the Travelling Salesman were invented in order to optimize travel paths.

The other alternative for the good doc is to apply the Travelling Salesman algorithm to his situation and base his visits to patients on geography. He might schedule his patients in such a way that he first sees all his patients that live in the Northeast quadrant and so on. Except now, the most pressing patients might need to wait till Dr. X actually services the patient’s part of the city.

Dr. X can of course optimize his travel path based on location as well as patient priority/needs, which is enough to give any grown person a raging migraine. And it doesn’t even get to the bottom of Dr. X’s biggest headaches, which is that
a) he spends an inordinate amount of time in traffic in
b) a gas guzzling vehicle that houses his medical equipment.

Waste of time, money and maybe even lives (imagine a patient dying while Dr. X is negotiating rush-hour traffic in DC)

So how can Dr. X compensate for this? By charging his patients for his time and attention. Or cutting down his clientele to a tiny sliver of a neighborhood. And yet, it makes for a wonderful story on “disruptive” medicine.

Glucose Meter to iPhone

Posted on February 13, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

A few weeks ago Techcrunch announced the $3.5 million in funding that Glooko received to connect Glucose meters to iPhones for tracking diabetes. Here’s a description of Glooko:

Launched last year, Glooko is a digital logbook for people with diabetes who have to check their blood sugar every day. There are dozens of glucose logbooks in iTunes, but almost all of them require manual entry. What makes Glooko different is that the company designed a $40 cable (sold separately) that works with seven of the top glucose meters. You just plug it into both devices and it downloads your daily readings.

This is an interesting approach because it allows someone to use the Glucose meter that they’re use to using all of the time. Although, I don’t know many people that want to carry around a glucose meter with their phone and a cable to connect the two. I’m sure that Glooko would argue that the problem is that the glucose meters don’t support a wireless (bluetooth or NFC I suppose) technology for the exchange of that data. They’re right that it is a limitation of the traditional glucose meters.

The solution is to go down the path that AgaMatrix has gone down with their blood glucose meter that attaches to the iPhone. Basically it makes your blood glucose meter the size of a thumb drive. If you don’t want to carry your phone, you can just carry the small meter and some strips (yep, I don’t know if we’ll ever get away from the strips). Then, when you hook the meter back up to your iPhone it uploads all the data. Or, just leave it attached to your phone since it’s not that big.

I’ll be interested to see how well Glooko does with their $3.5 million in investment. There’s a lot of people focusing on the diabetes market.

DrChrono EMR Raises $2.8 million and Has 15,000 Registered Providers

Posted on January 30, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

A few days ago the news came out that Y Combinator startup company DrChrono has raised another $2.8 million in funding. Here’s the summary from Techcrunch:

Drchrono, a startup that simplifies the professional lives of doctors by bringing electronic health records and much more to the iPad, has raised $2.8 million in funding led by Yuri Milner, with Google’s Matt Cutts and other investors participating. The startup had previously raised $1.3 million in seed funding from Milner, General Catalyst, Charles River Ventures, 500 Startups, Gmail creator and FriendFeed cofounder Paul Buchheit, Cutts, and the Start Fund.

It’s an interesting mix of people that are funding DrChrono. Matt Cutts interests me a bunch since he works on the search engine team at Google in charge of Spam. Obviously, this is a quite different space.

The most interesting information in the Techcrunch article is the number of providers and patients that DrChrono has in its system.

The company also announced it now has more than 15,000 registered providers, and more than 400,000 patients using the drchrono platform.

Of course, we know how EMR companies are with these numbers. It’s one thing to have a registered provider and it’s quite another to have them actually using the EHR software. Also, I can’t help but wonder if the 400,000 patients includes imports of a physicians past patients. I’d love to hear some real numbers. For example, how many daily active users (doctors) do they have using their iPad EHR?

I also find it interesting that DrChrono has only taken $4.1 million in funding versus funding like CareCloud’s $27.3 million and Practice Fusion’s $38 million. Seems like DrChrono has chosen the much more conservative EHR software route as opposed to the more ambitious healthcare platform route that the others are working on.

100Plus Founded by Practice Fusion Founder Ryan Howard and Chris Hogg

Posted on November 4, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I just saw the news hit Techcrunch that a new company 100Plus raised $500k from Peter Thiel and is being founded by Chris Hogg and Ryan Howard, CEO of free EHR vendor Practice Fusion.

My first response was, wait…Ryan Howard is founder of a new startup company. What about Practice Fusion. Then, as I read about 100Plus, I realized that 100Plus is basically an extension of Practice Fusion. I see it as Practice Fusion’s research division. Sure, Practice Fusion already has a research division, but 100Plus is likely going to be the way that Practice Fusion is able to leverage their currently 24 million records.

Techcrunch describes the new company, 100Plus as such:

Essentially, 100Plus is a personalized health prediction platform that uses data analytics and game mechanics to show just how much small changes in one’s behavior can lead to a longer and fuller life.

I’ll be interested to see what they produce. I’m sure they’ll reach out beyond just the Practice Fusion data to other healthcare data repositories as well. However, the game mechanics part of it sounds interesting to me. I’ve always believed that someone is going to find a way to improve our health using some form of game mechanics. I’m not sure if 100Plus will be the company to do that (they’re still in stealth mode until next year), but someone will.

Medical Care and Primary Care without Insurance Allows Technology to Flourish

Posted on June 30, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve previously posted that I believe the real EMR innovation will likely have to come together with healthcare innovation. The basic premise being that our current insurance reimbursement system is a weight on the backs of EMR software. The insurance requirements cause much of the unwieldy interfaces that are put out by EMR software and insurance requirements and limitations are a huge limiter on the technology innovation that could occur in healthcare.

Imagine how much more streamlined the EMR interface could be if EMR companies worried about patient care and not reimbursement. Imagine the new technologies that would be implemented if you weren’t so worried about the office visit reimbursement model we have today.

This premise is why I was so intrigued by this post on the popular Tech Startup blog, Techcrunch, called “The Most Important Organization in Silicon Valley That No One Has Heard About.” In the article, Dr. Samir Qamar has been putting together a different model for healthcare. “For only $49 per month and $10 per visit, MedLion is able to provide high quality medicine at a price point nearly any family can afford.”

How is he able to do this? Here’s a quote for part of how he’s able to accomplish it:

Part of MedLion’s value proposition has been availability to its patient base. Like many direct primary care practices, they find more than half of their patient interaction is via electronic means, as they aren’t forced by reimbursement rules to have a patient come to their office for something that could be done simply over phone or email. We want to be available for our patients whether they are in the Bay Area, Bali or Boise.”

I’m not sure if Dr. Qamar has found all the healthcare Innovation secret sauce, but I’m grateful for pioneering entrepreneurs like Dr. Qamar that are willing to try something different. Plus, there’s no better place for the application of technology than in these new models for healthcare. It’s exciting to consider what technology could really do when it’s not shackled by the 100 pound gorilla.

$5 million for a PMS and Revenue Cycle Management

Posted on October 13, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’d been meaning to post this for a while. It’s the news that the company CareCloud got a $5 million round of financing after their initial $2.3 million round of financing. Here’s the description of Care Cloud from the Techcrunch post:

A cloud-based app suite, CareCloud attempts to modernize the process of being a healthcare provider; physicians can use CareCloud’s web-based apps to streamline the managing of their businesses as well as collaborate with other doctors in the CareCloud’s healthcare provider social network.

The interesting part of this to me is that when I visited the CareCloud website it seems that they are basically a PMS and Revenue Cycle Management company. That seems like a lot of funding for such a niche.

The website does mention the healthcare provider social network which kind of sounds like a health information exchange, but really doesn’t give any details of how CareCloud plans to connect all these doctors together. Plus, without an EHR software or connections to other EHR software, what information are they planning to share?

I guess I’m still trying to get the vision of what $2.3 million was spent on initially and where they plan on spending the next $5 million. That’s a lot of cash if they’re just going to be a PMS and Revenue Cycle Management company. Of course, maybe they just need to spend some of that $5 million and update their website to portray what they’re really trying to do.