Medigram Offers a Safe, Legal Alternative to Texting While Doctoring

Three years of medical school and hospital rotations at Stanford was enough to convince Michael Chiu that the methods doctors and nurses use to exchange updates about patients are archaic, inefficient, and sometimes illegal.

Most hospitals, he explains, still depend on old-fashioned pagers to send doctors urgent alerts and other messages. But these systems can be so slow and clunky, Chiu says, that hospital staffers often resort to texting each other on their iPhones.

That would solve the problem—except that it’s a violation of the Health Insurance Portability and Accountability Act, or HIPAA, which forbids medical personnel from sending private patient data over unsecured networks. (Pager networks aren’t always secure, but they’re grandfathered in.)

So Chiu decided to do something about the situation. With just six months to go before getting his M.D., Chiu took a leave of absence from Stanford Medical School and started Medigram. The Palo Alto-based startup is developing a secure, HIPAA-compliant group messaging app for healthcare professionals.

“Paging is extremely annoying and inconvenient, and doctors work around it by texting, but unfortunately this is illegal,” Chiu said at a demo day presentation for StartX, the Stanford-affilated startup accelerator that hosted the company this winter. With Medigram, he says, “A nurse can simply ask a question and it’s fed to everyone on the team. A doctor can provide a simple answer. It provides a great method for staying informed about patients.”

Helping hospital staff adhere to privacy laws is a big part of the startup’s pitch—but Chiu thinks Medigram will gain a foothold mainly because it saves doctors and nurses time and hassle. In fact, the feedback from beta testers at three hospitals in Palo Alto has been so positive that Chiu is convinced he’ll be able to sell the system simply by getting doctors hooked, then hitting up their bosses for contracts.

“The bottom-up approach has been successful in other industries,” he says. “Yammer and McAfee are very well known for it. If we have 100 or 200 doctors on our platform already, it becomes much more compelling to the hospital administration to adopt that platform.

Chiu says he started thinking carefully about the hospital communications problem last summer. “One of the major pain points in the hospital is that when you’re using pagers it can take forever to get any sort of information about a patient’s status, discharge, medication changes, et cetera,” he says. “So I started to think about how we could utilize some of the social apps out there today, like Beluga.” (That social text messaging service was acquired and later shut down by Facebook.)

Chiu wanted to build a modern text messaging system that would be secure enough for hospitals to use. To round up the technical assistance he knew he would need, he attended a Startup Weekend hackathon in Palo Alto. “I proposed this idea and was able to get some engineers to build it out. We did really well and got some positive feedback from the panel of VCs and doctors,” he says.

That was enough to convince him to start working on the project full time. By January, Chiu, his co-founder Yuhao Ding, and the engineers they’d recruited had a working app and were testing it with users at the Palo Alto Veterans Administration Hospital and the Lucille Packard Children’s Hospital. Soon the app spread to Stanford Hospital, where it’s now being tested by more than 100 physicians and case managers.

Again, the app isn’t just about HIPAA compliance; Chiu says it was designed to reflect the way healthcare actually works in a hospital: “It’s an entire team taking care of patients—a combination of physicians, nurses, case managers, and social workers. One of the main value-adds is that we’ve given people who don’t have the chance to talk to the doctors frequently the ability to get information.”

Chiu tells the story of a case manager using the software at Stanford. “She had four patients who needed to be discharged in one day to four different skilled nursing facilities,” he says. “She found out [through Medigram] that one of them had a fever. Because of that she knew immediately that this person was not going to be discharged, and as a result she was able to focus on the other three, which helped her pace her communications with the nursing facilities appropriately.”

Anything that helps teams communicate more effectively will ultimately be a financial boon—meaning hospitals should be happy to pay for Medigram’s services, Chiu reasons. “At Stanford one of the metrics they use is the notion of an ‘avoidable day’—a day when the patient stays in the hospital due to non-medical issues, either transportation or logistics or because there is no place for them to go. They are trying to lower this number, and they have a program to get nurses, case managers, and doctors to talk more so that avoidable days won’t occur because of poor communications. So our platform is an adjunct to what a lot of hospitals are already doing.”

Since finishing at StartX and Y Combinator—Medigram was one of an increasing number of startups participating in multiple accelerator programs—the company has finished raising a seed round, Chiu says. Doctors at more than 50 hospitals and physician groups have asked for access to the software. The startup has competition from larger companies, Chiu acknowledges, but he says Medigram has the advantage of infiltrating hospitals from below. “All of our competitors are going through the traditional enterprise sales approach, where they talk to the CIO or upper-level administration and implement their software over many, many months of negotiation,” he says. “Our strategy is to go directly to the end users”—including residents and medical students.

An added bonus to this approach: the startup gets immediate feedback that it can translate into product improvements, such as a feature that repeats a message every 10 to 30 minutes until the recipient actually sees it. “One of the only benefits of pagers is that they keep going until you shut them off,” Chiu says. “The worry with these high-tech platforms is that if they don’t bug you enough, you won’t keep going back to it.” Maybe it should be no surprise that in healthcare, making an app more annoying is actually a plus.

Wade Roush is the producer and host of the podcast Soonish and a contributing editor at Xconomy. Follow @soonishpodcast

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