Medfusion is a small company with big goals.  Nice talk on the phone the other day with Jeff Dolan from Medfusion.  They're doing lots … and Jeff says they're trying to solve real problems.

They're doing interesting things with the Instant Medical History to help physicians with the narrative portion of the chart note.  The concept is that the patient will create this themselves — either online before the visit — or on the physician's office before the physician comes into the room.

I'm lukewarm about the whole idea.  While many patients would embrace this .. many others would not … and it's hard for the physicians to grasp a true return on investment figure for such a service.

The other components of their product line are similar to those provided my relayhealth, aboutmyhealth, mdhub, etc.  .. and I'm still not convinced that the complex components of these services are valuable at all.  It's tempting for most of these companies to develop components that gather complex pieces of data from patients and physicians .. but the core functions .. "hey doc I have a rash between my toes what should I do about it?"  … don't require complex structures interviews .. nor should they.  Indeed, it was pretty easy for me to confuse the "Instant Medical History" demo — causing it to give me a "I don't understand" screen .. with no option to enter free text as an alternative to the structured interview.

Alas .. the companies that develop complex tools are often missing the point of how technology can help us in our practices.  The tools can be very complex on the "back end" but for patients and physicians to embrace them, they need to retain simplicity on the front end.  

Why does this happen?  All too often, I've found that the physicians advising developers and business strategists involved in these companies are the technology enthusiasts.  I'll never forget the time we were interviewing physicians to serve as advisers at Medremote, and this guy comes in with a flurry of ideas and enthusiasm.  It was great talking with him .. lots of fun and he certainly had energy for what could be done.  This guy had not just one PDA .. but two! .. a WinCE device on the right hip, and a Palm OS device on his left hip.    This sort of physician often gets involved in informatics projects because they're so excited about all of the potential.  They're unusually smart, and often have programming experience from college or even graduate school. 

They're great to have for the white-board sessions to generate ideas .. but these folks are the worst people to have involved in shaping the framework of a development project or feature set of a product that should be designed to assist physicians and patients.   They're smart and very comfortable with complexity — so they don't recognize when the software is too complex for the user to understand.  Of course, this happens to developers too .. since they too are smart and comfortable with complexity.

The best physician-consultants, then, are those who understand the software and hardware, but have a low tolerance for complex processes.  Keeping it simple is top priority, but remains elusive for all but the best teams.   The hardest part, of course, isn't deciding what to could be done … but figuring out what should be done.

Medfusion is weaving partnerships with companies that have managed to create moderately successful niche products.   Seems that the business model is to broaden this niche into the mainstream by integrating these solutions with other existing products like EMRs. 

We'll see where all of this gets Medfusion.  So far, it's not clear to me that they are yet focused on keeping things simple enough to make it beyond the niches and into the mainstream.