a system that can toggle easily between English and Spanish, pairs graphics with text, and transmits the patient’s data wirelessly to a secured hard drive at the clinic, Lanier says. The program is compliant with the Health Insurance Portability and Accountability Act (HIPAA) rules, and has passed usability tests among low-education, low-income people who have never used an iPad before, Lanier says. The iPad-based system has shown clear advantages over the iPhone, because for some reason, people appear to get tired after answering just a few questions on the small screen, but they are comfortable going for longer periods of time on the tablet.
The business plan is built on a pretty straightforward software-as-a-service model, Lanier says. Customers have to buy the hardware themselves (and iPads are more expensive than clipboards and paper), and once they do that, they spend at least $5,000 for an annual license to the Tonic system, or much more, based on the volume of patients who use the program. The Tonic system should pay for itself not just by saving on costly data errors, but also by enabling patient satisfaction surveys that people will actually fill out, Lanier says. For example, in keeping with the simple/playful philosophy, Tonic enables patients to rate a doctor’s bedside manner as either like a teddy bear, or a bull.
In Lanier’s world, even the most mundane tasks that nobody thinks much about can be made fun. Tonic sought to do that with the screen at the end of the questionnaire, when it’s time to remind the patient to bring the iPad back to the nurses’ station, as opposed to getting any funny ideas about taking it home with them. “We’ll have people drag the iPad through a maze to bring it back to the nurses’ station. It says the same thing as ‘please return your iPad,’ but puts it in a friendly context. It makes people smile. When was the last time you saw a smile in healthcare?” Lanier says.
There are other electronic medical record (EMR) companies that are seeking to integrate patient-intake forms with database software, like Mountain View, CA-based Drchrono. Tonic insists that the back-end EMR software market is well-served, and it only wants to help collect the data, not manage it with software on the back end. “We’re not trying to be an EMR. Tonic is the pixie dust you sprinkle on your EMR,” Lanier says.
Compatibility with other software is always a challenge in health IT, where hospitals tend to run dozens of different proprietary programs that don’t usually work well together. When I asked if patients could fill out a Tonic form just once, and not have to bother filling out the same information over and over, Lanier said that’s the goal, but it will depend on achieving critical mass. If a patient from San Francisco enters data on the Tonic system at UCSF, and then gets in a car accident in Palo Alto and gets treated at Stanford University Medical Center, the intent is you wouldn’t have to enter the same information twice, “assuming all the hospitals are Tonic-enabled,” Lanier says.
The company is still very much in startup mode, seeking to win over a lot more hospitals than the original five UC campuses it has gotten started with. But Lanier is encouraged by what he’s seen from the early usability tests. Pediatrics departments have shown interest, suggesting that the Tonic programs are easy enough for kids to use, as well as adults. If Tonic can persuade enough hospitals that its program is worth the cost, it could change the way people think about their time in a hospital waiting room. “What we are ultimately trying to do is revolutionize the way data is used in healthcare,” Lanier says.
