Anyone who has ever visited an outpatient clinic knows it can be a crowded, chaotic place. Electronic health records (EHR) technology—software that puts a patient’s charts and health information online so doctors can access it, ostensibly leading to better, more efficient care while facilitating communication—has so far not lived up to its potential.
Tammy Dugan, co-founder and chief technology officer at Indianapolis-based Digital Health Solutions, and her team are on a mission to change that. The company’s first product is software called CHICA, which stands for Child Health Improvement through Computer Automation, and Dugan believes it could improve the way doctors care for children nationwide.
CHICA, which was developed over the course of more than a decade at Indiana University, increases the functionality of EHRs and can help doctors identify problems and assess patient risks earlier, Dugan says, leading to faster detection and treatment and better health outcomes for kids. EHRs are often criticized for being cumbersome, confusing, time-consuming, and are notoriously interoperable with one another.
“There are protocols a pediatrician is supposed to go through during the appointment, like autism screening, but there is very little time to do them during a 15-minute visit,” Dugan explains.
Digital Health Solutions loads CHICA onto tablets, which families receive upon arriving at the clinic and before seeing the doctor. CHICA asks parents 20 questions based on the child’s age and information gleaned from previous visits. Based on the family’s responses, the software uses an automated prioritization process to select the six most important issues for the physician to address during the visit.
The software enables a patient’s family to provide information on a wide range of topics, including asthma, attention deficit hyperactivity disorder, domestic violence, iron deficiency, lead exposure, and maternal depression. CHICA also allows doctors to hone in on problems that may otherwise have been overlooked.
Dugan says when a doctor looks up a patient’s EHR, they follow an embedded link to access CHICA—no extra training required. Once a doctor has checked all the boxes, indicating how a patient responds to the protocol checklist, the information is submitted to the patient’s EHR as a block of text which can then be incorporated into the doctor’s chart notes, streamlining clinical documentation.
CHICA is compatible with the widely used Epic and Cerner EHR systems. Digital Health Solutions piloted CHICA at five Eskenazi Hospital clinics across metro Indianapolis and one outpatient clinic affiliated with IU. Dugan says at least five more outpatient clinics will be using CHICA by the end of the year.
Dugan says feedback from doctors using CHICA has so far been positive, and she thinks one reason is because the software is meant to enhance their expertise rather than replace it. The software is written in a way that could be expanded to adult medicine or different specialties in the future, she adds.
The company has so far grown through grant money, and she says the plan is to continue on that path rather than seeking venture or angel investments. Dugan calls Digital Health Solutions, a member of IU’s SpinUp accelerator program, “an atypical startup” because the product existed before a company was formed to commercialize it, but she says it is now ready to sell CHICA on a subscription basis nationwide regardless of future funding. (Because it’s software, there is no formal clinical testing process required for marketing approval.)
Although the Affordable Care Act as we know it remains up in the air and is likely on the chopping block, Dugan says the law incentivized the adoption of EHRs. Interoperability is still a major hurdle to widespread adoption, she notes, but Digital Health Solutions is moving forward regardless because, as a third-party vendor tacking its clinical decision support software on top of existing EHRs, it’s a moot point for now.
“The primary reason we started the company is because we have a great system that we know increases the quality of patient care and helps kids,” Dugan says. “EHRs do a good job with drug interactions, but they can’t give outside-the-box solutions.”
