Modernizing Medicine: Prescription for success

July 07--About four years ago, Daniel Cane went out for a checkup and came back with a company.

The serial entrepreneur, who previously co-founded the education-tech company Blackboard, met his next co-founder in the doctor's office.

After the appointment, over lunch, he and Dr. Michael Sherling talked about how inefficient and archaic the systems and technology were in physicians' practices, even in 2010. And you know the story, there just had to be a better way. ...

Boca Raton-based Modernizing Medicine was hatched, and today the company has one of the leading electronic health record (EHR) applications for increasing efficiencies and improving treatment outcomes in particular specialties. One of four dermatologists in the nation is already using Modernizing Medicine's Electronic Medical Assistant, or EMA, an elegant and intuitive doctor-friendly iPad application. And EMA is making traction in ophthalmology, plastic surgery, orthopedics, otolaryngology (ear, nose and throat) and other specialties. The company of about 190 employees ranked No. 3 on the South Florida Business Journal's 2014 Fast50 list of fastest-growing companies, with revenue of $17.3 million in 2013. Modernizing Medicine plans to hire another 30 employees by the end of this year.

Strong traction and financial performance aside, what Cane and Sherling say they are most excited about is the company's recent partnership with IBM Watson, that supercomputer that won Jeopardy! a few years ago, and where it could lead. Modernizing Medicine was one of the first companies worldwide chosen to partner with Watson to bring its cognitive computing intelligence to healthcare. It's part of IBM's$1 billion project to bring Watson to the masses.

"Modernizing Medicine is not just about the productivity application that saves doctors a ton of time, it's about the fact we are using data and technologies like Watson to improve patient outcomes," said Cane, 37, Modernizing Medicine's CEO.

Modernizing Medicine has been developing a Watson-powered app, called schEMA, designed to help dermatologists offer optimal treatment options. As an enhancement to EMA, schEMA will combine the best of EMA's big-data processing with Watson's cognitive ability to help doctors by answering medical questions at the point of care.

Utilizing cognitive computing and natural-language processing, Watson uses published healthcare information, such as peer-reviewed medical journals, to quickly answer physicians' questions about conditions, treatments and outcomes, Cane said. The goal is to strengthen physician's recommendations and enable them to efficiently practice evidence-based medicine. Cane plans to have schEMA on the market by the end of the year.

In a demonstration for the Miami Herald, Cane and Sherling, Modernizing Medicine's chief medical officer, showed how EMA makes it easy for physicians to record notes in an exam, add photos or diagrams, see past records, make a diagnosis, order prescriptions and lab work, make a report for patients, and bill the insurance company, all by touch controls in about a minute or two. They also demonstrated how EMA can quickly show a doctor how a patient has progressed over time. "With EMA, you get a glance view of everything you have ever done for that patient," said Sherling, 39, who received his MD and MBA from Yale and did his clinical residency at Harvard.

Next they revealed the prototype of schEMA, asking Watson, "What treatment of psoriasis is more effective, methotrexate or cyclosporin?" Watson provided the answer, along with the sources of information. Next question: What does the National Psoriasis Foundation recommend for liver biopsy? Again, an answer in seconds, all information that can be considered and included in the doctor's notes.

"Doctors aren't looking for answers, they are looking for insights -- they want to see supporting evidence. They can take their own professional experience and meld it with technology," said Stephen Gold, vice president of IBM Watson Group. "What Modernizing Medicine is doing is bringing together the cognitive ability of Watson, with the mobility aspect of the tablet and joining it with big data. Physicians have said this is what we need to be as effective as we can. ... Why would I ever want to go to a dermatologist that doesn't have that capability again?"

As Modernizing Medicine rolls out its Watson-powered app for dermatology, it will also be expanding Watson's capabilities to work with its other medical specialties. "Watson isn't programmed, it is taught, so when you move into a new specialty you have to train Watson," Gold said. "We need to get this product out to many."

Cane and Sherling believe the opportunity is immense, and Modernizing Medicine also has been starting to partner with academic institutions to publish findings and show a more comprehensive picture of healthcare outcomes through the de-identified data on hundreds or thousands of patients.

"The much more exciting story is big data on the macro level," said Cane. "When you have 25 percent of the dermatology market [or approximately 3,400 providers] using the same cloud platform that is based on structured data and algorithms, you can start to show what works and what doesn't."

In reality, added Sherling, "physicians are doing research every day. But because the tool was wrong, we couldn't collect the data. .. With this system, everyone can do clinical research, and not just for the well-funded diseases...We can share our findings, in the true spirit of science."

Modernizing Medicine has raised nearly $30 million in three rounds of venture capital financing. The most recent round of $14 million was led by Summit Partners.

Mark deLaar, managing director of Summit Partners and an investor in and board member of Modernizing Medicine, said it was the strength of the management team, along with the company's innovative strategies for improving systems and healthcare outcomes, that attracted Summit. "In addition to building out specific specialties, Dan and Mike have done a great job with strategic partnerships, such as IBM Watson and others being developed," he said.

To be sure, the EHR marketplace is crowded, but "it's a very large market and the market is still growing, and coupled with the management team and its innovative approaches, you feel better about the opportunity," deLaar said. "They are building a better mousetrap."

On a recent Thursday afternoon, Modernizing Medicine's colorful open-style offices, tucked inside a sprawling office park, were buzzing with activity.

"If you are doing cutting-edge technology, you want to have a place people want to be. People are having lunch together, exercising together. And did you see the Zen room?," said Cane, referring to a quiet, darkened meditation room with comfortable furniture, a fountain and aromatherapy. In the center of the office area, dozens of employees were taking advantage of the free catered lunches on Mondays and Thursdays.

About half the employees come from a healthcare background -- doctors, nurses, healthcare sales -- while the other half come from technology, Cane said. In fact, 17 practicing physicians are Modernizing Medicine employees, often coming in in their scrubs, and are an integral part of the development process. "They are in the trenches with the team coding. Every one of our doctors knows basic coding languages," Cane said.

Cane is a trustee at Florida Atlantic University, vice president of the board of the South Florida Science Center and board member of United Way of Palm Beach County. Modernizing Medicine also supports United Way and every employee gets a paid day off each year to work at the charity or nonprofit of his or her choice. Along with programs for school groups, the company offers a large number of internships to both high school and college students.

When Modernizing Medicine won the Launch competition for later-stage companies at the eMerge Americas conference in May, Cane donated the $100,000 prize to FAU and Florida International University entrepreneurship programs and Venture Hive, a startup accelerator and incubator. "I feel very strongly about that it is our role to engage in the community and give back," he said.

Cane started his first company, the education-technology company Blackboard, while an undergraduate at Cornell University. He raised more than $100 million in venture capital and in 2004 helped take the company public on the NASDAQ. Blackboard later sold for $1.6 billion.

"I had exited Blackboard and I moved back to South Florida. This is where I grew up; this is where I wanted my kids to grow up ... My wife knew after two weeks of being around the house ["retired"] I was itching to start something. And she begged me, before I do whatever I'm going to do get a checkup.

"After my day of checkups, I said, 'Honey I am starting another company.' And she said, 'Of course you are.' I was not designed for retirement," Cane said. "I need to be doing this."

He said both education and healthcare are huge industries that don't move quickly and were in need of massive disruption, but that is where the similarities end. Healthcare is massively regulated -- and the opportunity for making change dwarfs anything he encountered with Blackboard.

"When the healthcare adoption measures came out, we gave away billions of incentive money but the systems are siloed. They don't talk to each other. We need to fix that," said Cane, speaking broadly about the industry. "We need a national patient identification system so we can share information about people. Right now there is no portability of information. Yes, we have advanced, but there is so much we can do."

"I want to be the company that is modernizing medicine by aggregating data ... giving doctors better access to information to make their decisions," said Cane. "We want to disrupt healthcare by shining a giant spotlight on what works and what doesn't, and providing technologies like Watson that bring evidence into the exam room. That is Modernizing Medicine."

Follow @ndahlberg on Twitter.

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