eHealth Records International
eHealth Records, International (EHRI) was founded in 2012 as a spin-off from OffSiteCare Resources, a telemedicine company founded by Dr. James Gude. OffSiteCare hired Nick Smith, the author of the HarmoniMD platform, to build a cloud-based Electronic Health Record (EHR) system that would serve the telemedicine physicians employed by OffSiteCare.
When Dan Smith joined the OffSiteCare board, he and the company researched the potential of building a full hospital-based EHR platform for developing-world hospitals. After visits to hospitals in countries including India, Tanzania,the Philippines, and Haiti, it was determined that there was a large and growing market for a hospital-based EHR and that it was time for HarmoniMD to branch off as the flagship product of eHealth Records International. EHRI was then formed as a California ‘C’ corporation and the rights to HarmoniMD were transferred to the new entity. This enabled EHRI to focus on software development while OffSiteCare focused on providing physician telemedicine services.
Through the research that had been done by visiting hospitals around the world, it was determined that, to be successful, HarmoniMD would have to embody the following:
- Manage every aspect of clinical care in the hospital and clinic environment.
- Be very low cost and priced by volume so that any hospital would see a return on investment within the first year.
- Operate on low-cost hardware and networking. This ruled out the use of Computers on Wheels (COWs) which cost over $10,000 each, and required the HarmoniMD application to run on inexpensive tablet computers and cell phones priced under $100.
- Utilize the tablet camera for reading bar codes and taking photos of patient conditions. This has become an important product differentiator as it allows physicians from any location to view the progress of wound care, postoperative healing, infection status and other conditions.
- Fit in a nurse’s or doctor’s pocket. This required the system to operate on a 7-inch tablet or cell phone. With so much information to present this has been a challenge, but is an important feature of the system.
- Be intuitive and easy-to-learn so that training costs could be kept to a minimum, especially for new hires. The goal was that any new employee can learn the system and within an hour or two perform patient care even if they had never worked on a computer before.
- Be able to function over the cell network so that physicians can work from remote locations, view patient information and place orders. This functionality is also needed to provide alternative means of accessing patient information when hospital networks are offline.
- Be flexible enough for any hospital to have its own electronic clinical document formats that don’t require version control and are interactive with the clinical database.
- Be offered as one complete system instead of a series of modules that had to be purchased and maintained separately.
- Be provided as both a hosted and local system to manage situations where internet connectivity is challenged.
With these and other requirements in mind, EHRI hired Kiko Taganashi to lead the development of the HarmoniMobile application, a process that would take over 3 years to perfect. Rob Miller was brought in to manage Quality Assurance and other employees were hired to build reports and Electronic Clinical Documents (ECDs).
In 2013, eHealth Records International founded Health Informatics International (HII), a Philippine-based sister company, to begin sales of HarmoniMD in that country. HII is 60% owned by its Philippine employees and 40% by EHRI in order to allow it to do business with governmental entities (Philippine law requires 60% ownership by Philippine citizens for this purpose).
In 2015, the HarmoniMD system was installed at Sonoma West Medical Center, a small California hospital as it was reopening. (This hospital had been closed largely because of the financial impact of a failed multi-million dollar EHR implementation.) This flagship implementation has shown that the system is robust and reliable and can manage all clinical data management as well as integrate with Lab Information Systems, Radiology Information Systems, Pharmacy and billing systems.
Besides HarmoniMD, the company has built a cloud-based Newborn Hearing Screening Reference Center system for the Philippine Department of Health (DOH) that utilizes the HarmoniMD platform for monitoring newborn hearing screening. This system is currently used throughout the Philippines to document the testing of newborns for hearing loss, a mandate of the Philippine Government that all newborns be tested for hearing loss within the first 90 days of birth.
HarmoniMD is also being used in dialysis clinics in the Philippines. In addition, HII has built an online health-training platform that is being marketed to universities for nurse training courses. The Philippine company is now financially self-sufficient having obtained local investment and revenue from its university, clinic, and hearing screening programs.
In 2016, eHealth Records International traveled to Tanzania and Kenya for successful HarmoniMD system implementations at Kilimanjaro Christian Medical Centre and Matata Nursing Hospital.