Praxis EMR - A history of innovation
Praxis EMR was started, like all great projects, with a very simple idea. Doctor Richard Low, a Yale Medical School Graduate who practiced Emergency Medicine and Internal Medicine for 20 years, saw first hand the complicated issue of medical documentation, and he detested it.
Noting that medical documentation was a waste of intellectual resources and a source of grief not only for him but also for most of his colleagues, he set out to find an intelligent alternative.
He recognized that documentation was critical for medicine, of course, but that it was even more critical to protect the physician from lawsuits and from third party payers and authorities, who were progressively second-guessing every practitioner.
And Dr. Low also noted how much useless drudgery and repetition was involved in all this verbiage.
So he began to think that the computer, if programmed well, could help the besieged physician in the quest for liberation from the restraints of bureaucracy and useless minutiae. "If we doctors did not have to waste time charting," he felt, "then we would be free to invest more time in the quality aspects of our profession such as spending more time with our patients and practice even better medicine".
Through the lens of the locum tenens organization that he had established in California, Dr. Low began to carefully examine how all his physician-clients were charting. The medical record was usually his foremost connection with his clients, since he was covering their practice in their absence.
That is where he observed that there were as many different ways of charting as number of doctors doing the charting. Each doctor client was unique, each practice was unique: Medicine was their art.
However, Dr. Low also felt that his charting was monotonous. He needed to be complete, and this involved repeating the mantras ingrained in his medical consciousness: "57 year old male, well developed in no acute distress, who presented with " How could he simplify this taxing and cumbersome process and yet still be an effective writer and physician?
It was during one of his many trips to Argentina, his country of birth, twenty years ago that Dr. Low met some fantastic engineers who were looking for work. Dr. Low brought forth his observations and ideas learned in his unique practice in the US, and shortly thereafter, a team of young, bright software developers assembled to brainstorm a novel solution to the problem that Dr. Low had identified.
Initially, they looked at the template solutions, but templates resulted stale and constricting. "How can we use the full capability of the computer to liberate the physician instead of the opposite?" Dr. Low asked.
After the template system was examined and discarded, the concept of a neural network intelligence engine that learned from the provider emerged. The idea was exciting, but of extraordinary complexity. The Problem Oriented Medical Record began to be analyzed in amazing detail and the patterns began to take shape. Hence, the Concept Processor was born.
From its inception, the Concept Processor was devised as an engine that would learn from each individual practitioner, returning his or her own words encapsulated in units of thought that could later be linked to other units of thought learned from before. The main idea of the software was that it would save an incredible amount of time by learning from the past, as most of the write-ups are repetitive in nature.
How to Sell such a Product?
Almost as complicated an issue as the solution itself was how to sell medical software to physicians nationwide once developed. It was Allan Bloom, Dr. Low's attorney in California, who provided the answer: Sell the product to the pharmaceutical industry and have them donate the software to doctors everywhere free of charge.
Thus began the growth and pulse of the Infor-Med Corporation.
Enter SmithKline Beecham
SmithKline Beecham was one of the companies that became immediately interested in the Concept Processor and finally bought a right of first refusal that allowed us to build Praxis. By this agreement, SB would pay to distribute 65 thousand copies free of charge to physicians or our company would inherit the software back free and clear.
After two years of very interesting work, Praxis 1 was finally developed.
At that point, it dawned on SB that a pharmaceutical company cannot conceivably give a product of this kind to physicians for many legal and liability issues. It was both good and bad news. Infor-Med ended up with a unique software but no method of distribution.
Enter the Early Adopters
Doctor Richard Low had met Doctor Clayton Reynolds in Lancaster, California, while doing Locum Tenens coverage of a local physician there. Dr. Reynolds was an Endocrinologist and the Chairman of Quality Assurance of the three hospitals in the area. Dr. Reynolds was known for his high standards, as it was his duty to evaluate the other providers in these hospitals. Their initial meeting was not only a learning experience for Dr. Low, but also the beginning of a long-term friendship that continues to this day.
Dr. Reynolds was significantly impressed with Doctor Low and requested that Dr. Low cover Dr. Reynolds' practice as well. A few years later upon the development of Praxis-Dr. Low invited Dr. Reynolds to become the first beta tester of Praxis 1.0.
If a doctor with such stringent and discerning capabilities such as Dr. Reynolds approved of the software, it was heading in the right direction. Dr. Reynolds not only approved, but also effusively praised the software, in an influential article published in Physicians and Computers in 1993 ("Thinking Like A Doctor") which jump-started Praxis' career.
Without question, the very first users of Praxis became also its strongest supporters as well as its best critics. Dr. Low has since then personally fielded thousands upon thousands of questions and comments from his clients, attempting to turn each Praxis user into a teacher to improve the software.
It became immediately obvious to Dr. Low and all Praxis users that although the reason for developing Praxis had been to save the physician time, its major virtue was an improvement in the quality of care and the decrease in physician stress from paperwork. This is obvious in retrospect because Praxis modifies the user's behavior for the better and eliminates random errors in documentation and in practice.
Still, the initial Praxis 1 was a Ferrari that was missing a wheel. At the very best, it could only be described as a charting software, not a full-fledged EMR.
In November 1997, after another five years of work and hundreds of recommendations from its early users, Infor-Med released Praxis 2 for Windows 95 - the first true EMR and about 20 x better than its predecessor.
At this time, Dr. Low finally left his practice of medicine to dedicate himself full time to the development of this cutting-edge innovation.
It was really the early adopters using Praxis all over the USA and now Canada that have helped the company realize its dream. Hundreds upon hundreds of ideas and critiques made their way into the honing of the new product.
The Birth of Praxis 3.0
Soon after the release of Praxis 2.0, Infor-Med experienced growing pains in the manifestation of technical obstacles and setbacks. Although developed in Object Oriented Programming, its technology was outdated because of its use of Borland C++, a technology that Microsoft was not really supporting.
Praxis quickly got into what software experts call "the infinite bug loop" -
a situation where for each bug you fix, you develop two bugs.
A decision was made to start again, but this time resulting in an all-encompassing EMR, taking concept processing to a new paradigm that was not limited to charting, but to actually running the clinical practice.
Praxis 3 became an amazingly ambitious project, based on all our ten years of experience with Praxis 1 and Praxis 2, plus the feedback from hundreds of savvy clients.
It was immediately concluded that Concept Processing could accomplish far more than great charting. For one thing, the same technology that allowed doctors to chart by learning from themselves, could be used to learn to handle the practice, to remind doctors of cases in the future, to manage customized practice guidelines and schedules, and to create intelligent flow charts.
After 7 determined years of improvement, Praxis 3 was finally released in January of 2005.
Praxis 3 Comes of Age
Praxis 3 has incorporated all the targeted features, and then some. It is today the most flexible, and powerful EMR in the market. In the process, we have learned how to teach it and how to properly support it. CRM software was added to our support team, which was clearly expanded.
Then, third parties came into the act. Praxis was one of the first 22 EMRs to be certified by CCHIT last year, after passing a rigorous examination. Unlike other EMRs that were certified much later, Praxis had nothing to change or add to be certified. It simply took the test and passed it with flying colors.
Praxis continues to be considered one of the best-known and respected EMRs in the country even though the company does surprisingly little in terms of marketing. Most of its sales come from the word of mouth of its own clients.
Now Praxis is about to release version 4, the fruit of three years of learning and incorporating its newest improvements. The most important improvement to note is the new Knowledge Exchanger, which will allow long time Praxis users to share their expansive knowledge bases with their colleagues in every specialty.
Pushing the envelope of EMR Technology and Shifting the Paradigm
Up until now, our unique technology has been criticized by our competition, afraid that the Concept Processor may do away with inferior templates. Of course, our avidly supportive clients would enthusiastically fan the flames of our competitors' fears.
Our plan is very simple:
- Develop the best physician-centric EMR by learning from our own doctors.
- Pursue concept processing technology to its greatest heights.
In short, develop the best EMR in the world.
Most providers place their patients first. The EMR should place the providers first. Providers have been, and will continue to be our foremost concern.
We thank all of our clients for pointing out the way and helping us get there!