Medical knowledge and information is doubling every 27 days or so, making it physically impossible for clinicians to keep up with advances and practice medicine simultaneously. Matt Titus, Vice President and Chief Commercial Officer with clinical content provider epocrates, spoke with Pharma’s Almanac Editor in Chief David Alvaro, Ph.D., to explain how the epocrates app — when used as a digital reference tool at the point of care — helps clinicians navigate important prescribing and other decisions, improving patient care while making it easier for clinicians to do a better job.
David Alvaro (DA): Can you introduce us to the history of epocrates, from the original idea through today?
Matt Titus (MT): The company started within an incubator — essentially a student project — at Stanford University with the goal of designing an innovative use for the PalmPilot. The end result was an app that would help clinicians make better decisions at the point of care, which was tested with physicians participating in the university health system. We have the same mission today, but in the last 25 years, the app has undergone several variations.
In light of the positive responses the app generated from day one, the students sought investors and raised $5 million in funding. The company name epocrates comes from Hippocrates, the founder of medicine. In the late 1990s, Internet-based systems were typically named E-something: E-web, E-newsletter, etc. Thus, Hippocrates was modified to epocrates.
The money was used to build out the beta-version, and when it was launched, it had 17,000 downloads in the first three months, which were really huge numbers at that time. In essence, it went viral before going viral was even a thing. It became very popular, and the company started selling branded PalmPilots with the app pre-loaded. Pharma companies would buy the PalmPilots for their drug reps to give out to physicians, which was allowed at that time. As a result, there were 100,000 downloads in the first nine months, with 400–500 new users added each day.
In 2001, the company pivoted away from the PalmPilot model to being an app company. This strategy paid off when Apple came out with the iPhone, which provided a new market for the app. epocrates was, in fact, one of the original companies involved in the launch of the App Store and was highlighted as a way to democratize medicine — a way to allow clinicians to understand treatment decisions at the point of care. The business took off from there.
The next chapter in epocrates’ history began in 2013, when athenahealth acquired the company.
DA: Could you speak a little about how the epocrates app helps clinicians overcome some of the challenges they face?
MT: A couple of decades ago, when a student went to medical school, medical knowledge would double every 10 years. Doctors could more or less keep up with advances by attending conferences, reading the literature, and pursuing continuing education courses. Today, medical knowledge and information is doubling every 27 days or so, making it physically impossible for clinicians to keep up with advances and practice medicine simultaneously.
In addition to the speeding up of scientific advances, drug discovery, and other innovations in medicine, there is a never-ending list of chronic conditions people are now suffering from. It is necessary to stay on top of burgeoning numbers of new therapies, as well as non-drug-based treatments. Clinicians cannot possibly know every drug and its side effects and interactions with all other drugs. The only way they can do that is to have access to a digital reference tool at the point of care to try and navigate these important decisions that must be made.
In fact, I would argue that the use case for the epocrates app has strengthened since it was originally launched based on the rate that medicine and technology have matured and continue to advance.
DA: What are the key features of the app, and how have they have evolved over time?
MT: One of our key goals is to provide clinicians as much information as quickly as possible at their fingertips so they can make the right decision for each patient at the point of care. There are a few core use cases in the epocrates app. The interaction check is widely used: it provides clinicians with information about potential harmful interactions between a drug they are considering prescribing with medicines a patient is already taking. Also, the app provides access to drug monographs so clinicians can quickly determine the correct dosage and learn about any warnings issued for any drug they are considering prescribing.
The app also includes clinical guidelines that suggest how a patient with a certain illness or disease should be treated. They come from professional associations, the FDA, and other governing bodies and can help clinicians evaluate and treat individual patients. There are also drug calculators for certain treatments and a formulary that provides information on insurance coverage for different insurance plans.
The app has evolved with technology. For instance, in 2021, epocrates launched a first-of-a-kind product called Bugs + Drugs. This product provides clinicians with information about which infections are most prevalent in their areas based on zip codes. Separately, knowing that clinicians are always seeking to learn more, epocrates launched a continuing medical education (CME) business in 2021. We work with a number of pharmaceutical companies and medical education companies, hosting their content. It provides clinicians with the opportunity to address knowledge gaps with respect to things like specific treatment regimens and therapeutic categories.
I also want to stress that the key idea behind epocrates is that it is developed by clinicians for clinicians. We have an entire team of HCPs, PharmDs., and Ph.D.s vetting and providing this information to and on behalf of their peers. That is why epocrates is so highly valued and widely used. The clinical information is relevant and from a trusted source.
DA: With the amount of information increasing at such a rapid rate, how does epocrates manage to stay abreast and keep the app current at all times?
MT: One of the ways epocrates has tried to attack this challenge is by continuously improving the taxonomy in our search features so that the time it takes to find answers does not change, regardless of how much information is coming into the app. Our user experience and medical information teams work closely together to keep that time as short as possible, because we know that the moment it takes too long for epocrates to provide an answer, the app will no longer be valuable to clinicians.
These days, clinicians are working more hours without seeing more patients. That is because they have to triangulate more digital resources every day, which extends their work hours, which is one factor that is accelerating physician burnout. epocrates helps by putting that information in one place and streamlining access. Ultimately, it helps physicians be better clinicians.
DA: Can you help contextualize how the app fits in with the broader technology trends outside of healthcare? One example would be omnichannel; why is it central at the point of care?
MT: At the heart of omnichannel, the goal is to reach the right clinician with the right message at the right time. That becomes complicated in an increasingly digital world. As a result of there being so many different media channels to reach people, it is difficult to know where to reach the right clinician with the right message at the right time. And even if you accomplish that, it is then difficult to know if they will take any action and if that action will be meaningful.
That is where epocrates provides a lot of value Over 60% of clinicians that use the app say that they have used epocrates to change a prescribing decision. The content within epocrates is truly clinical as it is written by M.D.s, DOs, Ph.D.s, and PharmDs. We are trying to help clinicians navigate the decision-making space and for many clinicians, epocrates serves as a second screen in the room that provides the missing information needed to make the right decision.
At epocrates, we believe that is the sweet spot in the omnichannel journey and where you want to have your message: at the point of care when providers are seeking missing information. It’s probably not a great place to plop an hour-long video. You can find other channels for that, right? But I think for us it is the right place in which we can help both clinicians and life science companies.
DA: Are there certain types of data you see physicians being more interested in that will merit expansion of the app?
MT: Absolutely, yes. As the purveyor of a user- or registration-driven platform, we know what our users are doing in the app at all times. We can tell what doctors are using the app and which drugs they are looking up and can estimate the likelihood that they will make a prescribing decision because they looked at drugs X, Y, and Z. We are constantly viewing their digital journeys and thus indirectly their decision-making processes. That information is used to guide further development.
We also have access to hundreds of lab tests and what normal ranges should be. Doctors look at certain lab tests before viewing specific drug monographs or doing something else in the app that provides needed guidance. It could be disease state information or something entirely different, but it helps clinicians in that particular space get patients the treatments they need.
epocrates is more committed than ever to using data to help our pharma and life science companies to understand their users and their target audiences. On the flip side, we are also committed to using data to drive personalized experiences for the users of our app — knowing what is relevant and useful for each individual clinician, so they continue coming back to epocrates day after day.
DA: When you look further into the future, what do you see as some of the more distant possibilities that the epocrates system may be able to unlock?
MT: I use the encyclopedia as an example. It was a printed collection of books with information on endless subjects. No one uses that anymore. It is all online now –– whether in the form of Wikipedia or other versions, and let’s not forget about YouTube. Medicine has not been very good yet at moving into video. However, as healthcare continues to adopt more digital practices, we will see more and more pharma content going toward video as well. While text is really great and can provide a lot of scientific information, people today want to see how to do things. Video has consequently been a huge development area for us. We will be launching two new video products later in 2023 that will allow us to speak the language of clinicians.
There is also a lot of talk about machine learning and artificial intelligence. We are incorporating these technologies as well to curate unique user experiences based on unique user journeys. That will allow the personalization of epocrates to be significantly increased. The rapid rate at which technology is advancing is creating a lot of opportunity for epocrates to keep evolving in terms of the method of delivery across the healthcare universe.
DA: Do you see the fundamental epocrates technology needing to evolve?
MT: Technologies like ChatGPT, which no one heard of just six months ago, will help epocrates keep up with the increasing speed at which content is being generated. epocrates will always be a clinician-to-clinician app. The question then becomes whether ChatGPT and other AI engines can be smart enough to help us write some of the medical content and stay up to date with the new content that is being generated. The hope is yes. Then a clinician could review the content to make sure it is correct. Technological innovations will continue, and digital technologies like AI have real potential to help us keep up with the speed at which scientific information is moving, but I do believe there will always be a need for humans.
Could we get to a place where ChatGPT is doing all the notetaking and entering all the data in the EHR accurately to alleviate that technological burden from a clinician? Maybe. We need to think about ways we can alleviate that data entry burden from clinicians to help them continue to practice medicine in a way that is effective and also efficient.
I think that technology will consequently continue to play a huge role in medicine and pharma/ life science in the next few years. We’ll continue to see some trends accepted on the margins by really innovative companies. Eventually, it is likely that due to cost pressures or other technological developments, those innovations will become the norm.
DA: I’m curious if there are still groups of physicians who are reluctant to adopt the epocrates technology?
MT: epocrates is widely used by medical school students because the human mind cannot physically memorize or remember every single piece of information that is needed on a daily basis. As a result, it is very difficult to find a clinician or physician in the United States that’s never heard of or used epocrates. One of the challenges for us is making it relevant for both older and younger clinicians, as well as clinicians that are generalists and those that are highly specialized.
To address these concerns, we spend a great deal of time and effort talking to clinicians in all different specialties about what they find useful in the app, as well as what features or content might be missing and what could be done better.
DA: Can you speak a little about innovations that you have underway?
MT: One of the things that is really important for epocrates is remaining disciplined because there are a lot of different pocket areas of medicine for which more features can be developed, both for life science companies and for our clinician users. We need to ensure that we maintain our core vision to help clinicians make decisions on a daily basis.
We evaluate potential new features along those lines. We are an innovative company and are constantly whiteboarding ideas and looking at different spaces, always with a focus on how epocrates can help clinicians contribute meaningfully to medicine. The key areas of focus are continued personalization, increasing clinical content, and incorporating video.
DA: Is there anything you can share about how the company is evolving?
MT: epocrates has always primarily been an app, and our goal is to expand outside the app. We touched on Web properties earlier. Outside of the Web, what might that look like? Do we land in the metaverse, if that sticks, or the VR applications being developed by major technology companies, such as Microsoft and Google? As the concept of what digital property means continues to expand, epocrates will continue to evolve its offering to meet clinicians where they are.
DA: Are there any big shifts or trends you’re seeing happening in healthcare itself that are going to really transform or alter the needs a physician might have at the point of care?
MT: There are so many healthcare companies making different tools and reference apps and EHR systems and so on. Clinicians are kind of tapped out in terms of being able to absorb new technologies being layered on top of one another while being faced with increasing patient loads. They don’t have the capacity for this anymore. As a result, it will be more difficult for some companies to gain traction.
We also expect to see more mergers and acquisitions in the healthcare technology space in the next five years or so. This activity will be essential, or the results could be too many applications, which is not good for clinicians who are already overloaded with information. When the features are combined in just a few apps, it will be easier for clinicians to practice medicine.
Pharma companies are also finally being more active in pursuing digital transformations. Consumers made the transition 10 years ago. Digital consumers are also digital doctors and clinicians with expectations of similar digital delivery at work. I think pharma companies will therefore really begin to try to increase digital interactions.
DA: Is there anything else you would like to mention?
MT: A recent epocrates user survey revealed that over half (59%) of respondents indicated that using the epocrates app saves them more than 20 minutes per day of administrative work — up from 46% the previous year. This indicates the app is getting more efficient and better at solving a lot of clinician queries and questions and becoming a more valuable resource for them.
Healthcare remains so important, and the staffing shortage is a real crisis We are seeing older clinicians retire because they feel it is not worth being in the field anymore and many physicians retired over the course of the pandemic as well. epocrates has a big part to play in helping to solve this issue by making it possible for clinicians to make better decisions more easily.