Skin in the Game

Every day at 3 a.m., Naples dermatologist Srdjan Prodanovich fires up his computer.

That's when his day starts, but he won't see his first patient until 9 a.m. Instead, he's working online with a team of software developers located six time zones ahead in Belgrade.

A native of Serbia, Prodanovich and an undisclosed investor have spent $3 million to develop EZDerm, a software program that helps dermatologists manage their patients more efficiently with electronic medical health records.

Sales of EZDerm started in December as a subscription service that costs $499 a month, and doctors who subscribe rave about it. Using iPads and gee-whiz technology such as voice recognition and 3-D images of the human body, EZDerm has wowed its first dermatologist customers.

The industry has been receptive, too. Nuance, the company behind Apple's Siri speech-recognition software, awarded EZDerm its annual medical-technology award at a health care summit in Portugal last year. And Prodanovich is scheduled to speak in San Francisco at TedMed in September, an annual conference that is the medical equivalent of the popular Ted conferences.

By 8:30 a.m., Prodanovich is off to his dermatology practice in Naples called Advanced Dermatologic & Cosmetic Institute where he might see as many as 60 patients until 5 p.m. He's back at EZDerm's offices at Venture X in Naples on Thursdays and Fridays, where some of the company's 25 employees work.

Although he still plans to continue to practice, Prodanovich acknowledges that EZDerm will likely demand more of his time as it grows. “I can have more impact on peoples' lives doing this than seeing 60 patients a day,” he reasons.

There are plans to expand the program to other medical specialties and for additional services such as billing. “There is a need for better health care and it's not possible without better technology,” he says. “Government is not going to be able to solve that.”

Electronic wishes
The 45-year-old Prodanovich (his first name is pronounced like “sir john”) isn't one to shy away from a challenge. He was visiting New York City on holiday in 1991 when civil war broke out in the former Yugoslavia. “I couldn't go back,” he says.

Prodanovich dreamed of becoming a physician and put himself through medical school while operating a family restaurant in Sarasota. “Somehow we managed,” he says with a smile. “If you want something, there's no other way.”

With a medical degree from the University of Miami and residency in dermatology, Prodanovich opened his practice in Naples in 2006. Naples was growing and Prodanovich figured it would be a good place to start his practice.

But while building his practice, Prodanovich grew frustrated with the lack of an effective electronic system to keep track of his patients. “When I opened in 2006 I tried to be as electronic as possible,” he says.

What Prodanovich found on the market was “nothing more than glorified word-processing documents,” he says. As his patient load grew, so did the paperwork. “The software started to interfere with patient care,” he says.

As he saw it, Prodanovich says software developers didn't understand the volume of paperwork that needs to be completed for each patient. Often, that paperwork can add hours to an already long day. “Most electronic health records are designed by engineers,” Prodanovich says.

So Prodanovich started writing down all the things he wanted in an electronic system. “I started with the vision on a Word document,” he says.

Most important was the need for time to counsel patients and ease of use. “Let's rethink why people are unhappy,” Prodanovich says. “I need my time for the patient.”

Spark of the iPad
The introduction of the first iPad in early 2010 gave Prodanovich the tool he needed. The newest iPads fit nicely in the physician's smock pocket and Prodanovich realized this was the perfect device that could allow a dermatologist or his assistant to jot down notes while touching a screen.

But as with all new technology, the cost of developing the software was prohibitive. “I wouldn't be able to pay iPad programmers in the U.S.,” he says, estimating the annual salary of a senior iPad programmer costs from $300,000 to $500,000.

So Prodanovich hired a team of Belgrade programmers in his home country of Serbia who do the same work for 20% of the cost of programmers in the U.S. To fund the venture, Prodanovich found an undisclosed partner and together they've invested $3 million in the effort so far.

Initially, Prodanovich estimated the program would cost $200,000 to develop. “Both of us are very religious about it,” Prodanovich says of the higher-than-expected cost. “In order to make great things, you need time. ”

Wow the customer
Instead of turning their backs to patients and typing lengthy notes, EZDerm lets physicians use an iPad and their index finger to touch shortcuts they've created and a 3-D body map to identify where the skin problem is located. If they prefer, they can use the voice-recognition software to record a patient's notes.

“I don't like long dictations in front of patients, I use more of the shorthand,” says Debra Price, who owns a dermatology practice in South Miami and started using EZDerm in February.

Price says the quality of the patient visit is most important. “I'm spending more time interacting with patients and less time scribbling notes,” she says.

The system has a Facebook-like page for patients called Sadio, which means “health” in Portuguese. Patients can grant access to their medical data on Sadio to any physician, friend or family.
Physicians who use EZDerm can offer this to patients at no extra cost and their visit is recorded on the patient's Sadio page. Sadio also allows patients and doctors to interact on a secure level.

Many physicians dread the hours of paperwork they have to fill out after they see their last patient. Barry Galitzer, a dermatologist in Fort Lauderdale, says he was able to save the cost of a transcriptionist and he can leave after he's seen the last patient. “I'm not staying a stitch longer at work,” he says.

Because the software is intuitive and requires only pointing or speaking, staff assistants learn to use it quickly. “It took them almost no time to learn it,” Galitzer says. “They didn't even take a class.”
Galitzer says Prodanovich's experience as a dermatologist was a major reason he adopted the system. “He's not just an owner, he's a user,” he says.

Prodanovich says there are opportunities to expand the system to other medical specialties and add services such as billing. But those will take more time and money, he acknowledges. For now, he's focused on dermatologists. “We wanted to make sure this worked,” he says.

Executive Summary
Company. EZDerm Industry. Health care Key. Developing a great product will take more time and money than you think.