In Which We Meet a ZocDoc Competitor and Find Out More About the Sausage Factory

ZocDoc, the medical appointment-booking website, says it syncs seamlessly with “all practice management systems that have 1 percent marketshare, and a lot that have less than 1 percent marketshare.” We reported this in a story about the service’s founding and growth last week, and a reader chimed in to express skepticism: “There are hundreds of practice management programs for doctors; ZocDoc says it syncs with all the versions that have more than a 1 percent market share.” Absolutely not true.

The author of that comment, James Davis, works in business development for, which provides “customizable online patient registration that allows the patient to complete and electronically sign all their paperwork before their scheduled visit to the doctor.” They also do insurance verification and patient self-scheduling. In other words, a ZocDoc competitor. Which is how Mr. Davis knows a little something about the difficulty of working with doctor software. (Mr. Davis was upfront about his conflicting interest.)

These software vendors often don’t offer APIs or tools to make integration easy, the reader said in an email. “Add to that the fact that most of these companies are mind-numbingly slow to get anything done and that allows me to say there is absolutely no way ZocDoc has integrated with every system with more than one percent market share,” he said.

There are more than 600 electronic medical record-keeping systems that RegisterPatient’s clients use, he says. “The fact of the matter is it takes lots of time and relationship building to put those integrations in place. I don’t think ZocDoc has put any measurable effort into doing this. Plus I spoke with the EMRs we’ve integrated with (one owns 40 percent of the podiatry EMR market) and the usual response other than ‘No we don’t integrate with them’ was ‘Who’s ZocDoc?'”

So how does ZocDoc manage? By skipping the software makers entirely, communications rep Allison Braley explained.

“We don’t actually work directly with the vendors to do these integrations,” she writes in an email. “We do it all ourselves because the process of working with the vendors is often too slow … We have IP that allows us to integrate with systems that don’t offer an API. The vendors are often not even aware that we’ve integrated.”

ZocDoc is also only integrating with whatever application is being used for scheduling, she said, which might not be part of the EMR or patient management system–it could be Outlook.

This approach goes back to the reasons for ZocDoc’s success and the absence of any real competition as of yet: the company built a huge infrastructure essentially by hand. It might be messy–OrganizedWisdom cofounder Unity Stoakes described the backend as a “sausage factory”–but it works.

The answer was a little more slippery when we tried to pin down how many systems ZocDoc integrates with and how much market share they have. How do you know if a system has more than one percent of the market?

ZocDoc’s answer: “In working with as many doctors as we do, we’re able to gather this information on our own. Every doctor we talk to shares what system they’re using, so we’re able to collect the data that way.” Seems sketchy. But since the original story said, “ZocDoc says it syncs with all the versions that have more than a one percent market share,” we’re letting it stand.

ZocDoc offers an separate web-based calendar for doctors who use unsupported systems.

UPDATE: Mr. Davis clarifies that RegisterPatient and ZocDoc are not competitors although they do offer some of the same services. “Patients don’t use us to search for docs and make appointments,” he said. “We work directly with EMRs or health care providers to offer specialty and even doctor specific online patient registration. (with some other bells and whistles thrown in for good measure. But what we do best is registration) If anything, we’d be a complimentary feature to Zoc Doc that would round out their service after an appointment was booked.” In Which We Meet a ZocDoc Competitor and Find Out More About the Sausage Factory