Big Tech Is Going After Health Care

https://www.nytimes.com/2017/12/26/technology/big-tech-health-care.html

by SREinSF • 9 years ago

138 195 9 years ago

ynonym00s• 9 years ago

Would love to get some insight into the work at Verily or DeepMind Health for a software developer interested in working in healthcare.

mtgx• 9 years ago

And it's going to throw your medical privacy out of the window in the process.

I suppose we'll also see some major deregulation similar to the net neutrality repeal in the healthcare industry before long.

rossdavidh• 9 years ago

Maybe, but in this case there's an entrenched interest (health care companies) that might want to use medical privacy as a way to keep themselves from being Uber-ized.

rafinha• 9 years ago

Not necessarily. You can still provide decent services collecting anonymized data.

zitterbewegung• 9 years ago

They are going after health care because they either ran out of customers or people to advertise to.

Hopefully they can make some progress but so far I don't see much.

Clubber9• 9 years ago

It's an immensely lucrative and recession proof industry.

hacker_95• 9 years ago

This article is pretty devoid of content, and really only mentions that the Apple watch can be used as a constant heart monitor. Big deal, you aren't going to get much information from measuring just your heart beat and knowing next to nothing else of whats going on in the rest of your body too.

The real technological breakthrough will come when we have the ability to measure in real time what is going on in our various organs, such as enzyme production and transportation of molecules, but that's a long way out yet.

lovemenot• 9 years ago

Toto, the producer of fancy toilets in Japan, is believed to be developing some kind of back-end analytic system.

blhack2• 9 years ago

Good.

I spent a few years working in a medical IoT startup, and the current state of the "mainstream" medical monitoring technology is not inspiring.

During a brainstorming meeting, I asked one of our cofounders, a physician, to tell me about some of the problems he had seen in health. Don't try and solve it, just lets talk about problems.

He said that by far one of the most common causes for re-hospitalization is congestive heart failure. It's a super common problem, and it's actually really easy to catch (it has strong indicators). When your heart begins to fail, depending on what side of it fails, your body will retain fluid (in the form of blood) in either your heart or your organs. Regardless, you will bloat up, and gain weight quickly.

So if a patient is at risk for CHF, a nurse will monitor their weight every day (or multiple times a day) and watch for spikes. If their weight spikes, a doctor will intervene in whatever way is necessary.

Can you imagine my frustration at hearing this? It's this massive problem with an obvious (CHEAP!! SO FUCKING CHEAP!!) solution.

I spend $30 on a scale from amazon immediately, and about an hour after it arrived I had it connected to an android tablet and broadcasting its readings to a webservice.

We never went to market with that (long story). Please, if you have the means to take something like that and scale it, do so. You could save lives. I'm currently trying. More people should be trying. This stuff is so easy, and the impact that you could have is massive.

Also: please call your grandparents and just talk to them. Ask them how they are feeling. Social isolation (full disclosure: this is what my current project is trying to solve) is probably the area where we as software people could have the biggest impact.

hacker_95• 9 years ago

The monitoring devices are the real problem, not the people. Do you think all weight spikes simply equate to having CHF? You can't just rely on such a basic measurement when dealing with an incredibly complex system such as the human body. A lot more specialist equipment is going to be needed to come to a final conclusion (Questioning from experts, MRIs, XRays, even Microsurgery with cameras).

What consumers can currently access are weighing scales, and heartbeat monitors. Maybe even temperature monitors. Do you think this stuff is useful for diagnosing medical conditions? There is a whole lot going on under the surface that we simply can't see at all, that's the real problem.

rhombocombus• 9 years ago

It is possible that some of the noise (non-medically relevant changes) could be filtered algorithmically, and conversely conditions might be able to be picked up that might not be noticed by a normal provider. Physicians use those tools to diagnose disease all the time, that's why there is a thermometer, scale, and stethoscope in every doctor's office in the world, I don't understand how these tools aren't useful.

killjoywashere7• 9 years ago

Your comment is a great example of the disconnect between people in this space and people not in this space. Do you actually think anyone in this space would believe that weight spikes are tied to CHF in all cases? You don't diagnose CHF by weight. It's something you trend in known patients.

Comments like this are one reason why doctors give zero shits about the potential of computing. Explaining even the basics of a narrow area of human physiology to some overly arrogant IT guy is maddening (arrogant is fine, for Pete's sake, it's not like doctors aren't arrogant). Yes, the doctors can be blamed for conflating computer scientists with the IT guy who came to replace their mouse. But the IT guy and the CS guy (always a guy) can both equally be blamed for their unholy arrogance. How many lives did you save today? Zero? Ok, at least I didn't spill any data (that I know of).

This can go round, and round, and round.

You have no idea how far down the problem goes. I know this because no one knows how far the problem goes. We sequence hundreds of thousands if not millions of genomes, and still we don't know. Do you really think we spend a decade in training and come out thinking everything is simple?!

Now, on the flip side, doctors also don't even know how to frame their problems, in no small part because they're only required to take 2 semesters of calculus. And then most of them punch out of math as fast as possible.

Computer scientists should be going to biology conferences. Go to ASCO. Pick a medical specialty, they have multiple conferences a year, I garauntee it. There's one or 10 in your city. If you want middle ground, look at microbiology, immunology, molecular biology. They use a fair number of quantitative methods (sequencing, mass spec, flow cytometry, etc).

c3534l• 9 years ago

If you're going to monitor every aspect of a person's life, you're going to generate so much data that you'll generate almost nothing but false positives. None the less, I don't see why you couldn't just scale your level of significance way up and be a useful screening device. Obviously any diagnosis must be made by a doctor, but that doesn't mean your biometric information wouldn't be useful.

frahs2• 9 years ago

This isn't about diagnosis, it's about monitoring already at-risk patients. He clearly stated nurses take this sort of measurement manually for at-risk patients, it's a simple solution to automate an existing workflow that involves an unnecessary amount of manual labor.

jmull• 9 years ago

I think they only use weight to screen people specifically at risk to determine if they need to take a closer look.

An easy, fast, cheap test which usually means a more expensive test or exam doesn’t need to take place.

SilasX2• 9 years ago

It seems like the real (meta)problem is that the system’s incentives don’t reward this. If a doctor’s take home pay increased as these things were avoided, you wouldn’t need some risk-tolerant startup to dive in with some innovative protocol; someone would have figured out a fix a long time ago.

(Edit: to adapt the old saying: if life-saving were profitable, common sense would make us all saints. But alas, we live in a world where regulatory arbitrage pays more.)

I think we should ask how we got to the point that the incentives are so incompatible and how we got to that point and how to realign them.

teej• 9 years ago

Both doctors and hospitals are financially incentivized to avoid rehospitilization. It is actively tracked and directly impacts billing. Check out the "Hospital Readmissions Reduction Program" that Obamacare introduced.

I’m sick of people spreading FUD about medical billing based simply on the ridiculous “the man is out to get me” narrative.

u801e8• 9 years ago

There are plenty of indicators that could be monitored in various patients for various diseases, but a lot of them may require doing things that are beyond the ability of someone who is not medically trained. Some of them require intravenous blood samples, for example. But others are like example you mention (which only requires that the patient weigh themselves at a given time each day).

It would be nice if we could make it simpler for people to measure things like their own hemoglobin A1C, blood urea nitrogen/creatinine, blood flow around organs/extremities, etc. and send the data to a service that can be used to alert medical staff if something looks like it's getting worse.

joshgel6• 9 years ago

Interesting you bring up heart failure readmissions. Not saying they aren't a problem, but here is a fascinating study in JAMA that argues that places with lower readmissions have higher (worse) mortality. https://jamanetwork.com/journals/jamacardiology/article-abst...

Not sure we (I'm a physician) understand even what the problems we need technology to solve are. But yes, we need technology to help (find and) solve some major problems that will improve lives.

blhack2• 9 years ago

Are there other examples of things you wish existed? Again, forget about if they could exist, just stuff you wish you had?

obastani• 9 years ago

Couldn't this finding be explained by the fact that the hospitals with lower readmissions tend to be poorer (since poorer patients are less likely to be able to afford care)? I only took a quick look, but I didn't see how the paper accounts for this and other possible causality issues. On the other hand, it's certainly plausible to me that lower readmissions can cause higher mortality.

aviv35• 9 years ago

Why do we need technology to help improve lives when so many diseases (type 2 diabetes, Crohn's, IBS, high blood pressure, arthritis, and dozens of others) can already be reversed and prevented by simply changing a person's diet and lifestyle habits? It's really quite insane that people would rather take pills for the rest of their lives to treat symptoms of a disease than actually getting rid of it altogether by giving up food habits.

Part of it is also due to traditional physicians being so dismissive of the role nutrition plays in a person's well being.

SQL2219• 9 years ago

The tech is the easy part. Integrating into a 24/7 high turn-over environment where all employees, IT included, are stretched to the max, is the real issue.

scruple• 9 years ago

And pumping the data in to their myriad EHR systems, getting those records associated correctly across those systems+, the unintuitive UI/UX problems you'll inevitably face, as well as training issues. And God help you if it's a place where they home brew their own solutions instead of going with a vendor. My company is in the health care space, as well, and a lot of the problems _do_ look easy ("that's just a CRUD app, right?" easy) until it comes time to get them adopted in the health care space.

NetOpWibby• 9 years ago

Failure to market an IoT product is unfortunately my experience as well. I hope the medical industry gets better, re-hospitalization sounds ridiculous for something easy to detect.

lazyasciiart• 9 years ago

Wifi-enabled scales that connect to webservices already exist on amazon - I assume the hard part is getting some certification so doctors/nurses can 'prescribe' it to patients when they leave hospital or while they're in hospital and getting the webservice to talk to $hospitalSoftware, etc?

ubernostrum• 9 years ago

I'll throw in a slightly contrary opinion.

I work for a health-insurance startup. And many of the people we cover are on extremely low fixed incomes. It's not unusual for them to be in situations where they have to choose which bill to pay this month and thus which utility will get shut off next month for non-payment. Their premiums are heavily subsidized and they only have insurance at all because of government programs, sometimes only because they're eligible for multiple programs which combine to help them out (and which are also constantly on the chopping block). So any kind of cellular phone, let alone a multi-hundred-dollar smartphone with service contract, is simply an unaffordable luxury for them.

And that's why I worry about these kinds of efforts. More affluent people can benefit from smartphone-centric approaches, but a huge percentage of the US slips through the cracks when you do that.

So solving America's health-care problem is not going to happen by focusing on people who have smartphones. That will just heighten the divide; the people who are already in a position to get good care will continue to get it, and the people who aren't will continue to get worse. If you want to avoid the grim-meathook-future problem, smartphone-centric (and, really, most tech-centric) approaches are unlikely to work.

rayiner• 9 years ago

Can you imagine my frustration at hearing this? It's this massive problem with an obvious (CHEAP!! SO FUCKING CHEAP!!) solution.

I suspect the nurse is there to perform the “getting the patient on the scale” function, not the “reading out the weight and tracking it” function.

delhanty2• 9 years ago

Perhaps the scales could be built into the bed somehow?

ep103• 9 years ago

Is there any chance you would be up for talking about where one could go about working in tech on problems like these? Every time I've looked, I usually just find hospitals maintaining poor IT infrastructure and CRM-type systems. I would love to work in this space.

Strangely, I've been able to find startups in the education space, but not in healthcare. I imagine 90% of the problem would be integration into the behemoth that is medical administration, but that's something I also have the skillset for.

Hacker news has a limit on replying to responses with less than a few votes, but my email is in my profile

mjfl• 9 years ago

Yeah, nothing's going to happen. Compliance costs are too high for any of Silicon Valley's business models to work.

adventured• 9 years ago

The way you fix the existing system, is by not trying to change it. You replace it instead. You build new, lighter, more nimble approaches to old problems, rather than trying to convince existing power structures to change. That's where any gains will come from by big tech entering the fray, if there end up being any.

Trying to change something like the hyper regulated, hyper stagnant, special-interest dominated US healthcare system, is a folly of an idea. You kill it instead by routing around it with new solutions wherever possible.

Simple example: the rapidly growing market for direct primary care subscription services [1]. Pair that up with guaranteed catastrophic coverage for all by the US Govt or state governments, and the US healthcare system as we know it is dead due to a simple route around that would dramatically lower costs. It's far easier to implode a failed bureacracy by replacing it in that manner, than by trying to change the existing bureacracy. You see that in everything from old media (which held a cartel stranglehold on broadcast access, the Internet routed around them), to the taxi medallion cartels (which Uber & Lyft murdered by routing around them instead of trying to convince them to change).

[1] http://www.businessinsider.com/direct-primary-care-a-no-insu...

snomad• 9 years ago

As the MOOCs found out, you can't just "replace" certain societal services - especially those beset with volumes of regulation and numerous groups of powerful stakeholders happy to reach out to politicians and the public (AARP, Insurance, numerous govt entities, drs groups, nurses groups).

2/3 of healthcare is paper pushing, the easiest thing the tech community can automate is boring old CRUD paper pushing. I hope one day we as consumers have the chance to get a USB stick to store and retain our own medical records. Walk into dr's office / hospital, hand over device, boom their is your whole history including previous surgeries, allergies, etc. Whatever is done gets imprinted on device, walk out with an updated history. That is some seriously productive low-hanging fruit.

Forge36• 9 years ago

I'm with you on that. For reference I pulled up Google's announcement that "Google Health" is being shutdown.

https://googleblog.blogspot.com/2011/06/update-on-google-hea...

I could see Big Tech enter in other areas (Apple Watch and and their research app are promising)

lern_too_spel• 9 years ago

The post doesn't say that they shut it down due to compliance costs. It says they shut it down because almost nobody found it useful.

nradov10• 9 years ago

Obviously that's false. There have been many successful Silicon Valley healthcare companies creating software, drugs, biotech, medical devices, etc. Just drive around and look at the names on some buildings.

tim3334• 9 years ago

The companies mentioned in the article "Apple, Google, Microsoft and other tech giants" have quite a bit of money for costs. Though for hospital they may need more of an IBM/Oracle corporate type model rather than apps.

oh-kumudo• 9 years ago

If there is one industry that needs to be disrupted, that is US's health care industry, it is too expensive.

epmaybe• 9 years ago

I don't think tech disruption is necessary to reduce costs, a multidisciplinary approach could do something similar.

Edit: apparently my comment never finished, lol. What I meant to say is that disruption could work, but I think that optimization and regulations with the tools we have today would also alleviate many problems we have.

dawhizkid3• 9 years ago

As someone who most recently worked in product at a healthcare startup I found the most difficult thing about innovation in the space is the cost of compliance/regulation.

When you work in an industry that is so highly regulated, and assuming you are working at a company that follows the rule of law, how do you actually "disrupt" a set of problems in this industry when there is so little wiggle room for doing things differently? Following legal guidelines in healthcare means reenforcing bad norms rather than disrupting them.

One of the biggest WTF moments I had when I first started was realizing that fax communication is HIPAA-compliant whereas email/SMS are not, even though in theory anyone could walk by a fax machine at any time and take medically sensitive information sent over.

newman8r2• 9 years ago

I'm pretty sure email can be HIPAA compliant as long as you implement the system using the established guidelines.

toomuchtodo• 9 years ago

Indeed it is as long as you’ve configured your email system to use TLS and not downgrade to no encryption if the handshake fails for mail systems where HIPAA-governed information is departing to.

Source: Not a lawyer, not your lawyer. Sign off provided by non profit bio research orgs lawyer before I set it up.

Clubber9• 9 years ago

Re email: Because you don't know if the destination server is encrypted (you send emails from your server and it finds the destination), any email must be intercepted at your server and a hyperlink to a secure site inserted in place of the email body. The email becomes just a notification via SMTP. The recipient then goes to the site and logs in to view the email. The PHI is what you care about (and it's, very, very strict). No PHI in the subject either.

I suspect the reason faxes are compliant is a few:

1. Grandfathered in. 2. The number of unauthorized people that can see them is very limited (to whomever has access to the fax machine). 3. Modern fax machines print face down. 4. Data is in hard copy format which is more difficult to copy.

As an aside, modern fax machines are probably less secure than the old ones. Fax machines using digi-boards and databases and whatnot. The vast majority of US healthcare use faxes though.

killjoywashere7• 9 years ago

Aerospace also has high compliance hurdles. But rockets are extremely phallic. Even urology can't beat aerospace on that axis.

And yes, having been in this space for a while, the fax is a great example, a loophole for lawyers, who still do lots of paperwork by fax, because there's case law to support the practice (not the security mind you, just the practice).

Neither the lawyers nor the doctors understand math. Between the two, the lawyers at least took a formal logic course.

Doctors think most of the software they use is just magic, if they think of it at all. The only other association with computers that they have is the IT guy who comes to replace their tower every other year.

ryanSrich• 9 years ago

FWIW, healthcare compliance is a solved problem (disclaimer: I work for the company that solved it - Datica.com).

The larger problem is that young companies don't understand what it takes to be compliant, nor the resources to do it themselves. Remember, compliance is all about proving what you say you do. If you can prove it, you're golden.

So it's not that SMS or email isn't HIPAA compliant, it's that the work, controls, and monitoring you'd need to put in place to prove compliance is a massive burden. This is where risk management comes into play. If risk isn't a core tenant of your offering, you're better off building the preferred UX (like using email over fax) and assuming no risk.

gumby• 9 years ago

It could be your mindset. When I worked in drug development (wet chemistry and lots of animal studies) the regulation, while everpresent, just didn’t seem like any kind of burden when compared to everything else we had to deal with.

junkscience2017• 9 years ago

so ELI5 why we shouldn't just get rid of HIPAA? from the way people talk, all HIPAA does is guarantee that things will always be awful(?) how does HIPAA help if it just keeps us in the past?

MBCook• 9 years ago

It’s also the law that prevents doctors from telling their friends about your hilarious medical conditions, or selling information about you to pharmaceutical companies to market to you directly.

It’s a very thorny law, but it’s like that for a reason.

mulmen• 9 years ago

For the same reason you won't call Uber to take you to the hospital if you cut off your arm.

dragonwriter• 9 years ago

One of the biggest WTF moments I had when I first started was realizing that fax communication is HIPAA-compliant whereas email/SMS are not

That's not exactly the case; fax communication can easily violate HIPAA and email, appropriately secured, can be compliant, even for PHI (SMS is more problematic because it's unsecurable).

The issue is specifically that there is precedent (or, at least, a widely held interpretation, not sure there is actually directly applicable case law) that fax is not an electronic communication mechanism for the purposes of HIPAA law and regulation, so while general rules on disclosure and communication apply to it.

even though in theory anyone could walk by a fax machine at any time and take medically sensitive information sent over.

Not having appropriate safeguards to prevent that at a HIPAA covered entity is, itself, a violation of HIPAA.

finnthehuman• 9 years ago

I work in medical devices. The regulation can be unnecessarily prohibitive, but more often than not I see it used as a cop-out.

Where one entrepreneur says "the status quo in this space is so behind the times I can't work there," another says "there are enhancements waiting to be back-ported into this tightly controlled space from domains that have already been proven it to be a good idea." Only one of those people knows how to make money.

That's just the low-hanging fruit. And there's so much of it. Foot-stomping about having a formal quality system instead of "move fast and break things" is letting the perfect be the enemy of good.

u801e8• 9 years ago

fax communication is HIPAA-compliant whereas email/SMS are not

I thought that HIPAA had the provision that stated that encrypted communication is compliant. That is, if the email or SMS was encrypted, then it would be in compliance with the act.

nradov10• 9 years ago

The Direct Project has an SMTP implementation which allows for emailing medical data in a secure, HIPAA compliant way. http://wiki.directproject.org/SMTP+Implementation+Developmen...

659087• 9 years ago

I don't want "big tech" anywhere near my doctor's office or anything else having to do with my health.

Clubber9• 9 years ago

Too late. HIS is Health Information Systems and have been around for decades.

Also, thanks to the patriot act, doctors and hospitals share your health information to the federal authorities without a warrant. So there's that.

https://cdt.org/insight/law-enforcement-national-security-ac...

aviv35• 9 years ago

It's unfortunate that people think "tech" is what health care needs, when in reality society would benefit tremendously if something as simple as a 5-10 day water fast became mainstream [again], as it used to be, before modern medicine took over.

mxwll3• 9 years ago

There are some major hurdles for these SV companies to overcome if they want any level of success in this arena. EPIC and Cerner together hold over 50% market share of EHR systems in American hospitals. Their interoperability and patient facing applications are a joke. EPIC actively makes it difficult for third parties to build on top of their system.

Sure, these SV companies have figured out how to build great tech at scale but transitioning an entire hospital network to a new EMR is a massive undertaking -- both technically and organizationally. Many doctors had their world rocked by the forced transition to using EMR systems and they run the other way from those claiming a novel technology will solve all of their problems.

There are much greater issues at play here and IMO the organizational problems within hospitals are far greater than the technical ones. To be successful hospitals will have to become tech companies. They aren't exactly the hottest place for top tech talent to end up.

I think the patient first approach that Apple and Samsung have been taking are likely to win out. If they can build a system that captures an individual's personal health record doctors will want that data. Hospitals will have no choice but to begin integrating that data even if it lives outside of the walls of EPIC, Cerner, et al.

jeremylee• 9 years ago

Both Epic and Cerner are making at least some strides toward opening up their platforms (Epic with App Orchard, and Cerner with Ignite, SMART on FHIR etc.) Athena has MDP ("More Disruption Please.") I get the feeling these organizations have at least come to the realization that they need to open up--granted their denial up to this point leaves them with a lot of catching up to do. But access to the data that exists in those systems is a pretty big carrot for integration partners to help push adoption.

methehack• 9 years ago

Sorry, dude, but I think you fell for it. These entities try to make you think they're open, but really they are keeping entrants at bay.

Here's an interesting episode of the weeds podcast that gives some context by exploring why the fax machine is still so prevalent in US healthcare.

https://player.fm/series/voxs-the-weeds/fax-reform-bonus

marktangotango• 9 years ago

But access to the data that exists in those systems is a pretty big carrot for integration partners to help push adoption.

The scary reality is, they don't even have access to the data in those systems. I had a friend contracted at cerner working on a FHIR api end point. Something as simple as answering the question "what medications have been administered to a patient" was extremely difficult to pull out of their system. One would think there'd be a simple report for that information, but they didn't have it. The domain/system knowledge wasn't there either. That one simple api endpoint drug on for months as new data was "found" in the 5000+ table schema. Oh, and they don't use foriegn key constraints in production either.

nikanj• 9 years ago

EPIC and Cerner are doing their best to, simultaneously:

1) Appear to be open, ready for innovation and playing fair (so hospitals don't replace them)

2) Maintain their position as gatekeepers, and use that position to extract as much revenue as possible. New startup wants to deploy tech at your hospital? Hospital probably will end up paying more to Cerner for the integration, than the new tech.

mxwll3• 9 years ago

You hit the nail on the head.

Building anything on top of EPIC is unbelievably painful. You either pay EPIC engineers to access their "Dark API's" or pay $$ for their certifications.

Very few of these big medical device start-ups are actually integrating with patient records at a significant scale. Every instance of EPIC or Cerner is different and there is a lot of manual work needed to get up and running with live data in the patient record.

grwthckrmstr• 9 years ago

Sounds EXACTLY like an industry ripe for disruption

PakG1• 9 years ago

You could say that about a LOT of organizations. Hospitals are perhaps another level though.

opportune4• 9 years ago

Apple and Samsung entering the healthcare space to compete with Epic (their name isn't all-caps) and Cerner, in reality, is going to be closer to this: https://xkcd.com/927/

Most of the employees at Epic and Cerner in the healthcare space are actually operations. Like, at least 60% of their workers are operations. Not only that, but they're not traditional IT workers who go out and get certs, they're really closer to devops professionals who are able to provide both IT support and have an intimate understanding of what they're working with. Last time I checked, Apple and Samsung don't really even have this tier of customer facing support. It's going to take organizational shifts for them to break into this sector, and it's not so sure a thing.

That said, I completely agree with your observation that hospitals need to become tech companies. My parents are medical professionals and I have also worked at a medical software company in the past, so I think I'm pretty well grounded when it comes to saying this: hospitals hate developers, and developers hate hospitals. From the perspective of the hospital worker, developers make overly confusing systems and as soon as the worker gets used to it, they completely change everything and make it even more complicated than before. From the perspective of developers, most hospital professionals are luddites who oppose all change and progress as a matter of principle. If the two roles were more closely integrated, these severe communication issues would be mitigated. Medicine needs to be redesigned form the ground up with these two fields learning each others' skills and understanding how and why the other field does what it does.

mxwll3• 9 years ago

Fair points - I don't believe that Apple / Samsung are necessarily going to build out their own EMR systems. Rather I think the bottom up approach they are taking by creating an enormous amount of personal health data -- heart rate and exercise activity now with a growing ecosystem of third party devices -- that is up to FHIR specs is a step in the right direction.

Your second point really resonates with me. I have spent the last few months working within a large healthcare organization and it is extremely difficult to make necessary changes. There is a lot of distrust of our team to the point of hostility. Very frustrating

tim3334• 9 years ago

Sure, these SV companies have figured out how to build great tech at scale

Their tech is much disliked by most doctors. There's even a protest group LetDoctorsBeDoctors with a humorous song video (https://www.youtube.com/watch?v=xB_tSFJsjsw)

There is also a fully functional heavily tested free open source solution that most doctors prefer in surveys, called VistA or Openvista.

Doctors at the VA really like VistA. In Medscape’s 2016 EHR Report, VistA was the top rated EHR overall and the most preferred solution for use as a clinical tool. http://hitconsultant.net/2017/05/10/reasons-not-to-replace-v...

I think that what Epic and Cerner have figured out is how to crack the corporate sales process. Doctors and patients don't choose the EHR system, managers do, and I guess Epic and Cerner are good at selling to them.

If any startups want to do a Red Hat type model building on top of VistA I hope they do well.

fiveFeet• 9 years ago

I am all for it if someone can make the doctors use emails instead of faxes.

dqv• 9 years ago

The problem is that we don't have a key server for doctors. I really wish someone would lobby the HHS to provide a key server that maps to providers' NPI. Then setting up PGP for email can be streamlined.

As it stands now, everything is fragmented because companies want to lock practitioners and health care orgs in. I'd love to see them start issuing "HIPAA compliant" seals for the implementation of open and secure standards that make it easier for health care systems to communicate and transfer data easily. That way all these closed solutions will have an incentive to actually make communication between practitioners easy and secure.

The biggest joke is secure messaging. There are all these apps for secure messaging between practitioners. Of course, you have to be using the same app to open a communication channel. I know at least one of these companies is using XMPP on their backend, so it's likely others are as well. They are literally using open source solutions to make a problem that the open source solution was supposed to solve! There's no reason why $SecureMessenger can not communicate with $MessageSecure. They just don't want that to happen because they think it will cause them to lose business.

dawhizkid3• 9 years ago

I am a big believer that we have already discovered a safe, free, plentiful lever against some of the most high profile diseases (cancer, Alzheimer’s, some mental illnesses) out there in fasting/calorie restriction/keto.

I highly doubt it will ever become mainstream for the simple reason that no healthcare or big tech co can make money from telling people to eat in a way that induces ketosis.

Science of Fasting doc: https://www.amazon.com/Science-Fasting-Sylvie-Gilman/dp/B075...

aviv35• 9 years ago

Insane how we both get downvoted isn't it? Oh well. Another decade or two before people wake up.

Agree with you, so much of our economy and social structure is built on the fact that people get sick - and either stay sick or get medicated for the foreseeable future. Sad. All we can do is mention it, even though we get shut down quickly be it online or IRL.

Mandatory anecdote: I cured severe arthritis in the knee 6 years ago through a 30-day water fast. It was gone by day 20 or so, and stayed gone for 6 years now. It's sad that so many people suffer needlessly.

dawhizkid3• 9 years ago

Step one is getting to consensus on sugar = toxic, then refined carbs = bad, then getting people to stop believing we were evolved to eat consistently throughout the day everyday

It’s amazing that “you are what you eat” has become so controversial

bawana2• 9 years ago

Physician here. SV Tech will win because it is customer centric. Traditional Healthcare tech is enterprise centric - the precept on which they base their strategies is 'economies of scale'. People are not widgets. Economies of scale (aka corporate controlled healthcare) do not apply. As institutions grow larger, eddy currents of dominance develop - fiefdoms that compete for control, power and share of the budget. There are so many layers of middle management that the most popular complaint is that everyone is a manager. Our hospital actually has 5x as many employees as there are patients in it. I know of no other industry where this skewed statistic exists. Can you imagine an airliner with twice as many stewards as passengers? Perhaps the legal profession is an exception, where you have so many bodies tending to a trial. In healthcare, patients are lost in this machine and the cacophony of voices speaking to them is a disservice. Perhaps tho in this era of the consumer age, some patients conflate quantity with quality and might actually feel 'more is better'. If healthcare is delivered through a watch on your wrist instead of an army of servants, the layperson might be able to focus his/her understanding on the single voice their device has.

The other secret weapon of SV is that it promises to get people to open up their pocketbooks to actually pay for their own healthcare. Government will adore them for that. If you think that will never happen, just stop and think for a minute. People shell out hundreds of dollars a year for the privilege of being tracked and being advertising targets. All because the mobile device caters to their impulse for 'connectedness'. Imagine if this device promised a longer life, better sex, better sleep, less disease. And it showed you with colorful cartoon graphs how much better you were every time you asked it. Forget the fact that many of these parameters are only relevant to the big picture. Statistics apply to populations and any attempt to assign characteristics from population studies to a given individual carry uncertainty. They never tell you how big the error bars are, do they? Certainly a better diet and more exercise confer health benefits. But trying to 'gamify' this data will just add a cognitive burden and most likely will lead to more popular misconceptions and misinterpretations. Or perhaps it will be a new social nexus?When I am in a Starbux or Panera, there are always a few conversations my ears cannot avoid as people share their health problems over a sandwich and a coffee. And I cannot help laughing at how ironic the whole HIPAA thing is.

Ultimately I fear that tech will foster the return of snake oil salesmen, on a massive scale. We are in a deregulation mania now and I think healthcare will soon fall under Trump's razor and he will encourage SVTech to make their move.

perpetualcrayon• 9 years ago

Why hasn't Big Tech made a bigger dent in the insurance industry?

tim3334• 9 years ago

Insurance has quite a lot of specialist knowledge that isn't really tech.

Apocryphon• 9 years ago

I wonder if this will prove to be an opportunity for cities outside of SV to grab a bigger piece of tech. Nashville?

https://www.bizjournals.com/nashville/news/2017/09/22/health...

AngeloAnolin• 9 years ago

Interesting to see the big players like Apple, Google and Amazon making significant investments in this area.

The big problem though still lies in the maze of regulatory bodies with which all these innovative solutions have to navigate before they even get mainstream. Small players who does not have enough financial leeway ends up burying what could be a groundbreaking solution. Of course, governments need to do their due diligence as public health is the one at stake but there needs to have a certain compromise where the end result is the good of the public and humanity.

Big Tech Is Going After Health Care

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