Putting healthcare in hackers' hands

http://blog.eligibleapi.com/?p=155

by kategleason • 13 years ago

94 43 13 years ago

blog.eligibleapi.com

aantix• 13 years ago

This is pretty amazing, not sure why it's not getting more attention.

The patient records (MRI, CT scan images, doctor writeups) are probably a lot harder to standardize I'm assuming?

That seems to be the missing piece from this API. Otherwise, great job you guys.. Open up the industry!

kategleason7• 13 years ago

Thank you. One step at a time. We're focused on winning as the platform where all US healthcare eligibility information is passed to prove that it can be normalized and done fast. Then we will move on to help hackers take over the whole healthcare transactional world including clinical, imaging, and pharma data :) Less talk, more do!

ef4• 13 years ago

It's true that the patient records use disparate standards, and that it's not trivial to convert them. But even when you have systems that adhere to the various existing data exchange standards, there are deeper structural reasons that organizations are hesitant to exchange data.

Their existing software often does a bad job of identifying the provenance of information or filtering out noisy irrelevant information, so unless they can be assured that everyone else is following the same policies around how things are documented and categorized, they're unwilling to mix a bunch of "outside" data with their own.

They also see little incentive to invest effort in opening up their own data to others, because it costs real money and doesn't really benefit them. This is where a good startup business could make a difference -- by doing the data exporting work "for free" in exchange for the ability to sell access to it.

seanwoods2• 13 years ago

What does this company actually do? Seems like you need to know a million buzz words, then take a leap, in order to figure out what problems this solves.

I'm a health care informatics professional (mostly clinical, not billing) and I can't seem to divine it.

daigoba66• 13 years ago

Healthcare providers in the US are paid by insurance companies. It is incredibly useful for providers to know if the patient that just walked-in for service actually has eligibile insurance benefits for the services about to be delivered. Historically this is done via phone calls and fax, if done at all.

There are ANSI standard EDI transactions designed specifically for healthcare insurance eligibility inquiries (there also exists transactions for claims, but that's the other side of the puzzle). The standards themselves are pretty simple. But unfortunately, from a business development and integration perspective, the effort required to become trading partners with healthcare insurance companies is extremely high. There are plenty of vendors and clearinghouses out there which make the process easier. But this company is trying to make the setup and integration even easier with self-service sign-up and credit card billing. It's a novel idea.

Edit: I have no affiliation with Eligible but I've been working with the underlying technology for many years.

GFischer3• 13 years ago

Thanks. You answered what Eligible does much clearer than the Eligible guys (and gals :) ) themselves.

It does look very useful :)

pc862• 13 years ago

I can only speak of physician's offices but I would imagine the process is much the same in hospitals, if more bureaucratic.

Before a test or lab is ordered, or before a specialist visit is scheduled, one of the assistants needs to verify that your insurance will actually cover the procedure. Typically this means the assistant needs to call the insurance provider, give them your information and what procedure(s) they are checking on.

Insurers provide this data but there are close to a dozen disparate standards and formats. Eligible consolidates all that into a REST API that developers can build applications on top of. From what I can tell this is definitely not for the healthcare industry, but for our industry to build healthcare applications.

I have no affiliation with Eligible, but I've been working in healthcare IT for several years, although not at the startup level.

kategleason7• 13 years ago

Traditionally health information technology has been run by non-technical bureaucracies sitting around a table creating "specs" that hackers then need to mud through (usually 300+ page pdf) in order to integrate/implement. The bureaucracies intentions are good: free up the data to build from, but the result is just the same old legacy vendors end up using it.

seanwoods2• 13 years ago

I appreciate your efforts, but this response doesn't really answer my question. It's too granular (and a bit biased). When I go to your web site, I need some context. I need business problems that this software solves. Based on the name I would say it's Medicare/insurance eligibility checking, but the web site should guide me through what needs the product addresses and why it's better than the alternatives.

Also, I'd advise you not to jump straight to messages about "non-technical bureaucracies." It's certainly true in some cases, but it sounds derogatory. Better to address the objectives these people are trying to meet.

craig552uk• 13 years ago

So... hospitals can reject the uninsured even more quickly...?

pc862• 13 years ago

Maybe you should try actually providing constructive criticism for the submitted link instead of this hurr USA insurance is dumb meme garbage.

carbocation3• 13 years ago

Your insinuation, that hospitals reject the uninsured, is incorrect. Please read about the Emergency Medical Treatment and Active Labor Act [1].

[1] = https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an...

kmax12• 13 years ago

How does develop an app with this without paying .05 for every api call? Seems like there is a need for some sort of testing sandbox where development can be done.

kategleason7• 13 years ago

When you sign up you get $30 free credit (600 free test transactions to start).

ncavig• 13 years ago

Just a suggestion, but it seems like n requests in t for free would be a good model too. eg: Free 60 requests free per hour. 600 free test transactions is great, but for ongoing development the sandbox idea or rate limiting for a free plan seems preferable to us 'hackers'

Edit: edited n of free requests per t in eg

carbocation3• 13 years ago

This looks incredibly powerful. If there were no edge cases of unsupported insurance companies, I think you'd be able to build tools around this service (as it currently is, not what it promises to be) to replace an entire class of office jobs already.

nwzpaperman5• 13 years ago

The problem is insurance companies and the gordian knot of legislation they've erected to block wise reform. You can't have real reform that includes them.

kategleason7• 13 years ago

Nah - not true. I'm bored with the argument that insurance companies are the bad guys. Gotta give me something more original :)

nwzpaperman5• 13 years ago

Boredom is hardly an argument for what is a large part of the problem. The history of contemporary insurance dates to the catholic church and the prohibition of usury. To get around the ban on lending money at interest, loans could be insured.

Default risk was priced and risk was conserved!

Fast-forward to the present day, the insurance concept was applied to healthcare as a way to smooth out one's healthcare costs over a lifetime and eliminate tail-risk to the individual. Since the 1930s, the insurance industry has evolved into a system to avoid paying for your healthcare costs. First, the growing expenses were thrown onto the employer (think auto manufacturers) and when the employers can't support the cost, onto the healthy by passing cost increases on to employees through increased premiums.

The fact is that if you consume something, you or someone(s) else will have to fund your consumption. The second law of thermodynamics applies to healthcare as well. There is no free lunch here either.

Insurance companies end up as an additional layer of administration expense. In the case of financialization of health care, the administration is extraordinarily expensive!

Risk is conserved!

carbocation3• 13 years ago

Anything that allows us to treat the insurance companies as a relatively homogenous, interchangeable set of entities reduces their power to impede progress. This is true whether you believe that they impede progress intentionally (i.e., are malicious actors), or just incidentally.

brechin• 13 years ago

This looks amazing, and puts a lot of patient-focused data out in a much more usable format.

I wonder about other parts of the chain (e.g. payer <-> provider) could benefit from this kind of tech-enabling?

TomaszZielinski2• 13 years ago

So I want to know their address and company registration data, just to know who to sue in case of a leak :)

https://www.eligibleapi.com/about-us - nothing https://www.eligibleapi.com/privacy - nothing https://www.eligibleapi.com/security - nothing https://www.eligibleapi.com/faq - yay, there's an email address :)

Seriously, what am I missing?

kategleason7• 13 years ago

Good point. Will add this to website now: 419 Fulton Street Suite F San Francisco, CA 94102.

Sidenote: this is the reason why great hackers stay out of healthcare. you're scaring people away with this comment. I understand privacy needs to be taken seriously, but I do not think it should stifle innovation.

GFischer3• 13 years ago

Well, you have a great team of investors, but you should be aware of that risk. HIPAA violations are extremely painful.

I'm not in the field yet, but I do have a business plan that deals with US healthcare, and lawsuits and the FDA are pretty scary :)

Edit: example HIPAA fines

http://www.ama-assn.org/ama/pub/physician-resources/solution...

fnbr• 13 years ago

I believe that was his point, no?

That is one of the major issues preventing innovation in healthcare- the potential to lose a huge lawsuit. This article:

http://www.nytimes.com/2013/02/24/business/overcoming-obstac...

illustrated one of the main problems: the legal framework surrounding malpractice is completely screwed up. In the article, it is claimed that

"As it is now, a doctor or hospital can be sued if the plaintiff can show that “normal standards of care” were not followed, even if those normal standards of care are inappropriate."

Assuming that this is correct (I am neither a physician nor a lawyer), this basically freezes innovation, and makes it nigh impossible for innovation to occur.

TomaszZielinski2• 13 years ago

You mean that I'm scaring people away and stifling innovation by asking what's your address and company data?

In other words, just in case I don't understand - a random poster on HN can stifle innovation in the healthcare industry by posting a half serious (missing address) half joke (suing anyone) comment ? I'm so happy I live in Europe :)

lostlogin• 13 years ago

And there are places other than the US to sell products too. I'm not advocating insecure data, but some systems are different to the US, less litigious etc. And the systems I'd most like to see improved are not accessible remotely (or rarely are), or are comparatively easy to secure (or seem to be to a layman at least), or are basic and loss of the info wouldn't get anyone anything they couldn't find out already (proper hospital rosters is what I have in mind. Wow hospital rostering systems are crap).

tommy_m• 13 years ago

Does anyone know if a similar API exists for patient billing records? I see the OP API provides information on claims, but those are not necessarily detailed bills. I would assume that the answer is no, due to the many forms such bills could take. I am hoping they are required to have/provide an electronic bill in a set format, perhaps for medicare reimbursement purposes? Thanks......

voyvf• 13 years ago

Well... this certainly beats parsing HL7, especially v2.x (http://en.wikipedia.org/wiki/Health_Level_7#HL7_version_2.x for those not familiar with it.)

Good work. :D

Putting healthcare in hackers' hands

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