Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

What’s Really Killing Digital Health Startups

techcrunch.com

Post reply on HN
Print view View original

11–20 of 159 posts

Re: What’s Really Killing Digital Health Startups

#11

Post by wlesieutre »

ghaff wrote: post #10
msrpotus wrote: post #7

Earlier quoted context omitted.

I wonder if part of the B2C difficulty is that insurance pays for most healthcare but (with a few exceptions) not for the lifestyle choices that would reduce healthcare costs. If there was more of an emphasis on preventative measures that insurance paid for, I wonder if it would be different.

What lifestyle changes would an insurer pay for--at least without very intrusive lifestyle monitoring? (Which will increasingly be possible to do whether it's done or not.) There are often discounts for gym memberships and the like. And annual physicals are typically paid for.

A friend of mine can log exercise and turn it into free money in his HSA. I don't know whether they validate it against an activity tracker or not, but this is already happening.

Re: What’s Really Killing Digital Health Startups

#12

Post by msrpotus »

ghaff wrote: post #10
msrpotus wrote: post #7

Earlier quoted context omitted.

I wonder if part of the B2C difficulty is that insurance pays for most healthcare but (with a few exceptions) not for the lifestyle choices that would reduce healthcare costs. If there was more of an emphasis on preventative measures that insurance paid for, I wonder if it would be different.

What lifestyle changes would an insurer pay for--at least without very intrusive lifestyle monitoring? (Which will increasingly be possible to do whether it's done or not.) There are often discounts for gym memberships and the like. And annual physicals are typically paid for.

I'm genuinely not sure. Paying for gym memberships, FitBits, and things to get people exercising could be one option. Or maybe insurers could use extra incentives to encourage people to get flu shots or regular checkups?

Re: What’s Really Killing Digital Health Startups

#13

Post by jobu »

d0m wrote: post #6

Also something less talked about is how hospital administrators don't want to share their data for competitive advantages. So, they're more than happy letting the EMR vendors taking the blame for the lack of interoperability while in fact that said lack of interoperability is exactly what they're looking for when partnering up with an EMR. So, when trying to sell a third-party product to a hospital, administrators fo…

This. Interoperability is great when it lets data into the system, but a huge threat when it allows data out.

Re: What’s Really Killing Digital Health Startups

#14

Post by samstave »

toomuchtodo wrote: post #5
jseliger wrote: post #3

I'm a grant writer and have worked for numerous Federally Qualified Health Centers (FQHCs) and a smaller number of hospitals. From their perspective, EMR and related systems have tended to cost at least as much as they've saved. Some of them have seen the vendor jousting Sung describes and have experienced all sorts of vendor fatigue and vendor lock-in. At the same time, FQHCs and hospitals are facing CMS requirement…

Why doesn't the federal government build an EMR system and require its use as a condition of accepting Medicare payments? Sure, I'd expect a terrible process and result previously (such as the mess healthcare.gov was when rolled out), but I have a lot more faith with the USDS and 18F in place.

They did. VA pioneered emr...

OpenVista by medsphere is based on Vista, the gov emr...

All emr companies are walled gardens.

In 2009 I built the first mobile HL7 compliant client for the iPhone which was emr agnostic and could work with any emr -across an esb... But all emr companies shunned us because they wanted to protect their walled gardens. At the time hospitals shunned us because they didn't believe the iPhone was a good enough device (big enough screen) to be usable...

We built integrations into a number of systems... But couldn't get traction at that early stage. So we open sourced it through medsphere...

Dr chrono came along and took different tack which was to make an actual emr...

After working with so many hospitals and these systems I basically gave up... The system is pretty broken and the artificial barriers to entry are pretty lame.

Re: What’s Really Killing Digital Health Startups

#15

Post by 5706906c06c »

To think that your startup can "disrupt" an industry that has the spending equivalent to that of the GDP of an entire country is a fool's game. Most need to focus on longevity versus strategizing a quick exit.

Also, I worked for one, been part of the contract negotiations and have seen at first hand the difficulty many face trying to deal with providers and payors.

Shameless plug, I'm available for HIPAA consulting in San Francisco. I'm a former InfoSec officer.

Re: What’s Really Killing Digital Health Startups

#16

Post by [deleted] »

samstave wrote: post #14
toomuchtodo wrote: post #5

Earlier quoted context omitted.

Why doesn't the federal government build an EMR system and require its use as a condition of accepting Medicare payments? Sure, I'd expect a terrible process and result previously (such as the mess healthcare.gov was when rolled out), but I have a lot more faith with the USDS and 18F in place.

They did. VA pioneered emr... OpenVista by medsphere is based on Vista, the gov emr... All emr companies are walled gardens. In 2009 I built the first mobile HL7 compliant client for the iPhone which was emr agnostic and could work with any emr -across an esb... But all emr companies shunned us because they wanted to protect their walled gardens. At the time hospitals shunned us because they didn't believe the iPhone…

[deleted]

Re: What’s Really Killing Digital Health Startups

#17

Post by salimmadjd »

I'm in the Health IT space but we took a different approach. Early on we realized most Health IT companies are really pharmaceuticals but they don't realize it. What I mean by this is, you need to have the budget of a pharmaceutical to play in this space: 1 - you need to spend millions to win over consumers and 2 - you need to have an existing network of connections into doctor's offices to convince them of your solution. Big Pharmas have both of those. They have reps that constantly visit doctors or hospitals to engage them and they have a well spent marketing budget to build awareness for their product. Most startups can't do either of those.

Then there is the long cycles. We signed some global Big Pharma brand (can't disclose). They actually approach us and were very eager to work with us. But even with that, it took exactly 2 years before we were able to roll out our pilot partnership.

Basically you need to go into this knowing it'll take 3-4 years before you can show any traction.

Re: What’s Really Killing Digital Health Startups

#18

Post by sachinag »

samstave wrote: post #14
toomuchtodo wrote: post #5

Earlier quoted context omitted.

Why doesn't the federal government build an EMR system and require its use as a condition of accepting Medicare payments? Sure, I'd expect a terrible process and result previously (such as the mess healthcare.gov was when rolled out), but I have a lot more faith with the USDS and 18F in place.

They did. VA pioneered emr... OpenVista by medsphere is based on Vista, the gov emr... All emr companies are walled gardens. In 2009 I built the first mobile HL7 compliant client for the iPhone which was emr agnostic and could work with any emr -across an esb... But all emr companies shunned us because they wanted to protect their walled gardens. At the time hospitals shunned us because they didn't believe the iPhone…

Yup. We need data at rest standards tied to Medicare reimbursement.

Re: What’s Really Killing Digital Health Startups

#19

Post by 5706906c06c »

salimmadjd wrote: post #17

I'm in the Health IT space but we took a different approach. Early on we realized most Health IT companies are really pharmaceuticals but they don't realize it. What I mean by this is, you need to have the budget of a pharmaceutical to play in this space: 1 - you need to spend millions to win over consumers and 2 - you need to have an existing network of connections into doctor's offices to convince them of your solu…

> Basically you need to go into this knowing it'll take 3-4 years before you can show any traction.

This x10MM

Re: What’s Really Killing Digital Health Startups

#20

Post by bpatrianakos »

Having done exactly this type of integration with legacy systems I think a point that gets glossed over is that it's the startups themselves who are full of engineers who think that the whole world has moved on to using NoSQL Node.js RESTful JSON APIs in the cloud (that buzzword soup was intentional) when the reality is that the majority of established businesses are using unsexy and what they would consider to be "legacy" technology.

So you have companies like one I was recently a part of integrating a Node web app and API with SOAP and SAML end points and suddenly it's everyone else's fault that things are hard when really you probably should have thought through those tech stack choices before you started.

I'm not saying the article is wrong. I agree with it wholeheartedly but there's a lot to be said for not researching the market you're about to jump into thoroughly enough before you begin.

Post reply on HN