What’s Really Killing Digital Health Startups

"As they are currently delivered, almost all of the prevention activities are expensive. If applied fully, using current protocols and the reference assumptions about costs (Table 2), they would increase health care costs by
$8.5 trillion over 30 years (Table 3), or
$283 billion per year, or
$1700 per person per year (data not shown). The only cost-saving activity is smoking cessation."

You can read the full paper here. It's from 2008, so perhaps some entrepreneur will be able to find the breakthrough that finally bends the cost curve: http://circ.ahajournals.org/content/118/5/576.short

Email is in my bio.

But that's only one piece. You need business relationships to even connect to the EMR in the first place. I think the problem with breaking into this industry is: (1) Huge incumbents with tons of cash who have shown they will spend a lot of money to smear each other, buy out smaller companies, or just implement the new feature in their own system. (2) Excessive government regulation which makes it hard to play in this area legally and makes everyone afraid to work with you.

I had a couple friends pitch me a medical-related startup idea a few years ago and I declined. They didn't last long before some bigger player came and implemented their idea thus stealing their customers.

Also, the article mentions reinventing the wheel of integration libraries. Having open APIs will not magically solve all problems. It mentions Kareo and says they are building out their own EHR. THAT is reinventing the wheel. An EHR is mega-huge. It has tons of modules and for the main vendors takes 18 months to 2 years or so to configure it to the satisfaction of all parties. It sounds like the advocated world is to have lots of small "open platform" companies re-invent the wheel by making a new EHR module-by-module but with different startups inter-operating instead of locking each other out. You realize that all the major vendors today started like that? They were all first one module and gradually added more. Why do you think hospitals tend to buy the integrated software to replace myriads of independent legacy systems? If you can't fully understand that and articulate why your "open platform" would be better then you're going to fail.

I'm excited to see where retail clinic initiatives like CVS's go, since that's actually a real change to how I, the patient, get care. Instead of consulting my insurer's website to find out what clinics they accept then calling up to make an appointment in a busy doctor's schedule, if I could instead just walk into the store and get what I need like I could any other product that would increase the convenience by enough that I might use it to keep healthy rather than to fix myself when I'm very sick.

We need ways for companies to compete in giving the most convenient service at the best prices. We need full price transparency. We need the prices to be things people could actually pay. (Insurance was originally for catastrophic care where the cost for a major illness or surgery would get too high.) Having prices so high that only insurers can pay them means only insurers DO pay them and since hospitals and clinics know this they can charge whatever they want.

(I once went to a dentist who advertised cheap wisdom tooth removal. I found out the way he did it was send a huge bill to the insurance and whatever the insurer declined to pay he would just forgive. Basically he is kinda willing to work for free but take as much as he can possibly get from the entity that has the deep pockets.)