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What’s Really Killing Digital Health Startups

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Re: What’s Really Killing Digital Health Startups

#51

Post by angersock »

lbhnact wrote: post #28
webjprgm wrote: post #25

No discussion about APIs in health care EMRs would be complete without mentioning HL7's new FHIR protocols: REST-ful web service endpoints for HL7 health data. It makes developing applications with these standards much easier. 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…

FHIR is probably the best hope that we've got. I am biased of course, but I've bet a few years of my life on it. :) Happy to help anyone learn more about the spec @medhacker [1] http://www.annemergmed.com/article/S0196-0644(15)00226-7/ful...

FHIR is gross and overdesigned, like everything else in this moribund industry.

Re: What’s Really Killing Digital Health Startups

#52

Post by kat »

paxtonab wrote: post #33

It's not just the lack of API's that makes it hard for digital health startups, a big hurdle is the perceived lack of security of a cloud based solution in regards to health care data. A friend of mine works for a digital health startup, and the majority of the RFP's they receive automatically disqualify them if they have anything hosted in the "cloud", so they are forced to buy and maintain all of their own servers.…

There are HIPAA certified cloud servers out there. I think the bigger problem is having tight security when integrating. It is considered safer to integrate behind a firewall (on an intranet) than worry about how to pass data between cloud-based software and locally hosted 3rd party databases/software

Re: What’s Really Killing Digital Health Startups

#53

Post by Mz »

organsnyder wrote: post #39
Mz wrote: post #26

Give me a fucking break. HIPAA compliance is actually an issue. Published APIs may have benefits to businesses, but what is the benefit to the patients? He claims this hurts patients when his only evidence is his company couldn't cut it. HIPAA was written in the interest of patients who don't want the entire world to know they are HIV positive or have had 5000 sex partners because they are a sex worker or whatever. L…

Just because the APIs are published doesn't mean that the data is out there for any unauthenticated client to access. Of course HIPAA is important, but it is not a serious problem for interoperability. I work on a SOA team for a large healthcare organization, so I'm well aware of the issues. The problem comes down to the usual case of entrenched vendors working to protect and expand their turf. EHR vendors are notori…

Well thank you for those remarks. It really doesn't change my assessment of the piece. He is basically arguing that his competitors aren't graciously handing over the reins so he can make bank. How shocking. Like him, other people want to protect their income stream.

He dismisses the presumed "cheap excuse" of HIPAA compliance given by someone who did not want to work with him. This does not give me confidence he takes HIPAA seriously. I had annual HIPAA training (as well as Gramm-Leach-Bliley) when I worked for a major insurance company for a few years. So I am not unfamiliar with HIPAA.

Re: What’s Really Killing Digital Health Startups

#54

Post by dankohn1 »

paxtonab wrote: post #33

It's not just the lack of API's that makes it hard for digital health startups, a big hurdle is the perceived lack of security of a cloud based solution in regards to health care data. A friend of mine works for a digital health startup, and the majority of the RFP's they receive automatically disqualify them if they have anything hosted in the "cloud", so they are forced to buy and maintain all of their own servers.…

I believe this is out-of-date. Our healthcare startup has passed in-depth security reviews from multiple huge carriers, and we operate in the cloud and use tons of open source. (We're hiring Rails devs!)

It is a meaningful effort to be HIPAA-compliant, that prevent us, for example, from using lots of cool SaaS services. The bigger issue for us is that each integration still has customizations associated with it, because of a lack of agreement about what fields mean.

Re: What’s Really Killing Digital Health Startups

#55

Post by joe_the_user »

apalmer wrote: post #38

Based on this article whats killing digital health startups is they dont understand they are fundamentally in the integration business. I worked for a company in a total different sector that eventually ended up being acquired for a significant amount of money. More or less the company 'succeeded' because almost everything 'product' wise was window dress. the actual value of the company was the fact that we had done…

Certainly you can make money at integration, vast amounts of money are made. But as one friend in the business really did tell me once "your job is taking one piece of crap and another piece of crap, get them to talk to each other and so turn them into a third larger piece of crap". Integration "works" but overall often makes the problem worse or at best allows you to run place. Imagine when something else has to talk to your "talks to ten things thing".

For good or ill, The start-up ideal is generally to solve problems broadly, to disrupt an entire industry rather than build one more extension to that industry.

The problem of integration, of conforming to byzantine standards and to the mess that overall existing health IT, is itself still just a detail in the overall problem of health and technology.

The fundamental problem is the messiness and unpredictability of physical human bodies/human health.

The reason that health records are a mess is that there is no easy to way to universally classify "what is going on" with a given person in a cut-and-dried fashion. For any field of a health record, there is significant gray areas once you get to a large scale (including "basic" things like "male" and "female").

Just as much, health procedures often don't benefit from automation because what one person does to care for another person is subtle and not easily codified.

Re: What’s Really Killing Digital Health Startups

#56

Post by maxerickson »

chimeracoder wrote: post #41
maxerickson wrote: post #37

Earlier quoted context omitted.

[1] Medicare reimburses less than the actual costs of services provided per-patient, before accounting for any overhead Hospitals don't even know what a given service costs, so this statement seems to need a little more equivocation around it.

> Hospitals don't even know what a given service costs, That's not really true. We're talking about the costs of goods sold, which means it's pretty easy to place a lower bound on the marginal costs. For example, if the lab supplies for running a certain test cost $100/unit from the vendor and Medicare pays $93, you know that the hospital is losing money off of it. We're not taking into account the overhead, infrastr…

I don't see it here:

https://hn.algolia.com/?query=by:chimeracoder%20medicare&sor...

I don't think you would have linked it in a comment where you didn't mention medicare.

I'm honestly curious about it, I certainly believe that Medicaid reimbursements are not matching costs, but I think for Medicare they often are.

Re: What’s Really Killing Digital Health Startups

#57

Post by criley2 »

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…

Considering that the average new molecular entity requires about $1 billion dollars over 10 years (factoring in cost of refining approximately 10,000 candidates into 1 entity capable of succeeding in Phased trials and receive approval), I'm not so sure these startups are anywhere near the "pharma" level.

Re: What’s Really Killing Digital Health Startups

#58

Post by kuschku »

joe_the_user wrote: post #55
apalmer wrote: post #38

Based on this article whats killing digital health startups is they dont understand they are fundamentally in the integration business. I worked for a company in a total different sector that eventually ended up being acquired for a significant amount of money. More or less the company 'succeeded' because almost everything 'product' wise was window dress. the actual value of the company was the fact that we had done…

Certainly you can make money at integration, vast amounts of money are made. But as one friend in the business really did tell me once "your job is taking one piece of crap and another piece of crap, get them to talk to each other and so turn them into a third larger piece of crap". Integration "works" but overall often makes the problem worse or at best allows you to run place. Imagine when something else has to tal…

> For good or ill, The start-up ideal is generally to solve problems broadly, to disrupt an entire industry rather than build one more extension to that industry.

But which start-up has ever done that?

Not even Google or Facebook did disrupt an entire industry – they just built one more extension to an existing industry.

Re: What’s Really Killing Digital Health Startups

#59

Post by ThomPete »

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…

What a great insight. You should really write a blog post about it because this is such a helpful perspective and needs to be understood both by entrepreneurs and investors.

Re: What’s Really Killing Digital Health Startups

#60

Post by gopher2 »

jnbiche wrote: post #45
shostack wrote: post #42

Earlier quoted context omitted.

So like Zapier but for that sector?

I have been consistently surprised that Zapier hasn't taken off like a rocket. Can anyone explain this? Zapier integrates an amazingly high number of SaaS's. And aside from the annoying lag due to their frontend being done as a SPA (which doesn't effect their API at all), they seem to be well-built. I do wonder a bit at their pricing, but it's not outrageously overpriced (and underpriced compared to many competitors)…

Random thoughts from working at a marketing/software company that people occasionally build Zapier integrations for.

Instead of their being one point of failure Company X Company Y integration, there are now two points of failure Company X Zapier Company Y.

So, things may break. And if they do there are more points of failure in figuring out why.

If we really want a working integration with some other software, we build it directly and support it directly.

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