71–80 of 159 posts
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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.
Even if a practice/vendor is savvy and deep pocketed enough to get past the politics and expenses, then you're at the whim of the competence of the interface teams which can range from incompetent to good, with the average being on the lower end. I've often seen something that should literally take a couple hours, take a year to get completed, if ever.
There are bigger initiatives taking place to try address some of these interoperatibilty issues, namely Health Information Exchanges (HIEs), although their economics remain unproven.
It's not all gloomy, I can honestly say that in the last 5 years, anecdotally, the hurdle to building interfaces feels like it's getting less and their sophistication and capabilities are getting higher.
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The amount of data is also a huge challenge. The HL7 "standard" for patient data exchange is huge - thousands of potential data points with tens of thousands of options. The IDC-10 code set allows more than 14,400 different codes. And that's just the tip of it: https://en.wikipedia.org/wiki/ICD-10 The US ICD-10 Clinical Modification (ICD-10-CM), for instance, has some 68,000 codes. The US also has the ICD-10 Procedur…
A lot of the HL7 stuff could be made a lot simpler if the hospitals embraced a simpler subset--instead, everybody picks and chooses features and fields, as do vendors, and then punt it off to integration work. It's dumb.
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Oscar Health is actually an insurer. They're trying to win by (a) better marketing and (b) using tech (like free fitness tracker) to reduce their loss ratio. I've heard their innovation was also in pre-paying facilities for services. The collection rate for facilities from insurers is abysmal, so Oscar can negotiate a substantial discount by paying up front. Same idea as if you go to an MRI facility and offer them ca…
What Oscar Is Up Against ( http://go.theinformation.com/152dc2 ) > After two years in operation, the financial trajectory is becoming clear, both in terms of the growth and the costs. In New York, the company projected a sevenfold increase in premium revenue next year to $399 million from 2014. But it also projects a loss of 12% of premiums, equivalent to $47 million, according to regulatory filings. ... > Oscar’s lo…
This sounds dumb to me.
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…
Bingo. That is precisely what our backend did for healthcare data. And the front end (portal) was really good for the time.
Now, where have we heard that before, in the mobile device space?
In summary I don't think it's only lack of willingness; bad design was baked in from the beginning and piled up over the years.
As an aside, speaking as doc and programmer whose been in this field for more than a decade, I repeatedly find hilarious the hubris from developers coming from outside the field who think they are gonna fix healthcare with their amazing new perspective. Poor bastards. I feel sorry for the ones who aren't being arrogant dicks about it.
I recently reconnected with a guy who had a super high profile successful startup (like, success level=my mom even uses it) who tried to start his next company in healthcare. Fast forward a few years (i.e. a few weeks ago) and he sounds like he has PTSD
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> HL7 compliant client... which was emr agnostic In my experience, there's no such thing. HL7 is a spec in only the loosest sense of the word. Half the time you had an 80-character console output dumped into the "freetext" fields. Then there's all the codes used for different drugs, tests, admission/discharge (plus differentiating when they're standardized or user-entered with appropriate typos). Point is, all the co…
That's exactly why I'd want to tie a nationwide EHR/EMR system to Medicare reimbursements. In this case, not only must you drag the horse to water, you must force it to drink.
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 "l…
Heh.. you hit the nail on the head here. I've been in health integration for the past five years. By restful nosql whizbang node standards, healthcare is full of really weird old shit, and if you want to interoperate, you have to be ready to party like it's 1999, because a lot of these systems were legacy even then. It is rather frustrating to see some of the API designs that are finally getting shipped in healthcare…
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> 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.
https://www.floridahospital.com/sites/default/files/finance_...
> In 2012, beneficiaries of Medicare and Medicaid received nearly 60% of the clinical services provided by Florida Hospital (as measured by charges)vi. However, payments from these government programs represented just 40% of Florida Hospital’s total net revenuevi . In comparison, private payers received 30% of the care provided by Florida Hospital and represented 56% of its total net revenuevi
And the next paragraph:
> hospitals such as Florida Hospital have no ability to negotiate the payments from the public payers – Medicare and Medicaid – that pay for the majority of the clinical services provided. This poses a tremendous financial challenge for hospitals because these payments do not cover costs. In order to overcome these shortfalls, hospitals negotiate higher rates from private insurance groups. For this reason, continuing cuts to Medicare and Medicaid payments create an unsustainable business environment and put undue financial pressure on private payers
(The common response to this is that we need to increase funding to Medicare. While it's true that Medicare happens to be underfunded, that doesn't actually address the structural problem. Because Medicare has the ability to change their reimbursement unilaterally[0] while it has to request additional funding from Congress, these two will always be out of sync).
[0] the word 'negotiate' is often used here, but since hospitals are essentially legally required to accept Medicare patients, it's no more a fair negotiation than the negotiation you have with Comcast over your bill. You can squeeze a few extra dollars out of them if you fight, but at the end of the day, Comcast has all the power, so they can - and do! - price-gouge.