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What’s Really Killing Digital Health Startups

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Re: What’s Really Killing Digital Health Startups

#81

Post by specialist »

gmarx wrote: post #77

Saying these companies could just open their APIs is probably wrong. None of the legacy EMRs has a good underlying data model and what they have tends to be customized per site. There might be some minor functionality you could get to work consistently across sites with such an open API but chances are it wouldn't cover everything your innovative startup needs. In summary I don't think it's only lack of willingness;…

What you say is true. I solved the problem by flipping it around.

I'm going to give away the secret sauce I created for our backend.

"Traditional" EMRs imagine an idealized data model and then write ETLs to import to that model. The jargon we used was "adjudicating the single best record (SBR)" or "source of truth".

My system slurped up all data, stored mostly as-is, and then used information retrieval strategies (think Lucene) instead of querying (think SQL).

This solution was wicked fast. We showed our customers data back to them, so validation was simple. And we were super nimble when they changed their minds (what is a "visitation", how to displays scripts, updating lab results).

Sad story short: our group was acquired, my strategy made the reigning CTO's head explode, he attempted a rewrite, failed, then the execs killed the product.

Re: What’s Really Killing Digital Health Startups

#82

Post by mbesto »

bpatrianakos wrote: post #20

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…

I'm sitting in the office of one right now. Their codebase is sitting in Microsoft Visual SourceSafe: https://en.wikipedia.org/wiki/Microsoft_Visual_SourceSafe

Yes, that's right folks - it's last release was exactly 10 years ago. You wouldn't believe some of the systems I've seen.

Re: What’s Really Killing Digital Health Startups

#83

Post by ScottBurson »

drivativ wrote: post #40

One way this industry may get nudged significantly (disruption is too strong a word and not exactly a great thing when dealing with peoples health) is to approach it from the outside the system and come at it from the consumer health angle. Yes, it is far more limited in many ways as you can't build a system a hospital can integrate but there is still a lot that can be done. 20-30 years ago, if you had a problem, you…

Maybe something like this? https://www.patientslikeme.com/

Re: What’s Really Killing Digital Health Startups

#84

Post by Skeletor »

At drchrono (#1 iPad EHR on the Market, YC W'2011) we are building a very open API that has an open door policy to our customers and other digital health startups.

If anyone is working in the digital healthcare space we'd love to work with you. You can get access to and build on our JSON API in 1-2 days. Sign up here: https://drchrono.com/api

Here is a youtube video we shot with a startup that built on our API: https://www.youtube.com/watch?v=HBCIzuXEH44

Re: What’s Really Killing Digital Health Startups

#85

Post by exelius »

Mz wrote: post #66
exelius wrote: post #65

Earlier quoted context omitted.

I'd say that the potential digital health startups that do their due diligence end up picking another industry. So it's only the guys who failed to do it who end up starting companies. The VC startup model relies on finding white space and occupying it. Heavily regulated industries (like health care) tend not to have a lot of white space because the boundaries are rigidly defined by law. It's not a good fit for healt…

I guess that depends on how you define it. If by "digital health" companies you mean medical industry companies, you may have a point. But part of what is wrong with American health care is that health care is a polite euphemism for medical care. Grocery stores do not get defined as being in "health care," though eating healthy is clearly a cornerstone of good health. But I think it is possible to want to do somethin…

They are largely one and the same; because as soon as you start claiming your product or service can improve a user's health, you're subject to the regulatory scope of the FDA.

I mean, you can claim that things like MyFitnessPal are health apps, but it's still a fine line you have to walk where you can't give any advice, all you can do is observe and report. Try to go any further than that and you're providing diagnostic services, which makes you subject to all sorts of laws. The FDA and DHHS are very aggressive in protecting their regulatory scope.

Re: What’s Really Killing Digital Health Startups

#86

Post by srunni »

Mz wrote: post #74
srunni wrote: post #69

Earlier quoted context omitted.

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…

Why did they start in New York? In order to do business in New York, an insurance company has to be headquartered (incorporated) there. (Edit: No other state requires this.) And New York is expensive. This sounds dumb to me.

They probably started in NY because most of the founding team is living in/near NYC, according to a document filed with the NY DFS (http://www.dfs.ny.gov/insurance/exam_rpt/x9475o13.pdf). It also states that "The Company is a wholly-owned subsidiary of Mulberry Health Inc. (“Mulberry”), a Delaware Corporation."

Perhaps they thought that the administrative costs stemming from operating in NY wouldn't make/break the company - it's whether they can substantially reduce the claims costs that will really determine the outcome. And if they're from NYC, the founding team probably had preexisting contacts in the local medical institutions, which made it easier to form the partnerships that are key to making Oscar's business model work. One of the founders is Joshua Kushner (https://en.wikipedia.org/wiki/Joshua_Kushner), whose family is well-connected in NYC (for example, his brother's father-in-law is Donald Trump).

Re: What’s Really Killing Digital Health Startups

#88

Post by Mz »

exelius wrote: post #85
Mz wrote: post #66

Earlier quoted context omitted.

I guess that depends on how you define it. If by "digital health" companies you mean medical industry companies, you may have a point. But part of what is wrong with American health care is that health care is a polite euphemism for medical care. Grocery stores do not get defined as being in "health care," though eating healthy is clearly a cornerstone of good health. But I think it is possible to want to do somethin…

They are largely one and the same; because as soon as you start claiming your product or service can improve a user's health, you're subject to the regulatory scope of the FDA. I mean, you can claim that things like MyFitnessPal are health apps, but it's still a fine line you have to walk where you can't give any advice, all you can do is observe and report. Try to go any further than that and you're providing diagno…

Inspections and licensing of restaurants and grocery stores are typically handled by local and county health departments. (Not the FDA)

http://www.fda.gov/AboutFDA/Transparency/Basics/ucm194244.ht...

Though, yeah, given that the FDA is the FOOD and Drug Administration, I am sure they impact grocery stores: https://foodpoisoningbulletin.com/2014/fda-proposes-rule-for...

That does not mean HIPAA impacts grocery stores, restaurants, etc.

Though if you search for "HIPAA and grocery stores" it does pull up Von's page on HIPAA related to the fact that stores can have a pharmacy window in them:

http://rss.vons.com/ShopStores/Pharmacy-HIPAA.page

So, yes, while anyone selling food will be regulated by existing food safety rules/organizations -- including the FDA -- that does not prevent someone from saying (to themselves) "I would like to make the world healthier. I don't think becoming a doctor is The Answer. I think The Answer is running an organic restaurant."

And please don't argue with me that how you conceptualize it does not matter. You cannot tell me that Chipotle, with its "Food with integrity" concept and supporting policies, is the same as any other fast food taco joint.

(I ate there consistently for a long time to get well after doctors wrote me off for dead. That did not cause Chipotle to suddenly have to comply with HIPAA.)

Re: What’s Really Killing Digital Health Startups

#89

Post by Mz »

srunni wrote: post #86
Mz wrote: post #74

Earlier quoted context omitted.

Why did they start in New York? In order to do business in New York, an insurance company has to be headquartered (incorporated) there. (Edit: No other state requires this.) And New York is expensive. This sounds dumb to me.

They probably started in NY because most of the founding team is living in/near NYC, according to a document filed with the NY DFS ( http://www.dfs.ny.gov/insurance/exam_rpt/x9475o13.pdf ). It also states that "The Company is a wholly-owned subsidiary of Mulberry Health Inc. (“Mulberry”), a Delaware Corporation." Perhaps they thought that the administrative costs stemming from operating in NY wouldn't make/break the…

The insurance giant I once worked for also has a wholly-owned subsidiary in New York. This is probably a common tactic for coping with the ...quirky New York law concerning "No insurance company can sell insurance in our state unless you incorporate in our state."

I know something about the history of the insurance giant I worked for. I know that their success has a lot to do with one of the founders having been a lawyer by trade and making strategic choices concerning things like where to found their headquarters.

I have trouble fathoming doing something less strategic while hoping to break into such a highly regulated industry, basically.

Anyway, thank you for replying. Have an upvote.

Re: What’s Really Killing Digital Health Startups

#90

Post by drivativ »

ScottBurson wrote: post #83
drivativ wrote: post #40

One way this industry may get nudged significantly (disruption is too strong a word and not exactly a great thing when dealing with peoples health) is to approach it from the outside the system and come at it from the consumer health angle. Yes, it is far more limited in many ways as you can't build a system a hospital can integrate but there is still a lot that can be done. 20-30 years ago, if you had a problem, you…

Maybe something like this? https://www.patientslikeme.com/

I have used them and they are definitely on the right path but they haven't yet got past the point of just showing a lot of graphs and comparative statistics, etc. As always, it comes down to translating data to useable knowledge, which we as an industry are obviously trying to figure out across pretty much all verticals
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