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What’s Really Killing Digital Health Startups

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Re: What’s Really Killing Digital Health Startups

#121

Post by webjprgm »

gmarx wrote: post #105
specialist wrote: post #81

Earlier quoted context omitted.

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 (th…

Better search is definitely needed and seems like something the EPICs and Cerners of the world could easily do if they just assigned a couple smart people and left them alone. Instead they'll probably form vast teams of search stakeholders. But search is only one need. You say EMRs imagine an idealized model. Maybe. They certainly never develop one. And that's what you need to reach the potential of medical data anal…

Out of curiosity, what kind of data do you propose searching? Do you mean searching a patient chart? Searching for lab results? Searching doctor notes? Or do you mean more like analytics to see trends? Or for finding patients, in the vein of an national patient ID service?

I ask because there is some amount of chart searching and organization analytics in the big EHR products so I'm curious which part you think is specifically lacking?

Re: What’s Really Killing Digital Health Startups

#122

Post by JoblessWonder »

kohanz wrote: post #36

As any engineer knows, most software applications have APIs; it’s simply a business choice whether to publish them or not. This makes it sound like opening an API up to the public is akin to flipping on a light switch, which as we all know is rather misleading. There are significant investments and expenditures (documentation, support, etc.) to make if you want to properly serve up a public API and no, not every comp…

Totally agree.

And I'm not sure it is safe to say that "most" software applications have APIs in the sense the author means.

Re: What’s Really Killing Digital Health Startups

#123

Post by kuschku »

joe_the_user wrote: post #101
kuschku wrote: post #58

Earlier quoted context omitted.

> 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.

Meh, Come-on, look at my context. Of course, disruption is never a fundamental up-end, just a streamlining towards a simpler and more productive approach - Uber and airBnB being the classics (whatever their social value or lack there-of). The start-up approach (or disruption, the most archetypical part of it) is aiming for more streamlining at the end of the process - rather than aiming to be one more orifice slurpin…

Well, many successful startups are just that, though.

"let you reserve rooms with the 1000 largest hotel chains in the world" is quite a fundamental change, as you get direct price comparison, info in which weeks it will be cheapest, etc. (And, unsurprisingly, there are dozens of startups doing exactly that).

Re: What’s Really Killing Digital Health Startups

#124

Post by Sherri »

I respectfully do not agree with John's statements.

1) You can do an easy light integration with the right IT shops just using for example on EPIC: Wellconnect, Oauth, and whitelisting servers on both sides. This takes three days and provides much of what most providers require.

2) Like stated at the recent Healthtech conference, no one should try to come into digital health without a decade of healthcare experience at least to understand the challenges, drivers, political, regulatory, clinical, technical, and macro financial.

Just my respectful but diverging opinion.

Best,

Sherri (CEO at Medigram)

Re: What’s Really Killing Digital Health Startups

#125

Post by disposition2 »

mbesto wrote: post #82
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.

Yes, but migrating to another VCS would be like working on a moving car and you have to pay the mechanic to plan -> dev -> implement...and then convince everyone who's worked with the VSS thought pattern (which is pretty different from SVN, GIT, just about everything) to use this new 'better' thought pattern or create something that will mimic the workflow they're are used to and connects to the new VCS...all the while you are still try to generate revenue rather than resolve a legacy 'issue' that really just looks bad and is still in place because: it works, everyone is used to it, you don't have the time / resources to make a change until it doesn't work.

Not that I'm arguing for VSS, it's awful, but there are business reasons I can see trumping the desires of wanting an upgrade.

Edit: spelling

Re: What’s Really Killing Digital Health Startups

#126

Post by rickard »

angersock wrote: post #109
gmarx wrote: post #71

Earlier quoted context omitted.

Can you be specific? I'm a skeptic but just now learning about it.

So, link is here for people playing the home game: https://www.hl7.org/fhir/ . First, it specifies 3 different formats: JSON, XML, RDF. It should only pick one, preferably JSON, because that's the lingua-franca of the web . Second, the datatypes are handled oddly ( https://www.hl7.org/fhir/datatypes.html ). Numbers, for example are supposed to handle arbitrary precision, but they pick the wrong datatype for it in thi…

I don't quite agree with your complaints.

Regarding #2, what do you consider the problem with representing arbitrary precision decimals as numbers? That your javascript json parser converts json numbers to 64-bit floats? I'm not sure that that is really a problem with FHIR - see e.g. https://www.npmjs.com/package/json-bigint . Or is the problem that exponents aren't allowed?

About #3, how would you standardise addresses? ISO has been at it for several years and still not produced a standard. See e.g. http://stackoverflow.com/questions/4840928/iso-standard-stre... for relevant links.

Your fourth complaint is plain invalid. A period consists of two dateTimes, both of which specify time zones.

Number one and five I can somewhat sympathise with, though.

Re: What’s Really Killing Digital Health Startups

#127

Post by [deleted] »

whereswaldo wrote: post #106
Skeletor wrote: post #84

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…

My dad's practice uses drchrono. It looks like the API usage is still in it's infancy. Can't wait to see more companies take advantage of it!

[deleted]

Re: What’s Really Killing Digital Health Startups

#128

Post by eitally »

JoblessWonder wrote: post #122
kohanz wrote: post #36

As any engineer knows, most software applications have APIs; it’s simply a business choice whether to publish them or not. This makes it sound like opening an API up to the public is akin to flipping on a light switch, which as we all know is rather misleading. There are significant investments and expenditures (documentation, support, etc.) to make if you want to properly serve up a public API and no, not every comp…

Totally agree. And I'm not sure it is safe to say that "most" software applications have APIs in the sense the author means.

In enterprise, unless it's been written in the last 5 years, the odds are good that it doesn't have APIs. Or, if it does have APIs and was written in the past 10 years, those APIs are only intended for internal (within the app itself) consumption and could never, ever be used externally.

Re: What’s Really Killing Digital Health Startups

#129

Post by JoblessWonder »

eitally wrote: post #128
JoblessWonder wrote: post #122

Earlier quoted context omitted.

Totally agree. And I'm not sure it is safe to say that "most" software applications have APIs in the sense the author means.

In enterprise, unless it's been written in the last 5 years, the odds are good that it doesn't have APIs. Or, if it does have APIs and was written in the past 10 years, those APIs are only intended for internal (within the app itself) consumption and could never, ever be used externally.

Yeah. From my experience, public API's are only opened up when there is enough money generated from them to fund someone dedicated to managing/implementing them.

Re: What’s Really Killing Digital Health Startups

#130

Post by syed99 »

Regulations, Big Pharma and Legacy Software will all take years to change, changing the behavior of an industry is usually pioneered by a few and in medicine that's pretty tough.

All is not lost though, startups that make software for healthcare are slowly taking hold of the market, but all those startups that have been killed off in the process have made a change for the newer ones to get this far.

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