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Big Tech Is Going After Health Care

nytimes.com

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Re: Big Tech Is Going After Health Care

#41

Post by mxwll »

There are some major hurdles for these SV companies to overcome if they want any level of success in this arena. EPIC and Cerner together hold over 50% market share of EHR systems in American hospitals. Their interoperability and patient facing applications are a joke. EPIC actively makes it difficult for third parties to build on top of their system.

Sure, these SV companies have figured out how to build great tech at scale but transitioning an entire hospital network to a new EMR is a massive undertaking -- both technically and organizationally. Many doctors had their world rocked by the forced transition to using EMR systems and they run the other way from those claiming a novel technology will solve all of their problems.

There are much greater issues at play here and IMO the organizational problems within hospitals are far greater than the technical ones. To be successful hospitals will have to become tech companies. They aren't exactly the hottest place for top tech talent to end up.

I think the patient first approach that Apple and Samsung have been taking are likely to win out. If they can build a system that captures an individual's personal health record doctors will want that data. Hospitals will have no choice but to begin integrating that data even if it lives outside of the walls of EPIC, Cerner, et al.

Re: Big Tech Is Going After Health Care

#42

Post by killjoywashere »

frahs wrote: post #39
killjoywashere wrote: post #16

Earlier quoted context omitted.

Your comment is a great example of the disconnect between people in this space and people not in this space. Do you actually think anyone in this space would believe that weight spikes are tied to CHF in all cases? You don't diagnose CHF by weight. It's something you trend in known patients. Comments like this are one reason why doctors give zero shits about the potential of computing. Explaining even the basics of a…

I agree that his comment was not in good taste, but I think he must have simply misread or skimmed the parent comment, or misunderstood. Your comment is a great example of unnecessary escalation. He made a mistake, no need to pin all this angst about the disconnect between doctors and engineers on one mistaken comment on the internet. While I think the parent commenter should apologize, I think ideally you should too…

Fair enough, happy to go first. I hearby apologize for escalating, although the disconnect and it sources stand. What is sufficient remedy? Shall I delete my comments?

Re: Big Tech Is Going After Health Care

#43

Post by SilasX »

blhack wrote: post #7

Good. I spent a few years working in a medical IoT startup, and the current state of the "mainstream" medical monitoring technology is not inspiring. During a brainstorming meeting, I asked one of our cofounders, a physician, to tell me about some of the problems he had seen in health. Don't try and solve it, just lets talk about problems. He said that by far one of the most common causes for re-hospitalization is co…

It seems like the real (meta)problem is that the system’s incentives don’t reward this. If a doctor’s take home pay increased as these things were avoided, you wouldn’t need some risk-tolerant startup to dive in with some innovative protocol; someone would have figured out a fix a long time ago.

(Edit: to adapt the old saying: if life-saving were profitable, common sense would make us all saints. But alas, we live in a world where regulatory arbitrage pays more.)

I think we should ask how we got to the point that the incentives are so incompatible and how we got to that point and how to realign them.

Re: Big Tech Is Going After Health Care

#45

Post by jnordwick »

killjoywashere wrote: post #30
jnordwick wrote: post #25

Earlier quoted context omitted.

A doctor accusing other professions of being arrogant? That's rich.

You mean where I said > I didn't spill any data (that I know of) > doctors also don't even know how to frame their problems, > most of them punch out of math as fast as possible.

How about the part where you said:

> How many lives did you save today? Zero? Ok, STFU

Last time I was at the hospital they seriously asked if I wanted Reiki. If you can get through med school and still believe in that, sorry If I don't have much respect for your education.

Doctors and IT people are the two most arrogant professions I've ever come across, and I even work in finance.

Re: Big Tech Is Going After Health Care

#46

Post by jmull »

hacker_9 wrote: post #11
blhack wrote: post #7

Good. I spent a few years working in a medical IoT startup, and the current state of the "mainstream" medical monitoring technology is not inspiring. During a brainstorming meeting, I asked one of our cofounders, a physician, to tell me about some of the problems he had seen in health. Don't try and solve it, just lets talk about problems. He said that by far one of the most common causes for re-hospitalization is co…

The monitoring devices are the real problem, not the people. Do you think all weight spikes simply equate to having CHF? You can't just rely on such a basic measurement when dealing with an incredibly complex system such as the human body. A lot more specialist equipment is going to be needed to come to a final conclusion (Questioning from experts, MRIs, XRays, even Microsurgery with cameras). What consumers can curr…

I think they only use weight to screen people specifically at risk to determine if they need to take a closer look.

An easy, fast, cheap test which usually means a more expensive test or exam doesn’t need to take place.

Re: Big Tech Is Going After Health Care

#47

Post by 4gfewrreg »

jghn wrote: post #22
killjoywashere wrote: post #16

Earlier quoted context omitted.

Your comment is a great example of the disconnect between people in this space and people not in this space. Do you actually think anyone in this space would believe that weight spikes are tied to CHF in all cases? You don't diagnose CHF by weight. It's something you trend in known patients. Comments like this are one reason why doctors give zero shits about the potential of computing. Explaining even the basics of a…

I'm a software guy in the healthcare space, albeit not medical devices. We see this problem all the time. Despite the fact that most of the people involved have degrees, often Phd level, in CS, Math, and Physics we see no end of other software folks from typical tech companies coming in and describing how we just don't know what we're doing and that we need big tech to come in and disrupt us. There's a reason we do t…

Ctrl+f "preventative care", 0 results. Gonna have to disagree with you.

Re: Big Tech Is Going After Health Care

#48

Post by u801e »

blhack wrote: post #7

Good. I spent a few years working in a medical IoT startup, and the current state of the "mainstream" medical monitoring technology is not inspiring. During a brainstorming meeting, I asked one of our cofounders, a physician, to tell me about some of the problems he had seen in health. Don't try and solve it, just lets talk about problems. He said that by far one of the most common causes for re-hospitalization is co…

There are plenty of indicators that could be monitored in various patients for various diseases, but a lot of them may require doing things that are beyond the ability of someone who is not medically trained. Some of them require intravenous blood samples, for example. But others are like example you mention (which only requires that the patient weigh themselves at a given time each day).

It would be nice if we could make it simpler for people to measure things like their own hemoglobin A1C, blood urea nitrogen/creatinine, blood flow around organs/extremities, etc. and send the data to a service that can be used to alert medical staff if something looks like it's getting worse.

Re: Big Tech Is Going After Health Care

#49

Post by teej »

SilasX wrote: post #43
blhack wrote: post #7

Good. I spent a few years working in a medical IoT startup, and the current state of the "mainstream" medical monitoring technology is not inspiring. During a brainstorming meeting, I asked one of our cofounders, a physician, to tell me about some of the problems he had seen in health. Don't try and solve it, just lets talk about problems. He said that by far one of the most common causes for re-hospitalization is co…

It seems like the real (meta)problem is that the system’s incentives don’t reward this. If a doctor’s take home pay increased as these things were avoided, you wouldn’t need some risk-tolerant startup to dive in with some innovative protocol; someone would have figured out a fix a long time ago. (Edit: to adapt the old saying: if life-saving were profitable, common sense would make us all saints. But alas, we live in…

Both doctors and hospitals are financially incentivized to avoid rehospitilization. It is actively tracked and directly impacts billing. Check out the "Hospital Readmissions Reduction Program" that Obamacare introduced.

I’m sick of people spreading FUD about medical billing based simply on the ridiculous “the man is out to get me” narrative.

Re: Big Tech Is Going After Health Care

#50

Post by WhitneyLand »

killjoywashere wrote: post #35
WhitneyLand wrote: post #32

Earlier quoted context omitted.

Why on earth do you think you can generalize your anecdotal experience to conclude tech people are any more arrogant than doctors or staff in whatever field? We can agree there is a massive disconnect, but there is plenty of arrogance to go around and I’ve seen it on both sides in these situations. Moreover, whoever’s arrogance it is, is only one part of the problem, and I think not the largest one. Just the legal an…

I have been working with some extremely smart, hard working computer scientists on a real, hard problem in this space, a problem I've been working on for 6 years. Easily 20 years of work left. I have a great deal of respect for what you are capable of. The white hot fury was directed at the sophmoric response of hacker_9 which I then used as an exemplar of a few trends in behavior I have watched for over a decade.

I understand your frustration, I believe your experience, no personal attack was intended.

I only hope we can agree that generalizations about good and bad character traits is tricky business, even if all this was not anecdotal. I hope there can be more agreement because there truly is life changing work that needs to be done, but as with so many things in life, it sometimes requires effort to remember our previos experiences may not always predict our future ones.

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