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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

#81

Post by joshgel »

aviv wrote: post #79
joshgel wrote: post #53

Earlier quoted context omitted.

Interesting you bring up heart failure readmissions. Not saying they aren't a problem, but here is a fascinating study in JAMA that argues that places with lower readmissions have higher (worse) mortality. https://jamanetwork.com/journals/jamacardiology/article-abst... Not sure we (I'm a physician) understand even what the problems we need technology to solve are. But yes, we need technology to help (find and) solve…

Why do we need technology to help improve lives when so many diseases (type 2 diabetes, Crohn's, IBS, high blood pressure, arthritis, and dozens of others) can already be reversed and prevented by simply changing a person's diet and lifestyle habits? It's really quite insane that people would rather take pills for the rest of their lives to treat symptoms of a disease than actually getting rid of it altogether by giv…

Before you become "so dismissive" of traditional physicians, you try getting someone to radically alter their lifestyle for the promise of potential benefit in 10-20 years. Even if you can point to a few people that have done it, I can point you to plenty of data that says it's really hard and most people can't. Even technology may not help: https://jamanetwork.com/journals/jama/fullarticle/2553448.

Edit: Also reversed is a pretty strong word. I haven't seen any compelling evidence that Crohn's can be cured with lifestyle change.

Re: Big Tech Is Going After Health Care

#82

Post by methehack »

jeremylee wrote: post #56
mxwll wrote: post #41

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…

Both Epic and Cerner are making at least some strides toward opening up their platforms (Epic with App Orchard, and Cerner with Ignite, SMART on FHIR etc.) Athena has MDP ("More Disruption Please.") I get the feeling these organizations have at least come to the realization that they need to open up--granted their denial up to this point leaves them with a lot of catching up to do. But access to the data that exists…

Sorry, dude, but I think you fell for it. These entities try to make you think they're open, but really they are keeping entrants at bay.

Here's an interesting episode of the weeds podcast that gives some context by exploring why the fax machine is still so prevalent in US healthcare.

https://player.fm/series/voxs-the-weeds/fax-reform-bonus

Re: Big Tech Is Going After Health Care

#83

Post by joshgel »

opportune wrote: post #80
aviv wrote: post #79

Earlier quoted context omitted.

Why do we need technology to help improve lives when so many diseases (type 2 diabetes, Crohn's, IBS, high blood pressure, arthritis, and dozens of others) can already be reversed and prevented by simply changing a person's diet and lifestyle habits? It's really quite insane that people would rather take pills for the rest of their lives to treat symptoms of a disease than actually getting rid of it altogether by giv…

Well as a physician, you can't really force your patient to exercise and eat better. The best you can do is prescribe a medication to treat the symptoms, tell your patient to exercise and eat better, and send them off. Do you have an alternative to prescribing medication for type 2 diabetes and Crohn's? Do you think doctors should simply withhold care since it's their patients' faults that they have those conditions?

Agree. My dad, also a physician, blames himself for being overweight. But if "everyone" is overweight, can it really be their fault? Surely "the system" has as much or more blame to share.

Re: Big Tech Is Going After Health Care

#84

Post by rco8786 »

aviv wrote: post #79
joshgel wrote: post #53

Earlier quoted context omitted.

Interesting you bring up heart failure readmissions. Not saying they aren't a problem, but here is a fascinating study in JAMA that argues that places with lower readmissions have higher (worse) mortality. https://jamanetwork.com/journals/jamacardiology/article-abst... Not sure we (I'm a physician) understand even what the problems we need technology to solve are. But yes, we need technology to help (find and) solve…

Why do we need technology to help improve lives when so many diseases (type 2 diabetes, Crohn's, IBS, high blood pressure, arthritis, and dozens of others) can already be reversed and prevented by simply changing a person's diet and lifestyle habits? It's really quite insane that people would rather take pills for the rest of their lives to treat symptoms of a disease than actually getting rid of it altogether by giv…

Accusing physicians of being dismissive of nutrition by being dismissive of technology is sort of ironic, no?

Re: Big Tech Is Going After Health Care

#85

Post by Clubber »

u801e wrote: post #75
Clubber wrote: post #34

Earlier quoted context omitted.

Re email: Because you don't know if the destination server is encrypted (you send emails from your server and it finds the destination), any email must be intercepted at your server and a hyperlink to a secure site inserted in place of the email body. The email becomes just a notification via SMTP. The recipient then goes to the site and logs in to view the email. The PHI is what you care about (and it's, very, very…

> Re email: Because you don't know if the destination server is encrypted (you send emails from your server and it finds the destination), any email must be intercepted at your server and a hyperlink to a secure site inserted in place of the email body Couldn't this be solved by just encrypting the email itself? Even the headers could be encrypted along with the body. On the subject of fax machines, would they still…

>Couldn't this be solved by just encrypting the email itself? Even the headers could be encrypted along with the body.

Yes, but that's typically more cumbersome as you have to trade keys with everybody that needs an email. I wrote an emailer for a medium sized company and it sent about 500K emails and 500K faxes a month. That's a lot of key management.

You could use symmetric encryption, but then you give out the shared key to so many people, it tends to lose value, especially when you don't control how your recipient organizations protect the key. (it could be in a file on a shared folder named Email-EncryptionKey.txt).

On top of all that, each client will have to be taught how to decrypt (and encrypt) emails, either at the employee level or at the network admin level. Most provider organizations are small. Typically a doctor or two with a nurse and a couple people working the schedule and regulatory. In summary, it would achieve the objective but it's not ideal.

>On the subject of fax machines, would they still be compliant if they're connected to a VOIP system?

Yes, as long as no PHI went over an unencrypted channel and all servers are secured (physical and computational) and logged.

Re: Big Tech Is Going After Health Care

#86

Post by aviv »

opportune wrote: post #80
aviv wrote: post #79

Earlier quoted context omitted.

Why do we need technology to help improve lives when so many diseases (type 2 diabetes, Crohn's, IBS, high blood pressure, arthritis, and dozens of others) can already be reversed and prevented by simply changing a person's diet and lifestyle habits? It's really quite insane that people would rather take pills for the rest of their lives to treat symptoms of a disease than actually getting rid of it altogether by giv…

Well as a physician, you can't really force your patient to exercise and eat better. The best you can do is prescribe a medication to treat the symptoms, tell your patient to exercise and eat better, and send them off. Do you have an alternative to prescribing medication for type 2 diabetes and Crohn's? Do you think doctors should simply withhold care since it's their patients' faults that they have those conditions?

Sure, most physicians nowadays will mention to the patient that diet and exercise are beneficial, but at the same time will outright dismiss the critical role that diet specifically plays in curing the disease.

Yes, the alternative is a 10 to 30 day water fast for both of those. I know several people that successfully cured both. Especially Crohn's, the amount of misinformation given by physicians is stunning and borderline criminal. $200K a year Remicade treatments GONE after 2 weeks of water fasting. Why would Big Pharma have any incentive to get this message out there?

High blood pressure for example can be reversed entirely after 5 days of water fasting. Completely gone. I don't know how else to say it. I have first hand knowledge of many successful water fasts, but the medical world has brainwashed everyone to the point that I get shut down immediately in any social setting by even mentioning this. But that's okay. Not forcing anyone to do anything they don't believe in. All I can do is share my knowledge and point people in the right direction when they're ready.

Re: Big Tech Is Going After Health Care

#87

Post by lazyasciiart »

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…

Wifi-enabled scales that connect to webservices already exist on amazon - I assume the hard part is getting some certification so doctors/nurses can 'prescribe' it to patients when they leave hospital or while they're in hospital and getting the webservice to talk to $hospitalSoftware, etc?

Re: Big Tech Is Going After Health Care

#88

Post by fcarraldo »

opportune wrote: post #80
aviv wrote: post #79

Earlier quoted context omitted.

Why do we need technology to help improve lives when so many diseases (type 2 diabetes, Crohn's, IBS, high blood pressure, arthritis, and dozens of others) can already be reversed and prevented by simply changing a person's diet and lifestyle habits? It's really quite insane that people would rather take pills for the rest of their lives to treat symptoms of a disease than actually getting rid of it altogether by giv…

Well as a physician, you can't really force your patient to exercise and eat better. The best you can do is prescribe a medication to treat the symptoms, tell your patient to exercise and eat better, and send them off. Do you have an alternative to prescribing medication for type 2 diabetes and Crohn's? Do you think doctors should simply withhold care since it's their patients' faults that they have those conditions?

AFAIK, as a patient with Crohn’s, there is no evidence that any specific diet causes or cures Crohn’s disease. If you know of dietary restrictions which reduce risk of Crohn’s in the same manner as type 2 diabetes, please share it, as I know many people (both patients and physicians) that would be happy to help make lifestyle changes to cure their disease.

Re: Big Tech Is Going After Health Care

#89

Post by joshgel »

obastani wrote: post #73
joshgel wrote: post #53

Earlier quoted context omitted.

Interesting you bring up heart failure readmissions. Not saying they aren't a problem, but here is a fascinating study in JAMA that argues that places with lower readmissions have higher (worse) mortality. https://jamanetwork.com/journals/jamacardiology/article-abst... Not sure we (I'm a physician) understand even what the problems we need technology to solve are. But yes, we need technology to help (find and) solve…

Couldn't this finding be explained by the fact that the hospitals with lower readmissions tend to be poorer (since poorer patients are less likely to be able to afford care)? I only took a quick look, but I didn't see how the paper accounts for this and other possible causality issues. On the other hand, it's certainly plausible to me that lower readmissions can cause higher mortality.

Sure. Or those hospitals gamed the system and didn't admit patients who should have been admitted. Or plenty of other explanations...

We call readmissions rate a Surrogate Marker. Something that isn't a hard outcome that we care about (that much), but rather an indicator of quality. We need surrogates to assess quality because hard outcomes are rarer. But this paper makes us think that maybe we need better markers.

Re: Big Tech Is Going After Health Care

#90

Post by PakG1 »

mxwll wrote: post #41

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…

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.

You could say that about a LOT of organizations. Hospitals are perhaps another level though.

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