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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

#111

Post by opportune »

fcarraldo wrote: post #88
opportune wrote: post #80

Earlier quoted context omitted.

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.

I agree, I was merely entertaining the parent's claim that Crohn's could be solved in that way. I'm sure he thinks Crohn's can be simply solved by going gluten/dairy free or by fasting.

Re: Big Tech Is Going After Health Care

#112

Post by marktangotango »

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…

But access to the data that exists in those systems is a pretty big carrot for integration partners to help push adoption.

The scary reality is, they don't even have access to the data in those systems. I had a friend contracted at cerner working on a FHIR api end point. Something as simple as answering the question "what medications have been administered to a patient" was extremely difficult to pull out of their system. One would think there'd be a simple report for that information, but they didn't have it. The domain/system knowledge wasn't there either. That one simple api endpoint drug on for months as new data was "found" in the 5000+ table schema. Oh, and they don't use foriegn key constraints in production either.

Re: Big Tech Is Going After Health Care

#113

Post by aviv »

opportune wrote: post #110
aviv wrote: post #104

Earlier quoted context omitted.

The way I comment here is not really how I relay this information to people IRL, especially because I'm very aware and sensitive to their health situation at the time. Here I know I'm going to get downvoted instantly, so I don't bother as much. Mostly threads like this frustrate me, because I know so many people can be helped but online communities shut down these types of discussions and people barely scroll all the…

I've worked in healthcare tech before and one thing we didn't need was more people claiming you could solve every problem with some random FOTM untested medical method that doesn't hold up to scientific scrutiny. No need to make yourself out to be some sort of scientific martyr. If you can't do people here the justice of backing up your comments, don't comment and then complain about getting down voted

I did back it up. Again, remember, there is not much "science" to back it up - because universities and pharmas have such little incentive to studying what may prove to render the medical world useless. Think about it. Why would they study it? If it doesn't work - anyway no one believed it. If it does - all their patented work becomes unncessary for many diseases.

So you are left with real life people who have seen success. And there are plenty once you open your eyes.

Re: Big Tech Is Going After Health Care

#114

Post by AngeloAnolin »

Interesting to see the big players like Apple, Google and Amazon making significant investments in this area.

The big problem though still lies in the maze of regulatory bodies with which all these innovative solutions have to navigate before they even get mainstream. Small players who does not have enough financial leeway ends up burying what could be a groundbreaking solution. Of course, governments need to do their due diligence as public health is the one at stake but there needs to have a certain compromise where the end result is the good of the public and humanity.

Re: Big Tech Is Going After Health Care

#115

Post by grzm »

aviv wrote: post #109
grzm wrote: post #108

Earlier quoted context omitted.

> "The way I comment here is not really how I relay this information to people IRL" > "Offline I'm much more patient" I encourage you to behave more like you do in real life here on HN. Much of what has unfortunately become accepted as discourse on many forums does serious damage to actual meaningful discussion. If that's not what you're interested in, please just refrain from commenting. Many on HN, for all it's fau…

Well, IRL people would give some verbal feedback before they dismiss my suggestion. In HN, they just downvote and walk away. And I have, so far I answered every comment, including the physician who wanted links to "proof", whatever that may be. After all, who really benefits from finding proof that water fast cures illnesses that otherwise require a lifelong regimen of medication and doctor visits?

Perhaps there's some chicken/egg going on here? On HN, members will downvote based on tone as well as message because many do value civil discourse and recognize that regardless of the value of the substance, the manner in which a member communicates that substance can drag HN down. And deciding not to couch your comments as constructively as possible is much more likely to result in downvotes, if that's what you're concerned about. You've gotten plenty of feedback in this thread.

If you have a message you want to convey, it's in your best interested to also convey it in a manner that has the best possible chance of being accepted. If you've already decided that's not worth the effort, it's probably not worth the effort to comment at all.

Re: Big Tech Is Going After Health Care

#116

Post by aviv »

fcarraldo wrote: post #88
opportune wrote: post #80

Earlier quoted context omitted.

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.

It's AFAYK because that's what you are being told currently.

Who do you expect to show you the evidence that a 2-week water fast will cure your Crohn's? The company that makes Remicade which brings them up to $200K a year per patient? A university that gets funded by the government that is lobbied heavily by the pharma companies?

Come on. Think about it.

I already shared it - now it's up to you to pick it up from here and do your own research if you are interested. I've seen many who have stopped and reversed diseases including Crohn's using water fasting followed by a diet of mostly fruits and veggies.

Re: Big Tech Is Going After Health Care

#117

Post by darkerside »

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…

Sad that you get down voted when you make so many valid and useful points. Galileo was in the same boat at one time!

I don't think you can blame traditional physicians. Most of them really didn't go to school for a decade to tell fat people to eat less. They want to solve medical problems, not play life coach.

Maybe there is a role for technology here. People accept statements from a machine that they'd take great offense to in person. Maybe Siri would be a better entity to tell you you're fat and need to lose weight.

Re: Big Tech Is Going After Health Care

#118

Post by aviv »

grzm wrote: post #115
aviv wrote: post #109

Earlier quoted context omitted.

Well, IRL people would give some verbal feedback before they dismiss my suggestion. In HN, they just downvote and walk away. And I have, so far I answered every comment, including the physician who wanted links to "proof", whatever that may be. After all, who really benefits from finding proof that water fast cures illnesses that otherwise require a lifelong regimen of medication and doctor visits?

Perhaps there's some chicken/egg going on here? On HN, members will downvote based on tone as well as message because many do value civil discourse and recognize that regardless of the value of the substance, the manner in which a member communicates that substance can drag HN down. And deciding not to couch your comments as constructively as possible is much more likely to result in downvotes, if that's what you're…

I agree, I may come off as a troll. I get your point. It's too bad if I do though, my intention is to point people in a direction that will help them and one that they've likely never come across before because no one in the traditional medical world will ever suggest this as a viable option.

I will make it a point to phrase my comments differently in the next health-related thread.

Re: Big Tech Is Going After Health Care

#119

Post by Clubber »

u801e wrote: post #102
Clubber wrote: post #85

Earlier quoted context omitted.

>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 sha…

> but that's typically more cumbersome as you have to trade keys with everybody that needs an email. What would be needed is a public key infrastructure. If organizations like the state board of medicine could serve as a certificate authority for physicians licensed in that state (or maybe the DEA since they issue id numbers to physicians that are needed for controlled substance prescriptions), then the key managemen…

That sounds fine in theory and if implemented well it would work, but I'm not sure how well it would work in reality. I just refer to my small business tax return every year to get an idea of how many forms would need to be filled out to just send email. How would that work for offices that send non PHI emails? Would it go through that system too, or would it have to key on recipient email addresses? How hard would it be to shut down and create a new email for each employee that left, etc. Would you have to have a special email server just for PHI and another for regular? How many times would employees accidentally send PHI over a non-secured channel on accident?

Also, physicians themselves rarely send emails, they have office assistants do it. They are busy providing care. How would that work? The office assistant position doesn't have any direct regulation (that I know of) so you'd either have to have the physicians send out emails (ya right), have an assistant use the physician's account (oh no), or add a bunch of regulation to office assistants (to the tune of doctors and nurses) which would make them more expensive and make office visits more expensive (etc).

It sounds good as a technologist, but if you look for unintended consequences (costs), I'll bet there are a bunch I didn't even think of.

Also, organizations are highly motivated to get this right because the fines have teeth. Up to $50K per incident capped at $1.5 million per annum.

https://www.truevault.com/blog/what-is-the-penalty-for-a-hip...

Re: Big Tech Is Going After Health Care

#120

Post by aviv »

opportune wrote: post #111
fcarraldo wrote: post #88

Earlier quoted context omitted.

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.

I agree, I was merely entertaining the parent's claim that Crohn's could be solved in that way. I'm sure he thinks Crohn's can be simply solved by going gluten/dairy free or by fasting.

Did you even see my reply? I don't "think" or speculate. I've seen it. 2 of them still take me out to lunch when I'm in town because I've changed their life with a simple suggestion which they took upon themselves to research further. It's all about a person's state of mind. If you want to be a slave to the systemic misinformation that's out there - sure, go ahead. If you want to explore alternative options that take away a physician's job security, all the power to you.
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