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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

#141

Post by NoNotTheDuo »

marktangotango wrote: post #112
jeremylee wrote: post #56

Earlier quoted context omitted.

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 sy…

I can vouch for some of that as well, although I disagree with some of it. The domain/system knowledge is there, but there's likely a relatively small group of people that know all of the ins and outs. And the group that knows about inpatient medications likely isn't the the same that knows about outpatient medications. And maybe the ordering of meds is different from the administration of meds.

I think the point about FK constraints is perhaps a little too generalized. In a 5000+ table schema (which is entirely accurate!), I'm sure there are some tables which don't have FK constraints enabled. But I know for a fact that there are FK constraints on some of the tables (because I created them!)

Re: Big Tech Is Going After Health Care

#142

Post by Clubber »

u801e wrote: post #131
Clubber wrote: post #119

Earlier quoted context omitted.

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 i…

> How would that work for offices that send non PHI emails? They could encrypt those emails as well. While sending a non-encrypted email that contains PHI is a problem, sending an encrypted email that doens't contain PHI shouldn't be an issue (as long as the intended recipient can decrypt it, which they should). > How hard would it be to shut down and create a new email for each employee that left, etc. That comes do…

Good discussion, but I think you are solving a problem that has already been solved, but you are proposing a much more cumbersome and complex way.

The current method is for insurance companies to install software on their SMTP server and that's about it. Much less overhead, much less chance of mistakes, much less cost to the physician's office, much cheaper overall and just as good for protecting PHI (since it's automated, no accidents).

Also, the vast majority of communication containing PHI is with insurance companies and the government, so your solution moves the onus of protecting PHI from the insurance companies to the small physicians, which I don't think is overly helpful.

Of course there is no way to really tell unless we complete vet it out and put cost associations with everything and do PHI leak risk assessments. I'm perfectly happy leaving this as a thought experiment though. :)

Re: Big Tech Is Going After Health Care

#143

Post by aviv »

fcarraldo wrote: post #138
aviv wrote: post #116

Earlier quoted context omitted.

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 her…

I’ve fasted for more than two weeks while suffering from a blockage large enough to prevent eating solid food. I still have Crohn’s. It’s possible and certainly important to manage inflammatory symptoms with diet, but unfortunately curing the disease through diet is just impossible. I’m glad it’s worked out for your friends. I just hope you aren’t preventing those with serious disease who need proper medical treatmen…

I don't, funny thing is I see it exactly the opposite, the traditional medical treatment and attitude towards alternative options is preventing those with serious disease from following through.

2 weeks is the minimum I've seen. Some need up to 30 and in rare, advanced cases even 40 days of fasting.

Re: Big Tech Is Going After Health Care

#144

Post by nradov »

grwthckrmstr wrote: post #137
nikanj wrote: post #59

Earlier quoted context omitted.

EPIC and Cerner are doing their best to, simultaneously: 1) Appear to be open, ready for innovation and playing fair (so hospitals don't replace them) 2) Maintain their position as gatekeepers, and use that position to extract as much revenue as possible. New startup wants to deploy tech at your hospital? Hospital probably will end up paying more to Cerner for the integration, than the new tech.

Sounds EXACTLY like an industry ripe for disruption

The EMR market for hospitals and large clinics really isn't ripe for disruption. This isn't an industry where a startup can quickly hack together an "80% solution" as an MVP and sell to some early adopters. Due to regulatory requirements and legitimate patient safety concerns any new entrant needs to be a 100% solution from the start. Otherwise they'll never make it past the first vendor down select.

There may be some limited opportunities for disruptive innovation in niche markets like smaller medical specialties with unique requirements, concierge medical practices, genetic counseling, etc.

Re: Big Tech Is Going After Health Care

#145

Post by nradov »

methehack wrote: post #82
jeremylee wrote: post #56

Earlier quoted context omitted.

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

You haven't addressed the point that jeremylee made about the SMART on FHIR platform now available in those EMRs. It's not a complete solution but it works today and people are building real applications on it. Take a look at the demos from the latest HL7 FHIR Applications Roundtable. https://www.hl7.org/events/fhirapps.cfm

Re: Big Tech Is Going After Health Care

#146

Post by [deleted] »

aviv wrote: post #86
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?

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 bor…

[deleted]

Re: Big Tech Is Going After Health Care

#147

Post by nradov »

ams6110 wrote: post #124
darkerside wrote: post #117

Earlier quoted context omitted.

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 of…

Is this a new thing? When I was a kid, we still had what was called a "family doctor." I'm not sure these really exist anymore. He never hesitated to tell my mom she needed to lose weight or my dad he needed to stop smoking. Maybe the fact that he wasn't a specialist allowed him to be more practical with his advice.

Family doctors (and specialists) still give their patients practical advice lose weight, drink less, eat better, exercise more, and stop smoking every day. Most patients ignore the advice. What more do you expect the doctors to do? If we want people to make better lifestyle choices it's going to take a new system of incentives separate from doctors.

Re: Big Tech Is Going After Health Care

#148

Post by nradov »

grzm wrote: post #126
ams6110 wrote: post #124

Earlier quoted context omitted.

Is this a new thing? When I was a kid, we still had what was called a "family doctor." I'm not sure these really exist anymore. He never hesitated to tell my mom she needed to lose weight or my dad he needed to stop smoking. Maybe the fact that he wasn't a specialist allowed him to be more practical with his advice.

From what I've seen, family doctors have been replaced by primary care physicians. There's still a place for generalists in the medical profession.

You've mixed up two separate concepts. Primary care physician is a role, not a specialty. Most PCPs specialize in family medicine, internal medicine, or pediatrics. The PCP acts as the patient's primary point of contact, leads the patient's care team, and makes referrals to specialists when necessary.

Re: Big Tech Is Going After Health Care

#149

Post by jakevn »

aviv wrote: post #97
joshgel wrote: post #93

Earlier quoted context omitted.

Prove it. In a randomized, placebo-controlled, double-blinded trial. There are plenty of quality and health savings organizations that would fund such a trial if there were any hint of benefit. But there isn't. I'm glad to hear that pseudo-science still gets shut down in social circumstances.

It is slowly trickling in. http://www.telegraph.co.uk/science/2016/03/12/fasting-for-th... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4684131/ I personally know multiple people that did listen to me and others who told them about the healing powers of a water fast, and cured their illnesses by doing it. There's really no downside. You are not "starving" yourself. That is such an insane myth. I myself did too - got…

So, no studies linked, just a quote collection and an interview?

Re: Big Tech Is Going After Health Care

#150

Post by nradov »

aviv wrote: post #136
darkerside wrote: post #133

Earlier quoted context omitted.

And it stops there after a short suggestion. Maybe it's time for "behavioral medicine" a la behavioral finance. We already know people aren't going to listen (they statistically don't) so how else can we tell them in ways that they will listen.

Make it like life or car insurance. I don't pay as high of a premium as a person with DUI history. Why is my health insurance premium the same as a person with an unhealthy lifestyle that frequents the doctor far more than I do for ailments resulting from their poor dietary choices?

For many people the premium isn't the same. Under US law, medical insurance companies are allowed to offer premium discounts for members who meet certain wellness goals such as maintaining a normal weight or blood glucose level.
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