Big Tech Is Going After Health Care • Hacker News Board

Re: Big Tech Is Going After Health Care

#191

Post by bawana » Thu, Dec 28, 2017, 4:21 PM UTC

snomad wrote: post #17

adventured wrote: post #12

Earlier quoted context omitted.

The way you fix the existing system, is by not trying to change it. You replace it instead. You build new, lighter, more nimble approaches to old problems, rather than trying to convince existing power structures to change. That's where any gains will come from by big tech entering the fray, if there end up being any. Trying to change something like the hyper regulated, hyper stagnant, special-interest dominated US h…

As the MOOCs found out, you can't just "replace" certain societal services - especially those beset with volumes of regulation and numerous groups of powerful stakeholders happy to reach out to politicians and the public (AARP, Insurance, numerous govt entities, drs groups, nurses groups). 2/3 of healthcare is paper pushing, the easiest thing the tech community can automate is boring old CRUD paper pushing. I hope on…

actually, most of my patients were not interested in reimbursing me for the cost of the usb stick, although they would gladly accept it for free. I was willing to provide their ENTIRE medical record, but they were not interested. I think people are just as happy to be spoon fed and not knowing what they are eating as long as its free.

Re: Big Tech Is Going After Health Care

#192

Post by aviv » Thu, Dec 28, 2017, 4:26 PM UTC

tomhoward wrote: post #187

aviv wrote: post #183

Earlier quoted context omitted.

No one is picking a fight with you. You come across as very paranoid. Again, you are very biased towards conventional medicine. If someone on an online forum spoke highly in favor of a new radiation therapy they underwent for some cancer, everyone would be cheering them and thanking them for the insight. No one would shut them down saying - "oh, that is anecdotal" -- "this worked for you, don't preach it as an end al…

As somebody who has been commenting about non-conventional health practices on HN for at least 6 years, and who has often paid close attention to Michele's comments on health topics, I can assure you that you're very wrong about her alleged bias toward conventional medicine, wrong to dismiss her suggestions on how to improve your style of communication, and wrong to display such an attitude about this or any other to…

I appreciate your response.

> None of this means we shouldn't try to help people where appropriate. But the way we go about trying to help people makes every bit of difference.

Agree that it makes a difference, which is why my style has evolved to what it is now. As I mentioned, it has been my experience that a more even-tempered, "civil" reply about water fasting simply gets downvoted instantly and rarely generates any discussion.

Yet on the flip side, here we are 40 or so comments deep, and trust me, this has already been food for thought for several HNers. They're not going to necessarily start fasting tomorrow (nor should they without doing their own research) but it planted a seed, and that's all I'm trying to do.

What gets me going on these threads is not a need to "convince one's self of their efficacy" as you put it. Based on my experience in this sort of parallel universe of the alternative medicine world, there is already no doubt in my mind that water fasting is what many people suffering from many of these diseases need. Its benefits are already well documented. I understand that we are all taught that we should wait for government agencies and pharmaceutical companies to study and approve every step we take in life. But any logical person can agree that we are not likely to get the FDA/CDC/XYZ to endorse water fasting any time soon. They're not in the business of telling people not to eat. I don't have any vested interest in getting people to fast. There's no "system" being sold. There's no kit to buy. No series of e-books to purchase. All the information is already out there, free for anyone to consume. And that's actually the point here - BECAUSE there is no industry around water fasting, it is highly unlikely to reach the mainstream any time soon. That's how messed up things are. You will see this in the CNN/NYTimes health section when someone figures out how they can productize not eating for 10-30 days.

I'm passionate about something I know will help people. I don't comment as often as I would like on health threads here and elsewhere because it often frustrates me how much ignorance is displayed online regarding alternative treatment options and how many people miss out on getting better when only conventional medicine that treats symptoms and rarely actually heals people gets praise and bubbles to the top.

Re: Big Tech Is Going After Health Care

#193

Post by aviv » Thu, Dec 28, 2017, 4:32 PM UTC

darkerside wrote: post #190

messick wrote: post #170

Earlier quoted context omitted.

This dude posted up thread that Crohn’s can be cured by a 2 week water fast, so I don’t think he’s on the same page as you.

His views sound a little more extreme (and seem to ascribe malicious intent to what I would label as systemic biases), but I think there's a lot of truth in the principles behind what he says. It's accepted today to dismiss anything that hasn't been scientifically proven, which ironically does a disservice to science. I think if you asked most true experts in the field doing cutting edge research, they'd be the first…

You are being naive.

Who do you expect to do the "cutting edge" research to confirm fasting can cure Crohn's? Do you honestly not realize this is career suicide? There is zero benefit to researchers funded by the government or pharma to find out not eating for 10-30 days is the cure to something they are selling $200K/year treatment for. This is not a conspiracy theory - this is modern life facts 101.

http://www.crohnscolitisfoundation.org/about/sponsors/

Yeah - sure, every corporate sponsor on this list just wishes for the day that it is finally known that Crohn's is not actually a lifelong incurable disease - and not only there is a cure - it literally costs nothing. In fact, you SAVE money by not eating too! LOL. It's astonishing how otherwise very smart people (especially on HN) cannot see beyond what's in front of them. I actually think the more conventionally-educated someone is, the harder it is for them to admit solutions are far simpler than they "should" be.

Re: Big Tech Is Going After Health Care

#194

Post by DoreenMichele » Thu, Dec 28, 2017, 4:47 PM UTC

tomhoward wrote: post #187

aviv wrote: post #183

Earlier quoted context omitted.

No one is picking a fight with you. You come across as very paranoid. Again, you are very biased towards conventional medicine. If someone on an online forum spoke highly in favor of a new radiation therapy they underwent for some cancer, everyone would be cheering them and thanking them for the insight. No one would shut them down saying - "oh, that is anecdotal" -- "this worked for you, don't preach it as an end al…

As somebody who has been commenting about non-conventional health practices on HN for at least 6 years, and who has often paid close attention to Michele's comments on health topics, I can assure you that you're very wrong about her alleged bias toward conventional medicine, wrong to dismiss her suggestions on how to improve your style of communication, and wrong to display such an attitude about this or any other to…

But I've learned that there are very valid, important reasons for people to be cautious about fringe health practices and wary of the motives of those evangelizing them, so the onus is on us to respectful, patient, modest and prudent in the recommendations we make and the way we go about attempting to convince people of their merits.

I think an important detail is that if you have no idea how and why it works, then you really have no means to ascertain when it is likely to work and also no means to fix the problem if things go wrong. Without that, conventional medicine is a safer bet because it has processes and controls in place.

I've found that the more effective my own healing practices have actually turned out to be, and the more content I've become with my own health and life progress, the less I need to evangelize them to others. I think the same trend is evident in Michele's comments here on HN.

Quite. The more my life works, the less I care what other people think of my story. I don't need the validation.

But I still need a conversation space where I can talk about it, if only because I'm a talker and it is a big part of my life. Some people can do a thing and feel no need to discuss it. I'm not one of them. That would make me insane.

So HN serves as a place for me to engage people in meaningful discussion on a thing that is a big part of my life and that requires a fair amount of background to really discuss.

Learning to engage constructively was a very long journey. I spent a lot of time probably sounding like the GP and then a lot of time trying to err on the side of caution. I do blog and I am currently trying to find my voice on a new health blog. It's an ongoing learning experience.

Thank you for chiming in.

Re: Big Tech Is Going After Health Care

#195

Post by u801e » Thu, Dec 28, 2017, 5:38 PM UTC

Clubber wrote: post #142

u801e wrote: post #131

Earlier quoted context omitted.

> 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 auto…

> The current method is for insurance companies to install software on their SMTP server and that's about it.

I would hope that they require TLS encryption for any connection to their SMTP server. Otherwise, any communication containing PHI could easily be intercepted. This also doesn't address the issue of securing the IMAP or Exchange and MTA server(s) that the sender uses to send the email to the insurance company.

> much less chance of mistakes

Unless the sender CCs a copy to another address where the MTA doesn't require TLS encrypted connections and doesn't have any such software installed on the MTA. That's why the solution I proposed (having the client program automatically encrypt the email before sending it and relying on PKI to handle decryption on the other end) would be more fool-proof since, even if the email was CC'd to another address, it couldn't be decrypted by the unintended recipient.

As for the cost argument, I think it could be implemented as a nominal cost on top of the costs that the physician already incurs in the process of applying/renewing their license, the practice license, etc (e.g. name, mailing address, telephone number, fax number, email address along with your PKI state board signed certificate).

> Also, the vast majority of communication containing PHI is with insurance companies and the government

Doctors have to communicate with other physicians outside of their group practice, hospitals they may not be affiliated with, and pharmacies. How is PHI communication in this context currently handled?

> 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.

That is true. But I think that the technology we currently have to secure communication between clients and webservers (that allows us to do things like buy things online, interact with the bank, file taxes, etc along with client side certificates) should work perfectly well with PHI containing information. The problem is setting up the PKI for that type of communication.

Since governments, universities, and private companies have already done this, there's no reason why hospitals (especially university affiliated hospitals), state boards, and health care providers can't also do this.

Re: Big Tech Is Going After Health Care

#196

Post by Clubber » Thu, Dec 28, 2017, 6:21 PM UTC

u801e wrote: post #195

Clubber wrote: post #142

Earlier quoted context omitted.

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 auto…

> The current method is for insurance companies to install software on their SMTP server and that's about it. I would hope that they require TLS encryption for any connection to their SMTP server. Otherwise, any communication containing PHI could easily be intercepted. This also doesn't address the issue of securing the IMAP or Exchange and MTA server(s) that the sender uses to send the email to the insurance company…

Based on that response, I don't think you are understanding how it works (or I didn't explain it well). This is for emails originating from insurance companies.

Software intercepts any queued or targeted outbound email, then:

  1. Replaces the body with a hyperlink to a web site and instructions, removing all PHI.
  2. Hyperlink instructs recipient to login create account / login to view mail over SMTP.
  3. Recipient logs into website (with TLS obviously) and reads email with PHI over secured channel.
  4. Recipient can now read and reply using the website.

Pretty simple. As far as physicians communicating with each other and pharmacies, they typically use faxes and phone calls.

Re: Big Tech Is Going After Health Care

#197

Post by SilasX » Thu, Dec 28, 2017, 6:29 PM UTC

teej wrote: post #49

SilasX wrote: post #43

Earlier quoted context omitted.

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.

Fair enough -- I was severely understating the extent to which there are financial incentives. But I think you're making a similar error in the opposite direction, coming from the approach of of "that problem is solved because we have a law for it." Imagine in any other context:

"Everyone makes a living wage, because we have minimum wage laws." -> No, cost of living can eat it up in some areas, and some people are forced to go contractor, where take-home can get arbitrarily low.

"Taxis provide vital, universal service because they're obligated to take you anywhere." -> Yeah, but in practice they can flout this with impunity.

In this case, yes, the most obvious cases of hospital failure will be undercompensated, getting some incentives right. But is that the same thing as saying that actual, effective measures to avoid screwing up will translate into higher profits, and the people capable of identifying these will benefit from pointing them out? I think that's a stretch.

Why do you think such a simple measure, as proposed by this startup, has to drag them kicking and screaming into implementation? Isn't this something a hundred doctors might have noticed and suggested? Something system level isn't working. Either the feedback loop between hospitals and doctors is broken, or it's too easy to relabel a readmission as being a new issue, or something like that.

If startups have that kind of resistance to something so simple, that suggests a lot of easy improvements are still being held up by misaligned incentives, and supports my original point that system level fixes are a bigger target for health outcome returns.

Re: Big Tech Is Going After Health Care

#198

Post by u801e » Thu, Dec 28, 2017, 7:10 PM UTC

Clubber wrote: post #196

u801e wrote: post #195

Earlier quoted context omitted.

> The current method is for insurance companies to install software on their SMTP server and that's about it. I would hope that they require TLS encryption for any connection to their SMTP server. Otherwise, any communication containing PHI could easily be intercepted. This also doesn't address the issue of securing the IMAP or Exchange and MTA server(s) that the sender uses to send the email to the insurance company…

Based on that response, I don't think you are understanding how it works (or I didn't explain it well). This is for emails originating from insurance companies. Software intercepts any queued or targeted outbound email, then: 1. Replaces the body with a hyperlink to a web site and instructions, removing all PHI. 2. Hyperlink instructs recipient to login create account / login to view mail over SMTP. 3. Recipient logs…

> This is for emails originating from insurance companies.

That was the part I misunderstood. I thought it was for physician offices sending information to the insurance company.

> Pretty simple. As far as physicians communicating with each other and pharmacies, they typically use faxes and phone calls.

And that's an issue that could be addressed if all entities had a PKI set up such that they could communicate online regardless of application protocol used while maintaining compliance with HIPAA).

Re: Big Tech Is Going After Health Care

#199

Post by darkerside » Thu, Dec 28, 2017, 9:49 PM UTC

aviv wrote: post #193

darkerside wrote: post #190

Earlier quoted context omitted.

His views sound a little more extreme (and seem to ascribe malicious intent to what I would label as systemic biases), but I think there's a lot of truth in the principles behind what he says. It's accepted today to dismiss anything that hasn't been scientifically proven, which ironically does a disservice to science. I think if you asked most true experts in the field doing cutting edge research, they'd be the first…

You are being naive. Who do you expect to do the "cutting edge" research to confirm fasting can cure Crohn's? Do you honestly not realize this is career suicide? There is zero benefit to researchers funded by the government or pharma to find out not eating for 10-30 days is the cure to something they are selling $200K/year treatment for. This is not a conspiracy theory - this is modern life facts 101. http://www.croh…

I'm actually not disagreeing with you. Except that I think there is room to say that there are people working in this area who, like you say, are incentivized to research in other directions, not necessarily the one that most helps us. That doesn't make them evil or bad people. They're doing more to help than any of us trolling around on the internet.

Re: Big Tech Is Going After Health Care

#200

Post by Clubber » Thu, Dec 28, 2017, 10:15 PM UTC

u801e wrote: post #198

Clubber wrote: post #196

Earlier quoted context omitted.

Based on that response, I don't think you are understanding how it works (or I didn't explain it well). This is for emails originating from insurance companies. Software intercepts any queued or targeted outbound email, then: 1. Replaces the body with a hyperlink to a web site and instructions, removing all PHI. 2. Hyperlink instructs recipient to login create account / login to view mail over SMTP. 3. Recipient logs…

> This is for emails originating from insurance companies. That was the part I misunderstood. I thought it was for physician offices sending information to the insurance company. > Pretty simple. As far as physicians communicating with each other and pharmacies, they typically use faxes and phone calls. And that's an issue that could be addressed if all entities had a PKI set up such that they could communicate onlin…

Yes, if you wanted to extend a nationwide system for any and all PHI communications, your idea would be a good approach.

In a more wonderful world than what we live in today, the US government would have setup a simple, unreadable (even by them) secure channel for everyday citizens to be able to transfer sensitive data to verified businesses and other citizens. They can't see past the criminals using it to subvert the police though.