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Re: Healthcare

#31

Post by tomh »

absconditus wrote: post #24
zdw wrote: post #20

Earlier quoted context omitted.

Epic's software looks and (according to the doctors that have to use it) works like a bad 1990's database program written in Access. I work with a hospital that has it implemented. It's inflexible crap, where their idea of someone using it on a tablet is "get one with windows, or here's a RDP session you can get to through a VPN". One doctor I know said it took him 17 clicks and both reading help and contacting the h…

As bad as Epic's software might be, the rest of the software in the industry is worse.

Interesting side note about InterSystems - I interviewed there a few times about 10 years ago, and the first step was a written exam in Mumps (the programming language). Turns out it's popular in the healthcare space, being used in both InterSystems Cache and VistA, the open-source medical records system used by the Veteran's Administration:

http://stackoverflow.com/questions/256876/tips-for-learning-...

Re: Healthcare

#32

Post by marshallp »

nradov wrote: post #29
marshallp wrote: post #10

Earlier quoted context omitted.

clayton christensen advises that the solution to healthcare is personalized medicine, technologies like portable diabetes monitors. Imagine if you needed surgery, a robot comes to your house and performs it, much cheaper than doctors and hospitals. such system are currently being developed with military funding - battlefield telerobotic surgery

WTF? My house is pretty far from being a sterile environment.

creating a small area of sterility isn't a impossible task, if you can create large one in an operating room, creating a smaller one can't be all that hard (with robotic equipment)

Re: Healthcare

#33

Post by nradov »

marshallp wrote: post #32
nradov wrote: post #29

Earlier quoted context omitted.

WTF? My house is pretty far from being a sterile environment.

creating a small area of sterility isn't a impossible task, if you can create large one in an operating room, creating a smaller one can't be all that hard (with robotic equipment)

Creating even a small sterile environment is actually quite hard. What is the robot going to do, autoclave or boil everything in my bedroom? The main reason that most patients actually survive surgery now is that a huge amount of effort goes into keeping operating rooms sterile.

Re: Healthcare

#34

Post by rsheridan6 »

nradov wrote: post #33
marshallp wrote: post #32

Earlier quoted context omitted.

creating a small area of sterility isn't a impossible task, if you can create large one in an operating room, creating a smaller one can't be all that hard (with robotic equipment)

Creating even a small sterile environment is actually quite hard. What is the robot going to do, autoclave or boil everything in my bedroom? The main reason that most patients actually survive surgery now is that a huge amount of effort goes into keeping operating rooms sterile.

The robot would probably bring its own portable sterile bubble.

Re: Healthcare

#35

Post by notJim »

The baffling thing to me about healthcare in the US is that there are a number of models[1] from other nations that have desirable characteristics, and yet everyone is the US seems to think it's this huge problem that is brand new and that no one has ever looked at before. It should be well known by now that most developed countries spend less money on healthcare and get higher coverage rates and better outcomes. Surely the sane thing to do would be to research those models and figure out which one seems the best fit to us and then adapt it. I'm not opposed to innovation, but our approach to solving the healthcare problem seems seriously fettered by a bad case of not-invented-here syndrome.

1: What I mean by this idea of different models is that everyone seems to assume that all universal healthcare schemes are created equal, but this is simply untrue. Some examples:

- Potential single-payer systems proposed in the US are most often compared to the Canadian system, but Canada actually has one of the worse systems (according to my previous metrics) among OECD countries.

- People also assume that a single-payer system is the only way to achieve efficiency, but Germany has a very effective healthcare system which is not single-payer.

Of course, even setting aside that we seem bad at considering the details of a solution to this problem, the real problem, in my opinion is that we can't even agree on what role government should play. If we can't even agree that the government should solve the healthcare problem, how can we even begin to agree on a solution?

Re: Healthcare

#36

Post by ippisl »

zdw wrote: post #20
absconditus wrote: post #5

I have worked on healthcare software for the last decade. Healthcare technology is really not something that one can understand from the outside. It is also not an area where web startup knowledge is as applicable (eventual consistency is entirely unacceptable, any caching of data must be very precise to avoid showing stale data to users and is generally not done, all sales to hospitals and most physician groups are…

Epic's software looks and (according to the doctors that have to use it) works like a bad 1990's database program written in Access. I work with a hospital that has it implemented. It's inflexible crap, where their idea of someone using it on a tablet is "get one with windows, or here's a RDP session you can get to through a VPN". One doctor I know said it took him 17 clicks and both reading help and contacting the h…

Will something like Microsoft lightswitch, which might enable business experts to write application with relatively little help solve this problem ?

Re: Healthcare

#37

Post by rdl »

OstiaAntica wrote: post #13
MJR wrote: post #8

Earlier quoted context omitted.

First, most Americans fall outside Medicare, Medicaid and the VA programs. The government currently does not regulate individual/employer coverage. I would not characterize the entire private insurance industry as an "employer-provided insurance ghetto" - what does that even mean? The whole second paragraph makes it clear that you don't understand the complexities of the Healthcare industry. You provide very broad br…

It is a common tactic for people invested in a broken status quo to dismiss critics as "not understanding the complexities". Which insurance company or regulator do you work for? I've worked on health care policy professionally, I assure you I understand the issues. Much of the distortion in the current system come from the fact that employers can deduct health care expenses, which means that you save around 15-30% v…

Didn't they bring up ending the employer deduction for insurance during the 2008 Presidential election? I'm all for it, but to make it politically viable you need to spin it in a way which doesn't look like raising taxes or reducing benefits, which is hard when eliminating a deduction. The only way I think it would work is to make personal insurance deductible, and somehow ensure that salaries take into account the implied value of current healthcare.

(Personally, I am so glad I have $100/mo $3500 deductible HSA coverage, personally; I'll eventually set up employer healthcare at my startup, but in the perfect world, I'd rather pay employees 1.5x as much to manage it themselves, and maybe another .5x to the government for other people's care; trying to find and manage benefits like that is a big pain.)

Re: Healthcare

#38

Post by buff-a »

When we look at healthcare, what's wrong with it, and what needs to happen to fix it, we can't see as clearly how the web, technology, and large networks of engaged users can impact healthcare in a positive way.

Because we are not allowed to. I can't even write an iOS app that shows images if they happen to be X-Rays.[1] Its a group of giant monopolies and special interests who as an industry spend more on lobbying than any other industry ($250m in 2010)[2]

And they need to. The industry is ripe for disruption. It amazes me that we allow utterly fallible human beings to attempt to diagnose in a 5 minute appointment conditions that they may never have heard of. And we talk of older doctors having more experience, but only more experience in the stuff they see everyday. Meanwhile computers can diagnose conditions more accurately than humans [3] but we'll see how far the AMA lets that go. Probably require an extra specially trained doctor to operate it. They'll probably require a man to run in front of it with a flag lest this dangerous machine hurt a patient.

[1] http://www.macworld.com/article/161397/2011/07/fda_regulatio...

[2] http://www.opensecrets.org/lobby/top.php?showYear=2010&i...

[3] http://news.ycombinator.com/item?id=3219909

Re: Healthcare

#39

Post by marshallp »

buff-a wrote: post #38

When we look at healthcare, what's wrong with it, and what needs to happen to fix it, we can't see as clearly how the web, technology, and large networks of engaged users can impact healthcare in a positive way. Because we are not allowed to. I can't even write an iOS app that shows images if they happen to be X-Rays.[1] Its a group of giant monopolies and special interests who as an industry spend more on lobbying t…

This is so true. The AMA and FDA are really the enemies of the public, countless suffering has occurred because of them.

Re: Healthcare

#40

Post by disgruntledphd2 »

marshallp wrote: post #39
buff-a wrote: post #38

When we look at healthcare, what's wrong with it, and what needs to happen to fix it, we can't see as clearly how the web, technology, and large networks of engaged users can impact healthcare in a positive way. Because we are not allowed to. I can't even write an iOS app that shows images if they happen to be X-Rays.[1] Its a group of giant monopolies and special interests who as an industry spend more on lobbying t…

This is so true. The AMA and FDA are really the enemies of the public, countless suffering has occurred because of them.

And yet we haven't had another thalidomide scandal since the FDA introduced mandatory clinical trials for new treatments. http://en.wikipedia.org/wiki/Thalidomide

I'm not saying you're entirely wrong, just that its not a simple as you make out.

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