Thinking of starting a Health IT company? Here are top three industry challenges

So true.

Don't mean this to be cynical, but if you actually want to have a chance of upending the healthcare system, always clearly identify the flow of money (are costs paid by carriers? providers? Medicare? consumers? are the prices negotiated?), regulation (are fines built into the cost structure? what regulations are relevant? are they incentivized to be ignorant?) , and decision-making (e.g. how billing departments more often decide on the EMR to go with rather than the docs). Then check again, because it's likely you missed a huge underground river.

Then the tricky part is to align your business plan with your customers' incentives.

There are differences between France and the US - especially in the mindset - but the payment system is very similar. In fact, the current french system (used for hospital billing since 2004, and tested for 10 years before that) was based on the US medicare DRG approach.

My job is to make patients pay as much as we can legally make them pay, using any mean necessary as long as it is legal.

In the past, my unit was the single most profitable in the whole hospital, by large. So I tried to sell things, and failed.

I would like to insist on the "incentives" topic with a quick example: I previously developed production analysis software to find and exploit the cases where an hospital could be more efficient and thus make more money (long story short, see one of my previous posts on http://news.ycombinator.com/item?id=4826314 for more details)

As I like to say, this is as good as printing money - I can say precisely what should be changed in a billing statement, why, how much it will gain, and the probability to find matching evidence in the patient file.

I can calculate an expected return, so that on small cases you can use unqualified personnel, while it might be worth to have a doctor study every page of the patient file for high profile cases (since, if you don't have evidence to back your billing claim, you are legally liable - it's not unusual for a large hospital to be fined sums with 6 digits if during an audit mistakes are found)

I tried to sell the software, with a commercial partner. In a year, we could only find a single client in the whole french public hospital system!!

Want to know why? The improved productivity - short term financial gains - can be used to demonstrate that the civil servants in charge were not as efficient as they should have been, or that they should hold to that level of efficiency in the future.

That's just like the OR example in the article - they don't want to be more efficient because basically, making more money is a liability to the top management personal career.

I was quite disgusted by this twisted way of seeing things. Medical credentials did not help me. Efficiency was not welcome. Improving one's profile, even at the expense of whole hospitals profitability, was.

I did not explore that much, but there seemed to be a demand for a service to selectively reduce profits, to maximize government subsidies in some units - something utterly disgusting for a libertarian. I didn't think I could do that, so I stopped.

I will try again very soon, but now I will make sure to carefully study the incentives, and do something I can morally agree with.

If your customers are physicians and other practitioners, the state laws are even more complicated as to who any data belongs to. In some areas, any data about patients is technically owned by their physician.

If you're contacting patients, your attorneys will debate at length whether something is legal under the rules of HIPAA. In the end, it will be a much ado about nothing, because HIPAA is barely policed or litigated over. So you'll end up with a large legal consulting fee, a confusing legal opinion, and no clear direction on whether to move forward or not. The next attorney will have a wholly different opinion.

Healthcare law in the US is absolute shit.