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

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

#31

Post by Mz »

FireBeyond wrote: post #28
lucidrains wrote: post #3

i've been thinking about how to create something that can disrupt the medical industry for a long time, ever since beginning medical school. the sad truth is that medical industry doesn't welcome software disruptions. software adoption is usually a bureaucratic process due to the direct risk to human health, not to mention HIPAA and other regulations. quality of the software is not as important as selling the softwar…

I'd also like to throw myself into the ring as someone with significant medical and IT experience curious and keen to do something here. Perhaps contact me (and anyone else is welcome to, too), if you'd like to talk further.

Shoot me an email. I paid health insurance claims for over five years and would love to chat, hear what you are contemplating and all that. (my gmail account: talithamichele)

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

#32

Post by FireBeyond »

rficcaglia wrote: post #10
rmorrison wrote: post #5

Earlier quoted context omitted.

I would recommend trying, especially if you have medical training and know the space. While it is difficult, with the appropriate go-to-market strategy and determination you can get a foothold and grow from there.

I recommend not trying - not for profit anyway - unless you directly influence (did they come to your birthday party?) multiple people at the C-Level at 2 or 3 major hospital prospective customers, ideally academic research centers, depending on your idea

The medical supply area is one that is -really- ripe for disruption, to the point of basically cartel-like behavior brazenly being exhibited:

* http://www.sfgate.com/news/article/Experts-warn-of-medical-i... * http://www.huffingtonpost.com/martha-burk/congress-should-pu...

This is one where, if you had the contacts, you could at least try to do a lot of good, for everyone - but definitely one where you should expect to receive staunch, and ugly, opposition.

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

#33

Post by error54 »

FireBeyond wrote: post #26
error54 wrote: post #17

As a current developer for a health IT company, much of this is true. Even with the current incentives to go electronic, many doctors just simply prefer paper charts and are willing to forgo the $40k a year just to keep things the status quo. My particular company is growing by leaps and bounds because we started with a very simple Practice Management model and grew out from there whereas I see a lot of startups try…

You should also consider the pre-hospital field - a paramedic/EMT in the field with a Toughbook, etc (where they're not still with paper) is typically using horrible software, with little flexibility to what by nature can be a rapidly changing encounter. I see this every day, and hear the cursing that accompanies it, and think to myself that there is so much that could be done to improve this.

That's a really great idea and honestly, our biggest problem now isn't a lack of work but rather a lack of programmers. The entire health care industry from the EMT's up to the hospitals really needs an overhaul as some of the software used is decades old.

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

#34

Post by guylhem »

FireBeyond wrote: post #24
guylhem wrote: post #6

As a health IT professional who did try, and will try again in 2013, this article is spot on. 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 legal…

"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…

Yes, that's the easy part - massaging the bill, testing.

Providing an accurate estimation of the expected gains however require both domain knowledge and statistical analysis.

Ie if your hypothesis is to add "morbid obesity", and you know how much it will gain in the bill, how likely are you to find that in the patient file, given the patient history and (hopefully) some text from the release letter?

Enough to send an unqualified worker who does not understand medical speech?

(you won't get paid for ideas, but for actual results - and too many false positives cost money, because humans have to do the fact checking)

Do you believe it's worth putting a MD on the case? It will cost more in fixed costs, and thus reduce potential gains.

Can you automate that for one patient file consisting of multiple inputs? Can you still do that for 100'000 files? How long does it take for your software to produce its result? Can it still work when it is missing some critical information you believed in your early development would never be missing - like the release letter?

Textual analysis, datamining, Bayes, even sentiment mining (see http://news.ycombinator.com/item?id=4908056) etc - everything is fair game (ex: "the patient did not seem morbidly obese, but upon calculating BMI score, was")

Then you have to convert the lead to a sale. I'm talking about having money in the bank. This requires more than a nod and a signature for hospitals. I know firsthand - in the end, only one hospital paid.

Interest and traction are irrelevant. What matters is how much money you get in the end, and how satisfied the customer is to recommend you to others (it's a small world, especially in the health-IT field)

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

#35

Post by pgr0ss »

lucidrains wrote: post #22
drstewart wrote: post #18

Earlier quoted context omitted.

What about HL7?

it's delimited by pipes... i mean, it is a standard, but it's far from ideal.

HL7 v3 is xml: https://en.wikipedia.org/wiki/Health_Level_7#HL7_version_3

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

#36

Post by markmark »

narcissus wrote: post #30
lucidrains wrote: post #22

Earlier quoted context omitted.

it's delimited by pipes... i mean, it is a standard, but it's far from ideal.

Technically it's delimited by whatever character is decided to be the delimiter, which is even better :) Having said that, it still seems to get data between all sorts of systems in the hospital.

In my experience with HL7 it's a standard, but every single system you talk to you need to write custom code to handle them, because everyone talks the "standard" a bit differently.

[edit] and as for the XML v3, nobody uses it. Nobody.

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

#37

Post by daigoba66 »

narcissus wrote: post #30
lucidrains wrote: post #22

Earlier quoted context omitted.

it's delimited by pipes... i mean, it is a standard, but it's far from ideal.

Technically it's delimited by whatever character is decided to be the delimiter, which is even better :) Having said that, it still seems to get data between all sorts of systems in the hospital.

That I think is the key distinction: HL7 works okay for a group of tightly coupled systems, usually internal to a single organization. The biggest problems today are with data interchange between providers, networks of providers, 3rd party vendors (cloud based or whatever) and the like. The finance and insurance industry have, I think, figured this out. Healthcare has not.

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

#38

Post by lucidrains »

robbiep wrote: post #27
lucidrains wrote: post #14

Earlier quoted context omitted.

thanks! i will try, at least for a little while. honestly, at this point, i think a true disruption can only happen if diagnostic tests are put into the consumer's hands instead of being held hostage at the hospital, and we just aren't there yet.

Hi - As a fellow med student I'm interested in what you mean here.. Are you suggesting that patients should be able to order their own tests?

hey robbie, don't know what year you are in, but basically yeah. a physician in a hospital basically looks at data on a patient to assess the state and then make decisions on management to affect the state. the problem is that these tests are hard to find off-the-shelf and often costs an obscene amount of money as well. i would look into the efforts of companies like scanadu, alivecor, cellscope. once we can get data to the consumers, then us developers can immediately start creating knowledge based systems that utilize the data to give the patient a clearer picture of their internal state.

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

#39

Post by FireBeyond »

guylhem wrote: post #34
FireBeyond wrote: post #24

Earlier quoted context omitted.

"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…

Yes, that's the easy part - massaging the bill, testing. Providing an accurate estimation of the expected gains however require both domain knowledge and statistical analysis. Ie if your hypothesis is to add "morbid obesity", and you know how much it will gain in the bill, how likely are you to find that in the patient file, given the patient history and (hopefully) some text from the release letter? Enough to send a…

Very true - on a slightly different note, my company cleans up in the insurance / claims management side by implementing a system of policy management not based on table lookups but by allowing our providers to build rules and flows of their own. You wouldn't (well, perhaps you would) believe how many claims processors rely on database tables hundreds of columns wide to cover every permutation for a policy possible, and how (relatively) easy it is to convert those into boolean logic and simple rules along the lines of "IF AmountPaid > Deductible THEN" etc.

We achieve auto-adjudication of claim rates into the low-mid 90th percent, whereas most of our competitors are in the 60s to 80s (and some clients, inefficiently using those competitors, are as low as 30% auto-adjudication when they come to us).

But working on the insurance side of things increasingly tweaks my moral compass the wrong way...

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