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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

#41

Post by guylhem »

trhtrsh wrote: post #29
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…

> 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. > 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. So your morality teaches that it's OK to scam patients, but not OK to scam the government?

If it is legal it is no scam. Making patients pay as much as legally possible is legal.

For ex, on preexisting conditions, the burden of proof is almost reversed. I'm simplifying, but more or less in an audit the opposite party has to prove the charge could not have been caused by the preexisting condition. It is almost impossible (good luck if you are trying to prove say that the chest x-ray had absolutely nothing to do with a physician making sure a cancer did not relapse - so I'll add that preexisting condition to the bill. it has a multiplier effect on the whole bill after a threshold)

This is also moral, according to my beliefs, since it helps improving reliability (here, giving a financial incentive to always check for relapses) and efficiency.

Reducing profits by accounting trickery is illegal. Reducing profits is also immoral in the belief system I have.

You have different beliefs - good for you.

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

#42

Post by [deleted] »

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.

[deleted]

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

#43

Post by sachinag »

drstewart wrote: post #18
sachinag wrote: post #13

This article understates the issues delivering software solutions to patients, providers, or payers. The lack of data standards has completely crippled the ability for new companies/products to innovate and break through. When I worked at a healthcare VC, we deemphasized IT in favor of medical devices because the path for success is much clearer and easier to trod. The reason I can be so confident that it's the data…

What about HL7?

HL7 is a data interchange format, not a data storage format. You can't code to that spec the way you can to DICOM. EHRcon and CDA are jokes.

And, of course, the vendors who stitch together siloed datasets from proprietary vendors make a killing. So that's yet another group who loves the status quo.

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

#44

Post by lucidrains »

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.

lol, yeah, im sure it works. it isn't json tho...

you could also say Cache (it's a post-relational database... whatever that means) is a standard database used in medical systems, but it sure isn't a postgres.

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

#45

Post by w1ntermute »

lucidrains wrote: post #14
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.

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.

This is going to be quite challenging as long as things are under government control. In fact, the best solution may be some sort of rapid transport that allows people to leave the government's jurisdiction fast enough to be treated and return rapidly. I'm still waiting to hear about Musk's hyperloop, but if it's for real, it could make a difference in this industry (among many, many others).

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

#46

Post by narcissus »

daigoba66 wrote: post #37
narcissus wrote: post #30

Earlier quoted context omitted.

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.

That's a good point and to be honest, I didn't deal much with things outside of the hospital itself (I mainly worked in the ADT 'sphere') but I could see how the 3rd party stuff could get hairy... especially if they're trying to deal with different message formats within the same facility.

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

#47

Post by narcissus »

markmark wrote: post #36
narcissus wrote: post #30

Earlier quoted context omitted.

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.

Absolutely (for both points). I found HL7v2 to be more of a 'standard of communication of data' as opposed to a 'standard of data'. A lot of the work I did in my last job was dealing with these differences... I think the best investment of my time was the code I wrote to more easily interact with the messages, just to help alleviate those differences.

All in all, very fun times :)

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

#48

Post by skue »

drstewart wrote: post #18
sachinag wrote: post #13

This article understates the issues delivering software solutions to patients, providers, or payers. The lack of data standards has completely crippled the ability for new companies/products to innovate and break through. When I worked at a healthcare VC, we deemphasized IT in favor of medical devices because the path for success is much clearer and easier to trod. The reason I can be so confident that it's the data…

What about HL7?

HL7 is often characterized as a "70% standard," meaning that instead of getting complete agreement from vendors, they decided to standardize most of it. (HL7 3.0 is an 80% standard, but no one really uses HL7 3.0, at least not in the U.S.)

Think of HL7 as a language with many dialects. As a result there are whole industries for translating feeds both within hospitals (integration engines) and between institutions (RHIO/HIEs).

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

#49

Post by flixic »

guylhem wrote: post #41
trhtrsh wrote: post #29

Earlier quoted context omitted.

> 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. > 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. So your morality teaches that it's OK to scam patients, but not OK to scam the government?

If it is legal it is no scam. Making patients pay as much as legally possible is legal. For ex, on preexisting conditions, the burden of proof is almost reversed. I'm simplifying, but more or less in an audit the opposite party has to prove the charge could not have been caused by the preexisting condition. It is almost impossible (good luck if you are trying to prove say that the chest x-ray had absolutely nothing t…

I very much disagree with this moral view. Just because something is legal doesn't make it moral.

See, when I'm being up-sold almost anywhere, in a store, eating place, etc., I can make good judgement on whether it makes sense to agree to a sale. However, when it comes to medical procedures, I can't make the same good judgment, because I lack the knowledge. So I trust the doctors to make good decisions, firstly medically, but secondly financially.

If I knew that they are adding many of these "reliability" checks, it would break the trust, and I would need to start making much more judgement on my own, this way probably making the matters even worse.

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

#50

Post by TillE »

Mz wrote: post #15
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…

When castles were everywhere, the bigger castle won. Then airplanes came along and essentially made castles obsolete as an aspect of war. The future solutions in health IT will likely appear to be orthogonal to current conceptualizations of the problem. I am curious what type of solution you have been pondering, if you don't mind me asking. (If you don't want to post it publically, my email adress is in my profile.)

As an aside, castles mostly died after serious cannons were developed in the late middle ages, some centuries before the invention of flight.
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