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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

#101

Post by chintan »

rficcaglia wrote: post #7
tel wrote: post #2

I'm in the 7th month of starting a Health IT company and would be happy to answer (some) questions if anyone has any.

I'm in the 41st month of a Health IT startup and I'd be happy to give you a preview of the questions you havent even thought of :) Honestly if you can't fund full speed (dev, QA, support, sales, mktg, ops, clinical studies) for a minimum three years before the first hospital sale , assuming you are selling to hospitals, then get out now. Happy to shar war stories over a pint!

How do you find your sales lead? Specifically, my question is how do you identify a potential sale target? Is it through your connections. call calls or online ads?

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

#102

Post by rficcaglia »

chintan wrote: post #101
rficcaglia wrote: post #7

Earlier quoted context omitted.

I'm in the 41st month of a Health IT startup and I'd be happy to give you a preview of the questions you havent even thought of :) Honestly if you can't fund full speed (dev, QA, support, sales, mktg, ops, clinical studies) for a minimum three years before the first hospital sale , assuming you are selling to hospitals, then get out now. Happy to shar war stories over a pint!

How do you find your sales lead? Specifically, my question is how do you identify a potential sale target? Is it through your connections. call calls or online ads?

Publish peer reviewed journal abstracts with data showing efficacy --- yes for software, not only for devices. Then present data at major conferences (though, you cannot be a presenter directly as it conflicts with vendor conflict of interest restrictions).

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

#103

Post by nradov »

sachinag wrote: post #43
drstewart wrote: post #18

Earlier quoted context omitted.

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.

HL7 CDA R2 works pretty well as a data storage format for certain types of medical records.

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

#104

Post by nradov »

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 V2 actually defines two standard encodings: ER7 and XML. They are both logically equivalent. The ER7 encoding is similar to old EDI standards and typically uses the '|' character as the field delimiter (although certain other characters can be used instead). Unfortunately the XML encoding is poorly supported and most applications use the ER7 encoding.

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

#105

Post by rficcaglia »

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…

I would argue that it is the crippling lack of appetite for change and innovation that stifles breakthrough technology that would create a data standard and a thriving interoperable service ecosystem.

The success of an innovative idea will attract the other members of a data ecosystem. ( Your example proves that!) So you need to have innovation first - not standardization. Standardization may follow.

You were right to abandon IT as a VC --- this is an industry that is not about ROI. The only reason I do it is I can afford to subsidize it, fueled by the letters we get from patients thanking us for making their lives better, or saving them a tremendous amount of pain and suffering.

The MDs at the hospitals I know don't do it for the money. Despite the outrageous prices in US healthcare, they get paid pennies on the dollar for 24X7X366 work (they take it home!) and little thanks (and lots of lawsuits). Often their own institutions don't support them. I would never recommend my child be an MD in the US, at least not for profit. (Advice a family friend and physician once told me when contemplating med school, which I took to heart.)

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

#106

Post by rficcaglia »

slap_shot wrote: post #11
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…

> the sad truth is that medical industry doesn't welcome software disruptions This is a message that really needs to stop being regurgitated around the technology start-up space. The medical industry DOES welcome software disruptions. The past two years have been the two biggest years in healthcare software disruption, in terms of VC dollars invested in that sector[0], the number of accelerators that have accepted he…

Raising funding is one way to punch through the hurdles discussed in the article. I think the point is that if you want to innovate, why should it take $5M in funding if you can demonstrate a good idea working. Answer: all the reasons mentioned in the article.

Small and agile is a function of penetration in the healthcare market --- the regulatory friction and customer requirements will slow them down considerably as they (hopefully) move past initial pilots. There a hundreds of small startups in HIT that get 1 or 2 pilots, but then never get past that point, likely due to the points in this article.

I welcome more and more funding in this space to help educate the buyers and realign priorities toward efficiency vs. status quo. But the industry does not welcome disruptions of any kind. VCs do, in terms of VC dollars invested.

I would make a guess that the ROI YC makes on its HIT investments will pale in comparison to other industries in the long term. Only PG will know.

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

#107

Post by rficcaglia »

intractable wrote: post #64

In my experience, one of the most significant hindrances has been access to and communication with medical personnel: - Medics, especially specialists / surgeons, have extremely busy schedules, often holding down both public & private patient responsibilities as well as performing duties for their specific colleges etc. - The level of IT-savvy amongst healthcare pros is generally low. - They seem to have a different…

Surprisingly I work with a lot of MDs who think communication and lack of professionalism and thoughtfulness in software engineers is a significant hindrance to success.

- Medics have extremely busy schedules and so they don't want to have their time wasted by lack of data, lack of rigorous testing, and risk to their patients. Software pros work in cozy offices not splattered in patient fluids, from 11AM - whenever, and yet don't expend the extra effort to statistically test data, design efficient algorithms and user interfaces, etc., before throwing something over the wall as a MVP. - The level of healthcare savvy among software pros is generally pretty low - MDs seem to have a logic that focuses on quality, meticulous attention to detail, going the extra distance without added compensation, acceptance of hard and legally binding rules about ethics, data collection, privacy, security, efficacy, peer review, etc.. Run the same software program n times and you will get n different bugs, from the same software developer.

When you find a software pro who is willing / able to help on all the above, you do need to hold on to them (and pay a high market salary, with good health care benefits, and reward them for quality and precision vs. MVP attributes.)

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

#108

Post by rficcaglia »

wging wrote: post #77
pionar wrote: post #75

This could really be for any enterprise IT company.

Eh. If you send out two shipments of Doritos, nobody dies. If you administer a med twice, a patient very well could die. Consequently, if you make it even 1% more likely that a med will be administered twice, patients will die.

Absolutely true. That said, software should never replace human thinking (until the singularity, Ray) and the clinician must be the final authority.

Same goes for pilots - the software can help, but as too many pilots have discovered, looking only at the instrument panel (especially one instrument) is a bad idea, speaking from experience ;)

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

#109

Post by jerf »

jQueryIsAwesome wrote: post #59
jerf wrote: post #55

Earlier quoted context omitted.

You are also encouraging the market to produce more of the relevant test in the future, and encouraging more competition to go for those treatments because they can make it profitable at a lower cost. The problem with your very static analysis is that you end up breaking both of those second-order effects, so while you may get to feel good in the short term, in the long term you are doing much more harm. You have to…

> and encouraging more competition to go for those treatments because they can make it profitable at a lower cost. They can make it more profitable but only helps a smaller subset of people because is better to sell 1000 $10 needless than 10000 $1 needles (transportation, packaging, liability, etc); plus is a strong incentive to use any procedure that makes the patient believe that he is getting better even if he act…

"They can make it more profitable but only helps a smaller subset of people because is better to sell 1000 $10 needless than 10000 $1 needles (transportation, packaging, liability, etc);"

You implicitly make the error that the same person faces the choice of selling a few expensive needles or lots of cheap ones. In a free market, if one person tries the former, someone else can do the latter.

The medical market is not very free, unfortunately, and the proposed solutions to the resulting problems are always to make it even less free. The results are so boringly predictable it hardly seems sporting to talk about them. Shortages, inefficiencies, you name the usual consequence of centralized planning and meddling and our medical systems are full of them, but ever and always the solution is to increase centralization. Pity we must once again grind ourselves to dust on the alter of government control en masse again.

The data I see does not match your assertion. For all people bitch about the US, and for all our neutering of the free market advantages we are desperately trying to jam into our system to keep up with the Euro-Joneses, it still has better outcomes than Europe in many key areas. I'm sure that will change soon enough, though.

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

#110

Post by error54 »

z00mer wrote: post #90
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…

e54 : What are your contact details?

Shoot me a message at jyoung@azaleahealth.com
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