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PicnicHealth (YC S14) Stores Your Medical Records In One Place

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Re: PicnicHealth (YC S14) Stores Your Medical Records In One Place

#31

Post by cookiecaper »

The medical space is so FUBAR'd that I don't see any value in trudging in there as a startup. It's just asking for pain. The industry is not ready for this kind of thing yet, and won't be for the indefinite future.

The whole way we do medicine just needs to be nuked from orbit. The current system we have is one of the most grotesque and tangible examples of human exploitation in modern times. This applies outside America too; your problems don't go away just because your government has given the industry a blank check.

Source: I was a long-term contractor who had options in a medical imaging startup.

Re: PicnicHealth (YC S14) Stores Your Medical Records In One Place

#32

Post by nogaleviner »

ejain wrote: post #20

One of the things that keeps me out of the healthcare space is that you could build the most amazing tool, yet it wouldn't catch on because no one has enough time or incentives to start using it (and you're not playing golf with the right people). That said, PicnicHealth looks nice, and I wish them best luck! The pricing seems a bit high for someone who doesn't have health issues and just wants to keep track of regul…

Founder here - Thanks for the good wishes! I totally agree that lots of people don't have the time or inclination to worry about this stuff. I used to be just like that, and then I got sick. That changes everything. When you're ability to function, feel good, and even live hinges on this stuff, you start paying attention real fast.

For the moment we're focused on folks with serious illnesses, but we've got plans down the road for pricing and a product geared more toward the casual user. Thanks again!

Re: PicnicHealth (YC S14) Stores Your Medical Records In One Place

#33

Post by rdxm »

thetylerhayes wrote: post #17
rdxm wrote: post #7

how can you even consider launching a service like this without being fully audited for HIPPA and ISO 27001. all i see on their site is boiler plate sec that in no way addresses the reality of the business domain they want to operate in. you'd be insane to put your data into something like this without those controls in place. moreover, they are asking for serious regulatory trouble launching without it. this one bus…

Hey I don't work at Picnic but I do work at Prime. Picnic and Prime do similar things. I've met the Picnic team. They're great, and so is Picnic. They understand HIPAA. I'll let @nogaleviner speak to the specifics of their HIPAA considerations but I do want to clear up some general things up about HIPAA since we've (as has Picnic) been working on this for a year or two now. 1. It's HIPAA, not HIPPA. 2. The "P" in HIP…

yes, i know what the acronym is, that was a typo.

even if they only are going to function as what's referred to in HIPAA as the "Business Associate" standard, if you really dig into it they'll essentially need the same level(s) of control as a straight-up HIPAA compliant business would. that is if they want to be in a defensible position when they get breached...

additionally, the reason that I mentioned ISO 27001, is that it's not just HIPAA, it's also all of the other controls both internal and external you must have in place. if your assertion is that they have sec dialed because their site is SSL enabled, well, that's frankly a little scary and somewhat naive.

Re: PicnicHealth (YC S14) Stores Your Medical Records In One Place

#34

Post by pptr1 »

This is a hard space to be in. I am glad ycombinator is funding startups like this. To survive in this space you need to be profitable early on and it looks like you guys are already focusing on that business wise.

The challenge for your business is the various Emr/EHR systems that you have to pull data from. Some of these vendors might not be so friendly, has data lock in is a business strategy. Some systems might not have HL7 or some other type of known integration; the interfaces could be proprietary. Some systems might use their own custom database. Getting out EHR data even in known databases (MySQL , SQL server, etc) could be challenging if integration doesn't work and you have figure out the schema mapping, as the vendor has no incentive to give you the schema.

I am not sure your one price fits all can work well. It seems like it would work for known systems you know you get data accurately out of. What about all those one off deeply proprietary systems; it might take allot more time. I guess getting EHR printouts and manually entering in data is one strategy, but it's quite error prone. Accuracy means everything here. On top of that some of these doctors might not have any incentives to let your team figure out how to pull data from their system.

I know this because I use to do data migrations for a top EMR company. Medical records migrations are considered the most complex.

I would also add that how would your customers know you won't lock in their data. Will you publish your data format?

Re: PicnicHealth (YC S14) Stores Your Medical Records In One Place

#35

Post by dawson »

angersock wrote: post #28
atmosx wrote: post #21

Earlier quoted context omitted.

Another problem is that doctors and health in General is highly specialized. So a doctor needs a set of options while the next needs another, etc. So it's kind of hard to fit everything in one basket. There is HL7 that should a sort of golden standard but many programmers on the field totally ignore it.

I hate HL7 with a passion. As for docs, the main problem is that they've spent the last century or two training snowflake workflows and vocabularies. :(

FHIR is a step in the right direction http://www.hl7.org/implement/standards/fhir/

Re: PicnicHealth (YC S14) Stores Your Medical Records In One Place

#36

Post by thetylerhayes »

rdxm wrote: post #33
thetylerhayes wrote: post #17

Earlier quoted context omitted.

Hey I don't work at Picnic but I do work at Prime. Picnic and Prime do similar things. I've met the Picnic team. They're great, and so is Picnic. They understand HIPAA. I'll let @nogaleviner speak to the specifics of their HIPAA considerations but I do want to clear up some general things up about HIPAA since we've (as has Picnic) been working on this for a year or two now. 1. It's HIPAA, not HIPPA. 2. The "P" in HIP…

yes, i know what the acronym is, that was a typo. even if they only are going to function as what's referred to in HIPAA as the "Business Associate" standard, if you really dig into it they'll essentially need the same level(s) of control as a straight-up HIPAA compliant business would. that is if they want to be in a defensible position when they get breached... additionally, the reason that I mentioned ISO 27001, i…

Yep.

Re: PicnicHealth (YC S14) Stores Your Medical Records In One Place

#37

Post by lucidrains »

dawson wrote: post #35
angersock wrote: post #28

Earlier quoted context omitted.

I hate HL7 with a passion. As for docs, the main problem is that they've spent the last century or two training snowflake workflows and vocabularies. :(

FHIR is a step in the right direction http://www.hl7.org/implement/standards/fhir/

Yes! I am also quite excited for FHIR!

Re: PicnicHealth (YC S14) Stores Your Medical Records In One Place

#38

Post by apu »

angersock wrote: post #12
rdxm wrote: post #7

how can you even consider launching a service like this without being fully audited for HIPPA and ISO 27001. all i see on their site is boiler plate sec that in no way addresses the reality of the business domain they want to operate in. you'd be insane to put your data into something like this without those controls in place. moreover, they are asking for serious regulatory trouble launching without it. this one bus…

You sound like a shill for Epic. This business challenge is only going to be solved by startups, because all of the existing players rely on it being such a fucked system. They're not going to fix anything.

Protip: accusing someone of sounding like a shill rarely leads to productive discussion.

Re: PicnicHealth (YC S14) Stores Your Medical Records In One Place

#39

Post by specialist »

pptr1 wrote: post #34

This is a hard space to be in. I am glad ycombinator is funding startups like this. To survive in this space you need to be profitable early on and it looks like you guys are already focusing on that business wise. The challenge for your business is the various Emr/EHR systems that you have to pull data from. Some of these vendors might not be so friendly, has data lock in is a business strategy. Some systems might n…

I implemented the backend for a few early health exchanges (BHIX, NMHIC, NYCLIX, etc). Things change, my observations are a few years old, so YMMV.

#1 - Players are loathe to share their data. Much integration is now occurring because of consolidation, vs interchange.

#2 - Patient privacy can only be protected one of three ways.

a) globally unique identifiers which are then used to hash / encryption the data (translucent database style).

b) centralized storage, ala thumb drive or dropbox.

c) better laws with real teeth.

I don't see a, b, or c on the horizon.

People freaked over RealID. Medicare for All isn't in the cards yet. So no GUIDs.

Centralized storage ala UK's NIH is contingent on single payer, aka Medicare for All. Not in the cards at this time.

As for privacy protections in the law with some real enforcement, well, that'd require consensus that our government should protect the rights of humans.

#3 - I worked very hard on ETL (extract transform load), atomizing HL7 into RDBMS and then back out again. Here's a free idea:

Don't bother. Just log the incoming HL7 (2.x, 3.x, misc other formats like CCA). Then index it with Lucene or equiv. Finally, map/reduce it to process queries.

I was very proud of our backend datastore. I could go on and on about auditing, making various queries performant, modeling, etc. Alas, every player wants to see their data their way, and canonical strategies just aren't feasible across multiple customers.

Re: PicnicHealth (YC S14) Stores Your Medical Records In One Place

#40

Post by specialist »

ejain wrote: post #20

One of the things that keeps me out of the healthcare space is that you could build the most amazing tool, yet it wouldn't catch on because no one has enough time or incentives to start using it (and you're not playing golf with the right people). That said, PicnicHealth looks nice, and I wish them best luck! The pricing seems a bit high for someone who doesn't have health issues and just wants to keep track of regul…

One of the things that keeps me out of the healthcare space is...

I dropped out, after implementing five exchanges, because it became obvious to all of us doing the work that single payer was the only correct answer. All of our customers and partners were competitors and had no incentive to share data.

I didn't anticipate consolidation of providers, perhaps accelerated by the passage of ACA. Babysteps, eventually leading to single payer? I don't know.

Maybe I should have stuck it out.

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