I killed my startup hours before closing a seed round
tamccann.com
tamccann.com
What happened to this employee? Just curious...
As I understand it, there's plenty of ups and downs in a new venture, especially e-Health where you're somewhat at the whim of government (most countries' health systems are highly government regulated) and there are already plenty of past-failures, even one by Google. But surely the investors would already have been aware of that, and had decided to take a risk, because e-Health is also inevitably going to be a very big market eventually (just who knows when the ducks will finally start to line up), and if they want to play in that space they have to try.
But it seems this entrepreneur had last-minute cold feet at even the thought of the hurdles they will encounter.
It's that question -- whether this team has enough perseverance to stand a chance in that stormy sea -- that seems to have been answered at the last minute. The investors already knew the chances would be low.
The market for seed-stage investments is very frothy today. Lots of investors are spraying and praying, and as a result often lack domain expertise in the areas in which they're investing. Founder pedigree and social proof weigh heavily in what seed stage investors consider "due diligence."
The goal was to make a mobile app that worked something like; install, find your doctor, take a photo of your drivers license, “sign” on the phone (to validate identity) and then magically (after a few days time) you have copies of all your past health records, accessible on your phone. Obviously, we had many ideas of what you could do next (visualize your health history, find correlations and causation, compare with norms, share with others, enhance with other data…) but we wanted to make it fast, easy and free to get your records. After a few months, we had this working (with lots of issues) and it was really cool!
I am having trouble understanding why medical records are apparently central to his vision. Why? I mean, if you are frustrated with how medicine currently works, why not do something "non medical" as a real alternative?
>do something "non medical" as a real alternative
What do you mean? Are you talking about alternative medicine?
But there are metrics you can track that can be medically significant and it doesn't require you to deal with doctor's offices or official medical records.
Why not offer a means to track diet, blood glucose readings for diabetics, and other metrics of that sort? It addresses the domains he was targeting -- people with chronic illness or "optimizers" trying to improve their sports performance -- without getting into dealing directly with official medical records, HIPAA compliance, etc.
That would be a cool app but I doubt many people would able and willing to keep entering the data required to get meaningful results. Medical records would conceivably "skip" that process and you could just peruse your historical data. So it's a matter of convenience, I guess.
Jim Clark, the founder of SGI, tried to do this in 1995, with Healtheon.[1] After several failures but a successful IPO (dot-com boom) which raised $40 million, the business pivoted into medical billing, and is now Emdeon, which does about half the commercial medical/insurance billing in the US.
So bailing out at the seed round was a good idea.
I'm sure some of this has changed as offices shifted to EMR (Electronic Medical Records) systems, but many offices don't scan the entire existing chart into a new system - just the key parts relevant to current care (e.g. labs from the last 6-12 months, etc.). The full chart is still in a tagged manila folder on a shelf or in a box depending on the office.
I've not regularly seen practices charge for sending records to other medical practices or for providing limited information to the patient directly (e.g. copies of labs), but that's usually not for an entire chart it's for items that can reasonably be faxed. Where I have seen practices charge it's when they also have a regularly scheduled outside service that comes in to scan entire charts that have been requested and for some specialties (e.g. neurology) those charts can easily be 500-1000 pages. I suspect that if a patient wants an entire chart transferred to a new practice that the old one will require that they request and pay for the copy, then it's the patient's job to get it to the new folks.
Changing systems can also be a problem; I know of one specialty practice that has a firewalled-off 2003 server with their old EMR on it because when they migrated to a new system only demographics and some other basic information could be automatically imported. When previous patients schedule appointments, they go into the old system and export all the relevant records to PDFs, then import those into the patient's chart in the new system.
Given the still-widespread need to either scan a bunch of paper, retrieve records from multiple systems, and pay for printing or burning to a CD I see no reasonable way for a company to offer that service free or even inexpensively.
Update: here's a nice resource on per-state costs: http://www.lamblawoffice.com/medical-records-copying-charges...
In Illinois, for example, it can legally cost you a minimum of $25 even for a single page, though as I noted most offices don't seem to have a problem with not charging for small numbers of pages.
So even with almost everything being faxed, digitized, etc. there were still fees to pay when requesting records. And I have reviewed claims that had hundreds of pages. It wasn't the norm, but if someone was in a serious accident that was followed by hospitalization and multiple surgeries, that did sometimes come across my desk.
So, I agree with you. Requesting records is actually something of a pain, even with standardized letters and procedures developed by a large company with years of experience. And, no, it is generally not free.
s/Personal Health Records are/Health Insurance in the US is/ and I still agree
Can you please elaborate?
Much of the frustration stemming from lack of PMR is rooted in the the way our de-centralized and privatized healthcare function. This isn't something you fix through better technology; it's something you have to fix through legislation. Our healthcare problem is mainly a legislative one.
Some are tackling PMR because it appears to a contributing cause of poor healthcare, when in fact is a symptom.
And, kudos to him for sharing it!
To me, this letter is basically saying you're just not up for the challenge. That's fine -- it's certainly better to admit it now, and it's likely a rational decision.
But the best companies usually aren't created by rational thinkers. The best entrepreneurs can take a horribly broken system and contort it in ways that nobody else even thought of, and then execute on a vision to make it the new reality.
You're not telling your investors "this market is too tough, let's not go here", you're basically just saying "This market really needs to be un-fucked, but I'm not the guy to do it".
Nothing wrong with that, let's tell it how it is.
This guy (T.A. McCann) has successfully built and sold a startup, so he doesn't lack the will -- he just lacks the will for this business.
Markets can be so tough that the time/cash/energy to succeed in them means the opportunity is not as attractive as others.
Now if you want to take on a big challenge, change the world, and build something magical, you can and you should. However none of these are required, and each of these is more likely to be a problem.