Comment by joe_the_user | Hacker News Reader

Comment by joe_the_user | Hacker News Reader

Parent Full thread

Certainly you can make money at integration, vast amounts of money are made. But as one friend in the business really did tell me once "your job is taking one piece of crap and another piece of crap, get them to talk to each other and so turn them into a third larger piece of crap". Integration "works" but overall often makes the problem worse or at best allows you to run place. Imagine when something else has to talk to your "talks to ten things thing".

For good or ill, The start-up ideal is generally to solve problems broadly, to disrupt an entire industry rather than build one more extension to that industry.

The problem of integration, of conforming to byzantine standards and to the mess that overall existing health IT, is itself still just a detail in the overall problem of health and technology.

The fundamental problem is the messiness and unpredictability of physical human bodies/human health.

The reason that health records are a mess is that there is no easy to way to universally classify "what is going on" with a given person in a cut-and-dried fashion. For any field of a health record, there is significant gray areas once you get to a large scale (including "basic" things like "male" and "female").

Just as much, health procedures often don't benefit from automation because what one person does to care for another person is subtle and not easily codified.

If you integrate the crappy thing everyone's using with something less crappy, gradually displacing the crappiest parts, then the world has gotten better. Maybe not fast by Silicon Valley standards, but still an improvement.

As for health records, perhaps the expectation of a neat database decomposition—data perfectionism—is itself the enemy. For just about any given application, such complete information isn't necessary to improve on the status quo.

From my perspective, too much effort is spent creating One More Standard to unlock data nirvana, and not enough on breaking down the organizational walls and misaligned incentives that brought us to this point.

The post author alluded to this, in mentioning the EHR cash incentives that tragically lacked viable interoperability requirements, and so just served to lock in the major vendors' existing systems.

> For good or ill, The start-up ideal is generally to solve problems broadly, to disrupt an entire industry rather than build one more extension to that industry.

But which start-up has ever done that?

Not even Google or Facebook did disrupt an entire industry – they just built one more extension to an existing industry.

Meh,

Come-on, look at my context. Of course, disruption is never a fundamental up-end, just a streamlining towards a simpler and more productive approach - Uber and airBnB being the classics (whatever their social value or lack there-of).

The start-up approach (or disruption, the most archetypical part of it) is aiming for more streamlining at the end of the process - rather than aiming to be one more orifice slurping up money from one of the vast streams of money that already exist. Contrast AirBnB with a company that might "let you reserve rooms with ten of the largest hotel chains in the world" - sure, both change things, neither absolutely change the world but AirBnB is still a more fundamental change (again, in values-free terms).

Well, many successful startups are just that, though.

"let you reserve rooms with the 1000 largest hotel chains in the world" is quite a fundamental change, as you get direct price comparison, info in which weeks it will be cheapest, etc. (And, unsurprisingly, there are dozens of startups doing exactly that).

Reply on news.ycombinator.com