Comment by writimov | Hacker News Reader

Comment by writimov | Hacker News Reader

Glad Anne Wojcicki, CoveredCA and Legal Aid were able to step in and help. There are some specific problems highlighted in the article that could be fixed by software startups:

1) Problem: Difficulty to identify a Doctor for a second opinion. a) Possible solution: software that allows you to input the medical term (or possibly the medicare code for a disease or combos of diseases?) and find all the second opinion doctors located near you. The software needs things like sort by reputation or reviews, price estimates, speed to get second opinion, time window (with a button to click for life-threatening emergency). Also, why be local? Through telemedicine you could video chat with your second opinion after digitally transferring records.

2) Problem: Too long to transfer medical records 5-10 days instead of 10mins. a) Possible solution: HIPAA and GDPR compliant digital medical health platform that works with all hospitals. (Very difficult to solve this because of non-standardization.) b) Secondary solution: Biometric authorization (fingerprint and voiceprint ID or DNA scan) and quick digital download of medical record in plain text. Must complete in less than 10mins even with slower bandwidth.

3) Problem: Didn't have health insurance. Hospital was looking at a potentially very large unpaid bill. a) Single payer government health insurance is the best solution. b) SW Tech company solution is quick instant insurance signup with government or charity guarantee for some percentage of bill. The rest of the bill is dumped into CoveredCA or something else. And the patient is enrolled for 1 year after the fact and must pay premiums. ? There are probably better solutions.

4) Problem: Must rely on humans. a) IBM Watson for disease diagnosis and treatment recommendations combined with additional neural net or machine learning technologies could be used to created automated second opinions. Feed all the raw data into the system to determine the outcomes and probability of recovery for all treatment options.

The problem is that when you have a hammer (a software startup), everything looks like a nail:

1. There may be a shortage of Doctors to provide a 2nd opinion. The cost of a medical education is quite high, and the pay has been going down these past few years. This can't be solved by a software startup.

2. Hospitals have less funding than ever, and are trying to do more with less. So there may already be software out there, but they can't afford it (or the staff to to maintain it, never mind the staff to distribute it). This can't be solved by a software startup.

3. This is really a political problem, and again that can't be solved by a software startup.

4. A medical opinion may not be a binary option, and it could be a moving target where data changes by the day, and it could be a suggestion to collect more data, or even to talk to someone else. Opinions by definition are arbitrary, as where something like IBM Watson may just give you options based on probability (but that probability is only as good as the data you collect, which may not be all inclusive, and may be a moving target). So a startup might even make things worse as people base their options on incomplete data or dated options.

The depressing reality is that there is a great deal of economic inequality in our society, and that's reflected in the quality of healthcare that many people receive. It should also be noted that poverty can prevent access to preventative healthcare strategies which include everything from diet to access to basic medication.

There are already standard protocols and data formats for transferring patient charts between providers within seconds. The standards actually work pretty well now and are supported by most major EMR applications. But many providers still haven't fully configured those features or linked their systems to existing nationwide health information exchange networks.

> b) SW Tech company solution is quick instant insurance signup with government or charity guarantee for some percentage of bill. The rest of the bill is dumped into CoveredCA or something else. And the patient is enrolled for 1 year after the fact and must pay premiums. ? There are probably better solutions.

CoveredCA kinda sorta does this already where if you get pulled into the system via a catastrophic diagnosis they will kick in and help spread the cost. However, I think that the hospital still winds up eating some chunk of the cost as well. The problem is that a doctor has to kick the process off and none of the doctors associated with the hospitals were going to do this.

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