Comment by zeratul | Hacker News Reader

Comment by zeratul | Hacker News Reader

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> We are going to change healthcare from the ground-up

This is so impossible!

You have a great product for 1-10 general doctor practices. You should focus on that and just that. If you feel like you have a lot of free time on your hands try knocking on 1-5 pain management doctors clinic. See how you do there. If you manage to customize their workflows and menus for pain management, move to 1-5 MDs obesity clinics, and so on. I suspect that after single pain management clinic you get burned out.

Have you ever looked at UMLS http://www.nlm.nih.gov/research/umls/ ? It has 2,612,024 mln medical concepts and counting. Many diseases are still poorly covered. Any time you talk with a specialist in a hospital he/she will need those terms in their documentation. Every disease has different workflow and different vocabulary. If a hospital thinks about adopting a new EMR, they will send ~100 their own IT people to EPIC/GE HQ to have them trained how to configure their system. Then, those ~100 IT people will work with ~1000 MD to have progress notes, flowsheets, and what have you configured to everyones liking. This is SO MUCH work and huge investment that has to have 0.0001% risk for the hospital and for the patients. Keep in mind that if patient dies and there are lacks in documentations someone will have to pay ... a lot.

I'm sure that some day you will have ~1k engineers and ~2k support team, each encumbered with basic medical knowledge and patient workflows. But then you will notice that healthcare can be changed only top-down not ground-up.

> This is so impossible!

This is exactly why I feel we need more such start-ups in this space - Naive but Bold that have a "Stay hungry Stay foolish" mentality.

Having said that, I pretty much agree with all what you said. The core problem is that few years working in health IT, most people (myself included) start thinking this way. And thats why I feel we need such bold visions, which may sound stupid or "impossible" at this point but can potentially change the status quo. Its very hard to predict when, how and who will bring the change but I know it ll happen, sooner or later.

PS: I disagree about the UMLS part - I don't think any company in their right mind would use Metathesaurus as their base vocabulary, may be synonyms, mappings etc but not as a coding vocabulary.

> The core problem is that few years working in health IT, most people (myself included) start thinking this way.

You hit the nail on the head, here. There's a fine line between "bold, fearless, and usefully foolish" and "too ignorant of an extremely complicated domain to accomplish anything useful", and in medical informatics that line is even finer than in many other fields.

> I don't think any company in their right mind would use Metathesaurus as their base vocabulary, may be synonyms, mappings etc but not as a coding vocabulary.

Just to chime in (in case anybody reading this comment thread is thinking about getting into this stuff), you're 100% correct: the UMLS is in no way supposed to be used as a coding vocabulary. If you try and use it as such, you're Doing It Wrong(tm). That's what clinical terminologies e.g. SNOMED-CT are for.

Of course, that doesn't mean that plenty of people haven't tried- it's just such a tempting-looking resource...

That said, I certainly wouldn't want to dissuade anybody from learning how to use the UMLS, or from using it for its intended purposes. It's a really valuable (and easily accessible) vocabulary resource.

Yes, UMLS is indeed a great resource! I do think one could use UMLS as a core vocabulary but with specific application context. At my company, we use it for information retrieval of clinical trials. NIH itself uses it in several of their services (MedlinePlus, ClinicalTrials.gov, etc)

In the context of EHR data-entry/documentation, using UMLS would not make sense just because of the inherent noisiness/granularity differences that come about due to the integrated view of the world. With terminologies like SNOMED-CT, you run into coverage issues and end up pre/post coordinating lot of knowledge.

Good point; I've used it as language resource for IR applications many times. What sort of clinical trial IR are you guys doing- storing and retrieving trial protocols themselves? Or is it about managing ongoing trials? Or something else entirely?

> With terminologies like SNOMED-CT, you run into coverage issues and end up pre/post coordinating lot of knowledge.

Well, yes, SNOMED is a post-coordinated vocabulary, so that's sort of the point- it's a feature, not a bug. Of course, there are so many ways to do post-coordination that you can easily end up in trouble when you try to exchange data with somebody else...

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