Ask HN: Checklist Platform for Hospitals – a good idea? | Hacker News Reader

Ask HN: Checklist Platform for Hospitals – a good idea?

9 pointskyro15 comments

I've recently started work on a project that I think will help hospitals greatly – digital checklists. I've read a few books and articles on how effective they were in boosting hospital efficiency and decreasing the rates of procedural infections by staggering percentages.

I was wondering if any of you health-oriented hackers/entrepreneurs in this community had any ideas or feedback on the feasibility of successfully implementing the idea.

I've not reached MVP yet, so all I've got up can be found at www.huddlemed.com

An additional question: I've gone ahead and purchased www.hospitalchecklist(s).com and am also looking for any advice on how to use those domains to do some initial advertising to gauge the market a bit. I do know that this sort of product is best marketed via direct channels to the higher-ups at hospitals. As a medical student soon entering clinical training, I'll hopefully find the people I need. Any advice on how to approach this aspect of marketing/sales or how to put myself in a good position to succeed in this department would be really great.

Thanks.

I am a doctor.

1. Your last sentence "... and save lifes" . I don't think that your iphone app will ever save a life. There is already a medical checklist system in the hospitals, based on paper checklists, which are controlled several times by nurses-assistants-supervisor doctors etc. Most of them are part of Case history written mostly on a computer software and then printed. This system evaluated in hundred years. To be able to change the whole system you must have a fully featured pc-mobile-tablet software. A simple-task app will be rejected by all hospitals. Even if you build something perfect to revolutionize the medical software system, it will be too hard to sell them. Because

1. They have already bought some years ago a new sofware and updated their system, and paid hundreds of thousands of dollars.

2. Who would bother with a new app having more problems and tasks?! Probably you will talk to the directors of the hospitals, which are more than 45 years old, always doctors and are not open to innovations.

3. You must compete with healtcare software giants.

4. I saw already minimum 3 of apps doing the same work. You must research the market.

Hence, I wouldn't lose my time with this idea. You can build better things instead of spending your time to sell the product to the hospitals.

It is not just an iPhone app. There is also a web interface where administrators will add, edit, and delete checklists.

I know the general response is that I'd be a fool to think this would work, but it just makes sense for several reasons:

1. The current system is pen and paper.

2. iOS devices are becoming almost a universal tool in many hospitals. In fact, some medical schools and hospitals are giving their students and residents new iPads on admission.

3. Checklists have shown to be incredibly effective, but there is no way to A/B test them, update them on the fly, etc.

I think those 3 points alone make this a no-brainer. Selling will be difficult, I agree, but part of me truly believes it's worth a try.

When you say A/B test do you mean with with patient outcomes?

I've done three stints in Healthcare IT, and I can tell you the biggest challenge you'll have is getting your software in the door. Most providers won't talk to you unless you build on top of platforms they already run (Epic, Cerner, Eclypsis, McKesson). And those platforms are legacy beasts with very few modern integration points like REST or even SOAP.

The only real way in is to have a friend who is a decision maker at a hospital and willing to take a chance on something you build. Or be part of a group that is building a new hospital so you can get your tech in. Either way the barriers to entry are so large, they aren't friendly to the average entrepreneur right now.

I was thinking to position the product more as a standalone component of healthcare. As of now, there is no need to access patient data. Administrators can access, add, and update checklists through a web interface, and then deploy new checklists out to all hospital staff who can access checklists through a browser or any iOS device.

As it currently stands, the main implementation of checklists in hospitals consists of nothing more than taping up a sheet of paper onto the OR wall. I want to give hospitals a tool to analyze checklist performance data and refine them for procedural purposes only – no patient data needed, as of now.

What are your thoughts on that?

I've worked on systems that have checklists tied to charging systems where the nurse practitioner is expected to record charges for every procedure as they check it off while caring for a patient. These "charge codes" are standardized across the industry, and multiple subsystems are designed to detect new charge codes and verify errors or insurance related issues as quickly as possible.

The basic lists as you described, are usually tied to charge codes and then applied on a patient by patient basis.

What you've observed is probably a hospital that didn't have such a system in place yet (they are expensive). While you could certainly pitch your product to such a place, they're likely going to ask if you can tie into a billing/charge code system. That's a pretty expensive and time consuming integration with legacy systems to do that.

My advice is to do as much business development as you can before writing any code. See if you can follow a nurse around and understand how the information flows through the system to figure out where you can add value without signing up for a lot of costly integrations.

The issue I see is that the checklist contains information that would be relevant to a malpractice claim. That makes integration important.

Good idea... I think so. Actually a checklist platform in general seems like it would be useful. But you're going to need some crazy insurance - just wait until someone dies because of a bug in your software.

I'm not in the healthcare industry but I know that Documentation is taking up increasingly more of health practitioners' time and that they hate it, no matter how good the initial intentions might be (all type of documentation is done in the name of quality...). Also, there are some very serious health implications whenever you introduce digital equipment, e.g. smart phones, pads, etc, in a hospital or similar environment. Have you considered this?

Hey, I'm also a medical student about to enter clinical training working on a healthcare SaaS. Let's talk. My email is in my profile.

Edit: You misspelled anEsthesia in your iPhone UI preview. Also, that use case (introducing the anesthesia team) is kind of ridiculous. The CRNA/anesthetist will always do a pre-op to ask you about allergies, hx of asthma, and hx of dental work. It's akin to reminding you to put on your pants before going to work.

I'll definitely hit you up some time.

With respects to the checklist on the splash page: I took that directly from the WHO Surgical Safety Checklist, which has become part of standard protocol in many hospitals.

I actually worked on a healthcare product that had this feature. It was called Pathway. It's similar to what you're describing with checkboxes for each "path" that the patient should be on for whatever reason they're in the hospital. It was actually really popular but got replaced by Flowsheets.

But with that said, for smaller facilities or even doctors offices, I think this would be very useful.

You may know this already, but I wonder if Epic Systems (http://www.epic.com/), a big healthcare tech company out of Wisconsin, has something like this as part of their bundled software for hospitals/medical professionals. If not, they may be interested in acquiring something like this.

I'm not trying to put you off, but be aware that selling to hospitals is incredibly ridiculously difficult.

+1 i'd be interested to know more about your sales plan

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