Several disruptive innovations will soon make life harder for health care’s established giants | Hacker News Reader

Several disruptive innovations will soon make life harder for health care’s established giants

economist.com

22 pointsmatstc15 comments

I think retail medic clinics like those increasingly found in Wal-mart will be a hugely beneficial development.

There is no reason to pay a doctor $175 to tell one of his assistants to swab your throat for strep and stick it in a machine to analyze when you can pay a technician at Wal-mart $25 to do the same thing.

These services make sense for the same reason you don't take your car to an Automotive Engineer to change the oil or fix a flat tire.

Except sometimes when you go to the doctor for that sore throat he notices you have throat cancer.

The Wal-Mart tech tells you it's negative for strep and sends you home with some Tylenol Flu medicine.

Well when the Tylenol doesn't help after a day or so you can go to a real doctor as the next step.

If the sore throat does go away (not related to the cancer), then hopefully your real doctor will catch said cancer during your yearly physical.

I'm not saying these places should replace real doctors for everything, I'm saying for the 98% of the time it's a common ailment like strep or the flu, they can save everyone a lot of time and money.

Sadly, a test for strep will not find cancer, but nor most likely will a doctor looking for strep notice other problems... you have to watch for unusual frequency and severity of symptoms and be willing to seek second opinions, preferably from specialists in that area of medicine. The test for strep can be done fine by the Wal-Mart lab. When it comes back negative and you still have persistent problems, go see your doctor!

Of course, maybe your doctor will test you for strep time after time coming up negative, and never notice the fricking golf ball sized swollen tonsils that are making you sick almost year round until you finally demand to go see the ear\nose\and throat specialists, where upon 1 nurse and 3 doctors in a row will do a double take upon seeing them and immediately schedule the surgery to remove them.... no, I'm not bitter at all! :| At least strep tests aren't painful....

After thinking about it, it would be really convenient to get flu shots and some vaccinations at a local store.

The only nuisance is keeping medical records straight. There's no central database to drop this information into, and subsequent health-care providers need to know exactly what you've had done in the past (regarding vaccinations). These would be good problems to solve.

Axolotl Corp. solved that problem years ago. Our software allows sharing medical records (including vaccinations) across a whole community of authorized care providers. http://www.axolotl.com/products/index.htm#community

What if they give you a sheet of paper, you xerox it there, and then store one copy next to your birth certificate and give the other copy to your regular doctor? I have an immunization record that I keep inside my passport (for yellow-fever reasons).

There is a franchise with a bunch of locations near me doing this.

http://www.anylabtestnow.com/

Another interesting development is primary care for cash, or "direct primary care". Somewhere between retail health clinics at the low end and concierge medicine at the high end, these are doctors you subscribe with for something on the order of $50 a month for a personal relationship with a primary care doctor.

Because of the compensation model, they've embraced conveniences like e-mail, phone calls and text messaging for communication, as well as once-common house calls.

They're also able to better-compensate their doctors and provide longer, more immediate appointments because they don't have nearly the overhead of an insurance-financed medical practice. This could help stem the tide of doctors leaving primary care practice (http://www.entrepreneurialmd.com/index/2008/11/18/angry-prim...), a trend which does not bode well for the future state of preventative medical care.

It's a very early trend, but I'm looking forward to seeing it develop. I currently know of Qliance (http://qliance.com/) in Seattle and Hello Health (http://hellohealth.com/) in Brooklyn. For more, you can check out videos from each organizations' founder: Dr. Garrison Bliss (http://www.tvw.org/media/mediaplayer.cfm?evid=2008030136C...) and Dr. Jay Parkinson (http://vimeo.com/2082073)

I would love to have primary care for cash here in Canada. Given the current system, you can't receive a given medical treatment unless you can convince a doctor to authorize it. Even if you are willing to pay out of pocket, you are out of luck unless you can find a doctor who is on the same page as you.

Right now, I'm trying to get a blood test for Vitamin D, but all the doctors I've gone to see are ignorant of the latest Vitamin D research, and don't see the value of doing the test. If I can't find a doctor who will authorize it in the next year or so, then I'm probably going to drive down to the US and pay cash using Direct Labs (http://www.directlabs.com/) or the Life Extension Foundation (http://www.lef.org/). It's terribly inefficient but I don't see any way around it.

I'm curious as to what research you're referencing. I started taking a vitamin D supplement a few weeks ago at the encouragement of my father, and it seems to be making a difference in my sense of well-being, but I'd welcome a few pointers if you have any handy. (Don't mean to impose, though.)

The big study on vitamin D that got everyone's attention was this one from the summer of 2007:

Vitamin D and Calcium Supplementation Reduces Cancer Risk: Results of a Randomized Trial (http://www.ajcn.org/cgi/content/abstract/85/6/1586)

There is also a lot of information about vitamin D research at the Vitamin D Council website (http://www.vitamindcouncil.org/).

That being said, I don't know if taking a vitamin D supplement would have any noticeable effect on your sense of well-being. I think it's probably a good idea to take one even if you don't notice a difference.

> I don't know if taking a vitamin D supplement would have any noticeable effect on your sense of well-being

Yeah, that was totally unexpected and is purely anecdotal.

A generally good article, but the last section, which discussed online medical records, was a bit vague. First, the author doesn't distinguish between enterprise health information systems (which doctors/hospitals use internally to create and maintain health records), and personal health records (such as Microsoft HealthVault and Google Health, which let patients aggregate their health information from different institutions). Although these two spaces are highly complementary (since health data will be interchanged between the two), they are different applications with different business models. Think of it as the difference between the software that Bank of America uses internally to manage its customer accounts, and a personal finance app like Quicken Online.

So when the author talks about VCs investing heavily in stealth challengers to Microsoft and Google, I'm not sure what he's referring to. The main reason Microsoft and Google are moving slowly is that the adoption of personal health records requires a lot of infrastructural changes: affiliations with hospitals/insurers/medical device makers/employers, adoption of standards for the exchange of medical information, and overcoming concerns over privacy and security. As a result, even if these startups emerge in 2009 with technology or business models that beat Google/Microsoft, I think it would realistically take at least a couple of years for them to gain traction. I would love to be proven wrong, though.

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