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Comment by lucidrains | Hacker News Reader

i've been thinking about how to create something that can disrupt the medical industry for a long time, ever since beginning medical school. the sad truth is that medical industry doesn't welcome software disruptions. software adoption is usually a bureaucratic process due to the direct risk to human health, not to mention HIPAA and other regulations. quality of the software is not as important as selling the software while offering strong credibility and insurance, which makes it significantly harder for the typical small agile team to succeed. i am at the point where im wondering if i should sacrifice my time and efforts on a medical startup or just settle for other challenges that are not so messy. regardless, software will fix our healthcare system one way or the other. it's probably just going to take a long time.

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> the sad truth is that medical industry doesn't welcome software disruptions

This is a message that really needs to stop being regurgitated around the technology start-up space.

The medical industry DOES welcome software disruptions. The past two years have been the two biggest years in healthcare software disruption, in terms of VC dollars invested in that sector[0], the number of accelerators that have accepted healthcare related start ups (YC has now invested in a several) and the rise of accelerators focused on healthcare (e.g. Rock Health, Health Box) that have graduated over 100 'small and agile' teams that have established product-market fit, and raised institutional funding.

Healthcare is a space that does require a significant understanding of industry-specific knowledge (third party payment models and regulations are examples), but I feel that many other industries that are being disrupted have similar barriers to entry.

In my experience, most developers ignore the medical industry, citing similar complaints as yours, but neglect to mention the incredible growth that has been demonstrated in that industry for a while now...

[0] http://rockhealth.com/resources/rock-reports/digital-health-...

Raising funding is one way to punch through the hurdles discussed in the article. I think the point is that if you want to innovate, why should it take $5M in funding if you can demonstrate a good idea working. Answer: all the reasons mentioned in the article.

Small and agile is a function of penetration in the healthcare market --- the regulatory friction and customer requirements will slow them down considerably as they (hopefully) move past initial pilots. There a hundreds of small startups in HIT that get 1 or 2 pilots, but then never get past that point, likely due to the points in this article.

I welcome more and more funding in this space to help educate the buyers and realign priorities toward efficiency vs. status quo. But the industry does not welcome disruptions of any kind. VCs do, in terms of VC dollars invested.

I would make a guess that the ROI YC makes on its HIT investments will pale in comparison to other industries in the long term. Only PG will know.

I would recommend trying, especially if you have medical training and know the space. While it is difficult, with the appropriate go-to-market strategy and determination you can get a foothold and grow from there.

Medical credential will help, but not a whole lot.

There is some strong interest in the market to keep things as they are, even if they are less efficient. Incentives are not aligned at all.

yeah, i've realized this as well. you certainly don't need any medical training to recognize the inefficiencies in the hospital.

I recommend not trying - not for profit anyway - unless you directly influence (did they come to your birthday party?) multiple people at the C-Level at 2 or 3 major hospital prospective customers, ideally academic research centers, depending on your idea

The medical supply area is one that is -really- ripe for disruption, to the point of basically cartel-like behavior brazenly being exhibited:

* http://www.sfgate.com/news/article/Experts-warn-of-medical-i... * http://www.huffingtonpost.com/martha-burk/congress-should-pu...

This is one where, if you had the contacts, you could at least try to do a lot of good, for everyone - but definitely one where you should expect to receive staunch, and ugly, opposition.

thanks! i will try, at least for a little while. honestly, at this point, i think a true disruption can only happen if diagnostic tests are put into the consumer's hands instead of being held hostage at the hospital, and we just aren't there yet.

Hi - As a fellow med student I'm interested in what you mean here.. Are you suggesting that patients should be able to order their own tests?

hey robbie, don't know what year you are in, but basically yeah. a physician in a hospital basically looks at data on a patient to assess the state and then make decisions on management to affect the state. the problem is that these tests are hard to find off-the-shelf and often costs an obscene amount of money as well. i would look into the efforts of companies like scanadu, alivecor, cellscope. once we can get data to the consumers, then us developers can immediately start creating knowledge based systems that utilize the data to give the patient a clearer picture of their internal state.

Hi lucidrains, I'd be curious too what kind of thoughts you have about the health startup field. If you'd like to email me, I would love to chat.

Im just entering my final year.

Like you I think there's plenty of room for disruption, not just on the medical devices side but also in terms of efficiencies.

So the three companies you reference are basically disrupting devices that cost thousands of dollars (ECG and otoscopes/dermatoscopes) - great for bringing down the costs of clinics or solo practitioners. A lot of these devices I think are probably being angled at the home user as well (particularly ECG) but the clinical relevance of giving a patient their own rhythm is pretty minimal... I mean if they have a dicky heart they likely have a pacemaker or ICD which will record suspect rhythms themselves.

I'd be fascinated to talk more to you and see where you are taking this because I think you are really saying is that if we give patients their results or order their own (bloods, EUC, any ELIZA etc studies) then we will be empowering them to make better health decisions. I have my own opinions on this based on what i've seen and if you're interested in discussing further my email is in my profile - although seems like you have a lot that would like to talk to you!

This is going to be quite challenging as long as things are under government control. In fact, the best solution may be some sort of rapid transport that allows people to leave the government's jurisdiction fast enough to be treated and return rapidly. I'm still waiting to hear about Musk's hyperloop, but if it's for real, it could make a difference in this industry (among many, many others).

I'd also like to throw myself into the ring as someone with significant medical and IT experience curious and keen to do something here. Perhaps contact me (and anyone else is welcome to, too), if you'd like to talk further.

Shoot me an email. I paid health insurance claims for over five years and would love to chat, hear what you are contemplating and all that. (my gmail account: talithamichele)

Hi FireBeyond, your email is not listed, but I'd appreciate it if you could email me as I have a few questions. I am curious as to what companies you may have meant when you said, quote: "There are entire companies devoted to nothing more than this - taking a ICD9/10 diagnosis, some procedure codes and massaging the bill to get the biggest possible bill". I had searched before for exactly this and found very little to lead me. Any help would be appreciated.

When castles were everywhere, the bigger castle won. Then airplanes came along and essentially made castles obsolete as an aspect of war. The future solutions in health IT will likely appear to be orthogonal to current conceptualizations of the problem.

I am curious what type of solution you have been pondering, if you don't mind me asking. (If you don't want to post it publically, my email adress is in my profile.)

yeah, would be happy to chat and learn from you! i don't claim to have the full picture.

As an aside, castles mostly died after serious cannons were developed in the late middle ages, some centuries before the invention of flight.

Well, you made me smile. But my point is I am trying to build a "first airplane" and I don't much care what the 900lb gorillas controlling the healthcare castles are up to.

But now I am wondering if I need to work on my metaphor. :-/

Have a great day.

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