Comment by dr_ | Hacker News Reader

Comment by dr_ | Hacker News Reader

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1) A mega platform on top of existing EHR's won't be an easy thing. It would require them to play ball and large players, like Epic, probably won't. 2) Chronic disease management is important, but really challenging. People don't really spend their days thinking about their illness. They don't look forward to having their blood sugar assessed. Any kind of disease management program is going to require that the patient be minimally engaged, yet data still effectively collected and assessed. The only evidence of real consumer engagement in health has been with respect to personal fitness. 3) HIPAA in a box is going to require some involvement of the government. They've thrown these regulations out there with rather vague specifications as to how they would be applied to ehealth initiatives. If the government wants to enforce this, which they have begun doing, they have to provide better guidance.

Just a few thoughts. In general though, Rock Health has grown into a great program and anyone who is pursuing a health related startup should give it strong consideration.

>* A mega platform on top of existing EHR's won't be an easy thing*

I built something like this in 2009 and got pretty much noplace with it. Our app, Contineo, was an HL7 compliant, back-end agnostic, mobile front end that would work with any HL7 compliant backend.

We were stonewalled by Epic, lead along by Siemens (who had begun talks with us on licensing our technology), we embarrassed Eclipsys as they didnt have a fully HL7 compliant system....

It was really difficult. So we opensourced the tech and gave it to Medsphere to integrate into OpenVista.

I still think there is a significant opportunity in disrupting healthcare in the large hospital, but I don't believe its via the EHR at this time, but through the patient room and patient experience.

If there are any folks out there that want to collaborate on something - I'd love to meet up.

(I applied to Rockhealth's second class and got too interview - but we didn't get selected.)

hey, would love to talk with you a bit more as a fellow med/tech enthusiast.

Me too, 2nd year med student and tech enthusiast.

Include me as well. !

These are some good points. On the EHR question, I think what we would like to see is a company that starts using the work coming out of Standards & Interoperability (S&I)[1]. One can reasonably expect that much of this work will surface in Meaningful Use requirements (since one of the primary objectives of MU is interoperability) and thus would force vendors, including Epic, to comply. The platform here would do the "hard work" of integrating under the S&I frameworks to multiple endpoints and exposing the integration through developer-friendly APIs, similar to what Eligible has done on the administrative side. We see this type of "easy" integration leading to more modularity for EHRs (which is supported by Meaningful Use requirements) and ultimately better end products for hospitals and patients.

[1]http://wiki.siframework.org/

Why do you think past efforts haven't "panned out" yet? Is it:

a) they're working on it, but just not there yet

b) the major EHR do everything in their power to delay progress by providing token access

c) it's actually very hard to sync medical records across so many different standards / systems

d) not enough patient / doctor demand / use-cases, i.e. people don't transfer as much as we think they do, diluting the value of inter-operability

? or something else? all of the above?

This area of HIT fascinates me because I hypothesize that it's a necessary precursor to reform. But, knowing little about the space, I'm not sure where to start my investigation.

None of the above, IMHO.

In San Francisco, Kaiser could electronically share patient data with every other system running Epic with very little technical work and price. We're talking hours of work here. That would let them share data with UCSF, PCMH and every other Epic site.

They don't. Why not? It's because sharing patient data makes it easy to poach patients, and that's bad for business. There are similar situations in other cities too.

I don't blame them because the government hasn't made data exchange required yet. It's coming, with some of the requirements for Meaningful Use Stage 2 & 3 and the work done by the S&I framework. APIs will help too, because HL7 is confusing to newcomers and costs money. Vendors could make this easier too, but it's not like Epic or Cerner could compel anyone to share patient data.

I have a more in depth answer about this topic here: http://www.quora.com/Electronic-Health-and-Medical-Records/W...

I would think HIPPA is one of the issues here. Federal law says it is a big no no to freely share health info without a raft of signed paperwork, basically.

Typically customers handle this through some type of waiver system. Generally at the initial visit in an organization a patient signs a ton of releases that state that the parent organization allowed to share patient information as needed through the course of treatment. Most people want to share their information, but there are systems in place to restrict access as needed by law/best practices. Patients can opt out of data, and some data sharing systems support this through various technical choke points. If you were a nurse at one organization, you may not want people snooping through your medical records at another medical organization. The Direct Protocol supports this through pseudo-anonymity of accounts.

I worked at an insurance company for five years. Part of my job was to get authorizations so I could request medical records. I had annual hippa training. I was not allowed to read any medical records or request any medical records that were not directly involved in doing my job. One standard of hippa is "minimum necessary." That means I am only entitled to as much information as is absolutely necessary to do the job and not more. So I suspect that some system to share records has serious challenges.

1) A mega platform on top of existing EHR's won't be an easy thing. It would require them to play ball and large players, like Epic, probably won't.

They definitely won't play ball with a platform attempting to integrate all of them. That's just a risk; there's no upside. It's possible that none of them would welcome a "platform" at all.

But survey the landscape of EHR vendors. There are a few unique positions of strength out there. Each aspect of uniqueness defines a hypothetical market. The mere existence of some of those markets would develop an asymmetry that simultaneously penalizes competitors and solves a big problem for the partner. Build the spark of the market and you have a significant ally with a strong incentive to nurture your business.

Idea quality indicator: you want the existing player aligned with you, not buying your company (then killing it). They should need you externally.

I'm building a business on one of these hypothetical markets. I made my choice based on my personal capability and fit with the details of the problem. But there are a huge number of different ways to improve both the quality and efficiency of healthcare. (You don't get to solve big problems if there are no big problems.)

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