
Launch HN: Liyfe Clinic (YC S20) – Telemedicine for breast cancer - littlesnail
Hi everyone,<p>I’m Lily Tang from Liyfe (pronounced Life) Clinic (<a href="https:&#x2F;&#x2F;liyfeclinic.com" rel="nofollow">https:&#x2F;&#x2F;liyfeclinic.com</a>), which launched just one week ago. We bring clinical knowledge and support to breast cancer patients without them stepping into clinics.<p>I worked 13 years as a cancer physicist in radiation oncology. During that time, I have witnessed repeatedly the problems associated with access to care—those patients who might have been diagnosed earlier, and those whose treatments could have been more compliant, and whose post-op symptoms could have been managed more efficiently after their initial treatment.<p>In fact, the average time a cancer patient gets to talk to a doctor is only 17 minutes. Without sufficient education and communication, patients often cannot understand their home instruction completely, and consequently their compliance is inadequate. All these affect treatment outcome. I wanted to change this situation.<p>If no one enjoys the process of hospital visits, and doctors don’t have enough time to communicate with patients, how about creating a telemedicine platform? It can offer 24&#x2F;7 access to personalized cancer consultation and support. This is how Liyfe Clinic began.<p>I met Sherry two years ago. We quickly became friends, and soon co-founders. Sherry started to build a HIPAA compliant platform for patient and doctor communication, including iOS, Android, and web versions. The platform has native HIPAA compliant communication infrastructure across all versions. It supports text, image, and video messaging, and file transfers. We also have video chat solution on top of WebRTC.<p>Many cancer patients need to see multiple doctors from multiple facilities, either at the same time or over some years. It is important for them to have a centralized place to store all of their medical records. This way, patients can easily share the records with all doctors—to improve communication efficiency and avoid potential medical mistakes. Therefore, we built a mini EHR system. Patients can upload and organize their profiles and medical records and choose whom they want to share.<p>Currently we focus on breast cancer and offer two types of services: virtual office visits and Liyfe membership. For virtual office visits, patients can choose to get a treatment second opinion, talk to a doctor, nutrition coaching, and emotional support. Once a service is chosen, we will match the patient with a provider, and then the provider can virtually see the patient using the video chat on our platform.<p>The membership program was developed recently after we talked to many patients. What patients really want and need is to be able to access a personalized professional help, anytime, anywhere. The membership program allows patient to text chat with a designated nurse practitioner (NP). Texting is a very low threshold access to care, and it lowers many barriers (fear, expense, inconvenience, time lost from work) to personalized professional care. Most patient questions can be answered by an NP. If there is a need to talk to a doctor or other specialists, the NP will triage that.<p>For long term, we would like work with local hospitals to provide a complete cancer service to patients—hospitals will take care of patients when they are at hospitals, and we will take care the rest.<p>If any of these situations resonates your or your family and friends’ experience, we’d love to hear your thoughts.
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Beefin
Congrats on the launch! I too am in the healthcare technology industry, but
I've consciously been staying clear of the telemedicine space. It just seems
extremely saturated especially these days in a post-COVID era.

Last I checked there are over 500 active telemedicine companies out there.

How do you plan on differentiating yourselves outside of your specialist
physician-base? And how will you get the tool in front of users? I feel like
SEO will be challenging and you may have to rely on grassroots/guerilla
marketing approaches partnering with hospitals/payers to showcase the total
cost value saving of using your product.

A similar use case I've seen is in my city a doctor friend just launched her
own SMS care service, which acts as a "buffer" before medicare recipients call
911. By getting their less serious questions answered and thus discouraged
from "abusing" ambulatory services, the payers (CMS) are very happy paying for
this service on a per patient basis. They then market the tool to their
patients and even provide financial incentives for using it. Just an idea of
how you can spread!

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technics256
Source on the 500 companies? That's staggeringly high.

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littlesnailcs
If you are interesting, here is the GoodRx article I mentioned above:
[https://www.forbes.com/sites/leahrosenbaum/2020/03/26/the-
co...](https://www.forbes.com/sites/leahrosenbaum/2020/03/26/the-coronavirus-
has-created-a-surge-of-telemedicine-demand-goodrx-now-lets-consumers-compare-
services/) In my opinion, primary care is not a winner take all market, and
the market is very large. What makes telemedicine interesting now is that the
new solutions are become more and more innovative, both on technology side and
business model side. Instead of picking from a list of providers, make an
appointment, and video chat. I personally tried Khealth, and I thought it is
very engaging, not a typical medical app. Another example is Forward health,
it really empowers the patients to understand their situation, instead of
giving prescriptions blindly.

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rubatuga
Don't you think that focusing solely on breast cancer is a bit too narrow? I
am wondering how hospitals would be willing to invest so much into just a
single subsection of their oncology department.

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littlesnailcs
Great question, we start with breast cancer for two reasons:

1\. population is big enough for us to perfect our product, 1 in 8 women in
the US will be diagnosed with breast cancer in their life time, Men will be
diagnosed as well. 2\. the complexity of breast cancer is less comparing to
other types, and there are more very good oncologists in this area as well.
Since we are small, we want to maximize the quality of the service with
limited resources.

We will expand to other cancer types later on. Many cancer centers actually
have a separate breast cancer department, examples in new york city: mount
sinai dubin breast center

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dfee
Oh man, I’ve spent too much time in telemedicine. There’s definitely real
value there, but 99% of the challenge is figuring out who’s going to pay for
it.

Per-member-per-month with ACOs? Physicians increasing codes and decreasing
overhead? Patients paying a premium for better access?

I like that you all are starting specific, and I wish you the best in figuring
out your revenue model.

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littlesnailcs
You are right, navigating through the eco-system is the challenge for digital
health solutions. We are current in hybrid mode, D2C and B2B2C. We are a
digital clinic, so we are handling the insurance, not our physicians.

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dfee
Yep. Familiar with it. Looks like two different sales strategies though. Good
luck out there.

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koolba
> The membership program was developed recently after we talked to many
> patients. What patients really want and need is to be able to access a
> personalized professional help, anytime, anywhere. The membership program
> allows patient to text chat with a designated nurse practitioner (NP).
> Texting is a very low threshold access to care, and it lowers many barriers
> (fear, expense, inconvenience, time lost from work) to personalized
> professional care. Most patient questions can be answered by an NP. If there
> is a need to talk to a doctor or other specialists, the NP will triage that.

Is this effectively what an HMO is supposed to be, but just for communication
via text?

Also, a lot of health insurance companies already offer a 24/7 nurse line,
usually for free. Search for “<your insurer> nurse line”. I don’t think it’s
for extended conversations, but if you want to ask a question or understand
the severity of an issue, it’s a great resource.

~~~
littlesnailcs
Agree many platforms (primary care services, insurance etc) provide chat
support for general health issues. Let me break down into two scenarios: pre-
diagnosis vs after diagnosis.

pre-diagnosis: we got lots of patient ask "is this cancer" question. Because
the symptoms sometimes are not super obvious, an oncology nurses with many
years of experience is able to ask the right questions, and give you much
accurate answer. The fact is that early diagnosis matters so much on the
outcome.

after diagnosis: again many questions can only be answered by oncology
professionals. Even the dietitian, which we also offered on our platform, they
are required to have oncology training, understand chemo drugs, then be able
to offer professional coaches.

We are thinking to collaborate with those primary care telemedicine/insurance
platforms, so they can refer their patients to the specialties ones, like us

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refresher
>Currently we focus on breast cancer and offer two types of services: virtual
office visits and Liyfe membership. For virtual office visits, patients can
choose to get a treatment second opinion, talk to a doctor, nutrition
coaching, and emotional support.

As someone who gets pretty bad medical anxiety, this sounds really great. I've
thankfully never had anything as sever as cancer, but I know that my family
doctor and hospital staff, while professional and skilled at their jobs, were
not always available for things like emotional support, general questions,
nutrition info, etc. I'm sure this service will be helpful to many, so good
luck!

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harshgupta
Congrats on the launch! Curious, how do you plan to acquire customers?
Wouldn't hospital systems want to keep the treatment within their system or
partner hospitals?

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littlesnailcs
Good question, we are not the competitor of hospitals, but collaborators. I am
not sure which industry you are in, it is kind of like buy vs build problem
for an enterprise.

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frequentnapper
Is your video chat platform Hipaa compliant? How do you handle calendar and
other timing or non-technical issues which would waste the providers time?

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littlesnailcs
Yes, we built video chat on top of webrtc, host node.js server on aws, https
termination on aws load balancer, then nginx to protect the data transition
between load balancer and the server. We encrypt peer to peer text/image
messages both during transition and store on the mobile device (using realm
encryption storage).

In regarding your second question, I assume you want to ask the membership
service. For telemedicine service, provider see patients and answer any
question (even is simple), this is reimbursable from the insurance. For
membership, our nurse practitioners will be the first layer on the other side
to answer any question via the chat, many of them have 20-30 years of
experience, and NP are actually eligible to prescribe medicine. Patient can
book a full session with oncologist when need.

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rizpanjwani
Hi there. this is interesting. I had this setup a few years ago for my web-rtc
project in the university. Setting up Turn and Stun servers was fun /s. I
really hope the quality has increased in the last 6 years.

Co-incidentally I'm building a telemedicine platform for ophthalmologists in
Canada. Wondering if we can connect?

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jtwaleson
I have an online eye test (easee.online) which we are expanding globally.
Would be interesting to connect to an ophthalmologist telemedicine platform.
Can we connect? My email is in my profile.

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paulocal
This is awesome. I like that its so focused. Are there any good resources you
referenced for building for HIPAA compliance?

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littlesnailcs
It is much easier now, COVID-19 pushed messaging tools to build hipaa
compliant version. Messaging: both twilio and sendbird provides hipaa
compliant api Video: daily.co Forms: jotform AWS: backend data storage Mobile
device: data storage using realms encrypting

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forgotmysn
id be curious to hear why you chose to apply to YC vs some healthcare industry
focused accelerators like Rock Health or IndieBio?

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littlesnailcs
The answer is that we actually have very limited knowledge about accelerators
space, and we didn't actually "shop" around. Both me and Lily know YC, from YC
alumni in this space, and the videos on Youtube. I think YC did really good
job on publishing the "secret source" so that every entrepreneur can benefit
from it.

In some way, our idea is kind of aligned. We want to make the barrier of
access good cancer care very low so that everybody can benefit from it.
Instead of working so hard to search for referrals in order to see the good
doctors.

One take away from 3 months in: digital health sits on the cross of
healthcare/bio and technology. YC has really diversified companies, and we
benefit a lot from the perspectives in different sectors.

