
Big Tech Is Going After Health Care - SREinSF
https://www.nytimes.com/2017/12/26/technology/big-tech-health-care.html
======
mxwll
There are some major hurdles for these SV companies to overcome if they want
any level of success in this arena. EPIC and Cerner together hold over 50%
market share of EHR systems in American hospitals. Their interoperability and
patient facing applications are a joke. EPIC actively makes it difficult for
third parties to build on top of their system.

Sure, these SV companies have figured out how to build great tech at scale but
transitioning an entire hospital network to a new EMR is a massive undertaking
-- both technically and organizationally. Many doctors had their world rocked
by the forced transition to using EMR systems and they run the other way from
those claiming a novel technology will solve all of their problems.

There are much greater issues at play here and IMO the organizational problems
within hospitals are far greater than the technical ones. To be successful
hospitals will have to become tech companies. They aren't exactly the hottest
place for top tech talent to end up.

I think the patient first approach that Apple and Samsung have been taking are
likely to win out. If they can build a system that captures an individual's
personal health record doctors will want that data. Hospitals will have no
choice but to begin integrating that data even if it lives outside of the
walls of EPIC, Cerner, et al.

~~~
nikanj
EPIC and Cerner are doing their best to, simultaneously:

1) Appear to be open, ready for innovation and playing fair (so hospitals
don't replace them)

2) Maintain their position as gatekeepers, and use that position to extract as
much revenue as possible. New startup wants to deploy tech at your hospital?
Hospital probably will end up paying more to Cerner for the integration, than
the new tech.

~~~
grwthckrmstr
Sounds EXACTLY like an industry ripe for disruption

~~~
nradov
The EMR market for hospitals and large clinics really isn't ripe for
disruption. This isn't an industry where a startup can quickly hack together
an "80% solution" as an MVP and sell to some early adopters. Due to regulatory
requirements and legitimate patient safety concerns any new entrant needs to
be a 100% solution from the start. Otherwise they'll never make it past the
first vendor down select.

There may be some limited opportunities for disruptive innovation in niche
markets like smaller medical specialties with unique requirements, concierge
medical practices, genetic counseling, etc.

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blhack
Good.

I spent a few years working in a medical IoT startup, and the current state of
the "mainstream" medical monitoring technology is not inspiring.

During a brainstorming meeting, I asked one of our cofounders, a physician, to
tell me about some of the problems he had seen in health. Don't try and solve
it, just lets talk about problems.

He said that _by far_ one of the most common causes for re-hospitalization is
congestive heart failure. It's a super common problem, _and_ it's actually
really easy to catch (it has strong indicators). When your heart begins to
fail, depending on what side of it fails, your body will retain fluid (in the
form of blood) in either your heart or your organs. Regardless, you will bloat
up, and gain weight quickly.

So if a patient is at risk for CHF, a nurse will monitor their weight every
day (or multiple times a day) and watch for spikes. If their weight spikes, a
doctor will intervene in whatever way is necessary.

Can you imagine my frustration at hearing this? It's this massive problem with
an obvious (CHEAP!! SO FUCKING CHEAP!!) solution.

I spend $30 on a scale from amazon immediately, and about an hour after it
arrived I had it connected to an android tablet and broadcasting its readings
to a webservice.

We never went to market with that (long story). Please, if you have the means
to take something like that and scale it, do so. You could save lives. I'm
currently trying. More people should be trying. This stuff is so easy, and the
impact that you could have is massive.

Also: please call your grandparents and just talk to them. Ask them how they
are feeling. Social isolation (full disclosure: this is what my current
project is trying to solve) is probably the area where we as software people
could have the biggest impact.

~~~
hacker_9
The monitoring devices are the real problem, not the people. Do you think all
weight spikes simply equate to having CHF? You can't just rely on such a basic
measurement when dealing with an incredibly complex system such as the human
body. A lot more specialist equipment is going to be needed to come to a final
conclusion (Questioning from experts, MRIs, XRays, even Microsurgery with
cameras).

What consumers can currently access are weighing scales, and heartbeat
monitors. Maybe even temperature monitors. Do you think this stuff is useful
for diagnosing medical conditions? There is a whole lot going on under the
surface that we simply can't see at all, that's the real problem.

~~~
killjoywashere
Your comment is a great example of the disconnect between people in this space
and people not in this space. Do you actually think _anyone_ in this space
would believe that weight spikes are tied to CHF in all cases? You don't
diagnose CHF by weight. It's something you trend in known patients.

Comments like this are one reason why doctors give zero shits about the
potential of computing. Explaining even the basics of a narrow area of human
physiology to some overly arrogant IT guy is maddening (arrogant is fine, for
Pete's sake, it's not like doctors aren't arrogant). Yes, the doctors can be
blamed for conflating computer scientists with the IT guy who came to replace
their mouse. But the IT guy and the CS guy (always a guy) can both equally be
blamed for their unholy arrogance. How many lives did you save today? Zero?
Ok, at least I didn't spill any data (that I know of).

This can go round, and round, and round.

You have _no idea_ how far down the problem goes. I know this because _no one_
knows how far the problem goes. We sequence hundreds of thousands if not
millions of genomes, and still we don't know. Do you really think we spend a
decade in training and come out thinking everything is simple?!

Now, on the flip side, doctors also don't even know how to frame their
problems, in no small part because they're only required to take 2 semesters
of calculus. And then most of them punch out of math as fast as possible.

Computer scientists should be going to biology conferences. Go to ASCO. Pick a
medical specialty, they have multiple conferences a year, I garauntee it.
There's one or 10 in your city. If you want middle ground, look at
microbiology, immunology, molecular biology. They use a fair number of
quantitative methods (sequencing, mass spec, flow cytometry, etc).

~~~
jghn
I'm a software guy in the healthcare space, albeit not medical devices. We see
this problem all the time. Despite the fact that most of the people involved
have degrees, often Phd level, in CS, Math, and Physics we see no end of other
software folks from typical tech companies coming in and describing how we
just don't know what we're doing and that we need big tech to come in and
disrupt us.

There's a reason we do things the way we do them and it's not because we're
stupid and/or ignorant.

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dawhizkid
As someone who most recently worked in product at a healthcare startup I found
the most difficult thing about innovation in the space is the cost of
compliance/regulation.

When you work in an industry that is so highly regulated, and assuming you are
working at a company that follows the rule of law, how do you actually
"disrupt" a set of problems in this industry when there is so little wiggle
room for doing things differently? Following legal guidelines in healthcare
means reenforcing bad norms rather than disrupting them.

One of the biggest WTF moments I had when I first started was realizing that
fax communication is HIPAA-compliant whereas email/SMS are not, even though in
theory anyone could walk by a fax machine at any time and take medically
sensitive information sent over.

~~~
newman8r
I'm pretty sure email can be HIPAA compliant as long as you implement the
system using the established guidelines.

~~~
toomuchtodo
Indeed it is as long as you’ve configured your email system to use TLS and not
downgrade to no encryption if the handshake fails for mail systems where
HIPAA-governed information is departing to.

Source: Not a lawyer, not your lawyer. Sign off provided by non profit bio
research orgs lawyer before I set it up.

~~~
newman8r
This is my understanding as well. Additionally, I believe you can send
encrypted attachments over an unencrypted connection. Furthermore,
[https://www.gpo.gov/fdsys/pkg/FR-2013-01-25/pdf/2013-01073.p...](https://www.gpo.gov/fdsys/pkg/FR-2013-01-25/pdf/2013-01073.pdf)
suggests that it's acceptable to send patients unencrypted PHI if they've
explicitly agreed to accept the risks associated with that (although I'd be
extremely cautious in those situations)

------
bawana
Physician here. SV Tech will win because it is customer centric. Traditional
Healthcare tech is enterprise centric - the precept on which they base their
strategies is 'economies of scale'. People are not widgets. Economies of scale
(aka corporate controlled healthcare) do not apply. As institutions grow
larger, eddy currents of dominance develop - fiefdoms that compete for
control, power and share of the budget. There are so many layers of middle
management that the most popular complaint is that everyone is a manager. Our
hospital actually has 5x as many employees as there are patients in it. I know
of no other industry where this skewed statistic exists. Can you imagine an
airliner with twice as many stewards as passengers? Perhaps the legal
profession is an exception, where you have so many bodies tending to a trial.
In healthcare, patients are lost in this machine and the cacophony of voices
speaking to them is a disservice. Perhaps tho in this era of the consumer age,
some patients conflate quantity with quality and might actually feel 'more is
better'. If healthcare is delivered through a watch on your wrist instead of
an army of servants, the layperson might be able to focus his/her
understanding on the single voice their device has.

The other secret weapon of SV is that it promises to get people to open up
their pocketbooks to actually pay for their own healthcare. Government will
adore them for that. If you think that will never happen, just stop and think
for a minute. People shell out hundreds of dollars a year for the privilege of
being tracked and being advertising targets. All because the mobile device
caters to their impulse for 'connectedness'. Imagine if this device promised a
longer life, better sex, better sleep, less disease. And it showed you with
colorful cartoon graphs how much better you were every time you asked it.
Forget the fact that many of these parameters are only relevant to the big
picture. Statistics apply to populations and any attempt to assign
characteristics from population studies to a given individual carry
uncertainty. They never tell you how big the error bars are, do they?
Certainly a better diet and more exercise confer health benefits. But trying
to 'gamify' this data will just add a cognitive burden and most likely will
lead to more popular misconceptions and misinterpretations. Or perhaps it will
be a new social nexus?When I am in a Starbux or Panera, there are always a few
conversations my ears cannot avoid as people share their health problems over
a sandwich and a coffee. And I cannot help laughing at how ironic the whole
HIPAA thing is.

Ultimately I fear that tech will foster the return of snake oil salesmen, on a
massive scale. We are in a deregulation mania now and I think healthcare will
soon fall under Trump's razor and he will encourage SVTech to make their move.

------
mjfl
Yeah, nothing's going to happen. Compliance costs are too high for any of
Silicon Valley's business models to work.

~~~
Forge36
I'm with you on that. For reference I pulled up Google's announcement that
"Google Health" is being shutdown.

[https://googleblog.blogspot.com/2011/06/update-on-google-
hea...](https://googleblog.blogspot.com/2011/06/update-on-google-health-and-
google.html)

I could see Big Tech enter in other areas (Apple Watch and and their research
app are promising)

~~~
lern_too_spel
The post doesn't say that they shut it down due to compliance costs. It says
they shut it down because almost nobody found it useful.

~~~
acdha
I think the argument is that the problems are too challenging for the
management culture common at places like Google. Getting a product developed,
certified, and deployed is likely be longer than it takes for them to get
bored, forget what they were doing, and move on to something else.

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oh-kumudo
If there is one industry that needs to be disrupted, that is US's health care
industry, it is too expensive.

~~~
epmaybe
I don't think tech disruption is necessary to reduce costs, a
multidisciplinary approach could do something similar.

Edit: apparently my comment never finished, lol. What I meant to say is that
disruption could work, but I think that optimization and regulations with the
tools we have today would also alleviate many problems we have.

------
zitterbewegung
They are going after health care because they either ran out of customers or
people to advertise to.

Hopefully they can make some progress but so far I don't see much.

~~~
Clubber
It's an immensely lucrative and recession proof industry.

------
Apocryphon
I wonder if this will prove to be an opportunity for cities outside of SV to
grab a bigger piece of tech. Nashville?

[https://www.bizjournals.com/nashville/news/2017/09/22/health...](https://www.bizjournals.com/nashville/news/2017/09/22/health-
care-is-growing-quickly-in-nashville-but.html)

------
AngeloAnolin
Interesting to see the big players like Apple, Google and Amazon making
significant investments in this area.

The big problem though still lies in the maze of regulatory bodies with which
all these innovative solutions have to navigate before they even get
mainstream. Small players who does not have enough financial leeway ends up
burying what could be a groundbreaking solution. Of course, governments need
to do their due diligence as public health is the one at stake but there needs
to have a certain compromise where the end result is the good of the public
and humanity.

------
hacker_9
This article is pretty devoid of content, and really only mentions that the
Apple watch can be used as a constant heart monitor. Big deal, you aren't
going to get much information from measuring just your heart beat and knowing
next to nothing else of whats going on in the rest of your body too.

The real technological breakthrough will come when we have the ability to
measure in real time what is going on in our various organs, such as enzyme
production and transportation of molecules, but that's a long way out yet.

~~~
lovemenot
Toto, the producer of fancy toilets in Japan, is believed to be developing
some kind of _back-end_ analytic system.

------
ynonym00s
Would love to get some insight into the work at Verily or DeepMind Health for
a software developer interested in working in healthcare.

------
perpetualcrayon
Why hasn't Big Tech made a bigger dent in the insurance industry?

~~~
tim333
Insurance has quite a lot of specialist knowledge that isn't really tech.

------
fiveFeet
I am all for it if someone can make the doctors use emails instead of faxes.

~~~
dqv
The problem is that we don't have a key server for doctors. I really wish
someone would lobby the HHS to provide a key server that maps to providers'
NPI. Then setting up PGP for email can be streamlined.

As it stands now, everything is fragmented because companies want to lock
practitioners and health care orgs in. I'd love to see them start issuing
"HIPAA compliant" seals for the implementation of open and secure standards
that make it easier for health care systems to communicate and transfer data
easily. That way all these closed solutions will have an incentive to actually
make communication between practitioners easy _and_ secure.

The biggest joke is secure messaging. There are all these apps for secure
messaging between practitioners. Of course, you have to be using the same app
to open a communication channel. I know at least one of these companies is
using XMPP on their backend, so it's likely others are as well. They are
_literally_ using open source solutions to make a problem that the open source
solution was supposed to solve! There's no reason why $SecureMessenger can not
communicate with $MessageSecure. They just don't want that to happen because
they think it will cause them to lose business.

------
659087
I don't want "big tech" anywhere near my doctor's office or anything else
having to do with my health.

~~~
Clubber
Too late. HIS is Health Information Systems and have been around for decades.

Also, thanks to the patriot act, doctors and hospitals share your health
information to the federal authorities without a warrant. So there's that.

[https://cdt.org/insight/law-enforcement-national-security-
ac...](https://cdt.org/insight/law-enforcement-national-security-access-to-
medical-records/)

------
mtgx
And it's going to throw your medical privacy out of the window in the process.

I suppose we'll also see some major deregulation similar to the net neutrality
repeal in the healthcare industry before long.

~~~
rossdavidh
Maybe, but in this case there's an entrenched interest (health care companies)
that might want to use medical privacy as a way to keep themselves from being
Uber-ized.

------
dawhizkid
I am a big believer that we have already discovered a safe, free, plentiful
lever against some of the most high profile diseases (cancer, Alzheimer’s,
some mental illnesses) out there in fasting/calorie restriction/keto.

I highly doubt it will ever become mainstream for the simple reason that no
healthcare or big tech co can make money from telling people to eat in a way
that induces ketosis.

Science of Fasting doc: [https://www.amazon.com/Science-Fasting-Sylvie-
Gilman/dp/B075...](https://www.amazon.com/Science-Fasting-Sylvie-
Gilman/dp/B075848T5T)

~~~
aviv
Insane how we both get downvoted isn't it? Oh well. Another decade or two
before people wake up.

Agree with you, so much of our economy and social structure is built on the
fact that people get sick - and either stay sick or get medicated for the
foreseeable future. Sad. All we can do is mention it, even though we get shut
down quickly be it online or IRL.

Mandatory anecdote: I cured severe arthritis in the knee 6 years ago through a
30-day water fast. It was gone by day 20 or so, and stayed gone for 6 years
now. It's sad that so many people suffer needlessly.

~~~
dawhizkid
Step one is getting to consensus on sugar = toxic, then refined carbs = bad,
then getting people to stop believing we were evolved to eat consistently
throughout the day everyday

It’s amazing that “you are what you eat” has become so controversial

~~~
aviv
The old "a calorie is a calorie" that Reddit/HN geeks like to point out
wearing their science hat. LOL. Oh man... Sometimes I think we've gone too
far. My kids have a hard time finding classmates to play tag with because most
of them are overweight and prefer to sit in the shade and eat their Costco
bought school lunch. It's really sad what's happening.

------
aviv
It's unfortunate that people think "tech" is what health care needs, when in
reality society would benefit tremendously if something as simple as a 5-10
day water fast became mainstream [again], as it used to be, before modern
medicine took over.

