
If hospitals were run like startups - osmode
https://omarmetwally.wordpress.com/2015/07/03/if-hospitals-were-run-like-startups/
======
dlitz
Seriously, the tech startup model isn't always the best one. Here are some
more points:

11\. If hospitals were run like startups, 10% of emergency patients would be
turned away ('not the target audience'), and any medical staff who complained
would be labeled "insufficiently pragmatic".

12\. If hospitals were run like startups, 90% of them would close their doors
within the first year of opening.

13\. If hospitals were run like startups, patients' medical information would
be used to sell them ads. The databases storing this information would also be
leaked within the first 10 years of opening, since details like security are
rarely a priority in a startup.

14\. If hospitals were run like startups, junior medical staff would be
overworked, underpaid, and burnt out. Actually, this is already the norm (at
least in Canada).

15\. If hospitals were run like startups, patients who went in to have their
appendix removed would find that their tonsils and wisdom teeth had also been
removed, and an RFID chip with their patient ID had been implanted "to serve
them better". This would be OK because it would be covered by the blanket
consent form referred to by the sign at the entrance that reads "by using this
facility, you agree to its terms and conditions (available upon request; may
change at any time)". Patients who had read it would know that they could opt
out.

~~~
codingdave
16\. If hospitals were run like startups, ER patients would be treated by
college dropouts who taught themselves surgery by watching videos of mom's
stitching their kid's dolls together.

I have worked IT in hospitals. I agree with the actual point the original
article is trying to make - hospitals are not doing technology well at all. I
don't want to bash the article too much, because that point is correct.

But there is an extremely important factor here - patient health. No
technological improvement is worth risking the health of a patient.

This is a core business principle at work - the point of most businesses is
not to have the best technology. Technology is a tool that often helps them
achieve their actual goals better. Just a tool. Technology for its own sake is
usually a mistake, and very much a mistake if it risks the health or life of
any person.

~~~
angersock
_No technological improvement is worth risking the health of a patient._

I disagree, least of all because the health of _the_ patients should be put
ahead of the health of _a_ patient.

The fact is that this unreasonable fear of harming patients has caused
everyone to be completely blind to the routine fuckups and inefficiencies
which, when taken together, doom the industry and patients as a whole.

Let's look at EMRs. Epic, for example. Integrating with Epic is pretty hard--
unless the client really twists their arm, they basically won't say anything
to help you with their software or access their piles of shitty databases
(mumps lol). They get paid tens or hundreds of millions of dollars a year (per
hospital!) to handle the task of not losing patient records, a task at which
they semi-succeed. They have no incentive to change. Oh, and one more
thing...hospitals are deathly afraid of having data duplication anywhere, so
they freak out if you start looking like you're a sibling system to their EMR
instead of just blindly consuming it.

Moreover, they--like many smaller vendors--do extreme customization work that
basically guarantees a new learning curve everytime somebody moves to a new
system. And the software looks like garbage, and is hard to use, but at least
lives aren't on the line and nobody was risked being harmed by some ~crazy new
startup EMR~. Hah, oh wait, they _are_ on the line, and people die due to bad
medication decisions that aren't flagged or are flagged and ignored by the
system.

And this whole system? Most of the mess is geared towards solving the billing
problem. It isn't geared towards the patients records problem, towards the
"what did this patient's body do at this time" problem. It isn't geared
towards the "hey, that's odd, all my lab messages have the same jank-ass free-
text formatting instead of an interface from the 90s".

The fact is that the vendors and hospitals have conspired in their fear and
greed to basically raise the barrier to entry so high that iterating on new
designs to help is quite hard, and instead just a good way of giving yourself
an aneurysm. And you don't want _that_ , because by that time you'll want to
step nowhere _near_ a hospital.

~~~
TeMPOraL
The state of ERP and MES systems is very similar to what you describe. I had a
brief chance to work with a few of them, and between the bugs, unimplemented
features and the UI design straight from Necronomicon, I have no idea how
factories even work, much less are able to produce and deliver quality goods
reliably.

------
TeMPOraL
If hospitals were run like startups, they'd advertise free advanced medical
procedures to draw people in, then the moment they'd find a buyer for the
hospital they'd shut the power down and told dying people in mid-operation
that they thank them for joining and being part of this great success.

~~~
Fomite
"We've decided to pivot on your cancer treatment. Our infection control
program has also been sunset."

------
thesumofall
While I agree with many of the ideas in principle, I'm wondering if startups
are really the best benchmark to compare with. Much of what the article states
might be closer to the ideals of Lean-driven firms such as Toyota. In fact,
many successful attempts have already been made to bring these principles into
healthcare. Without questioning the effectiveness of startups, I doubt that
all of their organizational principles are well suited for a context where
shortcuts and experiments can lead to real harm.

------
maj0rhn
If hospitals were run like startups, they would ship a 1.0 product as soon as
possible, tolerating the embarrassment it causes and not worrying about the
people they killed.

A better model is aviation, i.e. an industry where failure is often
catastrophic. Look at the success of jet engine manufacturers in producing
product that does not fail. Trans-oceanic flights on just two engines is
something that would have been considered folly 30 years ago. It's all well
and good for Southwest Airlines to have super-perky flight attendants that
innovate by singing songs during post-landing announcements, but the real core
of their business is safety, just like the real core of medicine is treatment
outcomes.

~~~
LLWM
Interestingly enough, in aviation you do see checklists with dozens or even
hundreds of items that need to be "clicked" every time, and incredibly
complicated UIs that take a huge amount of training to be able to use
effectively.

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michaelchisari
I expected an article that discussed the other side of the coin.

------
ianstallings
The main problem in healthcare IT, imho, is the barrier to entry for anyone
unfamiliar with the existing systems and regulations. Writing software for the
industry is so daunting that even some of the big boys won't touch it.

For instance, in the US, if someone hacks your user's credit card data there
will be some penalties involved, but life will continue. But if someone hacks
your patient's records in your healthcare system and you didn't follow the
rules regarding security? Up to $25k _per infraction_. If you did it willingly
you're in criminal territory and the fines get much larger.

And that's just the regulations in the US. Every other country has it's own
regulations you must follow.

Fortunately things are changing. Politicians are clarifying and updating laws
to accommodate new technology. The tools are getting better. And startups like
Dr. Chrono are slowly chipping away at the entrenched enterprise. But it's
going to be a slow process. After all, it's a very serious business.

------
lucidrains
Haha, I am a good friend of Omar's and the referenced physician-coder in the
story. While he made it sound as though I had avoided healthcare altogether
since graduating, I really did put in the effort! Part of me felt like I was
obligated to put in some time given I spent half a decade in my 20's learning
medicine. I worked for Listrunner in the past year and had a lot of fun
combining my software development talents and medical knowledge.

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yalogin
If hospitals run like startups they would not focus on software. That is not
what they are selling and if they are using money wisely they would get the
cheapest possible software and the meets the requirements and instead focus on
providing better health care. Which is what they do.

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gremlinsinc
Maybe there's a good startup in all this, Medical CTO Outsourcing to modernize
or at least fix UX/UI's in healthcare, and also fix performance and optimize
workflows.

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Gatsky
Well it's a good analogy on the information technology front, highlighting the
deficiencies. But a hospital doesn't have the same solitary focus that a start
up has.

The main point is that hospitals are political organisations. And like
political organisations, large scale change only comes after deepening crisis,
or leadership overhauls. Those are the only two ways. Efficiency and speed are
not even on the list of things a hospital is trying to optimize.

------
calcsam
This is why Chris Dixon advocates "full-stack startups" like Uber / Buzzfeed /
Tesla. Sometimes you have to rethink an industry from the ground up.

------
ams6110
Hospitals involve capital investment, human resources, and exposure to
liability unlike any startup can imagine. Thinking they will ever run like
startups is pretty much an impossibility. Even startups that get big don't
operate like startups anymore. If they have problems with IT operations, the
solutions are not going to be found by telling them to operate like startups.

------
iLoch
Hospitals need a "SpaceX" \- some company that comes in that's fairly well
funded and capable, starts out small and proves that there's a lot to gain
from using a different process than the typical ones currently employed. This
would probably mean instead of selling software to a hospital, you'd make your
own hospital - not exactly a startup project.

------
isildur158
Here is what happen when Intel decides to help a hospital:
[http://www.rambam.org.il/EnglishSite/AboutRambam/Publication...](http://www.rambam.org.il/EnglishSite/AboutRambam/Publications/NewsandEvents/Pages/Rambam-
Intel-Cooperation.aspx)

~~~
ams6110
Intel is hardly a startup though. Doesn't really support the OP's point.

------
afarrell
I'm going to shamelessly plug [http://verbal.care/](http://verbal.care/) here.
They started out building a tool for aphasia patients to communicate with
hospital staff and have pivoted to the more general mission of improving the
UX of intra-hospital communication.

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carterehsmith
> Each “progress note,” of which physicians can write two dozen or more each
> day, takes about 250 mouse clicks to navigate (not including the textual
> content of the note!).

Man, that is quite impressive, must be some kind of a world record? I would
really like to see that app :)

------
sysk
Pretty disappointed by the derisive comments in this thread. For a bunch of
startup enthusiasts and innovators, we sure do seem to like status quo. Or
maybe it's just a contrarian signalling thing? Sorry for going meta.

~~~
LLWM
Contrarianism is a bit strong. I'd say bullshit detector. It's a natural
response to the original author blindly praising one method while ignoring all
its flaws.

~~~
Omniusaspirer
He's not all wrong. I work in healthcare and can absolutely relate to most of
his complaints.

Paging systems are absolutely archaic and I've had important pages simply
never be delivered many times. Bed tracking software at my current hospital
has multiple full time employees whose job is 90% looking over things and
sending support staff to their next task via a page. Callback numbers that
take priority over any other task but then they won't pick up which just
wastes time for short concise directives. Manual charting that's made
incredibly tedious by poor UIs.

Hospitals shouldn't be run like startups, but they desperately need better
integration with technology.

~~~
refurb
_Hospitals shouldn 't be run like startups, but they desperately need better
integration with technology._

That is a perfectly logic statement that I'm sure most folks would agree with.

However, a blog title like that wouldn't get many clicks, would it?

------
Thaxll
Next: Hospital as a Service.

------
aaron695
Hospitals are a classic case of, because people won't make decisions that will
(or even might) kill people, many people die.

Not sure of a fix. The best I can think of is rankings.

------
angersock
Here are my 0.02USD on the situation. I lead an engineering team at a health
IT startup doing realtime physiological monitoring and operations analytics
for clinical use. I have seen our software through FDA certification in record
time. I have glimpsed the madness.

dlitz and others are playing the Waldorf-style heckling from the sidelines
"doh ho ho, hospitals-as-startups would shave ads into your scalp". That's
real cute. The fact is, hospitals as they've evolved are super gnarly
behemoths. They have this insanely conservative culture at all levels...nobody
wants to lose their job, and especially in IT, the successful ones have
basically made it their life's mission to prevent physicians (who are,
generally, pretty smart and freakishly stubborn people) from being overzealous
and doing stupid things like spewing patient data over cell phones. They still
do this.

Any change whatsoever in their operating environment takes months, because
they are completely optimized to prevent systematic change from occurring.
There is paperwork and lawyers and billing the likes of which you've never
seen. Sales cycles are over 18 months. 18. Months. You could conceivably have
two full children at a hospital before they have approved the project you'd
use to pay for same.

The technology in hospitals is a bad joke. They cannot reliably tell you the
status of a patient, what department they're in, or where in the hospital
they've been. Frequently, updates to patient details will come out saying "Oh,
whoopsie...this patient? They really are this other patient...wait, shit,
those are the same patient." Nurses and docs will occasionally just horde
equipment in their offices to guarantee that their department has what it
needs, and the hell with the rest. It's absurd. They thought, for a long time,
that no nurses would ever be interested in texting results around--and now,
guess what, in the handful of places rolling that out, it's been like the best
thing ever.

The people? Hoo boy. The nurses are awesome, but turnover and burnout tends to
be large, least of all because of how shitty the alarm management situation is
in certain ICUs. The docs? Some pretty great people, but getting product
feedback from them is basically like calling rand() over and over. They also
basically are in fire-fighting mode all the time. So, they'll do nothing to
help you until they need something yesterday, and then magically their
bitching will open up administrative doors that previously you didn't even
know existed.

And that brings us to the administration. Some folks "get it". Mostly, though,
especially in IT, they don't. They started their careers as machine operators,
and with the awesome application of seniority, they rise through to their
maximum level of incompetence. Things like billing 10K for 10gb of network
storage on a VM. They only buy big name software, and that's how the deathgrip
of Epic happens.

And if you could just bribe these folks to get shit done that'd be one thing--
but hospitals (correctly) tend to have these super draconian gift policies, to
the extent of not even being able to buy like a ham sandwich for a client. The
hospital systems sometimes employ technically incompetent people, but always
also close the backdoors we'd use to work around them.

Let's assume you find some docs and nurses on your side. Let's assume you find
some IT folks that know how to Get Shit Done, or at least stay out of your way
(you know, instead of taking two months to open a fucking port to let
something work). Well, now, it's off to the fucking races with legal and
billing.

Why? Because legal will have somebody look at a contract, go over it, send it
back, and then have somebody else look at it, back and forth and back and
forth, take vacations, sometimes just fucking lose the contracts, and then if
anybody anywhere made a revision, the process resets. We've had some SLAs and
MLSAs held up nearly years because of this. And you can't get them fired, and
nobody cares, because of the magical fucking pixie dust of "We're saving
people's lives here".

Billing and money, that's the real magic. Why? Because you've got to figure
out which buckets of money you're going to get paid from. Is it going to be a
grant? Is it going to be funding for some initiative? Is it going to be
operations? Will maintenance fall under normal service budget, or will it be
some setaside from a budget normally earmarked for new construction? Did legal
fuck you and make you miss a quarter's budget freeze?

And that's just the _clients_ trying to buddyfuck you. Like, actually worse
than gamers as customers.

~~~
Omniusaspirer
Absolutely nailed it, and a great piece of insight. The bureaucracy and
technical incompetence in hospitals is just agonizing to the point where I'm
not sure you can even fix them.

I'm increasingly convinced that healthcare needs a SpaceX style makeover.
Someone with a few billion dollars that can fund the top to bottom
construction of a new state of the art facility and fund the software and
medical equipment development to get things running how they ought to.

------
michaelochurch
If hospitals were run like Silicon Valley startups... I would quit my job and
become a plaintiff's attorney, and I would get rich as fuck suing these
motherfuckers.

Thread over.

~~~
angersock
Yeah, 'cause that's going to solve things. Also, congrats on probably your
shortest post in recent memory. :)

~~~
michaelochurch
If hospitals were run like SV startups, "solving things" would be pretty much
impossible because our society would be on fire.

