
I'm a doctor - help me disrupt healthcare - akrasia
Hey guys,<p>I&#x27;m a longtime reader of hacker news. I&#x27;m looking for a technical cofounder. I know this sounds bad but hear me out. I think a little bit about my background would be helpful. I graduated from UCSD in 2005 with my degree in computer science. I worked for a couple of years, mainly with PHP, before I applied to medical school. Currently I am a first-year resident at UCSF Fresno. After the year is over I will be heading to USC to start my radiology residency. I still try to code every once in a while and I know some Ruby on Rails, HTML&#x2F;CSS, and JavaScript.<p>With all the time I&#x27;ve spent in the health care system, I seen a lot of opportunities to start a company that would solve some of the problems I&#x27;ve seen in the hospital.<p>Many of the problems in healthcare involve two systems that need data from each other. For example there is a machine that measures pulmonary function and will generate a PDF report. This PDF report has values that need to be entered into an EMR&#x2F;EHR. This is time-consuming for some of the doctors and doctors should not be wasting their time with data entry. There is a stack of these reports and 10 minutes are spent entering in data and another one minute is spent interpreting the data.<p>I&#x27;m fairly certain I can write a program to do this and make an extra $500 per month from the hospital but starting a company around this idea seems to be a better option. With that being said, I&#x27;d rather have an engineer handle the coding and I would handle talking to hospitals and making sales. Many hospitals in the area need this sort of work done and I know we could generate income in this sector.<p>I&#x27;m looking specifically for somebody in California who can spend 2-3 hours per day coding on these projects. This person would probably be working on their own projects in their spare time. If this sounds like you please drop me an email at mtran115@gmail.com and we can talk some more.
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smalter
My unsolicited advice: rather than being "fairly certain" that you can make
$500/mo with your idea so that you would prefer to start a company first, I
suggest that you reverse the order of operations.

First, be certain that you can make $500/mo by building it yourself and get
the hospital paying $500/mo.

Then, if the opportunity looks good, start organizing (aka building an
organization, a company) around that.

You'll short circuit a lot of pain that way.

~~~
md2be
The guy is a first year resident and should be working 70 hrs a week
perfecting his skills. If he is cheating the system now by not being fully
committed, I can only imagine what he will be doing 7 years from now.

~~~
wbercx
Isn't technology meant to make our lives easier? If this can increase the
productivity of doctors, I reckon it's a good thing. That way they can spend
those full 70 hours a week perfecting their skills, instead of wasting 20
hours to enter and retrieve data every week.

~~~
DanBC
Why don't doctors have clerical staff to do the data entry?

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akrasia
depends on where you work and how much staff is hired for this type of work,
but with the way the EMR is set up, and who legally has to start and sign
notes (a doctor), you cannot avoid some data entry unless it is somehow
automated for you

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zekenie
I've done some work in clinical research and I can tell you that you might
need a legal cofounder more than a technical one! I had ways to automate
dozens of employees jobs away just by integrating data systems, but in the
eyes of the hospital it was too risky. They didn't want to violate HIPPA. I
wrote a little thing about it for The Scientist: [http://www.the-
scientist.com/?articles.view/articleNo/35249/...](http://www.the-
scientist.com/?articles.view/articleNo/35249/title/Researchers--Hire-Hackers/)

I'd love to talk to you more about this because these are problems I'd love to
see solved. I think its a real up hill battle though.

~~~
japhyr
It seems liability would be another reason to have a firm legal foundation.
You wouldn't want to miss an edge case that results in a patient's death. If
an investigation showed that your translation software made a mistake that led
a doctor to make a bad decision, you'd be in a pretty ugly spot.

This is part legal, and part QA, I believe.

~~~
akrasia
Yea, this is why I didn't want to start a company in healthcare. It's ugly.

I think I can avoid the whole thing by having my software just be a tool, not
a final read, and doctors will still have to double check the numbers against
the PDF hardcopy. It will just take 1 minute or less to glance at 10 values or
so and make sure they match up compared to typing it in themselves

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tpainton
As a physician of 15 years in internal medicine all I have to say is residency
must have become ridiculously easy if you have time to start a company.. For
me, 100 hours a week made that impossible so I waited until I was done. Your
idea is an old one. It's been deliberated and contemplated. You forget that
you're writing code that is essentially a medical tool that potentially
affects peoples lives. You will need massive insurance, and lots of
regulations to contend with. You will take on all liability with regard to
patient outcomes. In the end, it will cost you 10x more than 500 a week. I
don't even consider healthcare with my coding projects.

~~~
arbuge
I would think automating it would vastly reduce the likelihood of error vs.
manual entry.

~~~
jtheory
It's a different type of error that's possible, though.

Manual entry errors happen at predictable rates, and with good processes you
can get them down quite low.

Software error rates are not so predictable (unless you have full control over
all variables... and that's surprisingly hard to get). You could deploy this
software in the context of a slightly different version of the radiology
software which used a different font in PDFs (or whatever) and find that all
8's are now read as 3's; no human would do that.

If a human started getting input that wasn't sufficiently readable, they'd
talk to someone about it. Could the software do that?

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Xanza
Two pieces of advice from a very drunk technologist.

One, never approach a community that lives and breathes startups using words
such as "fairly certain," and "try." They have no power here.

Two, start the company, make a respectable business plan, and then whore
yourself out. No one is going to be interested in a joint venture with a few
paragraphs of information to go on.

You don't have to be perfect, nor do you even need a full roadmap of ideas or
plans, but people need to see that you're willing to put effort into it. No
one makes a successful startup, especially in the medical field without
considerable research and effort. If people don't see that you're willing to
put in the time, they'll never get behind you.

~~~
untilHellbanned
can't agree more

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miguelrochefort
That's not something I would call "disruptive". That's an improvement over
what currently exists, but it's trivial and doesn't disrupt anything in any
way.

~~~
kachnuv_ocasek
I was thinking the same – is 'fix/improve' a new meaning of 'disrupt'?

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jonaldomo
I would be willing to bet the hospital you work at is paying several million a
year for their EMR and all sorts of smaller contracts that probably nobody
knows about. One of those contracts probably supports the integration you are
looking to do and has not been configured yet because it has not went high up
enough the food chain. I think you are better off asking contacting the IT
department of the hospital and have them log a ticket to the EMR provider
(probably Cerner or Epic) and have them look at it before getting too
invested.

~~~
cimorene12
I second just telling the IT department about it so they can tell the vendor.
I work for an EMR company and I'm pretty sure UCSF is one of our
organizations. I don't know if the hospital will pay you extra for an
interface solution that the EMR company is supposed to take care of. I'd check
with your hospital first.

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thetylerhayes
Founder of a SF-based healthcare-related startup here. Emailed you. I'm not
looking for a job but happy to help how I can.

EDIT: To anyone in the Bay Area (or really anywhere) also thinking about
joining this industry, feel free to reach out to me too. My cofounders and I
have learned way more than we want to know over the past few months about the
healthcare industry + the startup side of things and are happy to pass on our
knowledge.

~~~
fatoki09
Hi, what's your email? I'm a recent college grad who deferred my med school
for admission for a year to learn Rails. Both of my parents are physicians and
I've been working in a clinical setting since the age of 15. I'm seeing many
opportunities to build tools that help improve physician workflow and I would
love to reach out to you for advice. Please let me know if you're available
for a short chat. My email is fatoki09(at)yahoo(dot)com.

~~~
thetylerhayes
My email's in my profile. Just shot you an email.

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thejteam
Is the time spent entering in data considered billable? If yes, then I doubt
the hospital will be interested. If no, then you may be onto something.I was
in a presentation not long ago at my former employer and we were being pitched
a pretty cool piece of software that would probably have saved me a couple of
weeks of tedious interface building. I pointed out to the VP how much time I
would save. He said that we bill by the hour. I don't work there anymore.

~~~
Agathos
Hospitals don't bill per hour; they bill per procedure. Data entry isn't a
medical procedure.

~~~
jtfairbank
However doctor's compensation is measured in a variety of ways depending on
the hospital. Some doctors might get paid hourly or by a fuzzier metric of how
much time a procedure takes, so they may not want to use this type of system.
Similarly, hospitals might be able to bump up the procedure if it takes more
time (ie is more involved). For example, a doctor who has to review charts and
do some data entry might be able to raise a standard level II checkup to a
level III one because they had to do more work. (checkup names are made up,
but you get the idea)

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bigchewy
Hi, I'm a 3 time healthcare entrepreneur (10 years) who has been down this
path, and many like it, several times already. The problem you are describing
is well known and in your hospital's IT queue, just so low on the list to be
invisible.

As others have rightly pointed out, the technical issues are perhaps 10% of
the problem. On top of that, because each EHR is configured so differently,
your solution will be a consulting effort not a product (read: expensive)

My suggestion - thoroughly evaluate how difficult this would be to get
approval for at your hospital. If you get past this stage, talk to other
hospitals. Learn what the implementation process will be at each hospital.
This will likely dissuade you but, if not, you've found a niche.

The reality is that this is not an IT problem but a process flow problem.
Somebody with a lower pay grade should be entering this data, say an MA or a
1st year resident, until the IT team can prioritize this known issue.

~~~
thetylerhayes
Agreed.

What this means is that usually in the medical world you can't just build a
product or service and sell it to EHR/EMR providers. Their (e.g., Epic,
eClinicalWeb) customer is hospitals and clinics. So you need to get hospitals
and clinics to demand/buy what you offer. Only then EMRs will pay attention
and only because increasing amounts of their customers are knocking down their
door asking for your product.

Very rare is the case where an EMR will see the market opportunity you're
carving out and buy your product. They don't care. They'll either buy your
company once you get big enough to represent a sizable addition to their
revenue (single millions is not even close) or just build an imitation feature
once they're forced to.

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lostlogin
Just to add to what you are saying, it isn't just docs wasting time with
systems that don't play nicely. Radiology is a hotbed of IT chaos with dozens
(zero exaggeration) of systems that just do not work properly. Cardiac CT
reports, MRI Spectro, CT dose reports, RIS systems and the PACS (there are
about 20 data points on this one alone) etc. Basically anything that has any
post processing done is also displayed horribly by viewing systems. Comparing
what I see when making reformatted images to what some poor doc gets when I
send him the reformats is very depressing. We have a radiologist who codes -
he is mostly mortal unfortunately and has a finite amount of time is his day.
Despite this he has made some amazing improvements in crap radiology workflow
practices.

~~~
ryanteo
Hi, Would you be okie with sharing some specific problems and painpoints over
email (but leaving out confidential details)? ryan.teo@gmail.com

    
    
      We have a group of friends who are familiar with healthcare and have programming backgrounds.
    

Ryan

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tpainton
Forget coding for health care. MD and coder for 15 years. You will make 10x
the profit if you avoid the regulations and liability of health care
software.. In addition, I'm not sure you have any idea how little few time
you're about to have.

~~~
akrasia
I've struggled with this for awhile. I've had some thoughts about improving
medical education that would avoid the legal hassles of healthcare and
generate a good income. That idea is for another time though.

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healthenclave
Sorry to piggy back on your post. But Indian Medical Doc here pursuing
Orthopedic Surgery Residency who also codes in Python, Django, Frontend and
Excellent in UI/UX is also looking for some help !! If there is anyone in the
audience who is a full stack python guy located in India or USA and can help
me disrupt Health care Kindly get in touch.

Have lived and worked in some of the finest hospitals in US (viz: Ny
Presbyterian and KCH brooklyn) and also in rural India this has given me a
very good understanding of health problems that can be fixed with technology.
Have already done some good amount of work and things are already in place.
Need someone who can complement me with the right skills.

HealthEnclave.com

Am looking for some one good with-

\- Django / Python / Flask \- Tastypie / Django Rest framework \- Fronend
Desing (HTML5, CSS3, Jquery, Bootstrap, Less) \- MongoDb / PosgreSQL

additional skills: (not necessary but it would be great if you have 'em)

\- Objective C (iOs dev) And JAVA for (Android) \- Some understanding of ML ,
Data analytics \- Electronics prototyping with Arduino

I am familiar with and have some amount of practical working knowledge of all
the above listed technologies.

Thanks Asingh [at] HealthEnclave [dot] com

~~~
md2be
Your a first year resident. How about finishing your training? This sickens
me.

~~~
healthenclave
You should not be making assumptions about people you don't know.

With that said I am not trying to make a quick buck here.There are real life
pain points that I am trying to solve. The longer it takes for me to create my
vision the longer people will have to live with pain, suffering, anxiety
(because of lack of proper information to make choices upon).

If a good surgeon who took Fees for his services die tomorrow then it would
not matter because his patients who just go to another surgeon. But if this
doc creates something that solves a real life issue that no one is able to
solve or maybe he creates the best one.. Only then would IMO would it even
matter that this person even existed

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leonth
> Many of the problems in healthcare involve two systems that need data from
> each other.

This. From my limited experience, even with all the systems able to talk HL7,
apparently what message segments the system sends, the message segments the
system reads etc. are different from system to system. The result is entire
subsystems or heavy customizations for redirection, massaging, and
transformation of messages. Something to think about systems integration.

Another approach is to buy subsystems from as few vendors as possible
(naturally subsystems from one vendor would all talk among themselves very
nicely) - but that is obviously not without any repercussions.

I'm a pharmacist based in Singapore working in IT side of things for the
pharmacy department in a public hospital here (means: pharmacy system, EMR,
inpatient automated system, decision support). Still learning but would be
happy to keep in touch.

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indymike
I started my career making medical devices talk with PCs back in the 80s.
Sounds like not much has really changed. Usually these machines have a serial
protocol or in newer machines, a webserver and API that can be used to get
data in a better format. You are lucky when you get good documentation.
Sometimes, the vendor sells PC software as an add on and doesn't want
competition.

This problem is probably a goldmine if a decent middleware could be written
that grabs data from the device, transforms it to a standard format, and then
loads it to EHR/EMR/HCM whatever software the hospital is using.

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venomsnake
Here is one question. How will you do with all the tape? This creates a
potential lawsuit point in case of failure (or even in case of blamestorming,
when the software worked correctly but a scapegoat is needed). So you will
need some form of insurance or regulatory approval.

I can create a very few extremely simple solutions in my mind that will be
quite precise. You don't even need much coding. In the worst case OCR can do
with simple extraction script if the PDF is too unruly. And are a weekend job.
But selling it to someone will be a pain.

~~~
lostlogin
Get out the US. Other places have less crap in the way and have better
performing services (ie their lack of regulation in the IT area is actually
capable of producing better results). Are the regulations just protecting
incumbents? Or am I overly cynical?

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shipesmash
Any software that handles/transfers this sort of data is going to be (to the
FDA) a Class II Medical Device. It seems like there would be a overwhelming
amount of work for a one or even two of you :/

[http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRS...](http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=870&showFR=1&subpartNode=21:8.0.1.1.21.3)

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ihnorton
The MDPnP group has done a lot of work on interoperability and securing
interactions. I don't know how much device-specific information they make
available, but some of the testing procedures could be helpful for validation:

[http://www.mdpnp.org/](http://www.mdpnp.org/)

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perlpimp
What I understand that Disruptive process means that you are to offer inferior
product for a price that matches the quality. You work hard and grow your
customer base and after a while you can go after higher quality and more
lucrative layers of the product market.

What you describe is an incremental improvement.

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yeukhon
As a responsible hospital, I will have to ensure your software will work 99%
of the time and that if anything goes wrong you'd be paying the loss. That's a
dangerous field to get into.

~~~
rwallace
That's one of the reasons why it matters so much that the guy is actually a
doctor. Not only does he have technical expertise in the target domain, he
already knows what's going on with safety regulations, liability insurance and
suchlike.

~~~
md2be
He is a first year resident with 3 months experience. Trust me, he doesn't
know jack.

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santa_boy
I'm from India but can understand where you are coming from. Think it a useful
idea that can work. Let me know if you want to explore.

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anoncow
As a fellow doc, i say welcome! Have you looked at DICOM? Most medical s/w,
h/w support it. And congrats on the radio residency!

~~~
akrasia
Yea DICOM is for imaging though (CT scan, MRI, etc ...) but I think you know
that already. Even though DICOM is a standard, there are still stupid things
that go on (e.g. radiologists have to hand type radiation doses that the
patient received because apps do not talk to each other).

HL-7 is the standard for other medical apps. Even though these standards
exist, the problems are still there and solutions are sometimes too pricey for
hospitals.

Thanks for the encouraging words ... it's been a long road.

~~~
lostlogin
Some systems automate the sending of dose data, but send it as an image with
the data hard burnt into it. Amazingly crap. I highly doubt that radiologists
are recording dose as they very rarely do any examinations that give dose. It
would usually be radiographers/Medical radiation technologists/Technicians etc
(pick your naming convention!). DICOM is capable of handling data other than
images, I believe some neurology systems produce data into the format. It has
a ton of fields that _seem_ to be able to be filled with user defined data and
yet not break the DICOM spec. There are many things about hospital IT that are
way more crap than hand recording of radiation doses.

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ryanteo
Hi,

    
    
      We're based in Singapore and previously built www.MedF1.com, a B2B platform for medical supplies ordering for private clinics. We did a health report generator from some Quest Diagnostic lab results previously for clinic chain in Singapore. Dropped you an email - ryan.teo@gmail.com.
    
      Interested in work with healthcare disruptors, we can design the software (mobile, web) and hardware (Ardiuno, Linux).
    

Best, Ryan

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md2be
This doesn't make sense. He says he is a first year resident and is starting a
new program next year?

~~~
mv
This question clearly reveals your lack of understanding of the US medical
education system.

I hate responding to trolls, but your comments through the thread have been a
bit abrasive to me. Accusing someone of 'cheating the system', saying someone
has to work 70 hrs a week, only having one shot, saying they should quit,
telling them they must work 13hours a day to learn.

I'm assuming you're in (or rather I hope you are) medical school and not just
someone applying. Here is the rub. Some people don't have to try to do well.
There are people who never studied for the MCAT and scored 36+. They didn't
have to really try to do well.

A radiology at the place he mentioned is _very_ competitive, so it is safe to
assume this guy was at the top of his class. The intelligence/knowledge
difference between the top of the class and the bottom is enormous. Not
everyone is the same. Don't fault him for what he wants to do in his free
time.

~~~
thetylerhayes
Thank you for writing this. I hadn't taken the time to look at the usernames
among all the negativity in this thread and realize much of it was from the
same person.

Side note when looking at your profile: looks like both hnofficehours.com and
hackernewsers.com are down/no more? Dead links.

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rdl
Is there some reason the pulmonary machine doesn't do HL7 or equivalent? Is it
just not configured?

~~~
ryanteo
It might be because the machine is old. Hopefully, it does have the option to
generate a CSV/ XML file. From the description, it does seem to have some kind
of computer connected to it and a printer.

Otherwise, you might have to parse the data from the serial port.

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zaay
I would be interested in this, but I am from Europe. I know my way around PHP
and RoR.

