Hacker News new | past | comments | ask | show | jobs | submit login
Launch HN: Liyfe Clinic (YC S20) – Telemedicine for breast cancer
70 points by littlesnail 39 days ago | hide | past | favorite | 27 comments
Hi everyone,

I’m Lily Tang from Liyfe (pronounced Life) Clinic (https://liyfeclinic.com), which launched just one week ago. We bring clinical knowledge and support to breast cancer patients without them stepping into clinics.

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.

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.

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 24/7 access to personalized cancer consultation and support. This is how Liyfe Clinic began.

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.

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.

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.

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.

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.

If any of these situations resonates your or your family and friends’ experience, we’d love to hear your thoughts.




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!


Sherry here. You made a good point. I wrote the first line of code exactly 2 years ago, at that time, we couldn't even find the infrastructure that is hipaa compliant (like messaging api etc), and we have to build everything on our own. We observed the rise of digital health in the last two years, which used to be a niche space. In fact, GoodRx is about to launch a telemedicine marketplace, to address the "hard to choose" issue you mentioned.

Healthcare is complicated, I think you would agree with me. It is a highly regulated industry, complicated ecosystem: physician, payers, patients, hospitals etc. To disrupt this industry, one company is not enough, so I actually think popularity of digital health startups is a good thing in general to really push the consumer adoption and the regulation to catch up.

In the cancer space, the quality of the services are super important - save lives. One good example is Memorial Sloan Kettering (MSK) - where Lily used to work at. MSK treats cancer only and does it super well. Patients from all over the world will come to treat there. We are the first mover and we want to be the "MSK" in digital space.

We are partnering with other parties in the ecosystem, if you are interested, here are more details: https://www.forbes.com/sites/berenicemagistretti/2020/08/05/...

We think our direct to consumer channel really helped the patients, as we already served many patients who would not be able to access the care easily. For example, they are in rural areas, or they live in places that do not have good cancer centers, or they are too busy to go to the hospitals, etc. We see the huge needs there. That is also the original drive why we started this company.

Regarding the product, we are still iterating the product for sure. Cancer is different from flu. It usually involves survey, chemo, radiation and others. It is quite complicated and the treatment could last 6 months to 1 year. Patients have questions all the time during the long period, that is why we think our chat solution could really add value. Thanks for suggestions on payers side collaboration.


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


If you are interesting, here is the GoodRx article I mentioned above: https://www.forbes.com/sites/leahrosenbaum/2020/03/26/the-co... 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.


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.


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


It's a billion dollar industry and growing. It seems okay to focus on breast cancer alone and later expand if they ever plan to.


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.


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.


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


> 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.


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


>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!


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?


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.


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?


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.


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?


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.


happy to connect, my linkedin https://www.linkedin.com/in/sherry-chen-6662a031/ , go from there?


Which AWS option did you have to use? Self managed or their propriety HIPAA offerings? Did they have to provide a Business Associate's Agreement?

Sorry for all the questions, this HIPAA compliance is confusing and using turnkey solutions seems to be expensive.


We managed it ourselves. My opinion is, if you have a clear infrastructure defined, like migrate from on-premises to the cloud, it makes sense to use their predefined infrastructure (not sure if there is a price difference). If you are still in the ideation stage, not clear what to build yet, just follow the best practices when you create new components (https://github.com/aws-quickstart/quickstart-compliance-hipa...), you can sign a BAA from aws artifact for your account.


Appreciate the response.


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


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


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


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.




Applications are open for YC Winter 2021

Guidelines | FAQ | Support | API | Security | Lists | Bookmarklet | Legal | Apply to YC | Contact

Search: