5 ms·

Plaid but for Healthcare

26 points by Mehulagarwal7 4y ago

nikisweeting 4y ago
This is a really difficult space because EHR/EMR companies are not incentivized to allow data-sharing. The moment they unlock those doors they lose the vendor lock-in that allows terrible solutions like Athena/Cerner/EPIC to retain their customers. They way they technically comply with FHIR data-sharing laws without actually allowing data sharing is by requiring a $100k API-key to unlock sharing, but they only issue it per-hospital or per-clinic. As an integrator you need to contact each individual care center that you want to integrate with, a process often taking up to a year per instance. There is no central "get all data from any EPIC instance in the US for a given patient" solution. Even after that point they often have separate APIs and technologies for read/write, and even different tech for different data fields within the same records, making efficient, seamless integration nearly impossible (intentionally). If all that wasn't enough, often these systems are very eventually consistent, meaning that to build a sync middleware between EHRs you end up with flip/flop race conditions where the lag between a write and the next read showing the update causes out-of-date data to be synced back on top of the original correct data. Because it's such a hard problem but so badly needed, there are plenty of existing companies specifically popping up in the FHIR/HL7 EHR integration/data-sharing space to try and solve this. I spent two years building one myself for a client, but it's not public, so these are my two public favorites: - https://www.redoxengine.com/ https://www.redoxengine.com/ - https://www.healthgorilla.com/ https://www.healthgorilla.com/ But there is a long tail of others, each with nuanced shortcomings and benefits: - https://www.interfaceware.com/iguana-integration-engine https://www.interfaceware.com/iguana-integration-engine or https://www.interfaceware.com/iguana.html https://www.interfaceware.com/iguana.html - https://www.humanapi.co/ https://www.humanapi.co/ - https://kno2.com/ https://kno2.com/ - https://www.healthcompiler.com/LP-API https://www.healthcompiler.com/LP-API - https://www.lyniate.com/ https://www.lyniate.com/ - https://www.clinicalpipe.com https://www.clinicalpipe.com - https://tigerconnect.com/ https://tigerconnect.com/ - https://www.qvera.com/hl7-interface-engine/ https://www.qvera.com/hl7-interface-engine/ - https://cliniconex.com/healthcare-collaboration/ https://cliniconex.com/healthcare-collaboration/ - https://clareto.com/ https://clareto.com/ IBM, Azure, and Google Cloud also offer FHIR cloud integration services. - https://cloud.google.com/healthcare/docs https://cloud.google.com/healthcare/docs - https://azure.microsoft.com/en-us/services/azure-api-for-fhir/ https://azure.microsoft.com/en-us/services/azure-api-for-fhi... - https://www.ibm.com/us-en/marketplace/merge-hl7-toolkit https://www.ibm.com/us-en/marketplace/merge-hl7-toolkit And even more if you're interested: - https://www.mdisolutions.com/solutions/hl7-integration-and-interface-engine/ https://www.mdisolutions.com/solutions/hl7-integration-and-i... - https://www.mylinks.com/ https://www.mylinks.com/ (Record aggregator for patients) - https://www.healthwizz.com https://www.healthwizz.com (Record aggregator for patients) - https://careevolution.com/MyFhr/ https://careevolution.com/MyFhr/ (Record aggregator for patients) - https://www.nextgen.com/products-and-services/electronic-data-interchange-edi https://www.nextgen.com/products-and-services/electronic-dat... - https://www.mulesoft.com/integration-solutions/soa/healthcare https://www.mulesoft.com/integration-solutions/soa/healthcar... (API switchboard / triggers platform like IFTT for healthcare) - https://paxerahealth.com/products/pacs-broker/ https://paxerahealth.com/products/pacs-broker/ The best place to learn more about all this is the main FHIR standards Zulip chat I think: https://fhir.zulipchat.com/ https://fhir.zulipchat.com/
- lofatdairy 4y ago
  Thanks so much for your comment. As someone also working on problems in healthcare IT (and with many complaints about existing solutions), it's at least reassuring to know that other people also find it as asinine as I do. There's also a ton of solutions I haven't seen before so it's a really great reference. On another note for people starting healthcare SaaS targeting clinics and hospitals, the situation also becomes a somewhat awkward juggling act between oneself, the clinic, and the EHR provider, since any API access offered by the EHR is meant to be given to the clinic (which often is ill-equipped to actually make use of this). Coordinating some handoff is thus non-trivial since you'll likely end up talking to people who don't know what API access is and need to get bounced around for a bit. You're also basically operating in a black box without much information about the EHR system itself, and developers with experience on multiple EHRs are a bit uncommon.
Mehulagarwal7 4y ago
We're building Health Compiler, devtools and API's that fast-track digital health companies in launching their patient experience apps in days - [https://www.healthcompiler.com/LP-API https://www.healthcompiler.com/LP-API] It takes roughly 1-3 months to build an integration (depending on EHR/PMS/Wearables) and high $$ upfront. With our single unified API & simple black of code digital health companies can easily access the data they need. We are looking for some early feedback from digital health hackers. If you are interested in testing our APIs, please fill out our form and we'll get in touch with you. Happy to answer any questions, Thx!
- Justin_K 4y ago
  How do you differ from Redox?
  - Mehulagarwal7 4y ago
    Redox is s PS play in a lot of sense - https://www.redoxengine.com/product/cost-of-integration/ https://www.redoxengine.com/product/cost-of-integration/ We are more consume the API and start getting the data Their minimum pricing is $45K upfront which doesn't make sense for a digital health innovator
bernf 4y ago
Plaid would be one of the worst companies to compare yourself to for privacy compliance.
- dheera 4y ago
  Yep, I refuse to use Plaid. It should be downright illegal for a third party to ask for a bank password.
  - willio58 4y ago
    We can blame plaid all day but the banks are the ones that created a need for a third party in the first place. How banks didn’t come together and create a more secure and planned version of plaid themselves shows the technical incompetency of the leaders of those banks.
    - dheera 4y ago
      I'm perfectly happy with the existing system of verifying deposits, I don't consider disclosing passwords to be an acceptable solution to a problem that doesn't exist.
      - willio58 4y ago
        The issue with that is waiting 2-3 days for the initial funds transfer to go through, maybe more if it’s a banking holiday. We live in a world where you can get 2 day delivery of most goods. The fact that it takes 2-3 days to even initiate a bank transfer using the old method is just silly
        dheera 4y ago
        They could make bank transfers instant, instead of resorting to sharing passwords. Sharing passwords is a universally bad practice and has been for decades.
        4y ago
tiffanyh 4y ago
There’s already some pretty big players in the “open banking but for healthcare” space. Like https://www.healthgorilla.com/ https://www.healthgorilla.com/ I wish this new company luck. Healthcare is unbelievably difficult market to enter.
- deleted 4y ago
  [deleted]
failTide 4y ago
Isn't plaid the company that puts up a phishing-esque 'real looking' bank login page, then captures the login info and then makes that banking data available to whichever third party had set the thing up? Not sure if they're still doing that. Definitely don't ever want that to happen with my medical records.
- ThunderSizzle 4y ago
  It's a fantastic self-hosted concept (e.g. a password vault that sync the data the password unlocks). It's a nightmare for security as a service concept
  - failTide 4y ago
    That's an interesting idea - although there would need to be a way to prove the data wasn't tampered with, since a lot of companies are using plaid to make decisions on loans and things. What the banking industry should do is just come up with a standard format for sharing financial data, with keys to prove the data was real, and let the consumer export those files and share with anyone they want. No need for multi million dollar federated systems.
- mal-2 4y ago
  It is unforgivable that they implemented it as an iframe. Who needs EV SSL verification? never heard of it. You can't even see if there's an HTTPS lock indicator! It was bad enough that it asks for bank login credentials, but doing so with no server validation at all is a terrible flow to be teaching users to accept.
  - iancarroll 4y ago
    You can’t implement what you suggest in a browser. The only trusted identity that browsers have is the parent page in the URL bar — which Plaid doesn’t remove. If Plaid tried to create some kind of secondary URL bar, phishing pages could just recreate it. aka the “line of death”: https://textslashplain.com/2017/01/14/the-line-of-death/ https://textslashplain.com/2017/01/14/the-line-of-death/
newaccount2021 4y ago
chevman 4y ago
Dev/engineering timeline is never the long pole in getting new healthcare products to market.
deleted 4y ago
[deleted]
timnetworks 4y ago
The <title> tag still says demo on the page, not sure if this is intentional.
ryanSrich 4y ago
Healthcare integration from a technology perspective is a solved problem. The real problem is that health systems have zero incentive to work with your shit. Oh…someone in rev cycle management wants to use your new SaaS to do a thing with PHI? And they need FHIR? How about HL7 V1 and an IT department that won’t take your call and a VPN connection procurement that takes 7 months to work? Oh also, your tiny little SaaS company also needs to spend $100k on getting a HITRUST certification. Sound good? “It’s cool that your using health connector XYZ but we’re not working with them, k thx bye”
jollofricepeas 4y ago
Hmm. 1. Nice idea but the TVM is tiny because its healthcare adjacent and built upon the straw foundation of healthcare startups and their backers. This functionality isn’t needed for most and is impossible to build where it’s needed — specialty medicine. 2. The true opportunity in the healthcare tech space is capturing a piece of the actual transaction either upstream like CoverMyMeds (marketing dollars) or downstream like RelayHealth, Change (Rx dispensing) which is what Plaid is actually doing. Nowadays this means capturing a piece of the specialty market which is extremely difficult due to the complexity of specialty medications. 3. New people to US healthcare don’t understand that outside of price transparency, the biggest fundamental issues in healthcare are actually time to therapy and patients remaining on therapy which is impacted by things like authorizations, lack of therapeutic support, and of course price again. What does this mean? I as a patient have my data per HIPAA. It is easily transportable by myself or my providers however there isn’t a whole lot I can do with it for the reasons I mentioned above. This isn’t the same problem as Plaid where theres a huge market because there’s a ton of choice and utility for the end user and also for startups looking to simply process a financial transaction.

26 points by Mehulagarwal7 4y ago

This is a really difficult space because EHR/EMR companies are not incentivized to allow data-sharing. The moment they unlock those doors they lose the vendor lock-in that allows terrible solutions like Athena/Cerner/EPIC to retain their customers. They way they technically comply with FHIR data-sharing laws without actually allowing data sharing is by requiring a $100k API-key to unlock sharing, but they only issue it per-hospital or per-clinic. As an integrator you need to contact each individual care center that you want to integrate with, a process often taking up to a year per instance. There is no central "get all data from any EPIC instance in the US for a given patient" solution. Even after that point they often have separate APIs and technologies for read/write, and even different tech for different data fields within the same records, making efficient, seamless integration nearly impossible (intentionally). If all that wasn't enough, often these systems are very eventually consistent, meaning that to build a sync middleware between EHRs you end up with flip/flop race conditions where the lag between a write and the next read showing the update causes out-of-date data to be synced back on top of the original correct data. Because it's such a hard problem but so badly needed, there are plenty of existing companies specifically popping up in the FHIR/HL7 EHR integration/data-sharing space to try and solve this. I spent two years building one myself for a client, but it's not public, so these are my two public favorites: - https://www.redoxengine.com/ https://www.redoxengine.com/ - https://www.healthgorilla.com/ https://www.healthgorilla.com/ But there is a long tail of others, each with nuanced shortcomings and benefits: - https://www.interfaceware.com/iguana-integration-engine https://www.interfaceware.com/iguana-integration-engine or https://www.interfaceware.com/iguana.html https://www.interfaceware.com/iguana.html - https://www.humanapi.co/ https://www.humanapi.co/ - https://kno2.com/ https://kno2.com/ - https://www.healthcompiler.com/LP-API https://www.healthcompiler.com/LP-API - https://www.lyniate.com/ https://www.lyniate.com/ - https://www.clinicalpipe.com https://www.clinicalpipe.com - https://tigerconnect.com/ https://tigerconnect.com/ - https://www.qvera.com/hl7-interface-engine/ https://www.qvera.com/hl7-interface-engine/ - https://cliniconex.com/healthcare-collaboration/ https://cliniconex.com/healthcare-collaboration/ - https://clareto.com/ https://clareto.com/ IBM, Azure, and Google Cloud also offer FHIR cloud integration services. - https://cloud.google.com/healthcare/docs https://cloud.google.com/healthcare/docs - https://azure.microsoft.com/en-us/services/azure-api-for-fhir/ https://azure.microsoft.com/en-us/services/azure-api-for-fhi... - https://www.ibm.com/us-en/marketplace/merge-hl7-toolkit https://www.ibm.com/us-en/marketplace/merge-hl7-toolkit And even more if you're interested: - https://www.mdisolutions.com/solutions/hl7-integration-and-interface-engine/ https://www.mdisolutions.com/solutions/hl7-integration-and-i... - https://www.mylinks.com/ https://www.mylinks.com/ (Record aggregator for patients) - https://www.healthwizz.com https://www.healthwizz.com (Record aggregator for patients) - https://careevolution.com/MyFhr/ https://careevolution.com/MyFhr/ (Record aggregator for patients) - https://www.nextgen.com/products-and-services/electronic-data-interchange-edi https://www.nextgen.com/products-and-services/electronic-dat... - https://www.mulesoft.com/integration-solutions/soa/healthcare https://www.mulesoft.com/integration-solutions/soa/healthcar... (API switchboard / triggers platform like IFTT for healthcare) - https://paxerahealth.com/products/pacs-broker/ https://paxerahealth.com/products/pacs-broker/ The best place to learn more about all this is the main FHIR standards Zulip chat I think: https://fhir.zulipchat.com/ https://fhir.zulipchat.com/

lofatdairy 4y ago
Thanks so much for your comment. As someone also working on problems in healthcare IT (and with many complaints about existing solutions), it's at least reassuring to know that other people also find it as asinine as I do. There's also a ton of solutions I haven't seen before so it's a really great reference. On another note for people starting healthcare SaaS targeting clinics and hospitals, the situation also becomes a somewhat awkward juggling act between oneself, the clinic, and the EHR provider, since any API access offered by the EHR is meant to be given to the clinic (which often is ill-equipped to actually make use of this). Coordinating some handoff is thus non-trivial since you'll likely end up talking to people who don't know what API access is and need to get bounced around for a bit. You're also basically operating in a black box without much information about the EHR system itself, and developers with experience on multiple EHRs are a bit uncommon.

Mehulagarwal7 4y ago

We're building Health Compiler, devtools and API's that fast-track digital health companies in launching their patient experience apps in days - [https://www.healthcompiler.com/LP-API https://www.healthcompiler.com/LP-API] It takes roughly 1-3 months to build an integration (depending on EHR/PMS/Wearables) and high $$ upfront. With our single unified API & simple black of code digital health companies can easily access the data they need. We are looking for some early feedback from digital health hackers. If you are interested in testing our APIs, please fill out our form and we'll get in touch with you. Happy to answer any questions, Thx!

Justin_K 4y ago
How do you differ from Redox?
- Mehulagarwal7 4y ago
  Redox is s PS play in a lot of sense - https://www.redoxengine.com/product/cost-of-integration/ https://www.redoxengine.com/product/cost-of-integration/ We are more consume the API and start getting the data Their minimum pricing is $45K upfront which doesn't make sense for a digital health innovator

bernf 4y ago

Plaid would be one of the worst companies to compare yourself to for privacy compliance.

dheera 4y ago
Yep, I refuse to use Plaid. It should be downright illegal for a third party to ask for a bank password.
- willio58 4y ago
  We can blame plaid all day but the banks are the ones that created a need for a third party in the first place. How banks didn’t come together and create a more secure and planned version of plaid themselves shows the technical incompetency of the leaders of those banks.
  - dheera 4y ago
    I'm perfectly happy with the existing system of verifying deposits, I don't consider disclosing passwords to be an acceptable solution to a problem that doesn't exist.
    - willio58 4y ago
      The issue with that is waiting 2-3 days for the initial funds transfer to go through, maybe more if it’s a banking holiday. We live in a world where you can get 2 day delivery of most goods. The fact that it takes 2-3 days to even initiate a bank transfer using the old method is just silly
      - dheera 4y ago
        They could make bank transfers instant, instead of resorting to sharing passwords. Sharing passwords is a universally bad practice and has been for decades.
        4y ago

tiffanyh 4y ago

There’s already some pretty big players in the “open banking but for healthcare” space. Like https://www.healthgorilla.com/ https://www.healthgorilla.com/ I wish this new company luck. Healthcare is unbelievably difficult market to enter.

deleted 4y ago
[deleted]

failTide 4y ago

Isn't plaid the company that puts up a phishing-esque 'real looking' bank login page, then captures the login info and then makes that banking data available to whichever third party had set the thing up? Not sure if they're still doing that. Definitely don't ever want that to happen with my medical records.

ThunderSizzle 4y ago
It's a fantastic self-hosted concept (e.g. a password vault that sync the data the password unlocks). It's a nightmare for security as a service concept
- failTide 4y ago
  That's an interesting idea - although there would need to be a way to prove the data wasn't tampered with, since a lot of companies are using plaid to make decisions on loans and things. What the banking industry should do is just come up with a standard format for sharing financial data, with keys to prove the data was real, and let the consumer export those files and share with anyone they want. No need for multi million dollar federated systems.
mal-2 4y ago
It is unforgivable that they implemented it as an iframe. Who needs EV SSL verification? never heard of it. You can't even see if there's an HTTPS lock indicator! It was bad enough that it asks for bank login credentials, but doing so with no server validation at all is a terrible flow to be teaching users to accept.
- iancarroll 4y ago
  You can’t implement what you suggest in a browser. The only trusted identity that browsers have is the parent page in the URL bar — which Plaid doesn’t remove. If Plaid tried to create some kind of secondary URL bar, phishing pages could just recreate it. aka the “line of death”: https://textslashplain.com/2017/01/14/the-line-of-death/ https://textslashplain.com/2017/01/14/the-line-of-death/

newaccount2021 4y ago

chevman 4y ago

Dev/engineering timeline is never the long pole in getting new healthcare products to market.

deleted 4y ago

[deleted]

timnetworks 4y ago

The <title> tag still says demo on the page, not sure if this is intentional.

ryanSrich 4y ago

Healthcare integration from a technology perspective is a solved problem. The real problem is that health systems have zero incentive to work with your shit. Oh…someone in rev cycle management wants to use your new SaaS to do a thing with PHI? And they need FHIR? How about HL7 V1 and an IT department that won’t take your call and a VPN connection procurement that takes 7 months to work? Oh also, your tiny little SaaS company also needs to spend $100k on getting a HITRUST certification. Sound good? “It’s cool that your using health connector XYZ but we’re not working with them, k thx bye”

jollofricepeas 4y ago

Hmm. 1. Nice idea but the TVM is tiny because its healthcare adjacent and built upon the straw foundation of healthcare startups and their backers. This functionality isn’t needed for most and is impossible to build where it’s needed — specialty medicine. 2. The true opportunity in the healthcare tech space is capturing a piece of the actual transaction either upstream like CoverMyMeds (marketing dollars) or downstream like RelayHealth, Change (Rx dispensing) which is what Plaid is actually doing. Nowadays this means capturing a piece of the specialty market which is extremely difficult due to the complexity of specialty medications. 3. New people to US healthcare don’t understand that outside of price transparency, the biggest fundamental issues in healthcare are actually time to therapy and patients remaining on therapy which is impacted by things like authorizations, lack of therapeutic support, and of course price again. What does this mean? I as a patient have my data per HIPAA. It is easily transportable by myself or my providers however there isn’t a whole lot I can do with it for the reasons I mentioned above. This isn’t the same problem as Plaid where theres a huge market because there’s a ton of choice and utility for the end user and also for startups looking to simply process a financial transaction.