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I have worked on healthcare software for the last decade. Healthcare technology is really not something that one can understand from the outside. It is also not

I have worked on healthcare software for the last decade. Healthcare technology is really not something that one can understand from the outside. It is also not an area where web startup knowledge is as applicable (eventual consistency is entirely unacceptable, any caching of data must be very precise to avoid showing stale data to users and is generally not done, all sales to hospitals and most physician groups are "enterprise" sales). There are many different standards for data transmission, but none of them are required and most people see them as more of a recommendation. Non-technical people are put in charge of technical projects. That being said, it is not a technologically challenging industry at the moment. Most of the work that is being done is just automating existing paper-based systems. The regulations that everyone worries about are really not very onerous. Complying with HIPAA is mostly common sense and the FDA does not yet regulate most information systems unless they control medical devices or provide specific types of alerting (vendors are preparing for the day when they do). Two of the biggest challenges that I see are the caliber of the technologists in the industry and the absolutely disgusting new interoperability standards that are being developed by people with questionable technical skills. The company to watch at this point is Epic (I do not work for Epic). They are really crushing a lot of other companies and they are somewhat progressive. http://www.epic.com/ http://www.epic.com/ If people are interested in some of the technology that is being used in the industry outside of the standard .Net and Java stuff take a look at InterSystems. They even have all of their product documentation online, which is a bit of a rarity for enterprise vendors. http://www.intersystems.com/ http://www.intersystems.com/

rdl 15y ago
I agree, especially about EPIC, but I think some of the integrated providers (like Kaiser) are themselves better at innovation than most of the software/services companies in the space.
- absconditus 15y ago
  Kaiser and Mayo are definitely doing things better than most other providers. Unfortunately the government is encouraging other providers to cargo-cult them by providing ARRA funds for copying some small part of what they do.
zdw 15y ago
Epic's software looks and (according to the doctors that have to use it) works like a bad 1990's database program written in Access. I work with a hospital that has it implemented. It's inflexible crap, where their idea of someone using it on a tablet is "get one with windows, or here's a RDP session you can get to through a VPN". One doctor I know said it took him 17 clicks and both reading help and contacting the help desk to enter simple information, which turned out to be in a totally nonintuitive way. We need the SMTP of medical communications, not the Microsoft Exchange. Epic's system is very like the latter. All medical software suffers from the problem of all software where the end user and the creator of software isn't the same person - it just doesn't work in a way that makes sense. The problem, for medical software at least, is that once you've one of the very few people who have a medical degree, you're often in demand to the point that deciding to 1. write software at a competent level and 2. have the business moxie to turn it into a decent business, the talent pool is basically nil.
- absconditus 15y ago
  As bad as Epic's software might be, the rest of the software in the industry is worse.
  - tomh 15y ago
    Interesting side note about InterSystems - I interviewed there a few times about 10 years ago, and the first step was a written exam in Mumps (the programming language). Turns out it's popular in the healthcare space, being used in both InterSystems Cache and VistA, the open-source medical records system used by the Veteran's Administration: http://stackoverflow.com/questions/256876/tips-for-learning-mumps-m-cache http://stackoverflow.com/questions/256876/tips-for-learning-...
- nradov 15y ago
  NwHIN Direct is specifically trying to become the SMTP of medical communications. Which is fine as far as it goes, but covers only a few limited use cases. http://wiki.directproject.org/ http://wiki.directproject.org/
- ippisl 15y ago

rdl 15y ago

I agree, especially about EPIC, but I think some of the integrated providers (like Kaiser) are themselves better at innovation than most of the software/services companies in the space.

absconditus 15y ago
Kaiser and Mayo are definitely doing things better than most other providers. Unfortunately the government is encouraging other providers to cargo-cult them by providing ARRA funds for copying some small part of what they do.

zdw 15y ago

Epic's software looks and (according to the doctors that have to use it) works like a bad 1990's database program written in Access. I work with a hospital that has it implemented. It's inflexible crap, where their idea of someone using it on a tablet is "get one with windows, or here's a RDP session you can get to through a VPN". One doctor I know said it took him 17 clicks and both reading help and contacting the help desk to enter simple information, which turned out to be in a totally nonintuitive way. We need the SMTP of medical communications, not the Microsoft Exchange. Epic's system is very like the latter. All medical software suffers from the problem of all software where the end user and the creator of software isn't the same person - it just doesn't work in a way that makes sense. The problem, for medical software at least, is that once you've one of the very few people who have a medical degree, you're often in demand to the point that deciding to 1. write software at a competent level and 2. have the business moxie to turn it into a decent business, the talent pool is basically nil.

absconditus 15y ago
As bad as Epic's software might be, the rest of the software in the industry is worse.
- tomh 15y ago
  Interesting side note about InterSystems - I interviewed there a few times about 10 years ago, and the first step was a written exam in Mumps (the programming language). Turns out it's popular in the healthcare space, being used in both InterSystems Cache and VistA, the open-source medical records system used by the Veteran's Administration: http://stackoverflow.com/questions/256876/tips-for-learning-mumps-m-cache http://stackoverflow.com/questions/256876/tips-for-learning-...
nradov 15y ago
NwHIN Direct is specifically trying to become the SMTP of medical communications. Which is fine as far as it goes, but covers only a few limited use cases. http://wiki.directproject.org/ http://wiki.directproject.org/
ippisl 15y ago