5 ms·

PicnicHealth (YC S14) Stores Your Medical Records In One Place

58 points by peter123 12y ago

anigbrowl 12y ago
Great idea, but I presume there was a reason why Google Health was shut down and abandoned this space in 2013. How will PicnicHealth avoid this? “When you’re dealing with potentially the hardest moments of your life, you don’t have to worry about these other logistical tasks and the feeling of confusion on what’s exactly going on,” Leviner said. True, but I sat down and uploaded most of my data to Google Health when I wasn't sick, and I've been wishing for a simple replacement ever since it shut down. This is a nice-looking project but it appears to leave users with little to no input of their own into their clinical record-keeping. I also wonder (based on previous experience with obtaining my own medical records) how they intend to deal with the fees imposed by medical service providers for the collation and administrative release of the data. I paid about $100 a few years ago for the records of a brief hospital stay, which ran into hundreds of pages (much of it duplicative, and with much of the salient information being in handwritten form).
- hga 12y ago
  Indeed; I have a number of health records that only exist because I kept copies (and I'm lucky my copies only got a bit damp: https://en.wikipedia.org/wiki/2011_Joplin_tornado https://en.wikipedia.org/wiki/2011_Joplin_tornado and http://www.ancell-ent.com/1715_Rex_Ave_127B_Joplin/images/ http://www.ancell-ent.com/1715_Rex_Ave_127B_Joplin/images/ ). In another case, my doctor worked for a multi-doctor practice that went out of business, and it was claimed all records were lost due to "computer problems". Nothing really valuable there, but with so much chaos in the US medical systems, where I have and see lots of doctors giving up independent practice and going to work for "the man" ... well, at the very least PicnicHealth should allow a client to send them paper copies or scans of records.
- conception 12y ago
  Have you looked at https://www.healthvault.com/us/en https://www.healthvault.com/us/en? Also, how does this product compete against Health Vault?
- troyastorino 12y ago
  Hi, one of the PicnicHealth founders here. It's great that you were motivated enough to upload your data to Google Health! Unfortunately for Google Health, most people weren't as motivated as you. We believe that Personal Health Records haven't yet been successful because they require users to manually upload their data, and most people just aren't willing to do this. That's one of the reasons why we take care of collecting and organizing records for our users. About fees, you're right: one of our users would have had to pay over $700 in fees if he had tried to get the records from just one of his hospitalizations on his own! We have relationships set up so that we avoid fees almost 100% of the time, and when we can't avoid a fee we cover that ourselves. Our job is also to sort through the mess and pull out the salient information so that you don't have to.
  - rcarrigan87 12y ago
    Very true, people generally take their health for granted until they experience an adverse event. Expecting people to take it upon themselves to handle their own medical records is wishful. Large doctor practices sometimes have 2 or even 3 people just dedicated to fulfilling medical record requests. That's a huge expense. I help run a home health company that is constantly requesting medical records. We still receive most records by fax! Our receptionist spends a good bit of her day handling this process. It's a huge waste on both ends. If you could make that process easier I think a lot of providers would be willing to pay... Regardless, best of luck! So much opportunity in this space, keep pushing.
    - nogaleviner 12y ago
      Would love to talk offline and hear more about how you're handling this. I'm only just learning about home healthcare deals with this stuff. I'm noga at picnichealth if you have a minute to chat at some point.
      - rcarrigan87 12y ago
        sure rcarrigan87 at gmail. Drop me a line and we can chat.
idiot900 12y ago
Interesting. Is there a demo login with dummy data, so we can see how well it actually works?
- nogaleviner 12y ago
  Founder here. We don't have a demo login up yet but it's coming soon. Stay tuned!
ryanSrich 12y ago
Is PicnicHealth a non-profit (although it doesn't appear to be)? If not how is the market willing and able to pay for such a service? (considering that users, not institutions are charged) > We personally make sure your doctor has updates before you get to the office. This is huge. With all the different record systems, many of which still use physical paper, this seems like a massive expense. Unless my physicians also have to use a piece of PicnicHealth software? edit: It looks like this works by integrating with a patient portal provided by the healthcare institution.
rdxm 12y ago
how can you even consider launching a service like this without being fully audited for HIPPA and ISO 27001. all i see on their site is boiler plate sec that in no way addresses the reality of the business domain they want to operate in. you'd be insane to put your data into something like this without those controls in place. moreover, they are asking for serious regulatory trouble launching without it. this one business challenge that will not be solved in the valley. this problem will eventually be solved by the large industry players in insurance and hospital management in a model similar to that of the DTCC..
- angersock 12y ago
  You sound like a shill for Epic. This business challenge is only going to be solved by startups, because all of the existing players rely on it being such a fucked system. They're not going to fix anything.
  - Pacabel 12y ago
    This is absurd. So rdxm is a "shill" merely because he or she pointed out some very real and important issues surrounding this sort of technology, and then also pointed out the fact that established players are best prepared to handle such challenges? Huh? If you're going to make such accusations, or even just hint at them, please provide us with at least some real evidence to show that rdxm is being directly compensated by one or more of the industry incumbents for posting that comment. Since I doubt very much that you can provide that evidence, I think it would be appropriate for you to apologize to rdxm and to the rest of the community here.
    - angersock 12y ago
      Eh, I'd expect somebody shilling for Epic or any of the other major vendors to sound the same way--which is exactly what I said, no more no less. I'm not going to apologize. The problem with bandying about "HIPPA [sic]" and random ISO security standards is that it only serves to dampen enthusiasm for fixing the staggeringly pervasive issues of mismanagement and technological obsolescence. Anybody can come up with a "no" or a problem--"but but but HIPAAaaaaa" is a common refrain from people who want to sound like they know something but who lack the talent or skill to fix the fucking thing.
r0m4n0 12y ago
Blue Shield of CA and Anthem announced a health exchange to store patient info a few days ago... Obviously PicnicHealth is onto something but they will have some challenges as they don't have massive relationships with providers. At launch it will have 9 million patient records without even blinking https://www.calindex.org/ https://www.calindex.org/
- nogaleviner 12y ago
  Founder here again. This is super cool. I haven't been able to get too much detail on it yet. Most of the health exchanges haven't gone far because they start with government of foundation funding and then have no business model, but with these guys behind it, they actually make sense. We'd be thrilled if we could focus on building a really good product for making medical data useful for patients instead of building infrastructure for moving it around.
  - r0m4n0 12y ago
    Very true, execution of a health exchange infrastructure has been riddled with troubles in the past. Interfacing with patient data is still a great idea, practically nonexistent today. a central location for data will only make your service more robust and require less integration.
ejain 12y ago
One of the things that keeps me out of the healthcare space is that you could build the most amazing tool, yet it wouldn't catch on because no one has enough time or incentives to start using it (and you're not playing golf with the right people). That said, PicnicHealth looks nice, and I wish them best luck! The pricing seems a bit high for someone who doesn't have health issues and just wants to keep track of regular tests, but I find it easier to trust a paid service than a company with a surprise business model.
- atmosx 12y ago
  Another problem is that doctors and health in General is highly specialized. So a doctor needs a set of options while the next needs another, etc. So it's kind of hard to fit everything in one basket. There is HL7 that should a sort of golden standard but many programmers on the field totally ignore it.
  - angersock 12y ago
    I hate HL7 with a passion. As for docs, the main problem is that they've spent the last century or two training snowflake workflows and vocabularies. :(
    - dawson 12y ago
      FHIR is a step in the right direction http://www.hl7.org/implement/standards/fhir/ http://www.hl7.org/implement/standards/fhir/
      - lucidrains 12y ago
        Yes! I am also quite excited for FHIR!
      - angersock 12y ago
        Urk. I'm not impressed--it's already shaping up to be super-enterprisey and architecture-astronauty, and supporting binary stuff means folks will keep smuggling in HL7 v2.
cookiecaper 12y ago
The medical space is so FUBAR'd that I don't see any value in trudging in there as a startup. It's just asking for pain. The industry is not ready for this kind of thing yet, and won't be for the indefinite future. The whole way we do medicine just needs to be nuked from orbit. The current system we have is one of the most grotesque and tangible examples of human exploitation in modern times. This applies outside America too; your problems don't go away just because your government has given the industry a blank check. Source: I was a long-term contractor who had options in a medical imaging startup.
pptr1 12y ago
This is a hard space to be in. I am glad ycombinator is funding startups like this. To survive in this space you need to be profitable early on and it looks like you guys are already focusing on that business wise. The challenge for your business is the various Emr/EHR systems that you have to pull data from. Some of these vendors might not be so friendly, has data lock in is a business strategy. Some systems might not have HL7 or some other type of known integration; the interfaces could be proprietary. Some systems might use their own custom database. Getting out EHR data even in known databases (MySQL , SQL server, etc) could be challenging if integration doesn't work and you have figure out the schema mapping, as the vendor has no incentive to give you the schema. I am not sure your one price fits all can work well. It seems like it would work for known systems you know you get data accurately out of. What about all those one off deeply proprietary systems; it might take allot more time. I guess getting EHR printouts and manually entering in data is one strategy, but it's quite error prone. Accuracy means everything here. On top of that some of these doctors might not have any incentives to let your team figure out how to pull data from their system. I know this because I use to do data migrations for a top EMR company. Medical records migrations are considered the most complex. I would also add that how would your customers know you won't lock in their data. Will you publish your data format?
- specialist 12y ago
  I implemented the backend for a few early health exchanges (BHIX, NMHIC, NYCLIX, etc). Things change, my observations are a few years old, so YMMV. #1 - Players are loathe to share their data. Much integration is now occurring because of consolidation, vs interchange. #2 - Patient privacy can only be protected one of three ways. a) globally unique identifiers which are then used to hash / encryption the data (translucent database style). b) centralized storage, ala thumb drive or dropbox. c) better laws with real teeth. I don't see a, b, or c on the horizon. People freaked over RealID. Medicare for All isn't in the cards yet. So no GUIDs. Centralized storage ala UK's NIH is contingent on single payer, aka Medicare for All. Not in the cards at this time. As for privacy protections in the law with some real enforcement, well, that'd require consensus that our government should protect the rights of humans. #3 - I worked very hard on ETL (extract transform load), atomizing HL7 into RDBMS and then back out again. Here's a free idea: Don't bother. Just log the incoming HL7 (2.x, 3.x, misc other formats like CCA). Then index it with Lucene or equiv. Finally, map/reduce it to process queries. I was very proud of our backend datastore. I could go on and on about auditing, making various queries performant, modeling, etc. Alas, every player wants to see their data their way, and canonical strategies just aren't feasible across multiple customers.

58 points by peter123 12y ago

Great idea, but I presume there was a reason why Google Health was shut down and abandoned this space in 2013. How will PicnicHealth avoid this? “When you’re dealing with potentially the hardest moments of your life, you don’t have to worry about these other logistical tasks and the feeling of confusion on what’s exactly going on,” Leviner said. True, but I sat down and uploaded most of my data to Google Health when I wasn't sick, and I've been wishing for a simple replacement ever since it shut down. This is a nice-looking project but it appears to leave users with little to no input of their own into their clinical record-keeping. I also wonder (based on previous experience with obtaining my own medical records) how they intend to deal with the fees imposed by medical service providers for the collation and administrative release of the data. I paid about $100 a few years ago for the records of a brief hospital stay, which ran into hundreds of pages (much of it duplicative, and with much of the salient information being in handwritten form).

hga 12y ago
Indeed; I have a number of health records that only exist because I kept copies (and I'm lucky my copies only got a bit damp: https://en.wikipedia.org/wiki/2011_Joplin_tornado https://en.wikipedia.org/wiki/2011_Joplin_tornado and http://www.ancell-ent.com/1715_Rex_Ave_127B_Joplin/images/ http://www.ancell-ent.com/1715_Rex_Ave_127B_Joplin/images/ ). In another case, my doctor worked for a multi-doctor practice that went out of business, and it was claimed all records were lost due to "computer problems". Nothing really valuable there, but with so much chaos in the US medical systems, where I have and see lots of doctors giving up independent practice and going to work for "the man" ... well, at the very least PicnicHealth should allow a client to send them paper copies or scans of records.
conception 12y ago
Have you looked at https://www.healthvault.com/us/en https://www.healthvault.com/us/en? Also, how does this product compete against Health Vault?
troyastorino 12y ago
Hi, one of the PicnicHealth founders here. It's great that you were motivated enough to upload your data to Google Health! Unfortunately for Google Health, most people weren't as motivated as you. We believe that Personal Health Records haven't yet been successful because they require users to manually upload their data, and most people just aren't willing to do this. That's one of the reasons why we take care of collecting and organizing records for our users. About fees, you're right: one of our users would have had to pay over $700 in fees if he had tried to get the records from just one of his hospitalizations on his own! We have relationships set up so that we avoid fees almost 100% of the time, and when we can't avoid a fee we cover that ourselves. Our job is also to sort through the mess and pull out the salient information so that you don't have to.
- rcarrigan87 12y ago
  Very true, people generally take their health for granted until they experience an adverse event. Expecting people to take it upon themselves to handle their own medical records is wishful. Large doctor practices sometimes have 2 or even 3 people just dedicated to fulfilling medical record requests. That's a huge expense. I help run a home health company that is constantly requesting medical records. We still receive most records by fax! Our receptionist spends a good bit of her day handling this process. It's a huge waste on both ends. If you could make that process easier I think a lot of providers would be willing to pay... Regardless, best of luck! So much opportunity in this space, keep pushing.
  - nogaleviner 12y ago
    Would love to talk offline and hear more about how you're handling this. I'm only just learning about home healthcare deals with this stuff. I'm noga at picnichealth if you have a minute to chat at some point.
    - rcarrigan87 12y ago
      sure rcarrigan87 at gmail. Drop me a line and we can chat.

idiot900 12y ago

Interesting. Is there a demo login with dummy data, so we can see how well it actually works?

nogaleviner 12y ago
Founder here. We don't have a demo login up yet but it's coming soon. Stay tuned!

ryanSrich 12y ago

Is PicnicHealth a non-profit (although it doesn't appear to be)? If not how is the market willing and able to pay for such a service? (considering that users, not institutions are charged) > We personally make sure your doctor has updates before you get to the office. This is huge. With all the different record systems, many of which still use physical paper, this seems like a massive expense. Unless my physicians also have to use a piece of PicnicHealth software? edit: It looks like this works by integrating with a patient portal provided by the healthcare institution.

rdxm 12y ago

how can you even consider launching a service like this without being fully audited for HIPPA and ISO 27001. all i see on their site is boiler plate sec that in no way addresses the reality of the business domain they want to operate in. you'd be insane to put your data into something like this without those controls in place. moreover, they are asking for serious regulatory trouble launching without it. this one business challenge that will not be solved in the valley. this problem will eventually be solved by the large industry players in insurance and hospital management in a model similar to that of the DTCC..

angersock 12y ago
You sound like a shill for Epic. This business challenge is only going to be solved by startups, because all of the existing players rely on it being such a fucked system. They're not going to fix anything.
- Pacabel 12y ago
  This is absurd. So rdxm is a "shill" merely because he or she pointed out some very real and important issues surrounding this sort of technology, and then also pointed out the fact that established players are best prepared to handle such challenges? Huh? If you're going to make such accusations, or even just hint at them, please provide us with at least some real evidence to show that rdxm is being directly compensated by one or more of the industry incumbents for posting that comment. Since I doubt very much that you can provide that evidence, I think it would be appropriate for you to apologize to rdxm and to the rest of the community here.
  - angersock 12y ago
    Eh, I'd expect somebody shilling for Epic or any of the other major vendors to sound the same way--which is exactly what I said, no more no less. I'm not going to apologize. The problem with bandying about "HIPPA [sic]" and random ISO security standards is that it only serves to dampen enthusiasm for fixing the staggeringly pervasive issues of mismanagement and technological obsolescence. Anybody can come up with a "no" or a problem--"but but but HIPAAaaaaa" is a common refrain from people who want to sound like they know something but who lack the talent or skill to fix the fucking thing.

r0m4n0 12y ago

Blue Shield of CA and Anthem announced a health exchange to store patient info a few days ago... Obviously PicnicHealth is onto something but they will have some challenges as they don't have massive relationships with providers. At launch it will have 9 million patient records without even blinking https://www.calindex.org/ https://www.calindex.org/

nogaleviner 12y ago
Founder here again. This is super cool. I haven't been able to get too much detail on it yet. Most of the health exchanges haven't gone far because they start with government of foundation funding and then have no business model, but with these guys behind it, they actually make sense. We'd be thrilled if we could focus on building a really good product for making medical data useful for patients instead of building infrastructure for moving it around.
- r0m4n0 12y ago
  Very true, execution of a health exchange infrastructure has been riddled with troubles in the past. Interfacing with patient data is still a great idea, practically nonexistent today. a central location for data will only make your service more robust and require less integration.

ejain 12y ago

One of the things that keeps me out of the healthcare space is that you could build the most amazing tool, yet it wouldn't catch on because no one has enough time or incentives to start using it (and you're not playing golf with the right people). That said, PicnicHealth looks nice, and I wish them best luck! The pricing seems a bit high for someone who doesn't have health issues and just wants to keep track of regular tests, but I find it easier to trust a paid service than a company with a surprise business model.

atmosx 12y ago
Another problem is that doctors and health in General is highly specialized. So a doctor needs a set of options while the next needs another, etc. So it's kind of hard to fit everything in one basket. There is HL7 that should a sort of golden standard but many programmers on the field totally ignore it.
- angersock 12y ago
  I hate HL7 with a passion. As for docs, the main problem is that they've spent the last century or two training snowflake workflows and vocabularies. :(
  - dawson 12y ago
    FHIR is a step in the right direction http://www.hl7.org/implement/standards/fhir/ http://www.hl7.org/implement/standards/fhir/
    - lucidrains 12y ago
      Yes! I am also quite excited for FHIR!
    - angersock 12y ago
      Urk. I'm not impressed--it's already shaping up to be super-enterprisey and architecture-astronauty, and supporting binary stuff means folks will keep smuggling in HL7 v2.

cookiecaper 12y ago

The medical space is so FUBAR'd that I don't see any value in trudging in there as a startup. It's just asking for pain. The industry is not ready for this kind of thing yet, and won't be for the indefinite future. The whole way we do medicine just needs to be nuked from orbit. The current system we have is one of the most grotesque and tangible examples of human exploitation in modern times. This applies outside America too; your problems don't go away just because your government has given the industry a blank check. Source: I was a long-term contractor who had options in a medical imaging startup.

pptr1 12y ago

This is a hard space to be in. I am glad ycombinator is funding startups like this. To survive in this space you need to be profitable early on and it looks like you guys are already focusing on that business wise. The challenge for your business is the various Emr/EHR systems that you have to pull data from. Some of these vendors might not be so friendly, has data lock in is a business strategy. Some systems might not have HL7 or some other type of known integration; the interfaces could be proprietary. Some systems might use their own custom database. Getting out EHR data even in known databases (MySQL , SQL server, etc) could be challenging if integration doesn't work and you have figure out the schema mapping, as the vendor has no incentive to give you the schema. I am not sure your one price fits all can work well. It seems like it would work for known systems you know you get data accurately out of. What about all those one off deeply proprietary systems; it might take allot more time. I guess getting EHR printouts and manually entering in data is one strategy, but it's quite error prone. Accuracy means everything here. On top of that some of these doctors might not have any incentives to let your team figure out how to pull data from their system. I know this because I use to do data migrations for a top EMR company. Medical records migrations are considered the most complex. I would also add that how would your customers know you won't lock in their data. Will you publish your data format?

specialist 12y ago
I implemented the backend for a few early health exchanges (BHIX, NMHIC, NYCLIX, etc). Things change, my observations are a few years old, so YMMV. #1 - Players are loathe to share their data. Much integration is now occurring because of consolidation, vs interchange. #2 - Patient privacy can only be protected one of three ways. a) globally unique identifiers which are then used to hash / encryption the data (translucent database style). b) centralized storage, ala thumb drive or dropbox. c) better laws with real teeth. I don't see a, b, or c on the horizon. People freaked over RealID. Medicare for All isn't in the cards yet. So no GUIDs. Centralized storage ala UK's NIH is contingent on single payer, aka Medicare for All. Not in the cards at this time. As for privacy protections in the law with some real enforcement, well, that'd require consensus that our government should protect the rights of humans. #3 - I worked very hard on ETL (extract transform load), atomizing HL7 into RDBMS and then back out again. Here's a free idea: Don't bother. Just log the incoming HL7 (2.x, 3.x, misc other formats like CCA). Then index it with Lucene or equiv. Finally, map/reduce it to process queries. I was very proud of our backend datastore. I could go on and on about auditing, making various queries performant, modeling, etc. Alas, every player wants to see their data their way, and canonical strategies just aren't feasible across multiple customers.