Because this is such an intensely localized service, expanding the network of participating ERs is pretty much the most important thing we need to do. We've made it a turnkey implementation for low- and mid-volume ERs, and there are some fairly compelling customer service and bottom-line benefits for participating hospitals.
I have had socialized health-care in all three of the countries I've lived in and dealt with the american solution a few times while traveling. Honestly wait times were about the same across the board. Socialized or not E.R. rooms are rarely able to cope with busy times.
Socialized health care usually only means worse service for the very rich. For everyone else it's a great thing.
Never waited more than 10 minutes in Spain, Italy, Portugal, Germany or UK (and lived on all those countries for a while), had to wait 4.5 hours on San Francisco just few months ago.
While I'm a fan of the German healthcare system, under 10 minutes is an overstatement. Honestly, the only time I've gotten treatment that fast was when I was covered in blood. I'd say my usual (non-critical) ER waits are closer to an hour, but still shorter in general than I had when in the US. (I've lived in Germany for 7 years now.)
Socialized health-care has its own problems but just from reading the comments here it seems like a better system as it routes people to the level of treatment they need. My understanding of the US system (and please correct me if I'm wrong) is that those without insurance have no other option than to attend the ER.
Here in Australia you'd generally go to a GP, a public health center or have a locum come out to visit you before heading to a hospital. There are certainly still wait times, and a system like this might be able to help, but in general I think there's a much better spread of patients to the right location.
Well, good luck. I'm rooting for you because your service would be amazing. You're dealing with the most fucked up, slow-moving, ass-backward industry in the history of capitalism though, so it's going to be a really tough battle.
I don't know about it being the worst possible industry -- government procurement or public education give it a run for its money some of the time. (I will refrain from playing the "find the common thread here" game.)
Seriously, though, I hope that this startup escapes the regulatory issues and goes Big. It solves a clear problem for both patients and hospitals, will greatly increase societal welfare, and it should attract Big Bucks (TM) because of the amount of money wrapped up in the problem it solves.
This page is one of the best brief sales pitches I've ever seen, by the way:
Everything about it is great. It scans great. It directly addresses the customers' needs and makes it explicit what tangible benefits buying in will get them. I have bookmarked it so that when software vendors ask how to improve their website I'll say "Your benefits section should look like this".
Sounds like a neat idea. You obviously have to get hospital permission/buy-in before this idea could really take off. This is a similar idea to OpenTable, the dining reservation system. Perhaps you could do (or already have done) some research to find out how that company has succeeded/failed and apply those lessons to your efforts. Online based reservation systems are a great idea, but seems like a lot of leg work is required to get it really rolling. Classic chicken/egg problem here with early adopters.
1. Add some auto-suggest features to the 'add a hospital' form.
2. Use an IP address/geolocation service to guess where I'm located and pre-populate the state for the form.
3. I tried to add my local hospital, and received a very ugly error message:
====
Internal Error
There was an error processing your request. The system administrator has been notified of the problem, it will be fixed as soon as possible. Please try again later.
TELEPHONE SUPPORT
For telephone assistance, call our on-duty support technician at (770)-597-9185.
If you can afford to wait do you actually have an emergency? There are many other options, including clinics in drugstores, which don't burden emergency departments.
I'm a father of 3 and this service would have been useful on several occasions. TRUE emergencies are handled VERY quickly at the ER, but there are a lot of times when the regular doctors office is closed (holidays, weekends, after business hours) but you REALLY need to take your sick child to get medicine or whatever. We've had more middle-of-the-night ear infections than I'd care to remember. :)
Better question, what is the likelihood that a hospital near most residents are busy enough at 2am where wait times are extremely excessive that you need to use a service like this to "schedule" your visit? I would imagine that the likelihood decreases considerably during the "middle of the night" especially when taking into consideration that there are probably more hospitals that are not level 1 trauma centers and/or county run facilities and are often the busiest between 11am and 11pm.
My last experience with the ER was in the 90s, but there were several times I (or my then wife) had to wait for hours in the evening or middle of the night to see a doctor at the ER, in both Columbus, GA, and Melbourne, FL.
I'm not sure what your qualifications are, but I've given mine -- a parent of 3 kids. Drugstores (in my area, anyways) are NOT able to handle ear infections because antibiotics require a physicians prescription. Urgent care facilities are always preferable to ER visits because they cost less for the patient and permit ER staff to handle true emergencies, there there are many instances where urgent care just isn't an option.
While you have a valid point, I think you're still missing the main issue: sometimes these clinics aren't open when you need them most. Emergencies big and small happen at any time during the day. Not many clinics and urgent care centers are open and easy to go to 24/7.
Do you honestly believe that I don't realize this?
The fact of the matter is that the vast majority of the visitors to this site believe that most problems have a technical solution. I happen to believe that this technical solution has the potential to exacerbate an existing problem and that other non-technical solutions are possible. What is needed is a combination of 24 hour clinics/urgent care centers, more fast-track departments and convincing certain people that there is no need to visit a doctor for a bad cold unless certain symptoms appear or one doesn't recover in a reasonable length of time. Encouraging more people to visit the emergency department for non-emergencies does not seem prudent to me.
My apologies if I was misinterpreting your replies as needless repetition.
I don't disagree with you, and it must be said I question the need for such a service...but given the state of waiting at emergency departments today, I could see how this is useful for those people with small emergencies that for whatever reason can't be dealt with elsewhere. For now. The long term solution would obviously be to do something similar to what you suggest.
I'm not sure how being a parent provides qualification in assessing the practicality of this startup, but if it does, then I would like to weigh in on this issue as I am a parent of 2. These clinics are typically staffed at least by a nurse practitioner, who can treat and prescribe medications (depending on the state) for almost any reasonable non-urgent condition, including antibiotics. If you live in a state where the nurse practitioner can not prescribe medications, there is usually a physician on staff that works along side the NP to assist in those situations.
These clinics sell themselves as being non-urgent care facilities that are able to treat conditions that otherwise would have required a physician or Emergency room visit. If they could not prescribe medications and treat most of these conditions, I am unsure how successful they would really be.
As much as I love the InQuickER idea, it's not hard to predict which one of NP clinics and InQuickER is going to make a bigger dent faster. Clinics are going to be everywhere in ten years. It's too good a system not to succeed.
Of course, InQuickER (or something like it) is just going to integrate with the clinics and urgent care centers. I'm going to select "ear infection" and enter my zip code and it's going to give me a selection just like Orbitz.
Drugstores in Illinois and (I thought) California can handle this problem, when they are staffed by nurse-practitioners (as many Walgreens are). NP's are the future of US health care.
This is a very good question, and a very complicated one. In many markets, retail clinics and urgent care centers are open 60 hours per week at best; nights and weekends, treatment options are scarce.
Additionally, many hospitals operate onsite "fast-track" clinics which are connected to the ED, so low-acuity conditions are essentially treated in something resembling a retail clinic.
Our goal is to make the emergency medical treatment experience as efficient as possible. Parents don't want to be sitting in the waiting room half the night, potentially exposing their children to contagious diseases in the er. Professionals lose valuable time to ER visits that drag on forever. We're trying to recapture that lost time and give the patients more control of the treatment process.
As yet another parent, this looks promising. My ER visits are usually in the 5-7 hour range. I also don't really care what the place is called: if I have an issue, I want to go to the closest place that can help me. If it happens to be the Walgreens three blocks away (it isn't), fine. Urgent Care, ER, trauma center or whatever.
Until recently, I always thought these places would triage, but my experience has been that it is just 'take a number and wait' I've been in with a broken arm, a torn nose (that required stitches) and couldn't believed we were treated exactly like a headache.
So, this looks great. Try the Silicon Valley next so we can try it!
In addition to making emergency treatment more efficient, you're also providing valuable decision support to people in some of the most stressful moments of their lives.
Anyone who is scared enough or in enough pain to be considering an ER visit is about as far from a 'rational actor' as possible. Helping them make good decisions not only smooths out the system, it also gives people essential help when they need it most.
InQuicker specifically notes that they aren't for urgent or emergency conditions (http://www.inquicker.com/when_to_call_911). I don't see any reason why this couldn't be extended to non-hospital clinics, they work pretty similarly.
Nice to meet you. I read your blog sometimes, and just watched a video presentation you gave with Steve Blank. My name is Zack. Customer development and agile software development seem like such neat, rational concepts.
I'm thinking of taking it a step further, though, and would like your opinion. I have a couple ideas for services, but they would take a couple weeks to build. Do you think it would be worthwhile to post an Ask HN thread, seeing if people express interest in paying for my potential products, before I build them?
Great idea! Which EHR/scheduling systems do you currently interoperate with? EmStat, Epic, etc. Alternatively, if you're not directly hooking into the ER's systems:
A) What sort of workflow do you use to exchange scheduling and appointment data between your site and the ER?
and
B) Is it the same for each participating hospital? If not, how are you planning on scaling your operation to include more than four hospitals? I'm genuinely curious, having done some work on ER workflow analysis and modeling. I think this is a great idea, but can envision some pretty significant workflow issues on your horizon depending on how you've got stuff set up currently.
Right now, we're use a manual workflow; we provide patients' preregistration data to nurses and registration staff through a web interface. Direct EHR integration is my next priority.
We're implementing at relatively low-volume locations (in the neighborhood of 25-35k pts per year), and so far we've used the same manual workflow at all locations without any problems, but I think we need full integration for long-term growth.
I'd love to talk further by email -- can you send me a note at tyler@mystartupdomain?
To answer one of your questions... From the registration page: "Your credit card will be charged a fee of $24.99 to complete the registration process."
Exactly. Originally, we experimented with offering this service to patients for free or for $2.99, but the hospitals were experiencing significant numbers of no-shows and bogus registrations; the $24.99 price point was actually requested by our pilot hospital as a form of data validation.
If we could find another way to keep the signal-to-noise ratio high, I would love to offer this service at a lower price point.
I say don't lower your price. What you want to do is segment the demand curve for ER services and slice out those who are willing to pay more to avoid wasting hours of their time.
It seems lowering the price would gut your revenue but you wouldn't increase your userbase enough to make up for it (there would be a big deadweight loss of utility that patients get, but don't have to pay for -- lost revenue for you).
Also, ER is an incredibly expensive thing to go through, so mentally your users may be more price-insensitive than usual--they'll bucket all the costs together in a 'big bath', so you can charge more.
Very, very interesting. My first concern when I saw this site was concerning no-shows and late arrivals -- I know many doctor's offices are forced to double book appointments and therefore run extremely late, simply to maintain profitability in the face of lateness and no-shows. Have the hospitals had any issue with late arrivals throwing off the schedule? I'd imagine that if, after paying $24.99 for this service, a patient is still seen late, he or she would be rather (rightly) peeved.
Nice. You may want to consider a Google maps mashup centered on my location. If the hospital(s) I know aren't participating, this would be easier to use than a drop down box.
Great idea! Right now we have a fairly small network of participating hospitals (3, to be exact), and engaging visitors who aren't in our current service area is a bit of a trick. I'll pass this one along to the designer for our next revision.
From what I understand, there are a number of hospitals that can do some measure of call-ahead scheduling for ERs. What would prevent you from asking about each hospital policy and at worst doing a Twilio automated call to the number if they choose that one? At worst your automated message would get hung up on, and you'd tell them that it could not be processed and tell them to go there directly.
At best, you win because the ER staff hits the right keys for your automated message. Or they agree to do a full agreement with you.
I don't understand (even after looking at the How it Works page) is how it works. Since you can't predict what types of injuries that are going to come in that are more critical than yours, how can you gaurantee an appointment time?
The short answer: we can't. Sometimes, we miss the guaranteed appointment time. However, we do everything we can to ensure that our predictions are accurate, and we do everything we can to ensure that the patient experience is still as smooth as possible if we're wrong.
At this point, we have a 99.9% success rate with that guarantee: less than 1 out of every 1,000 patients has requested a write-off of the bill.
Can you expand on this a bit - for example, do you come up with the appointment times based on your own models, or does the hospital update your system to say "well, we're having a light day, so most people can get in two hours after they send us their triage info, regardless of what comes up."
I also wonder if you could talk about the incentives you use to get hospitals to sign on to your program - while you're adding value, you're also costing them staff time. Do you pass on a portion of the $25 to them, or is the idea that they will make up the cost by having more people come to them and thus getting more volume?
Lastly, have you considered partnering with insurance companies to offer this service as part of a premium's offering?
All-in, great idea you have - this is the kind of health care innovation we need.
Interesting. Actually, this is a good way to separate two of the crucial functions of health care: actually fixing medical problems, or demonstrating serious concern and sympathy for someone's medical problems.
A person interested in the first can use inquicker; someone more interested in the latter can still bustle off to the ER and pace around, or something.
Awesome, meaningful, useful startup. Congratulations. I hope you are successful and expand to my area. My friend spent 4 hours in the ER on his birthday to get some stitches. This would have been a huge help.
I'm not sure I comprehend this. Isn't it the role of the emergency services to prioritise your visit? If you're critical you'll get seen, otherwise you wait.
If you're capable of shopping around for the best appointment time then shouldn't you be seeing a GP instead?
This service doesn't bypass triage. It just puts your name and info on the triage list and allows you to wait from home instead of taking up space in the waiting room. The hospitals are (apparently) intensely involved in this process.
Bingo. Most patients fall into the general "low-acuity" category, which means that they are essentially seen in the order in which they arrive at the ER; this is the default case in our system. However, the ED caregivers do have the ability to change it.
Nifty idea -- I work for a Hospital with California's largest ER, and several ERs in other hospitals owned by the same company. Unfortunately, I'm having a hard time seeing something like this working in our environment (for a variety of reasons). However, I CAN see how this could be killer for small Urgent Care clinics. I can't tell you how many times I'd love to just go on a website and see what the wait times are for all my local urgent cares -- and then reserve/travel to the one I can get in quickest. Nice idea, clean design... really cool. Best of luck with it.
Just for a note as to my experience, there should be a "relinquish" or "Cancel" when setting up an appointment. I clicked next step and it booked my time temporarily. Ten minutes later it'll be open, but if you're releasing this you're going to want to allow us curious folks to cancel out.
Also, it looks like it booked the SOONEST appointment rather than the one I requested. In the "When" row I selected 10:30PM and it said on the next page 11:15AM was what I had selected.
A killer idea. Every friend of mine that has had kids echoes my experience, which is that you end up going to the ER way more than you expect to --- your primary care pediatrician sends you there any time the answer to an "is it serious" phone call is "maybe".
If this scales, it will let me pick which of 4 local ER's I'm going to go to based on wait time. I'd pay $50 a visit for that. I'd subscribe to a service like this simply in anticipation of needing it eventually.
This is a great service but it seems unfortunate that it has to exist at all.
The health system in Canada isn't ideal (or the Netherlands where I am now) but having to check emergency room wait times has never even occurred to me.
That's fair. I should have been more accurate since Canada is a gigantic country. My experience is based on living in Vancouver and Montreal (although I went to a hospital in Toronto on one occasion and waited only 30 minutes).
This is extremely common in my area (Ottawa/Gatineau). In fact, people travel the ~40 minutes to my small town where we have a relatively new hospital, and use our ER.
Great idea, but why focus on the ER in your branding? The question that the end user has is "How can I get treatment for this health problem as soon as possible, without having to wait around in a waiting room"? It seems like the way that you're answering this could easily be extended to clinics and urgent care centers, couldn't it?
Also, I echo the calls for a map-based or local-search interface.
Because from a pure marketing perspective very few people have the problem of having horrendous waits at clinics, but tens of millions of people have had the experience of waiting 3-5 hours in an ER waiting room.
I've personally had horrendous waits in clinics, urgent care centers, and ERs. I've also had really quick experiences with an ER. I'm not saying I'm typical, I'm just saying that my personal experience is such that your point never would have occurred to me.
But even granting your point, you can still market against that experience without implying that you only schedule people for ERs.
Right now I imagine that this site gets most of its business from people who call the ER directly, and then the participating ER tells them about the site (I could be totally wrong about that, though). Going forward, though, I would think that way that this is going to be used is that a user will know they need treatment, go to the site (find it via a search engine, whatever), look for the treatment facility that satisfies some mix of 'near', 'soon', and 'perceived ability to treat my problem', and put their name down.
If there's a marketing hump to get over, I would think it would be snagging people who are coming from a search engine or via some route other than having the ER send them there directly. It seems like the perception that this is just for ERs is more a problem in this sense - I'd personally be less likely to use it if I thought it wouldn't include nearby clinics in the list of places I could sign up for.
What this service does, if I'm reading this right, is bypass the stage where you talk to a triage nurse - you're triaged based on what you report is wrong with you, as opposed to what a nurse sees is wrong with you.
Do you have any mechanisms in place for two-way communication between the hospital and the people booking appointments? Specifically, I'm thinking about situations where a series of individually minor symptoms may collectively indicate something major is going on, but that a layman wouldn't know.
Like let's say that I go on your site and see that I can get an appointment at an ER in three hours, so I book that because I'm feeling slightly off. My symptom description seems innocuous enough - went for a walk in the countryside, right arm is tingling a bit, small red bump on my leg, etc. - but to someone trained in medicine they indicate that I've been poisoned by some sort of tick, and I need treatment ASAP, as opposed to in three hours. Is there a way for the nurse who processes this reservation into the hospital to call me and say "screw the booking, get here now!"?
Yes, we do have the capacity to reprioritize patients based on symptoms. Patients who reserve a treatment time online are responsible for their own health until they arrive at the ED, but we do give the ED caregivers the capacity to communicate with the patient early on if they deem it prudent; this feature is generally used in the sort of situations you describe, where the patient's condition may be more serious than he or she realizes.
One of the primary reasons for the large influx of patients is the diversion of primary care visits into the ER for non-urgent matters. A booking system that encourages non-urgent care visits to the ER as opposed to other urgent care options does nothing to help this.
As other commenters have mentioned, the problem with overcrowded ERs from a patient perspective where they have a potentially emergent case is NOT in the middle of the night - it's during the day, where other options (including primary care and urgent care facilities) are available.
Emergency medicine should not be treated in the same convenience form-factor as other consumable goods, and applying this approach is socially irresponsible in the big picture.
Your argument is that on-site ER wait times are an effective deterrant for frivolous ER visits. They aren't: they impose costs on both legitimate and illegitimate visits. That cost is also imposed randomly: currently, your ER wait is luck-of-the-draw.
If you want to solve the ER overcrowding problem, you should do it directly, by adding a surcharge (over and above the one that already exists) for nonessential ER visits. There's no rational reason to force people to sit in a crowded ER waiting room.
Meanwhile, a retail interface to the ER scheduling systems that already exist is more likely to help than hurt overcrowding, because it will route patients to the least crowded ER in their area.
The problem with the surcharge idea (and lots of other market-oriented solutions to health care problems) is that, under our current system, market forces don't really apply in the same way that they apply to, say, items in the grocery store. Very few people going to an ER are paying out of pocket: many don't have insurance[1], and will either not pay for their visit or will negotiate some sort of payment plan at a reduced rate with the hospital. And, of course, those visitors with insurance don't care what the hospital ends up charging their insurance company- that's the whole point of insurance. This is, of course, especially true during emergency or urgent care situations.
[1] To the extent that emergency room overcrowding is due to people without other health care options (i.e., the un- and under-insured) using ERs as their primary care facilities, surcharges really won't help: by definition, these are people who can't pay for medical care... so adding additional surcharges probably won't have much effect on their ER utilization.
The people who are using the ER because they have no other option and who cannot pay out-of-pocket are not at all germane to this startup idea, which is part of my point.
There is no reason at all that our respective agendas about how US healthcare should be run should require me to wait on-site in the hospital, as opposed to in my home at 1AM, or in my hotel room when I get violently ill on a trip.
There will always be cases when people need to use the ER, and there will never be a good reason they shouldn't be able to call ahead for a soft appointment. Everything about the system, from patient routing to triage to hospital staffing, works better with a system like InQuickER in place.
Oh, I absolutely agree with the usefulness of InQuickER!
My argument was only with the idea of using surcharges to deal with overcrowding. The reason that ERs are chronically overcrowded is not (generally speaking) because of people getting ill on trips, being in car accidents, or having ear-infected kids. The reason that ERs are overcrowded is the large number of people for whom ERs serve as primary care facilities.
As you (correctly) pointed out, these people probably wouldn't be using InQuickER-like services anyway, so they're not relevant to the question of whether scheduling systems are helpful or not. I think that scheduling systems lke InQuickER definitely could be helpful to patients that use them, and maybe to the ERs themselves... but also that, depending on the specifics of a given ER's catchment area, they won't have much impact on overall crowded-ness, since that's largely due to a segment of the population that won't be using the scheduling system anyway.
Now, if one could find a way to make these people more likely to use the scheduling system, you might see more of an effect.
Of course, I could be completely wrong- IANDNAIHEOHQE (I am not a doctor nor am I a health economist or healthcare quality expert), and when it comes to health care quality interventions (which is what InQuickER basically is) it is not at all uncommon for things to behave in a counter-intuitive manner. That's why solid evaluation of system outcomes is so important. Hopefully the participating hospitals are keeping a close eye on their utilization statistics... for their sake, I hope that the InQuickER people are insisting on it- being able to show a significant change in in-ER waiting time due to their system would be the single best marketing tool that they could possibly hope for.
Adding to the list of things that I could be completely wrong about, my sense of who InQuickER's users are could be dead wrong. Tyler, what are your user demographics like? Do they mirror those of the hospitals that are using the system?
So, I've been an ER nurse for the last 15 years. I run the Hackers and Founders Silicon Valley meetup, and I love to support startup ideas. It's extremely rare that I don't support a startup idea or give it a fair shake.
This is a spectacularly bad idea. I can unequivocally say without a doubt that if you pursue this service, someone will die.
Why? Because I've seen it happen.
Part of my job as an ER nurse is to triage patients that come in. Triage involves sorting through the dozens of patients that come in every night, and decide who can wait and who cannot because they have a life threatening emergency. People having symptoms of a heart attack move to the front of the line. People who ate a bad taco and have the shits get seen on a space available basis. That's the gig. I sort patients: sort_by_acuity([bad taco, bad taco, bad taco, heart attack, runny nose, cough, gun shot wound, ear infection, headache, headache, headache, stroke, headache]).
I've been doing this job for 15 years, and I have seen plenty of triage mistakes that can change people's lives for ever. I've made a few myself. You care for thousands of patients a year, you're going to drop a ball every now and then. But, I have a lot of experience doing this, and I have a lot of knowledge and very good instincts on when someone is very ill. Patients do not have that knowledge and I would never trust your customers to make that decision when life and death is on the line.
This is why ER's are almost universally abysmal at judging how long it's going to take to be seen by the doctor. The same team that is taking care of your earache at 3am or helping you get stitches after you cut your finger on your computer case, is the same team that can crack your chest open and do open heart massage on you after a thug sticks a knife in your heart. We take care of bladder infections and dying babies, sometimes right next door to each other at the same time. ER's are built for safety, not speed or even convenience. The fact that in the US, they are primarily the only type of physician that can be seen 24/7 without an appointment is an unfortunate effect of our health care system. But, we have to care for the sickest patients first, and you can never predict when the next ambulance is going to roll through the door. So, ER's suck at estimating wait times. But, you will, eventually see a doctor.
Now, I understand that you have a disclaimer that says that people should call 911 for Emergencies, and that they will not use your service for life threatening emergencies. I don't think that's not going to keep you from getting sued when Uncle Bob dies of his massive heart attack that he though was a bad burrito and put his name on your waiting list. That's also not going to help you sleep at night thinking about how you might have prevented Uncle Bob's death.
I'm not trying to flame you. I'm really not trying to be nasty. I'm just trying to communicate what a big, big, huge mistake I believe this application is. Please, shut it down.
The need for such a website also points to a larger problem: a lot of people in the US, including most insured people, do not have access to timely primary care for non-life threatening problems.
Say your daughter has an ear infection, the appointment your HMO primary care physician gives you one week from now, is no good. So you go to the ER. There is no effective in-between option. I don't know if this website fixes that problem or exacerbates it. But that is the real problem.
This whole un- under- insured category people talk about in the US exists because people are actively being put in insurance plans where we know they will not have access to some health care services they will need. Let's not kid ourselves.
I guess it depends on your doctor, but we usually get an appointment the same day if someone is actually sick. Also, the in-between option is "urgent care", which is open at least 8 hours or so on Saturday and Sunday.
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[ 3.4 ms ] story [ 113 ms ] threadWe already have all the localization code, and with more hospitals I think this would work great as a module on the site.
I sent the suggestion "upward", but I have no way to know if it'll go anywhere.
So... what was that with the socialized medicine bashing?
Socialized health care usually only means worse service for the very rich. For everyone else it's a great thing.
Here in Australia you'd generally go to a GP, a public health center or have a locum come out to visit you before heading to a hospital. There are certainly still wait times, and a system like this might be able to help, but in general I think there's a much better spread of patients to the right location.
Not always:
http://en.wikipedia.org/wiki/Free_clinic
I don't know how widespread those are, though.
Seriously, though, I hope that this startup escapes the regulatory issues and goes Big. It solves a clear problem for both patients and hospitals, will greatly increase societal welfare, and it should attract Big Bucks (TM) because of the amount of money wrapped up in the problem it solves.
This page is one of the best brief sales pitches I've ever seen, by the way:
http://inquicker.com/page/inquicker_benefits
Everything about it is great. It scans great. It directly addresses the customers' needs and makes it explicit what tangible benefits buying in will get them. I have bookmarked it so that when software vendors ask how to improve their website I'll say "Your benefits section should look like this".
Best of luck.
1. Add some auto-suggest features to the 'add a hospital' form.
2. Use an IP address/geolocation service to guess where I'm located and pre-populate the state for the form.
3. I tried to add my local hospital, and received a very ugly error message:
====
Internal Error
There was an error processing your request. The system administrator has been notified of the problem, it will be fixed as soon as possible. Please try again later. TELEPHONE SUPPORT
For telephone assistance, call our on-duty support technician at (770)-597-9185.
====
The fact of the matter is that the vast majority of the visitors to this site believe that most problems have a technical solution. I happen to believe that this technical solution has the potential to exacerbate an existing problem and that other non-technical solutions are possible. What is needed is a combination of 24 hour clinics/urgent care centers, more fast-track departments and convincing certain people that there is no need to visit a doctor for a bad cold unless certain symptoms appear or one doesn't recover in a reasonable length of time. Encouraging more people to visit the emergency department for non-emergencies does not seem prudent to me.
I don't disagree with you, and it must be said I question the need for such a service...but given the state of waiting at emergency departments today, I could see how this is useful for those people with small emergencies that for whatever reason can't be dealt with elsewhere. For now. The long term solution would obviously be to do something similar to what you suggest.
There are 5,700 hospitals in the U.S.(AHA) and ~ 4,500 emergency rooms.
Do you know how many of these clinics there are?
Of course, InQuickER (or something like it) is just going to integrate with the clinics and urgent care centers. I'm going to select "ear infection" and enter my zip code and it's going to give me a selection just like Orbitz.
For example here is the list of states which CVS operates clinics in:
http://www.minuteclinic.com/en/USA/Clinics.aspx
Here is the list of conditions they can treat:
http://www.minuteclinic.com/en/USA/Treatment-and-Cost.aspx
Note "treat and write prescriptions" in the very first sentence on the page.
Additionally, many hospitals operate onsite "fast-track" clinics which are connected to the ED, so low-acuity conditions are essentially treated in something resembling a retail clinic.
Our goal is to make the emergency medical treatment experience as efficient as possible. Parents don't want to be sitting in the waiting room half the night, potentially exposing their children to contagious diseases in the er. Professionals lose valuable time to ER visits that drag on forever. We're trying to recapture that lost time and give the patients more control of the treatment process.
Until recently, I always thought these places would triage, but my experience has been that it is just 'take a number and wait' I've been in with a broken arm, a torn nose (that required stitches) and couldn't believed we were treated exactly like a headache. So, this looks great. Try the Silicon Valley next so we can try it!
Anyone who is scared enough or in enough pain to be considering an ER visit is about as far from a 'rational actor' as possible. Helping them make good decisions not only smooths out the system, it also gives people essential help when they need it most.
Nice job. :)
I'm thinking of taking it a step further, though, and would like your opinion. I have a couple ideas for services, but they would take a couple weeks to build. Do you think it would be worthwhile to post an Ask HN thread, seeing if people express interest in paying for my potential products, before I build them?
Zack
A) What sort of workflow do you use to exchange scheduling and appointment data between your site and the ER?
and
B) Is it the same for each participating hospital? If not, how are you planning on scaling your operation to include more than four hospitals? I'm genuinely curious, having done some work on ER workflow analysis and modeling. I think this is a great idea, but can envision some pretty significant workflow issues on your horizon depending on how you've got stuff set up currently.
We're implementing at relatively low-volume locations (in the neighborhood of 25-35k pts per year), and so far we've used the same manual workflow at all locations without any problems, but I think we need full integration for long-term growth.
I'd love to talk further by email -- can you send me a note at tyler@mystartupdomain?
Oh, and one last question: where you funded by YC?
If we could find another way to keep the signal-to-noise ratio high, I would love to offer this service at a lower price point.
Awesome job, by the way.
It seems lowering the price would gut your revenue but you wouldn't increase your userbase enough to make up for it (there would be a big deadweight loss of utility that patients get, but don't have to pay for -- lost revenue for you).
Also, ER is an incredibly expensive thing to go through, so mentally your users may be more price-insensitive than usual--they'll bucket all the costs together in a 'big bath', so you can charge more.
At best, you win because the ER staff hits the right keys for your automated message. Or they agree to do a full agreement with you.
I don't understand (even after looking at the How it Works page) is how it works. Since you can't predict what types of injuries that are going to come in that are more critical than yours, how can you gaurantee an appointment time?
At this point, we have a 99.9% success rate with that guarantee: less than 1 out of every 1,000 patients has requested a write-off of the bill.
I also wonder if you could talk about the incentives you use to get hospitals to sign on to your program - while you're adding value, you're also costing them staff time. Do you pass on a portion of the $25 to them, or is the idea that they will make up the cost by having more people come to them and thus getting more volume?
Lastly, have you considered partnering with insurance companies to offer this service as part of a premium's offering?
All-in, great idea you have - this is the kind of health care innovation we need.
A person interested in the first can use inquicker; someone more interested in the latter can still bustle off to the ER and pace around, or something.
If you're capable of shopping around for the best appointment time then shouldn't you be seeing a GP instead?
If this scales, it will let me pick which of 4 local ER's I'm going to go to based on wait time. I'd pay $50 a visit for that. I'd subscribe to a service like this simply in anticipation of needing it eventually.
Good luck.
The health system in Canada isn't ideal (or the Netherlands where I am now) but having to check emergency room wait times has never even occurred to me.
'Down a hospital hallway, a row of stretchers line the wall near the nurse's station. On one of them is an elderly woman who's in pain.
She has been waiting for four hours to get into a room with a bed, but there isn't one available.
This is happening nearly every day in hospitals across the province and the GTA," said a nurse with 22 years of on-the-job experience.'
Also, I echo the calls for a map-based or local-search interface.
But even granting your point, you can still market against that experience without implying that you only schedule people for ERs.
Right now I imagine that this site gets most of its business from people who call the ER directly, and then the participating ER tells them about the site (I could be totally wrong about that, though). Going forward, though, I would think that way that this is going to be used is that a user will know they need treatment, go to the site (find it via a search engine, whatever), look for the treatment facility that satisfies some mix of 'near', 'soon', and 'perceived ability to treat my problem', and put their name down.
If there's a marketing hump to get over, I would think it would be snagging people who are coming from a search engine or via some route other than having the ER send them there directly. It seems like the perception that this is just for ERs is more a problem in this sense - I'd personally be less likely to use it if I thought it wouldn't include nearby clinics in the list of places I could sign up for.
Do you have any mechanisms in place for two-way communication between the hospital and the people booking appointments? Specifically, I'm thinking about situations where a series of individually minor symptoms may collectively indicate something major is going on, but that a layman wouldn't know.
Like let's say that I go on your site and see that I can get an appointment at an ER in three hours, so I book that because I'm feeling slightly off. My symptom description seems innocuous enough - went for a walk in the countryside, right arm is tingling a bit, small red bump on my leg, etc. - but to someone trained in medicine they indicate that I've been poisoned by some sort of tick, and I need treatment ASAP, as opposed to in three hours. Is there a way for the nurse who processes this reservation into the hospital to call me and say "screw the booking, get here now!"?
Emergency medicine in the US is in a horrible state. Overcrowding is one of the primary reasons. See: http://www.ama-assn.org/amednews/2009/01/19/prsb0119.htm
One of the primary reasons for the large influx of patients is the diversion of primary care visits into the ER for non-urgent matters. A booking system that encourages non-urgent care visits to the ER as opposed to other urgent care options does nothing to help this.
As other commenters have mentioned, the problem with overcrowded ERs from a patient perspective where they have a potentially emergent case is NOT in the middle of the night - it's during the day, where other options (including primary care and urgent care facilities) are available.
Emergency medicine should not be treated in the same convenience form-factor as other consumable goods, and applying this approach is socially irresponsible in the big picture.
If you want to solve the ER overcrowding problem, you should do it directly, by adding a surcharge (over and above the one that already exists) for nonessential ER visits. There's no rational reason to force people to sit in a crowded ER waiting room.
Meanwhile, a retail interface to the ER scheduling systems that already exist is more likely to help than hurt overcrowding, because it will route patients to the least crowded ER in their area.
[1] To the extent that emergency room overcrowding is due to people without other health care options (i.e., the un- and under-insured) using ERs as their primary care facilities, surcharges really won't help: by definition, these are people who can't pay for medical care... so adding additional surcharges probably won't have much effect on their ER utilization.
There is no reason at all that our respective agendas about how US healthcare should be run should require me to wait on-site in the hospital, as opposed to in my home at 1AM, or in my hotel room when I get violently ill on a trip.
There will always be cases when people need to use the ER, and there will never be a good reason they shouldn't be able to call ahead for a soft appointment. Everything about the system, from patient routing to triage to hospital staffing, works better with a system like InQuickER in place.
My argument was only with the idea of using surcharges to deal with overcrowding. The reason that ERs are chronically overcrowded is not (generally speaking) because of people getting ill on trips, being in car accidents, or having ear-infected kids. The reason that ERs are overcrowded is the large number of people for whom ERs serve as primary care facilities.
As you (correctly) pointed out, these people probably wouldn't be using InQuickER-like services anyway, so they're not relevant to the question of whether scheduling systems are helpful or not. I think that scheduling systems lke InQuickER definitely could be helpful to patients that use them, and maybe to the ERs themselves... but also that, depending on the specifics of a given ER's catchment area, they won't have much impact on overall crowded-ness, since that's largely due to a segment of the population that won't be using the scheduling system anyway.
Now, if one could find a way to make these people more likely to use the scheduling system, you might see more of an effect.
Of course, I could be completely wrong- IANDNAIHEOHQE (I am not a doctor nor am I a health economist or healthcare quality expert), and when it comes to health care quality interventions (which is what InQuickER basically is) it is not at all uncommon for things to behave in a counter-intuitive manner. That's why solid evaluation of system outcomes is so important. Hopefully the participating hospitals are keeping a close eye on their utilization statistics... for their sake, I hope that the InQuickER people are insisting on it- being able to show a significant change in in-ER waiting time due to their system would be the single best marketing tool that they could possibly hope for.
Adding to the list of things that I could be completely wrong about, my sense of who InQuickER's users are could be dead wrong. Tyler, what are your user demographics like? Do they mirror those of the hospitals that are using the system?
This is a spectacularly bad idea. I can unequivocally say without a doubt that if you pursue this service, someone will die.
Why? Because I've seen it happen.
Part of my job as an ER nurse is to triage patients that come in. Triage involves sorting through the dozens of patients that come in every night, and decide who can wait and who cannot because they have a life threatening emergency. People having symptoms of a heart attack move to the front of the line. People who ate a bad taco and have the shits get seen on a space available basis. That's the gig. I sort patients: sort_by_acuity([bad taco, bad taco, bad taco, heart attack, runny nose, cough, gun shot wound, ear infection, headache, headache, headache, stroke, headache]).
I've been doing this job for 15 years, and I have seen plenty of triage mistakes that can change people's lives for ever. I've made a few myself. You care for thousands of patients a year, you're going to drop a ball every now and then. But, I have a lot of experience doing this, and I have a lot of knowledge and very good instincts on when someone is very ill. Patients do not have that knowledge and I would never trust your customers to make that decision when life and death is on the line.
This is why ER's are almost universally abysmal at judging how long it's going to take to be seen by the doctor. The same team that is taking care of your earache at 3am or helping you get stitches after you cut your finger on your computer case, is the same team that can crack your chest open and do open heart massage on you after a thug sticks a knife in your heart. We take care of bladder infections and dying babies, sometimes right next door to each other at the same time. ER's are built for safety, not speed or even convenience. The fact that in the US, they are primarily the only type of physician that can be seen 24/7 without an appointment is an unfortunate effect of our health care system. But, we have to care for the sickest patients first, and you can never predict when the next ambulance is going to roll through the door. So, ER's suck at estimating wait times. But, you will, eventually see a doctor.
Now, I understand that you have a disclaimer that says that people should call 911 for Emergencies, and that they will not use your service for life threatening emergencies. I don't think that's not going to keep you from getting sued when Uncle Bob dies of his massive heart attack that he though was a bad burrito and put his name on your waiting list. That's also not going to help you sleep at night thinking about how you might have prevented Uncle Bob's death.
I'm not trying to flame you. I'm really not trying to be nasty. I'm just trying to communicate what a big, big, huge mistake I believe this application is. Please, shut it down.
Say your daughter has an ear infection, the appointment your HMO primary care physician gives you one week from now, is no good. So you go to the ER. There is no effective in-between option. I don't know if this website fixes that problem or exacerbates it. But that is the real problem.
This whole un- under- insured category people talk about in the US exists because people are actively being put in insurance plans where we know they will not have access to some health care services they will need. Let's not kid ourselves.