Healthcare Entrepreneurship-as-a-Service

We are witnessing a dramatic unbundling of the services that power business. Almost every aspect of business can be unbundled into a monthly service.

My startup, Pristine, runs on a number of unbundled cloud services that until recently, would have traditionally been outsourced to HR firms or mega-IT companies. We run Pristine on ZenPayroll, RelateIQ, Google Apps, Expensify, Maxwell Health, Xero, Resumator, MediaTemple and more. Similarly, we’ve built our flagship service, EyeSight, on top of a broad array of development tools and services (check out the Pristine Engineering Blog to learn more about how the sausage is made). We’ve made it a priority to invent and do as little as possible by utilizing 3rd party stacks and services everywhere possible.

Healthcare is not immune to this trend. There are a number of companies that are unbundling health IT entrepreneurship:

This list should be 10x longer than it is. With all of the capital and startups entering the health IT space, companies providing the infrastructure to accelerate growth will thrive. As the old saying goes, “During a gold rush, sell pickaxes.” The companies listed above are selling pickaxes to proverbial gold miners.

I’ll conclude this post with some areas that can be commoditized as a service. Feel free to leave comments on other areas or companies that I missed.

  • Interoperability as a service (in lieu of HL7)
  • HIPAA compliant videostreaming as a service
  • HIPAA compliant image / video sending as a service
  • Analytics as a service

About the author

Kyle Samani

Kyle Samani

Kyle is CoFounder and CEO of Pristine, a VC backed company based in Austin, TX that builds software for Google Glass for healthcare, life sciences, and industrial environments. Pristine has over 30 healthcare customers. Kyle blogs regularly about business, entrepreneurship, technology, and healthcare at


  • What started out as a nice ad for yourself went on to point at a theory I’ve mulled over for some time.

    But first, as wrong as the thinking may be, I believe the big players in the EHR world don’t want interoperability. They don’t have APIs that will reduce your reliance on them. That is by design. I think this is old fashioned, but it still works for the bigs.

    If you look at the history of social media, the survivors thrive because they created an “eco system” where anyone could build onto the base system. Hence FB is strong with the efforts of others.

    To be a game changer, having an API to whatever you start online is key.

    In many industries the big players not only don’t have an API, they’ll terminate contracts if they see you are letting someone “fiddle” directly with the database…even though this is generally the only option to do anything custom.

    Don’t forget, as these services go to subscription based fee cycles…they had that before, only it was called a support contract.

  • Yup — a responsive HTML5 template (your list seems to all use the same one), and a Web site, and you have a biz. 🙂

    Pristine — “another pair of eyes” is a good idea.
    Patients might soon demand it as a standard of care.
    Like a quick second opinion.

  • As a small Marketing Consulting company, I use a lot of tools-as-a-services Kyle uses. They’re GRRReat.

    I do tend to agree with John Brewer – that healthcare IT big players do not want interoperability in spite of all the press releases and Photo Ops they do at HIMSS.

    Even if the ‘as-a-service’ model works, you can plug in lot of technology tools and solutions, but in the end, if the overall service does not help improve a workflow, all of that is null.

    Workflow and practice efficiency comes first. Many vendors are throwing in tons of ‘cool’ gadgets and tools, but sometimes they just create more commotion.

  • As a developer, I’m absolutely positive this is the wrong way to go. Your startup now has to have an expert in all the listed fields and you simply can’t afford to do that. My company is a one stop shop that designs and builds tools with an eye toward interoperability and reusability. This allows us to solve a particular problem once and be done with It and to use that solution as the way to solve that particular problem in perpetuity. Not only do you have a bewildering forest of technologies you are going to have an amazingly difficult time troubleshooting. No, I’ve been in this industry a long time and I’ve seen thousands of projects going down this path. If you are going to have to do the development anyway, do it right, don’t “borrow” some junior developer’s work and his mistakes. Moreover, now you have to integrate these disparate data streams into a cohesive whole, where if you started fresh and built from scratch you could probably get the whole thing done in the same amount of time you spend integrating. In fact, I know my company would spend less time and have a better product, because we generate about 80% of our code, so everything works the same, looks the same and is automatically documented. Further You will have to worry about versioning and changing interfaces breaking your application where I have complete control over my own source code.

    I’ll be speaking about this precise thing at the NC Federal Advanced Technologies Review next month. Maybe you should come listen.


  • @ M. Kirk – I’m surprised you wouldn’t want unbundling with the biz you are in…more one and done projects.

    I believe what you are saying is, if you are using 10 different services to run your business, there are 10 areas of expertise needed just to function…then when somebody leaves, lookout.

    Don’t forget folks, this is a normal progression of the business cycle. Next we’ll have consolidation.

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