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Why Doctors Reject Tools That Make Their Jobs Easier

blogs.scientificamerican.com

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Re: Why Doctors Reject Tools That Make Their Jobs Easier

#61

Post by WalterBright »

Zelphyr wrote: post #58
EB66 wrote: post #57

Earlier quoted context omitted.

I agree. This article is off the mark. On the contrary, doctors want tools that will assist them in providing better patient care outcomes. In all my career, I've never met an anesthesiologist, trauma surgeon nor a hospitalist who has ever expressed a concern that technology will make them obsolete. On the contrary, almost universally these individuals are overworked and are thrilled to hear about anything that might…

> doctors do not want tools that are clunky And yet every EMR system I've ever seen is comically bad. Why the medical providers haven't revolted over being forced to use those things is beyond me.

Most consumer software is tragically bad. For example, the automatic cat feeder I have has probably the second worst user interface I've ever seen.

The worst was a thermostat.

Heaven help you if you ever lose the manual.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#62

Post by jrumbut »

zdragnar wrote: post #54
jrumbut wrote: post #51

Earlier quoted context omitted.

One of the problems I see here, and would love to find a way to solve it, is that software is best developed interatively. I see a lot of software that has some cool ideas, it just needs some tweaks to get rid of ridiculously annoying flaws, or needs to put some more control in the user's hands. Unfortunately, and inevitably, a little tweak in medical software may as well be a tweak on a satellite in space. Like I sa…

Safety first, full stop, no exceptions. Until correctness can be done easily in accessible programming languages with a decent developer pool, iteration in this space, along with other life-critical spaces such as trains, planes (and wouldn't automobiles be nice too?) is sadly a long, manual process compared to web development. Edit: to expand a bit on correctness, think Coq but with the ease of Java or Typescript. E…

Well that's totally true, but even then I have no idea what the legal mechanism is for making a formally verified language in the context of a medical device looks like, or even decision support software like the grandparent was discussing.

Even if such a thing existed, it would require a very rich set of constraints on the program to be able to encode something like "won't make the wrong decision when a patient has a pulmonary embolism and these three other conditions" and I think that's what doctors would want.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#63

Post by projectileboy »

Zelphyr wrote: post #58
EB66 wrote: post #57

Earlier quoted context omitted.

I agree. This article is off the mark. On the contrary, doctors want tools that will assist them in providing better patient care outcomes. In all my career, I've never met an anesthesiologist, trauma surgeon nor a hospitalist who has ever expressed a concern that technology will make them obsolete. On the contrary, almost universally these individuals are overworked and are thrilled to hear about anything that might…

> doctors do not want tools that are clunky And yet every EMR system I've ever seen is comically bad. Why the medical providers haven't revolted over being forced to use those things is beyond me.

Because it’s the same situation as with any enterprise software - the buyers are not the users, and they are evaluated at how well they did or not do their job based on a whole host of criteria that have absolutely nothing to do with satisfied users.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#64

Post by daveFNbuck »

jrumbut wrote: post #51
Fomite wrote: post #24

An alternative headline is "Tool Makers Make Tools That Don't Help Doctors". I know a ton of colleagues who flinch every time someone mentions that this'll just hook into the EMR system, because they know everything will be broken and tedious for years before another vendor comes along. At a conference I was at recently, I'm nigh positive "Decision Support Tool" was a dirty word.

One of the problems I see here, and would love to find a way to solve it, is that software is best developed interatively. I see a lot of software that has some cool ideas, it just needs some tweaks to get rid of ridiculously annoying flaws, or needs to put some more control in the user's hands. Unfortunately, and inevitably, a little tweak in medical software may as well be a tweak on a satellite in space. Like I sa…

This is not unique to software. Physical objects also benefit from iterations in development. That doesn't mean you have to update things you've already sold. The iteration happens when people buy the next version. This used to be how software was sold too.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#65

Post by rpcastagna »

EB66 wrote: post #60
Zelphyr wrote: post #58

Earlier quoted context omitted.

> doctors do not want tools that are clunky And yet every EMR system I've ever seen is comically bad. Why the medical providers haven't revolted over being forced to use those things is beyond me.

They really are comically bad (Cerner, Epic, Meditech, all of them), but they are effective data silos which is a step up from having that data silo'ed in filing cabinets. People outside healthcare really don't understand the sheer amount of time your physician spends trawling through the medical record in the regular course of doing his or her job. You can think of the patient chart as a shared "My Documents" folder…

These experiences also exacerbate the perception that I referred to before that can basically be summarized as "every previous attempt at making this better ended up being completely terrible". A whole slew of people want to improve things, but a lot of the time they don't take that responsibility seriously enough -- or know, fully, what that entails -- and when they bail that leaves the next would-be "disruptor" at a disadvantage.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#66

Post by noonespecial »

The number one thing you can do to get doctors to use your new tool is find a way so that they don't have to enter patient data again.

The fear they have isn't that they'll be replaced on the job. The fear they have is that they will be required by some policy to enter yet another copy of the same data into yet another "time saving" system.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#67

Post by conanbatt »

Zelphyr wrote: post #58
EB66 wrote: post #57

Earlier quoted context omitted.

I agree. This article is off the mark. On the contrary, doctors want tools that will assist them in providing better patient care outcomes. In all my career, I've never met an anesthesiologist, trauma surgeon nor a hospitalist who has ever expressed a concern that technology will make them obsolete. On the contrary, almost universally these individuals are overworked and are thrilled to hear about anything that might…

> doctors do not want tools that are clunky And yet every EMR system I've ever seen is comically bad. Why the medical providers haven't revolted over being forced to use those things is beyond me.

Its my believe that its impossible to build the killer EMR, or at least, nobody has approached that.

There are many reasons for it, just as making software to manage restaurants has been an impossible one. The use cases are operationally extremely different in all cases.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#68

Post by conanbatt »

zdragnar wrote: post #54
jrumbut wrote: post #51

Earlier quoted context omitted.

One of the problems I see here, and would love to find a way to solve it, is that software is best developed interatively. I see a lot of software that has some cool ideas, it just needs some tweaks to get rid of ridiculously annoying flaws, or needs to put some more control in the user's hands. Unfortunately, and inevitably, a little tweak in medical software may as well be a tweak on a satellite in space. Like I sa…

Safety first, full stop, no exceptions. Until correctness can be done easily in accessible programming languages with a decent developer pool, iteration in this space, along with other life-critical spaces such as trains, planes (and wouldn't automobiles be nice too?) is sadly a long, manual process compared to web development. Edit: to expand a bit on correctness, think Coq but with the ease of Java or Typescript. E…

> Safety first, full stop, no exceptions.

And here you are, cutting-edg hospitals running 2012 versions of modern software, and paying millions of dollars for the privilege.

The direction has to be exactly the opposite, by giving the patient increasingly more control over his own health.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#69

Post by jayd16 »

Zelphyr wrote: post #58
EB66 wrote: post #57

Earlier quoted context omitted.

I agree. This article is off the mark. On the contrary, doctors want tools that will assist them in providing better patient care outcomes. In all my career, I've never met an anesthesiologist, trauma surgeon nor a hospitalist who has ever expressed a concern that technology will make them obsolete. On the contrary, almost universally these individuals are overworked and are thrilled to hear about anything that might…

> doctors do not want tools that are clunky And yet every EMR system I've ever seen is comically bad. Why the medical providers haven't revolted over being forced to use those things is beyond me.

Its really strange how much punishment doctors seem to receive and how much they're willing to take. The hours alone would be laughable in any other industry.

Re: Why Doctors Reject Tools That Make Their Jobs Easier

#70

Post by jcranmer »

Someone wrote: post #43
cf498 wrote: post #32

Earlier quoted context omitted.

I think this is something that isnt that present in our profession as it should be. If you are an electrical engineer, it is clear and present, that your products might kill someone if you screw up. The same goes for a mechanical engineer. And it will be your responsibility. If you screw up and should have known better, you might even go to jail for negligence. We on the other hand have the Therac-25. We claim to be…

Therac-25 was thirty years ago, and still is the go to example. That made me wonder. If you compare, for example, https://en.wikipedia.org/wiki/List_of_bridge_failures#2000–p... or https://en.wikipedia.org/wiki/List_of_structural_failures_an... with https://en.wikipedia.org/wiki/List_of_software_bugs , software doesn’t look that deadly.

People generally don't attribute failures to software bugs if there is anything else that contributes to failure. The list in particular is missing the loads of accidents caused by bad UI; incidents of "I was just following the GPS's/autopilot's directions" that result in death are missing (such as the KAL 007 airliner incident).
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