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Doctors ask engineers to spend more time in the hospital before building apps

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Re: Doctors ask engineers to spend more time in the hospital before building apps

#21

Post by Barrin92 »

bobthepanda wrote: post #12
gregjor wrote: post #10

Earlier quoted context omitted.

Domain expertise is not wasted time. It makes the difference between a useful application and a pile of code. Developers should not assume they know more about a business domain than the people working in it.

Isn’t that the job of a product manager, though? To figure out what the product should actually do?

tacit knowledge especially in an hands-on field like medicine where patients are involved cannot be conveyed by a manager with a power point presentation.

This compartmentalisation in the name of efficiency is actively harmful. Developers should get out more and get first hand experience of the environments they develop software for.

Re: Doctors ask engineers to spend more time in the hospital before building apps

#23

Post by freedomben »

bobthepanda wrote: post #12
gregjor wrote: post #10

Earlier quoted context omitted.

Domain expertise is not wasted time. It makes the difference between a useful application and a pile of code. Developers should not assume they know more about a business domain than the people working in it.

Isn’t that the job of a product manager, though? To figure out what the product should actually do?

Yes, but I don't think it's wise or effective to put the onus all on a PM. As a dev, we often can have great insights into how much work/effort/maintainability one feature or another is, and having a rough knowledge of the business domain allows us to make much better recommendations regarding what we should do.

Additionally, in my experience the best engineers have been part product manager anyway, just as the best product managers have been part engineers.

Re: Doctors ask engineers to spend more time in the hospital before building apps

#24

Post by freedomben »

Barrin92 wrote: post #21
bobthepanda wrote: post #12

Earlier quoted context omitted.

Isn’t that the job of a product manager, though? To figure out what the product should actually do?

tacit knowledge especially in an hands-on field like medicine where patients are involved cannot be conveyed by a manager with a power point presentation. This compartmentalisation in the name of efficiency is actively harmful. Developers should get out more and get first hand experience of the environments they develop software for.

Could not agree more. It's a bit like the game of telephone that many of us played as children. The more hops in the connection, the greater ability for knowledge loss and distortion.

I once had a PM tell us to do a feature a certain way, despite engineers saying we thought it was dumb. We shipped and had lots of user complaints, and lost millions of dollars ultimately in lost revenue due to cancellations that we think were at least in part to this. We eventually reversed course but much damage had been done.

Afterward there was a witch hunt (which I staunchly oppose, but I digress). It turned out that the PM had taken the word of another PM who in turn heard from another that had gone on location and misunderstood what the customer was saying. To save a few thousand bucks the company only sent one person and expected them to brief everybody else on their findings. In hindsight I'm sure that skinnier travel budget wasn't so worth it.

Re: Doctors ask engineers to spend more time in the hospital before building apps

#25

Post by freedomben »

maxsilver wrote: post #20
zdware wrote: post #9

I worked a tiny bit over a year around 2013 at a hospital network and was on a team that maintained custom integrations with Cerner, an EHR system. It was by far one of the coziest jobs I ever had. Low stress environment, redundant meetings, etc. But development of any kind of god awful. It was extremely sluggish, lots of red type, and seemed to follow a manual QA approach over any sort of automated testing. Things w…

Agreed, this mirrors my experience in healthcare. Hospitals pay the highest amount of money, for the lowest quality of software (regardless of whether developed internal, or purchased through healthcare software vendors). The jobs are easy, and you can go months without doing any real work whatsoever. The company might not even care (since for hospitals, sales cycles are often measured in years, and minor upgrade cyc…

This was my experience in government work too. For every three engineers that accomplished nothing, there was one doing real work. Most good engineers would work there for 6 months or less and then flee in boredom or fear of not finding work at a "real job" again. The good engineers that stayed often found a niche they really liked, and were worshipped as rock stars by management and stakeholders, so they were pretty happy.

Re: Doctors ask engineers to spend more time in the hospital before building apps

#26

Post by freedomben »

mothsonasloth wrote: post #11

From software development classes in School to University, we were told the most powerful method of requirements gathering was observation. Yet in my whole professional life I've never had a chance to do it despite putting the idea forward. One of my old colleagues who managed to observe a client was met with hostility and questions from the people he was observing. Other times clients want to dictate and have no dia…

I once was in a position where I could observe, and I can confirm that:

> the most powerful method of requirements gathering was observation.

But the vast majority of my time has been at companies where engineers are never cleared to travel to meet with customers and gather information. It's insanity IMHO. It was the one bright spot about doing contract wor.

Re: Doctors ask engineers to spend more time in the hospital before building apps

#27

Post by oomkiller »

Unfortunately the problem is much greater than engineers not understanding doctors and other clinical staff, in my experience. For startups that want to sell to health systems and similar-sized/larger entities (really this is the minimum size that can work for most startups, practice sales usually have more friction than value), you unfortunately have to focus on the buyer, which is very rarely someone who is "in the trenches." Best case scenario, having software that is compelling to the end users can help you get your foot in the door early on, but actual adoption will only happen if you can convince the business stakeholders of your value.

In the US healthcare system, clinicians and the business often have opposing objectives and values. This is starting to change with value based care becoming more popular, but it's still all about providing what the business wants, it just happens to align with the clinicians more these days. You'll still need to support IE9 due to that botched Vista upgrade, build out a custom EMR integration, and deliver whatever random feature the sales folks promised (can you automatically fax things?) before you can move on to the features that the clinicians actually want.

The system itself is how we ended up with billing-driven documentation EHRs like Epic. Paradoxically, due to massive adoption, I think Epic and Cerner are some of the only places where real innovation could happen. I think even huge companies like Apple, Amazon, and Google will have a hard time breaking into the space, no matter how much cash they throw at it. For them, the only answer is to go fully vertical like Kaiser-Permanente, but I doubt they have the stomach for this.

Re: Doctors ask engineers to spend more time in the hospital before building apps

#28

Post by tracker1 »

oomkiller wrote: post #27

Unfortunately the problem is much greater than engineers not understanding doctors and other clinical staff, in my experience. For startups that want to sell to health systems and similar-sized/larger entities (really this is the minimum size that can work for most startups, practice sales usually have more friction than value), you unfortunately have to focus on the buyer, which is very rarely someone who is "in the…

Exactly.. short of the parent company of a hospital also owning a software company for the software this likely won't happen. Even then, software engineers RARELY get to interact with the people using said software for any meaningful time... It's usually meetings with your PM, Manager, their manager, and maybe the same on the other side. That's like 3-6 layers of separation in this telephone game.

Re: Doctors ask engineers to spend more time in the hospital before building apps

#29

Post by starpilot »

With any of these tech inroads into non-tech fields, the issue is always communicating to the non-tech people that your solution has value, and not developing the tech solution itself. If you're a salesman walking into a person's house, telling them they live their life wrong, and your (expensive) solution will fix it, good luck with that.

Re: Doctors ask engineers to spend more time in the hospital before building apps

#30

Post by Para2016 »

pragone wrote: post #16

I’m not at all surprised. As a semi retired software engineer and currently 4th year Med student, I still maintain a dream of building a usable EHR that puts the clinical, patient-focused side of things first. Currently implementations allow for increased billing recovery, but at a cost to both doctors and patients. I just don’t know how you’d start in competing with something like Epic or Cerner, from a business sid…

Epic lets you change provider context to Emergency department, internal medicine, etc. I think they just need to make the provider context suck a whole lot less. Epic Haiku (mobile) is a pathetic joke as well. Nevermind, I think you're right actually, the whole thing needs to be burned to the ground and built completely different. The only thing Epic has going for it is that it's not Cerner.
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