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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

#51

Post by magicalhippo »

sys_64738 wrote: post #34

Software developers are incredibly poor at gathering requirements. The best choice for gathering those requirements is to have a management consultant who does nothing but study business process and document the current clinical process. Once that's documented then you can discuss what needs to change from that document to extract the core requirements. Having a software person shadow a medical professional will only…

> Software developers are incredibly poor at gathering requirements.

Customers are also often incredibly poor at defining their requirements, at least in my experience. Like having undocumented routines which are only recalled by that one employee once they have to actually perform them, once a year or so.

Of course it's usually a really critical, time-sensitive issue when they discover that the routine they never told us about hasn't been implemented and thus cannot be done... almost never fails that.

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

#52

Post by EpicEng »

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?

Of course there should be people who's primary concern is firguring out what to build, but the buck doesn't stop there.

If you're not solving problems you're just a medoicre code jockey. I want to work with people who build iseful things, not people who stop and understanding syntax and think that code is a goal into itself.

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

#53

Post by ndonnellan »

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…

Speaking as someone still working at a big non-epic/cerner EHR company-that-might-have-just-gone-private: it's not easy. When the money is controlled by large insurers who care about government and billing minutiae, and big hospital/health-care groups choose which software solutions to use, it's an uphill battle to make stuff that is really, truly patient centric.

Everyone I work with cares really strongly about making a really good product. We have great designers/UXers, a lot of experience in building different pieces of the workflows that tens of thousands of doctors and hundreds of thousands of nurses, MA, PAs, front-office staff _and_ patients, but when you spend a whole year readying for ICD-10 and then some yokels in DC push the deadline back a year... I belabor my point.

Engineers wanting to start a health care company should try working for a big EHR company first. Then go start somewhere else using modern technology, modern development practices with just a little more wisdom. Maybe.

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

#54

Post by nradov »

bm98 wrote: post #37
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…

Standards like SMART-on-FHIR [1] and CDS Hooks [2] have the potential to allow innovation developed outside of Epic and Cerner inside of those products. Both of those vendors even have "App Stores" [3] [4]. So far, though, there aren't a lot of apps in these stores, and none of my doctors (all of whom work for large academic medical centers and use Epic) have access to any third-party apps - so I do wonder whether th…

Epic, Cerner, and their major competitors are actually a lot more open now and no longer putting up major roadblocks. The real roadblocks appear to be in the hospital and clinic IT departments. They have to upgrade to a current version of the EHR which supports SMART on FHIR (many organizations are several versions behind) and then enable the app store feature. Some organizations have concerns about using third-party apps due to training requirements, security, and malpractice liability.

I do think that SMART on FHIR makes it easier to turn clinicians into software developers, so hopefully that will spur some innovative apps.

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

#55

Post by commandlinefan »

More time? I wish I was given _any_ time with my users so I could actually understand what features would make their lives easier. I actually did get to spend about two hours with some actual users of my software a month ago and I noticed that they were scrolling up and down a lot. I asked if it would make their workflow quicker if I made the save button float in the lower-right corner of the browser (I.e. position: fixed). They said, “you can do that? Oh my God, that would be amazing!” It took two seconds of CSS and has saved them hours already.

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

#56

Post by commandlinefan »

gregjor wrote: post #3

Example of a more general problem: developers not understanding the business domain. Developers often blame “poor requirements” for schedule and budget overruns, but they didn’t spend any time learning the business domain.

> they didn’t spend any time learning the business domain

Weren’t given any time to learn it. FTFY.

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

#57

Post by commandlinefan »

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?

“So, you physically carry the specifications to the developers?”

“Well, no, my secretary does that...”

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

#58

Post by ken »

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…

When I was developing internal software at a big company, I went to observe some actual users at the company. (I thought what we were building didn't make sense, so I wanted to see if they actually used it that way.) I got a tongue lashing from management for that one! "You're a developer. You're not supposed to talk to users."

The entire project, of course, was eventually cancelled.

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

#59

Post by nradov »

sonnyblarney wrote: post #43

Maybe we need a profession, you know, people who create experiences ... maybe we can call them 'UX designers' or 'UI designers' or something. Where they investigate how people use and relate to information before the Engineers build stuff. Maybe I'm just crazy!

They have UX designers. The problem is those designers don't necessarily understand clinical workflows. That takes years of experience.

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

#60

Post by canada_dry »

sonnyblarney wrote: post #43

Maybe we need a profession, you know, people who create experiences ... maybe we can call them 'UX designers' or 'UI designers' or something. Where they investigate how people use and relate to information before the Engineers build stuff. Maybe I'm just crazy!

Hey, there's a concept!

But, for companies that can't/won't (I consulted for one that wouldn't even hire professional BAs - they expected line staff to write the specs)... at least have the PMs and programmers go spend several hours in the client's dept. (around month-end is usually good) to get a feel for how things actually work.

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