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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

#61

Post by nradov »

qudat wrote: post #42
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…

Healthcare is a heavily regulated industry and as such only large companies are able to successfully navigate the bureaucracy. The only way to usurp coercive monopolies is by creatively destroying it (e.g. uber)

The regulatory requirements for security and interoperability are all things that every EHR vendor ought to be doing anyway. Regulations aren't a significant obstacle to new market entrants.

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

#62

Post by maxxxxx »

ken wrote: post #58
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.

I see that a lot too. There are a lot of well-paid managers whose only role is to be middlemen between engineers, customers and other departments and they protect that role jealously.

I agree that some developer probably shouldn't be talking to customers but overall they should. I have had many occasions where we received a spec and after discussion with users quickly saw how we could meet their needs in a much simpler way than the middlemen had come up with.

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

#63

Post by samstave »

I am biased, but I spent almost half a decade building/designing systems for Healthcare. I had direct interaction with the users, the vendors and the actual go-live planning for a number of facilities.

Healthcare has a lot of issues, EPIC was a stone-walling garden, Siemens wanted to steal stuff, OpenVista was a non starter, Philips talked a big talk but never followed through, Not everyone was truly HL7 compliant, Users didnt believe on Apps on the iphone/ipod-touch as the screens were too small and the average age of users was ~57, The number of employees in a large hospital is in the thousands, Patient Entertainment systems were snake-oil-jokes, "medical grade" devices were a fraud, and selling into them at this time was a unique process for every hospital -- and while the users (clinical staff) really really want to (and do) provide good care, training 1,000+ Staff/Nurses on your new tech is very daunting.

Obviously we have made a ton of progress in tech in healthcare, but finding a way to consume more time with staff/processes can be a difficult problem to figure out access.

Silicon valley needs an actual research hospital for tech - if I were throwing my billionaire last name on SFGH/UCSF/Oakland etc's hospitals - I'd do a lot more than just buying the name of the building - seeking how to work together to make an SV research hospital happen in an innovative way.

(We had a fully integrated HL7 iphone app which could interact with OpenVista, and other systems like Vocera and Philips and Siemens systems. We had a channel to work with hospitals around here but the screen size and costs of providing handhelds to nurses were too high for 2007. YC Turned us down, Epic and Cerner would allow integrations... We opensourced it to Openvista.)

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

#64

Post by otto_ortega »

I'm have the desire to make an attempt of developing a new type of EMR system, putting special focus on the documentation part of things.

Is there any health care practitioner around here with time for a 15-minutes phone interview or willing to exchange a few emails so I can better understand his/her needs?

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

#65

Post by derekp7 »

commandlinefan wrote: post #55

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:…

The problem is that it may take 2 seconds of CSS, but it is a software change that then requires the product to be revalidated, along with the matching paperwork (functional design doc, software design, technical design, customer support documentation and training material) and validation evidence to be submitted to your official document control system. And this process can take days, weeks, or months, depending on how complicated (due to extreme CYA) your compliance department makes the process. And the company compliance folks want to go overboard as they want to make sure the FDA auditors are happy the next time there is a surprise audit.

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

#66

Post by chiph »

samstave wrote: post #63

I am biased, but I spent almost half a decade building/designing systems for Healthcare. I had direct interaction with the users, the vendors and the actual go-live planning for a number of facilities. Healthcare has a lot of issues, EPIC was a stone-walling garden, Siemens wanted to steal stuff, OpenVista was a non starter, Philips talked a big talk but never followed through, Not everyone was truly HL7 compliant, U…

At a previous job we integrated with Vocera. Fun easter-egg with them - ask it to "Beam me up".

https://www.vocera.com/solutions-support/easter-eggs

> costs of providing handhelds to nurses were too high for 2007

Perhaps you should have looked at integrating with the Ascom handsets.

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

#67

Post by m0zg »

samstave wrote: post #63

I am biased, but I spent almost half a decade building/designing systems for Healthcare. I had direct interaction with the users, the vendors and the actual go-live planning for a number of facilities. Healthcare has a lot of issues, EPIC was a stone-walling garden, Siemens wanted to steal stuff, OpenVista was a non starter, Philips talked a big talk but never followed through, Not everyone was truly HL7 compliant, U…

I think eventually we'll have to sidestep most of this fraud entirely by enabling self-serve early diagnostics and cranking up the doctor-replacing technologies to the max. Machines are good at recognizing patterns in non-adversarial environments not starved for compute. There's every possibility that they could do diagnostics better than a human could. Treatment will be up to human doctors for the foreseeable future, though.

Too bad Theranos salted the earth for much of this innovation for the next decade. But it's still happening, starting with EKG and ultrasound.

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

#68

Post by brent_noorda »

Trisell wrote: post #38

It also doesn’t help that to break into this market you have to overcome years of customization and millions upon millions of dollars in sunk costs that management isn’t likely to throw out for something that “works better for clinicians.” Not to mention the cost of retraining entire hospitals worth of staff to use the new system.

So true. After over 30 years as a programmer, I recently switched to being a nurse in a hospital where half the day (it seems) is spent charting in the very old DOS legacy charting system. No one would write a system like that today, but with thousands of people muscle-memory trained on the old system, what reasonable argument could be made for a change?

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

#69

Post by macjohnmcc »

When I was a programmer at a non software company I would frequently sit with the users and watch how they used the existing software or how they did a task that we were considering creating software to help with. It was a great way to make a useful product right away rather than get back and lot of negative feedback about how it doesn't do what they need or expect if the software was written without that insight.

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

#70

Post by BurningFrog »

commandlinefan wrote: post #55

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:…

> I wish I was given _any_ time with my users

With some effort and/or ingenuity, you can probably take time with your users, one way or another.

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