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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

#81

Post by analog31 »

ams6110 wrote: post #75
analog31 wrote: post #71

Earlier quoted context omitted.

I'm sure I'm being naieve, but could we just get rid of billing altogether if we nationalize the health care system? I have to recount an anecdote. My mom was hiking in a foreign country, and got injured. She hobbled to the next town, and found a clinic. They treated her and were ready to let her go. She said: Q: Okay, how do I pay? A: You don't pay for health care. Q: I'm American. I'm not part of your health care s…

Somebody will be paying, and will want adequate and auditable documentation about what they are paying for. The potential for fraud is too great. Medicare and states all have to watch for fraud in their claim payments.

That's true. But I think the system could be simpler if there were fewer, and possibly just one, entities. I work in a factory, so we live by SAP. And it's complex, typical "enterprise" software, but I don't think it's even within an order of magnitude as complex as Epic.

We want an audit trail, but most of the transactions are made within a single business entity, e.g., from the stockroom to an assembly area. We've had process improvement projects that reduced the number of SAP transactions required to make something.

So maybe the key isn't so much having a government run system, but simply reducing the number of entities. For instance a hospital doesn't have to make a claim to Medicare, if the hospital is Medicare. Also, the game of figuring out how much to bill the patient goes away.

We don't even know how many entities there are in the medical system, or how much money is going to each one. Were I inclined towards cynicism, I'd suspect that this is by design.

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

#82

Post by xenadu02 »

ams6110 wrote: post #75
analog31 wrote: post #71

Earlier quoted context omitted.

I'm sure I'm being naieve, but could we just get rid of billing altogether if we nationalize the health care system? I have to recount an anecdote. My mom was hiking in a foreign country, and got injured. She hobbled to the next town, and found a clinic. They treated her and were ready to let her go. She said: Q: Okay, how do I pay? A: You don't pay for health care. Q: I'm American. I'm not part of your health care s…

Somebody will be paying, and will want adequate and auditable documentation about what they are paying for. The potential for fraud is too great. Medicare and states all have to watch for fraud in their claim payments.

If we had a national healthcare system the documentation would consist of proof of citizenship or permanent residency (or guardian's proof of same in the case of minors). That allows spot-checks to validate that fake or deceased people aren't being "treated" to generate fake charges.

Right now even Medicare/Medicaid need lots of process to verify you are eligible and/or enrolled. That wouldn't be a problem if everyone were covered automatically.

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

#83

Post by fencepost »

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…

We had a fully integrated HL7 iphone app which could interact with OpenVista, and other systems like Vocera and Philips and Siemens systems.

So you were attempting to provide charting capabilities on the first generation iPhone? Honestly even now with larger screens, etc I can't imagine that working well on anything smaller than a tablet, and HL7 would only be a selling point to potential partners or investors - 90+% of potential end users wouldn't have a clue about it. You might as well say "our app supports JSON and EDI!"

In 2007 that would have been a dancing bear - amazing to see, but not because of how well it dances.

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

#84

Post by tyingq »

One issue with software at hospital is that the various departments buy what's best for them, with little regard to interop needs with other departments.

So, admissions, for example, buys what they want, and don't care about the integration with, say, radiology.

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

#85

Post by fencepost »

danieltillett wrote: post #72

I have often wondered if it would be better to just hire professional data entry people to follow the doctor around and enter all the information into the system. Does it really make sense paying someone $500K a year to peck and tap into a EHR?

Hiring a medical assistant to effectively take dictation and record things in the EMR happens, but far more common are voice recognition systems and templating (which leads to its own set of issues). Long additional hours charting are another thing that happens - most doctors I know seem to spend at least a couple extra hours charting, dealing with labs, etc after they've seen their last patients for the day.

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

#86

Post by assblaster »

m0zg wrote: post #67
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…

>But it's still happening, starting with EKG and ultrasound.

Whole-body ultrasound? How would an AI understand how to interpret images with low signal:noise? Who will be performing the actual ultrasound image capture? Who will be ordering the imaging tests? How will an AI understand a patient that can't meaningfully interact with an AI?

What's the utility of "EKG" [sic] for diagnosing non-cardiac problems? Or, do you come from the perspective that all medical problems can be diagnosed with an ECG, urine analysis, ultrasound (of what?), blood test, and CT scan? Do you realize that an ECG is more complex than a single vector ECG via Kardia mobile?

I thought we were trying to reduce healthcare costs, but you're recommending over-utilization of expensive diagnostics?

Why are you limiting treatment to doctors only, why not have AI do everything?

Everything you've written demonstrates an extremely limited understanding of the practice of medicine, a characteristic far too common shared by those who are trying to "disrupt" medicine.

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

#87

Post by aasasd »

nradov wrote: post #59
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.

Jakob Nielsen was writing for decades now that the first job of an interface designer is to sit down with future users and see how they do their work. (Always users, more than one.)

It doesn't take years of experience in the target field. It just takes hours of watching and listening and figuring out what people are actually trying to do.

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

#88

Post by fencepost »

Para2016 wrote: post #30
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.

The only thing Epic has going for it is that it's not Cerner.

They also have that they're not eClinicalWorks or descended from Medical Manager (Intergy), that has to count for something!

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

#90

Post by tivert »

danieltillett wrote: post #72

I have often wondered if it would be better to just hire professional data entry people to follow the doctor around and enter all the information into the system. Does it really make sense paying someone $500K a year to peck and tap into a EHR?

> I have often wondered if it would be better to just hire professional data entry people to follow the doctor around and enter all the information into the system.

Those data people are called "medical scribes," my doctor has started using one. Seems like they're mostly pre-med college students looking to get exposure to healthcare environments.

https://en.wikipedia.org/wiki/Medical_scribe

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