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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

#111

Post by zhte415 »

chii wrote: post #97
SolarNet wrote: post #93

Earlier quoted context omitted.

Sure, but adequate and auditable documentation need not involve the patient nor money. Just a "here is the medical care we dispersed, on this date, to this person, it took these resources, these people administered the care." No following up every record for payments, no arguing with insurance companies over the price. And also, what abuse? If medical care is free and drugs are cheap, the only real abuse is drug abus…

> And also, what abuse? a clinic could mis-report (over-report?) how many patients they treated, and/or the procedure. They can then claim back more money than they actually spent, netting easy profit.

Audits. Monitoring of anomalies. Multiple traps.

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

#112

Post by DoreenMichele »

mgamache wrote: post #79

I work on a telemedicine product using Google Glass Enterprise and the current version of our product was shaped greatly from feedback provided by one early user (physician). It really focused our use cases and made the product much better. That being said, optimizing the current medical process will only get you so far. It will probably not result in large disruptive positive changes. Those will have to come from ou…

It will probably not result in large disruptive positive changes. Those will have to come from outside the current process.

Rest assured that anything that makes a significant impact on health will cause people to completely freak out if it hasn't been vetted via the current medical system, even though this vetting process kills a lot of therapies that people then lament that they wish they had access to.

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

#113

Post by craz8 »

chii wrote: post #97
SolarNet wrote: post #93

Earlier quoted context omitted.

Sure, but adequate and auditable documentation need not involve the patient nor money. Just a "here is the medical care we dispersed, on this date, to this person, it took these resources, these people administered the care." No following up every record for payments, no arguing with insurance companies over the price. And also, what abuse? If medical care is free and drugs are cheap, the only real abuse is drug abus…

> And also, what abuse? a clinic could mis-report (over-report?) how many patients they treated, and/or the procedure. They can then claim back more money than they actually spent, netting easy profit.

That happens with the current system

Some years ago, I met a doctor on vacation - bit of an ass, but whatever

Last year, I found out he’d gone to prison for “performing procedures” that he was mot present for, including some whilst he was on the beach in Fiji with me!

So, the federal government already has procedures to catch cheats at every level.

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

#114

Post by jdminhbg »

emilfihlman wrote: post #101
chii wrote: post #97

Earlier quoted context omitted.

> And also, what abuse? a clinic could mis-report (over-report?) how many patients they treated, and/or the procedure. They can then claim back more money than they actually spent, netting easy profit.

Solved by not allowing money to enter the circle. Results in you needing to sell the drugs/things you overcount on, which is rather easy to track and find out.

> Solved by not allowing money to enter the circle.

This is not possible without socializing the entire economy. At some point, you have to pay doctors, nurses, staff, equipment manufacturers, etc.

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

#115

Post by solatic »

SolarNet wrote: post #93
ams6110 wrote: post #75

Earlier quoted context omitted.

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.

Sure, but adequate and auditable documentation need not involve the patient nor money. Just a "here is the medical care we dispersed, on this date, to this person, it took these resources, these people administered the care." No following up every record for payments, no arguing with insurance companies over the price. And also, what abuse? If medical care is free and drugs are cheap, the only real abuse is drug abus…

> Sure, but adequate and auditable documentation need not involve the patient nor money. Just a "here is the medical care we dispersed, on this date, to this person, it took these resources, these people administered the care." No following up every record for payments, no arguing with insurance companies over the price.

This is naive. The source of income (whether it's insurance companies, the government, patients) are not the people who actually buy medical supplies for the hospitals. The simplest way to commit fraud is to charge the insurance company (in a privatized system) or the government (in a public system) for large amounts of care for fake patients in fake cases, which is only caught if an audit shows a mismatch between claims and supply, e.g. a hospital claims that it dispensed 5,000 doses of a $10,000 drug but can only show a purchase order for 100 doses (leading the hospital to fraudulently get $499 million).

You would think that the way to deal with that issue is to vertically integrate, i.e. the hospital issues orders for medical supplies which it doesn't pay for directly, and the medical supply company is compensated in some other way, probably by government funding. But this turns into a government-run market and it has all kinds of issues. Without pricing as a guide, hospital doctors over-prescribe supplies whose real price is far higher than older but similarly effective alternatives. Drugs which the hospital didn't order, but are absolutely crucial for patient X, are either completely unavailable (if the official supplier doesn't stock it) or tied up in medical bureaucracy (to get a special exemption for a special delivery of the drug). The quality of patient care suffers as a result.

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

#116

Post by danieltillett »

tivert wrote: post #90
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

Sounds ideal - they can even remind the doctors to wash their hands before touching the patient.

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

#117

Post by dmix »

DoreenMichele wrote: post #110
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…

I will see your anecdote and raise you one. :) When I was an American military wife, I mostly just flashed my military ID, made an appointment, picked up my meds, etc. I was diagnosed with atypical CF in my mid thirties and some of the things I was prescribed were not on the formulary of the military hospital. I went in town and had a co-pay of (IIRC) $13 per prescription. One day, I tripped across an old receipt: Mo…

Sorry, how is this relevant to what the OP comment posted? I don't follow...

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

#118

Post by mac01021 »

olefoo wrote: post #109
Joky wrote: post #103

Earlier quoted context omitted.

> If medical care is free It is never "free" (almost nothing is). Costs are usually covered through (forced) mutualization (usually through taxes).

If you are that strong a believer in the evils of socialism do you avoid Freeways, airports and the internet? All of which depend on public subsidy.

1. Noone said anything about the evils of socialism.

2. Why do you expect people to refrain from using services they've been forced to pay for?

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

#119

Post by DoreenMichele »

dmix wrote: post #117
DoreenMichele wrote: post #110

Earlier quoted context omitted.

I will see your anecdote and raise you one. :) When I was an American military wife, I mostly just flashed my military ID, made an appointment, picked up my meds, etc. I was diagnosed with atypical CF in my mid thirties and some of the things I was prescribed were not on the formulary of the military hospital. I went in town and had a co-pay of (IIRC) $13 per prescription. One day, I tripped across an old receipt: Mo…

Sorry, how is this relevant to what the OP comment posted? I don't follow...

We already have a healthcare system within the US where billing seems to mostly not happen. So, presumably, it isn't completely alien and foreign and something America would need to steal from elsewhere.

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

#120

Post by samstave »

fencepost wrote: post #83
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+%…

eh,

WEll - we had an ESB appliance which would tie into the various HL7 capable systems such that we could integrate for certain services, and provide interfaces/applications which turned an ipod touch into a quick duty/assignment/nurse-call/alert/control device.

Basically the intention was initially to integrate the ipod touch as effective a remote to the hospital.

Tie in with RTLS, assignments, results, orders...

So, yeah - it worked pretty well. Had support from nurses and doctors, but it was too early...

We were told by too many people it was too expensive and too small and nobody would want to interact on the phone.

We knew the ipad was coming... but failed to convince people.

About two years afterward, the iPad came out - we had already folded and released what did open source to OpenVista, and then Dr. Chrono was able to get traction where we couldnt.

(We were only two founders, no funding.)

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