Doctors ask engineers to spend more time in the hospital before building apps • Hacker News Board

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

#121

Post by samstave » Sun, Dec 30, 2018, 6:59 AM UTC

chiph wrote: post #66

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.

We did, but Ascom were generally viewed as being ugly and the "blackberry" of handsets, and had their own issues. I can't recall the details too clearly now - but I think at that time, Vocera was also the new sexiness in the market and so most hospitals were going Vocera.

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

#122

Post by hvindin » Sun, Dec 30, 2018, 7:00 AM UTC

analog31 wrote: post #71

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…

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…

As an Australian I always struggle with the idea that healthcare would cost money above a couple of dollars for things that aren't essential.

But almost every American I've ever spoken to who hasn't experienced decent national healthcare seem to have a bizzare view that "if it's free then obviously it will be abused", not realising that it's just as open to abuse as a system where end customer are also involved because shockingly customers arent usually the ones committing the fraud.

It genuinely feels like theres a view that some people might not "deserve" healthcare, and the way we determine who "deserves" healthcare is not the very humane "well they need it, therefore they deserve it" but rather "capitalism. Definitely the answer."

Makes me a little sad, but I guess when you have nothing else to compare it to...

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

#123

Post by sjwright » Sun, Dec 30, 2018, 7:53 AM UTC

hvindin wrote: post #122

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…

As an Australian I always struggle with the idea that healthcare would cost money above a couple of dollars for things that aren't essential. But almost every American I've ever spoken to who hasn't experienced decent national healthcare seem to have a bizzare view that "if it's free then obviously it will be abused", not realising that it's just as open to abuse as a system where end customer are also involved becau…

Also Australian.

The concept of abuse seems hilarious. What abuse? That people might visit their local doctor more frequently? That's a good thing! Many ailments get more expensive to treat the longer they are left untreated.

Once you come to terms with the fact it's permanently cheap/free, the psychological incentive to be wasteful ("use it or lose it") disappears completely. By comparison the American capitalist health system continually reinforces the notion that healthcare has monetary value, which means failing to take advantage of it feels wasteful.

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

#124

Post by odyssey7 » Sun, Dec 30, 2018, 7:57 AM UTC

cordite wrote: post #31

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…

Epic is often compared to Salesforce, which is to say even if there is a better localized app for a specialty (of which there are many in healthcare), the next questions are: How do integrate this into the other apps, how does it get into the record, how can people in other specialties receive information downstream to act appropriately from medical side to billing side. Then there's the last non-app part, what is th…

> There are whole teams in health care and applications from suites like Epic ... just for refining billing.

To anyone interested in AI in healthcare, I suspect that datasets of procedure and diagnosis billing codes could be some of the most accurate and immediately usable of their size.

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

#125

Post by gaius » Sun, Dec 30, 2018, 8:01 AM UTC

sjwright wrote: post #123

hvindin wrote: post #122

Earlier quoted context omitted.

As an Australian I always struggle with the idea that healthcare would cost money above a couple of dollars for things that aren't essential. But almost every American I've ever spoken to who hasn't experienced decent national healthcare seem to have a bizzare view that "if it's free then obviously it will be abused", not realising that it's just as open to abuse as a system where end customer are also involved becau…

Also Australian. The concept of abuse seems hilarious. What abuse? That people might visit their local doctor more frequently? That's a good thing! Many ailments get more expensive to treat the longer they are left untreated. Once you come to terms with the fact it's permanently cheap/free, the psychological incentive to be wasteful ("use it or lose it") disappears completely. By comparison the American capitalist he…

The concept of abuse seems hilarious. What abuse? That people might visit their local doctor more frequently? That's a good thing!

In the UK A&E is flooded with people with minor ailments that could have been treated at home with a first aid kit, or people who are just drunk. The system is definitely taken for granted. People even call ambulances for a ride to an appointment, not even an emergency.

Source: once spent 5 hours waiting to be seen in A&E, sitting on a plastic chair with a broken leg, while kids with grazed knees and people with minor colds were seen before me. If I needed the bathroom or a glass of water, I had to get up and hobble there on my broken leg. The NHS were great once I actually got seen, but they are swamped with idiots demanding unnecessary medical attention, because it's free.

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

#126

Post by gaius » Sun, Dec 30, 2018, 8:02 AM UTC

tracker1 wrote: post #28

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.

Didn’t Massachusetts General develop MUMPS in-house?

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

#127

Post by paulie_a » Sun, Dec 30, 2018, 8:04 AM UTC

Ideally every developer should have to spend a significant amount of time actually interacting with their customer, and in this case the customers customer. It would give a different perspective about that feature that is being built. It sounded good in a planning meeting and will never be used in the real world.

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

#128

Post by paulie_a » Sun, Dec 30, 2018, 8:13 AM UTC

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?

If a developer is relying only on the product manager without first hand experience. It's a recipe for failure. I am a huge promoter of making devs do CSR, hell even make them do sales calls on occasion. The insight to the end user pain points is important. Devs need to hear it first hand.

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

#129

Post by KineticLensman » Sun, Dec 30, 2018, 8:21 AM UTC

gaius wrote: post #125

sjwright wrote: post #123

Earlier quoted context omitted.

Also Australian. The concept of abuse seems hilarious. What abuse? That people might visit their local doctor more frequently? That's a good thing! Many ailments get more expensive to treat the longer they are left untreated. Once you come to terms with the fact it's permanently cheap/free, the psychological incentive to be wasteful ("use it or lose it") disappears completely. By comparison the American capitalist he…

The concept of abuse seems hilarious. What abuse? That people might visit their local doctor more frequently? That's a good thing! In the UK A&E is flooded with people with minor ailments that could have been treated at home with a first aid kit, or people who are just drunk. The system is definitely taken for granted. People even call ambulances for a ride to an appointment, not even an emergency. Source: once spent…

Also UK. Some 'abuse' of A&E happens because people cannot alway get access to a local surgery as opposed to driving to a nearby hospital, especially at weekends.

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

#130

Post by gforge » Sun, Dec 30, 2018, 8:24 AM UTC

I am an orthopedic surgeon during the day and at night I write code. I just don't believe that spending a few hours watching surgery actually helps. You need to really work with the software, a solve daily problems and be aware of what problems are trivial software fixes.

For instance, when I sign lab results I get to see the references for twenty year old subjects. It would be much more helpful to see the patients last lab result (in 60+% of the cases this is available).

Another example is in the ER where we have a list of all the patients. There is a column for my name so that I know which cases I am handling, unfortunately that column is too the far right and only visible after resizing the other columns. This setting is also not saved so each time I open the list I have to resize over and over again. If you could move that column to the left would be great, or even just bold font my patients' name.

The major problem that I see is that we have:

- huge monolithic software that make any change a living nightmare

- all changes are treated as we were doing open heart surgery. Most stuff we do is trivial but having a standard that high makes it almost impossible to deploy updates - especially the minor changes that really would change things.

- 80% of users complain about the software but very few understand the underlying problem.

- much of our software is spec driven - I can sign my lab results and I can see the patients in the ER, no one bothered to add the last tweaks to actually make it easy.