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

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141–150 of 216 posts

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

#141

This is so true. One of my previous professional experience was working for a company that delivered a complete hospital information system that was used in two of the biggest health institutions in the Middle East. Initial software development was done offsite, but then, the owner and CTO of the company thought it more wise to bring in the developers on-site. On-site here meant that our team was provided an actual a…

A problem with so many local customizations becomes apparent when it’s upgrade time. You must do several X the testing and there’s a higher risk of something breaking.

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

#142
post #105

Earlier quoted context omitted.

>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…

You don't have to be rude... > What's the utility of "EKG" [sic] … What’s the Difference Between ECG and EKG? The fact of the matter is that an ECG and an EKG are the exact same thing. That’s right, the most surprising difference between an ECG and an EKG is that there is no difference at all. Both ECG and EKG stand for electrocardiogram. So, if an ECG is the same thing as an EKG, then why are there two different abb…

EKG also avoids confusing patients. ECG and EEG are a little to close to each other. And don't get me started on explaining what EGG is when you already have ECG and EEG to worry about.

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

#143
post #84

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.

You could also make the same complaints about the vendors for each.

It’s fun when some systems handle a bed-swap gracefully. But others don’t.

Or what happens when you figure out who your John Doe is and how to propagate that.

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

#145
post #130

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 l…

All that you mention points to lack of proper UX design process as part of SDLC. Observation is part this process, it is important and better not to be skipped, because it can provide very useful insights, but it’s just a single stage of research - there are more techniques and methods to solve problems that you mention.

Yes, there have been numerous people pointing out this in this thread. I think that UX design is viewed as frosting on the cake instead of the thing that actually makes it work. Unfortunately I think one of the issues is that the SDLC is broken.

For some reason we keep getting features that few of us actually requested but that often make sense in that they are life saving, that is if people actually used them. I have a ton of indicators flashing all-over the place and after a while your brain simply adapts and ignores them. I doubt that anyone has actually done any analysis to see if these tools actually save lives.

I've been involved in some projects when I've spent 30 minutes with UX people and then never heard back from them. When the final product arrives it is full of annoying flaws, e.g. the latest software I was involved in the work flow is: 1. click on "open software" from the patient chart 2. a new window opens where I manually have to click on "log in" (note, I'm not adding a password) 3. the UI goes into authentication 4. the UI goes back to the login screen 5. the UI asks me a question that I _always_ answer the same thing to 6. I actually get to the data I was interested in

The most annoying part is number 4 - if I accidentally click on "log in" everything breaks and I have to close the window and redo everything from start.

Most of these UX issues fall under the category - murder by a thousand cuts. It is mentally tiring to be faced with all these issues but none of them is like open heart surgery where one mistake can be fatal. What happens is that doctors/nurses become tired and don't put the effort into the patient interaction where the actual value in healthcare is created. I'm pretty sure that bad UX in the end kills many more patients through this than malfunctioning critical hardware.

I truly wish that people in this forum that create health-care software think of UX and actually use their software more than just "I clicked through and everything works". Your bosses will probably never ask for UX features because they have a deadline, but you are in charge of designing and during that process it is easy to fix many of these annoyances (e.g. just disable the log in button).

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

#146

Earlier quoted context omitted.

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.

This. I had half of my face stop working and had recently moved (and not yet registered with a new GP.) I went to my previous GP and they turned me away (no longer in the catchment area) so I eventually ended up in A&E. It doesn't help that the local ones near me at the time seem to live in the past... No call queuing or online scheduling, have to call within a 1 hour slot for appointments (so that's an hour of busy…

Why does the NHS have catchment areas? Surely you should be allowed to visit any GP anywhere. People do travel after all.

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

#147
post #92

Earlier quoted context omitted.

>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…

Sure, I realize there's much that the current tech does not cover. But you gotta start somewhere, and through extremely wide deployment tens of thousands of lives will be saved, and important feedback will be collected to improve products. $400 watch that does a dozen other things and that the user would buy even if it didn't have ECG is not "expensive diagnostics". This is where things are at, whether you like it or…

Smart/Self-serving diagnostic tools occasionally fail for legal feasibility reasons before they are adopted by the market. Consider a smart heart monitoring system, maybe connected to a canary that will alert a healthcare professional or first responders if something is amiss. Absolutely nobody wants to be liable for misdiagnosing acute symptoms, which may lead to death or false positives.

It doesn't even have to be acute symptoms, either. A large healthcare company a friend worked at was working on a smart heart monitor that for some reason they wanted to connect to an app. In their head, the app would be used by both the patient and their doctor who would check on the patient. If they have a lot of patients, that's an overwhelming amount of data streaming in 24/7. The time commitment to really evaluate those data for anomalies was too high, as were the stakes. Doctors were scared that if they missed something they might be held liable for unrelated medical emergencies which is terrifying for them. At the time, algorithms were really not good enough to catch the really subtle markers of an impending medical problem. At least according to the guy that told me this, he was a biomed/hardware engineer not a programmer or statistician by any means.

Even if you had some legalese associated with the product to make this a non-issue, doctors still wouldn't trust the idea. So they pivoted the technology to something else that was more traditional. It is much harder to pursue justice for an algorithm than a human. I guess what I want to get at here is: sometimes the software and hardware are working as intended, but subtleties can be lost on the technical side (programmers, biomed engineers) can kill a product. Stuff like market research, liability and legality, and public perception of the tech.

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

#148
post #117

Earlier quoted context omitted.

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.

Billing definitely happens. And one procedure can trigger billing from multiple different providers. I had my appendix out a few years ago and received separate bills from the hospital, the surgeon, the anesthesiologist, and possibly something else (nursing?). I was able to get the hospitals portion written off ($~20,000 and I was unemployed and uninsured at the time) but no such luck with the other providers, and those bills and the collections agencies followed me for years until I could get them paid off.

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

#149

Earlier quoted context omitted.

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.

If they are public employees, they have sort of a standardized salary coming straight from the healthcare ministry/department/whatever where the specific hospital just administer the HR part. You still think in a for profit manner, where healthcare in most countries is not a for-profit endeavour. As long as it works, it's fine, even if it's a net negative. You try to limit the money you waste and inefficiencies, but not by pulling levers on the staff salaries.

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

#150
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.

From my Spanish Perspective. What fraud? Going to the doctor is literally useless unless you're ill. They will literally send you away home if they find you to be fine. The doctors and nurses and personnel and what have you will also get mad at you for wasting their time unjustifiably (and I've done this myself and oh boy they left an impression on me). If you mean Government fraud, from the ones planning the system…

You're right that "patient"-doctor fraud is unlikely, but receiving unnecessary medication (addictive/fun/valuable drugs) or medical people overcharging or charging for unperformed or unnecessary procedures is a possibility for fraud.
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