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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

#171

Post by DanBC »

sjwright wrote: post #146
therealidiot wrote: post #134

Earlier quoted context omitted.

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.

If you're inside the catchment area it's very difficult for the GP to not register you. GPs are expected to provide service to almost anyone living in their region.

If you're outside the catchment area the GP can chose to offer full service; offer limited service; or offer no service.

The full service includes things like home visits, so it's not surprising that GPs seek to limit that to patients who live far away.

For people who are travelling there are temporary registrations, but also GP walk in centres and GP out-of-hours services.

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

#172

Post by DanBC »

sjwright wrote: post #161
gaius wrote: post #152

Earlier quoted context omitted.

Surely you should be allowed to visit any GP anywhere A GP practice is a private business, usually all the GPs are partners just as lawyers or accountants would be, and the staff such as receptionists are not NHS employees, they work for the practice. If they can't bill the NHS for their services because you're not on their books, they aren't interested. It is surprising perhaps, but many people in the UK are unaware…

Right, but why are private practices artificially limited for whom they can bill the NHS? That seems like pointless, unnecessary bureaucracy that comes back to bite them with more A&E visits.

> why are private practices artificially limited for whom they can bill the NHS?

I'm not sure they are. Here's the (admittedly complex) book: https://www.england.nhs.uk/publication/primary-medical-care-...

Note this is only for England. I have no idea about the rest of the UK.

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

#173

Post by DoreenMichele »

philtar wrote: post #167
DoreenMichele wrote: post #119

Earlier quoted context omitted.

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.

I find your anecdote a little difficult to balance with the stories of all the vets who need medical treatment but can't get it.

I'm not up on what you are referencing.

I can tell you active duty is different from what retirees deal with. Also "vets" doesn't necessarily mean they are retirees. If they didn't serve long enough to qualify for retirement, it's possible to be a veteran without still being part of the military benefits system.

You actually have insurance in the military. When my husband was on recruiting duty, we did not live near a military base. I had to deal with insurance at that time.

But when you get treated at a military facility, you show your ID and there is no bill -- at least, this was true back when I was a military wife.

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

#174

Post by technics256 »

samstave wrote: post #120
fencepost wrote: post #83

Earlier quoted context omitted.

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... S…

Could you elaborate on Siemens wanting to steal it?

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

#175

Post by commandlinefan »

derekp7 wrote: post #65
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…

Oh absolutely - it was as simple as a fix can be, given (perfectly legitimate) quality control concerns, but it never would have happened if I hadn’t had a rare opportunity to actually observe how they work.

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

#176

Post by criddell »

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.

There's a balance though. A huge bureaucracy to stop all fraud is expensive and cumbersome. There's going to be an acceptable level of fraud in order to keep the administration costs of the system in check.

Other countries have figured this out. The US could use the experience of our allies that already have systems that are working to design a system for us.

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

#177

Post by m0zg »

whymauri wrote: post #147
m0zg wrote: post #92

Earlier quoted context omitted.

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…

Sure, there will be cases where your device will say "I'm at a loss here, go see a doctor". The point is, right now the majority of (very expensive!) doctor visits are a total waste of everyone's time, and your money.

There's no rational reason why I need to drive to a lab for bloodwork or simple diagnostics, and have a human do it: a robot at a local convenience store should be able to do the job. There's no rational reason why I need a doctor to misdiagnose my elbow pain as something requiring surgical intervention (I just stopped using my laptop in bed and it went away). Another doctor ordered a ($900) MRI to diagnose pain in my left shoulder and then told me I have a SLAP tear there based on extremely blurry results (again $$$$, surgical intervention, and 6 months of recovery). Bullshit, bud, I don't - it's a non-dominant arm, and I'm someone who doesn't do a lot of throwing or work above shoulder level. It was that dang laptop in bed again. Someone with weaker critical thinking skills and google-fu would be thousands of dollars poorer thanks to taking that doctor's "advice". In fact they could end up with a permanently fucked up shoulder and elbow, too.

Did you know that medical errors are the third leading cause of death in the US, right after heart attack and cancer? Seems to me that "human" doctors are also a dangerous proposition.

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

#178

Post by analog31 »

Joky wrote: post #103
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…

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

To me, this just sounds like something normal and beneficial, described in scary-sounding words.

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

#179

Post by samstave »

technics256 wrote: post #174
samstave wrote: post #120

Earlier quoted context omitted.

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... S…

Could you elaborate on Siemens wanting to steal it?

They had told us that they wanted to integrate with us - then they expressed interest in buying us and had us come in for several meetings with their tech staff so they could ostensibly perform some due diligence - and had us go through our arch and demo for them and explain the vision and the features we had - claiming that they'd be forthcoming with an offer... then ghosted us after and it became clear they were then trying to create their own system based on our archtecture and what we shared with them.

Recall that scene from (was it silicon valley) where they did the whole thing on the whiteboard at the VC - where they stole the idea from there... yeah that happened to us.

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

#180

Post by mgamache »

DoreenMichele wrote: post #112
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.

Balancing safety vs progress is tricky. Additionally, people's perception of risk is also really bad so the resulting choices are sub-optimal.
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