Ask HN: Why is medical software so hard to use? • Hacker News Board

Re: Ask HN: Why is medical software so hard to use?

#21

Post by duffpkg » Wed, Nov 03, 2021, 1:22 AM UTC

flerovium wrote: post #15

duffpkg wrote: post #12

I wrote Hacking Healthcare for O'Reilly Media, created ClearHealth/HealthCloud, WebVista, yada yada... There are several factors that collide to make everything in software associated with health exponentially more difficult than in other areas. First, people's lives are actually on the line, the stakes are very high. Second, government regulation plays a significant role in how things can and cannot be done, this is…

Then why isn't more of it done on an electronic paper? If it served in the old world, why can't the software equivalent work?

Is there any electronic paper that works well and is reasonably priced?

Re: Ask HN: Why is medical software so hard to use?

#22

Post by Decabytes » Wed, Nov 03, 2021, 1:29 AM UTC

I work at a software company that works with medical data. We used to be much more agile before we were bought. After we were bought we went for government validation of our product. Once our system was validated, it really hindered our ability to change it. Every change has to be validated, and the system it touches has to be retested. It has really slowed down how quickly we get out updates, and I can see why software just stops after awhile once it is good enough

Re: Ask HN: Why is medical software so hard to use?

#23

Post by Taikonerd » Wed, Nov 03, 2021, 1:36 AM UTC

I have a related question...

The two big EHR systems (Epic and Cerner) are infamously complicated, user-unfriendly monoliths. And they're not interoperable, so once you pick one, it's very hard and expensive to switch your hospital to the other.

My question is, could EHR be "refactored" into smaller pieces? So your billing system is provided by Vendor X, and your imaging system is provided by Vendor Y, and they all talk to each other over an open protocol? That would make it easier for hospitals to switch away from individual systems / vendors that they hate.

Re: Ask HN: Why is medical software so hard to use?

#24

Post by tata71 » Wed, Nov 03, 2021, 1:37 AM UTC

flerovium wrote: post #10

anm89 wrote: post #7

Because the primary concern of all projects is compliance. Building the thing is an afterthought and it's gonna be expensive and take for ever to deliver anyway so everyone just throws their hands up and accepts it. Our whole system is designed around making Healthcare this highly moated bonanza for insiders who know how to gameplay beaurocracy so I'd argue its not much of a surprise that that's what we get: a bloate…

Is this the case? Transportation and logistics (especially national and international) is highly regulated, but the software is highly usable compared to medical records. Hedge fund automated trading software needs to pass innumerable compliance requirements. But the software is superb. Low-latency arbitrage software has incredible compliance burdens, but is some of the best engineered code on the planet.

People who own small logistics firms are culturally far more likely to fly in the face of regulation than those in the AMA.

This could explain the adoption/demand of more-cutting-edge SaaS etc.

Re: Ask HN: Why is medical software so hard to use?

#25

Post by SqueamOssi » Wed, Nov 03, 2021, 2:15 AM UTC

flerovium wrote: post #6

version_five wrote: post #5

Isn't it the classical enterprise software situation where the user is not the buyer? These are bought by administrators from sales reps based on features that appeal to "leadership". Its the same with any SAP or other major vendor implementation, the software itself is a steaming pile of crap, but it ticks all the boxes a non-user wants to see (compliance and reporting and whatnot). There is no incentive for the ven…

Really? I know medical professionals waste 50%+ of their highly-compensated time because of poor usability. If that isn't a cost to the buyer, I don't know what is.

I think the point that version_five was trying to make is that the decision makers have no visibility on how usable a system is in advance - they only see the checkboxes. At best, decision makers if they're curious, will learn how unusable and inefficient the system is years after they're locked in to their multi-million dollar commitment to implementing and training people on the system. And upon this discovery the vendors are of course there to say, that the hospital just need some more customizations, user training, or a new expensive module. Which just furthers the hospital's lock-in. The lather-rinse-repeat of enterprise software.

Re: Ask HN: Why is medical software so hard to use?

#26

Post by SqueamOssi » Wed, Nov 03, 2021, 2:40 AM UTC

Isn't this problem with inefficient and expensive healthcare systems another example of poorly aligned incentives? The vendors have financial incentive to build and sell systems that require long term, expensive, support contracts. Hospital administrators are incentivized to install turnkey systems (that don't require lots of their involvement), and to choose systems that provide reasonable assurance of regulatory compliance. It is simplest to accept vendors claims of improved productivity and overall long term return on investment. When the cost turns out to be higher than anticipated due to reduced productivity of staff and growing software customization services, those costs can be passed on to patients. From the perspective of the Hospital admins, and the vendors, all is well.

Re: Ask HN: Why is medical software so hard to use?

#27

Post by 25522552 » Wed, Nov 03, 2021, 2:47 AM UTC

F__a__t431

Re: Ask HN: Why is medical software so hard to use?

#28

Post by User23 » Wed, Nov 03, 2021, 3:21 AM UTC

It used to be the patient's charts were literally hanging from the foot of the bed and the doctor doing the rounds would flip through them.

Is there any current system that provides that level of frictionless experience for doctors? Or observability that the doctor is actually looking at the charts thoroughly for patients and patient advocates? In my observation there isn't. Although I will say that the ICU doctors I've observed are generally quite conscientious with the digital systems, even though it's clearly about as frictionless for them as JIRA is for us.

Re: Ask HN: Why is medical software so hard to use?

#29

Post by robbiep » Wed, Nov 03, 2021, 4:12 AM UTC

duffpkg wrote: post #12

I wrote Hacking Healthcare for O'Reilly Media, created ClearHealth/HealthCloud, WebVista, yada yada... There are several factors that collide to make everything in software associated with health exponentially more difficult than in other areas. First, people's lives are actually on the line, the stakes are very high. Second, government regulation plays a significant role in how things can and cannot be done, this is…

I like the concept of 'paper bandwith'. That rings so true with my experience. I've lived through a number of transitions from paper to Cerner.

At one hospital, they were going live across the entire 600 bed facility in a 2 week period. It was also the start of the new interns - I was there as a surgical registrar.

We went from having our 4 person team (Senior Registrar, myself, 2 Juniors) pushing the cart with the files around, taking 4 minutes per patient, Juniors carefully watching and observing the examination, writing useful shorthand, to a situation where both Juniors were pushing dual-screen COWs frantically trying to keep up with reported findings and plans.

Later in that transition period I was on nights and called to review a patient with SOB. They had been in for 10 days - typical chest that could be APO/could be Pneumonia. The last time the chest findings were documented in Powerchart was 10 days ago on ED admission!! Of course, poor documentation is part of the problem but every day that patient had had their chest examined, there just wasn't a useful way to document it in a shorthand way and the juniors were totally overwhelmed, requiring 2 of them to do the job of half of one of them previously

Re: Ask HN: Why is medical software so hard to use?

#30

Post by mikewarot » Wed, Nov 03, 2021, 4:28 AM UTC

duffpkg wrote: post #12

I wrote Hacking Healthcare for O'Reilly Media, created ClearHealth/HealthCloud, WebVista, yada yada... There are several factors that collide to make everything in software associated with health exponentially more difficult than in other areas. First, people's lives are actually on the line, the stakes are very high. Second, government regulation plays a significant role in how things can and cannot be done, this is…

A friend used to work ER, any time the computers went down, the backlog in the waiting room would get cleared up. Paper works so much better when you're just trying to save someone's life, and don't know which of the hundreds of different forms you'll eventually have to fill out in the computer.