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Everyone hates the electronic medical record

logicmag.io

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Re: Everyone hates the electronic medical record

#21

Post by mr_toad »

nradov wrote: post #14
FwarkALark wrote: post #7

Earlier quoted context omitted.

Is this something where a public competitor might help? It surely can't be worse than private industry.

There is (or was) a public competitor. VistA was largely developed by the federal government. Some organizations still use it and it's available for free, but independent reviews have generally rated it as worse than the private industry products. https://worldvista.org/AboutVistA

I have to wonder how independent those reviews are when medical staff consistently rate it higher than commercial products, the system has won multiple awards, and when the VA tried to implement a commercial replacement it failed.

Vista is public domain, so there’s no money in it and no-one to take management out for expensive lunches.

Re: Everyone hates the electronic medical record

#22

Post by JusticeJuice »

sixothree wrote: post #6
JusticeJuice wrote: post #4

I wrote a thesis on EHR's 7 years ago. They really haven't seemed to improve much. I personally think a big part of the issue is actually scope, these systems are expected to do everything - medical notes, script ordering, appointment management, billing of course, and 3000 other things. This weirdly leads to a distribution problem, you can't be a serious competitor in just one area, you have to do everything. Only t…

Yea. But in that time there has been an absolute revolution in what can be done with that data. FHIR specifically has completely changed the landscape.

Yes. FHIR was pretty well established when I was writing the thesis, but I am very pleased to see it get more and more usage since then. Apart from interoperability the opportunities to do much better data mining from free-text medical notes with AI, are huge now. Back when patient prescription lists ot structured, so many new drug interactions were found, now there's the chance to do similar stuff from open medical records.

Patient-accessible medical systems are more common now too, which is great. EHealth got way more common. At the end of the day though, what your doctor is clicking on still sucks, which is the sad part.

Re: Everyone hates the electronic medical record

#23

Post by perilunar »

I spent two hours this morning helping my elderly mother fill in a hospital admission form online. The session timed out just before submission, but we logged in again and everything was saved. I'm grateful that it was online, so I could help her remotely via screen sharing and not have to travel to fill in forms (I'll visit when she goes in, just don't want to have to travel repeatedly for paperwork.)

Entering medical history and current medications was a pain in the arse though, and is something we have done many, many times over the last few years. FFS just implement an standard text format that we can upload or link to.

Re: Everyone hates the electronic medical record

#24

Post by JusticeJuice »

FwarkALark wrote: post #7
JusticeJuice wrote: post #4

I wrote a thesis on EHR's 7 years ago. They really haven't seemed to improve much. I personally think a big part of the issue is actually scope, these systems are expected to do everything - medical notes, script ordering, appointment management, billing of course, and 3000 other things. This weirdly leads to a distribution problem, you can't be a serious competitor in just one area, you have to do everything. Only t…

Is this something where a public competitor might help? It surely can't be worse than private industry.

The UK government tried this, wasted 12.4 billion pounds over 10 years, and ultimately wrote most the project off. The dream of an EHR is just deceptively tricky, so many smart, well-funded, well-connected teams have tried and failed.

ref: https://barnett.surge.sh/welcome/intro.html

Re: Everyone hates the electronic medical record

#25

Post by 8organicbits »

mrcarruthers wrote: post #13
KennyBlanken wrote: post #8

> Patient R was in a hurry. I signed into my computer—or tried to. Recently, IT had us update to a new 14-digit password. Once in, I signed (different password) into the electronic medical record That's IT infrastructure incompetence, not an EMR issue. At the two healthcare systems I go to, both utilize RFID badge readers plus PIN. In the ER and urgent care, nurses need only tap their badge and enter a quick pin and…

The email thing is probably a privacy requirement. Email isn't encrypted meaning your email provider (and the EMR's) can fully read the contents of said email.

I think people want to waive that privacy concern. My email provider has access to tons of my private data including lots of health data. Given the option, I suspect many would prefer to just get an email.

Re: Everyone hates the electronic medical record

#26

Post by perilunar »

wharvle wrote: post #9
jackvalentine wrote: post #3

Disclaimer - I work for a health service that isn't in the USA and has a very extensive EMR. I don't disagree. I started my career dealing with paper folders of records that were fastidiously organised by a team that made sense of them. Now everything is electronic and fucking _everywhere_. The work didn't go away - but giving everyone a computer made it everyone's problem and nobody's job. A really good EMR (or othe…

This is everywhere. We made everyone their own secretary but gave them crappy tools and no training. Also they’re never gonna be doing it more than very part-time, so will always tend to be bad at it and find it a distraction from the work they’re actually good at. I’m skeptical computerization has even been a net benefit for productivity for most jobs , for that and other reasons. I think it’s been such a huge boost…

Yes, we should have given the computers to the secretaries and librarians (and a few other jobs), and kept them away from everyone else.

Re: Everyone hates the electronic medical record

#27

Post by D13Fd »

mrcarruthers wrote: post #13
KennyBlanken wrote: post #8

> Patient R was in a hurry. I signed into my computer—or tried to. Recently, IT had us update to a new 14-digit password. Once in, I signed (different password) into the electronic medical record That's IT infrastructure incompetence, not an EMR issue. At the two healthcare systems I go to, both utilize RFID badge readers plus PIN. In the ER and urgent care, nurses need only tap their badge and enter a quick pin and…

The email thing is probably a privacy requirement. Email isn't encrypted meaning your email provider (and the EMR's) can fully read the contents of said email.

Yes but it should be the consumer’s right to simply say they don’t care about the risks, and prefer the convenience.

Re: Everyone hates the electronic medical record

#29

Post by ianso »

Popping up here to mention OpenMRS, a healthy open-source EMR used by hundreds if not thousands of facilities across the world, mostly in Africa and Asia. An old version is packaged/integrated with some other apps into Bahmni, which is a full-blown hospital management system.

Honestly, people complain about software all the time and all software sucks to some extent, some more than others of course. Complaining about all EMR just because the USA bodged a national rollout in their uniquely messed up healthcare situation is a bit myopic.

Re: Everyone hates the electronic medical record

#30

Post by thaumasiotes »

FwarkALark wrote: post #7
JusticeJuice wrote: post #4

I wrote a thesis on EHR's 7 years ago. They really haven't seemed to improve much. I personally think a big part of the issue is actually scope, these systems are expected to do everything - medical notes, script ordering, appointment management, billing of course, and 3000 other things. This weirdly leads to a distribution problem, you can't be a serious competitor in just one area, you have to do everything. Only t…

Is this something where a public competitor might help? It surely can't be worse than private industry.

Private industry is already worse than the older system of keeping notes with pen and paper. (Source: my mother operated her own medical practice and applied for a government subsidy to switch over to electronic medical records, then complained about how it reduced the functioning of her practice.)
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