Everyone hates the electronic medical record • Hacker News Board

Re: Everyone hates the electronic medical record

#61

Post by makeitdouble » Tue, Jan 30, 2024, 6:47 AM UTC

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…

Same disclaimer: not in the US.

From the other side of the table, as patients that were very regularly ill and bouncing between medical professionals, EMR were a godsend.

For instance in vacation at the other end of the country, we lost an Anapen with a luggage mishanded at the station, though we had a spare but we actually didn't (was in the same bag...). We went to the closest doctor, showed the insurance card and they got access to the allergologist's diagnosis and original prescription, gave us a new one with a memo in the file, and done.

Same way having two generalists looking at us, one near my work and another near home wasn't an issue. At no point did we have to bring folders full of papers to explain long treatment histories etc. (it still helps to have the key files, in particular scans)

I moved away and everything is back in small silos at each doctor/clinic, and it's a real PITA.

I'm truely sad it's such a pain on the care giving side, because there's so much potential and I think it merits investing a lot to get something decent. It's such an important part of our forseable future.

Re: Everyone hates the electronic medical record

#62

Post by YetAnotherNick » Tue, Jan 30, 2024, 6:47 AM UTC

FwarkALark wrote: post #59

YetAnotherNick wrote: post #52

Earlier quoted context omitted.

Is there any industry in which public competitor is better than private one?

I mean, all industries? The profit margin guarantees this. Anyone who has worked in private industry will verify its utter incompetence in the long term.

Can we talk about particular examples? I know for a fact that in my area private train ticket booking app is vastly better than government one. So at least there is an exception.

Re: Everyone hates the electronic medical record

#63

Post by dieortin » Tue, Jan 30, 2024, 6:48 AM UTC

JusticeJuice wrote: post #24

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.

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

If I’m not mistaken, the Spanish healthcare system has a fully electronic medical record.

Re: Everyone hates the electronic medical record

#64

Post by redsoundbanner » Tue, Jan 30, 2024, 6:52 AM UTC

cfu28 wrote: post #37

redsoundbanner wrote: post #33

Earlier quoted context omitted.

Why was the government subsidizing that?

Probably as part of the meaningful use policy in the US. Early adaptors were initially incentivized to move to EMRs off paper charts. Today the incentive no longer exists. Instead theres a penalty in the form of reduced Medicare/medicaid reimbursement for practices that don’t comply.

Great answer. Thanks for not just downvoting me.

Re: Everyone hates the electronic medical record

#65

Post by stevebmark » Tue, Jan 30, 2024, 6:53 AM UTC

Wow, this is all over the place, not worth reading. Also it fails to point out a critical and very confusing distinction: EHR stands for "electronic healthcare record," as in an individual record / file / document, but in healthcare tech "EHR" usually refers to "Electronic Healthcare Record System" - a product like Epic / Athenahealth / etc. Also surprisingly no mention of the semi-garbag-y healthcare data interchange format FHIR.

The author seems confused - confusing issues with EHR system UX and data entry and data fidelity and interoperability itself.

Re: Everyone hates the electronic medical record

#66

Post by bongodongobob » Tue, Jan 30, 2024, 6:53 AM UTC

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…

I could see that badge system easily costing a million+ dollars, fyi. RFID identity management is an entire platform in itself and is extremely expensive.

Re: Everyone hates the electronic medical record

#67

Post by yannis » Tue, Jan 30, 2024, 6:54 AM UTC

ianso wrote: post #29

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…

Very true, people complain about software, but my recent experience in a Gulf country, was stellar, all my medical records, were entered properly including procedures, it takes approximately 12 minutes to get medicine from the pharmacy and can view the records online. The patient interface could be improved a bit but did its job perfectly. The article was stellar, as it summarized the state of the art and the issues well.

Re: Everyone hates the electronic medical record

#68

Post by friendzis » Tue, Jan 30, 2024, 6:56 AM UTC

m463 wrote: post #48

I wonder if it can just be a market. Standardize the data format and install apps that manipulate it. Let pediatricians choose one editor, surgeons another, nurses another, etc... Maybe the surgeon's app is text to speech. The pediatrician hooks into his stethoscope.

These parts are largely irrelevant at large as they make at most single digit percentage of complexity

Re: Everyone hates the electronic medical record

#69

Post by singingfish » Tue, Jan 30, 2024, 6:57 AM UTC

Relevant - paper here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3250633/ - which is the paper that rescued my PhD (on electronic health records rather than medical records, but adjacent).

Note that Scotland got electronic medical records much more correct than England by making the whole thing a Clinician lead process rather than the English technocratic approach.

Finally it's very difficult to do "proper" scientific research on electronic health records, as control matched research is not achievable. Therefore you have to reach for things like single case study

Final brag - when I submitted my PhD it was politically quite sensitive so we had to find the right external assessors. One expert, one person whose judgement we trusted. The expert returned their report saying what a great piece of work it was and it should receive high commendation. The other person said it was solid and thorough but ultimately pretty obvious. Therefore I conclude that I received better than a high commendation for my work :D

Re: Everyone hates the electronic medical record

#70

Post by avh02 » Tue, Jan 30, 2024, 6:59 AM UTC

rurban wrote: post #54

I, as patient, love it though, the German system. In January they added electronic receipts ("Rezepte") and this was the deal breaker for me. Lots of smaller doctor offices complained though. Only the bigger ones offer it.

I can say this has its flaws too... I was recently trying to pick up a prescription but the first pharmacy i visited did not have it in stock, they gave me my card back and i went to another pharmacy who could not find a prescription on the card. Turned out the first pharmacy forgot to "release" the prescription back after they told me they don't have it in stock.

Had to go back to the first pharmacy, have them unlock it, go back to the second pharmacy, only to be told after they could read the prescription that they do not have it in stock either.

The problem here is not the digitalization itself but the tangibility of the implementation. how could i possibly tell that i was wasting my time on my way to the second pharmacy?

With paper i would see that someone forgot to hand me back my prescription and i would not have left the first pharmacy prematurely.