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Everyone hates the electronic medical record

logicmag.io

111–120 of 343 posts

Re: Everyone hates the electronic medical record

#111
post #49

I created the ClearHealth/HealthCloud open source (GPL) EMR which to my knowledge is the only open source one to receive full federal certification. Operations (not surgery) are so incredibly bad / incompetent in most healthcare settings that software frequently gets the blame for much deeper problems. This article is a doctors perspective on how software did not fix a completely broken workflow. I don't begrudge him…

"Operations (not surgery) are so incredibly bad / incompetent in most healthcare settings that software frequently gets the blame for much deeper problems." "In my experience doctors are a tremendous barrier to resolving problems in healthcare operations," I'm a hospital-based physician that works in a system with great operations and results. The physicians, nurses and other staff work amicably together. Management…

One of the biggest scandals in Norwegian health care at the moment is a botched transition to Epic in one of the biggest university hospitals. Doctor dissatisfaction has gone to the roof at the point where 50% of the doctors are considering quitting.

https://www.nrk.no/trondelag/70-leger-soker-aktivt-ny-jobb-v...

Re: Everyone hates the electronic medical record

#112
The one group who doesn't hate it: Australian patients.

New test result appears in your my health record app, the GP you are seeing has some crippled practiceware, you just show them your phone. Telehealth appointment to renew a script because my GP isn't available? $20 and done in 15 minutes with an eprescription.

This won't solve the hospital space issues, but at this rate I can see "tap to check-in with your hl7 2.3 adt a08" as a semi practical workflow

Re: Everyone hates the electronic medical record

#114

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 medic…

> FFS just implement an standard text format that we can upload or link to.

This exists, and it's older than the Web: https://en.wikipedia.org/wiki/Health_Level_7 .

However agreeing on how to use is another can of worms, see https://www.ihe.net/

Re: Everyone hates the electronic medical record

#115

Earlier quoted context omitted.

"Operations (not surgery) are so incredibly bad / incompetent in most healthcare settings that software frequently gets the blame for much deeper problems." "In my experience doctors are a tremendous barrier to resolving problems in healthcare operations," I'm a hospital-based physician that works in a system with great operations and results. The physicians, nurses and other staff work amicably together. Management…

I know that devs that work on EMRs might read this thread. I'm pleading with you to take the EMR to the next level when it comes to UI/UX and reliability.

I've managed large enterprise health organizations across multiple sites that use Epic. We built an adjunct system that is still used by some of them that papered over serious problems that doctors using them never knew wasn't only Epic. We defined, documented and tested real world workflows before we subjected patients to them. There are a lot of other ways to address those issues operationally. You have management, IT and operations problems, not software EMR vendor problems. No software is perfect, Epic less perfect than most. Your facility chose that system and decided how it was implemented in a way that is dangerous or potentially dangerous to patients. No software vendor can fix that. That's really the heart of my rants in response to this article.

I built that EMR, it was/is called ClearHealth/WebVista/HealthCloud. Your facility would never have bought it because incompetent management will only buy Epic. We solved the problem by buying organizations and replacing the incompetent management.

Re: Everyone hates the electronic medical record

#116
post #72
post #58

Earlier quoted context omitted.

How should operations be changed to address the problems?

At ClearHealth/CLH we defined thousands of core business processes in a typical over 100 bed acute care institution. These are complicated animals. A hospital of any size is pretty much a city unto itself. There isn't one thing, there are a lot, a lot of things from how items and equipment are procured which is very complex to simple things like making sure that people wash their hands when they should. How laundry a…

"99,000 americans a year die from hospital acquired infections that are entirely preventable using procedures and operations (not surgeries) that are known and evidentially proven. It's just really hard to get all of the parts of the orchestra to play the same tune so those people die needlessly."

??? I dont get this. The problem are Antibiotic resistant bacteria. You go to a Hospital (ER) and have a open wound.. chances are you die of an infection. How is this preventable??? This is a big problem atm and there is no good solution. you cant test people if they come in bleeding like hell for Resistant bacteria. I mean you can but ... I would like to hear the solution to that problem. Thank you.

Re: Everyone hates the electronic medical record

#117
post #92

Earlier quoted context omitted.

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

Germany too

hahahahahahahahahahahahahahahaha

This is a joke. We want to have this but its like everything in germany if its about something digital. Its a fucking mess. Everyone can read it. Most doctors dont use it and even many insurance dont use it... its a fucking mess

Re: Everyone hates the electronic medical record

#118
post #93

Earlier quoted context omitted.

"Operations (not surgery) are so incredibly bad / incompetent in most healthcare settings that software frequently gets the blame for much deeper problems." "In my experience doctors are a tremendous barrier to resolving problems in healthcare operations," I'm a hospital-based physician that works in a system with great operations and results. The physicians, nurses and other staff work amicably together. Management…

This sounds a lot like Epic. Respectfully I don't understand how your facility can face those issues with a system like that and also be considered to have great operations and results. With Epic it is possible to workaround a lot of notorious problems but management has to understand and have in place the operational capacity to do it. If a system is allowed to persist in an organization that may have or actually di…

Are you saying that the cancelled orders are due to a management decision/policy, and not a software bug? Or that EMR wasn't intended for managing orders and the decision to use it in such a way was wrong? Asking as someone who's mostly unfamiliar with this.

Edit - I'm trying to make sense of this thread, and it seems like this might be a reasonable summary: There's good and bad software (epic). The fact that management chooses epic instead of good software makes it a management problem.

@hyponatremia121 says that EMR software (epic) is terrible, which doesn't contradict the above. @hyponatremia121 pleading for EMR devs to focus on UX might be misplaced since their only experience is epic and not better EMR software.

@duffpkg saying that epic shouldn't be blamed here seems overreaching. If epic were good/hard to misuse this conversation wouldn't happen in the first place. But there's always well marketed terrible software, and I agree organizations that aren't able to avoid this do have organizational problems.

Re: Everyone hates the electronic medical record

#119

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

Following the sources listed there, "wrote most of the project off" seems like an overstatement.

> The MPA found that there have been substantial achievements which are now firmly established, such as the Spine, N3 Network, NHSmail, Choose and Book, Secondary Uses Service and Picture Archiving and Communications Service. Their delivery accounts for around two thirds of the £6.4bn money spent so far and they will continue to provide vital support to the NHS. However, the review reported the National Programme for IT has not and cannot deliver to its original intent.

Of the rest of the £12.4bn, £3.4bn is "expenditure by local NHS organisations, for example on local IT and training and ensuring compliance of local systems with Programme delivered systems", which probably isn't entirely wasted either.

Re: Everyone hates the electronic medical record

#120
post #104

Earlier quoted context omitted.

One would hope, but alas! Perl was notorious for being write-only back in the day. PoSh is closer to read-only for most devs. If someone makes sure to write things out the long way (or uses a linter to do this) it's very easy to grok. Actually learning to write it is the tricky bit.

> One would hope, but alas! Perl was notorious for being write-only back in the day. I don't agree that's a valid rebuttal, as the operative word is the weasel copout "know what they are doing". > PoSh is closer to read-only for most devs. A read-only language is a language with a serious expressiveness problem. In contrast with, say, Python, which you need to go way out of your way to write code that's hard to under…

>the weasel copout "know what they are doing"

Let's try a precise quality comparison, more for fun than anything. We have established someone knowing what they're doing makes any comparisons meaningless. I imagine you would agree with me that someone who "only kind of knows what they are doing" is even less helpful (what do they know? what do they not know?). So our last option is someone who does not know what they're doing, at all - they've never programmed before in their lives.

How many minutes of study would it take for them to decipher what a PowerShell program taken at random from the world of all programs written and used by human beings is actually doing? How about a Python script? How about a Perl program?

Most complete programs are short. Most complete programs do not use complicated data structures or algorithms. And most complete programs do something relatively simple, but useful to the writer. So one would expect T(PoSh) Now, how many minutes of study would it take for them to write and use a PowerShell program, versus a Python program, versus a Perl program? Our hypothetical knows-nothing person is statistically probably running Windows, to start. That cuts down on the time needed to fiddle with installation - PowerShell is right there, whereas someone totally new to this could easily lose a week just trying to get either of the other two installed and running for the first time. That's probably going to swamp the calculation.

After they've got it installed, they will likely spend a lot of time Googling or GPT-ing around for code that already does what they want. This is likely to be straightforward no matter which of the 3 we're working with. But they will almost certainly need to tweak it somewhat to get it to perform exactly what they want to do. This is going to be tough in any of the above languages. The readability of PowerShell would probably let this person figure out how to tinker with it relatively quickly.

After they've written a few useful programs already, sure, they might want to switch to something else - but probably not; most people have better things to do with their time than rewrite something that already works. More importantly that moves them from "doesn't know anything" to "kind of knows what they're doing", which is not a category of people we can reason about in general - although, if we were to reason about this person in particular, it seems reasonable to suspect that whatever tool they started with would be the tool they would stick with, especially now that they've paid the one time cost of actually getting it installed and working on their computer.

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