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Everyone hates the electronic medical record

logicmag.io

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Re: Everyone hates the electronic medical record

#121

Post by phonon »

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

VA is moving to Oracle Cerner.

https://fedscoop.com/va-still-has-significant-concerns-as-or...

Re: Everyone hates the electronic medical record

#122

Post by rswail »

throwaway346434 wrote: post #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…

Except that specialists (in particular) hate uploading results into the government EHR. They want to review test results and then communicate with the patient, and the only way to do that is to not upload the results.

I had to talk to the pathology supplier, then get a letter from the specialist approving it, before they were allowed to upload the test results that were bulk billed on Medicare.

There's no incentive to get specialists to change their record keeping.

I've also spoken to several friends that are leading specialists, they had a long list of reasons why it was a bad idea medically, but changes in workflow would solve most of them.

Re: Everyone hates the electronic medical record

#123

Post by duffpkg »

rendaw wrote: post #118
duffpkg wrote: post #93

Earlier quoted context omitted.

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 managem…

I am lacking all the information as to whether we are even talking about Epic but Epic is a lousy tool. It is still just a tool though. For the unititiated Epic is not some tiny little software program to manage an ICU, it's a city scale platform to run most of a hospital city. You can do a lot of good things with it and a lot of stupid things with it. If in fact orders are being randomly cancelled in the ICU that's a problem that should have never reached a live rollout to an ICU without some sort of consideration for how to resolve it, that isn't a software vendor problem, that's a management problem. This is nicking an artery and blaming the scalpel. Maybe if it happens once but if it happens consistently the problem isn't the scalpel. The problem is with how the scalpel is being used. Epic dates some of it's underlying pieces to the 1980's at least, it has some well known problems and bugs. Better managed facilities develop workflows that successfully route around those problems.

In-N-Out does not as I understand it develop it's own Point of Sale system, they work with a vendor. What do you think would happen if In-N-Out had a location that was consistently failing to ring up orders or lose them randomly? Would the cashier blame the POS vendor and store management stand by and do nothing while the problem persisted? Would the system be rolled out without definition and documentation of workflow, reliability testing and proper training of the cashiers? Can we not operate our hospitals at least as well as we operate a burger stand?

Re: Everyone hates the electronic medical record

#124

Post by ako »

duffpkg wrote: post #80
persnickety wrote: post #77

Earlier quoted context omitted.

> In-N-Out instead of McDonalds, What is this comparison trying to illustrate?

A lot of facilities run on a McDonalds type thinking when they should be looking at how In-N-Out is able to deliver a very similar product that is both dramatically better and either the same price or even cheaper. In-N-Out staff is well compensated, customers rate the institution as one of the most beloved in american life. McDonalds achieves neither of those things. What makes In-N-Out different? The difference is…

I'm from Europe, have never heard of In-N-Out before, don't know how they work, nor the quality they provide...

Re: Everyone hates the electronic medical record

#125

Post by msteffen »

duffpkg wrote: post #80
persnickety wrote: post #77

Earlier quoted context omitted.

> In-N-Out instead of McDonalds, What is this comparison trying to illustrate?

A lot of facilities run on a McDonalds type thinking when they should be looking at how In-N-Out is able to deliver a very similar product that is both dramatically better and either the same price or even cheaper. In-N-Out staff is well compensated, customers rate the institution as one of the most beloved in american life. McDonalds achieves neither of those things. What makes In-N-Out different? The difference is…

Some of these suggestions seem like non-trivial management problems, though, I think?

Diesel fuel and generator maintenance: how do you hire for that? Does that position require experience? In what? Where do you post that job ad to get qualified candidates? If you hire wrong, it seems like the results could be worse than foisting the task on a doctor, no?

Revising formularies: how many doctors at a hospital have the right expertise for that? Who cares for their patients while the formulary work is happening? Can you hire someone temporary to come do it so it doesn’t disrupt operations, and how expensive is that person and how good is the result?

I’m a software person, not a doctor, but I _can_ see how these choices would be made if the alternative seemed riskier to someone inexperienced at hiring for hospitals.

Re: Everyone hates the electronic medical record

#126

Post by cutemonster »

rendaw wrote: post #118
duffpkg wrote: post #93

Earlier quoted context omitted.

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 managem…

When management insists to continue using software that:

> the EMR [is] cancelling orders I placed on critically ill patients in the ICU more times than I can count

then I suppose the management is a problem?

Maybe more competent managers would have given the software a test run smaller scale first?

And had a plan for returning to paper and pencils again, if the new software didn't work?

Re: Everyone hates the electronic medical record

#128

Post by ako »

Overall, while we as developers often prefer to focus on complex software engineering challenges, it looks like here the core problem is the user experience of complex data entry/administrative applications.

Designing for so many different types of users, different (customizable) processes/operations, different organizations using the software, is equally difficult to any engineering problem.

Unfortunately, the area of user experience is still very much undervalued for enterprise software, especially by the financial buyers. And without buyers valuing these aspects, vendors will not focus on these aspects.

Re: Everyone hates the electronic medical record

#129

Post by pintxo »

Naijoko wrote: post #116
duffpkg wrote: post #72

Earlier quoted context omitted.

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.. cha…

No direct experience here, but afaik the solution is strict hygienic standards, constant testing and isolation of positive cases.

Re: Everyone hates the electronic medical record

#130

Post by Naijoko »

duffpkg wrote: post #80
persnickety wrote: post #77

Earlier quoted context omitted.

> In-N-Out instead of McDonalds, What is this comparison trying to illustrate?

A lot of facilities run on a McDonalds type thinking when they should be looking at how In-N-Out is able to deliver a very similar product that is both dramatically better and either the same price or even cheaper. In-N-Out staff is well compensated, customers rate the institution as one of the most beloved in american life. McDonalds achieves neither of those things. What makes In-N-Out different? The difference is…

"Responding to the request below for a specific example. Hand washing, you wash your hands when medically appropriate to prevent facility acquired infections. If you don't you are progressively warned ultimately leading to termination and/or loss of license. If instituted nationally this alone would save at least 5,000 lives a year. Good luck getting it instituted at most facilities."

Sad thing is most staff in hospital doesnt wash hands. Reality is it would cost so much time. Handwashing is like a minute and staff has to go in an out of rooms where hand washing is needed so many times an hour it would slow everything down. And then trying to fire staff about this is not real because this would kick out half of it and it isnt replaceble. The problem is more why has staff to get in and out of stations so frequently. And multiresitence bacteria.

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