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Everyone hates the electronic medical record

logicmag.io

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Re: Everyone hates the electronic medical record

#131

Post by vinay427 »

ako wrote: post #124
duffpkg wrote: post #80

Earlier quoted context omitted.

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...

Respectfully, I’m not sure what you are asking for. In-N-Out is only in a small fraction of the US so most people from the US wouldn’t know much about it either. I believe that’s why the GP comment provided a little more context which was more or less sufficient for me to understand the comparison.

Re: Everyone hates the electronic medical record

#132

Post by Naijoko »

pintxo wrote: post #129
Naijoko wrote: post #116

Earlier quoted context omitted.

"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.

In germany we have this allready but it doesnt work. It reduce the problem. But the real problem is ER. In a life death situation it doesnt work. ER are very hard to keep clean. But yes you are absolutly right

EDIT:// I am no doctor but did work in Hospitals. Doctor friends working in ER are telling me about those dangers. And also bigger Hospitals have less control about it.

Re: Everyone hates the electronic medical record

#133

Post by Terr_ »

jharsman wrote: post #100
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…

This is very true. There several reasons why most EHRs are so bad: 1) The people who pay generally do not use the system. This is true for enterprise software in general and leads to vendors prioritizing having all features organizations ask for (regardless if they are a good idea or not) and also prioritizing features management deems important over fundamental workflow, UX and polish in general. 2) EHRs are very la…

> So many vendors are focused on charging money for customer specific features or adding new features to win new tenders.

In turn, this enterprisey anti-pattern creates unfocused products which can be configured to sort-of-solve every niche customer requirement that might block the sale.

The result is a massive ball of muddy configurations and feature-flags, so that learning isn't very portable and backend integrations are very painful.

Re: Everyone hates the electronic medical record

#134

Post by [deleted] »

JusticeJuice wrote: post #95
Zanfa wrote: post #84

Earlier quoted context omitted.

This is absolutely true in my experience as well. Ironically, it's also a somewhat of a circular problem, given the inherent complexity of medical processes, every organization has organically formed their processes over decades. When choosing software solutions, they pick software that caters to their specific needs, rather than change processes to fit existing software. This results in vendors building endlessly co…

Yeah, I've seen the term "sociotechnical" used to describe this relationship between software and process. A process is built in part for a system, and therefore the system in part needs to support the process. Changing the setup isn't just a technical challenge, it's a challenge in creating sociotechnical change. I think it's a very easy thing to underestimate.

[deleted]

Re: Everyone hates the electronic medical record

#135

Post by Terr_ »

JusticeJuice wrote: post #95
Zanfa wrote: post #84

Earlier quoted context omitted.

This is absolutely true in my experience as well. Ironically, it's also a somewhat of a circular problem, given the inherent complexity of medical processes, every organization has organically formed their processes over decades. When choosing software solutions, they pick software that caters to their specific needs, rather than change processes to fit existing software. This results in vendors building endlessly co…

Yeah, I've seen the term "sociotechnical" used to describe this relationship between software and process. A process is built in part for a system, and therefore the system in part needs to support the process. Changing the setup isn't just a technical challenge, it's a challenge in creating sociotechnical change. I think it's a very easy thing to underestimate.

> Yeah, I've seen the term "sociotechnical" used to describe this relationship between software and process.

Maybe "cybernetic", although that has largely been taken over by sci-fi connotations.

Re: Everyone hates the electronic medical record

#136

Post by sl-1 »

complex1314 wrote: post #111
hyponatremia121 wrote: post #86

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…

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...

Same thing going on in Finland [1].

1. https://fi-m-wikipedia-org.translate.goog/?_x_tr_sl=auto&_x_...

Re: Everyone hates the electronic medical record

#137

Post by lotsofpulp »

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…

>I personally think a big part of the issue is actually scope, these systems are expected to do everything

If I were to guess, the goals of admin and workers might not match because the primary goal of the admins deciding and implementing the EHR is to avoid liability for the organization in the event of an error, but errors are inevitable. And if liability for individual errors are so costly (as they are in the US for healthcare stuff), then the primary goal for the workers also becomes avoiding liability.

In this situation, I can envision something like a crew of people working in the hospital that do good, quick, but undocumented work 99% of the time, are now being slowed down by documentation or other cover their ass needs. Obviously, it is possible that the new documentation needs are also uncovering malpractice that went unnoticed before. The question is are the tradeoffs worth it, which does not have a simple, objective answer.

Re: Everyone hates the electronic medical record

#138

Post by pjc50 »

msteffen wrote: post #125
duffpkg wrote: post #80

Earlier quoted context omitted.

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…

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

Yes, that's the discipline called "operations". Crucially it's a separate set of skills from anything one might learn in medical school.

Re: Everyone hates the electronic medical record

#139

Post by jdietrich »

Terr_ wrote: post #74
danielvaughn wrote: post #51

Earlier quoted context omitted.

This was my experience trying to create technology in the real estate world. Realtors are the same way.

Many of the most painful technical problems are actually three business problems in a trenchcoat. Sometimes too many people are too invested in the crazed/idiosyncratic way of doing things... and unless the humans can be convinced to fundamentally change their process, adding software will only give you... well, craziness with a computer .

>Many of the most painful technical problems are actually three business problems in a trenchcoat.

This is a superb line and I will be stealing it.

Re: Everyone hates the electronic medical record

#140

Post by pjc50 »

Flibble21 wrote: post #96
JusticeJuice wrote: post #24

Earlier quoted context omitted.

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

I have a friend that has worked on this project for over a very long time and the issue is not that the UK tried to implement EHR records from scratch but rather that GPs (General Practitioner, think local doctors surgeries) had mostly all implemented EHR systems already. The issue is that these systems are created by several (6-8 if memory serves) different private companies and the UK Government can't force the GP…

> The issue is that these systems are created by several (6-8 if memory serves) different private companies and the UK Government can't force the GP to change or adopt a standard system.

Yeah, the UK healthcare system is only mostly nationalized.

I do think these IT issues could be fixed, but only if there was someone at Cabinet level who knew what operations management was, which we're unlikely to get in the forseeable future.

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